Scott Webb (Host): Welcome to the Iowa Specialty Hospitals and Clinics ISH Dish Podcast, practical Health Advice From Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life.

I'm Scott Webb, and today we're going to discuss foot and ankle pain with Chrysten Dohrmann. She's an Advanced Registered Nurse Practitioner specializing in Podiatry.

Chrysten, it's so nice to have you here today. We're going to talk about foot and ankle pain, and I think I have both of those, but before we get to that, tell everybody about yourself, where you provide care, what types of treatment you offer, and so on.

Chrysten Dohrmann, ARNP: Sure. My name's Chrysten Dohrmann. I'm a Nurse Practitioner for Iowa Specialty Hospitals. I have a strong cardiac background, but I joined the podiatry team in July, so I'm excited to kind of get a little further away from the heart. I am from the area, so that's kind of exciting too, that I can help treat some of the people that I know.

I treat patients here in Belmont, Clarion and Garner. I will start to see patients in Hampton, hopefully in November, if not sooner. And start seeing patients in 2026 in Mason City.

Patients can make appointments for me or with me for foot and ankle pain, sports injuries, toenail issues, ingrown toes, fungus of their toes, corns, calluses. And then if they need to see Dr. Hensley, Dr. Greenfield, we can definitely make sure that that happens.

Host: Yeah, sounds good. As you say, we're a cardiac person, so you went as far away as you could from that, right? Feet and ankles and I suffer from plantar fasciitis in one of my feet. I, keep waiting for it to go away. I keep doing my part, but no luck yet. But what are some of the most common causes of foot and ankle pain, and how can individuals determine if their pain requires medical attention?

Chrysten Dohrmann, ARNP: There's not really one single thing that can cause foot ankle pain. There are a plethora of different possibilities, like you mentioned plantar fasciitis. It's super common, especially for anybody that walks and that's, you know. All

Host: Almost all of us, right.

Chrysten Dohrmann, ARNP: Population. Exactly. Arthritis can start in pretty early. Like I said, everybody uses their feet to get around and so you can start to have pain from that, limitations. Any sort of ligament tendon, you know, even when you were younger and you hurt your ankle playing a sport, it can come back to kind of bite you later on in life with arthritis or just some weakening of those different tendons and ligaments.

So lots of different things. Anybody can come and see us. I mean, even if it's just so that we can kind of tell you what to do at home to resolve some of that pain. Or maybe there are further things that we can do, medication, injections, surgeries, to help you get around a little bit easier and without pain.

Host: Yeah. And that's maybe a little bit down the line, some of the stuff you mentioned there, injections, surgery, but what are maybe some effective home remedies or over the counter treatments for managing our, we'll call it minor foot and ankle pain?

Chrysten Dohrmann, ARNP: Ice is great. You know, you've heard the saying, RICE with the rest, ice compression, elevate, icing is great. Especially for like that plantar fasciitis pain, heel pain, Achilles pain. Elevation, stretching is really important. Sometimes those different injuries or pains that you can have is from a tightening or you don't have quite as much range of motion because of a strain on a muscle.

And so stretching is great. Non-steroidal anti-inflammatories. So those would be like your ibuprofen, naproxen, things like that, as long as your health history allows you to take those, then that's a great start too, just to kind of help get some of that inflammation and pain under control. Shoes are a huge thing, making sure that you have supportive shoes, and sometimes just rest, you know, it's hard for us to sit down and relax. And so that can be a helpful thing too.

Host: Yeah, sometimes you just need some rest. And at my age, in my, we'll call it mid fifties, rest is good. I like that. Good shoes. Sometimes you have to spend a little bit more, but not necessarily, but you know, I find that shoes are so important for me anyway. How about physical therapy and exercises and how they, you know, maybe contribute to the recovery and prevention of foot and ankle injuries?

Chrysten Dohrmann, ARNP: Like I mentioned, you know, plantar fasciitis, can be caused by a shortening or a tightening of your calf muscle. So physical therapy does a great job of helping with that range of motion, lengthening it out so that it's less stress and tension on that plantar fascia. Like I mentioned also when you're younger and you have those sports injuries or even just you're walking across the yard and you sprain your ankle, you kinda weaken some of those ligaments and tendons.

And so physical therapy kind of helps strengthen the muscles, the joint itself just to make it easier for you to walk or so that you're walking properly and not causing strain on other areas.

Host: Yeah. So how about surgery? I don't want to think about surgery. I'm sure most of us don't, but it may be an option or folks may get there if they've tried everything else. So what are some of the latest advancements in the surgical interventions?

Chrysten Dohrmann, ARNP: Surgery is often like last, you know, last thing that you want to do. But when it comes to the latest advancements, it's really trying to make the surgical site as small as possible or as less invasive so that your recovery is a little bit easier.

