I have had two patients come into my office last week. One being treated for gout for over two years... and doesn't have it and one not knowing they have gout with supporting lab work indicating he does have gouty arthritis.
Gout is a recurring acute arthritis that affects the peripheral joints, most notably the great toe joint we call the 1st metatarsalphalangeal joint. The arthritis stems from a build up of monosodium urate crystals in and around joints and tendons. Supersaturated hyperuricemic fluids, notably joint fluids, crystallize causing a severe red, hot, swollen joint. The arthritis may become chronic and deforming. It should be of note that not all hyperuricemic people develop gout. A build up of uric acid crystals in the joint may be from excessive breakdown or over production of purines. (Purines generally come from animal products). Gout classically begins in the evenings or early mornings.
So what do you look for in a gouty attack?
1: Gout generally presents in one joint at a time.
2: Pain is sudden with the joint becoming red, hot and swollen.
3: May present with a low grade fever: e.g. < 100 degrees.
4: More common in men (20:1).
5: Generally it is joint sparing unless it is chronic, then gout can destroy the joint.
6: Most commonly attacks the great toe joint (called Podagra), followed by the middle foot and then the ankle joint.
7: Crunchy tophi felt in the ears, olecranon bursa, and the Achilles tendon.
Sometimes a diagnosis of gout can be made on x-ray which may reveal dissolving bone that looks like rat bites, punched out lesions and Martel's sign which is overhanging bone. Blood tests can also help with the diagnosis of gout but there is no consistent level unless serum uric acid acids normal values which generally range from (2.5 to 8.0 mg/dL).
Treatment ranges from Colchicine which is both diagnostic and therapeutic to a strong anti-inflammatory such as Indomethacine. Some gout patients may have to go on maintenance medications such as Allopurinal or Probenecid for a few weeks to several months.
To prevent gout, avoid foods and medications that can exacerbate a gout attack: organ meat (liver, kidney, heart and brains), lard, anchovies and sardines, alcohol especially red wines and diuretics like Lasix.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Sunday, October 26, 2008
Friday, October 17, 2008
Managing injuries of the toes.
My apologies. It has taken me longer to recovery from hurricane Ike than what I thought. So let's get back into the swing of things.
It has been about 6 weeks since Ike hit the Houston area and as a result, I have seen a rash of toe injuries walk or limp into my office. A few cuts and scrapes, a few contusions (deep bruises), and a lot of broken toes. They have come mainly from dropping heavy objects on them like tree branches, heavy furniture, cans from grocery bags, and stubbing them against an immovable object.
The majority of digital fractures heal spontaneously without requiring some sort of treatment. The largest portion of digital fractures for those seeking medical attention require buddy splinting (tapping the injured toe with an adjacent to to provide stability) and a stiff soled shoe to keep the toes from bending while walking. Ten percent of these fractures require some sort of reduction of the deformity associated with the injury which can include closed reduction (not requiring surgery) or open reduction with either temporary or permanent fixation (surgery).
When you sustain a toe injury, it can take some time to heal. For those spontaneous healing injuries, it may take one to two weeks to completely heal. But for the more serious injuries, it could take up to 10 to 12 weeks, and in some cases longer, to completely resolve.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
It has been about 6 weeks since Ike hit the Houston area and as a result, I have seen a rash of toe injuries walk or limp into my office. A few cuts and scrapes, a few contusions (deep bruises), and a lot of broken toes. They have come mainly from dropping heavy objects on them like tree branches, heavy furniture, cans from grocery bags, and stubbing them against an immovable object.
The majority of digital fractures heal spontaneously without requiring some sort of treatment. The largest portion of digital fractures for those seeking medical attention require buddy splinting (tapping the injured toe with an adjacent to to provide stability) and a stiff soled shoe to keep the toes from bending while walking. Ten percent of these fractures require some sort of reduction of the deformity associated with the injury which can include closed reduction (not requiring surgery) or open reduction with either temporary or permanent fixation (surgery).
When you sustain a toe injury, it can take some time to heal. For those spontaneous healing injuries, it may take one to two weeks to completely heal. But for the more serious injuries, it could take up to 10 to 12 weeks, and in some cases longer, to completely resolve.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, September 27, 2008
Pharmacy does and dont's...
Here are a few tips to avoid complications at your pharmacy:
1: Prescriptions for painkillers and sleeping aids get extra scrutiny, so don't try to do anything out of the normal.
2: Don't use drive throughs at pharmacies. More mistakes are made at the drive throughs.
3: Just know that most prescriptions are filled by less-qualified pharmacy technicians than the pharmacists.
4: Generics are fine, but it is advised to not replace blood thinning or thyroid medications with generics.
5: There is no national database to track all of your medications. Therefore, try to stick with one pharmacy or if you want to change, have all of your prescriptions moved to the new pharmacy.
6: To avoid long lines, don't go to the pharmacy on Monday or Tuesday evenings. This avoids the weekend refill crowd.
7: Be kind to your pharmacist or technician if they can't reach your doctor to authorize a refill. It is against the law in most states for them to do it.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: Prescriptions for painkillers and sleeping aids get extra scrutiny, so don't try to do anything out of the normal.
2: Don't use drive throughs at pharmacies. More mistakes are made at the drive throughs.
3: Just know that most prescriptions are filled by less-qualified pharmacy technicians than the pharmacists.
4: Generics are fine, but it is advised to not replace blood thinning or thyroid medications with generics.
5: There is no national database to track all of your medications. Therefore, try to stick with one pharmacy or if you want to change, have all of your prescriptions moved to the new pharmacy.
6: To avoid long lines, don't go to the pharmacy on Monday or Tuesday evenings. This avoids the weekend refill crowd.
7: Be kind to your pharmacist or technician if they can't reach your doctor to authorize a refill. It is against the law in most states for them to do it.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Friday, September 26, 2008
Skin-Saving Remedies
A rare but observable skin condition we see in our offices is psoriasis. There is an estimated 7.5 million people in the United States that have this autoimmune skin condition. There seems to be a few new drugs on the horizon that may give those sufferers much needed relief.
Stronger medications: a new injectable drug called ustekinumab may be approved by the FDA this year. It seems to slow down the autoimmune response which causes the build-up of the patients inflammation. This inflammation then forms the grey-silver plaques were are all familiar with.
Over-the-counter: A cream called Psorent is formulated on an old therapy of coal tar (called LCD). Psorent doesn't leave the stain on the skin like coal tar did and also doesn't have the odor.
Natural therapy: reduce stress in your life. There is much literature indicating that increased stress can result in psoriatic flare ups. You may want to ask your primary care physician or dermatologist for medications that will help put your mind at ease.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Stronger medications: a new injectable drug called ustekinumab may be approved by the FDA this year. It seems to slow down the autoimmune response which causes the build-up of the patients inflammation. This inflammation then forms the grey-silver plaques were are all familiar with.
Over-the-counter: A cream called Psorent is formulated on an old therapy of coal tar (called LCD). Psorent doesn't leave the stain on the skin like coal tar did and also doesn't have the odor.
Natural therapy: reduce stress in your life. There is much literature indicating that increased stress can result in psoriatic flare ups. You may want to ask your primary care physician or dermatologist for medications that will help put your mind at ease.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Wednesday, September 24, 2008
Athlete's Foot revisited.
Thank God I finally am back to some normalcy from hurricane Ike. But I was more fortunate than most.
I have seen a lot of athlete's foot recently and wanted to talk briefly about its symptoms, prevention and care.
In my opinion, athlete's foot is perhaps the most misdiagnosed skin condition on the body. Not only by patients, but medical professionals as well.
Essentially, athlete's foot is a fungal infection. These are caused by 'dermatophytes' that come from three organisms: Microsporum (most common but does not cause athlete's foot), Epidermophyton, and Trichophyton which is mainly responsible for tinea pedis or athletes' foot. The most common form occurs in-between the toes and generally 'weeps' or expresses a clear fluid. The second most common type is red, scaly, and itchy (like you see on TV). It itches because it causes an inflammatory response which is essentially an allergic reaction. But the majority of athlete's foot does not present to the patient with symptoms. Patients come into my office all the time complaining of dry skin which is in actuality, athlete's foot.
Generally, you get this fungal infection from communal areas that are warm and damp such as locker rooms, weight rooms, showers, and pools. Also, people who share shoes are susceptible to acquiring athlete's foot.
To prevent athlete's foot, wash your feet daily with mild soapy warm water and dry your feet thoroughly, especially between the toes. Change socks daily and try to wear natural fibers vs. synthetic or blended fibers. Alternate shoes and use foot powder, if your feet have a tendency to sweat. Avoid going bare-footed and if your shoes are made of cloth or mesh, wash them once a month.
To treat athlete's foot, use over-the-counter antifungal creams twice to three times a day for two to no more than three weeks. If your symptoms do not improve, see your local podiatrist for an evaluation.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
I have seen a lot of athlete's foot recently and wanted to talk briefly about its symptoms, prevention and care.
In my opinion, athlete's foot is perhaps the most misdiagnosed skin condition on the body. Not only by patients, but medical professionals as well.
Essentially, athlete's foot is a fungal infection. These are caused by 'dermatophytes' that come from three organisms: Microsporum (most common but does not cause athlete's foot), Epidermophyton, and Trichophyton which is mainly responsible for tinea pedis or athletes' foot. The most common form occurs in-between the toes and generally 'weeps' or expresses a clear fluid. The second most common type is red, scaly, and itchy (like you see on TV). It itches because it causes an inflammatory response which is essentially an allergic reaction. But the majority of athlete's foot does not present to the patient with symptoms. Patients come into my office all the time complaining of dry skin which is in actuality, athlete's foot.
Generally, you get this fungal infection from communal areas that are warm and damp such as locker rooms, weight rooms, showers, and pools. Also, people who share shoes are susceptible to acquiring athlete's foot.
To prevent athlete's foot, wash your feet daily with mild soapy warm water and dry your feet thoroughly, especially between the toes. Change socks daily and try to wear natural fibers vs. synthetic or blended fibers. Alternate shoes and use foot powder, if your feet have a tendency to sweat. Avoid going bare-footed and if your shoes are made of cloth or mesh, wash them once a month.
