More than just "foot pain"

In my profession, I have diagnosed numerous and varying disorders which are not typically something a primary care doctor would initially send a patient to a foot and ankle specialist for. I have screened numerous diabetic patients, and have found a substantially high number of patients with PAD, or peripheral arterial disease. Of these, many have needed vascular surgery intervention to prevent below knee amputations. Through this screening process, we have saved numerous patients from amputations of their legs.

To a greater extent, this disorder may lead to stroke, heart attacks, and even amputations from gangrene. I have had patients ask me why they need to go to the hospital for their rest pain, and thank me after the fact. Today I thought I would give some general guidelines to put to rest many of the confusions regarding this systemic and devastating pathologic process.

"Doctor, my foot hurts me at rest. I take ibuprofen and it doesn't help. I let my leg down and it feels a little better, but when I raise it up it hurts again. I can only walk for a block then I have to rest. My ingrown nail is turning black and I stubbed it 2 weeks ago."

These are just some of the various complaints that a patient may have before they know that they have significant PAD. Slow to heal wounds, and non healing wounds are commonplace in poor circulation sufferers. Pain at rest is usually significant, because it means the tissue is starving for oxygen, and if the blood vessels are too narrowed or closed to deliver, then pain will follow. Trivial injuries which lead to significant pain and color changes of the toes, from blue to black, will also indicate a serious vascular pathology which requires hospitalization. Each patient that we see gets a thorough vascular exam for their legs, and noninvasive dopplar studies are done every Friday at our office.

Pain with consist ant ambulation, "ie intermittant claudication" may need additional interventions from a vascular surgeon. Usually blood thinners, such as plavix or aspirin are needed, as well as a walking regimen lead by a physical therapist to get 30 minutes to 1 hour of daily walking to help open the small vessels and treat this are in order. We also offer MICROVAS therapy for small vessel disease, as this tends to simulate the activity level of walking for 30 minutes, and helps to increase the blood flow to the leg and foot. I always listen to the pulses with the dopplar if I can not feel them with my hands. This is usually the case with diabetic patients, as their vessels are more rigid and difficult to feel with hands and fingers alone.

Athletes Beware: Poor foot mechanics could cost you your edge in sports!

How is this possible?



The results conducted by the American Podiatric Medical Association concluded that a staggering 73 percent of people asked said that they are suffering from foot pain.

The question is: why has foot pain become one of the most common complaints in the examination room?

For many people, this problem can be caused by one of the following: the kinds of shoes they wear, what activities they participate in, or how their feet are formed. Wearing poorly-fitting shoes can turn minor problems into major ones. People who engage in athletic activities are another segment of the population that are mostly affected by foot pain. Factors such as fallen arches, overpronation, and poor support can all be contributing factors to lower extremity pain. Parents can also be the cause of foot-related problems, because genetics play a role how the foot was formed in the womb. This can enhance the likelihood that someone will suffer from an array of painful foot conditions.

The Mechanics of the Foot
Flat feet can cause abnormal rotation of the feet when walking or running. Our feet handle balance, stability, and bear the weight of the body. The parts of the foot that help to keep the foot in harmony with the body include the arch, heel, tarsals and meta-tarsals. The arch provides stability by the following structures: the tendons, ligaments, and muscles. Pain can result from raised arches or abnormally-low arches, which can cause the foot to rotate abnormally. With high arches, the body’s weight is abnormally emphasized on the outer edge of the foot (oversupination). Conversely, overpronation happens with fallen arches because the weight of the body is concentrated on the inside of the foot, causing the ankles to roll inward .

Serious Foot Issues May Occur with Flat Feet A quick way to see if fallen arches or high arches are an issue is to find a good area where a foot impression can be made, such as on concrete. Immerse on foot in cold water and then stamp your foot onto the dry surface. Then, lift the foot off the ground and see the impression that is left by the foot. A flat foot with overpronation will leave a complete mark where the entire foot has touched the ground. A high arch will leave just a part of the ball of the foot’s outside portion, and heel of the foot. Either of these arch conditions can cause painful bony growths in the heel because the foot has to deal with too much pressure in places it is not intended to handle.

Orthotics Provide Effective Relief for Therapy For Plantar Fasciitis
People suffering from fallen arches, heel spurs, or who need plantar fasciitis treatment can get relief by using the best orthotics available in their shoes. They offer the needed support to fix the weak structures in the foot, such as those that make up the arch. They also offer cushioning in areas where too much pressure occurs, such as in the heel or ball of the foot. Orthotics are available in an array of sizes and types and are made to keep up with anyone’s activity level.

