A Brief Introduction to Dr. Marshal Gwynn!

Hi, my name is Marshal Gwynn and I am brand new at blogging!  I just recently moved from Binghamton, NY to just south of Salem to work at Shenandoah Podiatry.  I was born in Portland, OR and grew up in Wenatchee, WA.  I did my undergraduate schooling at Brigham Young University in Provo, UT.  I kept moving east when I decided to attend the Ohio College of Podiatry Medicine in Cleveland, OH.  One of my fourth year rotations was done at the Salem VA Hospital.  I absolutely loved my rotation, especially when I had time to get out in the community and see some of the sites.  I still remember hiking to the Dragon's Tooth on the Appalachian Trail.  I still have pictures of the Roanoke Star when I visited.  After podiatry school I received my three years of surgical training at United Health Services Hospitals in Binghamton, NY.  I was excited when I saw an opening at Shenandoah Podiatry, because of the possibility of returning to this area. 

It was during my schooling that I met my first, and only, Virginian girl.  Long story short we got married.  I've been promising for years to bring her home to Virginia again.  As excited as I am to move to this area it doesn't hold a candle to how happy my wife is to be in the area.  It is our plan to be here for years to come.  I look forward to meeting and serving the people in this community. 


Come visit me in both offices! I am in Troutville on Mondays and Thursdays and in Blacksburg on Tuesdays, Wednesdays and Fridays.



- Dr. Marshal Gwynn

Shoe Selection

Choosing the “right” shoe for walking, or any activity for that matter, can prevent needless foot related injuries and discomfort. If the average person takes 8,000 to 10,000 steps a day, it becomes clear, selecting the “correct” shoe is paramount. Here’s how to select a walking shoe that’s right for you.

Analyze your feet

Not all feet are the same. They are complicated and intricate structure of bones, joints, ligaments, and tendons working in concert to support our body weight on varying surfaces. And they come in many different sizes and shapes. For the most part, feet fit into three categories:

• Low arched, straight foot
• Medium arched, slightly curved foot
• High arched and usually more curved foot

Know your body weight

Body weight can factor into the shoe selection process. Increased weight places more demands upon your feet. Since this is the case, consider increasing the level of protection a shoe can offer by selecting a shoe from a greater controlling category (see “select running shoe type”). For example, you may opt for a motion control shoe rather than a stability shoe or a neutral shoe. Just remember to make sure the shoe fits comfortably on your foot before you purchase it. Consider trying on shoes near the end of the day when your foot is at its largest. And use the socks or stockings that you intend to wear with those particular shoes.

Select a running shoe type

Running shoes can usually be divided into three overall functional types

• Motion Control shoes are typically based upon a straight design and are usually suited for people with low arched, straight feet
• Stability type shoes are for those individuals with a medium arched foot (typically deemed “normal”) and have a slight curve to the shape of the shoe.
• Neutral Type shoes are based upon a curved design and best fit those individuals with a high arched foot.

As you examine shoes from each of these categories, you’ll notice the motion control shoes become the most rigid and resistant to twisting and bending. Several shoe manufacturers, including Asics, Brooks, Etonic and Reebok make walking shoes are approved by the American Podiatric Medical Association’s Seal of Acceptance.

Why Do Diabetics Need Special Shoes?

There’s a question that we get in our Blacksburg and Roanoke offices quite frequently – and that is, “Why is it that your diabetic patients require special shoes?”

To understand the answer to this question, one must first understand the diabetic foot. One big reason why it is important for any diabetic person to carefully monitor and control blood glucose levels is that when uncontrolled, many complications can arise. Some complications that are frequently seen in our office are nerve damage, decreased blood flow, and foot and joint problems. All of these problems can and do affect the feet.

Besides the bladder, bowel and stomach issues that can arise from diabetic neuropathy, poor sensation can have devastating effects on a patient’s feet without proper care and attention. Inability to feel pain, pressure or temperature can easily allow for rubs, blisters, burns and other injuries to go unnoticed.

Feet are sensitive and the blood supplying oxygen to the lower extremities may be reduced without you even being aware of it. The decreased oxygen delivery to the feet from poor circulation results in slower healing and nail growth.

Uncontrolled blood glucose levels can be inherently dangerous. “Rollercoaster” blood sugar levels can damage tissues and cells. An elevated blood glucose level can cause dehydration and dryness of the skin as well as promote the growth of bacteria and fungi (since sugars are a good food source for these organisms). Because of this, bladder, gum, and skin infections are common in our diabetic patients with high sugar levels. 

So, Why Special Shoes?

