Runners: Fit Feet Finish Faster

Both long-distance runners and casual joggers can improve their performance by keeping their feet in top condition and taking steps to control foot problems common in runners.

The human foot is a biological masterpiece that amazingly endures the stresses of daily activity. For runners, the feet are more vulnerable to injury than any other part of the body, and these athletes should be on the alert for signs of foot problems that can slow them down if not treated promptly.

The most common complaint from runners is heel pain caused by inflammation of the ligament that holds up the arch, a condition known as plantar fasciitis. In athletes, heel pain can result from faulty mechanics and overpronation in which pressure is unequally applied to the inside of the foot. It also can be caused by wearing running shoes that are worn out or too soft.

At the first sign of heel pain, runners are advised to do stretching exercises, wear sturdier shoes and use arch supports. In some cases, icing and anti-inflammatory drugs, such as ibuprofen, are helpful. Should heel pain continue, custom orthotics, injections and physical therapy might be required? Surgery normally isn’t considered unless heel pain persists for more than a year and conservative treatment has failed to bring relief.

Neuromas and tendonitis are other common foot problems that affect runners. A neuroma is a pinched nerve between the toes that can cause pain, numbness and a burning sensation in the ball of the foot. Overly flexible shoes often are the cause and padding, orthotics or injections usually are effective. Sometimes surgery is the answer if pain between the toes continues for more than six months.

Serious runners can be sidelined with tendonitis if they ignore the warning signs of this overuse-related condition. There are several forms of tendonitis that affect the Achilles and other areas, and all are treated with rest, icing, stretching and anti-inflammatory medications, and sometimes with orthotics and physical therapy. Over-zealous training usually causes tendonitis, especially among beginners who try to do too much too soon.

A common myth among athletes is that it’s not possible to walk or run if a bone in the foot is fractured. Surprised patients often say “It can’t be broken, I can walk on it." That’s dead wrong, especially with stress fractures when pain and swelling might not occur for a few days. If a fracture or sprain is suspected, runners should remember the word RICE as an abbreviation for Rest-Ice-Compression-Elevation. Should pain and swelling continue after following this procedure for three or four days, you should see a foot and ankle specialist for an x-ray and proper diagnosis.

Other common foot ailments runners should watch for are:
Athlete’s Foot: This fungal skin disorder causes dry, cracking skin between the toes, itching, inflammation and blisters. It can be prevented and controlled by washing the feet regularly and carefully drying between the toes; switching running shoes every other day to allow them to dry; wearing socks made with synthetic material instead of cotton; and applying over-the-counter ointments.

Toenail Problems: Ingrown nails can cause inflammation and possible infection and usually are treated by cutting the corner of the nail with sterile clippers. Black toenails happen when a blood blister forms under the nail from trauma, and it’s best to let the nail fall off by itself. Fungal toenails are yellow, brown or black and sometimes are irregularly shaped and thick. They are best treated with oral anti-fungal medications.

Foot Odor: There are more than 250,000 sweat glands in the foot and daily hygiene plus regular changing of shoes and socks are best for controlling sweat and odor. Runners should avoid wearing cotton socks and running without socks. Foot powders, aerosols antiperspirants and vinegar soaks also are helpful.

Blisters, corns and calluses: Never pop blisters unless they are larger than a quarter or are painful or swollen. Use a sterile instrument to lance the corner, leave the top as a biological dressing, wash, apply antibiotic ointment, and cover with a Band-aid. Corns and calluses are caused by repeated friction, and should be treated by aseptically trimming the dead skin and eliminating the underlying cause.

CHECK KIDS’ FEET BEFORE SCHOOL STARTS

Simple At-home Checks Help Spot Foot Problems

During the annual rite of preparing for the new school year, it is recommended that parents take five minutes at home to check for signs of possible foot disorders that could prevent active children from participating in sports and other activities.
The American College of Foot & Ankle Surgeons (ACFAS) suggests these additions to this year’s back-to-school checklist:
• Do the bottom of the child’s shoes show uneven wear patterns?
• Does the child walk irregularly? Is one leg longer than the other or do feet turn in or out excessively?
• Do pre-schoolers walk on their toes?
• Does the child often trip or stumble?
• Does the child complain of tired legs, night pains and cramping?

If parents take time to perform these checks, they will identify symptoms of common foot ailments, such as ingrown nails, and more serious foot disorders like flat feet that can hamper a child’s performance in physical education classes and sports. If a child’s shoe is worn on the big toe side of the foot, it could be a sign of poor arch support or flat feet.