Tough Heel Pain

Many patients are becoming even more active with age, and as this new generation of elderly patients become our community's senior citizens we are finding out more often that you are only as young as you feel. With this, there are different aches and pains, and they are more common and can be restricting towards maintaining this level of leisure. Above all other pains common to the foot and ankle, heel pain is by far the most common. Sometimes, we will be a 3rd and 4th opinion to attempt to remove this nuisance from our patient's feet. Most often heel pain is treated by cortisone injections, physical therapy, weight loss, and orthotics.

But what about the patients who have been there and done that?

There are few treatments that are more promising in the field of heel pain management with more potential than the

Extra Corporal Shockwave Therapy

for very tough heel pain. A good overview of the proposed mechanism for how this works involves using devices that generate pulses of high-pressure sound that travel through the skin and yeild natural repair from the tissues and increased blood flow networks to damaged tissues.

For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger and without causing further damage to the tissues like repeated cortisone injections may do.

The FDA has approved the use of some ESWT machines for heel pain and tennis elbow. ESWT devices evolved from lithotripters (a.k.a. kidney stone shock wave machines). The discovery of the beneficial effects of ESWT came as German researchers were trying to determine what type of high-pressure pulses could be sent through the body to disintegrate kidney stones without causing harm to surrounding tissue. In laboratory animals and humans, it was discovered (with some surprise) that surrounding tissue would often heal back stronger and this applies well to our topic of heel pain.

Physical therapists use ultrasound machines that warm internal tissue by high frequency sound waves, but the ESWT machines send higher-energy pulses 2 or 3 times per second rather than continuous lower-energy waves. Electricity is not sent into the body. It may take as long as 5 months to see the full benefit of an ESWT treatment. The beneficial effect of the high-pressure waves may be from the growth of new blood vessels ("neovascularization") in small cavities that are created by the pulses. New blood vessels to an area of tissue would promote healing either directly or indirectly by providing additional growth factors to the area of concern by way of new vascular channels.

Some studies have even shown this therapy to be equivalent to a fasciotomy, which is an invasive procedure that involves an incision to sever the medial fibers of the fascia for reduced pressure and tension on the inferior heel bone. This means that you can get equivalent results without the complications of a minor procedure. We provide 2 variations of the ESWT, a high energy and a lower energy, and each has benefits that have been shown to work well on difficult heel pain. Either method will be beneficial to our patients, and if you are limping in the AM, or have trouble walking after a brief rest from activity because your heel is holding you back, you should consider a consultation with one of our doctors.

Fungus Amongs't Us

Nail fungus is a slow moving colonization of human keratin, which rarely causes life threatening issues, but may almost always cause some form of discomfort with shoegear, ambulatory compromise, or unsightly appearence to the feet.

Nail fungus attacks all people. But there are some people that have higher risk of getting nail fungus infection. Who are those people, and why the more risk?

In general this apply with people that have lowered immune system. This include people with circulatory system problem, diabetic people, late-aged people and patients with cancer and chemotherapy treatment, for instance. Also with age, comes the liklihood of increased fungal risk. Low immune systems may allow the fungus to spread easily. Usually, once it infects one toenail or nail, they will spread immediately to the other nails on the same feet or hand over many years.

There are many kinds of treatment, ranging from mild to aggressive. Some used home-brewed remedies, or some use natural treatments, and some goes to the doctor. The latter option is the one that most people choose, because they want effective and safe treatment. But what they don’t know is that prescribed medicines can cause side-effects because of their toxic chemical ingredients. This can be hard for people with liver diseases, because nail fungus treatment can take 3 months or more.

At the Family Foot and Leg Center, we use a variety of topical therpy, and have had excellent success with the Coot Touch Nail Laser System. The success rate statistics of treatment is 60–80 percent. There is a 15% chance that it will reoccur. Because of this statistic, many doctors advise the use of anti-fungal solutions after treatment to prevent another infection.

Simple tips to prevent fungus infection:

Wear open footwear as much as possible.
Change socks immediately if it becomes damp or wearing absorbent socks is more preferable.
Don’t wear high top boots if not needed.
Treat fungus as early as you can to stop its spreading.

Big Toe Pain

Seemingly every year around this time we see numerous patients from all over the country with lingering pain and difficulty walking which can be caused by the great toe joint. Some patients may think that bunions are the only thing that can cause this pain, but truly this is only part of the story. Numbers of studies in recent years show the natural progression of arthritis in toe joints which do not seem to have any bunion characteristics, such as prominent bone on the inside of the foot and deviation of the great toe towards the lesser toes, and this can be related in most cases to a distant trauma which occured an unknown time ago.

We offer several pain management modalities to provide nonsurgical relief in this area, ranging from orthotics and cortisone injections, to the new Cold LASER therapy for recurrent pain which can reduce symptoms in chronic pain of arthritis significantly without medications.

Something as trivial as stubbing your toe, or landing abruptly and resultant pain in the bottom of the joint that seems to go away, may eventually return later on as a limitation in joint motion, and pain in the foot which is related to the adaptive and errosive side effects from "hallux rigidus". This is quite prevalent after age 50 and can effect men and women, and can be the major source of a significant amount of discomfort and limitation with walking.