To treat athlete's foot, use over-the-counter antifungal creams twice to three times a day for two to no more than three weeks. If your symptoms do not improve, see your local podiatrist for an evaluation.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, September 6, 2008
New injectable "pillows for the feet" helps reduce foot pain.
September has started off a little sluggish regarding my postings. But I am starting the month off with some very exciting information.
I have been reading recently about a new product that some Podiatrist's across the country are using to help reduce pain to the balls of the feet due to the loss of fat pad. The product is called Sculptra and is a bioabsorbable product that is injected just under the skin to replace the fact pad that is lost.
Sculptra, also called New-fill, is made of poly-L-lactic acid. The product has been used safely outside of the U.S. since 1999 and was recently approved by the FDA to be used on people who have fat pad loss to their face due to complications associated with HIV. However, as I mentioned, there are a few Podiatrists across the country who are using it to treat fat pad loss to the feet.
We lose fat pad to our feet naturally due to aging. But we can also lose this fat from participating in ballistic sports (mainly running long distances/jogging), wearing high heels and people who have diabetes.
Loss of this fat pad causes pain to the bones in the front of the foot (called metatarsalgia), can lead to nerve pain (called neuromas), thick callouses, and ulcers (especially those with diabetic neuropathy). Injection of Sculptra replaces this lost fat 'cushion' to the feet and has shown a high success rate in reducing these problems.
The side effects seem to be very minimal and are those associated with receiving a 'shot' in general. The only two negatives to this procedure is 1) the Sculptra can break down just like our natural fat from to much pressure and additional injections may be required and 2) since the use of this product is not approved for the feet, insurances will not cover the procedure so it is an out-of-pocket expense.
This is very exciting news and is something I am going to explore and may be offering my patients very soon.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
I have been reading recently about a new product that some Podiatrist's across the country are using to help reduce pain to the balls of the feet due to the loss of fat pad. The product is called Sculptra and is a bioabsorbable product that is injected just under the skin to replace the fact pad that is lost.
Sculptra, also called New-fill, is made of poly-L-lactic acid. The product has been used safely outside of the U.S. since 1999 and was recently approved by the FDA to be used on people who have fat pad loss to their face due to complications associated with HIV. However, as I mentioned, there are a few Podiatrists across the country who are using it to treat fat pad loss to the feet.
We lose fat pad to our feet naturally due to aging. But we can also lose this fat from participating in ballistic sports (mainly running long distances/jogging), wearing high heels and people who have diabetes.
Loss of this fat pad causes pain to the bones in the front of the foot (called metatarsalgia), can lead to nerve pain (called neuromas), thick callouses, and ulcers (especially those with diabetic neuropathy). Injection of Sculptra replaces this lost fat 'cushion' to the feet and has shown a high success rate in reducing these problems.
The side effects seem to be very minimal and are those associated with receiving a 'shot' in general. The only two negatives to this procedure is 1) the Sculptra can break down just like our natural fat from to much pressure and additional injections may be required and 2) since the use of this product is not approved for the feet, insurances will not cover the procedure so it is an out-of-pocket expense.
This is very exciting news and is something I am going to explore and may be offering my patients very soon.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, August 23, 2008
Skin cancer of the foot is rare but deadly.
Skin cancer of the feet is very rare. But since feet are generally very neglected to daily inspection, a cancerous lesion can be missed.
Like most skin cancers, they arise mostly from exposure to the sun. Many people who use sun screen miss putting protection on their feet specifically the bottoms. Constant sun exposure kills skin cells damaging the DNA setting up the possibility of a melanoma.
Skin cancer is a tumor of the melanocytes in the skin. While they can arise from moles and 'birth marks' called nevi, again it occurs mainly in sun exposed areas. Melanoma generally occurs in the 4th - 7th decade of life (30's - 60's) and occurs more frequently in fairer skinned individuals.
How can you spot a possible melanoma? Here are a few pointers:
Remember your ABC's...
Asymmetrical - the edges of the spot are irregular.
Borders - again are irregular and notched.
Color - spots are multicolored (pink, purple, white, gray, tan, black, blue or brown).
Diameter - greater than 6 mm or a little more the 1/4 of an inch. (Generally the width of a pencil eraser).
Elevation - the spot is generally elevated as compared to the skin next to it.
Also be aware of any spot that has changed in appearance recently and rapidly.
If you have any concerns about a spot on your calf, ankle or foot make an appointment with your local podiatrist immediately. It is better to be safe than sorry.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Like most skin cancers, they arise mostly from exposure to the sun. Many people who use sun screen miss putting protection on their feet specifically the bottoms. Constant sun exposure kills skin cells damaging the DNA setting up the possibility of a melanoma.
Skin cancer is a tumor of the melanocytes in the skin. While they can arise from moles and 'birth marks' called nevi, again it occurs mainly in sun exposed areas. Melanoma generally occurs in the 4th - 7th decade of life (30's - 60's) and occurs more frequently in fairer skinned individuals.
How can you spot a possible melanoma? Here are a few pointers:
Remember your ABC's...
Asymmetrical - the edges of the spot are irregular.
Borders - again are irregular and notched.
Color - spots are multicolored (pink, purple, white, gray, tan, black, blue or brown).
Diameter - greater than 6 mm or a little more the 1/4 of an inch. (Generally the width of a pencil eraser).
Elevation - the spot is generally elevated as compared to the skin next to it.
Also be aware of any spot that has changed in appearance recently and rapidly.
If you have any concerns about a spot on your calf, ankle or foot make an appointment with your local podiatrist immediately. It is better to be safe than sorry.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
What are hammertoes?
OK... I admit it. I see a lot of hammertoes. And I am always asked, "Why are my toes crooked?" Basically you have either a foot with an arch to high or a foot with little to no arch.
Our bodies are three dimensional so hammertoe deformities can happen in all 'three dimensional planes'. The one podiatrists see most frequently is in the 'sagittal' plane of deformity which means the toe is bent in up and down. The second most frequent deformity is in the 'transverse' plane of deformity where the toes move from side-to-side or what most people refer to as an "overlapping" toe. The final plane of deformity is what we refer to as the 'coronal or frontal' plane were the toe wants to 'roll'. We see this mainly on the great toe or the little toe and is generally associated with a bunion. (More on bunions in another post).
Hammertoes occur at the joint closest to the foot. If any of these deformities occur at the joint closest to the tip of the toe, it is referred to as a 'mallet' toe.
If you are interested, here is the physiology of what causes hammertoes:
1: Flat feet - pes planus: (Flexor stabilization) A flat foot is a flexible or hypermobile foot. We in podiatry refer to this as 'excessive pronation'. The middle of the foot fails to lock while walking creating a very mobile front of the foot. The 'flexor' tendons work to early in an attempt to stabilize the foot causing the toes to bend.
2: High arched feet - pes cavus: (Flexor substitution) muscles in the back and side of the calf are weak causing an inability to plantarflex the foot (basically to move the foot down). The muscles located in the foot contract creating a high arched foot and thusly, hammertoes.
I am asked if hammertoes can be prevented. The answer is yes and no. Good custom molded orthotics can help keep the feet in correct alignment thus either helping to prevent or at least slow down the deformity. However, by the time I see people in my office, the deformity has reached a point to where the only correction is to perform reconstructive surgery.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Our bodies are three dimensional so hammertoe deformities can happen in all 'three dimensional planes'. The one podiatrists see most frequently is in the 'sagittal' plane of deformity which means the toe is bent in up and down. The second most frequent deformity is in the 'transverse' plane of deformity where the toes move from side-to-side or what most people refer to as an "overlapping" toe. The final plane of deformity is what we refer to as the 'coronal or frontal' plane were the toe wants to 'roll'. We see this mainly on the great toe or the little toe and is generally associated with a bunion. (More on bunions in another post).
Hammertoes occur at the joint closest to the foot. If any of these deformities occur at the joint closest to the tip of the toe, it is referred to as a 'mallet' toe.
If you are interested, here is the physiology of what causes hammertoes:
1: Flat feet - pes planus: (Flexor stabilization) A flat foot is a flexible or hypermobile foot. We in podiatry refer to this as 'excessive pronation'. The middle of the foot fails to lock while walking creating a very mobile front of the foot. The 'flexor' tendons work to early in an attempt to stabilize the foot causing the toes to bend.
2: High arched feet - pes cavus: (Flexor substitution) muscles in the back and side of the calf are weak causing an inability to plantarflex the foot (basically to move the foot down). The muscles located in the foot contract creating a high arched foot and thusly, hammertoes.
I am asked if hammertoes can be prevented. The answer is yes and no. Good custom molded orthotics can help keep the feet in correct alignment thus either helping to prevent or at least slow down the deformity. However, by the time I see people in my office, the deformity has reached a point to where the only correction is to perform reconstructive surgery.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Sunday, August 17, 2008
Big Bags should cause Red Flags.
I know. You are wondering, "When is this guy going to start talking about feet and ankles again." Well believe it or not... I am.
I mentioned earlier that the old nursery rhyme, "the foot bone is connected to the ankle bone, is connected to the knee bone, is connected to the hip bone, etc." is truer than one thinks. Our skeletal system has a physiological alignment, that when is close to correct as possible, reduces abnormal stresses thus reducing pain and discomfort. When one portion of this system is out-of-alignment, it can affect a part or the whole body. So, this brings me to my topic of... big bags.
Kids and women have a tendency to purchase big bags to carry massive amounts of 'stuff'. Kids to carry books for school and women... well, I really don't know what all you carry. But these big bags can cause pain, strains, and in younger children, permanent misalignment of the skeletal system. So here are a few tips to reduce or eliminate this problem:
1: Lighten the load: carry no more than 25% of your weight in your backpack or oversized purse. Excessive weight can cut off blood supply and compress nerves in the arms. Cutting off blood supply can lead to fatigue and compressing nerves can lead to numbness and loss of hand and finger mobility.
2: Keep the backpack or purse close to your body: also use both straps on the backpack instead of slinging it over one shoulder.
3: Carry equal amounts of weight in both arms: if you have mutliple bags (like groceries or shopping bags) balance the bags between each side. Unequal balance twists your torso and makes your spine work harder. (If you only have one bag or carry a heavy item over one shoulder, be sure to switch it often to avoid constant twisting of your torso in one direction).
