Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. And with me is Dr. Brandon Borer, Columbus Orthopedic and Sports Medicine Clinic physician, here to discuss common foot problems and how to treat them. Dr. Borer, welcome.

Brandon Borer, DPM: Thank you and thank you for having me.

Host: Absolutely. So, Dr. Borer, let's jump right into this. What are some of the most common foot and ankle problems that you encounter in your practice, particularly in the Columbus area?

Brandon Borer, DPM: Yeah. So, some common ailments that I see around the Columbus area probably focus mostly around overuse and chronic misuse. It's a heavy blue collar manufacturing type of community. And so, people are on their feet a lot on hard surfaces that we're really not meant to be on long term. So, plantar fasciitis is a big one, and arthritis as we advance in age.

Host: So, how do you then explain how you identify whether a foot problem requires conservative non-surgical treatment or something more intensive?

Brandon Borer, DPM: Yeah. So typically, it starts with conservative care. If this person happens to have sought out care from another provider and has already gone through conservative care, then we may jump forward to a more aggressive surgical approach. But generally, when I first see someone, we start with conservative care and progress from there based on how they respond.

Host: So, always start with that conservative care and then move up, as you say, as the patient responds. So, you mentioned plantar fasciitis before. What about that and bunions or heel pain? What are some of the nonsurgical treatments that you recommend?

Brandon Borer, DPM: Sure. So, nonsurgical care for plantar fasciitis often includes at-home stretching, appropriate shoe gear and arch supports, but can also include a steroid injection. Non-surgical care for a bunion would require accommodative shoe gear, something that would reduce pressure from the area of the eminence. Oftentimes, you know, heel pain and plantar fasciitis are pretty much the same treatment, unless the heel pain originates from the back of the heel where the Achilles tendon may be involved. And usually, physical therapy is very helpful for that.

Host: So, PT and other methods, again, plantar fasciitis, of course. I know some people that have had it, and it's really debilitating for some people. So, good to know that you have the non-surgical treatments to approach treatment for this. If the nonsurgical treatments for plantar fasciitis doesn't work, what is the next step then?

Brandon Borer, DPM: There are surgical options for plantar fasciitis, that would include cutting or releasing part of the plantar fascia. But we also take a look at other possible contributing factors, right? If they have a very tight posterior calf muscle group, sometimes the calf muscle or achilles tendon need to be a lengthened in conjunction with surgery for the plantar fascia to completely treat the patient, not just focusing on the one area. So, we get a better long-term outcome.

Host: Right. Got it. So, Dr. Borer, foot pain is often dismissed as minor. You know, I'm just going to walk it off. It's fine. When should someone consider seeing a podiatrist, so they get out of that mindset of, "Eh, I'm just going to walk it off"?

Brandon Borer, DPM: Yeah. There are some instances where you may injure your foot. And it is a minor thing, and it does go away in the course of a few days. But if you have a deformity, such as a bunion or a hammer toe, or maybe a flat foot, or if you've had a serious injury or pain that is lasting longer than just a few days, maybe beyond a week, it would be a good idea to seek out the professional care of a podiatrist.

Host: So if it's lasting for a couple of weeks, better safe than sorry, right? Go see the podiatrist before it gets worse. That would be the proper advice, yes?

Brandon Borer, DPM: Correct.

Host: Absolutely. So as a double board-certified podiatrist and certified wound care specialist, how does your advanced training help you treat more complex foot conditions like a diabetic foot ulcer or a chronic wound?

Brandon Borer, DPM: Sure. Yeah. So, oftentimes these things all overlap. You know, somebody may have a chronic wound, for instance, because of a tight posterior muscle group. or a deformity of a toe or a bunion. And so, knowing how to treat what is there from maybe a wound standpoint, but also how to treat them from a surgical standpoint so as to prevent this from reoccurring is very helpful.

Host: Absolutely. Okay. Let's shift gears a little bit to what people can do to avoid foot issues. And a lot of that comes in with the footwear we decide to purchase. And I think a lot of times we purchase footwear because, "Man, this looks really cool" or it's inexpensive. So when it comes to footwear, what should we look for when choosing shoes to prevent common foot issues?

Brandon Borer, DPM: You hit it on the head there, looks can be deceiving, right? And these companies do a really good job of advertising, right? And getting spokespersons to promote their brand. But I think if you're looking for a shoe to prevent or to maybe help any foot ailment, you'd be looking for something that is accommodative and supportive, something that feels comfortable. You know, you shouldn't have to break your shoe in or wear it in, so to speak. It should be comfortable when you're trying it on. But you also want something that will be supportive. If it's extremely flexible, as in the sole being as flexible, it's not going to last long term, and you'll likely continue to suffer.

Host: Well, that's really good advice. I know I've bought shoes before and I've said to myself, "Oh, I'll wear these in" or "I'll break them in." So obviously, that was probably the wrong thing to do. So, I know there are some common myths or misconceptions, if you will, about foot and ankle health that you encounter. Are there any that you'd like to debunk or something that you hear more often than others and you're like, "No, that's not right. That's not correct"?

Brandon Borer, DPM: One thing that I encounter quite a bit, is when people come in, usually advanced in age, and they say like, "You know, I have these hammer toes," or "I have this bunion because my parents didn't give me the appropriate fitting shoe." And there have been studies looking at indigenous people around the world who never wear a close-toed shoe, and they also have bunions and hammer toes. And so, only in very rare instances do I think people would get a bunion or hammer toe from shoes that were too small as a child, that is one thing that does come up.

Host: Okay. That's a good one, because I've often heard as well that improper fitting shoes will cause certain foot problems like you just described. That's a good one to debunk. So for patients dealing with, let's say, reoccurring foot problems, how do you approach creating long-term treatment plans or preventative strategies for those people?

Brandon Borer, DPM: Yeah. You know, a lot of it comes down to patient education and sort of getting them to buy into what I'm trying to tell them, because if they've had this long-term pain and they've tried different things, it's hard to convince them that what I'm telling you is going to work. They don't want to deviate too far from their comfort zone. And so, patient education is typically key.

Host: Absolutely. Well, this has been really valuable, Dr. Borer. We appreciate it. Before we wrap up, is there anything else you'd like to add or anything else you'd like to cover that we didn't go over?

Brandon Borer, DPM: In regards to my practice or just like podiatry in general?

Host: Sure. Yeah, I would love to hear about your practice.

Brandon Borer, DPM: Well, I I guess, I think it would be good public information to know that, you know, as a foot and ankle provider, not only do we treat foot ailments or wounds, but other ankle-related issues, and ankle trauma if needed.

Host: So, everything foot and ankle related, we could do a whole 'nother podcast about ankle issues as well, we should probably do that sometime, Dr. Borer. I would like that. And I know there's a lot of people dealing with ankle issues, especially as they age and weekend warriors out there playing pickleball and tennis and basketball. I'm sure you see a lot of those issues coming to you right now.

Brandon Borer, DPM: Yeah, absolutely. Especially as it gets colder and people are kind of forced indoor playing court sports, we've seen some Achilles tendon issues and some ankle ligament tears as well. So, I'm happy to help people with that as well.

Host: I love it. Well, let's have you on again and we'll go over those things as too. I think that would really be important. Dr. Borer, thank you so much for your time today. We really appreciate it.

Brandon Borer, DPM: Thank you for having me.

Host: Once again, that is Dr. Brandon Borer. And for more information and resources, just visit columbushosp.org. That's columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Healthcasts. Thanks for listening.