Nolan Alexander (Host): When you have tire trouble, you have car trouble. So when you have foot ailments, what does that mean for your body and you? Today we're talking about foot problems. This is Health Dose from my Michigan Health. I am your host, Nolan Alexander, and with me is Laura Reitz, DPM, a Podiatrist at my Michigan Health.

Dr. Reitz, how are you and your wheels today?

Laura Reitz Sushynski, DPM: I'm doing well. How are you?

Host: I'm doing great. There's so much that podiatry covers. From a general sense, what are the most common foot problems that people generally face and what are their typical symptoms?

Laura Reitz Sushynski, DPM: Well, podiatry covers anything foot and ankle. There are 28 bones in the foot and approximately 29 muscles, give or take if people have extra bones, extra muscles. So realistically we can fix lots of problems in the feet. Some of the big ones that we see on a daily basis are diabetic foot issues.

 With diabetes comes a lot of lower extremity problems, between wounds and neuropathy, not being able to feel their feet. And then for the non-diabetic population, sports injuries and plantar fasciitis are some of the big ones. Infected toenails, ingrown toenails are another really big one that we see on a regular basis. So literally if it's ankle down, we see it.

Host: So you said 28 and 29 bones and muscles?

Laura Reitz Sushynski, DPM: Yes.

Host: Wow, that's a lot.

Laura Reitz Sushynski, DPM: It is.

Host: And you mentioned some of the common ones. What are those typical symptoms from those common issues that you see?

Laura Reitz Sushynski, DPM: So plantar fasciitis, essentially pain on the bottom of the foot. A lot of patient's feel pain first step in the morning. It gets worse and better throughout the day. They sit down for lunch, they go to stand up, and they have to warm up per se before they start walking again because of the pain on the bottom of the foot.

In regards to ingrown toenails, on the edges of the nail, you can get little infections. So if you're noticing significant pain on the tip or the edge of the toenail, drainage, discoloration, redness, all signs of problems that probably should be seen sooner rather than later.

Host: Well, I like that you touched on some warning signs for an ingrown toenail. What might some warning signs be for plantar fasciitis?

Laura Reitz Sushynski, DPM: Just generalized foot pain, pain on the bottom of the foot. You can't walk the way you want to walk. Again, it's that first step in the morning. First step after lunch, you go to step up and shooting, burning, ripping sensations on the bottom of the foot. Pain on the bottom of the foot, feeling like you have to warm up before you walk again.

A lot of patient's will say, you know, I, I have to kind of walk with a limp for the first 10 steps because the bottom of my foot just hurts.

Host: So, it seems like it's pretty obvious and not something that you should ignore.

Laura Reitz Sushynski, DPM: Yes. The sooner it gets treated, the better and the faster we can treat it.

Host: So with that, how can podiatrists help in diagnosing and treating common foot problems? And when should one seek specialized care?

Laura Reitz Sushynski, DPM: I typically tell patient's that they should seek specialized care when they can't treat it themselves, when what they're doing isn't working anymore. Primary care physicians are a great first-line. A lot of times they can get patient's on antibiotics, if there's an infection in the foot. They can get them in orthotics or an appropriate shoe if there is a foot pain problem, like a plantar fasciitis problem starting. But then when that doesn't work anymore, when the infections continue to come, when the pain continues to come, it is time to see someone a little bit more specialized. In this office particularly, we do take x-rays on most patients.

If it's a infection issue, we may take a sample of the drainage and send it to pathology for specific antibiotics. If the antibiotics you're on aren't working, we may adjust those. But getting deeper into the problem, finding the root cause, and then treating that.

Host: That seems like pretty comprehensive care.

Laura Reitz Sushynski, DPM: For the most part it is yes, as long as it involves the foot. Yes. We don't treat anything above the ankle, but comprehensive below.

Host: I've talked to friends and relatives too, and sometimes when we have foot problems we can mention that to some of our older relatives, whether it be our parents, see if they've gone through it before. And with that, sometimes there comes some household things that you talked about taking care of yourself. But also there's probably some common myths. So what are some myths about foot problems that both patients and general practitioners should be aware of?

Laura Reitz Sushynski, DPM: A big one is heel spurs. You know, if we x-ray the population, I would say 50 to 75% of us have a heel spur. A lot of patients think that heel spurs cause pain. Heel spurs typically are not painful unless they are hooked, and or broken. And most of the time the pain on the bottom of the foot is actually plantar fasciitis.

Another big concern that I hear a lot from my patients is treatment is going to be painful. We try not to cause pain here in the office. So if it's an ingrown toenail, if it's a wart, if it's plantar fasciitis, if you need an injection, we do our best to make it painless. Is it going to hurt? Maybe a little bit.

 We are using needles and procedures, but we try to make it as pain-free as possible. I have a lot of patient's after we do a procedure that say, oh, that didn't hurt as much as I thought it would. And, you know, I really made it to be this big thing in my head. And it's not, we can do it a lot less painful than I think patients think.

Host: That's wonderful to hear, but the start of that, you really think 50 to 70% with heel spurs if you were to scan?

Laura Reitz Sushynski, DPM: Yeah, a decent amount of us. I don't know the exact number off the top of my head. I haven't, done all the research on specific numbers, but most patient's do have a small spur on the bottom of their foot. It is an anatomical variant that most of us have. Where that plantar fascia inserts into the heel, it does create an extra tension. And so as that plantar fasciitis becomes irritated, the heel spur can grow. Taking x-rays in the office, most of my patients have some sort of little itty-bitty spur. Big spur, not as much, but yeah, a small spur is very common.

Host: Tell that's interesting as well as, the pain that you talked about as far as pain levels of going through foot care. With that from a practitioner's perspective, what emerging trends in foot care do you feel like are worth noting, and how might they change standard care practices here in the near future?

Laura Reitz Sushynski, DPM: There's not a lot of new stuff out there in regards to podiatry medicine. A lot of it is tried and true medicine that has been around for a while. I will say lifestyle modifications though that are more common. I feel like in the sports medicine world, and in the Instagram, social media world, recovery is a big thing right now.

People are really talking about their sleep scores and red light therapy and massage therapy and the red light saunas and steam rooms and all of that are really, kind of the in vogue thing right now. And that's actually really helpful in the podiatry world as well. Because red light therapy, massage therapy, the Theragun massage therapy that a lot of people talk about really does help tendonitis, plantar fasciitis.

If you think about it, we're on our feet all day long, and if you're not recovering like you should, you're going to have some pain, you're going to have some tenderness, you're going to have some tendonitis or plantar fasciitis or aches and soreness. So with this being on trend and kind of the on vogue thing to do, we're recovering longer, we're healing better, and we're having less pain.

Host: Very unique point about how we're using social media to help us out in a variety of ways.

Laura Reitz Sushynski, DPM: Yes.

Host: What advice would you give to someone though who's hesitant to seek help for foot problems?

Laura Reitz Sushynski, DPM: Don't wait. If somebody has problems and they want to seek help, the sooner the better. If it's plantar fasciitis, we can get that inflammation down and healed quicker. If it's an infection, we don't have a lot of room between the soft tissue of our foot and our bones. So infections in the foot can become serious very quickly. The sooner you seek care, the sooner we can treat you, the sooner we can get the pain gone. There's no need to suffer.

Host: Well, thank you so much for joining us today. This has been Dr. Laura Reitz, a Podiatrist at My Michigan Health. Thank you again for your time.

Laura Reitz Sushynski, DPM: Thank you.

Host: For those interested in more information on services provided at Wound Care Centers, you may visit www.mymichigan.org/wound. This has been Health Dose from My Michigan Health.

Thank you for listening.