4th Quarter Injury?!

Can you imagine getting injured during the 4th quarter of a game? Let alone the Superbowl? How many saw cornerback Richard Sherman go down and gasp at the unfortunate event? Luckily, with the Seahawks in the lead there was no rush to put Sherman back in the game. The last quarter was the second time Sherman hit the bench due to his injured ankle.

Due to Sherman ignoring his injury and pain when he originally hurt his ankle in the beginning of the game, Sherman may have caused an even more severe injury. In both our Blacksburg and Troutville offices, we never want you to ignore your pain! Forget the phrase, "walk through the pain" as we don't want to injure yourself even more! Just remember, your feet shouldn't hurt! Now onto the reason we actually watch the Superbowl: commercials! My favorite is absolutely the Budweiser puppy commercial If you or any loved ones have any pain or discomfort, don't hesitate to give our office a call! We will do our best to work with your schedule and get you in quickly!

What Causes Gout?

"Gout is caused by an increase, or build up, of uric acid in the body.  It is usually a result of a decreased excreation of uric acid in our urine.  Initially the uric acid is found in the blood, but over time it will defuse throughout the body.  This includes the joints.  As uric acid increases in concentration in the joints it is more likely to crystallize.  These crystals can cause a lot of pain during an acute gout attack. 
 

The question can be asked: Why is gout usually seen in the feet?  Uric acid is not water soluble.  This means that it will crystallize if given the right conditions.  First, in high enough concentrations it can crystallize.  Second, as temperature decreases it is more likely to crystallize.  Gout can be found in any joint, but I believe it happens more in the feet because of the decreased temperature found in the feet.  The feet are the structures in the body that are furthest from the heart, making them the coolest. 

Symptoms of an acute gout attack include pain, edema (swelling), and erythema (redness) around the joint involved.  It is common to see a patient that was drinking alcohol or eating a steak dinner one evening to wake up the next morning with an acute gout attack.  The pain is usually 10 out of 10 and can be so painful it hurts to even let the bed sheets rest on the affected area.  An acute gout attack can mimic different arthritic conditions, including septic arthritis.  A diagnosis is made definitively through joint aspiration, which is then sent to a pathology lab."

- Dr. Marshal Gwynn

Heels, Yeah!

Extracted from Shape Magazine November 2013

After one hour and six minutes of wearing heels, most women are in pain, a new U.K. survey found. Still, more than 40% say they're willing to suffer for fashion. Sound familiar? Lessen the hurt with these tips from heel-wearing podiatrists in New York City:

1. Find the Right Fit: Narrow feet can slip around in shoes, so choose a heel with an ankle strap for added stability, Krista Archer suggests. If you have wide feet, your best bet is a wedge with a rounded toe box, which is more forgiving on joints than pointy-toed stilettos.
2. Be a Pencil Pusher: "Slip off your shoes under your desk at work, put your feet together and try to pick up a pencil with your toes to activate the 38 muscles in each foot and strengthen your arches," Suzanne Levine advises.
3. Stretch It Out: "Over time, wearing heels of the same height will cause your Achilles tendons to tighten and shrink, which can lead to pain," Jacqueline Sutera says. Do a few downward dog stretches each night to release tension in the back of your legs. 

foot with narrow flats on

foot without shoes on

If you notice deformities developing (hammertoes, bunions, taylor's bunion) or pain from your current deformities, don't hesitate to give us a call. There are plenty of conservative and surgical treatments available!

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

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.

Got Gout?

Got gout? If so, here is a recommendation for reducing you pain and discomfort! Watch what you eat and drink. Changes in diet, including overindulging in certain foods and beverages can cause gout attacks.

Gout attacks are extremely painful, they are caused with uric acid accumulates in the tissues or a joint and crystallizes. This most commonly occurs in the big toe joint because the toe is the coolest part of the body and uric acid is sensitive to temperature changes. Foods high in purines contribute to uric acid build up. People prone to gout attacks should avoid purine-rich items such as shellfish (shrimp, crab, etc.), organ meats (kidney, liver, etc.), red meat, red wine and beer. Gout can be treated with medications, diet changes and increasing consumption of appropriate fluids. In some severe cases surgery is required to remove uric acid crystals and repair the joint. For more information on gout, visit our website at www.ShenandoahdPodiatry.com.

Super Bowl 47 Injuries

As the two teams lined up for their grand entrances into the Superdome last night in New Orleans, some of the players were facing questionable injuries. Let's break them down (not literally):

• Ravens: WR Tandon Doss (ankle)
• Ravens: LB Dannell Ellerbe (toe, back)
• Ravens: FB Vonta Leach (knee, ankle)
• Ravens: LB Terrell Suggs (achilles, bicep)
• 49ers: TE Garrett Celek (foot)
• 49ers: S Dashon Goldson (foot)
• 49ers: RB Frank Gore (ankle, shoulder)

source

It's unfortunate it doesn't matter which sport you play, you're likely to get injured. However, in order to not keep you off your feet for too long with an injury, stop playing when it hurts. We don't like to hear, "play through the pain," it's more likely the injury will get worse if you just ignore it! Both our Blacksburg and North Roanoke offices see athletes of all levels daily. From Virginia Tech players to Hollins, our goal is to get them back on the playing field in the appropriate time frame. If you are having any kind of discomfort in your lower extremity, please take our advice and seek professional help. It may be a quick fix or a boot may be necessary- but the sooner the better!!

Wedding Shoes

As a bride-to-be, my current fixation is…wedding shoes! I'm hoping I'll be able to wiggle these into the wedding budget somehow, we'll see! 

