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

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

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

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

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

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

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

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

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

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

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

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

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

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

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