Does Turning 30 = Foot Pain?

I'm sure by now you've seen the hit website, Buzzfeed, which displays popular social content on the web. Well, the other day I was scrolling through and an interesting title, 30 Unexpected Things You Learn in Your Thirties, caught my eye.

Working at Shenandoah Podiatry, naturally #16 jumped out at me:

I love the reference to orthotic shoe inserts as they really are an investment and they really do help with back pain (in addition to knee and foot pain!)

So our question is, when you hit the big 3-0 did you experience back and foot pain out of the blue? If you are experiencing any pain or discomfort, give our office a call! We do our best to work with your schedule and get you in quickly to see one of our doctors! We are conveniently located in Blacksburg (right off of 460) and in Troutville (North Roanoke right off 81).

Worker's Hand Attached to Foot!

A worker's hand was cut off by a machine late last month and was temporarily attached to the man's foot in order to preserve the hand! Who knew you could do that?? After doctors worked on other injuries for the man, they removed the hand from the foot to reattach to his wrist. Despite having to wait for him to recover in order to complete the reattachment, the man is doing well and will need to have several other procedures conducted once the hand is reattached.

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So basically we want to stress, if your hand gets cut off in an accident, let the docs know they can attach it to your foot to prevent it from dying (temporarily).

Leo DiCaprio with a Cane!

Did you recently see Leo walking around with a cane? Apparently he was showing his architect a design and wound up popping a few ligaments, spraining his ankle. Besides his upcoming premier of The Wolf of Wall Street, DiCaprio doesn't seem to be phased of his ankle injury. Luckily he looks pretty good, even with a cane!

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So how do you sprain your ankle? Well, just as DiCaprio experienced, it's caused by stretching or tearing one or more ligaments on either or both sides of the ankle. Many patients are seen in the winter with ankle sprains due to weather related injuries and of course a plethora in the spring as kids are starting up their sports and running starts up again with the warmer weather.

In order to prevent ankle sprains:
- always wear proper footwear
- warm up prior to exercise
- carefully run or walk on uneven terrain

Treat ankle sprains with RICE therapy- Rest, Ice, Compression and Elevation. If you are experiencing pain or swelling even a week after the incident, give our office a call! We are accepting new patients in both our Blacksburg and Troutville (North Roanoke) offices!

Are You Wearing the Wrong Shoes?

Tone It Up (#TIU), a website dedicated to educating people on fitness and nutrition, features a member of their "community" every Tuesday. One of the questions the TIU team asks the members on the feature is "Did you have any setbacks along the way? How did you overcome them?" A recent members response is as follows:

"I did actually have a pretty big set-back. In May 2012, I ran the 500 Festival Mini Marathon, but I ran in the wrong shoes (minimalist shoes). Shortly after finishing, my left foot began hurting badly. I went to the doctor and found out that I had two stress fractures in my foot, which forced me to stop just about all types of exercise for several months. I've just recently reintroduced running back into my routine. Even though it's been over a year, still bothers me. Now, I'm a huge advocate for making sure people wear the best shoes for their body!"

As this member states, you do need to find the best shoes for YOU. A doctor or shoe salesman can't say, "this is the perfect shoe for all runners, walkers, etc." Each person needs to be evaluated in a few different ways and seeing a podiatrist is the first step in a successful exercise regimen.

Alec Baldwin's Wife with Twisted Ankle!

It looks like Mrs. Baldwin went for a run and wound up being chased by paparazzi on bikes! Crazy! One wound up getting too close to her and she twisted her ankle. Her instagram feed shows her icing her ankle (way to go!).

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Have you ever twisted you ankle? It certainly isn't a pleasant injury but completing RICE therapy (Rest, Ice, Compression and Elevation) can help you get back on your feet sooner than you think!

In addition to treating twisted ankles in our Blacksburg and Roanoke offices, we also treat patients with sprained ankles, fractures, broken bones and of course ingrown toenails, warts and much more!

If you or a loved one is in need of foot and ankle care, either

It's Turkey Day Craft Time!

Are you looking for some crafts for the kiddos while dinner is preparing this Thursday? Well look no further, below our craft is easy and you probably have most of the supplies laying around your house.

