A Word About Running Shoes

With warm weather and running season here for a short time,
it’s the perfect time to start getting geared up for some good old-fashioned
exercise.  Wearing the appropriate
running shoes means more than feeling comfortable—it can be the difference
between remaining injury free and sitting out for the season.  Whether you plan on tackling a marathon or just
hitting the trails for fun, here’s how to select a pair of running shoes to
keep you going mile after mile after mile…

Shop for shoes at the
end of the day.
Your feet swell
throughout the day, so you want to find a shoe that fits your largest foot
size.  Your feet will expand as you run, and
you don’t want to be stuck with shoes that leave your feet feeling cramped.

Bring your orthoses
with you.
If you wear custom
orthoses, make sure you have them on hand when trying on shoes.  The style and size of shoe you need to buy
will likely change when you are wearing your orthoses.

Try out your shoes
while running.
You won’t just be
walking in these shoes, so don’t just walk around when trying them on.  Take a few laps around the store or see if
the store has a treadmill where you can jog for a few minutes to really see how
they feel.  Most stores allow you to
return shoes if you haven’t worn them outside, so you can bring them home and
run on your own treadmill or jog around a bit inside before you have to fully
commit to your purchase.

Don’t make any
changes right before race day.
A bright,
shiny, new pair of shoes will surely help anyone run a little faster for a big
race, right?  Wrong!  This is a common mistake that many runners
make.  Unfortunately, they usually
realize their error in the middle of that big race, when their feet are
blistered, injured, and painful.  Running
shoes take a while to break in, so it’s best to try out a new shoe several
weeks before race day to feel certain that your feet are completely content in
your new gear.

Find a specialty
running store.
These stores usually
have an expert on hand who can analyze your gait and foot type and provide
recommendations on shoes that will work best for you.  While you may pay a bit more than at a
department store, it’s more likely that you will end up with a better pair of
shoes in the long run.

Don’t fall into the
fad trap.
Minimalist shoes and
barefoot running may be all the rage right now, but that doesn’t mean it works
for everyone.  For most foot types, a
minimalist shoe may do more harm than good.
Running without support can cause injuries such as plantar fasciitis or
stress fractures, and it puts stress on every other part of the body in new
ways.  Those who run barefoot or in
minimalist shoes have to work up to it slowly and may even need to consult an
expert to see if their foot type will be able to handle such minimal support.

Listen to your
It may sound trite, but if
your feet hurt, it’s probably time to replace your shoes.  Brands are always changing, so even if a
certain brand has been your standby in the past, you may need to try something
new to find optimal comfort.

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Time To Get Those Feet Working Again

The scent of spring is in the air, the weather is warming up, and the long winter hours spent indoors are behind us. It’s the perfect time to get outside and start exercising. As you head to the great outdoors or the gym for a workout, here are a few tips to help keep you injury free and ready to get in shape.

Start out slow. It’s great to have workout goals, but you don’t have to meet them the first day you start exercising! Give your body a chance to adjust to your new routine by gradually working up to your goals. Pushing too hard right away will leave you open to more injuries, not to mention causing you quite a few aches and pains.

Warm up and cool down. It’s easy to skimp on the warm up and cool down, but they are key to preventing common injuries, such as muscle tears or strains. Warm up with a light jog and active stretching for 5-10 minutes before doing any static stretching or starting the hard part of your workout.

Wear the proper equipment. Be sure to think about safety whenever you exercise. Your shoes should be sport specific and designated for that activity alone; don’t go for a run wearing the same shoes you have walked around in all day. Wear the proper pads during contact sports, strap on a helmet for biking, and wear reflective gear when on the roadside at night. A little common sense goes a long way!

Remember that age matters. It seems a little unfair, but as we get older, we become more prone to injuries and less able to bounce back after having one. You may find it more difficult to do some of the activities that came naturally a few years ago. Keep this in mind, and modify your exercise to your current ability level.

Stay healthy and hydrated. Eating energy-rich foods and drinking plenty of water will make any workout more of a success. It is much more important to stay hydrated during the day than to chug water in the middle of a workout. Keeping your body properly fueled before exercise will leave you feeling better later.


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The Confusion About Prescription Orthotics

Just Because it Looks Like a Duck Doesn’t Mean It’s A Duck…..







There  seems to be a lot of confusion about the concept of Custom Orthotics.

There is a bombardment of misleading ads and displays regarding orthotics everywhere we go – malls, online, television, fairs ….if you grab something off the shelf, how can it be ‘custom fit’? There are many digital scan techniques to diagnose your foot problem, but don’t assume that high-tech is better.

Custom, functional orthoses are unique – unique to YOU. By definition, custom-made functional orthoses can only be made from a three dimensional anatomical model of the patient’s own feet.

