Heel Pain Strikes Even the Best Athletes

Plantar Fasciitis Disables Carlos Quentin

KANSAS CITY, Mo. — Outfielder Carlos Quentin, who led the Chicago White Sox in home runs last season, went on the 15-day disabled list Friday with painful plantar fasciitis in his left heel.

The condition causes soreness in the bottom of the heel when you walk or stand. The move was retroactive to Tuesday.

“You have to learn how to play with soreness,” manager Ozzie Guillen said. “But it’s hard to play when you’re in pain. That’s two different things — play when you’re sore and play when you’re in pain. And I think he was in pain for all this month and that’s why I think it was hard for him to perform.”

Source: ESPN

 

Dr. Nirenberg’s Comments:

Plantar fasciitis is number one reason for heel pain.

Surprisingly, heel pain due to plantar fasciitis often occurs after the person has been resting and first starts walk. Patients often tell me they hate to get out of bed. This isn’t because they want more sleep, but due to excruciating pain in their heel the moment their foot touches the floor.

 The pain may ease up or even go away completely as the person continues to walk. However, as soon as they rest and resume walking, it often returns with a vengeance. Plantar fasciitis is due to an inflammation of the main ligament in our heel. There are many conservative treatments for this problem and surgery is usually not necessary.

 

Dr. Michael Lacey, my associate, writes:

Many of our elderly or overweight patients believe heel pain is due to their age or weight. When heel pain is due to plantar fasciitis, age or weight may be part of the problem, but the main issue is usually an abnormality with the structure of the person’s foot. Clearly, Carlos Quentin of the Chicago White Sox is a 26 year old professional athlete in great physical shape!

Nonetheless, he is now on the disabled list—for at least two weeks. He has tried to play through the pain but recently, but it became so severe he had to be carried off the field. 

In our practice, plantar fascitis is the most common cause of heel pain and one of the most common ailments that we treat. If you have plantar fasciitis, see a podiatrist – don’t let it put you on the disabled list.

Blisters May Be Soft, But They Are Painful

Blister on the bottom of the foot

Blisters are a common, annoying, and painful foot problem. At some point, nearly everyone gets at least one on their foot.

A blister is a pocket of fluid that forms between the outer and inner skin of our feet usually in response to friction. They can also form in response to heat, moisture, an allergic reaction, or an infection.

Sometimes blisters are due to a bony problem under the skin. Blisters are our body’s way of preventing the skin on our feet from breaking open.

Unfortunately, blisters can be very painful and they can lead to serious infections or even in some cases gangrene.

Preventing Blisters

The best way to prevent a blister is to remove the source of the friction. This may mean simply wearing a good pair of socks, padding your foot with moleskin, or perhaps, buying a new pair of shoes or wearing a different shoe brand or style.

I also recommend keeping your feet dry, wearing shoes that fit well and using a sprinkle of good foot powder.

The very interesting thing about blisters is that what works to prevent a blister today may not work tomorrow. Here is why: our feet change shape in response to temperature, humidity, the time of day, amount and type of activity, and other factors. An area of your foot that does not rub against your shoe today, may be a problem tomorrow.   

Treatment of Blisters

People in good health can treat small blisters by puncturing them with a sterile instrument and socking their foot in diluted betadine solution repeatedly. If blisters recur, they may be due to bone problem or spur in your foot, or in some cases may not be a blister. In any event, you should have the problem checked by a podiatrist.

Further, if larger blisters develop or if you have an underlying medical problem, such as diabetes, neuropathy, arthritis, or poor circulation, don’t treat the blister yourself; promptly see a podiatrist.

– Dr. Nirenberg

What You Need to Know Before You Have a Pedicure

 

Nothing beats rewarding our tired, aching feet with a relaxing pedicure. It eases tension, and makes our feet feel and look better.

However, like so many other pleasures in life, pedicures can be dangerous. The main culprit is germs.

In one salon over 100 customers developed an infection from a dirty whirlpool.

Over the years I’ve treated several people who developed infections after pedicures and in one tragic case, the woman needed her big toe amputated.