At The Family Foot and Leg Center, we offer numerous conventional and proven treatment protocols for our patients to give you the best chance at pain free ambulation. If you have arthritic changes on a regular xray, and the deformity is not too severe, you may even qualify for the latest implant arthroplasty technique known as "joint resurfacing". This is a relatively advanced joint replacement which allows patients to walk immediately after the surgery, and there are no weight bearing restrictions with a very high success rate both in the short term and long term.

Not everyone is a candidate, but for those who are, you will experience immediate relief. After several weeks post operatively, your range of motion should be close to the other foot, and in most cases significantly increased from before the procedure is done. It is an outpatient procedure, and we have strict criteria prior to undergoing this advanced modality. We offer numerous other therapies for other conditions of the foot and ankle, and I urge you to check out our website regularly as changes are constantly bringing our current and future patients up to date on the latest in the care of your foot and ankle conditions.

Tennis Time and Common Injuries!

With season in full swing, we are seeing more patients with tennis on their minds, and with sports will often bring associated injuries. Here are some common guidelines before making an appointment at Family Foot and Leg Center to treat the typical tennis injuries that are encountered:

Calf and Achilles tendon injuries
The common underlying cause in both calf muscle and Achilles tendon injuries is a tight calf muscle-Achilles tendon unit. This muscle-tendon unit crosses both the knee and the ankle. You can tell your calf muscle-tendon complex is tight if you cannot raise the ball of your foot higher than the heel of that foot with the leg extended (straight). A sudden overload from pushing off your foot while your leg is fully extended is the usual cause of injury.
Achilles tendinitis involves inflammation of the Achilles tendon as a result of overuse. To treat Achilles tendinitis, decrease playing time, take NSAIDs, use heel lifts in your regular shoes, and diligently stretch the calf muscles with your leg held straight.

A ruptured Achilles tendon is more severe than tendinitis. You may feel a sudden snap in the lower leg, as if someone has kicked you in the back of the foot. This is not a particularly painful injury, and a player may be lulled into thinking that the injury is not as severe as it really is. After an Achilles tendon rupture, a player will be able to walk flat-footed, but will not be able to stand up on his or her toes on the affected side. Treatment can consist of casting or surgery, but surgery is recommended for most Achilles tendon ruptures, especially for athletes.
With tennis leg (a tear of the calf muscle on the inside of the leg) you may feel as if you have been shot in the upper calf by a pellet gun. This muscle tear can be quite uncom-fortable. It is important to stop playing immediately and treat the calf muscle with RICE. Tennis leg may take several weeks to resolve.

Ankle sprains

Sprains of the outer ligaments of the ankle are common in tennis. You can minimize the risk by selecting shoes that are specifically designed for tennis and that have substantial support built into the outer counter of the shoe. The most effective treatment for ankle sprains is the usual RICE for 24 to 36 hours, then walking with an appropriate support on the ankle. If the swelling, pain, and bruising are severe, see your physician. Even after the most minor sprain, some sort of stabilizing ankle support is recommended during play for 6 weeks.
Tennis toeTennis toe can occur as the toes are jammed against the toebox of the shoe during tennis's quick starts and stops. Tennis toe is a hemorrhage under the toenail that can be quite painful. Your physician will treat this by drilling a hole in the toenail and relieving the pressure. Prevent tennis toe by keeping your toenails cut short and wearing shoes that provide adequate toe space.

Z - Coil Is HERE!!

Family Foot and Leg Center is the only registered distributer of this fine product in Naples Florida.

Here are some commonly asked questions and answers for our patients convenience.

What types of painful conditions may be alleviated by wearing Z-CoiL® footwear?

Z-CoiL®-wearers have reported significant relief from the pain associated with many medically-diagnosed conditions, including:
• Heel spurs, plantar fasciitis, and metatarsal pain
• Lower back pain and sciatica
• Arthritis and other common joint pains

Will Z-CoiL® footwear help me jump higher?
No, but you will land softer.

How soon before I can expect results?
The relief our customers experience may be immediate, or may occur gradually, over days or even weeks. Some people enjoy complete relief from pain when wearing their Z-CoiL® shoes; others achieve only partial relief, though they may be able to reduce the amount of pain medication they take.

Is Z-CoiL® footwear stable?
Many customers report that they actually feel more stable in their Z-CoiL® footwear than in regular shoes. The coil in the heel is cone-shaped, and so it compresses straight down, following the line of least resistance rather than tipping. The flexible coil also absorbs some surface deviations to protect the ankle.


