Ingrown Toenail Removal!!

An ingrown toenail (onychocryptosis) occurs when part of the nail penetrates the skin, which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin - this is not technically an ingrown toe nail, but can also be painful (a corn/callus is also common down the side of the nail and is a reaction to this pressure, rather than the nail actually penetrating the skin).
What does an ingrown toe nail (onychocryptosis) look like:
Usually the side of the nail penetrates deep and it is difficult to see the edge of the nail. The severity of appearance of the nail will vary. Some will just have a nail that appears deeply embedded down the side or sides of the nail. In some the corner or a small spike of nail may penetrate the skin, just like a knife. This can result in an infection and the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.
What are the symptoms of in ingrown toenail (onychocryptosis):
Pain is the main symptom of an ingrown toe nail - usually just starting as some minor discomfort. This may be just the pressure from the side of the nail or it may be because the nail has actually penetrated the skin down the side of the nail. The toe is not necessarily infected, but this can develop after the nail penetrate the skin to become ingrown. The infection can spread, making the toe red and inflamed (paronychia). A collection of pus may also develop.
What causes an ingrown nail (onychocryptosis):
Poor cutting of the nail is most commonly blamed as being the cause of an ingrown toe nail, but this is not necessarily the case. The following factors are involved in the cause of ingrown toenails (onychocryptosis): the primary risk factor is the shape of the nail - a nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail (incurvated nails). Some nails go down the side into the nail fold area for a relatively large distance. A large portion of the nail is almost vertical rather than being horizontal. The most severe of these types of nail is called a 'pincer nail' in which both side of the nail are very curved. The shape of the nail is usually inherited (congenital), but it can be influenced by trauma and/or shoe pressure. poor cutting of these types of nails can leave a sharp corner (or if worse, a small spike) that will initially cause symptoms by putting pressure on the skin and then later penetrate the skin. Trimming too far down the sides is a common cause of an ingrown toe nail. footwear that is tighter is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk on an ingrown nail. previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail pressure from the toe next to the nail that has ingrown can sometime be a factor a 'chubby' or fleshy toe is more likely to have a nail grow into it. Those whose feet swell are a lot are more prone to having this happen.
Self treatment of the ingrown nail (onychocryptosis):
The cornerstone of self treatment and prevention of ingrown toe nails involves cutting the nail straight across to allow the corners to protrude, so that they do not penetrate the skin. Cut the toe nails straight across without tapering the corners. However, this can be difficult if the nail is very curved down the side. In this case DO NOT 'dig' down the sides - seek professional help for this (see below). It is a myth that a V should be cut in the end of the nail to treat an ingrown toe nail. The apparent reasoning behind this is that if you cut a V in the nail, the edge of the nail will grow together as the nail grows out. This does not happen - the shape of the nail is determined by the growing area at the base of the toe, not the end. Avoid wearing shoes and socks that are too tight. Keep feet clean to prevent the ingrown nail from becoming infected. Those with poor circulation or diabetes should not do any self management of ingrown toenails but see a Podiatrist. See below to find a Podiatrist. See below for how a Podiatrist would manage an ingrown toenail (onychocryptosis).
Podiatric treatment of the ingrown nail (onychocryptosis):
Initial treatment of the ingrown nail (onychocryptosis): Antibiotics are often used to treat the infected ingrown toenail, but don't forget that the cause of the infected (the ingrown nail) is still there, so there is not a lot of point in treating the infection while the cause remains. Sometimes antibiotics are used to help the infection clear after the nail has been removed. A skilled Podiatrist at Advanced Foot & Ankle Center can easily remove the corner or spike that has penetrated the skin, often with relatively little discomfort. If the ingrown nail is too painful, a local anesthetic may be needed to do this. Don't forget that unless the offending piece of nail that is causing the ingrown toe nail is removed, the infection is likely to persist. After this some antiseptic dressing for a few days is all that is needed to clear up the infection, especially if you are healthy and have no healing problems. Antibiotics and/or prolonged period of dressings are needed, especially if there is a problem with wound healing or if the circulation is poor or if you have diabetes. Occasionally, after the above treatment if the pain persist - this may be due to there being another spike of nail deeper down causing the ingrown toenail. Ongoing treatment of the ingrown toenail (onychocryptosis): Ingrown toe nails have a great tendency to happen again. They happen in the first place because of a number of reasons - the most common of those reasons is the shape to the nail. Generally, this is if the nail is curved down the side. With good self treatment (see above), it may be possible to prevent it reoccurring. Regular treatment by Dr. Raymond A. DiPretoro, Jr. can often be needed, as a conservative approach to prevent the nail becoming a problem is can be recommended. Surgical treatment of the ingrown toe nail (onychocryptosis): if the ingrown nail is severe, or if conservative care is difficult, or if the ingrown toenail does not respond well to conservative care, then minor surgical intervention is a good option. Minor surgery is a relatively simple procedure and is very successful for long term relief that is permanent. a number of different minor surgical procedures can be used by a Podiatrist to treat an ingrown toe nail. Almost all of these are done in the office under a local anesthetic. the most common procedure is the removal of a portion of the nail down the side of the nail that is causing the problem. In the worst case of a total nail which is curved, it may be necessary to remove the entire nail. After a nail or part of the nail is removed, it will grow back as the growing cells at the base of the nail are still there, unless something is done to remove them. Most commonly an acid is used to destroy the growing cells to prevent regrowth. Other options to prevent it growing back include, surgically debriding the growing area or using a laser. For some reason a few percent do reoccur. Generally, after the surgery you will need to keep your foot elevated for a few hours and rest is advisable. The following day, you can return to work or school. It is advisable not to take part in vigorous activities, such as running for 2 weeks after the surgery. The use of an open toe shoe, so that there is no pressure on the area also facilitates healing.