These devices are designated to reduce the pathological forces (the natural forces of standing, walking or just going through normal daily activities) and to control abnormal motion or abnormal position of the foot.

Custom prescription (functional) orthotics are not only made ‘from scratch’, based on your Doctor’s creation of a 3-D mold of your feet and his detailed prescription to accommodate your particular biomechanical needs (the forces exerted on your foot), but they are made specifically and only for you. In doing so, your doctor is able to address every small and different motion in your foot to make sure that you are working at optimum performance.

Custom functional orthotics are extremely useful in treating heel pain, bunions, neuromas and most painful foot conditions, including hallux limitus (See ‘What We Treat: Lack of Joint Motion’).

There is no substitute for custom orthotics. If you have found some relief from over-the-counter or step-in-foam devices, imagine that multiplied by ten, and that is the benefit you will see by coming to us for prescription orthotics.



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What is Gout ?

Your foot health can be greatly affected by what is going on in the rest of your body.  Gout is a condition that illustrates this principle.   Gout occurs when high levels of uric acid in the body cause a buildup of uric acid crystals to be deposited in a joint.  This can occur in any joint in the body, but the big toe joint is one of the most common places where crystals accumulate.  The crystal deposits create a very painful, red, swollen joint.  Acute gout occurs as a sudden onset of pain, often in the middle of the night.  The affected area can be so tender that the bed sheets rubbing across the foot can cause extreme pain.
There are several reasons for a buildup of uric acid in the body.  The body may make too much uric acid, or it may have difficulty getting rid of uric acid.  Gout can occur as an isolated condition, or it can be potentiated by other health conditions, including diabetes and obesity.  Gout can also be triggered by diet and lifestyle factors.  Alcohol use and certain foods, such as red meat and foods high in fat, increase uric acid levels in the body.

The buildup of uric acid without any other symptoms is known as asymptomatic gout.  Acute gout starts when symptoms appear.  Symptoms may disappear for several months or even years, but they usually recur.  They may recur in the same joint and may begin to involve other joints as well.  The period in between acute attacks is known as inter-critical gout.

Chronic gout occurs when patients suffer from repeated attacks of gout.  Chronic gout is serious, and repeated attacks can cause permanent joint damage and bony changes.
Acute attacks of gout can be managed by an anti-inflammatory drug and pain reliever prescribed by your podiatrist.  Then patients are often prescribed a drug to manage the uric acid levels in the body, in order to prevent another attack from occurring.  Those who suffer from gout can help prevent another attack by avoiding food triggers and decreasing alcohol intake.

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Ankle Sprains

Ankle sprains are among the most common sports injuries.  They often occur on the outside of the ankle when the foot rolls outward too far.  The injury is usually followed by swelling, bruising, and severe pain.  The severity of an ankle sprain is based on the extent of injury to the ankle ligaments.  There may be a partial tear to one or several ligaments, or even a complete rupture.
Although ankle sprains happen frequently, they are not to be taken lightly.  Recovery can take some time, and after one injury, subsequent sprains are more likely to occur.  Therefore after spraining an ankle, it is important for the athlete to seek medical care.  A podiatrist can assess the injury and take x-rays to be certain that a fracture is not present.  He can also create a treatment plan for the patient to start recovering.
Treatment for ankle sprains depends on the severity, which will be determined by the podiatrist.  Most ankle sprains will be treated with the “RICE” protocol: rest, ice, compression, and elevation.  Anti-inflammatory medications, such as ibuprofen, may be taken to help reduce pain and swelling.  In addition, the doctor may prescribe a brace to protect and offload the injury.  Later a brace or taping can also be worn during athletic events to help prevent future sprains.
Often physical therapy is beneficial for rehabilitating a sprained ankle.  A physical therapist teaches the patient strengthening exercises and stretching to improve the ankle’s range of motion.  The patient may also perform exercises to improve balance when walking and playing sports.  Once the ankle has recovered, the patient can slowly ease back into activity.  When resuming normal activity, it becomes crucial to wear a brace or athletic taping to decrease the likelihood of re-spraining the ankle.

If an ankle sprain is recurrent, custom prescription orthtotics may be considered to address the biomechanical component that is causing poor alignment of the foot, making it prone to injury.

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What is Charcot Foot ?

Charcot foot is one of the many complications that can occur from diabetes.  Charcot is a form of arthritis that affects the joints and bones in the feet.  Patients with diabetes often have decreased sensation in their lower legs and feet, a condition known as peripheral neuropathy.  Because of the decreased sensation, someone with neuropathy does not have the ability to sense pain like someone with full sensation would.  This means that repetitive injury to the feet can occur without the patient even knowing it.  Continued trauma combined with the resulting increased blood flow to the area causes the bones and joints to weaken.