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Of course we had to pick our craft by choosing the one with a foot involved! The only supplies you need are:
- red/maroon washable paint
- yellow washable paint
- brown washable pain
- bubble/wiggly eyes
- paper
- glue
- paper plates

Instructions:
1. Press your hands into the red paint and press them onto the paper with palms next to each other to create a feather look
2. Repeat step 1 with yellow paint
3. Now press your foot into the brown paint then on the paper with your heel at the top of your paper
4. Adhere bubble eyes with glue at the top of your heel
5. Dip your finger into the yellow paint and press a dot just below the eyes
6. Dip your finger into the red paint and drag it a couple centimeters next to the nose

Ta-da! You now have fun turkey art and a fairly easy clean up :)

Did you know we treat children in both our Blacksburg and Roanoke offices? Well, we do! Everything from ingrown toenails, warts, broken bones, fractures and much more! If you your child is suffering from pain or discomfort, give us a call and we'll work with your schedule for your preferred date and time!

Metatarsalgia

Metatarsalgia translated means pain in metatarsals or ball of the foot.  In other words it is medicines junk term/diagnosis for pain in the ball of the foot.  It doesn't describe the location or cause of the pain making it more difficult to effectively treat. 

For example if a patient presented with pain in the ball of the foot (metatarsalgia) and radiographs revealed a fractured bone then I would diagnose a broken bone not metatarsalgia.  On the other hand if a patient presented with pain in the foot with no obvious diagnosis after a physical exam/radiographs then I would diagnose metatarsalgia.

If you feel you have any questions or concerns, or you have a foot or ankle concern give us a call at 808-4343!

- Dr. Marshal Gwynn

Fall Foot Blues

Do your feet hurt more than ever since summer has ended? If so, you are not alone. We see a lot of patients like you each fall. When it comes time to put the summer shoes away, these people get the shoe blues. 

In summer, sandals provide the freedom which allows your feet to feel comfortable. If you start wearing closed shoes again in autumn, the shoes can rub against bunions and hammertoes and cause you pain. Sometimes the friction of shoe against skin can cause painful corns and calluses to build up. Your first line of defense is to wear comfortable, well-fitting shoes. Pick footwear with a toe box wide enough so that your toes aren’t crowded together. If you wear shoes with heels, keep the heel height to two inches or less to avoid putting pressure on bunions. Wear socks to reduce the friction of shoes against your feet. You may also want to take your shoes to a shoe repair shop and get them stretched in the areas that are bothering you. Using the pads to shield the corns may help, but avoid medicated pads, which contain acid that can be harmful. 

If you try our tips to no avail, contact our office. There are several types of conservative treatments we can offer before we suggest surgery including:

• Trimming corns and calluses professionally- don’t attempt this yourself because you run the risk of injury or infection.
  
• Providing custom shoe inserts
  
• Injecting corticosteroids, which ease pain and inflammation or prescribing pain medication

If conservative measures like these don’t give you results, surgery may be your next alternative.

Don’t let painful feet and toes keep you from enjoying all that fall has to offer, visit our www.ShenandoahPodiatry.com!

Foot Cream to Kill HIV?

Ciclopirox, a drug commonly used to treat foot fungus, has been suggested to kill HIV cells. "In a study performed at Rutgers New Jersey Medical School, not only does the drug Ciclopirox rid infectious HIV from cell cultures, but the virus also doesn't bounce back when the drug is withheld." - CNet.com

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However, because the drug is a topical it does not treat the whole body (a systematic treatment) meaning it only prevents HIV not actually treating it.

Luckily, since the drug is already FDA approved for human use, the process of approval for HIV use might be sped up!

To learn more about the research and interviews head to cnet.com

Patient Testimonials

We are so fortunate to have such caring patients. We're glad we're able to serve the New River Valley and Roanoke Valley communities!

You're Active! So Keep Your Feet Fit!

Are you a daily walker, a hiker or a triathlete? Any level of intensity in your daily activities can create any of the serious and common injuries below.

Let's take care of your feet together, because healthy feet are happy feet!

Heel Pain- the most common complaint from runners caused by inflammation of the ligament which holds up the arc, known as Plantar Fasciitis

Causes:

• Plantar Fasciitis is classified as an overuse injury, the same as tendonitis. Sudden increase of activities such as going on vacation, starting a new exercise routine or changing jobs can contribute.
• Wearing non-supportive footwear on hard surfaces puts abnorman strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one's job requires long hours on the feet.
• During the summer months, we see an increased number of patients in our offices with plantar fasciitis due to walking barefoot or wearing flip flops. Obesity may also contribute to plantar fasciitis.

