Persistent foot or ankle pain may seem like just an annoyance. But without proper treatment, the pain and discomfort can get worse, potentially damaging mobility and quality of life.
In this segment, Dr. Caitlin Zarick, Podiatric Surgeon with MedStar Washington Hospital Center, joins the show to discuss when you should see a podiatric surgeon and how a comprehensive, patient-focused approach offers the latest innovations in podiatric surgery, health and treatment.
Selected Podcast
When Should You See a Podiatric Surgeon?
Featured Speaker:
Learn more about Caitlin Zarick, DPM
Caitlin Zarick, DPM
Caitlin Zarick, DPM, is a board-qualified reconstructive foot and ankle surgeon and associate professor in the Department of Plastic Surgery at Georgetown University.Learn more about Caitlin Zarick, DPM
Transcription:
When Should You See a Podiatric Surgeon?
Melanie Cole (Host): Persistent foot and ankle pain may seem just like an annoyance, but without proper treatment, the pain and discomfort can get worse potentially damaging mobility and quality of life. My guest today, is Dr. Caitlin Zarick. She’s a Podiatric Surgeon with MedStar Washington Hospital Center. Welcome to the show, Dr. Zarick. What are some of the common sports injuries that a podiatric surgeon would see? What are some of the most common things that happen to our feet?
Dr. Caitlin Zarick (Guest): Yeah, one of the most common things – especially around the summertime when everyone is a little bit more active – are common ankle sprains. Ankle sprains are usually treated conservatively and will usually get better in a month, maybe a couple of months depending on how severe it is. Sometimes it’s either just with an ankle brace, or if it’s a severe ankle sprain, patients need to be offloaded sometimes in a boot. There’s only very few patients who over a period of time had done significant damage to their ligaments, and those are the types of patients that might require some more advanced care.
Melanie: People are tempted to walk it off – you have a pain in your ankle, you rest it a few days, maybe you put a wrap around it – what do you tell people about those types of home treatments – wrapping, icing, keeping it up, that sort of thing?
Dr. Zarick: They are definitely good treatments for sure, but occasionally they need to be more aggressively treated with something that’s called a CAM boot, which basically acts as a big cast that you’re able to walk in. If you’re doing these home remedies, it might not be enough, which can actually lead to chronic issues or issues that are persistent in the future that sometimes will occasionally need surgical intervention.
Melanie: While we’re talking about that – so if people do injure themselves, do you see a lot of – they used to call them turned ankles because of heels and things like that – and are those the type of things we can do home treatment? Or, do you have to hear something to go see a surgeon? People say, “Oh, I didn’t hear my ankle pop, so I don’t have to go see anyone?”
Dr. Zarick: You don’t necessarily have to hear something, but if you have – things you want to look for would be significant swelling in your ankle or bruising. Those are not things you would typically see if it’s just a simple turned ankle from wearing a high heel, and that’s when you would want to seek the more advanced help.
Melanie: Let’s talk – before we talk about surgical intervention, people try all sorts of things to level out their gait and to make that base of support as strong as it can be. What do you think about inserts and the ones you can even buy at the store – Spenco’s and these other ones – do we use these? Do we want to make sure our arch is nice and supported? Speak about that a little bit.
Dr. Zarick: Yeah, so there’s definitely – some people have a perfectly normal foot, and they don’t necessarily need any kind of arch support. But there’s other people that have – you’re born with a bunion, you’re born with a flat foot or a really high arch foot, and these foot types can put extra strain on different tendons and ligaments, which over a period of time can cause arthritis in the joint as well as just pain and degeneration of your tendons. Those are the type of people – whether you’re having pain or not – but if you have this abnormal foot type, that’s the kind of person that should seek some type of arch support, whether it’s a custom arch support or orthotic.
I typically recommend people try the over the counter ones first because they’re typically less expensive. The ones that you want to avoid are any of the inserts that you can bend in half with your hand. Those are really just giving you a cushion as opposed to giving you support in your foot. The better ones -- you mentioned the Spenco and the Super Feet -- are ones that have a more rigid sole to them and it actually is more like a piece of plastic that will give you some support inside of your shoe.
Melanie: Dr. Zarick, how important are shoes? Because people think they should be wearing walking shoes if they’re walking or running shoes only if they’re running, but the technology has changed so much. Tell us a little bit about shoes we should be wearing.