Parents can spot several potential foot problems by observing kids’ walking patterns. For example, if a parent determines that one leg is longer than the other, heel lifts may be required to restore proper balance.

Toe-walking in younger children can result from too much time spent in walkers as toddlers. Parents are urged take action to correct tightness in the Achilles tendon area that occurs from excessive toe-walking. ACFAS recommends stretching exercises that can be fun for small children and will help prevent lower back pain as they get older.

For those beginning college, heel pain and shin splints can plague freshmen not acclimated to walking long distances across campus to attend classes. Daily stretching and proper walking shoes are recommended, and for those with deformities such as hammertoes, surgery may be necessary to make walking more comfortable.
Parents also should heed complaints about tired legs, heel pain and leg or foot cramps at night. There’s no such thing as “growing pains,” so when kids complain about leg and foot pain they might have flat feet or another disorder that should be evaluated immediately. Children with flat feet are at risk for arthritis later in life if the problem is left untreated.

Parents who notice a potential foot problem should have the child evaluated by the foot specialist at Central Kansas Podiatry Associates.

Pain to the Bottom of the Heel Can Have Many Causes

Pain on the bottom of the heel is most often caused by plantar fasciitis. Heel pain may also be due to other causes, such as a stress fracture, arthritis, nerve irritation, or, a bone tumor or cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed.

A stress fracture to the heel bone will cause pain when walking, but the heel area may also be red, hot, swollen, and bruised.

Arthritic conditions such as rheumatoid arthritis and psoriatic arthritis not only affect the joints, but can also cause inflammation of the tendons and ligaments in the foot leading to heel pain.

There are 2 types of nerve entrapments that can cause heel pain. Tarsal Tunnel Syndrome is similar to Carpal Tunnel Syndrome. A large nerve to the inside of the foot can be compressed by large veins, a soft tissue mass, or even because of the structural changes to the foot from severe flatfoot deformity. Patients with Tarsal Tunnel Syndrome have pain to the bottom of the heel, but may also experience shooting pains along the entire bottom of the foot and numbness and tingling of the toes.

Baxter’s nerve entrapment is another cause of heel pain. Baxter’s nerve is a small nerve branch on the bottom of the foot that becomes entrapped by a muscle on the bottom of the foot. This type of heel pain is typically worsened with long activity and often radiates to the outside of the bottom of the heel.

Certain types of heel bone cysts or tumors can also cause heel pain. Bone cysts can be filled with water or blood. Fatty tumors called lipomas are common in the heel bone. Rarely, the heel bone can have a metastatic tumor.

Plantar fasciitis is an inflammation of the band of tissue that extends from the heel to the toes. Plantar fasciitis generally results in pain to the heel after any period of rest and with long activity.

A thorough history and physical exam is necessary to properly diagnose heel pain. X-rays, diagnostic ultrasound, MRI, CT scans, or nerve studies may be necessary as well.

If you have pain to the bottom of your heel, call Central Kansas Podiatry Associates for further evaluation.

Question: I have a large bump on the inside of my foot that seems to be getting larger, what is it, and can it be removed?

Answer: A bunion is a bony prominence, along the inside of the foot, at the base of the big toes. This “bump” represents a misalignment of the big toe joint. Bunions commonly occur on both feet, but on foot may be more severe than the other. They tend to be hereditary but can occur without a family history. They are not caused by poor shoe gear, but are often aggravated by the shoe. This deformity is cause by abnormal foot function. A foot that rolls in excessively (pronates excessively) allows abnormal stress to go through the big toe joint to cause the deformity. This is a progressive deformity. The deformity never gets better, only worse.

Conservative care consists of decreasing the pressure on the bony prominence by a wider or softer shoe or padding around the deformity. Sometimes good arch support of an orthotic will improve foot function enough to decrease the irritation of the deformity and slow down its progression. If conservative care is not successful, then surgical straightening is the treatment choice. Surgical treatment revolves around realigning the structural deformity. The bony prominence is removed and the joint is realigned. The type of procedure and the length of recovery are determined by the severity of the deformity.

In order for your surgeon to establish a diagnosis and determine the severity of the deformity, a health history, physical examination, and x-rays are necessary to evaluate the extent of your bunion deformity. Depending on your individual needs as well as your overall medical, condition, your surgeon will recommend the best treatment regiment for you.