4: Roller bags and luggage: many people have gone to roller bags and luggage to avoid having to carry heavy items. But these can have a hidden problem as well. Make sure that your bag or suitcase handle extends to your waist. A short handle can cause abnormal bending putting extra force on your spine. If the handle is to short, many stores sell extenders.
5: Big fat wallet (if only I had this problem): a fat wallet is a nice problem to have, but sitting on a bulge in your hip pocket can also cause a twist to your torso. Switch your wallet from pocket to pocket or thin it to basic essentials.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
I mentioned earlier that the old nursery rhyme, "the foot bone is connected to the ankle bone, is connected to the knee bone, is connected to the hip bone, etc." is truer than one thinks. Our skeletal system has a physiological alignment, that when is close to correct as possible, reduces abnormal stresses thus reducing pain and discomfort. When one portion of this system is out-of-alignment, it can affect a part or the whole body. So, this brings me to my topic of... big bags.
Kids and women have a tendency to purchase big bags to carry massive amounts of 'stuff'. Kids to carry books for school and women... well, I really don't know what all you carry. But these big bags can cause pain, strains, and in younger children, permanent misalignment of the skeletal system. So here are a few tips to reduce or eliminate this problem:
1: Lighten the load: carry no more than 25% of your weight in your backpack or oversized purse. Excessive weight can cut off blood supply and compress nerves in the arms. Cutting off blood supply can lead to fatigue and compressing nerves can lead to numbness and loss of hand and finger mobility.
2: Keep the backpack or purse close to your body: also use both straps on the backpack instead of slinging it over one shoulder.
3: Carry equal amounts of weight in both arms: if you have mutliple bags (like groceries or shopping bags) balance the bags between each side. Unequal balance twists your torso and makes your spine work harder. (If you only have one bag or carry a heavy item over one shoulder, be sure to switch it often to avoid constant twisting of your torso in one direction).
4: Roller bags and luggage: many people have gone to roller bags and luggage to avoid having to carry heavy items. But these can have a hidden problem as well. Make sure that your bag or suitcase handle extends to your waist. A short handle can cause abnormal bending putting extra force on your spine. If the handle is to short, many stores sell extenders.
5: Big fat wallet (if only I had this problem): a fat wallet is a nice problem to have, but sitting on a bulge in your hip pocket can also cause a twist to your torso. Switch your wallet from pocket to pocket or thin it to basic essentials.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, August 16, 2008
Mexican food the new health craze?
It used to be, "avoid Mexican food because it is so full of hydrated fat and calories." Well, for the most part, Americanized Mexican food can be very unhealthy. But when you look at authentic Mexican food you may be able to slash the risk of breast cancer by a third and lose a little weight while you are at it. Here are a few recommendations:
1. Eat more fish: this omega-3-rich staple of coastal Mexico can be tried in seviche, snapper Veracruz, tacos and salads.
2: Go light on meat: only use an ounce or two of lean beef or chicken in your tacos.
3: Add just a bit of cheese: skip Monterey Jack and Cheddar which is practically unknown in Mexico. Try a tablespoon of crumbly, dry Cotija or low-fat feta cheese on beans in burritos.
4: Load up on beans: pinto, black and other legumes are rich in nutrients that help lower cholesterol. Refried beans can be healthy as well if you get the low-fat variety cooked without lard.
5: Pour on the salsa: green or red sauces are made from antioxidant-rich tomatoes, tomatillos, chili peppers, onions, garlic and lime or lemon juice which are low in fat and full of fiber.
6: Pile on the produce: colorful peppers for the fajita platter; lettuce, tomatoes, corn and onions for the tacos; greens and guacamole in the Southwest salad.
7: Wrap it all in corn or whole wheat tortillas: these are higher in fiber, minerals, vitamins than their processed-flour counterparts.
Ummm! I'm hungry already.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1. Eat more fish: this omega-3-rich staple of coastal Mexico can be tried in seviche, snapper Veracruz, tacos and salads.
2: Go light on meat: only use an ounce or two of lean beef or chicken in your tacos.
3: Add just a bit of cheese: skip Monterey Jack and Cheddar which is practically unknown in Mexico. Try a tablespoon of crumbly, dry Cotija or low-fat feta cheese on beans in burritos.
4: Load up on beans: pinto, black and other legumes are rich in nutrients that help lower cholesterol. Refried beans can be healthy as well if you get the low-fat variety cooked without lard.
5: Pour on the salsa: green or red sauces are made from antioxidant-rich tomatoes, tomatillos, chili peppers, onions, garlic and lime or lemon juice which are low in fat and full of fiber.
6: Pile on the produce: colorful peppers for the fajita platter; lettuce, tomatoes, corn and onions for the tacos; greens and guacamole in the Southwest salad.
7: Wrap it all in corn or whole wheat tortillas: these are higher in fiber, minerals, vitamins than their processed-flour counterparts.
Ummm! I'm hungry already.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Friday, August 15, 2008
How to burn fat...
I have patients who come into my office with foot pain that is directly attributable to their weight. Now, I don't profess to be a personal trainer, but unfortunately, I have had to lose some weight at various points in my life. I see people at health clubs that are peddling their stationary bike or going a mile-a-minute on the treadmill only to become frustrated that they are not losing any weight. The problem is physiological... the faster the heart rate the less fat you lose. Our bodies were designed this way to shut down certain systems and to reserve energy. So how do you lose weight?
To lose weight, your hear rate should be at approximately 55% (give or take 5%) of your maximum heart rate. So what is your maximum heart rate? Take 240 and subtract your age. This gives you your maximum heart rate. For aerobic exercise you should be at a target 75 - 80% of your maximum heart rate. For fat burning, again, you should be at 55%.
Example for a person who is 55 years old: 240 - 55 = 185 for maximum heart rate. Aerobic would be 185 x .80 = 148 bpm (beats per minute) with fat burning 185 x .55 = 102 bpm.
So the next time you are advised to shed a few pounds, realize that long duration and steady is better than short duration and fast.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
To lose weight, your hear rate should be at approximately 55% (give or take 5%) of your maximum heart rate. So what is your maximum heart rate? Take 240 and subtract your age. This gives you your maximum heart rate. For aerobic exercise you should be at a target 75 - 80% of your maximum heart rate. For fat burning, again, you should be at 55%.
Example for a person who is 55 years old: 240 - 55 = 185 for maximum heart rate. Aerobic would be 185 x .80 = 148 bpm (beats per minute) with fat burning 185 x .55 = 102 bpm.
So the next time you are advised to shed a few pounds, realize that long duration and steady is better than short duration and fast.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, August 9, 2008
Are pedicures for men?
Frequently I have patients (mainly female) who come into my office and ask, "what do you think about pedicures?" I respond, "they are fine as long as you are aware of a couple of things."
1: I recommend purchasing your own bits and files to be used. Most nail salons are fine with cleanliness but to safeguard against a contaminated tool being used, purchase and take your own and cleanse them yourself.
2: Open cuts, wounds or sores do not have your foot immersed in water. There is a nasty little bacteria that can exist in communal water sources so exercise caution.
3: Thick callouses should be trimmed by your podiatrist. Callouses can mean an ulcer underneath the thick skin, so it is better to have them parred by a medical professional especially if you are diabetic or immuno-compromised. You can maintain your callouses at home using specially designed skin files or a pumice stone.
4: Nail polish. I advise my patients to wear nail polish only for special events and occassions. Put the polish on the nail the day before or the day of and remove the polish one or two days after. Nail polish can cause nails to become brittle and can also lead to fungal nails.
5: If your feet are dry wear socks. Yes, wear natural fiber socks which helps protect your skins natural oils, especially during the summer, and can wick excessive moisture away which can lead to the loss of these oils.
Also, if you are a man and feel comfortable being seen at a spa with a bunch of beautiful women... then by all means... GO!
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: I recommend purchasing your own bits and files to be used. Most nail salons are fine with cleanliness but to safeguard against a contaminated tool being used, purchase and take your own and cleanse them yourself.
2: Open cuts, wounds or sores do not have your foot immersed in water. There is a nasty little bacteria that can exist in communal water sources so exercise caution.
3: Thick callouses should be trimmed by your podiatrist. Callouses can mean an ulcer underneath the thick skin, so it is better to have them parred by a medical professional especially if you are diabetic or immuno-compromised. You can maintain your callouses at home using specially designed skin files or a pumice stone.
4: Nail polish. I advise my patients to wear nail polish only for special events and occassions. Put the polish on the nail the day before or the day of and remove the polish one or two days after. Nail polish can cause nails to become brittle and can also lead to fungal nails.
5: If your feet are dry wear socks. Yes, wear natural fiber socks which helps protect your skins natural oils, especially during the summer, and can wick excessive moisture away which can lead to the loss of these oils.
Also, if you are a man and feel comfortable being seen at a spa with a bunch of beautiful women... then by all means... GO!
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Wednesday, August 6, 2008
"Hand-me-down" shoes are not good for the feet.
Pre-World War II, hand-me-down clothes existed in a lot of families. Articles such as shirts, pants, coats and shoes if in good condition would be given to younger family members to wear. The practice today is not as prevalent, but occasionally still exists. While articles such as pants, shirts, and coats may be advisable, I strongly discourage handing-down of shoes of any type.
While the individual receiving the shoes may have the same foot length, very rarely does the person have the same foot width and/or height. Shoes when broken-in conform to the initial wearers foot architecture. This can cause foot problems to the second person that can lead to foot pain, change in foot structure and even serious foot injury. Many of these problems are muscular in nature and generally can be resolved but discontinued use of the "hand-me-down" shoe. But if structural changes occur, sometimes the only resolve is to perform reconstructive surgery.
I notice this quite frequently in athletic shoes. Cleated shoes are especially a big culprit for causing foot problems in hand-me-down shoes. Also, it is advised to change running shoes about every three to six months depending on usage.