Diabetic Nerve Pain in the Foot!

Diabetes is one of the most common reasons people seek relief for painful feet. With diabetes, four types of foot problems may arise in the feet.

Nerve Problems due to Diabetes

The most common contributor to diabetic foot pain is a nerve problem called Peripheral Neuropathy. This is where the nerves are directly affected by the disease process. There are basically three types of peripheral neuropathy: sensory, motor, and autonomic neuropathy.

A large percentage of pain diabetic patients complain of is due to sensory neuropathy. This can show up as "sensitive pain," where the amount of pain is not proportional to the amount of insult that is causing it. For instance, just touching the skin or putting a sheet over your feet in bed could be painful. This can be present at the same time as numbness in the feet. Sensory neuropathy symptoms can include burning, tingling or a stabbing pain.

Relief is foremost on someone's mind when painful neuropathy has raised its ugly head. The first thing to do is to check your blood sugar for the past several weeks to see if there has been a trend toward high blood sugar (Editor's Note: The A1c test is traditionally employed to determine this, and should be repeated about every three months.) Persistent high blood sugar can contribute to this type of pain.

Massaging your feet with a diabetic foot cream, or using a foot roller, often takes the edge off the pain. Vitamin B preparations are often recommended; and there are a variety of prescription medications that do work. Using cushioned, supportive shoes and foot support inserts is always needed to protect the feet from the pounding, rubbing and irritating pressures that contribute to neuropathic pain.

Motor neuropathy can contribute to another painful diabetic condition. The nerves to the muscles become affected by the disease process. This makes the muscles feel weak and achy. Some of the first muscles to become affected are those in the thigh; other common muscles include the shin muscle and the small muscles of the feet. When motor neuropathy is present, walking imbalances can result. These can cause increased rubbing of the foot in the shoe, inflammation of the skin, increased callous formation, and pain.

Helping yourself against the ravages of motor neuropathy involves correcting those walking imbalances with supportive shoes and foot support inserts. Foot exercises, massage and using foot rolling devices are excellent ways to help keep those muscles and joints from becoming stiff.

