Transcription:
Is Pain in Your Foot or Ankle Keeping You From Activity?

Melanie Cole: Minor foot problems such as blisters or cuts can cause complications if left unattended. The good news is that you can prevent many foot complications with some simple everyday foot care. My guest is Dr. Brian Reade. He's a podiatrist with St. Luke’s Cornwall Hospital. What are the most common foot issues that you see every single day?

Brian Reade, DPM, FACFAS: The most common foot conditions I see daily are likely bunions, hammer toes, especially this time of year, the springtime when people are getting out, they're doing some yard work, maybe getting a little exercise in. Most commonly I think we have to say plantar fasciitis or heel pain and Achilles tendonitis and ankle sprains are very common this time of year.

Melanie: Let's talk about some of those. Plantar fasciitis, to start, can be so painful and debilitating, and for some people, it comes and goes. What do you recommend when they start to feel that pain? Explain a little bit about what it is and what that pain is like?

Dr. Reade: Plantar fasciitis is the most common cause of heel pain in adults. Often, it’s pain on the bottom of the heel. Typically, when it starts, it’s a sharp pain when weight bearing after periods of rest. When you get out of bed in the morning, you're sitting down for a long period of time resting or in the car, first few steps are very painful, that’s pretty typical of plantar fasciitis. The plantar fascia is an extension of the calf muscle and the Achilles tendon, so the most important thing to do initially is a lot of good calf stretching and arch stretching and wearing arch support is probably the best way to treat it on your own initially.

Melanie: As long as we're talking about arch support, there are so many. There are Spankos and Superfeet and there are all kinds of things that people can buy at the store. What do you think of some of those? Some of them are pretty hard plastic but they warm to your foot. Do you think that people need to have a professionally made arch support, an orthotic? Do you think they can try those first? Speak a little bit about shoes and arch support for feet.

Dr. Reade: I think two of the ones you named are probably the best two that are commercially available. The Spanko arch support and the Superfeet are both good as you stated. They initially have a hard plastic feel, but that’s important. You need that plastic shell to really support the plantar fascia or the arch ligament. The soft floppy, your gellen type inserts, really don’t provide the support you need. My favorite arch support that I like to recommend is one called Parasteps, very similar to the Spanko and the Superfeet, but they have a little bit of a softer feel and also have the good structural integrity to support the arch. As far as shoe gear, obviously this will vary depending on people’s occupations, but recreationally, I just really like good running type sneakers, a neutral type shoe with an arch support is probably the best recommendation.

Melanie: What about good foot hygiene? Some people have nails that look a little bit yellow or they let them grow too long or they have smelly feet, of course, a lot of people have that problem. What do you tell people about good foot hygiene? That'll segway us into diabetic feet and keeping really good control of those.

Dr. Reade: Just some common sense rules, not really great formula for good foot hygiene other than just some common sense daily cleansing, just checking your feet, inspecting them daily, things like fungal rashes in between the toes can creep up on you quickly unless you check and wash and dry in between your toes daily. Some people have excessive sweating and there are some commercially available drying agents that are helpful with that. If the sweating or odor becomes excessive, then certainly a visit to a podiatrist with some prescription strength roll-on type medications are helpful.

Melanie: Now tell us about watching your feet. If you're somebody with diabetes, it’s even more important that you practice that good foot hygiene and you keep a watch on them, you check your feet. What are you looking for?

Dr. Reade: With diabetics, many people have heard the catastrophic results of diabetes in your feet and horrible things like amputations. The number one rule prior to even any type of foot advice is good rigid blood sugar control, really maintaining your blood sugar within normal limits is paramount. Most of the side effects of your feet from diabetes come from poor circulation or something called neuropathy or an inability to feel. If you can keep your blood sugar in normal range, then you won't develop poor circulation or neuropathy. If you're diagnosed diabetic, just important for daily diabetic foot checks, check your feet every day, look for any areas of drying, cracking, redness, swelling, any kind of rashes or blistering, you should see your podiatrist immediately.

Melanie: You mentioned bunions as something that you see pretty commonly. What are they and why do they cause so much pain for people?

Dr. Reade: Bunions are actually a misalignment of the big toe joint. In laymen’s terms, you'll see that bump on the inside of your big toe joint and it’s actually a misalignment of the first metatarsal bone, which is the bone that goes into the big toe joint. The reason they become so painful is just pressure from show gear. It’s a little bit of a wife’s tale; shoe gear does not cause bunions. Bunions are an inherited foot structure trait. However, shoe gear does aggravate them or make them symptomatic. Just avoiding any narrow shoes, wearing a show or sneaker that’s wider through the toe box to prevent the rubbing or irritation of the bump is the best first treatment for them.

Melanie: What about things we can do nutritionally for our feet? Does vitamin D help our feet? Are there certain foods that we can eat that can help? That’s our base of support. What else can we do?

Dr. Reade: You’ve touched on something that’s actually a pretty hot topic right now in the foot and ankle literature in the foot and ankle world is vitamin D deficiency. Where I am in New York right now, northeast and some other areas that have less of a sunny season is vitamin D deficiency, so routinely, on our preoperative patients now, we’re getting vitamin D levels. Vitamin D, just a good balanced diet if you are some of these areas where we don’t have good sunshine all year long, certainly having vitamin D levels, and if you are vitamin D deficient, you can take your doctor’s recommendations on D3 supplements and sun exposure. Good daily walks in the sun are helpful as well.

Melanie: Wrap it up for us with your best advice about keeping good care of our feet and our ankles and when these issues, we've touched on a few today and there's so many we can discuss, start to bother us what is a good time to see a podiatrist.

Dr. Reade: To wrap it up, sooner than later. I'm a podiatrist who works in an orthopedic practice and do a lot of foot and ankle surgery, but the overwhelming majority of these conditions can be treated within an office visit or two nonoperatively without surgery conservatively. Get on things early. Don’t let them become chronic. They become more difficult to manage that way. When you have some early signs, it pays to have a quick visit and get things resolved quickly.

Melanie: Thank you so much for sharing your expertise with us today in this really interesting topic. So many people have so many questions about their feet, so thank you again for being with us. This is Doc Talk presented by St. Luke’s Cornwall Hospital. For more information, please visit stlukescornwallhospital.org. That’s stlukescornwallhospital.org. This is Melanie Cole. Thanks so much for tuning in.