Transcription:

Bill Klaproth: Your feet take the whole weight of your body so it’s important to take good care of them. Here to talk with us about common foot problems and how to treat them is Dr. Brandon Borer, orthopedic surgeon, pediatrist at Columbus Community Hospital. Dr. Borer, thank you so much for your time today. So what are some of the most common issues you treat?

Brandon L. Borer, DPM: Yeah, thanks for having me. I would say some of the most common issues that I treat would be heel pain and then acquired deformities such as bunions and hammer toes.

Bill: So why heel pain? Why does that pain seem to be the most common?

Dr. Borer: Yeah, also a good question. I see a lot of heel pain and it’s mostly related to pain on the bottom of the heel associated with planter fasciitis, and that is related to more of a chronic overuse. In this community, there is a heavy presence of manufacturing and folks that are on their feet several hours of the day on concrete. Our feet just aren’t really made to withstand that month over month, year over year. We develop an overuse of certain parts of the foot.

Bill: So that continual pounding day in and day out, can you explain to us what is planter fasciitis?

Dr. Borer: So on the bottom of the foot, on the bottom of the heel, there is an area where the planter fascia begins. There are three bands of the planter fascia. The medial band is the largest band and takes the brunt of the work. The function of the planter fascia is to support the arch. So if you are walking on concrete, your foot is naturally going flex and the arch will collapse somewhat with every step. When it does collapse, the planter fascia tightens and supports the arch. That is the natural phenomenon with every person. But like I mentioned, on the hard surface, especially if you're carrying any excess weight—such as a box of tools or any sort of manufactured equipment—the planter fascia will get inflamed. When it becomes inflamed, it actually has less blood flow to the center, which can then degenerate and then become a chronic inflammatory process.

Bill: So with planter fasciitis, let’s just stick with this for a minute, is that something that with rest will go away? Or when is it time to see the doctor for that particular injury?

Dr. Borer: Well, if you are in a situation where you can rest, if you could step away for a vacation or if perhaps you were changing jobs from working on the floor up to an office job, it would take care of itself. Most people don’t have that luxury. So they come to see me after struggling for a couple weeks, perhaps even months, without any relief. I would say a good time to see or to seek out treatment is when you’re just in over your head. You can’t get this to feel better and it’s effecting your everyday functioning.

Bill: Well, let me ask you this then—when is the right time to see a pediatrist as opposed to a family practice physician?

Dr. Borer: Well, any time you have an ailment that’s effecting your foot or ankle, I would probably seek help from a specialist just to get the best continuum of care for that condition.

Bill: What are some of the other foot and ankle problems that people should be aware of?

Dr. Borer: Well, there are quite a few. Like I mentioned before, the bunions and hammer toes. Those are usually acquired deformities, meaning you inherit them and there’s a family history of them. You can also make those worse with certain types of shoes. There’s also arthritis which can affect the arch of your foot. There can be also tendon and ligament issues. A lot of those certain industries or ailments affect people of different age ranges and activity levels.

Bill: That’s very interesting. So if someone starts to feel discomfort, are there ways to prevent further issues?

Dr. Borer: Yeah. Good support of the foot is always… That’s the first thing I’d recommend to anybody before they seek out help. If they think, “God this one foot is really bothering me,” first they need to evaluate what they’re doing. Perhaps they need to get better shoes. By better I mean a more supportive shoe. It should be a comfortable shoe, but the shoe should also be rigid and supportive enough to shield stress away from the foot. We don’t want a flexible flimsy shoe because that is not protecting your foot from the wear and tear of the day. The other thing I would put in that shoe would probably be an arch support. That doesn’t have to be a custom or semi-custom device that costs several hundred dollars. You can get a good support for $50 that can really do a lot of good for the person.

Bill: So there are surgical procedures to help treat these kinds of issues, but what if someone doesn’t want to go under the knife, if you will. What are some other forms of treatment?

Dr. Borer: Sure. It really ranges depending on the condition. We can use oral anti-inflammatories. There’re also injections available for certain ailments such as arthritis. Then I have used physical therapy for help along the way for several different conditions. So there are other treatment options.

Bill: Then on the other side, what are the benefits of surgical procedures?

Dr. Borer: Well, the benefit of a surgical procedure in my opinion would be a predictable endpoint. What I mean by that is sometimes I’ll see people who will come in and maybe they have a fracture of one of the bones in their foot. It’s well aligned. I would say well you don’t have to have surgery, but it is easier for me to predict and end point of when this is going to be better if we do surgery versus if we don’t. If we don’t do surgery, we’re just simply relying on that patient’s natural physiology to heal it. As we age or as we develop other comorbidities, sometimes it takes longer for certain patients to heal. That can be frustrating for them and for me to watch them go through this.

Bill: How do you generally diagnose foot issues? Do you use x-rays and MRIs and other techniques? How do you generally do that?

Dr. Borer: Yeah. Most all foot conditions, well the diagnosis would start out with the clinical exam. You really get a good idea of what’s going on there, and are ordering these other tests sometimes just for verification. Such as you see someone with a bunion or hammer toe, well we need an x-ray for documentation purposes. There are other times when we need to get advance imaging such as a CT or MRI to look at more specific or harder to diagnose problems in the foot or ankle.

Bill: Now I know you mentioned physical therapy. How often is physical therapy the answer. In general, are most common foot problems taken care of with physical therapy?

Dr. Borer: I would say in my practice, most of them are not taken care of with therapy. Not to say that therapy doesn’t work. It’s just that for instance if someone does have a bunion, there’s no way that therapy is going to make that better. Often times, it needs to be corrected surgically. I do use therapy more as adjunctive type of treatment after surgery as a way to get the patient back up and moving faster and get them a full range of motion after surgery.

Bill: So Dr. Borer, this caught my ear earlier. You said things like bunions and hammertoes can be hereditary?

Dr. Borer: Yeah. Bunions, hammertoes, certain foot postures are often hereditary. There’s actually been studies done of some tribes who never wear shoes in central African and South America, and they also develop bunions and hammertoes, which kind of debunks the theory that my shoes didn’t fit right when I was a kid and that’s why I have a bunion. We’ve found that people that don’t wear shoes develop them as well.

Bill: That is really interesting. So Native Americans had bunions and hammertoes. And you're right, they didn’t have shoes. That visual you're painting right now is kind of crazy.

Dr. Borer: Yeah. I mean…

Bill: And interesting.

Dr. Borer: It is, and people find that very interesting. They're sure that they hand-me-down shoes that they got are the root of the cause, but often times it’s genetic.

Bill: Well how about that. Well Dr. Borer, thank you so much for talking with us today. This has been very interesting. For more information about common foot problem and how to treat them, head on over to columbushosp.org. That’s columbushosp.org. This is Columbus Community Health Cast from Columbus Community Hospital. I’m Bill Klaproth, thanks for listening.