Keep the muscles working and the joints moving!

Autonomic neuropathy affects the nerves to areas that are not under our conscious control. The sweating mechanism is altered -- so the person who suffers with this condition may have thickened, dry cuticles and nails; as well as dry, stiff, cracked skin -- which is subject to a buildup of thicker calluses with more pain. Bacterial and fungal infection could be more likely; an additional source of pain and concern.

Daily use of toenail oil and conditioning foot cream made specifically for diabetic foot care can play an essential role in preventing these problems.

Circulation Problems

Circulation problems in the feet may cause intense pain, even though the feet may feel numb to the touch. This is due to the effect of high blood sugars on the arteries, capillaries and veins. Arteries feed fresh blood away from the heart. This fresh blood nourishes and provides oxygen to the tissues. The blood enters and leaves the tissues through capillaries and goes back up to the heart to get refreshed with oxygen and nourishment by way of the veins.

The arteries most commonly affected are those behind the knee and the calf. These arteries are subject to the same fatty deposits that most people have, however, the process can be accelerated in diabetes. These fatty deposits thicken the walls of the arteries, and may develop calcium deposits. Blood flow to the feet could then be partially or totally blocked. Because the tissues are starving for oxygen, this can be an extremely painful process. Such pain is often described as though the feet are in a vise, and are being strangled.

The capillaries are known to get thickened and stiff from diabetes -- thus not as efficient in delivering oxygen and nutrients to and from the tissues.

The veins can get swollen and painful. This happens when the arteries cannot handle the blood flow, and little channels are created to direct the blood over to the veins instead of trying to push the blood through closed arteries. Sometimes there is more blood than the veins can handle. They become so full that the valves become broken. Blood then pools in the feet and legs and can leak out into the skin, creating ulcerations, which can be very painful.

With the approval of your medical doctor, support hose, exercise, massage, physical therapy, medications and various surgical procedures can be used to improve the circulation.

Muscle & Joint Problems

Muscle and joint problems in the diabetic patient are a frequent source of discomfort and pain. The muscles are affected by diabetic neuropathy, circulation problems and atrophy. The tendons (attachment of the muscle to the bones) may become stiff and contracted due to the walking imbalance associated with peripheral neuropathy.

This walking imbalance forces the foot and joints to move in ways that are not healthy and that Mother Nature never intended. In addition, they may stiffen in this bent position because of the excess blood sugar combining with the proteins in the joints. This is called diabetic glycosylation of the joints.

This, combined with the normal imbalance all people, including non-diabetics, are subject to, can lead to stiff hammertoes, bunions, spurs, and tiny fractures with dislocation of the bones (called Diabetic Charcot Deformity). These problems can be sources of pain, infection, ulceration and major medical concern.

With consent from your foot healthcare provider, foot rollers, massage and specially made shoes and inserts might be the best way to deal with these muscle and joint problems.

Frequent Infections

Diabetic persons become more susceptible to bacterial, fungal and yeast infections due to medical and nutritional changes that takes place in the body.

Bacterial infections show up in areas on the foot that become irritated, ulcerated or injured. The signs of a bacterial infection include redness, swelling, warmth, pain and tenderness as well as the presence of pus. (Editor's Note: Blind diabetics can detect foot infections by touch, and, in some cases, by smell.) This kind of infection can either be on the skin, called cellulitis, or can spread to the bone. When infection has spread to the bone it is called osteomyelitis. It is interesting that even though a diabetic may have numbness in their foot, they could sometimes feel pain when they have a bacterial infection. When a diabetic suddenly develops pain while their feet are numb, it could be a sign that an infection is present -- and a health care provider should be contacted without delay.

Fungal or yeast infections in the foot commonly occur as athlete's feet or fungal toenails. Athlete's feet can cause the skin to become blistered, scaly, red, inflamed and painful. A bacterial infection can occur on top of this because the irritated skin serves as a good place for germs to thrive. Fungal toenails can become very thick, powdery and ingrown. These thick nails can leave debris under the nails and cause severe irritation to the skin surrounding the nails. They can even become ingrown with callused nail grooves. This can cause infection to the areas surrounding the nail and is a source for medical concern.