Acute Charcot is recognized clinically by warmth, swelling, and redness of the skin.  X-rays show massive destruction, fractures, and dislocation of bone.  As Charcot progresses, the bones will remodel, but the foot will remained deformed.  Most commonly Charcot results in a “rocker-bottom foot,” aptly named because of the arch collapse that creates a bony prominence on the sole of the foot.  It is common to have a foot ulcer form beneath the collapsed arch. The ulcer forms because of the increased pressure beneath the bones in the arch.

Early diagnosis is key for decreasing the complications of Charcot foot.  By recognizing the problem quickly, progression of the deformity can be slowed or halted by staying off of the foot until the acute phase of the disease is over.  Reducing the amount of trauma to the foot allows the body a chance to start the healing process.  This can often take quite a bit of time, but maintaining a complete non-weight-bearing state is crucial for healing to occur.

After the acute phase of Charcot is over, preventive care is needed to promote further healing and to avoid recurrence.  Custom bracing, and or prescription orthotics are needed to accommodate the new foot shape and prevent injury to the foot.  Patients should keep blood sugar levels in check, and inspect their feet daily to identify any injuries that could lead to further problems.

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It’s Not Just About Feet !

Although foot care is our specialty and focus, we at Tri-State Podiatry truly care about the person attached to those feet.

One of the things we enjoy about coming to work each day is not only helping people become more active by relieving foot pain, but also learning about our patients’ daily lives and experiences.

This is Francis. He doesn’t mind our disclosing the fact that he is 96 yrs old. He recently drove himself to our office and, while talking with him before the Doctor came in, he  mentioned that his wife had washed all the curtains and that he had asked her to wait for him to get home to help hang them. When asked how long they were married, his immediate response was “75 years July 16th”. He added, ‘my wife is doing pretty well, she gets a LITTLE bit forgetful at times”. Really ??? What about us?

I think Francis and his wife take the record for the longest married couple in our practice. Congratulations and best wishes !

(see more stories below)

This is June. She is a lovely lady. We always are happy to see her on the schedule.

We were concerned when we heard that June had been in the hospital, and were happy to see her return to our office.  Learning that she had taken a fall at home, we asked what had happened. She said, matter-of-factly, “ I broke my wrist and had bleeding on the brain.”

June , who lives alone, was able to call her family, who brought her to the hospital. Her injuries were felt to be serious enough to transport her across Lake Champlain to a large medical center.

After examinations and many tests, a doctor came in and said, “I am afraid we need to operate”. June replied, “Oh no you’re not !’ The surprised doctor asked why.

“Because I just had a perm”, June answered.

Doctor: “Do you mean to tell me that your perm is more important than your life?”

“Yes it is,” June stubbornly replied.

Amazingly, June got her way. She spent a few days in the hospital under close observation and was discharged home, without surgery. As you see from her beautiful smile above, she has recovered nicely. We certainly enjoyed a good laugh that day !

Below is another illustration of the fun we have with our patients:

Recently, Dr. Donela was treating a patient in our Massachusetts office. She lives in the Berkshires, and is a Biology teacher at the local high school.

In the course of conversation, it was discovered that Dr. Donela and Jackie were fellow alumni from Walt Whitman High School in Huntington Station, New York (Long Island).

On a subsequent visit, they both shared their yearbooks with each other and realized that, in spite of the nearly 20 year spread in graduation years, they both had the same teacher. Interestingly, he was their Biology teacher.

This is a picture of Dr. Donela and Jackie with their yearbooks. The staff enjoyed listening to all the reminiscing.

Connecting with people is what is so rewarding about what we do !

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Kids’ Feet

In the medical profession, it is often said, “children are not just little adults.”  This wise saying sums up what doctors and parents know very well: children have their own unique characteristics and need to be treated as such.  This is true in the podiatric world as well.  Many foot concerns are more common in children, and those that affect people of any age may be treated differently in the pediatric population.

Plantar warts are a common occurrence in children.  This pesky skin problem is often recurring in kids, and can cause significant pain for many.  Self-treatment with over-the-counter medications may not be enough to keep warts at bay, so it is a good idea to visit the podiatrist to look at other options.  There are many ways to treat plantar warts, including cryotherapy (freezing the wart) or using a topical medication such as salicylic acid.

Many children also experience ingrown nails, which can make participation in sports or activities painful.  If an ingrown nail becomes infected, a podiatrist can remove the nail border to stop the painful growth and eliminate the infection.  This can be done as a temporary treatment, or as a permanent treatment that prevents the nail border from ever growing back.  Rubbing can cause such nail problems from shoe gear or from structural foot problems that cause pressure on the nail (see the July 2011 post for more information).