Neuromas- A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the 3rd & 4th toes.

The thickening, or enlargement, of the nerve that defines a neuroma is the results of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

Tendonitis- The Achilles tendon is the largest tendon in the human body and is very strong, but is also the tendon we rupture most often. Everyone who is active can suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Treatment depends on the degree of injury to the tendon, but normally includes rest, which may mean a total withdrawal from running or exercise for a week, or simply switching to another exercise, such as swimming, that does not stress the Achilles tendon.

Stress Fractures:

A stress fracture usually occurs in the feet and legs. They are more common in sports like running or jumping, because this type of activity forces 2-3 times the person’s body weight onto the lower limbs. The biggest symptom with a stress fracture is pain with tenderness and swelling that worsens with weight-bearing exercise.

Make sure to see a podiatrist so we can keep you active into your late, late years!

Foot Problems? Get them in shape for summer!

Come learn ways to get your feet in tip top sandal shape for summer! Dr. Kate will give suggestions on ways to treat bunions, hammertoes and heel pain as well as running tips (are you a heel striker?) to reach your PR!!

Bring your questions and get answers!
No pre-registration required, this is a FREE event!

Virginia Tech Triathlon Club

Thanks to the Virginia Tech Triathlon Club, Dr. Kate of Shenandoah Podiatry was able to spread more information on foot and ankle care (especially now that it's training season)!

Listed are a few of the questions members asked:

• Member: Should I scrape off my calluses before a run?
• Dr. Kate: I find them to be beneficial, especially before race day. If you remove them, you might get blisters! You can certainly scrape off a couple of layers if you prefer, just don't make the skin raw and therefore vulnerable

• Member: I have tendonitis on the top of my foot, what can I do about it?
• Dr. Kate: Ice your foot 10-15 minutes a few times a day, stretch, don't tie shoes too tight, and try stretchy laces that you can get a Dicks Sporting Goods.

• Member: Can you correct your overpronation?
• Dr. Kate: There are certain ways where you can make you foot over pronate, less. You can train you foot to midfoot strike instead of heel strike as well as wear orthotics.

Got Feet? Your Guide to Sports & Running Injuries

Shenandoah Podiatry offers two free books, "Got Feet? Your Guide to Sports and Running Injuries" and "Got Feet? A User's Guide to Foot and Ankle Health." Today I'd like to take an excerpt out of our running book, as more and more people are slipping on their running shoes to hit the Huckleberry trail in this beautiful Blacksburg weather!

"Chapter 10: How Do I know if I Need Orthotics? Foot pain is not normal and should not be ignored. It can lead to complex problems that can affect the functioning of other parts of the body, including the hips, knees and back. Foot-related problems are often treated very successfully with functional orthotic shoe inserts.

Orthotics are prescribed to:

• Reduce pain
• Provide support
• Prevent or slow down the development of a foot deformity
• Provide better positioning of the foot, knee and hips
• Improve the overall biomechanical function of the body"

As you can see, Shenandoah Podiatry is here to help. We want you to be an informed patient, knowing what we can do to help and how. To receive your free book, head to our website and request either one or both!

Nail Disorders

Anatomy of the Nail:

Nail Plate- Is the hard and translucent portion of the nail.

Nail Bed- Is the skin underneath the nail plate.

Matrix- Is the part in which the nail rests and is responsible for the production of the cells that become the nail plate.

Hyponychium- Distal nail groove which forms a seal that protects the nail bed.

Nail Grooves- Medial and Lateral

Lunula- The whitish crescent-shaped base of the nail.



Nail disorders are more common than people know. There are a number of different nail disorders that can be treated by your podiatrist. Nail abnormalities can show problems with the color, shape, texture, or thickness of the nails. Sometimes the nails can tell the health of a patient.


Here is a group of some common nail disorders:

Anonychia- This is the absence of the nail itself.

Beau's Lines- Is a depression across the nail plate which is caused by a stressful event.

Green Nail- A disorder of the nail that may be due to an infection caused by Pseudomonas.

Hapalonychia- A pliable nail plate that is usually caused by hyperhidrosis.

Clubbed nail- When the angle of the nail plate and proximal nail fold is greater than 180 degrees. This condition may occur in cardiac, pulmonary, or gastro-intestinal disease.