In order to maximize a person's ability to fight off infections, think strengthen the immune system. This comes from good blood sugar control, moderate exercise, good nutrition and supplements, if recommended by your health care professional. Fungus can make the skin raw and fungus toenails can become thick, irritating, painful and infected with bacteria. Self-inspection and daily maintenance of the skin and nails is essential to prevention. Once your toenails or skin on the feet become infected with fungus, it is important to treat it right away to prevent ulceration and bacterial infection. Medications prescribed by your foot healthcare professional are recommended, but various over-the-counter and home remedies have found success. The use of tea tree oil, sesame oil, garlic, grapefruit seed extract, and galberry root soaks are among them.

It is important to note that not all diabetics can detect the pain of these problems -- and therefore should have their feet visually and manually inspected every day. Be Prudent, Be Cautious and Follow the Rules of Good Health!

Happy Halloween from Advanced Foot & Ankle Center!!!!!!

40 Fun Facts About . . .

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Halloween

Because the movie Halloween(1978) was on such a tight budget, they had to use the cheapest mask they could find for the character Michael Meyers, which turned out to be a William Shatner Star Trekmask. Shatner initially didn’t know the mask was in his likeness, but when he found out years later, he said he was honored.h The first Jack O’Lanterns were actually made from turnips.e Halloween is the second highest grossing commercial holiday after Christmas.f The word “witch” comes from the Old English wicce, meaning “wise woman.” In fact,wiccan were highly respected people at one time. According to popular belief, witches held one of their two main meetings, or sabbats, on Halloween night.g An intense and persistent fear of Halloween is called Samhnainophobia Samhainophobia is the fear of Halloween.a Fifty percent of kids prefer to receive chocolate candy for Halloween, compared with 24% who prefer non-chocolate candy and 10% who preferred gum.a The owl is a popular Halloween image. In Medieval Europe, owls were thought to be witches, and to hear an owl's call meant someone was about to die.g According to Irish legend, Jack O’Lanterns are named after a stingy man named Jack who, because he tricked the devil several times, was forbidden entrance into both heaven and hell. He was condemned to wander the Earth, waving his lantern to lead people away from their paths.g The largest pumpkin ever measured was grown by Norm Craven, who broke the world record in 1993 with a 836 lb. pumpkin.b Stephen Clarke holds the record for the world’s fastest pumpkin carving time: 24.03 seconds, smashing his previous record of 54.72 seconds. The rules of the competition state that the pumpkin must weigh less than 24 pounds and be carved in a traditional way, which requires at least eyes, nose, ears, and a mouth.d Trick-or-treating evolved from the ancient Celtic tradition of putting out treats and food to placate spirits who roamed the streets at Samhain, a sacred festival that marked the end of the Celtic calendar year.d “Souling” is a medieval Christian precursor to modern-day trick-or-treating. On Hallowmas (November 1), the poor would go door-to-door offering prayers for the dead in exchange for soul cakes.e The first known mention of trick-or-treating in print in North America occurred in 1927 in Blackie, Alberta, Canada.d “Halloween” is short for “Hallows’ Eve” or “Hallows’ Evening,” which was the evening before All Hallows’ (sanctified or holy) Day or Hallowmas on November 1. In an effort to convert pagans, the Christian church decided that Hallowmas or All Saints’ Day (November 1) and All Souls’ Day (November 2) should assimilate sacred pagan holidays that fell on or around October 31.e Black and orange are typically associated with Halloween. Orange is a symbol of strength and endurance and, along with brown and gold, stands for the harvest and autumn. Black is typically a symbol of death and darkness and acts as a reminder that Halloween once was a festival that marked the boundaries between life and death.g Halloween originated in Ireland over 2,000 years ago Ireland is typically believed to be the birthplace of Halloween.f With their link to the ancient Celtic festival of Samhain (a precursor to Halloween) and later to witches, cats have a permanent place in Halloween folklore. During the ancient celebration of Samhain, Druids were said to throw cats into a fire, often in wicker cages, as part of divination proceedings.g Scarecrows, a popular Halloween fixture, symbolize the ancient agricultural roots of the holiday.g Halloween has variously been called All Hallows’ Eve, Witches Night, Lamswool, Snap-Apple Night, Samhaim, and Summer’s End.d Halloween was influenced by the ancient Roman festival Pomona, which celebrated the harvest goddess of the same name. Many Halloween customs and games that feature apples (such as bobbing for apples) and nuts date from this time. In