Texas Foot Doctor's Blog
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Many people underestimate the importance of keeping their toes physically fit. Toes take a lot of abuse from the hours we spend on our feet each day. The American Orthopaedic Foot and Ankle Society recommends doing the following simple exercises to strengthen your toes and prevent foot discomfort.
These foot workouts work great to strengthen the feet and toes to prevent fatigue and cramping.
Toe raise, toe point, toe curl: Hold each position for five seconds and repeat 10 times. This especially recommended for people with hammertoes or toe cramps.
Toe squeeze: Place a small, cylindrical object, such as a wine cork, between your toes and hold a squeeze for five seconds. Do this 10 times. Recommended for people with hammertoes and toe cramps.
Big toe pulls: Place a thick rubber band around the big toes and pull them away from each other and toward the small toes. Hold for five seconds and repeat 10 times. Recommended for people with bunions or toe cramps.
Toe pulls: Put a thick rubber band around all of your toes and spread them. Hold this position for five seconds and repeat 10 times. This is especially good for people with bunions, hammertoes or toe cramps
Golf ball roll: Roll a golf ball under the ball of your foot for two minutes. This is a great massage for the bottom of the foot and is recommended for people with plantar fasciitis, arch strain, or foot cramps.
Towel curls: Place a small towel on the floor and curl it toward you, using only your toes. You can increase the resistance by putting a weight on the end of the towel. Relax and repeat this exercise five times. Recommended for people with hammertoes, toe cramps, and pain in the ball of the foot.
Marble pick-up: Place 20 marbles on the floor. Pick up one marble at a time and put it in a small bowl. Do this exercise until you have picked up all 20 marbles. Recommended for people with pain in the ball of the foot, hammertoes, and toe cramps.
Sand walking: Take off your shoes and walk in the sand at the beach. This not only massages your feet, but also strengthens your toes and is good for general foot conditioning.
The Common Denominator
Foot and Ankle Specialists see a vast variety of foot and ankle pathology. Dr. Sara Suttle and Dr. Paul Marciano are Foot and Ankle Surgeons in Southlake, TX. They treat everything from Bunions and Plantar Fasciitis, to Hammertoes and Achilles’ Tendinitis. But all of these conditions have something in common. Patients that suffer from each of these ailments, and many more, all have a Common Denominator: A tight Achilles’ tendon.
A tight Achilles’ tendon, or Equinus, is the root cause behind the majority of foot and ankle conditions. The ankle joint requires 10-15 degrees of flexion for normal ambulation. When a tight Achilles’ tendon limits this flexion, the foot has to flatten out to compensate for this lack of motion.
What is Equinus?
Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.
People with equinus develop ways to "compensate" for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by "toe walking," while a smaller number take steps by bending abnormally at the hip or knee.
Foot Problems Related to Equinus
Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:
• Plantar fasciitis (arch/heel pain)
• Calf cramping
• Tendonitis (inflammation in the Achilles tendon)
• Metatarsalgia (pain and/or callusing on the ball of the foot)
• Arthritis of the midfoot (middle area of the foot)
• Pressure sores on the ball of the foot or the arch
• Ankle pain
• Shin splints
Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus.
To diagnose equinus, the foot and ankle surgeon will evaluate the ankle's range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight and to assess whether bone is interfering with ankle motion. X-rays may also be ordered. In some cases, the foot and ankle surgeon may refer the patient for neurologic evaluation.
Although treatment for each of the above-mentioned conditions is different, treating the underlying problem, the equinus, is always necessary. This can be done conservatively, by stretching and Physical Therapy or surgically, by different lengthening techniques.
This article will touch on a few of the most common foot and ankle ailments and how a tight Achilles’ tendon perpetuates them.
Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present.
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying cause-equinus- that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching the Achilles’ tendon, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.
Other characteristics shared by most types of flatfoot include:
“Toe drift,” in which the toes and front part of the foot point outward
The heel tilts toward the outside and the ankle appears to turn in
A tight Achilles’ tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse
Bunions and hammertoes may develop as a result of a flatfoot.
A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. This foot type includes a tight Achilles’ tendon, or Equinus.
Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
The most common cause of hammertoe is a muscle/tendon imbalance. It is this imbalance, which leads to a bending of the toe. This imbalance is from a tight posterior group, including the Achilles’ tendon.
The treatments of these conditions vary greatly. Management ranges from conservative to surgical correction of the deformity. Only your Foot and Ankle Specialist can determine the cause of your condition and the appropriate treatment regimen. Contact Dr. Paul Marciano or Dr. Sara Suttle at Academy Foot and Ankle Specialists if you suffer from foot or ankle pain. After a complete evaluation, they will formulate a treatment plan best suited for your condition to get you back on your feet!
Diabetes can be dangerous to your feet. Even a small wound or cut can lead to serious complications. Diabetes may lead to decreased blood flow to the feet as well as decreased sensation to the feet. This is a double-edged sword because Diabetic patients with poor circulation and neuropathy have trouble detecting wounds and ulcers, and also have a harder time healing and resisting infections.
To avoid serious problems that could result in losing a toe, foot, or leg, be sure to follow the guidelines below:
1. Daily Foot Inspections. Check for cuts, blisters, swelling, or nail problems. Use a magnifying hand mirror to better visualize the bottoms of your feet. At the first signs of any problem, make an appointment with one of the doctors and Academy Foot and Ankle Specialists.