Parents also often worry when their child has gait abnormalities, such as in-toeing, out-toeing, or very flat feet.  Children may outgrow some of these issues with time.  For example, flat feet are common in children when they start walking at age one, and can persist for several years, eventually returning to a normal arch height.  But a podiatrist should evaluate older children who have significant foot pain with their flat feet, along with knee and ankle pain.  The doctor can then decide what treatment is necessary to help improve symptoms.  Muscle weakness, limping, and frequent tripping are not normal, and should be evaluated by a podiatrist to determine possible underlying causes.  When in doubt about whether your child is walking normally, it is a good idea to visit the doctor and address your concerns.


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Why Do I Have Calluses on the Soles of My Feet ?

Calluses are thickened portions of skin that appear on the body in areas receiving high amounts of friction or irritation.  A seasoned guitar player could point to the toughened areas on her fingers from years of strumming, or a mechanic from wielding tools day after day.  Most of us remember the reasons we develop calluses on our hands, but usually we can’t quite recall when or why the calluses on our feet showed up.  We wear shoes more often than not, and most people aren’t playing instruments with their toes.  So why do we get calluses on our feet?

Calluses on the feet are similar to those on the hands in that they appear in high pressure areas.  However, since we walk on them, our feet receive a unique set of pressures.  Not only do our feet pound against the ground with each step we take, they must also receive the impact of the body’s weight simultaneously.  How this force from the body is distributed in the feet depends on the anatomy of the body and the way a person walks.  If the foot structure is altered due to a deformity or a gait problem (such as limping or a shortened limb), it causes forces to be distributed unevenly in the feet.  This uneven distribution can create areas of high pressure.  Of course, this alone will not create a callus.  But add in the repetitive motion of walking that puts even more stress on areas already under high pressure, and a callus eventually develops.

High pressure areas and their associated calluses can occur due to several conditions.  In a foot with hallux abducto valgus (HAV), the big toe is deviated toward the outside of the body and the big toe joint becomes flexible and unstable.  In this situation, excessive force is placed on the outside of the big toe and the ball of the foot beneath the second toe.  This causes calluses to appear on the outside of the great toe and on the sole of the foot under the second toe.  Similarly, in a person who pronates excessively, calluses appear on the ball of the foot and the side of the big toe due to more force on these areas when walking.  Someone who has a hammertoe will walk with the toe bent, so more force will be placed on the small part of the toe touching the ground.  This creates a callus on the bottom tip of the hammertoe, and a corn on the top of the toe where it hits the shoe.

Because of the multiple factors involved in their development, treatment of calluses involves more than just removing them.  A podiatrist needs to address the underlying causes in order to prevent a painful callus from persisting.

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What is That Bump on My Foot?

One of the most common reasons to visit a podiatrist comes from a painful bunion.  Patients typically complain of “bump pain” on the side of the foot at the base of the big toe.  There may even be numbness at the site of the bump.  While this painful prominence is often the reason for a patient’s visit, bunions are not an isolated problem.  Bunions most often occur due to a biomechanical problem known as Hallux Abducto Valgus (HAV).  HAV is a foot structure that appears when the great toe (the hallux) points toward the other toes instead of staying in line with the rest of the foot.  This internal muscle imbalance often occurs from flat feet and over-pronation when walking.  Women commonly suffer from HAV and bunions, often related to wearing unsupportive shoes and high heels.  The prominence on the side of the great toe can become swollen and sore from rubbing on shoe gear, creating great discomfort.

Treatment for HAV and bunions ranges from non-surgical to surgical care, depending on the severity of the deformity.  It is important to realize that HAV is a progressive process, meaning that it will continue to worsen without intervention.  The goal of non-surgical treatment is to decrease pain and slow development of the deformity, but it cannot completely eliminate HAV or the bunion.  Ice and anti-inflammatory medications will decrease the swelling at the prominence.  Wearing shoes with a wider toe box and avoiding high heels will reduce pressure and pain on the side of the foot.  A podiatrist may create custom orthoses that will decrease pronation and slow the progression of the HAV.  A podiatrist can also provide special padding that will help decrease pain at the bunion site from shoe gear.

Progression of the deformity may cause severe pain that will not respond to non-surgical treatment.  Often, HAV causes the big toe to drift so far over that it impinges on the other toes, creating more pain and other deformities.  In these circumstances, surgery may be necessary to fix the deformity and eliminate the associated pain.  There are numerous surgical options available for treatment of the problem.  Surgery typically involves removal of the bunion and realignment of the big toe with the other bones of the foot, using pins or screws to hold the bones in place.



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