fact, in the past, Halloween has been called San-Apple Night and Nutcrack Night.f Scottish girls believed they could see images of their future husband if they hung wet sheets in front of the fire on Halloween. Other girls believed they would see their boyfriend’s faces if they looked into mirrors while walking downstairs at midnight on Halloween.g Because Protestant England did not believe in Catholic saints, the rituals traditionally associated with Hallowmas (or Halloween) became associated with Guy Fawkes Night. England declared November 5th Guy Fawkes Night to commemorate the capture and execution of Guy Fawkes, who co-conspired to blow up the Parliament in 1605 in order to restore a Catholic king.e Harry Houdini (1874-1926) was one of the most famous and mysterious magicians who ever lived. Strangely enough, he died in 1926 on Halloween night as a result of appendicitis brought on by three stomach punches.d According to tradition, if a person wears his or her clothes inside out and then walks backwards on Halloween, he or she will see a witch at midnight.g Mexico celebrates the Days of the Dead (Días de los Muertos) on the Christian holidays All Saints’ Day (November 1) and All Souls’ Day (November 2) instead of Halloween. The townspeople dress up like ghouls and parade down the street.d During the pre-Halloween celebration of Samhain, bonfires were lit to ensure the sun would return after the long, hard winter. Often Druid priests would throw the bones of cattle into the flames and, hence, “bone fire” became “bonfire.”f Dressing up as ghouls and other spooks originated from the ancient Celtic tradition of townspeople disguising themselves as demons and spirits. The Celts believed that disguising themselves this way would allow them to escape the notice of the real spirits wandering the streets during Samhain.f The average American will spend $66.28 on Halloween in 2010, totaling $5.8 billion The National Retail Federation expects consumers in 2010 to spend $66.28 per person—which would be a total of approximately $5.8 billion—on Halloween costumes, cards, and candy. That’s up from $56.31 in 2009 and brings spending back to 2008 levels.a According to the National Retail Federation, 40.1% of those surveyed plan to wear a Halloween costume in 2010. In 2009, it was 33.4%. Thirty-three percent will throw or attend a party.a In 2010, 72.2% of those surveyed by the National Retail Federation will hand out candy, 46.3% will carve a pumpkin, 20.8% will visit a haunted house, and 11.5% will dress up their pets.a Halloween is thought to have originated around 4000 B.C., which means Halloween has been around for over 6,000 years.e In 1970, a five-year-old boy Kevin Toston allegedly ate Halloween candy laced with heroin. Investigators later discovered the heroin belonged to the boy’s uncle and was not intended for a Halloween candy.e In 1974, eight-year-old Timothy O’Bryan died of cyanide poisoning after eating Halloween candy. Investigators later learned that his father had taken out a $20,000 life insurance policy on each of his children and that he had poisoned his own son and also attempted to poison his daughter.e Teng Chieh or the Lantern Festival is one Halloween festival in China. Lanterns shaped like dragons and other animals are hung around houses and streets to help guide the spirits back to their earthly homes. To honor their deceased loved ones, family members leave food and water by the portraits of their ancestors.d Halloween celebrations in Hong Kong are known as Yue Lan or the “Festival of the Hungry Ghosts” during which fires are lit and food and gifts are offered to placate potentially angry ghosts who might be looking for revenge.d Both Salem, Massachusetts, and Anoka, Minnesota, are the self-proclaimed Halloween capitals of the world.d Boston, Massachusetts, holds the record for the most Jack O’Lanterns lit at once (30,128).c The Village Halloween parade in New York City is the largest Halloween parade in the United States. The parade includes 50,000 participants and draws over 2 million spectators.d In many countries, such as France and Australia, Halloween is seen as an unwanted and overly commercial American influence.d Children are more than twice as likely to be killed in a pedestrian/car accident on Halloween than on any other night.d -- Posted October 4, 2010 References a “Halloween.” National Confectioners Association. Accessed: September 30, 2010. b “Largest Rutabaga-World Record Set by Norm Craven.” World Records Academy. December 6, 2008. Accessed: October 4, 2010. c Levenson, Michael and Kathy McCabe. “A Love in Common for Pumpkins.” Boston Globe. October 22, 2006. Accessed: October 2, 2010. d Morrow, Ed. 2001. The Halloween Handbook. Secaucus, NJ: Citadel Press. e Rogers, Nicholas. 2003. Halloween: From Pagan Ritual to Party Night. New York, NY: Oxford University Press. f Skal, David J. 2002. Death Makes a Holiday: A Cultural History of Halloween. New York, NY: Bloomsbury. g Thompson, Sue Elled, ed. 2003. Holiday Symbols and Customs. 3rd Edition. Detroit, MI: Omnigraphics, Inc. h “Trivia for Halloween.” IMDB. Accessed: October 2, 2010.