The good news is that you can do a few simple things to minimize this danger.

1. Be Sure You’re Healthy Enough For a Pedicure

Consider your health first. Do you have diabetes, poor circulation, neuropathy (numbness or burning in the feet) or skin problems on your feet? These may increase your risk of infection, and you might not want to chance a pedicure.

If you are not sure if you’re healthy enough for a pedicure, have your feet checked by a podiatrist and get his or her opinion.   

2. Check Your Legs, Feet and Ankles Before the Pedicure

Any breaks in the skin, nicks, cuts or other sores on your legs, feet or ankles increase the risk of germs penetrating your skin, and until these problems heal you should avoid pedicures.

Along these lines, don’t shave your legs for at least one day prior to your pedicure as razors can leave tiny breaks in the skin too small for you to see, but large enough for nasty bacteria to enter.

3. Ask the Pedicurist Questions

There are a few simple questions you should ask the pedicurist or nail salon at your first visit or even over the phone before you go.

• Is the pedicurist licensed? They should be. And you should be able to see the license prominently displayed.
• Are the pedicurist’s instruments disposable? If not, ask how they clean the instruments. The best way to kill germs is by cleaning the instruments in a sterilization machine called an autoclave.   Soaking instruments in a disinfectant solution is not as good, but can be okay if a hospital grade disinfectant is used and the solution is changed regularly.
• How does the salon clean the footbath (and is it cleaned after every customer)?  Footbaths can breed germs. If the customer who last used it had an infected sore on their foot, you’ll want to be sure the salon disinfected it properly.  

4.  See How the Salon Looks

The salon should be clean with no dirt, debris, or hair or nail clippings on the floor or counters, and it should be organized, with bottles clearly labeled and instruments put away in drawers or containers.

If this is not the case, it is likely the salon isn’t taking the time to properly disinfect footbaths or instruments.

 5. Pay Attention to the Pedicurist

The pedicurist should be neat and presentable, with clean hands, or better yet, they should wear latex gloves.

And prior to the pedicure, he or she should examine your feet and ask about medical problems that may affect your feet.   

6. Be Wary of Pain

A pedicure should never hurt.

Pain during a pedicure may mean the pedicurist is doing something wrong or it could be signal your foot has problem that needs medical attention. Either way, it means its time to stop the pedicure.

Final Thoughts on Pedicures

When salons follow some relatively simple steps pedicures can be safe, soothing and a great reward for our battered feet.

If you have doubts about your salon or pedicurist, don’t risk your health, trust your instincts and go somewhere else.

Please feel free to share your experiences with pedicures.

– Dr. Nirenberg

Size Does Matter! — At least when it comes to your feet!

Clown told to avoid oversized shoes

A Moscow State Circus clown says he was told by circus management not to wear his oversized clown shoes following an accident in Britain.

They Don't Look Hazardous

Valerik Kashkin said after he broke the metatarsal bone in his left foot as a result of a fall from a high wire in the city of Liverpool he was told to avoid wearing his size 18 shoes as a safety precaution, The Daily Telegraph said Thursday.

“The shoes are an important part of my costume, and I was disappointed to be told I couldn’t do this part of my act,” Kashkin, 40, said.

Kashkin said he is confident in his ability to wear the shoes and still remain safe during his act, which consists of him crossing a wire while simultaneously playing a drum-kit, double-bass and trumpet.

“I feel fine, and think I could do it in the shoes — the impact might be lost on the audience now,” Kashkin told the Telegraph.

Moscow State Circus General Manager Paul Archer agreed the loss of the large shoes may detract from Kashkin’s act but he said the precautionary ban was necessary.

 Source: UPI

Dr. Nirenberg’s Comments:

 Usually, when we think of poor footwear we think of squeezing our feet into shoe that are too small.

However, this story reminds us that size does matter and shoes that are too large can be just as detrimental to our feet.

Oversized shoes can allow our feet to slide and cause friction resulting in corns, callouses or blisters.