Spend the time and the little bit of extra money and insure that your child or young adult has adequate shoes for their particular foot architecture and the environment where they will wear the shoe.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
While the individual receiving the shoes may have the same foot length, very rarely does the person have the same foot width and/or height. Shoes when broken-in conform to the initial wearers foot architecture. This can cause foot problems to the second person that can lead to foot pain, change in foot structure and even serious foot injury. Many of these problems are muscular in nature and generally can be resolved but discontinued use of the "hand-me-down" shoe. But if structural changes occur, sometimes the only resolve is to perform reconstructive surgery.
I notice this quite frequently in athletic shoes. Cleated shoes are especially a big culprit for causing foot problems in hand-me-down shoes. Also, it is advised to change running shoes about every three to six months depending on usage.
Spend the time and the little bit of extra money and insure that your child or young adult has adequate shoes for their particular foot architecture and the environment where they will wear the shoe.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Monday, August 4, 2008
CDC looks at Diabetes and Arthritis.
The CDC back in 2005 and 2007 utilized date from the Behavioral Risk Factor Surveillance System (BRFSS) and found that the prevalence of arthritis in adults diagnosed with diabetes was 52 percent. The survey also indicated that the rate of physical inactivity was 28.9 percent in the diabetes with arthritis population vs. 21 percent of those with diabetes alone. This survey was also independent of age, sex or body mass (BMI).
The study emphasized that inactive people with diabetes who become more active benefit from improved glucose tolerance and increased physical function. The barriers faced by diabetics are just like all other physically inactive people: lack of time, competing responsibilities, lack of motivation and difficulty finding an enjoyable activity. The following are some fitness options that are low impact and can protect the already painful joints of arthritis:
1: Water exercises: more gyms and senior centers are offering pools for aqua aerobics and aqua cross-training. Water provides non-weightbearing environment which decreases the pull of gravity on the patient.
2: Recumbent bike: body positioning also decreases weightbearing on the foot, knees and lower back and is good at raising the heart rate for aerobic exercise.
3: Flat walking with light weights. Walking on surfaces that can provide some shock absorption (cork tracks, etc.) with supportive shoes is also a good means of getting physical activity.
4: Pilates: this exercise strengthens, stretches and tones the body to be better conditioned to handle weightbearing cardio activities.
There is another benefit to become more physically active. With the lack of physical activity, patients often will feel a level of depression. Some reasons may be due to a feeling of being handicapped, a feeling of remorse for their medical condition and a feeling of less-self-worth. Studies have shown that exercise releases endorphins into the body increasing physiological sense of well being.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
The study emphasized that inactive people with diabetes who become more active benefit from improved glucose tolerance and increased physical function. The barriers faced by diabetics are just like all other physically inactive people: lack of time, competing responsibilities, lack of motivation and difficulty finding an enjoyable activity. The following are some fitness options that are low impact and can protect the already painful joints of arthritis:
1: Water exercises: more gyms and senior centers are offering pools for aqua aerobics and aqua cross-training. Water provides non-weightbearing environment which decreases the pull of gravity on the patient.
2: Recumbent bike: body positioning also decreases weightbearing on the foot, knees and lower back and is good at raising the heart rate for aerobic exercise.
3: Flat walking with light weights. Walking on surfaces that can provide some shock absorption (cork tracks, etc.) with supportive shoes is also a good means of getting physical activity.
4: Pilates: this exercise strengthens, stretches and tones the body to be better conditioned to handle weightbearing cardio activities.
There is another benefit to become more physically active. With the lack of physical activity, patients often will feel a level of depression. Some reasons may be due to a feeling of being handicapped, a feeling of remorse for their medical condition and a feeling of less-self-worth. Studies have shown that exercise releases endorphins into the body increasing physiological sense of well being.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Sunday, August 3, 2008
The "symptomless" foot.
I have patients who come into my office and complain of a lack of sensation or worse, burning to their feet. Peripheral neuropathy effects primarily the feet and legs, sometimes affecting the hands. Peripheral neuropathy is dangerous because the onset is so subtle, people don't really know when they lose their sensation.
The main culprit is diabetes with arthritis, especially of the lower back, as the number two cause. Sometimes we don't know what the cause is and we refer to this as idiopathic neuropathy.
The 'symptomless' foot is actually more likely to have a problem because people will see their podiatrist when their foot hurts. But without pain, people with neuropathy delay seeking medical help which can lead to ulcerations, lacerations, puncture wounds with retained foreign bodies, pathologic fractures and worse amputations.
So what do you do if you have peripheral neuropathy? Here are a few tips:
1: Check you feet daily. You will need to use your eyes and hands to compensate for the lack of sensation. Have a family member or friend check the bottom of your feet daily for any of the above mentioned problems. If you live alone, get a small mirror and place it on an out-of-the-way place in the bathroom. This way you can visually inspect the bottom of your feet daily.
2: Check your shoes before putting them on. Turn them upside down and shake them. In addition, use your hands to feel for any objects that may be inside of the shoe.
3: Wear something on your feet as often as you can. I see to much trauma from people who don't wear shoes at home inside or out.
4: If you see a problem, seek medical attention immediately. The cut, ulcer, swelling may not feel bad or even look bad (especially on the bottom of the foot). But don't take a chance. 85% of the amputations I perform on neuropathic feet could have been prevented if medical treatment was sought immediately.
In addition to a lack of feeling, people with peripheral neuropathy can have a change in their circulation. So if the skin of your feet especially around the toes appear blue, purple or white, also seek the opinion of a medical professional.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
The main culprit is diabetes with arthritis, especially of the lower back, as the number two cause. Sometimes we don't know what the cause is and we refer to this as idiopathic neuropathy.
The 'symptomless' foot is actually more likely to have a problem because people will see their podiatrist when their foot hurts. But without pain, people with neuropathy delay seeking medical help which can lead to ulcerations, lacerations, puncture wounds with retained foreign bodies, pathologic fractures and worse amputations.
So what do you do if you have peripheral neuropathy? Here are a few tips:
1: Check you feet daily. You will need to use your eyes and hands to compensate for the lack of sensation. Have a family member or friend check the bottom of your feet daily for any of the above mentioned problems. If you live alone, get a small mirror and place it on an out-of-the-way place in the bathroom. This way you can visually inspect the bottom of your feet daily.
2: Check your shoes before putting them on. Turn them upside down and shake them. In addition, use your hands to feel for any objects that may be inside of the shoe.
3: Wear something on your feet as often as you can. I see to much trauma from people who don't wear shoes at home inside or out.
4: If you see a problem, seek medical attention immediately. The cut, ulcer, swelling may not feel bad or even look bad (especially on the bottom of the foot). But don't take a chance. 85% of the amputations I perform on neuropathic feet could have been prevented if medical treatment was sought immediately.
In addition to a lack of feeling, people with peripheral neuropathy can have a change in their circulation. So if the skin of your feet especially around the toes appear blue, purple or white, also seek the opinion of a medical professional.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Tuesday, July 29, 2008
Aspirin... the wonder drug?
Aspirin is a medicine-cabinet staple. Many have touted it as a wonder drug. Aspirin relieves back pain, lowers the risk of stroke, heart attack and colon cancer. But taking aspirin may not be for everyone.
60% of the population, healthy and those being treated for coronary disease, may have some level of resistence to the benefits of aspirin according to a recent review in the Journal of the American College of Cardiology.
What is aspirin resistence? Aspiring affects the platelets in our arterial system and keep them from 'sticking' lowering the risk of clotting. People with aspiring resistence don't get this benefit but can still get pain relief.
How can you tell if you are resistant? Blood tests can help your physician determine if you may need a different therapy, especially if you're at risk for heart disease. These test aren't widely available, but it doesn't hurt to ask your physician.
What are the alternatives? Other antiplatelet drugs exist if you are aspirin-resistant.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
60% of the population, healthy and those being treated for coronary disease, may have some level of resistence to the benefits of aspirin according to a recent review in the Journal of the American College of Cardiology.
What is aspirin resistence? Aspiring affects the platelets in our arterial system and keep them from 'sticking' lowering the risk of clotting. People with aspiring resistence don't get this benefit but can still get pain relief.
How can you tell if you are resistant? Blood tests can help your physician determine if you may need a different therapy, especially if you're at risk for heart disease. These test aren't widely available, but it doesn't hurt to ask your physician.
What are the alternatives? Other antiplatelet drugs exist if you are aspirin-resistant.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Thursday, July 24, 2008
Marathons takes years of training.
It happens every year. About six weeks before and six weeks after the Houston Marathon, I get an increase of patients complaining of foot, ankle and leg pain. My "running" career lasted about 20 minutes in middle school when I strained a hamstring and vowed to never run long distances again. I have spoken with some physicians and trainers about training for marathons and this is what they say:
1: If you don't currently run long distances daily, walk before you run. Start with very brisk walks (~ 20 minute miles) for 2 to 3 weeks as you build up your muscular system to handle the stresses.
2: Start jogging. Jog at a pace to build up muscles and lung capacity. Work to jog a mile in 10 to 15 minutes.
3: Rule of 2: Increase your intervals by 2 miles once you can keep your pace at the 10 to 15 minute level.
4: Take the talk test. While jogging, if you can't carry on a leisurely conversation without becoming winded, your pace is to fast.
Most experts say that it takes approximately 2 years to adequately train for marathons.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: If you don't currently run long distances daily, walk before you run. Start with very brisk walks (~ 20 minute miles) for 2 to 3 weeks as you build up your muscular system to handle the stresses.
2: Start jogging. Jog at a pace to build up muscles and lung capacity. Work to jog a mile in 10 to 15 minutes.
3: Rule of 2: Increase your intervals by 2 miles once you can keep your pace at the 10 to 15 minute level.
4: Take the talk test. While jogging, if you can't carry on a leisurely conversation without becoming winded, your pace is to fast.
Most experts say that it takes approximately 2 years to adequately train for marathons.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Wednesday, July 23, 2008
Old and someone elses medication.
I have patient's come into my office periodically and say, "I took my wife's, husband's, son's, daughter's, etc. medication because this is what I think I have and they had the same thing." Shivers go up my spine.
Here are some tips on medications:
1: Never self diagnose. If you feel you need to make medicine, make an appointment and see the appropriate physician or specialist.
2: Never take medication prescribed for someone else unless you contact your doctor or specialist first. Discussing your medical issue on the phone is better than taking the medication without knowing what the problem may be. Medications work differently on different people. Age, weight, allergies and correct diagnosis must be considered.