Daily Foot Care for People with Arthritis!

Simply defined, arthritis is inflammation of the joints.  When the joints are inflamed, they often become stiff, swollen and painful.  Although there are more than 100 types of arthritis, three stand out as types that are likely to affect the foot and ankle, according to the American Academy of Orthopaedic Surgeons.

Osteoarthritis is the most common type, usually due to wear and tear on the cartilage of the joints over time.  According to the Centers for Disease Control and Prevention (CDC), one in two Americans will get some form of osteoarthritis in their lifetime, and about 27 million adults currently have it.

Rheumatoid arthritis is a systemic inflammatory disease that affects joints throughout the body. According to the latest data from the CDC, an estimated 1.5 million US adults have rheumatoid arthritis (RA), but the prevalence among women is nearly double that of men.  Although the cause is not known, RA is believed to be an autoimmune disorder in which the affected person’s immune system attacks and destroys cartilage throughout the body.

Post-traumatic arthritis is similar to osteoarthritis and may develop years after a fracture or other injury.

Other common forms of arthritis that may affect mobility include:

Ankylosing spondylitis, which usually affects younger people (between the ages of 17 and 45), although it can affect older people, as well.  This type of arthritis often has a hereditary component, and produces inflammation that causes swelling between the vertebrae of the spine and in the joints between the spine and pelvis.  It may also affect the hips, knees and shoulders.

Bursitis is inflammation of the bursae—the small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints.

Gout results from deposits of uric acid crystals in the connective tissue near joints or in the joints themselves.

Psoriatic arthritis can produce symptoms similar to RA, and is associated with psoriasis, a common skin disorder that causes scaling and flaky skin.

Maintain a Healthy Lifestyle

A large body of research has demonstrated the benefits of regular physical activity for people with all types of arthritis. It helps reduce joint pain and stiffness, strengthens muscles around the joints, and increases flexibility and endurance.  Regular physical activity also helps promote overall health and fitness by providing more energy and facilitating sleep and weight control. 

If you have arthritis, it’s also important to have regular checkups with your doctor, including a foot exam. Take medications only as directed and follow any dietary recommendations.  Following a healthful diet can also help!