With the feet, a lot of post-surgery care is being non-weightbearing, and that's hard for a lot of patients. So if we can perform the surgery so that they are back on their feet a little bit faster. Lots of fusions. People hear fusion and they think that that's a bad thing because then I can never move my foot again.

But really it's just trying to fuse one little joint so that you don't have pain when you walk anymore, so it can actually be really helpful. And even with plantar fasciitis, like you said, you've done the things that you want to help make your plantar fascia a little bit less angry, and sometimes it's just clipping a teeny tiny part of that to give it some more length so that there's less stress.

Host: Yeah. And not to make it all about me, but since I'm the host, let's talk a little bit more about plantar fasciitis. You know, I, again, I've tried all the things, that I've seen in, in the media and social media and AI searches and all of that, but what are some of the, from an expert, you know, what are some of the recommended treatment protocols? What am I not doing or not doing right?

Chrysten Dohrmann, ARNP: Anytime that people, you know, they come in with plantar fasciitis, we start more conservative, right? So we're not going to jump straight to surgery, like you said. So really the icing, we tell our patients to stretch, then ice, then stretch again. When you do the stretches, you want your leg as straight as possible and you're going to bend your toes up towards your nose as much as possible.

So a lot of people will do that, like up against the wall, trying to stretch out that calf muscle. Taking those anti-inflammatories and doing it regularly. So if you take, you know, ibuprofen one time is probably not going to help get rid of that inflammation in your heel. But if you take it a little bit more regularly, not necessarily four times a day, but if you, and it's a little hard on the stomach, and some people, like I said, they're not clinically, they shouldn't be taking ibuprofen if they have any kidney or, they're on a blood thinner. So making sure that your primary care provider is okay with you taking something like that. So that's more of the conservative.

So stretching, icing, NSAIDs. Sometimes even just the proper shoe or insoles are important to give you a little bit more cushion and support that arch so that you're not putting the strain on that fiber that's, you know connecting your heel to your toes. Rest. Which is really hard to do, especially with the busyness of life.

And then if those don't work, then we can progress to, like a steroid injection and sometimes just one steroid injection will help nip that pain just because it helps get rid of the inflammation right away. Sometimes we'll do a second injection, but if that doesn't work, then that's when we kind of proceed to doing more of the, like the surgery or the lengthening of that plantar fascia.

Host: Yeah. Lots of options and things that we can do to help ourselves course. How about custom orthotics? I think about those often and then I don't do it right. I'm sure a lot of us like that. Sounds like a great idea, but it also seems like a lot of work. So what, about custom orthotics and how do they help in the management of chronic foot and ankle issues?

Chrysten Dohrmann, ARNP: Everybody's foot is different. And so you may not find the over the counter insoles that you get are really going to work for you. Even sometimes if patients are having more, they lose that fat on the bottom of their foot and so they have more pressure of the bony prominences, they need the custom orthotics because they can obviously design them specifically for each specific foot. You know, they do the molds and it is a little bit of a process and sometimes they can be expensive, but because they can get it so specific to your foot, they're good for years upon years, you don't need to get it redone again. So that's the nice thing about them.

I haven't really done a lot with the custom orthotics, so again, I'm sorry I'm not as knowledgeable on that topic, but, we send it a lot for patients that maybe have wounds or they, need more support in certain areas that you're not going to find in those ones that you can get online or that you can just go to Walmart and buy.

Host: We touched a little bit on shoes and footwear choices. Just wanted to drill down a little bit more in that because I find like the more I wear, you know, they're convenient, but the more I wear like slides or shoes I can just slip on, that seems to make things worse for my feet. And you know, and again, not that you have to spend a lot of money, but the right shoe is important. So how do we do that? How do we get the right footwear?

Chrysten Dohrmann, ARNP: Yeah. You want to find the best support and even you can find like a neutral shoe that's pretty common for just the everyday person. Other times you can go to like a shoe store, specialty area, or you know, someplace like that where they can actually look at your shoes, see if you hyper pronate or you supinate, whatever that you do like with your ankle to kind of give you better support.

Yeah, the slides are no good and Crocs basically every shoe that my 10-year-old wants to wear, I have to say no, those are not good. Right. Another important is the toe box. I don't think that people understand how important that is too. Like we are in north Iowa, we have a lot of farmers and some of those cowboy boots or the different boots that they wear aren't the greatest because they're squishing everything and causing wounds or causing, bunion pain, calluses, corns, things like that. So making sure you find a shoe that gives you the support that you can't bend very much. You, that's another one. People will say, oh yeah, I can bend my shoe up in a big ball. And it's so cushiony, it's so soft. It feels so good. Well actually it's not giving you much support at all.

So maybe finding something different. Obviously a lot of people will just buy something online. I did that this last fall. I ordered a pair online and turns out they did not fit my foot right and they weren't the right size and they didn't give me the right support in the right areas.

And so that can be frustrating. I don't want people to just buy whatever they see online and then put their foot in, you know, a bad shoe that's going to give them issues later on.