-          Proper shoes are the first line of defense against injury and infection.

-          Well fitting shoes are comfortable and allow proper circulation in the feet.

-          Proper shoes will allow your feet to breathe while still protecting them.

-          Proper shoes can prevent the development of ulcers, blisters and fungus.

How are these shoes different?

-         Deeper and wider to accommodate diabetic inserts, allow more room for feet, and reduce possible pressure points.

-         These shoes provide excellent support which is recommended for anyone buying shoes.

-         Most have a breathable fabric upper to promote good air circulation within the shoe.

-         Most are custom ordered for size or even custom molded to a patient’s foot.

-         The toe boxes are roomier to prevent pinching or squeezing the toes as well as to allow for more room for foot deformities.

-         Many are easily adjustable or have elastic which makes it easier to put on without making the shoe too tight or too loose.

-         Available with Velcro to make putting on shoes easier for patients with peripheral neuropathy who can not feel their fingers well enough to lace shoes. 

 

If you are interested in a pair of these shoes for a loved one or yourself, please give our office a call at (540) 808-4343!

Martin Luther King Jr Day

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Today we celebrate Martin Luther King Jr. who used his most precious feet to fight for freedom and called others to use their feet to stand up for what they believe in. Remember those who have walked to bring about the changes that we get to enjoy today. Never underestimate the power you have to make positive changes in our world and know that with belief, creativity, and ingenuity anything is possible!!!

Foot Exams Help Prevent Ulcerations

diabetic foot syndrome

We urge all of our patients to make sure their primary-care physicians check their feet during every office visit for signs of ulcerations that, left untreated, can lead to infection and ultimately result in lower limb amputations.

It’s a simple exam that takes two minutes to determine if you are at risk for developing a foot ulcer. Perhaps the easiest way to remember to get your feet checked is to remove your shoes and socks in the examining room. Most diabetic patients are vulnerable to foot ulcerations caused by poor blood circulation in the lower extremities and neuropathy that inhibits nerve sensation.

Ulcers are the leading cause of foot amputations among people with diabetes, but they are preventable in most cases if doctors routinely check their patient’s feet.

In a routine foot exam we check for nerve sensation, skin irregularities (corns, calluses, punctures and areas of redness), swelling, drainage, and foot deformities that cause unnatural pressure points that are prone to ulceration.

Patients with diabetes who have their feet checked regularly can prevent foot ulcers or have them treated at early stages by their podiatrist.

Shoe Shopping Tips

Here are some tips to help reduce the risk of foot problems. Use this guide when you shop for shoes:

• Fit new shoes to your largest foot. Most people have one foot larger than the other.
• Have both feet measured every time you purchase shoes. Your foot size increases as you get older.
• If the shoes feel too tight, don`t buy them. There is no such thing as a "break-in period."
• Most high heeled-shoes have a pointed or narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.
• Shoes should be fitted carefully to your heel as well as your toes.
• Sizes vary among shoe brands and styles. Judge a shoe by how it fits on your foot - not by the marked size.
• There should be a half-inch of space from the end of your longest toe to the end of the shoe.
• Try on both shoes.
• Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day.
• Walk around in the shoes to make sure they fit well and feel comfortable.
• When the shoe is on your foot, you should be able to freely wiggle all of your toes.
• Women should not wear a shoe with a heel higher than 2 1/4 inches.

If you have any hesitations about your shoe selections, make an appointment and we'll help identify what you should look for in a shoe with your specific foot shape (high arches, high instep, etc.)!

Bunhead's Crazy Competition

According to ABC Family's new show, Bunheads, the girls say the best dancer is the one with the worst looking feet!

Why a foot doctor?

Dr. Kate and I were talking the other day about the different types of doctors and other fields she might of considered entering other than Podiatry. After talking, I started wondering why Dr. Kate chose becoming a Doctor of Feet afterall and here's what she had to say!

What made you decide to become a foot doctor? When was this? My grandpa was Type 1 Diabetic with complications and he was the only grandparent I never met, this made me become interested in Diabetes. I also wanted to specialize in surgeries as opposed to an orthopedic doctor or doing hip surgeries, etc. Another reason is because I was an athlete in school and was exposed to injuries. So Podiatry covers all of the above- Diabetes, Surgeries and Sports Medicine! I believe I made the decision my senior year in college.

You're a young doctor, do you think its an advantage or disadvantage drawing patients to you? I 100% believe it's an advantage because Podiatry training is becoming better, you're well trained and are given good exposure to multiple aspects of Podiatry.

