Holiday Foot Care Reminders

With the holidays fast approaching, many individuals may feel the mounting pressure of finding the perfect gift by spending hours at the mall.  The pressure placed on feet dashing from store to store can add up, and in individuals with diabetes can become dangerous.   Even though the holiday of St. Nicholas passed this past week, in which children leave their shoes out to be filled with treats, individuals with diabetes may still want to leave their old shoes out for good and opt for a better, pressure relieving pair.  

High pressure in a healthy foot signals pain, and subsequent alleviation of the inciting pressure by the person moving their foot or changing their shoe to stop the pain from occurring.  In diabetic individuals with peripheral neuropathy, pain and areas of high pressure cannot be felt due to loss of sensation.  This loss of sensation causes of loss of protection to the foot and wounds may develop in areas of abnormally high pressure.  Any deformity that predisposes the foot to rub in a shoe creates an area that is more likely to ulcerate.  Surgery to remove deformities including bunions, hammer toes and bony bumps in the ball of the foot are one of the ways that your podiatrist may remove an area of increased pressure that is likely to develop or has previously developed an ulcer.  Surgery to lengthen the tendon that attaches the calf muscles to the heel bone is also used to lessen pressure on the ball of the foot.  When this tendon is too tight, the heel is lifted and the front of the foot is levered down towards the ground, creating an area of high pressure. 

Along with surgery, regular callus and corn removal by your podiatrist is also very helpful in removing pressure.  Shoes, casting and custom orthotics are all used to better disperse pressure on the foot.  These treatment means are also useful to prevent ulcers from developing or recurring.  By custom molding shoes to the foot, deformities are accommodated for and areas of high pressure are relieved.  Custom orthotics for diabetic patients with neuropathy are made with several layers of material so that any friction that would normally be imparted to the foot is instead absorbed by the orthotic.  Talk to your podiatrist about taking pressure off this holiday season and keeping your feet healthy!

Brian Timm, DPM, FACFAS

Secrets of Chronic Achilles Pain

1) NOT all posterior heel pains are tendon problems.

We will provide a thorough examination, which includes diagnostic ultrasound, radio graphs, and clinical exam with history taking to provide the best possible outcome for your pain. There are several other structures which are present and could be treated in a different manner than any straight forward Achilles tendinitis.  Noted above, there is a bursa which is present here and can often be the root cause of pain secondary to bursitis. This is treated differently than Achilles tendinitis. This may also require MRI to determine how much of the inflammation is related to bone versus soft tissue. Additionally, and more rarely, a stress fracture can cause this pain in the calcaneus. This is not common but we check for this as well.

2) Tendon tears do NOT always require surgery.

After clinical examination and proper staging/grading of the extent of the tear, we have had success in treating Achilles partial tears and even ruptures non-surgically in select patient populations. We have a variety of techniques at our disposal in order to facilitate the healing process if surgery is not indicated. In the case of chronic tears there are several nonsurgical treatments that work, particularly PRP injections, High energy shock-wave treatments, and even physical therapy with anti inflammatory ultrasound.

3) Bone spurs are NOT always relevant. 

Often times patients will state that they "Have had a spur in the past but it went away". Usually any bone protuberance which is either palpable or visible on a plan radio-graph or MRI will NOT go away spontaneously ever and always if indicated will need resection if it is the root cause of the symptoms. In most cases the spur is not the root cause of the symptoms, and is not required to remove it, but there are far too often very large spurs which are not even symptomatic that are visible on X-ray examinations in many of our patients, therefore backing up further the concept that bone spurs are not always the real problem.

Bio-mechanically a bone spur will exist in areas of either repeated chronic trauma, or areas of chronic taut insertions. Rarely is this an isolated tumor of bone, and that being said, it is often not necessary to remove the bone spur.


Dr Timm

Board Certified by the American Board of Podiatric Surgery