Preventive Foot Health and Footwear

• See a Dr. Raymond A. DiPretoro, Jr. for regular foot examinations and proactive/preventive foot care. Follow your podiatrist’s recommendations or prescriptions for footwear.
• Buy shoes that are shaped like your feet.  Look for shoes with a square or round toe box so that toes have room to move around.  Avoid pointed-toe shoes as much as possible. You may need special accommodative footwear to prevent damage to vulnerable areas of the feet, especially if you have any irregularities in foot shape or size.
• Choose shoes that provide a good heel counter and arch support.  Avoid slip-on shoes such as mules, loafers or flip flops, and avoid high-heel shoes.
• Look for shoes with extra cushioning in the mid soles and outer soles.
• Never depend on shoes to fit better after they are “broken in.” Your feet should feel comfortable in new shoes when you buy them.  

Foot Self Care

• Inspect your feet daily. Use an extended mirror to see the bottoms of your feet, especially if you cannot reach them or see them without assistance.
• If you have any coexisting conditions such as neuropathy (loss of sensation) or compromised blood flow in your legs or feet, be extra cautious. Check inside your shoes for sharp or rough edges that can hurt your feet.  Also check for foreign objects, including nails, sticks, rocks, etc., that may enter or become embedded in your shoes during activity.
• Wash your feet daily using lukewarm water.  Never use hot water, or you may burn your feet (use your elbow to test water temperature). After washing, dry your feet thoroughly (remember to dry between the toes) and keep them supple by applying lotion only to the tops and bottoms of the feet (never between the toes, since this may promote a warm, moist environment that is conducive to fungal infections).
• Avoid exposing your feet to temperature extremes, and avoid walking barefoot, especially if you have neuropathy.
• Do not attempt to cut toenails if you have neuropathy, joint deformation or other foot problems related to arthritis. See a Podiatrist at Advanced Foot and Ankle Center regularly for toenail care and foot examinations. Never attempt to cut or file calluses, corns or other protrusions on your feet.
• Avoid using wart removers or other harsh chemicals on your feet.
• Stay as active as possible to maintain circulation in the feet and the rest of your body, to help improve function and for overall health and wellbeing.

Foot Health Resources for People with Arthritis!

Advanced Foot & Ankle Center is committed to providing information, education and resources for people with arthritis and their caregivers to help ensure proper foot care and condition management for the many types of arthritis.  Click on the following links for more information:

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• Read about all aspects of arthritis at the Arthritis Foundation web site: http://www.arthritis.org/

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• Get information about juvenile arthritis from the Arthritis Foundation web site: http://www.arthritis.org/conditions-treatments/disease-center/juvenile--arthritis/

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• Get information for caregivers for people with arthritis from the Arthritis Foundation: http://www.arthritis.org/caregiving.php.

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• Get general information about how arthritis affects the foot and ankle from the American Orthopaedic Foot and Ankle Society (AOFAS): http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Arthritis.aspx 

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• Get specific information about rheumatoid arthritis and its effects on the foot and ankle from the American Academy of Orthopaedic Surgeons (AAOS): http://orthoinfo.aaos.org/topic.cfm?topic=a00163 

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• Read about arthritis at the US National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002223/

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• More general information about arthritis can be found at Medline Plus: http://www.nlm.nih.gov/medlineplus/arthritis.html 

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• Learn about things physicians and patients should question related to arthritis and rheumatology (this information is geared more toward physicians, but patients should also be aware): http://www.choosingwisely.org/doctor-patient-lists/american-college-of-rheumatology/

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• Caregiving and Arthritis: http://arthritis.about.com/od/caregiving/Caregiving_and_Arthritis_Information_on_Care_Needs_for_Caregivers.htm

Sports Medicine: High impact sports can result in sharp burning pain in the ball of your foot!

Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes.

Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes.

CAUSES

• This can cause a sharp, burning pain in the ball of your foot.
• Your toes also may sting, burn or feel numb or tingling in your toes.

FACTORS

• High heel Shoes. Tight or ill fitting shoes can place extra pressure on your toes and the ball of your foot.
• High Impact Sports.  Repetitive trauma to your feet from running and or sports activities with tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
• Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton’s neuroma.

