Transcription:
Common Foot and Ankle Problems

Melanie Cole (Host): Foot and ankle pain can affect every aspect of your life, whether your foot pain is chronic or acute; it requires careful attention and care. My guest today is Dr. Eric James. He’s an orthopedic surgeon with BayCare Health. Dr. James what are some of the most common foot issues that you see every day.

Eric R. James, MD (Guest): I think some of the most common things that I see in the office would be ankle and foot arthritis, plantar fasciitis, and I see a fair amount of fractures and other traumatic events like ankle sprains.

Melanie: So then let’s start with something like plantar fasciitis since many people suffer from this, it can be quite painful. Tell us a little bit about what it is and what you feel once you have determined that that’s what it is, are some of the best treatments and in-home thing people can do.

Dr. James: Sure. So, plantar fasciitis is a condition where the tight fibrous band on the bottom of your foot called the plantar fascia gets inflamed and as a result of this, people get a lot of pain primarily back at the heel in the bottom of the foot. And this is a condition that can be quite painful. It tends to affect many people from relatively young folks all the way through their life. This is something that I see very frequently in the office and it is primarily diagnosed based on physical exam, but we usually do get an x-ray to evaluate the foot as well. This is something that we have many conservative treatments for that tend to make it feel better, but one of the most important things is typically regaining some flexibility through the calf muscle. We see commonly that people have a very tight calf muscle when they have plantar fasciitis and if we can do some specific stretching exercises; we can tend to make this improve reasonably quickly.

Melanie: And as we get into more of these conditions of the feet Dr. James, how important are shoes as far as do high heels contribute to feet problems and are good running shoe with a nice orthotic, something that you like to recommend to people to help keep those healthy feet or falling arches?

Dr. James: Yeah, absolutely. We spend quite a good deal of time discussing shoe wear often when people come into the office. As far as high heels go, I try to not keep people away from wearing the shoes that they need and or want to wear. But I like to make people aware of the issues associated with it. What we tend to see with high heels is that quite frequently they are also narrow in the front part of the foot and you can contribute to processes like getting bunions and hammer toes as a result of the tight toe box shoes. So, what I typically recommend as far as high heels go is use them when you need to but have something else to switch to when you are not necessarily on stage or need to have the high heels specifically on. As far as tennis shoes go, that’s also a discussion that we have a lot. A good tennis shoe that is something that is supportive and comfortable to you can be very helpful in maintaining foot health and also just keeping it more comfortable.

Melanie: What about excessive pronation or arch support? How important is that and how do you determine or if someone wants to look at their own feet to determine if they have high arches, low arches, or falling arches as we age? Tell us a little bit about pronation, supination and how that can affect our ankles and our feet.

Dr. James: This is also a common issue that I see in the office is discussing foot position and how it relates to you. What I first attempt to figure out when somebody comes in discussing foot position is, is this a position that your foot has been all of your life or is this something new and changing and that helps drive some of our discussion. For instance, if you have had a flat foot and you have had it all of your life, flat feet tend to run in your family; then this is fairly normal for you and this may or may not cause any issues for your foot. However, a foot that is changing in position where you went from a normal shape of your foot into a more pronated position or a flat foot position; then we look at what’s causing this. Is this related to degenerative changes or arthritis in the foot or is this related to a tendon being weak allowing the foot to change in position?

Melanie: That’s very important for people to notice. Another common one is Achilles tendonitis. People feel that pain back there which kind of goes along with plantar fasciitis sometimes as far as calf stretching and such. What do you tell people about Achilles tendonitis?

Dr. James: Yeah, that’s absolutely correct. This is – I consider them to be in the same family as Achilles tendonitis and even to some extent some other things we talk about like metatarsalgia which is kind of a pain underneath the forefoot. These are directly or most of the time related to the calf muscle being too tight and it’s an overuse sort of injury right where the Achilles connects at the back part of the heel. We do a lot of the similar treatments for plantar fasciitis with this with working on your calf stretching, potentially a period of immobilizing the foot and ankle in a boot, medications and other things can be useful as well. But this is something that is generally treated conservatively, although it can be at times somewhat slow to improve.

Melanie: What about things that we can do to strengthen the bones and muscles of our feet? Do you recommend things like vitamin D or any kind of supplementation to help with our feet?

Dr. James: So, vitamin D insufficiency is fairly common in the population. Although this is something that we like to generally check and look at levels if we are concerned about ultimately the vitamin D level. I think in general, using a multivitamin is reasonable to supplement a healthy diet. I think one of the bigger things for maintaining our foot health and particularly bone density-wise and strength-wise is maintaining weightbearing exercise on a regular basis. We have seen this in multiple studies and multiple locations that simply maintaining our activity level is fantastic at helping to maintain our bone density levels and decrease pain associated with a lot of conditions including arthritis.

Melanie: And then what about some special considerations for someone with diabetes? What do you want them to know about keeping an eye on their foot and checking for wounds and changes in circulation?

Dr. James: Yeah, you hit the nail on the head there. Diabetes is commonly associated with a process we call neuropathy where the sensation in the foot is not as good as it should be and people with diabetes have the potential to get wounds or ulcerations or even in some cases, have objects penetrating their foot and not really feel it. So, in my patients who have diabetes, I do stress the importance of daily diabetic foot checks. So, essentially what that is, is after you get out of the shower, you take a look at your feet, top and bottom and in between the toes to make sure you don’t have any wounds. Some people find this difficult to do just because of positioning to see the bottom of the foot and in that case, a mirror on a stick can be helpful to make sure you don’t have any wounds on the bottom of your foot.

Melanie: Dr. James wrap it up for us. Tell us a little bit more about some of the common foot issues that you see whether it’s bunions, or problems with people’s nails or arch pain or what you tell people about orthotics. I mean there are so many topics. So, give us your best advice as an orthopedic surgeon what you would like people to know about their feet and their ankles and making sure that they keep that base of support strong and healthy as possible.

Dr. James: Yeah, we could definitely spend all day talking about this. One of the most important things and I think we have already hit on it a couple of times is maintaining the calf flexibility. If we could improve our calf flexibility as a society, we’d drive away a lot of these common problems through the foot and ankle. So, maintaining flexibility is important and like I said, maintaining exercise level is important. I think above and beyond that, we see arthritis and other common problems in the foot very frequently and quite often there are very simple modifications we can do to your shoe wear, to your activities or simple medication treatments that can be quite helpful. I find a lot of people come in to me expecting that because I’m an orthopedic surgeon that surgery is really the only option I have, and I would say that the vast majority of my practice is involved in all of the non-operative treatments for these common foot conditions. So, if you have a foot and ankle issue, if you have pain in your foot, if your foot is keeping you from doing what you want to; come see me. I’m not out to directly get you into surgery. I want to get you back to doing what you want to do and with as least difficulty as possible.

Melanie: What a wonderful summary Dr. James and such a great point that you make because people might have that tendency to think that way about orthopedic surgeons but it’s really not the case. And thank you so much for joining us and sharing your expertise on the many ways that people can take great care of their feet. You’re listening to BayCare HealthChat. For more information please visit www.baycare.org, that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.