Koilonychia- This is known as a spoon nail. This condition is seen in iron deficiency anemia.

Leukonychia- Is a disorder of the nail where the nail exhibits white spots.

Lindsay's Nail- A condition that shows the far half of the nail discolored pink or brown and the near half dull and white. This disorder is seen in liver disease.

Macronychia- Is an abnormally large nail.

Mee's Line- A white band across the nail that is associated with arsenic poisoning or a stressful event.

Melanonychia- A disorder that demonstrates longitudinal, pigmented bands in the nails .

Micronychia- Is an abnormally small nail.

Onychatrophia- This disorder shows atrophy of the nail.

Onychauxic Nail- This disorder shows hypertrophy (Thickening) of the nail.

Onychia- A disorder where there is inflammation of the matrix.

Onychocryptosis- This is an ingrown nail.

Onychogryphosis (Rams horn nail) - Another disorder where there is thickening of the nail.

Onycholysis- This is a separation of the nail plate from the nail bed.

Onychomalacia- This is a softening of the nail plate.

Onychomycosis- Is a nail that is infected with a fungus.

Onychophosis- This type of nail is seen with a callus in the nail groove.

Onychopuntata- This disorder shows pitting of the nails as seen in lichen plannus, alopecia, and psoriasis.

Onychorrexia- Nails that are abnormally brittle.

Onychoschizia- This condition demonstrates splitting of the nail plate into layers.

Paronychia- Inflammation of the tissue folds around the nail. There may be infection with this type of nail.

Raquet Nail- A short and fat nail.

Subungual Hematoma- Associated with trauma. There is formation of a hematoma underneath the nail plate.

Terry's Nail- With this condition the proximal 2/3 of the nail plate is white. This disorder can be seen with hepatic cirrhosis.


So you see, there are many disorders of the nail. Some disorders may be more serious than others. If you suspect any nail disorders, make an appointment with your podiatrist to be properly evaluated.

Your legs are different lengths? No way!

You are at the tailor having your pants altered when the tailor informs you of the discrepancy in your leg length or, if you go to a bad tailor, they may measure one leg only and you notice the difference when you wear your pants for the first time. What is going on? Did the tailor make a mistake or are your legs really two different lengths?

One of the myths that seem to have become fact is that everyone has different length legs. Yes, it may not be exact to the faction of inch (or millimeter), but from a “macro” perspective your legs should be fairly equal. Most people do not ever realize that there is a discrepancy. If the length difference is causing problems, our podiatrists can help.

At Shenandoah Valley Podiatry we can measure the limbs in two different ways. We will take a measurement with our patient lying down; this measures the actual lengths of the bones, without any soft tissue involvement or input from issues such as scoliosis. It is known as the structural limb length. We will also find the functional limb length by taking a measurement while the patient is standing and with input from all structures.

Limb length difference can cause pain and injury in various ways. Most commonly, however, the pain is limited to one side. The pain can be experienced in the feet and ankles, knees, hips, or lower back. Symptoms can be felt in the upper back and neck because the difference in limb length affects the shoulders as well. Regardless of the location of pain, it is caused by the overuse of muscles and soft tissues that are forced to work harder than usual. When there is a difference in limb length, the long limb will try and shorten itself by the foot pronating, while the short limb will try to make itself functionally longer by supinating. This causes an imbalance which leads to the injury.

How can we treat your limb length discrepancy? Sometimes it is as simple as placing a lift under the short limb. Other times, physical therapy is needed to rehabilitate the soft tissue. You have tried both of those? Sometimes you need a custom molded orthotic to best control the abnormal motions. Unlike many other podiatry offices, Dr. Feeny has a personal guarantee that if you are not satisfied with the results you see within 90 days, return your orthotics and we will refund you 100% of the money you paid.

Our patients are often surprised at how quickly we can heal their lower extremity pain with these options. Schedule your appointment today with Dr. Feeny or Dr. Kate. Remember, we are here to keep you going!

Time Wounds All Heels - Literally

When John Lennon said, "I believe that time wounds all heels," I'm pretty sure he was referring to karmic justice and not our feet. But the literal interpretation isn't far from the truth!

Something we have seen patients complain of increasingly in our offices is heel pain - given many years, lots of walking, dancing, running, and general wear and tear, and wearing stylish-but-unsupportive shoes, it's no surprise that people's heels are hurting!