Why your feet could be giving you back pain – and could cure it

By Kevin  Braddock, The Times Online

There is a new buzzword in foot care: Orthotics. The science of treating deformities and abnormalities in the musculo-skeletal system – traditionally associated with ungainly corrective footwear – has been given a high-tech makeover.

Now, off-the-shelf or custom-made insoles worn in shoes to correct the gait (walking style) and support weakness in the foot are created using the latest in computer scanning technology. Available from £15 at High Street foot clinics, the great thing about them is no one can tell you’re wearing them.

Experts also say that orthotics could be the answer to curing leg, knee and even lower back pain.

Delicate: Damage in the feet can make itself felt in other parts of the body

Do you need orthotics?

Some estimate that the distance we travel on our feet every ten years is equivalent to the Earth’s circumference. So the 26 bones and 33 joints that make up each foot take a pounding over the course of a lifetime.

And given that between one and two times a person’s entire body weight is

absorbed to as much as three-and-a-half times when running, it is hardly surprising they are susceptible to injury.

‘Feet are fairly delicate structures,’ says consultant podiatrist Simon Costain of the Gait & Posture Centre in Harley Street. ‘Damage may be painless in the foot but felt elsewhere in the body.’

For instance, collapsed foot arches – also known as flat feet – which can be inherited or brought on by weakening of the muscles in the feet through sustained strain caused by wearing high heels, ageing and weight gain, are a common cause for knee pain.

‘The condition can cause the heel to turn outwards at the ankle,’ says Costain. ‘This misalignment can result in painful grinding of the knee. We can track even further up the body, to lower back pain caused by the feet.

‘For example, leg length inequality can cause a tilt in the pelvis – if the legs are functionally different because of a collapsed arch in one of the feet, we can use orthotics.’

Therapy often centres on treating pain caused by walking with high or flattened arches, and problems caused by overpronation or oversupination – the way the foot rolls inwards or outwards through a step to distribute impact throughout the foot.

‘Our feet are like shock absorbers, and the ability to roll inward or outward is essential,’ says Costain.

Difficulties begin when there is too much or too little pronation or supination, or if it happens at the wrong time when walking.

By creating extra support underneath specific parts of the feet – lifting the ankle a few millimetres, for example – insoles, made of foam rubber or carbon fibre, rebalance the action of the foot and correct other mechanics of the gait.

 

Walk away from your sore feet

 

Orthotics are frequently used by footballers, rugby players and runners – but their uses go beyond the playing field. They can be used to treat a range of common medical problems, experienced by one in five of the population.

These include metatarsalgia (pain in the ball of the foot, sometimes caused by dropped metatarsals where the bones we use to push off when we walk become misaligned) achilles tendonitis (soreness of the large tendon that connects the back of the ankle to the calves) and plantar fasciitis (a painful condition caused by tearing and inflammation of the tissues around the ligaments that connect the heel to the front of the foot).

Tibialis posterior pain, also known as acquired flat feet, causes pain on the inside of the ankle as a result of the collapse or rupturing of the muscles that hold up the arches.

Costain says: ‘Moving from high heels to flat shoes often provokes this kind of pain but an orthotic can be worn in either or both type of shoe to help alleviate the problem.’

Costain says that about 70 to 80 per cent of patients referred to his clinic by GPs can benefit from orthotics and estimates that they could also help up to 70 per cent of the general population to treat or prevent injuries or improve the efficiency of the gait.

‘Not enough people use them,’ he says. ‘The analogy we use is with racehorses – most have orthoses put on before each race and they would not run without them.’

 

Screen test: A scan can reveal feet are the cause of many problems

Pinpointing the problem

 

While gait analysis is increasingly available in sports shops and gyms, Michael O’Neill, from the Society for Chiropodists & Podiatrists, says prospective wearers should undergo a full gait analysis with a trained podiatrist or other medical expert (see below).

‘A full analysis will include watching how someone walks, from their neck and shoulder to arm swing, knee function and leg swing, rather than just the foot,’ says O’Neill. ‘From there, we make a temporary device and subsequently make improvements once we know we are on the right track.

‘We can use orthotics to control problems, improve the way the foot works and change its mechanics.’