 ASSESSMENT / DIAGNOSTIC

1. When did your symptoms begin?
2. Did your symptoms begin gradually or suddenly?
3. What type of footwear do you wear for work?  Is the pain worse in certain pairs of shoes?
4. Does any type of activity ease the pain or worsen it?  Do you participate in sports? If so, what types in particular?
5. Are you having pain in any other part of your body?
6. What medications and supplements do you take regularly?

 TREATMENT OPTIONS 

• Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve.
• Injections. Some people are helped by the injection of steroids into the painful area.
• Decompression surgery.  Surgically removing pressure points on nerves such as the nerve, ligament or bone or growths  may provide pain relief.  Caution is advised as these procedures can result in permanent numbness in the affected toes.

BASE – SAFE SOLUTIONS

• Anti-inflammatory medications. Over-the-counter non-steroidal anti-inflammatory medications can reduce swelling and relieve pain.
• Regular ice massage may help reduce pain.
• Footwear. Avoid high heels or tight shoes. Select shoes with a broad toe box and extra depth.
• Rest. Reduce high impact activities on your feet such as jogging, aerobic exercise or dancing until your pain subsides.

Never let any painful condition go untreated. If the pain and discomfort persist for over 10 days contact Dr. Raymond DiPretoro, Jr. At Advanced Foot & Ankle Center immediately for an examination.

How Overweight/Obesity Affects Your Feet and What to Do About It!

How Overweight/Obesity Affects Your Feet—-and What to Do About It

You may be aware that being overweight or obese puts you at increased risk for heart disease, diabetes and other ills. But did you know that carrying around extra pounds also puts you at increased risk for foot pain and other foot conditions that may be preventing you from exercising regularly and functioning at your best? The National Foot Health Assessment 2012, conducted for the Institute for Preventive Foot Health (IPFH) by The NPD Group, revealed that 51% of survey respondents who described their foot health as “fair” or “poor” reported being obese. By contrast, only 21% of respondents who were not overweight or obese described their foot health as “fair” or “poor.” Other research, including an article published in the journal Arthritis Care Research in February 2012, supports the notion that, as the authors of the article state, increasing BMI is “strongly associated with foot pain and disability.” A person whose body mass index (BMI) is greater than or equal to 25 is considered overweight; a BMI greater than or equal to 30 means the person is obese.

Being overweight or obese affects not only the feet, but the ankles, knees and hips, as well. Your gait, or how you walk and move around, may be altered as you compensate for that extra weight. You’re also at greater risk for injuries such as a broken ankle or knee problems so severe that replacement is necessary. Studying the Canadian Joint Replacement Registry, researchers found that people with BMIs of 30 to 35 are 8.5 times more likely to need total knee replacement than those with BMIs of less than 25. People with BMIs of more than 35 are nearly 19 times more likely to need total knee replacement, while those with a BMI of 40 or higher are nearly 33 times more likely to require total knee replacement.

What to Do

Your foot health is one more reason to lose weight safely by following a healthful diet and engaging regularly in physical activity. The following tips can help address foot pain and discomfort related to being overweight, and may also make it easier for you to do your daily activities and participate in an exercise program.

• Because being overweight is associated with diabetes, check your blood sugar levels regularly. Keeping blood sugar levels under control reduces the risk of foot ulcers that, untreated, can lead to life-threatening infections or amputation. Click here for specific foot care concerns related to diabetes.
• Wear padded socks— to help protect against injuries to the skin/soft tissue of the foot. 
• Avoid walking barefoot, even at home, and take other important steps to avoid injury to the skin/soft tissue of your feet.  
• Practice good foot hygiene, examining your feet daily for cuts, bruises and other potential trouble spots, and taking other steps to take care of your feet. 
• Because your weight may increase your vulnerability to foot and lower extremity conditions, be sure to get regular foot examinations from your Podiatrist at Advanced Foot & Ankle Center!
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Remember: If you are under a doctor's care for any chronic condition, be sure to talk with your doctor before starting a new diet or exercise program.