Dr. Zarick: Yeah, shoes are very important, and it’s hard to tell every single patient that you should be wearing this one specific type of shoe. I can speak from my own experience that different sneakers feel more comfortable on my feet, and other sneakers that I recommend to my patients all the time do not feel comfortable on my particular feet at all. I have wide feet with high arches, so something that can accommodate my wider foot in the front is going to be more comfortable for me than a more rigid sneaker that doesn’t help accommodate that, and actually presses on my toes and causes them to go numb. While it is very important to be wearing more supportive shoes, it can also take some time for you to find that particular shoe or that particular brand that is going to be the best fit for your particular type of foot.
Melanie: That is so important, and when might surgical intervention be necessary? What types of conditions do you see where you say, “You know what? This is something that I’m going to have to really fix.”
Dr. Zarick: Yeah, so there is a multitude of surgical things that need to be done for the foot. Going back to the ankle sprains, if it’s been several months and you’re really inhibited in your daily activities where you’re still getting pain and swelling in the area – we’ve done further testing, you’ve done physical therapy and you’ve exhausted all of that, that’s when you become a good surgical candidate and where surgery – you would really benefit from that.
Other things, obviously bunions and hammertoes, are very common things that the podiatric surgeon will do surgery for if it’s inhibiting your activities or inhibiting the kinds of shoes that you can wear and really causing you pain on a daily basis. Other common things would also be arthritis – whether it’s arthritis of your big toe joint, arthritis in the back of your foot near your heel, and then another common area is arthritis across the mid portion of your foot. That is also a common area to need surgical intervention for as well.
Other things – potentially a lot of patients that have diabetes they can get wounds and different things. There are multiple surgical interventions that we can do to prevent wounds and infections from happening in this type of patient. One of the most complex surgeries that we perform is what’s called a Charcot reconstruction surgery. A Charcot's foot is something that happens in our diabetic patient population. It can happen to people that also just have neuropathy on their feet. Their bones start breaking down, and it morphs into an irregular shaped foot. We actually can reconstruct the arch and fuse a bunch of joints together in the foot to give them a more stable foot that they can ambulate on.
Melanie: So with the exception of things like diabetes, Dr. Zarick, if somebody has just a chronic type situation then they can see a podiatric surgeon when it affects the quality of their life. Whereas, an acute situation, you might have to actually go to the Emergency Room and have it fixed?
Dr. Zarick: Correct, they can – if it’s an acute situation where you can’t get an appointment right away, then you should definitely go to the Emergency Room. If it’s an ankle sprain and you can wait a couple of days for an appointment, that’s fine to come and see is in a couple of days. The more chronic situations, those patients we are typically seeing more frequently and evaluating when the appropriate time for surgery would be.
Some other acute situations we do see fractures in the foot, like a fifth metatarsal fracture. Some people are familiar with the term a Jones’ Fracture, and other midfoot fractures are other common things that we see as well.
Melanie: What about plantar fasciitis? It’s something that especially the weekend warriors -- and in the summer, people running – besides shin splints, plantar fasciitis seems to be so common and yet so painful, and it can be debilitating. What do you tell people about it?
Dr. Zarick: It is definitely one of the most common things that we see. In 95 to 99% of people, it goes away with simple, conservative treatment, which includes a bunch of stretching and those over the counter inserts, as well as some other things that I usually recommend. There’s a very small percentage of the population that doesn’t get better with these simple, conservative things, and physical therapy, and such. I’ve done, a couple of times, on patients something called PRP or platelet-rich plasma injections, which seems to be pretty effective. It’s done on other parts of the body as well. These patients typically aren’t needing any kind of major reconstructive surgery for their plantar fasciitis, although, on occasion, it is done.
Melanie: Wrap it up for us, Dr. Zarick, with your best advice about when to see a podiatric surgeon and some prevention of common sports injuries that you might be seeing to protect our feet and ankles?
Dr. Zarick: Yeah, so really, the best time to come and see us is any time you’re having foot or ankle related pain – whether it’s been present for months or you’ve just had an injury, and you need to be evaluated, those are really the best times to come and see us.