What do you love about your job? Helping people overcome their disease or complication and educating them on how it affects their foot health. Also, I met my current boyfriend through a patient (who is a good friend now!) and am thankful this career has led me to the person I hope to marry!

What do you do in your free time? When I can I spend time with my friends and family and try to live a healthy and active lifestyle with sporting activities.

How would you encourage others to enter this same profession? I would encourage them to shadow which is following a doctor around to educate them on what they would be taught and able to do.

Thanks Dr. Kate for taking the time out of your hectic day to inform others on what it's like to be a Podiatrist!

Wireless Shoe Inserts

A Canadian company is producing a wireless shoe insert which supposedly will monitor the pressure people put on their feet. This will be particularly helpful for diabetics which often receive diabetic foot ulcers and numbness leading to amputations.

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Due to the numbness, diabetics don't feel pain in their feet which this new insert will help. A watch is worn with the inserts and will trigger if people are putting too much pressure on their feet and risking numbness.

The product is currently under approval so we'll see what comes of it! Hopefully this or something like it will be available soon to prevent more and more amputations everyday.

From Flats to Stilettos, it's Agony of the Feet



I went to visit my boyfriend's grandparents the other week and his grandpa cut out this article from the Richmond Times for me!

The article describes how women will wear 5 inch stilettos to work throughout the week then will switch to flats or flip flops over the weekend. (Around these parts, however, with all the students it's more of wearing flats throughout the week and growing 5 inches taller on the weekend!) 

When conducting a study on the feet, it was found that "women who wore so-called 'high risk' shoes that lacked sound structure and support, including high heels, sandals and slippers, were more likely to complain about foot pain later in life."

Listed are some common problems associated with wearing heels (or frequently switching from heels to flats to heels):

• Bunions- Experts say bunions, when the big toe points toward the second toe causing a bump to appear on the outside edge of your toe, are partly genetic. Wearing pointy-toe high heels can make the problem worse.
• Hammertoes- Shoes that crowd the toes together can cause the second, third, fourth and fifth toes to become bent, like a claw.
• Corns- Thickened skin on the top or side of the toe.
• Neuromas- Pinched nerves that cause a burning sensation, tingling or numbness between the toes and in the ball of the foot.
• Heel pain- Plantar fasciitis commonly causes inflammation of the thick tissue on the bottom of the foot, which leads to pain in the bottom of the heel.

What it comes down to is if height is important to you, wear wedges instead of platform or high heels. I personally recommend Danskos (I wear them everyday!) however, they are an investment, but they will give you the height and the support you need.

Also, make sure to stretch, yes it may sound silly to stretch after removing your heels for the day, but it will help in the long run with pain, swelling and discomfort!
Here are some quick stretching exercises we recommend: Plantar Fasciitis stretches and Heel Pain stretches

Charlie Sheen: Hammertoes Aren't Winning

Charlie Sheen has recently announced his major turn off in women- hammertoes. Yes, the man fired from Two & Half Men because he has a number of addictions feels he has the right to deem women with hammertoes unattractive!

Hammertoes are everywhere in Hollywood!
Katie Holmes’ Feet

Even when women have a longer 2^nd toe than big toe is “bad too”; luckily his previous 3 significant others, Brooke Mueller, Denise Richards and porn star ex-girlfriend Bree Olson all had pre-approved feet.  

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Mr. Sheen, you have winning feet, don’t you?

Dedicated to your healthy feet,
Dr. Kate

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Embarrassed by your feet?

Many people look down at their feet this time of year and think, “How am I supposed to wear flip flops with my feet looking like this?”

Well, that’s what Shenandoah Podiatry is here for! We have several treatment options in the office to help your winter feet.  From routine foot care where we remove corns and calluses that have built up over months to Keryflex, a nail restoration treatment performed in our office.

We want you to return to your healthy and active lifestyles looking your best and we’re here to make this happen!

Call our office today to get your feet summer ready!

What is Neuropathy?

Dr. Jennifer Feeny, of Shenandoah Podiatry, discusses the reason you have pain in your foot, even though it is numb. Dr. Feeny also discusses the possible causes of neuropathy and treatment options.

A Sobering Foot Study

As a child, I remember being fascinated that one could change the color of a celery stalk or even a coffee filter simply by putting its tip in colored water. Many of us were exposed to this experiment as children because teachers often use it to show students how plants take in water and nutrients. But what's that got to do with feet?