3: Purge your medicine box periodically. I recommend that you go through where you store your medications and discard any prescription that is more than six months old. All medications have a shelf life and you don't know how long the medicine in that bottle was sitting on the shelf before it was dispensed to you.
4: Put medicines on a closet shelf. Medications need to be kept in a cool, dark environment. Keeping them in your closet avoids heat and humidity generated in the bathroom.
5: Don't flush medications down the sink or toilet. Medications are being found in ground water. Check with your pharmacy to see if they have a take-back program to dispose of old medications.
6: Crush the drugs and mix them with coffee grounds in a sealed plastic bag. The medications are less likely to get into the water supply and reduces the risk of humans ingesting them.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Here are some tips on medications:
1: Never self diagnose. If you feel you need to make medicine, make an appointment and see the appropriate physician or specialist.
2: Never take medication prescribed for someone else unless you contact your doctor or specialist first. Discussing your medical issue on the phone is better than taking the medication without knowing what the problem may be. Medications work differently on different people. Age, weight, allergies and correct diagnosis must be considered.
3: Purge your medicine box periodically. I recommend that you go through where you store your medications and discard any prescription that is more than six months old. All medications have a shelf life and you don't know how long the medicine in that bottle was sitting on the shelf before it was dispensed to you.
4: Put medicines on a closet shelf. Medications need to be kept in a cool, dark environment. Keeping them in your closet avoids heat and humidity generated in the bathroom.
5: Don't flush medications down the sink or toilet. Medications are being found in ground water. Check with your pharmacy to see if they have a take-back program to dispose of old medications.
6: Crush the drugs and mix them with coffee grounds in a sealed plastic bag. The medications are less likely to get into the water supply and reduces the risk of humans ingesting them.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Tuesday, July 22, 2008
Pain free knees.
OK... you are saying... "he is a Podiatrist. What does he know about knees?" Remember the old nursery rhyme "the foot bone is connected to the ankle bone, connected to the "knee" bone..." Well it is true. Our muscle and skeletal system was designed to work in a certain biomechanical alignment.
Studies have indicated that a source of some knee problems stem from these poor biomechanics of the foot especially during walking. Some people whose feet have a tendency to roll the foot outward (pronating or flat foot) while walking or running can develop knee pain that doesn't necessarily reflect knee damage. By going to a Podiatrist they can evaluate the biomechanics of your feet while walking (the gait phase), check the type of shoes you are wearing, and look at the way your shoes wear pattern. Orthotics and physical therapy can compensate for these biomechanical abnormalities and the discomfort can go away.
Losing just 15 pounds of weight can decrease the load forces on your knees and feet sometimes cutting the pain by 50%. Staying active can build atrophied muscles around the knee and can absorb more stresses. However, one should avoid those exercises that can put more stress on your knee like squats and jogging.
Ice is a natural pain killer. Applying ice to a swollen and painful joint can help reduce inflammation. Ice should be used for the first 3 days of the onset of discomfort. After that contrast therapy can be initiated which uses a combination of ice and heat at determined intervals as recommended by your orthopeadic physician, physical therapist, trainer or podiatrist.
Antiinflammatories like Ibuprofen can be used on a temporary basis and OA (osteoarthritis) suffers can use supplements such as glucosamine, chondroitin, collagen and MSM.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Studies have indicated that a source of some knee problems stem from these poor biomechanics of the foot especially during walking. Some people whose feet have a tendency to roll the foot outward (pronating or flat foot) while walking or running can develop knee pain that doesn't necessarily reflect knee damage. By going to a Podiatrist they can evaluate the biomechanics of your feet while walking (the gait phase), check the type of shoes you are wearing, and look at the way your shoes wear pattern. Orthotics and physical therapy can compensate for these biomechanical abnormalities and the discomfort can go away.
Losing just 15 pounds of weight can decrease the load forces on your knees and feet sometimes cutting the pain by 50%. Staying active can build atrophied muscles around the knee and can absorb more stresses. However, one should avoid those exercises that can put more stress on your knee like squats and jogging.
Ice is a natural pain killer. Applying ice to a swollen and painful joint can help reduce inflammation. Ice should be used for the first 3 days of the onset of discomfort. After that contrast therapy can be initiated which uses a combination of ice and heat at determined intervals as recommended by your orthopeadic physician, physical therapist, trainer or podiatrist.
Antiinflammatories like Ibuprofen can be used on a temporary basis and OA (osteoarthritis) suffers can use supplements such as glucosamine, chondroitin, collagen and MSM.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Monday, July 21, 2008
Try something "fishy" for your feet.
Throw away those old razor blades, pedi-eggs, and pumice stones. Now there is something better for your dry, scaly feet... fish. FISH?
My wife is Taiwanese and I remember last year she was talking about going to some hot springs and having fish eat on our feet. "Say what?" "Yes, honey... they make your feet clean, clean, clean." I have to admit, I was not real excited about this exprience.
Well the latest craze in pampering of the feet at one spa in the D.C. suburbs is to dunk your feet into a warm tank of water and having your tootsies cleaned by little carp.
The tiny carp called garra rufa are known in Asia as Doctor Fish. First used in Turkey they are now very popular in Asia. The fish thrive in hot water which does not support much plant or aquatic life. Therefore these fish feed on whatever food source is available which includes dead, flaking flesh on our feet. They leave live skin alone, because they have no teeth and without teeth, they can't bite into living flesh.
So far, about 5,000 people have taken "the plunge" and tried this new spa rage. This may catch on here in America as some states are beginning to regulate the use of razors to trim callouses which they feel are not sanitary.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
My wife is Taiwanese and I remember last year she was talking about going to some hot springs and having fish eat on our feet. "Say what?" "Yes, honey... they make your feet clean, clean, clean." I have to admit, I was not real excited about this exprience.
Well the latest craze in pampering of the feet at one spa in the D.C. suburbs is to dunk your feet into a warm tank of water and having your tootsies cleaned by little carp.
The tiny carp called garra rufa are known in Asia as Doctor Fish. First used in Turkey they are now very popular in Asia. The fish thrive in hot water which does not support much plant or aquatic life. Therefore these fish feed on whatever food source is available which includes dead, flaking flesh on our feet. They leave live skin alone, because they have no teeth and without teeth, they can't bite into living flesh.
So far, about 5,000 people have taken "the plunge" and tried this new spa rage. This may catch on here in America as some states are beginning to regulate the use of razors to trim callouses which they feel are not sanitary.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Thursday, July 17, 2008
Barefeet lead to summertime injuries.
Even though I am a Podiatrist, I have to admit... "I hate shoes." When I was a child through my early adult years, I despised wearing shoes. But that is one of the ways I found Podiatry and became a Podiatrist... to many foot complications from years of not wearing shoes.
It is a natural tendency during the warmer months for children, teenagers and adults to not want to wear shoes. "My feet get to hot," I hear all the time when someone comes into my office or I see someone in the emergency room from an injury related to going barefooted. Here are just a few things I see as a result:
1: Athletes foot which leads to hard to treat fungal nails. If you are in areas where there is a lot of moisture (communal bathrooms, pools, ponds, lakes, oceans) and walk around barefooted you set yourself up for athletes foot or tinea pedis. I see people in my office with other complaints and notice they have tinea and 90% of these presentations are asymptomatic (no itching, redness, or weeping between toes).
2: Puncture wounds. Nails, broken glass, thorns, pieces of metal (I took a sewing needle out of a ladies foot just the other day) can lead to infections and scaring. Some of these foreign bodies are hard to see on x-ray so a large incision must be made on the bottom or top of the foot to find it. Also, it is very important that if you do step on something, go to the ER or your family doctor for a tetanus shot.
3: Lacerations and crush injuries. I see most of these from objects falling on the foot such as bottles from coolers and cans from groceries. If you lacerate your foot, don't use hydrogen peroxide as this kills good tissue. WASH, WASH, WASH. Wash the area with mild soapy water and rinse it under running water thoroughly.
4: Fractures and ripped off toenails. This comes mainly from stubbing the toe or catching the nail on the edge of a step. Fractures may require surgery and the toenail may have to be totally removed. Some nail injuries can cause damage to the nail matrix (where the nail grows from) leading to a deformed nail that does not grow straight or a portion stop growing altogether.
So even though your feet may be 'hot' wearing shoes, I advise protecting them as much as possible to avoid injuries.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
It is a natural tendency during the warmer months for children, teenagers and adults to not want to wear shoes. "My feet get to hot," I hear all the time when someone comes into my office or I see someone in the emergency room from an injury related to going barefooted. Here are just a few things I see as a result:
1: Athletes foot which leads to hard to treat fungal nails. If you are in areas where there is a lot of moisture (communal bathrooms, pools, ponds, lakes, oceans) and walk around barefooted you set yourself up for athletes foot or tinea pedis. I see people in my office with other complaints and notice they have tinea and 90% of these presentations are asymptomatic (no itching, redness, or weeping between toes).
2: Puncture wounds. Nails, broken glass, thorns, pieces of metal (I took a sewing needle out of a ladies foot just the other day) can lead to infections and scaring. Some of these foreign bodies are hard to see on x-ray so a large incision must be made on the bottom or top of the foot to find it. Also, it is very important that if you do step on something, go to the ER or your family doctor for a tetanus shot.
3: Lacerations and crush injuries. I see most of these from objects falling on the foot such as bottles from coolers and cans from groceries. If you lacerate your foot, don't use hydrogen peroxide as this kills good tissue. WASH, WASH, WASH. Wash the area with mild soapy water and rinse it under running water thoroughly.
4: Fractures and ripped off toenails. This comes mainly from stubbing the toe or catching the nail on the edge of a step. Fractures may require surgery and the toenail may have to be totally removed. Some nail injuries can cause damage to the nail matrix (where the nail grows from) leading to a deformed nail that does not grow straight or a portion stop growing altogether.
So even though your feet may be 'hot' wearing shoes, I advise protecting them as much as possible to avoid injuries.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, July 12, 2008
Heel pain in active children.
Every so often, more so in the summertime, I have a parent bring their active child into my office complaining of heel pain. These children generally fit the following criteria:
1: Ages 9 - 14.