Does it take a long time to get used to wearing Z-CoiL® footwear?
Most people get used to wearing the footwear right away. Others may take several hours or even a couple of days to adjust to the extraordinary feeling of the shoes. If this is the case, we suggest you wear your Z-CoiL® shoes for a few hours each day at first, and gradually increase that time until you feel more comfortable in them.

It is also normal to experience some soreness in your legs during the first few weeks of wearing Z-CoiL® shoes, due to the increased mobility they provide. If you continue to experience pain in your feet, ankles, knees, hips, or back while wearing your Z-CoiL® footwear, however, you should take them off and return to your
Z-CoiL® distributor for a footwear adjustment.

Can objects get caught in the open coil?
Small rocks or loose materials may occasionally get caught in the coil, but they should be easy to remove with a simple shake. We do recommend caution around cords, wires, hoses, and chairs with rungs, which may catch in the coil.

Can I drive wearing Z-CoiL® footwear?
Yes, but be careful not to let the floor mat or pedals catch on the coil. Also be aware that the shoes thick cushioning may reduce your feel for the pedals. You may need to move your seat back an inch or so to compensate for the thickness of the forefoot cushioning. If you feel unsafe driving in your Z-CoiL® footwear, wear other shoes.

Can I use my Z-CoiL® footwear to play sports?
Our customers have reported using their Z-CoiL® shoes for walking, running, hiking, golf, and more, although we do not recommend them for sports that involve significant lateral movement, like tennis. You need to be the judge of how Z-CoiL® products will work for you. Many people have been able to become more active and get back in the game because of their Z-CoiL® footwear.

Can I use custom orthotics with them?
You certainly can. In fact, Z-CoiL® footwear makes an ideal footbed for custom orthotics. Skilled Z-CoiL® fitters will ensure that your prescription orthoses fit in your shoes properly. Your prescribing healthcare professional may even be able to work with the Z-CoiL® fitter to further enhance the performance of your orthotics.

Arent Z-CoiL® shoes considered high heels?
Not at all. The Z-CoiL® heel, when uncompressed, is only about 1/2 of an inch higher than the cushioned forefoot. When the coil compresses, an average distance of 1/8 to 1/4 of an inch, the heel is level or just slightly higher than the forefoot. This minimal heel rise is beneficial to most people, helping them achieve a healthier, more erect standing posture. In the rare event that this is not the case, the coils can be adjusted to a lower effective heel height.

How long will my Z-CoiL® shoes last?
The steel coils can last a lifetime, though the rubber heel pad will probably last between six months and two years with normal use. People who put their Z-CoiL® footwear to hard use may wear through the pad in three months, while those who go easy on their footwear have been known to wear them for several years. Fortunately, even if the heel pad does wear out, there’s no need to buy a new pair of shoes. The coil/heel pad assembly can easily be replaced by a Z-CoiL® distributor at a minimal cost.

By comparison, most running or comfort shoes with EVA or gel-based soles have a life of 200 miles or 3 months, at which time their cushioning is reduced by 50%.

Some of your shoes have optional foam heel covers; why don’t you cover up the coils on all your styles?
We do make an Enclosed Heel System™(ECS) that comes standard with our Z-Duty Work Boot and Z-Walker Safety Toe styles, and can also be retrofitted on our other styles. The ECS is designed to address workplace safety concerns, in environments where objects are more likely to get caught in an open coil. The molded foam material that encases the coil slows the speed at which the coil compresses, which dampens its shock-absorbing capabilities to some degree, although a stiffer coil also proves useful when a person is picking up heavy objects.

At first, many people are taken aback by the appearance of our shoes; however, those who put them on and experience significant relief from pain soon see them in a different light!

Can I order Z-CoiL® footwear over the Internet or by phone? There is no Z-CoiL® store near me.
Yes you can! In August 2010, Z-CoiL changed its long-standing policy of no internet or phone sales in response to strong customer demand. We still believe that a personalized fit is essential for maximizing the incredible pain relief benefits of Z-Coil shoes. However, for those people in pain who have difficulty visiting a store near them, we now offer Online andTelephone Sales. We ask the customer a series of fitting questions and make corresponding adjustments to the shoes prior to shipping. If further adjustments are needed, we encourage the customer to visit their nearest Z-CoiL distributor. We also offer a Risk-Free, 30-Day Trial Period.

Where are Z-CoiL® shoes manufactured?
Z-CoiL Footwear is headquartered in Albuquerque, New Mexico, where the products are designed and engineered. Our products are manufactured in South Korea. Al Gallegos had tried for years to find a U.S. shoe manufacturer willing to produce his unusual shoes, but they all laughed at his idea and turned him down. At last he found a willing partner in South Korea who had 20 years of experience, including making products for Nike® and Reebok®.

Hopefully this is helpful for you all, and please do not hesitate to ask us about our shoes, as the doctors here at FFLC will be sporting these new shoes at the Downtown and East Naples locations.

Dr Timm