A common cause of heel pain is plantar fasciitis, meaning inflammation of the plantar fascia. The plantar fascia is a thick, broad band of fibrous tissue located at the bottom (plantar) side of the foot. It attaches to the heel as well as all five toes at the ball of the foot. The plantar fascia is not elastic like muscles are, so when we wear shoes with no arch support, our arches start to flatten and the plantar fascia pulls constantly where it is attached to the heel. This overworks the plantar fascia, causing it to become inflamed and irritated.

Given an infinite amount of time and many years of wearing unsupportive shoes, anybody could develop heel pain. If you're having heel pain, don't let your feet suffer anymore! Come see Dr. Feeny or Dr. Kate and they'll give you plenty of options to heal your hurting heels.

For more information, check out our website at http://www.blogger.com/www.shenandoahpodiatry.com.

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.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a condition that is caused by compression of the tibial nerve or its branches.

Tarsal tunnel syndrome is analogous to carpal tunnel syndrome of the wrist.

The tarsal tunnel is a narrow space that lies on the inside of the ankle.

The tunnel is covered with a thick ligament called the flexor retinaculum.

Structures within the tarsal tunnel include:
-Arteries
-Veins
-Tendons
-Nerves

Tarsal tunnel syndrome is a compression on the posterior tibial nerve.
This syndrome produces symptoms anywhere along the path of the nerve.

Possible symptoms include:

-Tingling
-Burning
-Numbness
-Shooting pain
-Paresthesias

Contribute Factors to Tarsal Tunnel:
-Soft tissue masses:
Lipomas-is a benign tumor composed of fatty tissue
-Tendon Sheath Ganglia:
Neoplasms- is an abnormal mass of tissue as a result abnormal proliferation of cells
-Nerve tumors
-Varicose Veins

Work up:

Tinel sign- Percussion of a nerve with radiation of pain along the course of the nerve.

The doctor may order any of the following tests to help with the diagnosis:
-Electromyography (EMG) - A technique for evaluating and recording the electrical activity produced by skeletal muscles
-Nerve conduction velocity (NCV)
-Magnetic resonance imaging (MRI)- In cases of suspected soft-tissue masses and other space-occupying lesions
-Ultrasonography
-Radiography

Conservative Treatment:

-Rest
-Ice
-Non steroidal anti-inflammatory drugs-to help reduce pain and inflammation
-Immobilization- Restricting movement of the foot by wearing a cast or cam boot
-Physical therapy
-Injection therapy
-Orthotic devices. To control any abnormal bio mechanics of the foot








-Surgical Therapy

Tarsal tunnel release surgical intervention may be needed if conservative therapy fails to alleviate pain and symptoms. This procedure is used to decrease pressure on the posterior tibial nerve. Any space occupying lesions may also be excised.
                                                           Learn more at http://www.shenandoahpodiatry.com/

Tailor's Bunion

Tailor's bunion is as an acquired lesion that causes chronic pain and swelling over the outer aspect of the distal foot. It is also known as a bunionette and is characterized by a painful prominence on the outer aspect of the foot in the area of the fifth metatarsal head.

These types of lesions were often seen on tailors with a cross-legged sitting posture. The posture resulted in pressure being placed on the lateral side of the foot.

Causes

Extrinsic causes - Commonly chronic

• Tailors' posture
• Footwear

Intrinsic causes

Structural Abnormalities

• Lateral bowing of the metatarsal shaft
• Enlargement of the metatarsal head
• Congenital splayfoot

Presentation

• Symptoms - Painful keratoses on the outer, bottom, or top aspect of the metatarsal head.

Imaging Studies

• Weight-bearing x rays of both feet
• Vascular studies are important with patients who have questionable circulation

Treatment

Conservative

• Padding
• Shoe modification
• Orthotic devices
• Anti-inflammatory medications
• Corticosteroid injections

Surgical Treatment

• Can be treated with simple removal of osseous bump when there is no evidence of anglular deformity
• With an angular deformity or a deviation in the bone is present an osteotomy (cut in the bone) is made and held together with a screw. The level of bone cut varies with the level of the deformity.

Possible Complications

• Malunion- Incomplete union or union in a faulty position
• Nonunion- A nonunion occurs when a broken bone does not heal
• Nerve Injury
• Joint pain and stiffness
• Symptomatic hardware
• Infection
• Recurrence