2: More males than females.
3: Large frame or slightly overweight.
4: Involved in a sporting activity requiring cleats (more specifically soccer).
5: Nothing seems to relieve the pain.
I palpate the back of the heel and will elicit pain at a level of 7 to 9 out of the 10 scale. X-rays of the foot will reveal a separation of bone towards the back which is normal and is not a fracture. This is an open growth plate which indicates the child has not reached skeletal maturity at least of the foot and ankle. (It also means you will still be buying new shoes about every year).
This condition is what we medically refer to as apophositis or Severs disease. This is a very treatable condition with the most important aspect of this treatment being time. The child will need to stop the 'offending' activity and shoes for about 2 to 3 weeks. Icing of the heel 2 to 3 times a day with a sock on for approximately 15 minutes helps reduce the inflammation. Wearing an open back shoe or using a heel lift takes pressure off the back of the heel. In extremely painful situations, I will put the child in a CAM (Controlled Ankle Motion) walking boot and oral anti-inflammatories medications for a week to ten days.
As a special note, I am uncomfortable when Pediatricians, whom I respect, attribute pain in the foot and ankle as "growing pains." Discomfort (pain at a level of less then 3 out of 10) is somewhat normal for a child in the age range I mentioned above. However, pain at a level starting at 5 or above is not normal and you should take your child to visit your local Podiatrist.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: Ages 9 - 14.
2: More males than females.
3: Large frame or slightly overweight.
4: Involved in a sporting activity requiring cleats (more specifically soccer).
5: Nothing seems to relieve the pain.
I palpate the back of the heel and will elicit pain at a level of 7 to 9 out of the 10 scale. X-rays of the foot will reveal a separation of bone towards the back which is normal and is not a fracture. This is an open growth plate which indicates the child has not reached skeletal maturity at least of the foot and ankle. (It also means you will still be buying new shoes about every year).
This condition is what we medically refer to as apophositis or Severs disease. This is a very treatable condition with the most important aspect of this treatment being time. The child will need to stop the 'offending' activity and shoes for about 2 to 3 weeks. Icing of the heel 2 to 3 times a day with a sock on for approximately 15 minutes helps reduce the inflammation. Wearing an open back shoe or using a heel lift takes pressure off the back of the heel. In extremely painful situations, I will put the child in a CAM (Controlled Ankle Motion) walking boot and oral anti-inflammatories medications for a week to ten days.
As a special note, I am uncomfortable when Pediatricians, whom I respect, attribute pain in the foot and ankle as "growing pains." Discomfort (pain at a level of less then 3 out of 10) is somewhat normal for a child in the age range I mentioned above. However, pain at a level starting at 5 or above is not normal and you should take your child to visit your local Podiatrist.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Thursday, July 10, 2008
How to buy shoes.
Buying proper fitting shoes is not an easy task. But if you follow a few basic steps (no pun intended) you can insure you have shoes that not only look nice, but are healthy for your feet as well. Here are the basics:
1: Purchase shoes later in the day. I tell my patients to go shopping for shoes in the middle afternoon to evening. Blood pools in our feet during the day so are feet are generally larger in the afternoon and evening then in the morning.
2: Have your feet measured routinely. I already wrote a post regarding this issue, but I recommend after the age of 40 you should measure your feet every couple of years. For infants, juveniles, and adolescents who have not reached skeletal maturity of the foot (an x-ray by a Podiatrist can tell you if your child has or not), I recommend annually.
3: Wear the appropriate sock or stocking. This is common sense but I see people buying athletic shoes after work with dress socks or stocking on their feet. Take a pair of athletic socks with you or some stores have slip on socks so you can try on shoes.
4: Evaluate the toe break. Take the shoe you are wanting to purchase and hold the heel placing the toe of the shoe on a solid surface at a 45 degree angle. Push toward the toe area and the shoe should bend at an area close to the tip. If the shoe breaks towards the middle, this shoe does not have adequate support to your middle foot and can create problems. (Jogging shoes are notorious for this problem).
5: Walk, walk, walk. I recommend you spend about ten minutes walking in the shoe. Don't just slip the shoe on for a couple of minutes and decide it is the right fit. Give the shoe a bit of a workout.
A little attention to detail can go a long way to prevent foot pain and deformities in the future.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: Purchase shoes later in the day. I tell my patients to go shopping for shoes in the middle afternoon to evening. Blood pools in our feet during the day so are feet are generally larger in the afternoon and evening then in the morning.
2: Have your feet measured routinely. I already wrote a post regarding this issue, but I recommend after the age of 40 you should measure your feet every couple of years. For infants, juveniles, and adolescents who have not reached skeletal maturity of the foot (an x-ray by a Podiatrist can tell you if your child has or not), I recommend annually.
3: Wear the appropriate sock or stocking. This is common sense but I see people buying athletic shoes after work with dress socks or stocking on their feet. Take a pair of athletic socks with you or some stores have slip on socks so you can try on shoes.
4: Evaluate the toe break. Take the shoe you are wanting to purchase and hold the heel placing the toe of the shoe on a solid surface at a 45 degree angle. Push toward the toe area and the shoe should bend at an area close to the tip. If the shoe breaks towards the middle, this shoe does not have adequate support to your middle foot and can create problems. (Jogging shoes are notorious for this problem).
5: Walk, walk, walk. I recommend you spend about ten minutes walking in the shoe. Don't just slip the shoe on for a couple of minutes and decide it is the right fit. Give the shoe a bit of a workout.
A little attention to detail can go a long way to prevent foot pain and deformities in the future.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Wednesday, July 9, 2008
High heel shoes can create long term foot problems.
I don't know why all you beautiful women out there have to destroy your feet by wearing high heel shoes. Somewhere in our society, we (no one ever knows who those we are) placed in your minds that the only way to look beautiful was to wear a shoe that made your foot crooked and forced you to walk on heels made out of pencils.
OK... OK...! Before you beat me up for all of those women, and who knows maybe some men, that refuse to give up their heels, we can compromise.
First, let's discuss the damage that high heel shoes can potentially cause the foot.
1: They place to much pressure on the ball of the foot. Our feet were designed to walk on soft grass, sand, flowers, etc. until we thought we would eat the fruit from that forbidden tree. As a result, we now walk on surfaces made of concrete, asphalt, tile, linoleum, etc. So our feet take a beating. Our entire foot from toes to the heel were designed to support a certain amount of our bodies weight on the surfaces we walk on. Someone wearing heels places more weight (called ground forces) on the front of the foot which can lead to fat pad atrophy, painful bones in the ball of the foot, and yes, those dreaded hammertoes and bunions.
2: It shortens the posterior muscles of the calf which help us walk. By constantly keeping your heel higher than the front of the foot, this shortens the muscles in the back of the leg which can lead to painful conditions like plantar fasciitis and tendonitis or tendonosis of the Achilles tendon.
What to do. Well if you feel you must wear heels, limit their use. Wear them only on special occasions like parties and important business meetings. If you work in an office or sales, wear supportive shoes as much as possible and wear the heels when meeting with others in the office or on sales calls.
For the best biomechanical health of the foot, wear a heel no higher than an inch-and-a-half and a totally enclosed shoe as much as you possibly can.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
OK... OK...! Before you beat me up for all of those women, and who knows maybe some men, that refuse to give up their heels, we can compromise.
First, let's discuss the damage that high heel shoes can potentially cause the foot.
1: They place to much pressure on the ball of the foot. Our feet were designed to walk on soft grass, sand, flowers, etc. until we thought we would eat the fruit from that forbidden tree. As a result, we now walk on surfaces made of concrete, asphalt, tile, linoleum, etc. So our feet take a beating. Our entire foot from toes to the heel were designed to support a certain amount of our bodies weight on the surfaces we walk on. Someone wearing heels places more weight (called ground forces) on the front of the foot which can lead to fat pad atrophy, painful bones in the ball of the foot, and yes, those dreaded hammertoes and bunions.
2: It shortens the posterior muscles of the calf which help us walk. By constantly keeping your heel higher than the front of the foot, this shortens the muscles in the back of the leg which can lead to painful conditions like plantar fasciitis and tendonitis or tendonosis of the Achilles tendon.
What to do. Well if you feel you must wear heels, limit their use. Wear them only on special occasions like parties and important business meetings. If you work in an office or sales, wear supportive shoes as much as possible and wear the heels when meeting with others in the office or on sales calls.
For the best biomechanical health of the foot, wear a heel no higher than an inch-and-a-half and a totally enclosed shoe as much as you possibly can.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Tuesday, July 8, 2008
Cushioned insoles do not relieve back pain.
You may have seen the commercial. An individual can barely walk and is grabbing their back due to severe lower back pain. They purchase a pair of Dr. Scholl "Back Pain Relief Insoles" and ...walla... from a medicine bottle poors out these 'magic' insoles that cures back pain, migraine headaches, hemorrhoids, axiety... well... you get the picture.
Most people think that when they are in pain that 'cushiony' resolves the problem, especially when it comes to their feet and back. In fact there is no clinical evidence that 'soft' insoles or orthotics assists in reducing 'structural' pain in the feet, ankle, knees or lower back. What people need are 'functional' orthotics to provide structure to their otherwise abnormal body framework.
If you remember the old nursey rhyme, "the foot bone is connected to the ankle bone, the ankle bone is connected to the knee bone, the knee bone is connected to the hip bone, the hip bone is connected to the back bone, etc." is based somewhat in fact. The difference is that these are not bones but joints and all joints have a correct anatomical alignment. When one joint is out of alignment, then other joints must compensate and generally carry a greater load than what it should.
I personally have had insoles or orthotics made for my patients (called custom molded orthotics) that have abnormal biomechanical function to their feet that have either reduced or totally eliminated lower back pain. But these insoles are functional and provide support vs. accommodative which provide cushion. (I will discuss in a future blog when accommodative orthotics or needed). Most of the time I find that these patients with lower back pain have a limb length discrepancy (one leg shorter than the other) which can also generally be compensated for by custom molded insoles.