Custom-made orthoses are created by taking plaster casts of the foot, but specialist clinics increasingly use cameras and lasers to map a three-dimensional image.

Ready-made insoles can also be bought. However, Jimmy Walsh, of fitness chain Runners Need, says: ‘Off-the-shelf insoles can help sportsmen and women who have already been diagnosed with overpronation or supination, but prescribing orthotics really requires a trained medical professional.

‘There are some trainers that help remedy these problems and some off-the-shelf insoles such as Sorbothane, Sofsole and Spenco have an orthotic function and will take more impact out of the foot when running, but they won’t correct the gait.’

 

So, what’s the next step?

 

Your GP can refer you to NHS podiatry services, however simple orthotic insoles are available from chiropodists, with more specialised appliances costing from £75 to several hundred pounds from clinics.

‘I’d never say orthotics are the magic bullet,’ says Costain, ‘but very often they prove to be extremely helpful in a range of ways.’

And O’Neill argues that orthotic therapy will work only as part of a wider package.

‘A person’s mobility, stretching regime and muscle balance are all as important. Orthotics on their own won’t work.’

Scan that reveals secrets of the sole

During gait analysis, a practitioner – usually a podiatrist, osteopath or chiropractor – takes a detailed medical history, including any specific complaints such as pain in the foot or elsewhere in the body. This is followed by a physical examination of the foot to check for any abnormalities.

‘The GaitScan pad has thousands of pressure sensors linked to a computer which shows on a screen the distribution of pressure across the feet,’ says Dr Roger Reid, a chiropractor at London’s Body 4 Life Healthcare.

‘Red shows most pressure, and blue the least. Pressure should be evenly distributed across the sole. The patient first stands still on the pad, where an uneven distribution of pressure could indicate a musculo-skeletal problem such as different leg lengths or misaligned hips.

‘After this, the patient walks across the pad a number of times. Problems with pronation – the rotation of the foot – would show up as uneven pressure during this part of the scan.’

If needed, the scans, above, can be used alongside a mould of the foot which is sent to a specialist orthotic manufacturer that uses CadCam technology.

‘This uses cameras and lasers to scan the surface of the mould and is the most accurate way of capturing the anatomy of the foot,’ says Pat McGonigle, of Pegasus Orthoses, who create orthotics for Chelsea Football Club and the Royal Family.

‘This is then used together with patient-specific information about sex, age, weight, height and medical problems, to create a 3-D computer model of an orthosis, which can then be manufactured.’

 

Running insoles cured my painful shins

 

Relief: Katharine Vile wears orthotics for high arches

Literary agent Katharine Vile began using orthoses after experiencing severe shin pain.

‘I was suffering from soreness in the lower leg, and found I was in pain just standing up and walking. It was even stopping me wearing my favourite heels. I enjoy running but it got so bad in February this year that I had to stop exercising. Friends suggested I look at orthotics,’ says the 38-year-old.

Katharine visited a physiotherapist who discovered that she had high arches, a common inherited condition in which the arch of the foot is higher than average, often requiring supporting insoles.

‘High arches often mean the feet are very poor shock absorbers and they can lead to pain in the knee, lower back and the arches themselves,’ says Simon Costain.

The orthosis is built up under the arch of the foot to help take the weight of each step as it is distributed through the foot. Treatment was simple – the physiotherapist prescribed orthoses to use in her running shoes. They cost about £70.

Katharine says she noticed an improvement almost immediately.

‘Within a couple of days I could feel the difference. Now, when I’m standing, my feet are flat rather than falling in on themselves,’ she says.

She was able to return to running and has found that she no longer suffers leg pain when wearing her everyday shoes.

‘The physio suggested I should wear them in my other shoes.

‘I like wearing high heels and I know it would help, but just wearing them in my running shoes has helped and the pain has gone, so I think I can get away with it.

Dr. Nirenberg’s Comment:

This is an excellent article. Numerous scientific studies have shown poor foot structure can cause not only back pain and problems, but also ankle, leg, knee and hip pain. In patients where these problems are related to weak, unstable, or flat feet, I have had good success alleviating their pain with custom made arch supports (orthotics).