Things to prevent it is obviously good shoes, which we had touched based upon. If you know you have a weak ankle, wearing an ankle brace when you’re doing heavier sports activities and really just being cautious about who’s around you and the amount of activity that you’re doing. Patients really need to be sensitive towards, “I had pain over here when I was on vacation,” and taking it easy for a couple of days instead of being that weekend warrior who has been going out and doing more activities.
Melanie: That’s great information. Thank you, so much, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.
When Should You See a Podiatric Surgeon?
Melanie Cole (Host): Persistent foot and ankle pain may seem just like an annoyance, but without proper treatment, the pain and discomfort can get worse potentially damaging mobility and quality of life. My guest today, is Dr. Caitlin Zarick. She’s a Podiatric Surgeon with MedStar Washington Hospital Center. Welcome to the show, Dr. Zarick. What are some of the common sports injuries that a podiatric surgeon would see? What are some of the most common things that happen to our feet?
Dr. Caitlin Zarick (Guest): Yeah, one of the most common things – especially around the summertime when everyone is a little bit more active – are common ankle sprains. Ankle sprains are usually treated conservatively and will usually get better in a month, maybe a couple of months depending on how severe it is. Sometimes it’s either just with an ankle brace, or if it’s a severe ankle sprain, patients need to be offloaded sometimes in a boot. There’s only very few patients who over a period of time had done significant damage to their ligaments, and those are the types of patients that might require some more advanced care.
Melanie: People are tempted to walk it off – you have a pain in your ankle, you rest it a few days, maybe you put a wrap around it – what do you tell people about those types of home treatments – wrapping, icing, keeping it up, that sort of thing?
Dr. Zarick: They are definitely good treatments for sure, but occasionally they need to be more aggressively treated with something that’s called a CAM boot, which basically acts as a big cast that you’re able to walk in. If you’re doing these home remedies, it might not be enough, which can actually lead to chronic issues or issues that are persistent in the future that sometimes will occasionally need surgical intervention.
Melanie: While we’re talking about that – so if people do injure themselves, do you see a lot of – they used to call them turned ankles because of heels and things like that – and are those the type of things we can do home treatment? Or, do you have to hear something to go see a surgeon? People say, “Oh, I didn’t hear my ankle pop, so I don’t have to go see anyone?”
Dr. Zarick: You don’t necessarily have to hear something, but if you have – things you want to look for would be significant swelling in your ankle or bruising. Those are not things you would typically see if it’s just a simple turned ankle from wearing a high heel, and that’s when you would want to seek the more advanced help.
Melanie: Let’s talk – before we talk about surgical intervention, people try all sorts of things to level out their gait and to make that base of support as strong as it can be. What do you think about inserts and the ones you can even buy at the store – Spenco’s and these other ones – do we use these? Do we want to make sure our arch is nice and supported? Speak about that a little bit.
Dr. Zarick: Yeah, so there’s definitely – some people have a perfectly normal foot, and they don’t necessarily need any kind of arch support. But there’s other people that have – you’re born with a bunion, you’re born with a flat foot or a really high arch foot, and these foot types can put extra strain on different tendons and ligaments, which over a period of time can cause arthritis in the joint as well as just pain and degeneration of your tendons. Those are the type of people – whether you’re having pain or not – but if you have this abnormal foot type, that’s the kind of person that should seek some type of arch support, whether it’s a custom arch support or orthotic.
I typically recommend people try the over the counter ones first because they’re typically less expensive. The ones that you want to avoid are any of the inserts that you can bend in half with your hand. Those are really just giving you a cushion as opposed to giving you support in your foot. The better ones -- you mentioned the Spenco and the Super Feet -- are ones that have a more rigid sole to them and it actually is more like a piece of plastic that will give you some support inside of your shoe.
Melanie: Dr. Zarick, how important are shoes? Because people think they should be wearing walking shoes if they’re walking or running shoes only if they’re running, but the technology has changed so much. Tell us a little bit about shoes we should be wearing.