So if your lower back has begun hurting you without injury or illness, make an appointment with your local podiatrist to have a lower extremity biomechanical evaluation done. Functional orthotics may just be what the Dr ordered.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Most people think that when they are in pain that 'cushiony' resolves the problem, especially when it comes to their feet and back. In fact there is no clinical evidence that 'soft' insoles or orthotics assists in reducing 'structural' pain in the feet, ankle, knees or lower back. What people need are 'functional' orthotics to provide structure to their otherwise abnormal body framework.
If you remember the old nursey rhyme, "the foot bone is connected to the ankle bone, the ankle bone is connected to the knee bone, the knee bone is connected to the hip bone, the hip bone is connected to the back bone, etc." is based somewhat in fact. The difference is that these are not bones but joints and all joints have a correct anatomical alignment. When one joint is out of alignment, then other joints must compensate and generally carry a greater load than what it should.
I personally have had insoles or orthotics made for my patients (called custom molded orthotics) that have abnormal biomechanical function to their feet that have either reduced or totally eliminated lower back pain. But these insoles are functional and provide support vs. accommodative which provide cushion. (I will discuss in a future blog when accommodative orthotics or needed). Most of the time I find that these patients with lower back pain have a limb length discrepancy (one leg shorter than the other) which can also generally be compensated for by custom molded insoles.
So if your lower back has begun hurting you without injury or illness, make an appointment with your local podiatrist to have a lower extremity biomechanical evaluation done. Functional orthotics may just be what the Dr ordered.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Sun screen needed for feet.
Most people when they go to the beach or pool put sun screen on themselves to protect them from the harmful UV rays that can cause skin cancer. But there are two mistakes I see people make when it comes to sun screen for the feet.
1: Most people do not put sun screen on the soles of their feet. People will cover the tops but forget to cover the bottoms. Especially for those sun worshipers that lay on their stomach to tan the back side of themselves forget that the bottoms can burn like every other area of the body.
2: Putting sun screen on your feet when you wear flip flops or sandals. If you did not catch my previous post about flip flops and sandals or just want to wear them regardless, put sun screen on your feet when go outside even when you wear long pants. Malginant melanoma is very rare on the feet, but when it occurs can become very deadly since most skin changes to the feet are not caught until it is to late. Even if you survive, the skin cancer can become so invasive that you may lose a portion or the entire foot.
So remember, especially during the summer months, protect your feet from the harmful rays of the sun.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1: Most people do not put sun screen on the soles of their feet. People will cover the tops but forget to cover the bottoms. Especially for those sun worshipers that lay on their stomach to tan the back side of themselves forget that the bottoms can burn like every other area of the body.
2: Putting sun screen on your feet when you wear flip flops or sandals. If you did not catch my previous post about flip flops and sandals or just want to wear them regardless, put sun screen on your feet when go outside even when you wear long pants. Malginant melanoma is very rare on the feet, but when it occurs can become very deadly since most skin changes to the feet are not caught until it is to late. Even if you survive, the skin cancer can become so invasive that you may lose a portion or the entire foot.
So remember, especially during the summer months, protect your feet from the harmful rays of the sun.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Sunday, July 6, 2008
Flip flops are bad for your feet.
It is summertime and most people want to live in flip flops. I hear from people who live in them, "My feet just get to hot to wear shoes in the summertime." But it is always amazing to me how people will spend the time and money to come into my practice complaining of foot pain wearing flip flops and argue with me that they have worn flip flops for years and their feet never hurt before. Well, this is not before... this is now.
Flip flops are generally made from some form of plastic or rubberized material with a toe wedge that generally fits in between the big and second toe with two oblique straps across the top of the foot. The sole of the traditional flip flop has no arch and provides no rigid structure to support the foot. For people with severely pronating (flat) feet, this can lead to increased deformities such as bunions, hammertoes, tendon dysfunction and ligamentous laxity. Muscles in the foot and calf can be overused creating pain and discomfort in these regions as well. In addition, most of the foot and ankle is exposed to injury especially from striking the foot against an object or dropping an object on top of the foot. I have had instances in my career where I have had to amputate toes due to degloving or partial amputations from objects being dropped on it.
Flip flops also expose the foot and ankle to the weather (creating dry cracking feet) and fungal elements (athletes foot and fungal toenails).
I recommend that if you want to wear flip flops or even sandals, only wear them for beach activities, the swimming pool, communal showers or maybe a quick trip to the store for some eggs and a gallon of milk. If you want to wear flip flops to a picnic, I recommend taking a pair of tennis shoes in the car and change in to them if you decided to participate in a sporting activity such as volleyball, softball or a game of touch football.
"The journey of life is taken on step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Flip flops are generally made from some form of plastic or rubberized material with a toe wedge that generally fits in between the big and second toe with two oblique straps across the top of the foot. The sole of the traditional flip flop has no arch and provides no rigid structure to support the foot. For people with severely pronating (flat) feet, this can lead to increased deformities such as bunions, hammertoes, tendon dysfunction and ligamentous laxity. Muscles in the foot and calf can be overused creating pain and discomfort in these regions as well. In addition, most of the foot and ankle is exposed to injury especially from striking the foot against an object or dropping an object on top of the foot. I have had instances in my career where I have had to amputate toes due to degloving or partial amputations from objects being dropped on it.
Flip flops also expose the foot and ankle to the weather (creating dry cracking feet) and fungal elements (athletes foot and fungal toenails).
I recommend that if you want to wear flip flops or even sandals, only wear them for beach activities, the swimming pool, communal showers or maybe a quick trip to the store for some eggs and a gallon of milk. If you want to wear flip flops to a picnic, I recommend taking a pair of tennis shoes in the car and change in to them if you decided to participate in a sporting activity such as volleyball, softball or a game of touch football.
"The journey of life is taken on step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, July 5, 2008
Bunions are a dislocation of the big toe.
I am often asked, "what causes bunions?" Generally, bunions are a 'genetic' dislocation of the big toe joint and is normally caused by poor biomechanics (the way the foot functions) on individuals. Bunions can be the result of trauma, can be caused by previous surgeries, and yes... by wearing improper shoes. (There is one surgeon who believes almost all bunions are caused by improper shoes.)
I am also asked by patients (or people at parties who know I am a Podiatrist), "Can I wear something that will straighten my toe back to normal." The answer quite simply is "No." Devices worn on or around the great toe joint can only correct the deformity while wearing the device.
The next question is, "What can I do to fix it." To correct the deformity you must have surgery to reconstruct the poor alignment of the great toe and the bone that it communicates with in the foot. (These structures are called the hallux (big toe) and 1st metatarsal (bone it aligns with in the foot)). Normally this requires transection of tendons and ligaments, surgically cutting and realigning of bone, and remodeling of the joint capsule. Depending on the severity of the deformity, two types of procedures can be performed. Distal and proximal procedures otherwise known as head or base correction.
Head procedures are done with the surgical 'cut' conducted at the head of the 1st metatarsal or close the the big toe. Base procedures or done with the cut closer to the middle of the foot. The difference is immediate walking with the head procedure, while the base procedure will require a minimum of being off of the surgical foot for a minimum of six weeks.
If you have a bunion deformity, even if it is not painful, you may want to consult with your local Podiatrist for a clinical and radiographic evaluation. Don't allow your bunion to get to severe (or you to old) where you may have limited options in correcting this very correctable deformity.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
I am also asked by patients (or people at parties who know I am a Podiatrist), "Can I wear something that will straighten my toe back to normal." The answer quite simply is "No." Devices worn on or around the great toe joint can only correct the deformity while wearing the device.
The next question is, "What can I do to fix it." To correct the deformity you must have surgery to reconstruct the poor alignment of the great toe and the bone that it communicates with in the foot. (These structures are called the hallux (big toe) and 1st metatarsal (bone it aligns with in the foot)). Normally this requires transection of tendons and ligaments, surgically cutting and realigning of bone, and remodeling of the joint capsule. Depending on the severity of the deformity, two types of procedures can be performed. Distal and proximal procedures otherwise known as head or base correction.
Head procedures are done with the surgical 'cut' conducted at the head of the 1st metatarsal or close the the big toe. Base procedures or done with the cut closer to the middle of the foot. The difference is immediate walking with the head procedure, while the base procedure will require a minimum of being off of the surgical foot for a minimum of six weeks.
If you have a bunion deformity, even if it is not painful, you may want to consult with your local Podiatrist for a clinical and radiographic evaluation. Don't allow your bunion to get to severe (or you to old) where you may have limited options in correcting this very correctable deformity.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Wednesday, July 2, 2008
When was the last time your foot was measured?
I have people, especially ladies, who come into my practice complaining of foot pain. I almost have to pry their shoes off with a crowbar and I ask them, "When was the last time you had your feet measured?" This is what I generally hear... "I have worn a size six-and-a-half shoe since I was sixteen!" I can tell you that many of these women have grandchildren older than sixteen.
Many of the 'general' foot pain complaints (where people tell me their whole foot hurts at the end of the day) can be attributable to improper shoe fit. As we get older our feet change in size and no, they do not get smaller unless they have been injured or you started binding them like the ancient Chinese or American Indians. Our feet mostly get wider and sometimes can get longer. When I was 35 years old I wore ten-and-a-half medium width shoes. Now at 54 years old I wear twelve wide shoes. Genetics, age, child birth (yes ladies you can start blaming your ugly feet as you mature on your children), injuries, and improper fitting shoes can alter the size of our feet.
I recommend that after the age of forty you have your feet measured at a reputable shoe store at least once a year. The device used to measure your feet is called a Brannock. They are manufactured to measure adult men, adult women, juvenile/adolescent, and infant feet. It is important that the correct device is used. There are three measurement that need to be taken: foot length, foot width and most importantly where the great toe breaks. I also recommend that when you purchase shoes, go in the middle of the day or evening and spend time walking around in each shoe (a minimum of five minutes).
A little attention to proper fitting shoes can ensure that your feet remain healthy and pain free for many years.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Many of the 'general' foot pain complaints (where people tell me their whole foot hurts at the end of the day) can be attributable to improper shoe fit. As we get older our feet change in size and no, they do not get smaller unless they have been injured or you started binding them like the ancient Chinese or American Indians. Our feet mostly get wider and sometimes can get longer. When I was 35 years old I wore ten-and-a-half medium width shoes. Now at 54 years old I wear twelve wide shoes. Genetics, age, child birth (yes ladies you can start blaming your ugly feet as you mature on your children), injuries, and improper fitting shoes can alter the size of our feet.