Nail Deformity Can Best Be Treated With Correct Diagnosis

Many patients are concerned because they have thick yellow toenails that are deformed and difficult to cut. Nail deformity has many causes including: trauma, psoriasis, fungal infection, thyroid disease, and lung disease. Correct diagnosis of the toenail deformity is essential for proper treatment.

Patients often ask about taking Lamisil Tablets for their nail deformity. Lamisil, and other oral anti-fungals, can be an excellent treatment for deformed toenails due to fungal infection; however, oral anti-fungals are not effective for other causes of nail disease. There are several topical products now available to reduce nail deformity that is not caused by fungus.

A thorough history & physical along with a nail biopsy is the best way to diagnose the reason for the nail deformity.

If the deformity is caused by fungal infection, oral anti-fungal agents, like Lamisil, may be a good choice. When prescribing oral anti-fungals it is important to monitor the patient’s liver functions, much the same way as patients who are on diabetes and/or cholesterol medications. If the patient’s liver functions are normal, oral anti-fungal agents are very safe medications. For patients who cannot take oral anti-fungals, topical treatments are available.

If you have thick yellow nails, call CKPA for an evaluation & treatment options.

Lax Care of Foot Puncture Wounds Hikes Risk for Serious Infections

Bare feet are universally associated with summer, but for those who enjoy walking barefoot, a local foot and ankle surgeon warns that inattention to seemingly minor puncture wounds on the soles of your feet can allow serious infections to develop and spread.

Going barefoot heightens risk for puncture wounds, which require different treatment from cuts because the tiny holes often harbor foreign matter under the skin. Glass, nails, needles and seashells are common offenders. Regardless of the substance, anything that remains in the wound increases your chances for complications.
Puncture wounds in the feet too often are superficially treated, and it is best to get proper care within the first 24 hours to make sure anything that might be embedded in the wound is removed. Research shows 10 percent of puncture wounds do result in serious infection, but such complications can be prevented with prompt and appropriate medical attention.

The depth and relative cleanliness of a puncture wound are the main factors determining possible infection risk. Studies show 60 percent of patients who required incision and drainage of a puncture wound had something embedded. With the increasing prevalence of drug-resistant bacteria, even healthy people are getting potentially life-threatening Staph infections. So if you step on something and the skin is broken, get treated right away.

Proper treatment of a puncture wound involves thorough cleaning to decrease infection risk and tetanus shots often are needed. Following treatment, the wound should be monitored carefully at home.

Sometimes an infection can develop later and migrate to the bones. So if the wound stays red, swollen and sore after a few days, go back to the doctor for further treatment. In all cases, a puncture wound on your foot should never be taken lightly.

Lawnmower Accidents Needn’t Be a Rite of Summer

Summertime is here and weekend gardeners are cautioned that their yards could become "toe-away" zones if they’re not careful when operating rotary-blade lawn mowers.
Each year, some 25,000 Americans sustain injuries from power mowers, according to the U.S. Consumer Products Safety Commission. Although the number of accidents has steadily declined since the 1982 adoption of federal safety standards, too many foot injuries from power lawnmowers are still seen. The blades whirl at 3000 revolutions per minute and produce three times the kinetic energy of a .357 handgun. Yet patients are still seen who have been hurt while operating a mower barefoot! Foot injuries range from dirty, infection-prone lacerations to severed tendons to amputated toes.

If a mower accident occurs – with just a minor injury – immediate treatment is necessary to flush the wound thoroughly and apply antibiotics to prevent infection. Superficial wounds can be treated on an outpatient basis, but more serious injuries usually require surgical intervention to repair tendon damage, deep clean the wound and suture it. Tendons severed in lawnmower accidents generally can be re-attached surgically unless toes have been amputated.

Children under the age of 14 and adults over age 44 are more likely to be injured from mowers than others. Anyone who operates a power mower to take a few simple precautions:
• Don’t mow a wet lawn. Losing control from slipping on rain-soaked grass is the leading cause of foot injuries caused by power mowers.
• Wear heavy shoes or work boots when mowing – no sneakers or sandals.
• Mow slowly across slopes, never go up and down.
• Never pull a running mower backward.
• Keep the clip bag attached when operating a power mower to prevent projectile injuries.
• Use a mower with a release mechanism on the handle that automatically shuts it off when the hands let go.
• Always keep children away from the lawn when mowing it.