Dr. Zarick: Yeah, shoes are very important, and it’s hard to tell every single patient that you should be wearing this one specific type of shoe. I can speak from my own experience that different sneakers feel more comfortable on my feet, and other sneakers that I recommend to my patients all the time do not feel comfortable on my particular feet at all. I have wide feet with high arches, so something that can accommodate my wider foot in the front is going to be more comfortable for me than a more rigid sneaker that doesn’t help accommodate that, and actually presses on my toes and causes them to go numb. While it is very important to be wearing more supportive shoes, it can also take some time for you to find that particular shoe or that particular brand that is going to be the best fit for your particular type of foot.
Melanie: That is so important, and when might surgical intervention be necessary? What types of conditions do you see where you say, “You know what? This is something that I’m going to have to really fix.”
Dr. Zarick: Yeah, so there is a multitude of surgical things that need to be done for the foot. Going back to the ankle sprains, if it’s been several months and you’re really inhibited in your daily activities where you’re still getting pain and swelling in the area – we’ve done further testing, you’ve done physical therapy and you’ve exhausted all of that, that’s when you become a good surgical candidate and where surgery – you would really benefit from that.
Other things, obviously bunions and hammertoes, are very common things that the podiatric surgeon will do surgery for if it’s inhibiting your activities or inhibiting the kinds of shoes that you can wear and really causing you pain on a daily basis. Other common things would also be arthritis – whether it’s arthritis of your big toe joint, arthritis in the back of your foot near your heel, and then another common area is arthritis across the mid portion of your foot. That is also a common area to need surgical intervention for as well.
Other things – potentially a lot of patients that have diabetes they can get wounds and different things. There are multiple surgical interventions that we can do to prevent wounds and infections from happening in this type of patient. One of the most complex surgeries that we perform is what’s called a Charcot reconstruction surgery. A Charcot's foot is something that happens in our diabetic patient population. It can happen to people that also just have neuropathy on their feet. Their bones start breaking down, and it morphs into an irregular shaped foot. We actually can reconstruct the arch and fuse a bunch of joints together in the foot to give them a more stable foot that they can ambulate on.
Melanie: So with the exception of things like diabetes, Dr. Zarick, if somebody has just a chronic type situation then they can see a podiatric surgeon when it affects the quality of their life. Whereas, an acute situation, you might have to actually go to the Emergency Room and have it fixed?
Dr. Zarick: Correct, they can – if it’s an acute situation where you can’t get an appointment right away, then you should definitely go to the Emergency Room. If it’s an ankle sprain and you can wait a couple of days for an appointment, that’s fine to come and see is in a couple of days. The more chronic situations, those patients we are typically seeing more frequently and evaluating when the appropriate time for surgery would be.
Some other acute situations we do see fractures in the foot, like a fifth metatarsal fracture. Some people are familiar with the term a Jones’ Fracture, and other midfoot fractures are other common things that we see as well.
Melanie: What about plantar fasciitis? It’s something that especially the weekend warriors -- and in the summer, people running – besides shin splints, plantar fasciitis seems to be so common and yet so painful, and it can be debilitating. What do you tell people about it?
Dr. Zarick: It is definitely one of the most common things that we see. In 95 to 99% of people, it goes away with simple, conservative treatment, which includes a bunch of stretching and those over the counter inserts, as well as some other things that I usually recommend. There’s a very small percentage of the population that doesn’t get better with these simple, conservative things, and physical therapy, and such. I’ve done, a couple of times, on patients something called PRP or platelet-rich plasma injections, which seems to be pretty effective. It’s done on other parts of the body as well. These patients typically aren’t needing any kind of major reconstructive surgery for their plantar fasciitis, although, on occasion, it is done.
Melanie: Wrap it up for us, Dr. Zarick, with your best advice about when to see a podiatric surgeon and some prevention of common sports injuries that you might be seeing to protect our feet and ankles?
Dr. Zarick: Yeah, so really, the best time to come and see us is any time you’re having foot or ankle related pain – whether it’s been present for months or you’ve just had an injury, and you need to be evaluated, those are really the best times to come and see us.
Things to prevent it is obviously good shoes, which we had touched based upon. If you know you have a weak ankle, wearing an ankle brace when you’re doing heavier sports activities and really just being cautious about who’s around you and the amount of activity that you’re doing. Patients really need to be sensitive towards, “I had pain over here when I was on vacation,” and taking it easy for a couple of days instead of being that weekend warrior who has been going out and doing more activities.
Melanie: That’s great information. Thank you, so much, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.