According to a Danish urban myth, our feet can absorb alcohol in much the same way. The myth proposes that vodka can enter the blood stream through unbroken skin and cause intoxication if one stands in a puddle of it. Three Danish Ph.D. students set out to test this myth's validity by doing just that. In their comically named "PEACE ON EARTH" (Percutaneous Ethanol Absorption Could Evoke Ongoing Nationwide Euphoria And Random Tender Hugs) study, each stood in 700mL of vodka for three hours.  Their behavior and blood alcohol levels were documented every half hour to gauge their absorption. 

Aside from presumed pruning, observed changes were insignificant over the course of the study. Not surprisingly they concluded that we, unlike celery, are incapable of absorbing nutrients through the skin of our feet.

The point of all of this is that our skin is designed to keep out everything from infections to vodka. When our skin is compromised through a cut or an ulcer, it can no longer do its job. Proper foot care and visiting your podiatrist when the need arises will keep your feet healthy - and apparently sober.

If you'd like to read more about the study, visit British Medical Journal: PEACE ON EARTH.

Diabetic Foot Care

Diabetics are more likely to have foot problems.
If these problems worsen they can lead to complications and even infections.

It is important to recognize and treat any foot problems so that complications do not occur.

Diabetic patients can have nerve damage in their feet. This is known as diabetic neuropathy.
The patient may experience numbness and tingling in their feet.

The diabetic patient with neuropathy may have a lack of sensation in their feet.
This type of patient may not experience pain the way that someone without neuropathy would experience pain.

The diabetic patient may not feel a cut, or blister.

Numbness may change the normal balance of walking and standing.
Poor weight distribution can even lead to fractures.

Pressure points can lead to ulcerations and blisters.

The diabetic patient may also have a deficiency in their circulation. The diabetic with both a wound and poor circulation could develop an infection or even gangrene.

This type of event could possibly lead to a partial amputation of the foot.

When the diabetic has nerve damage and circulation problems it is important to notice changes in the feet to prevent any complications.



Prevention:
Control of glucose levels

Regular visits to the primary care doctor

Inspecting the feet regularly:

Look between toes

Check for any cracks, blisters, scrapes, or ulcers

Look at the bottom of the feet (use a mirror if needed)

Wear protective shoe gear

Preventing any injury to the feet

Wash your feet with mild soap and water (Do not use hot water)

Dry carefully between the toes

If you note any lesions or any signs of infection notify your podiatrist immediately

See the podiatrist regularly for foot care

Never try to trim calluses yourself

Wear good fitting shoes

Avoid tight shoes and high heels

Wear clean socks and change them daily

Do not walk barefoot

Make sure there is nothing in your shoes before putting them on

Apply proper sun screen



When foot problems are found early proper treatment can take place. Notify your podiatrist immediately. Early treatment and care of a minor problem may prevent a major problem such as a serious infection.



Foot problems can be prevented through good glucose control, daily foot care, and regular inspection.

Olympic Feet

With the winter Olympics going on right now, it makes me think of all the different sports we are able to participate in. Sports that ask us to run, jump, kick, twist, turn, and glide. Sports that ask for speed and agility that, without the versatility of our feet, would not be possible or at least would look quite a bit different!

The 26 bones and 33 joints in each foot allow us to effortlessly become mobile in many different ways. When I see someone skate their heart out down the length of the ice and stop on a dime, my breath is taken away. Though it may seem like the boot is doing the work, anyone who has ice skated before and had sore feet the next day will tell you otherwise. The complexity of the foot is amazing. And even more amazing than that are the mechanics that make a human foot work properly, the podiatrist.

Though feet are not visible during the winter Olympics, they are still a very important part of the games. A ski or a skate is merely an extension of the foot. Bobsledding wouldn’t be possible without the help of our feet mustering up enough momentum to make the sled go. Even changing the balance and placement of your feet in curling can change your game.

During the 2010 winter Olympics root for team feet! And keep in mind all the amazing things your feet do for you everyday.

Though we are all about feet, we want to recognize those who haven’t given up the games they love because their mode of movement is different than the movement of the original game. We want to recognize how these sports have been modified to work for all kinds of people. For more information about wheelchair and ambulatory sports check out http://www.wsusa.org/.

Take Me Out To The Ballgame

For over one hundred and fifty years, Americans have been devoted to the game of baseball as both fans and participants. With the arrival of each spring, thousands of people across the country search for their gloves and cleats in preparation for the upcoming baseball and softball season.

Spring also brings an influx of patients to the local emergency rooms and doctor’s offices because of the injuries associated with our national pastime. Before you ever step up to the plate, take the time to ensure that you are actually ready to run the bases. Read more about baseball and your feet in my new article Baseball and Your Feet.

Learn more about sports injuries here!