I recommend that after the age of forty you have your feet measured at a reputable shoe store at least once a year. The device used to measure your feet is called a Brannock. They are manufactured to measure adult men, adult women, juvenile/adolescent, and infant feet. It is important that the correct device is used. There are three measurement that need to be taken: foot length, foot width and most importantly where the great toe breaks. I also recommend that when you purchase shoes, go in the middle of the day or evening and spend time walking around in each shoe (a minimum of five minutes).
A little attention to proper fitting shoes can ensure that your feet remain healthy and pain free for many years.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Tuesday, July 1, 2008
What is a Podiatrist?
According to the American Heritage dictionary podiatry is "the branch of medicine that deals with the diagnosis, treatment, and prevention of diseases of the human foot. Also called chiropody." While this definition is limited to its Greek roots, podiatry encompasses treatment of the 'anatomical' leg. "Anatomical leg?" you ask.
In anatomy the anatomical leg begins just below the knee joint at the tibial tuberosity and includes the foot. The area between the knee joint and the pelvis is referred to as the thigh. However, we generally refer to the lower appendage of the human body as "the leg."
In each of the 50 states and Puerto Rico a podiatrist's scope of practice can be different. In some states podiatrist's can only diagnose, treat and prevent diseases of the foot not including the ankle while in some states this extends, as previously mentioned, up to but not including the knee. As a general rule of thumb, podiatrist's diagnose, prevent, and treat medically and surgically diseases of the foot and ankle.
Podiatric Medical School is 4 years just like MD or DO schools. Our course of study is the same with Podiatry incorporating a strong emphasis in biomechanics of the lower extremity. Therefore, podiatry uses strappings or custom molded orthotics (also called inserts) as treatment modalities. Graduates do either 2 or 3 year residences in Podiatric Medicine and Surgery and have their own certifying boards in medicine, surgery or both.
Podiatry is also somewhat of an autonomous medical specialty. Most podiatrist's have their own x-ray equipment and can therefore take and read x-rays right in their office. We see a broad range of patients in terms of age and I personally see patients as young as 6 months old and I have one patient who is 103. We treat dermatological problems from simple warts and fungal infections to cancerous lesions of the skin. Of course, podiatry plays a great role in care of diabetic patient's and work in conjunction with other medical professionals.
So the next time you have a concern about your 'leg' check your yellow pages or the Internet for a podiatrist close to you.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
In anatomy the anatomical leg begins just below the knee joint at the tibial tuberosity and includes the foot. The area between the knee joint and the pelvis is referred to as the thigh. However, we generally refer to the lower appendage of the human body as "the leg."
In each of the 50 states and Puerto Rico a podiatrist's scope of practice can be different. In some states podiatrist's can only diagnose, treat and prevent diseases of the foot not including the ankle while in some states this extends, as previously mentioned, up to but not including the knee. As a general rule of thumb, podiatrist's diagnose, prevent, and treat medically and surgically diseases of the foot and ankle.
Podiatric Medical School is 4 years just like MD or DO schools. Our course of study is the same with Podiatry incorporating a strong emphasis in biomechanics of the lower extremity. Therefore, podiatry uses strappings or custom molded orthotics (also called inserts) as treatment modalities. Graduates do either 2 or 3 year residences in Podiatric Medicine and Surgery and have their own certifying boards in medicine, surgery or both.
Podiatry is also somewhat of an autonomous medical specialty. Most podiatrist's have their own x-ray equipment and can therefore take and read x-rays right in their office. We see a broad range of patients in terms of age and I personally see patients as young as 6 months old and I have one patient who is 103. We treat dermatological problems from simple warts and fungal infections to cancerous lesions of the skin. Of course, podiatry plays a great role in care of diabetic patient's and work in conjunction with other medical professionals.
So the next time you have a concern about your 'leg' check your yellow pages or the Internet for a podiatrist close to you.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Sunday, June 29, 2008
Using Medications Safely
When you are not feeling well, you may reach for some type of medicine like aspirin for a fever. When taking medication, there are things you can do to ensure you are using them safely. All medications have benefits, but they also have potential risks. Here are some ways you can understand the benefits and risks:
1. Keep a list of all medications you take. Include maintenance medications, medications taken only when needed, over-the-counter medications, vitamins and supplements, and herbal remedies. Take this list with you when you visit your doctor or a specialist. Keep a list in your purse or wallet in case of an emergency.
2. Use one primary pharmacy. If you use mutliple pharmacies make sure that each knows what medicines you are on. The pharmacist can help you look for potential interactions.
3. Tell your doctor or pharmacist about any allergic reactions or severe side effects you may have with a particular medication.
4. Take the time to read labels carefully and follow the directions.
5. Make sure you understand exactly how you should take each medication.
6. Don't take someone elses medicine or take medication that is past its expiration date.
7. Use antibiotics wisely and take them until completed even if you are feeling better. (If you have a sore throat or lung congestion, these may be due to a virus which an antibiotic will not help.)
8. Store medications properly. Some medications must be refrigerated. Keep all medications in a cool, dry location, which means the bathroom is not the best place to keep them.
9. Do not over use Tylenol (Acetaminophen). I recommend only using Tylenol to break a fever. If the fever has not broken in 12 hours you need to seek medical advice. A recent study showed that nearly 4 out of 10 adults who took the maximum dose of acetaminophen for eight days had lab tests suggesting possible harmful liver effects.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
1. Keep a list of all medications you take. Include maintenance medications, medications taken only when needed, over-the-counter medications, vitamins and supplements, and herbal remedies. Take this list with you when you visit your doctor or a specialist. Keep a list in your purse or wallet in case of an emergency.
2. Use one primary pharmacy. If you use mutliple pharmacies make sure that each knows what medicines you are on. The pharmacist can help you look for potential interactions.
3. Tell your doctor or pharmacist about any allergic reactions or severe side effects you may have with a particular medication.
4. Take the time to read labels carefully and follow the directions.
5. Make sure you understand exactly how you should take each medication.
6. Don't take someone elses medicine or take medication that is past its expiration date.
7. Use antibiotics wisely and take them until completed even if you are feeling better. (If you have a sore throat or lung congestion, these may be due to a virus which an antibiotic will not help.)
8. Store medications properly. Some medications must be refrigerated. Keep all medications in a cool, dry location, which means the bathroom is not the best place to keep them.
9. Do not over use Tylenol (Acetaminophen). I recommend only using Tylenol to break a fever. If the fever has not broken in 12 hours you need to seek medical advice. A recent study showed that nearly 4 out of 10 adults who took the maximum dose of acetaminophen for eight days had lab tests suggesting possible harmful liver effects.
"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS
Saturday, June 28, 2008
Leg pain may be circulatory.
Leg pain, especially at night or leg pain after walking short distances (less than 3 or 4 blocks), could be a medical condition known as peripheral arterial disease. This involves narrowing of the blood vessels supply blood to your lower extremity. Plaque composed of fat and cholesterol builds up inside the walls of your arteries and restricts normal blood flow. This build up is known as atherosclerosis also known as hardening of the arteries. When it affects the heart it is called coronary artery disease (CAD) which can cause a heart attack. When it affects the arteries to he brain it is called carotid artery disease and can lead to a stroke.
Artherosclerosis in the arteries that supply blood to kidneys, stomach, arms, legs, or feetis called periperal arterial disease (PAD). Currently it is estimated this disease affects 8 million Americans and tends to incease with age and is present in a disproportionate number of African-Americans. Compated to other people, someone with PAD is six to seven times more likely to experience coronary artery disease heart attack, stroke, or a ministroke called a TIA (Transient Ischemic Attack). What is a disturbing statistic is half of the population with PAD do not have symptoms.
"One of the first signs of PAD can be painful cramping or fatigue in the legs and buttocks that occurs during activity but stops during rest," says Chacko Alexander, M.D. "PAD can also cause leg numbness, cold legs or feet, skin color changes in the arms or legs, toe or foot sores that don't heal quickly, hair loss on feet and legs, and burning or achy feet and toes when resting or lying down. In advanced stages, blood flow to a leg or foot can be severely blocked, causing tissue death that may result in amputation."
People diagnosed with PAD usually can be treated with lifestyle changes, medications, or a combination of both. In some instances, however, surgery may be necessary to open vessels using a variety of techniques.
If you exprience any of these symptoms and are African-American, older than 40, female on birth control pills, diabetic, smoke, have a history of heart disease or a family member with PAD or CAD, consult your family doctor or see a Podiatrist for an evaluation.
"The journey of life is taken one step at a time... none of them should painful." G.M. Barclay, DPM, AACFAS
Artherosclerosis in the arteries that supply blood to kidneys, stomach, arms, legs, or feetis called periperal arterial disease (PAD). Currently it is estimated this disease affects 8 million Americans and tends to incease with age and is present in a disproportionate number of African-Americans. Compated to other people, someone with PAD is six to seven times more likely to experience coronary artery disease heart attack, stroke, or a ministroke called a TIA (Transient Ischemic Attack). What is a disturbing statistic is half of the population with PAD do not have symptoms.
"One of the first signs of PAD can be painful cramping or fatigue in the legs and buttocks that occurs during activity but stops during rest," says Chacko Alexander, M.D. "PAD can also cause leg numbness, cold legs or feet, skin color changes in the arms or legs, toe or foot sores that don't heal quickly, hair loss on feet and legs, and burning or achy feet and toes when resting or lying down. In advanced stages, blood flow to a leg or foot can be severely blocked, causing tissue death that may result in amputation."
People diagnosed with PAD usually can be treated with lifestyle changes, medications, or a combination of both. In some instances, however, surgery may be necessary to open vessels using a variety of techniques.
If you exprience any of these symptoms and are African-American, older than 40, female on birth control pills, diabetic, smoke, have a history of heart disease or a family member with PAD or CAD, consult your family doctor or see a Podiatrist for an evaluation.
"The journey of life is taken one step at a time... none of them should painful." G.M. Barclay, DPM, AACFAS
Subscribe to:
Posts (Atom)