Five Tips to Fix Your Aching Feet

Bunions, Flat Feet & Weak Ankles

Most of us don’t think about our feet until they hurt.

Even then, we limp around hoping the pain will go away. But with two to three times our body weight pushing down on each foot with every step, it usually doesn’t.

Fortunately, you can do a few things for relief.

 

1. Wear Only Great-Fitting Shoes

In one study, 88% of women admitted that at some point they knowingly squeezed their feet into shoes that were too small.

Further, as we age, our feet tend to become larger, but most people insist on wearing the same shoe size they wore years ago.

In addition to making sure your shoes fit properly, make sure they have a good arch support and that the heel counter—the area that wraps around your heel—is firm and strong.

 

2. Feet Need Exercise, Too

I can hear the couch potatoes now:  “My feet get enough exercise.”  Perhaps, but walking to the fridge or standing in line at McDonald’s isn’t exactly exercise.

Most people agree our entire body needs exercise, but few people think about keeping their feet in shape.

Yet, with the average person walking over a hundred thousand miles in their lifetime, feet need all the help they can get.

Foot exercises tone, stretch, and strengthen feet, while alleviating fatigue, soothing soreness, and increasing blood flow.

 

3. Take the Plunge

Nothing soothes sore, aching feet more than a relaxing footbath.

You can use a bathtub or plastic basin, or for some serious relief, I recommend buying a massaging footbath.

Make sure the water is warm, not hot (I’ve seen patients soak in water so hot they received second-degree burns).

Add good quality bubble bath to the water; and for those who are not diabetic or have poor circulation, adding Epsom salts is great, too.

 

4. Moisturize Your Way to Healthier Feet

Good moisturizers can sooth dry, irritated skin.

The secret to finding a good moisturizer for your feet is not by price; more expensive doesn’t mean better.

Read the ingredients and avoid products with alcohol or alcohol derivatives—the best dry-skin products tend to be creams without alcohol.

These are gooier and absorb slowly, so I recommend applying them just before going to bed.

 

5. Nailing Down Nails

Caring for your nails will go a long way in helping to alleviate foot problems.

Long, jagged, and thickened toenails can catch on socks or pantyhose, dig into adjacent toes, or suffer injury by pressing against the inside of our shoes.

In my practice, I have seen unkempt nails lead to blisters, infections, ingrown toenails, and even gangrene.

When trimming your toenails, follow the contour of the toe and avoid cutting into the corners. Smooth any rough edges with a nail file.

 

Final Thoughts on Aching Feet

Caring for your feet is your responsibility. However, when problems don’t go away, become serious, or if you have diabetes or poor circulation, get professional help and see a podiatrist.

The Surprising Truth About High Heels

 

If you’re a woman with foot problems—perhaps bent, crooked toes such as hammertoes or bunions, or corns and calluses—it’s not due to wearing high heels.

Our doctors, mothers, and even pop magazine articles have sold us on the idea that women’s foot problems are often from wearing high heels.

However, after treating hundreds of women who had horrible feet and swore they rarely, if ever, wore high heels, I began to question if high heels were really the reason so many women had foot problems.

Could women’s feet be genetically unique from men’s?

And could these differences make them more likely to develop foot problems?

The answer was a resounding yes!  

Like the female brain and most of her body, doctors are finally beginning to realize the female foot is remarkably different from that of the male.

A woman’s feminine frame (generally, wider hips and proportionately shorter legs) and her precise chemical physiology (pregnancy, menopause, and menstrual cycle, or lack of a cycle) profoundly affect her feet, altering their function, shape, and at times, chance of injury.

Even the shape of a woman’s foot is unique.

Compared with males, women have a foot that is shorter and narrower with an instep that isn’t as long (the average American woman wears a shoe size of 8.5).

Taken together, all these factors create a “female foot” that is more prone to foot problems, such as hammertoes, bunions, and pinched nerves—with or without high heels.

Does this mean I recommend you wear high heels?