Host: Yeah, I mean, we've all done that. We've all worn shoes that weren't comfortable because we liked the way they looked, you know, and we wanted other people to notice our shoes. But as we get older and these foot and ankle issues become more of a daily nuisance, right? It does seem more important maybe to look, maybe not quite as cool, you know, but be comfortable and be supported, right.

Chrysten Dohrmann, ARNP: Yeah, my grandma was a cosmetologist back in the sixties and seventies, and she would wear high heels all day every day to, you know, cut hair and do hair, and she had some of the worst feet problems that I've seen of anybody because of those choices she made. So just trying to tell people, you know, spend a little bit more, find the right shoe. Your body will thank you later.

Host: Yeah, a couple hours at a wedding in high heels is one thing, but doing it all day every day. Right? Yeah. Let's, let's talk about, I think I know what they are. I've never had one. I think, knock on wood, but what is a bunion and what causes it and what do we do to prevent and treat.

Chrysten Dohrmann, ARNP: A bunion is a deformity of that big toe joint, and a lot of the times it happens because either body mechanics are not allowing your toe to move or your toe is moving too much. It's causing ligaments weakening. And so it kind of causes some deformity. And you can have a lot of arthritis in the area too.

A lot of people will have gout. Gout can contribute to it and you don't realize it. But really it's that swelling of that large toe joint, and it can push up against the side of your shoe. Be really uncomfortable, your toe won't move quite as much, and that can really impact how you walk too, and it can further having some wound issues.

We see bunions in a lot of patients. It's not necessarily just the elderly, it can be anybody. And treatment, again, you can do anything from the conservative treatment where you try NSAIDs, you try different shoes, wider toe boxes. They have some different orthotics or orthoses, like things that can help with that.

 And if that doesn't work, then we progress to having like a steroid injection or even as far as surgery and surgery, when I was younger, I thought that a bunion surgery was just absolutely horrendous and the recovery is so bad and honestly, it's really not bad. You're non-weightbearing for, you know, a few weeks, but can really improve your pain and your you know, you're not as limited with your being able to get around, after the surgery. So it was pretty impressive.

Scott Webb: Right. Yeah. As you've said, there's been a lot of advancements and it, even though it's not your area per se, it certainly is an option for folks, especially if they've tried everything else. And along the lines of trying everything and helping ourselves, are there some lifestyle modifications, things we could do, maybe lose a little weight, adjust our activities, maybe a little less pickleball, what can we do to help ourselves?

Chrysten Dohrmann, ARNP: Well, I mean, being active is great. I don't want somebody though that's not active to just go out and start running 2, 3, 5 miles a day. So just kind of easing into it. Again, we talked about footwear and how important that is. I don't want you to go out and start exercising in flip flops or hey dudes crocs, you know?

Because you're not gonna be supporting those joints. And they're pretty stressed. Anytime that we walk, we run, we jump. It's impressive, the kind of stress that they can handle. So just, yeah, making sure that we're supporting everything. You're not going out and doing pickleball when you've never played it before, just kind of easing into an activity.

Losing weight is important. Obviously the less stress that we can put on that joint, the better. So every few pounds that you lose reduces that stress on that ankle joint, and feet. A lot of people will say, oh yeah, after I lost all this weight, my feet actually shrunk. And it's because of the reduced stress that your feet are under after losing that weight. So.

Host: I did want to end, not on a bummer, but I did want to end on a surgical note if we can and just say, or suppose that someone needs surgery, they've tried everything else, or they're just going to go right to that cut, right to the chase. What happens next for folks?

Chrysten Dohrmann, ARNP: Making an appointment with one of us podiatry providers for sure. And I don't do the surgeries. I'm not in the OR with Dr. Hensley or Dr. Greenfield, but I can definitely help get you in touch with them, do the either the MRI or the radiographs that we would need before you would do surgery to just try to help get you in quicker.

OR is usually pretty busy. Make an appointment with me and then I can kind of facilitate things to get you in faster, get you in the OR and get you fixed up.

Host: Yeah. And as you've said here today, that some of these things used to maybe be a little scarier or used to seem scary, but today, whether it's fusions or you know, work on a bunion, whatever it might be, a little time off our feet, and then most of us are back to doing whatever it is we do, pickle ball or otherwise. Right.

Chrysten Dohrmann, ARNP: Yeah, exactly.

Host: Great. Well, I appreciate your time and your expertise today. Thanks so much.

Chrysten Dohrmann, ARNP: Yeah, absolutely. Thank you.

Host: And thank you for listening to Iowa Specialty Hospitals and Clinics ISH Dish Podcast. For more information on the topic we discussed today, visit us on the web@iowaspecialtyhospital.com. There you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics, and explore all the services that we offer. For the ISH Dish Podcast, I'm Scott Webb. Thanks for tuning in.