2. Use Warm Water Only. Keep feet clean by washing them daily in lukewarm water. Use the same temperature you would use to give an infant a bath. If you have neuropathy, use your hands to check the temperature of the water to avoid making it too hot and avoid scalding injury to your feet. If you have neuropathy in your hands, ask a family member to check the water temperature for you.
3. Easy Does It! Be gentle when washing your feet. Always use soft washcloths and avoid abrasive tools like pumice stones and files unless approved by your doctor. After washing, dry feet thoroughly with special care to dry in between the toes. Moisture can easily collect in between the toes leading to fungal infections.
4. Moisturize. Use a moisturizer daily to help dry skin from itching or cracking. Avoid putting moisturizer in between the toes. Again, too much moisture in this area can lead to fungal infections. For severely dry and cracked skin, ask your doctor for a prescription strength cream. Kera-42 can be found at Academy Foot and Ankle Specialists. Ask your doctor if this cream is right for you.
5. Careful Nail Care. Have your Podiatrist trim your nails for you at your scheduled visits. In between nail care should be done with caution. File nails instead of cutting them, if at all possible. Improper cutting of nails can lead to wounds, ingrown toenails, and infections.
6. Leave Your Corns/Calluses to the Doctor. Always let your Podiatrist trim any painful corns or calluses. If these build up too much, wounds can develop underneath them. Resist temptation to perform your own “Bathroom Surgery!”
7. Socks. Always wear a fresh, clean pair of socks every day. Special Diabetic Socks can be purchased. These socks lack tight elastic and seams that can be problematic for Diabetic patients. If your feet are cold at night, wear socks. Never use heating pads, heaters, or hot water bottles to warm feet. Again, Diabetes makes it difficult to properly manage hot/cold temperatures leading to thermal injury.
8. Shoes. Diabetic shoes and inserts shoes always be worn. Visually inspect the insides of your shoes before putting them on. Diabetic patients with neuropathy may not feel a rock or foreign object in their shoe. Walking on such things can lead to a blister or a wound very quickly. And always wear shoes. Never walk barefoot—even at home!!
9. Good Management of your Diabetes. Only you can control your blood sugar. Watch your diet, exercise, and keep on top of your Diabetes medication. Good management of your blood glucose levels will greatly reduce the likelihood and severity of Diabetes related complications.
10. Don’t Smoke. Smoking is directly related to inhibiting your body’s ability to heal.
11. And last, but certainly not least, see a Foot and Ankle Specialist segularly. Regular appointments with your podiatrist can help prevent the complications associated with Diabetes.
October is National Physical Therapy Month! Academy Foot and Ankle Specialists would like to honor our Physical Therapy Team. Please allow me to introduce Lisa (our Physical Therapist) and her lovely assistant, Michael!
Don’t let their youthful glow fool you; this team comes with a ton of experience. Lisa has been a Physical Therapist for over 28 years and Michael has over 10 years under his belt.
Lisa has worked in a variety of Physical Therapy settings, including Acute Care Hospitals, Rehabilitation Hospitals, and Skilled Nursing Facilities. She also has experience in Home Health Care and more specialized training treating orthopedic and sports medicine patients. In her free time, she attends Bible Study Fellowship and enjoys walks with her husband and attending Birdville High football games.
A little known treasure about Lisa: When she was just out of 5th grade she already had her own advice column in the Fort Worth Star Telegram! So if she’s treating your feet, she can also give you free advice!!
“I love helping people reduce or resolve their pain and get back to doing the things they love and teaching them how to manage their foot problems.” –Lisa
Thanks, Lisa! Academy Foot and Ankle Specialists are lucky to have you on our team!
Michael as been in the PT biz for over 10 years! He is a veteran of the US Navy Reserves. (Thank you for your service, Mike!). He has experience in Fitness Centers, Rehabilitation Hospitals, and Outpatient Therapy Clinics.
In his spare time he enjoys spending quality time with his family, camping, fishing, and taking road trips. Michael also plays softball and football with community and church leagues. Michael’s true love, however, is his son. He takes great pride and joy in watching him grow. They share a love for horses and spend a lot of their time together enjoying that pastime.
“My favorite part of my job is helping people return to their busy, active lifestyles and assisting youth and athletes [getting back] to the sports they love.” –Michael
Thanks Michael! The doctors at Academy Foot and Ankle appreciate all you do!
If you work with or know a Physical Therapist or Physical Therapy Assistant, take the time to thank them in honor of National Physical Therapy Month.
Patients often come into the office seeking treatment for a fracture. They often don't know the difference between a "break/broken bone" and a "fracture." Well, guess what? There IS NO difference! The truth is, these terms can be used interchangeably.
A bone fracture is a medical condition inch there is some kind of break in a bone. These can come from direct impact onto the bone, abnormal forces through a bone, or repetitive stress on a bone. There are certain medical conditions that can weaken bones and contribute to fracture as well. Some examples are osteoporosis, bone cysts, and bone cancer. These kinds of fractures are known as pathological fractures.
See a doctor as soon as possible if you think that you have a broken bone in your ankle, foot or toe. Until your appointment, keep weight off the leg and apply ice to reduce swelling. Use an ice pack or wrap the ice in a towel so it does not come into direct contact with the skin. Apply the ice for no more than 20 minutes at a time. Take an analgesic such as aspirin or ibuprofen to help relieve the pain. (Note: Do not take any medications before consulting a physician). Wear a wider shoe with a stiff sole.
If you think you have a broken bone, or fracture, in your foot or ankle; contact a physician at Academy Foot and Ankle Specialists at 817-424-3668 to get X-rays and find out what treatment plan is right for you.
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