That would be like a nutritionist recommending Häagen-Dazs!

High heels place your feet in a weakened position, causing foot problems that would develop anyway to worsen more quickly, and high heels worn excessively can cause their own unique foot problems, such as pinched nerves, bent toes, or a shortened, tight Achilles tendon.   

Wearing high heels should be thought of like a dieter having a hot fudge sundae occasionally: it’s a decadent treat.

The key word is “occasionally,” and you should add to that “briefly.”

Now that you know the truth about high heels, feel free to slip on a sexy, gorgeous pair and look stunning—briefly and occasionally—guilt free!

Feet Need Vitamins too

 

Many of my older patients wish they had taken better care of their feet when they were younger.

Thankfully, doctors and the health food industry are finally recognizing what many people have wanted for years: safe, natural ways to keep their feet strong and healthy.

The safest, simplest way to keep your feet healthy throughout life is already in your kitchen: water.

 

 

Water regulates temperature and metabolism, delivers electrolytes to muscles and lubricates our joints.

With each foot containing 33 joints and depending on 19 muscles, even slight dehydration can cause your feet to cramp and fatigue.

I recommend drinking eight glasses of water a day.

Guzzling Mountain Dew, Mocha Frappuccinos or six-packs of Bud Light isn’t the same.

Caffeinated and alcoholic beverages can actually cause dehydration.

Drinking water, not only for your feet, but also for your whole body, should be common sense, yet at any time, 75 percent of Americans are mildly dehydrated.

Moderate or severe lack of water can make feet cold and more vulnerable to infection.

Dehydration can also make toenails brittle and the skin of our feet dry.

Dry skin may not seem like a big problem, but on the feet, dry skin can crack and develop deep, painful fissures that are at risk for infection.

 

A patient with dry skin on their heel.

 

I’ve seen simple breaks in the skin, particularly in the feet of the elderly and people with diabetes, lead to catastrophic infections, at times resulting in the foot’s amputation.

However, dry skin on the feet may indicate more than just a lack of moisture.

Sometimes it’s psoriasis, a fungal infection or a sign of a more serious condition, such as diabetes, poor circulation or a thyroid disorder.

If your feet have severe or persisting dry skin, you should see a podiatrist.  

The best way to soothe dry skin is with moisturizers and applying vitamin A, D and E. You can put these on your feet separately, mix a concoction or buy a vitamin-enriched cream.

When choosing a cream, don’t go by price; more expensive doesn’t mean better.

Read the ingredients and avoid products containing alcohol or alcohol derivatives, which actually dry skin. Surprisingly, alcohol is common in many so-called moisturizers.

Dry, irritated skin also responds to foot powder, particularly when the powder is enriched with zinc or menthol.

A sprinkle a day will not only help keep the skin moisturized, but also lessen odor and perspiration.

Urea also helps keep feet healthy. A natural compound, urea attracts moisture, slowing its escape from the skin. Look for it by itself or in moisturizers.

For patients with severely cracked heels, I often prescribe medicated creams containing 40 percent urea.     

I also recommend urea for frail, brittle toenails.

To strengthen toenails, apply Biotin, a B vitamin, and take calcium and vitamin A. Vitamin C helps nails too—not that they have to fight off colds, but they can get painful hangnails, which this vitamin prevents.

Caring for your feet as you age also means keeping your bones strong.

Bones form the foot’s foundation, in turn supporting our entire body. With aging, bones lose strength and develop osteoporosis.

Combine osteoporosis in your feet—each foot a jigsaw puzzle of 28 small bones—with a one hundred and fifty or two hundred pound person landing on them repeatedly and you have a great chance for fractures.

Women past menopause are at the greatest risk for osteoporosis.

A simple test can check for osteoporosis and, if necessary, your doctor will prescribe medication.

To help prevent osteoporosis, eat foods rich in calcium and vitamin D and exercise regularly, doing activities that put weight on your feet such as walking, aerobics or weight lifting.

Lastly, vitamins and minerals—and in rare cases, even water—are not always safe for everyone. Before starting any supplements, always check with your doctor.