As I've scoured the stores and websites (hello Nordstrom) I've become unsatisfied with my results (residing in Southwest VA doesn't help either). My original goal was to find hot pink satin wedges since the ceremony will be in grass. Then the whole "gold glitter" craze began and the pink shoes were out the window. After I found the dress I unfortunately came to the realization that I can't wear gold glitter shoes- as I have silver detailing on my dress. 

Now I've decided to go back to the pink shoes but they must be…pink glitter shoes!! And now my focus has somehow turned to Jimmy Choos and Christian Louboutins. And honestly people- it's my one chance to go ALL OUT! 

Of course I have a few rules in order for one of these ridiculously over priced pair of shoes to come to my hands: they have to be comfortable and they can't be in the quadruple digits unfortunately. 

Now let's get into why these shoes are priced the way they are and how to people (other than being their wedding shoes) justify them? 

At the low price of $3,395 these break my "quadruple digits" rule

A salesman at the Christian Louboutin boutique in LA explains, "each shoe is handmade in Italy using only the finest materials. Each craftsman has a specific job and they employ the best people. Christian left school at the ripe old age of 12 and has been designing shoes since then. His company launched in 1991 and his shoes have been a favorite of celebrities and royalty, Princess Caroline of Monaco was one of his first customers, ever since." Sounds like a good enough reason to me *visions of red soles dance in my head* -source 

One 'investigator' reports she has two pairs of Loubs and while she can wear them for a couple of hours, after that the effects of the narrow toe box kicks in…ahh the price to pay for beauty!

The one token of advice I've come across time and time again is, "buy what you can afford." I completely agree with this and that's why I'm using my wedding budget to pay for them! 

What Does a Podiatrist Do?

A Podiatrist is a foot and ankle specialist- we offer all services listed below and more!

Dr. Kate Steklachich

Dr. Jennifer Feeny

• Surgeries- everything from removing a bunion to reconstructive surgeries 
• Bunions
• Warts
• Ingrown Toenails
• Routine/Diabetic Foot Care
• Custom Orthotics & Over the Counter Orthotics
• Heel Pain/Plantar Fasciitis
• Heel Spurs
• Bone Spurs
• Neuropathy
• Neuroma
• Corns/Calluses
• Athlete's Foot
• Nail Fungus
• Injuries

The list can really go on and on! Our Blacksburg and Roanoke offices want to stress that we specialize in feet and ankles. A lot of people may think going to a general surgeon or orthopedist for surgery is a better idea than a podiatrist for a problem they are having with their feet or ankles. However, because we specialize and are day in and day out dedicated to this specific area- we know it best! If you have a question about a condition, pain or something else you are experiencing and it isn't listed here or our website- give us a call! We are happy to answer any questions you may have. 

Arnica Pain Relief

A couple days ago in our Blacksburg office, a patient mentioned to me a cream she has been using for pain. She mentioned it even helps with bruises! I had to immediately ask the name of the cream and she said it's called Arnica and she buys it at Annie Kay's Natural Food Store in Blacksburg, VA.

I know a woman that works over there and asked her to send me some information on it. Turns out it's a best seller item and all the employees swear by it! I love learning about new products from my patients.

Here is a bit more information about the pain relief cream:

• Reduces pain, swelling and discoloration from bruises
• Temporarily relieves muscle pain and stiffness due to minor injuries, overexertion and falls

If you'd like to learn more visit their website at: www.boiron.com

- Dr. Kate

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.)!

What Do Podiatrists and Pedometers Have In Common?



They both involve FEET!

Health experts- myself included- say 10,000 steps a day is the magic number to get (or stay) on the healthy track. Side effects include increase in energy, weight loss and less frequent sickness (<- I’d take those side effects any day!)

One tip to obtain these “side effects” is to keep track! Make sure you record your total number of steps per day to keep yourself accountable. You might be expecting these results when you assume you’ve walked that amount each day when in reality it’s only been 7,500 or 8,000 steps. If you’re really looking for weight loss, go ahead and write down your food intake daily and you might see double digits lost on the scale sooner rather than later!

If you find any pain after your daily walks, make sure to see a podiatrist as soon as possible so you can get back on your feet!

- Dr. Kate Steklachich

Outrun Injuries

Zurich Marathon (Photo credit: Wikipedia)

If a nagging ache is keeping you off the treadmill, track, or trail, the fix may be in your feet. Research recently published in Medicine & Science in Sports & Exercise found that runners who land on the ball of their foot are 40% less likely to have repetitive stress injuries than those who touch down heel-first.



"I don't recommend minimalist shoes if you have a history of chronic injuries or if you run extreme mileage. Runners can still run in adequate running form in regular running shoes, minimalist shoes aren't always necessary," Dr. Kate Steklachich, D.P.M.

Following the strategies listed to (slowly) switch up your strike:

• Touching down with a stiff leg ups the force of impact, so keep a slight bend in your knee
• Bend your back knee more than usual, and don't let your rear leg lag behind. This will help you take short, fast strides (aim for 165 steps a minute), lessening your injury risk.
• When your foot hits the ground, it should be aligned with your hip.
• Angle your foot slightly down and land on the outer ball of your foot, behind the second-to-last pinkie toes. After the front of the foot hits, let your heel naturally touch down, then push off your toes again to begin the next step.

source: Shape Magazine August 2012 Issue

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.

source

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.

Sports Injuries & Children

English: Child Soccer player. (Photo credit: Wikipedia)

If your children are playing sports this fall, pay attention to six tips that could protect them from serious ankle injuries.

Every fall season, foot and ankle surgeons see an increase in ankle injuries among young athletes. Football, soccer and basketball are the sports most likely to lead to sprains, broken bones and other problems, says Roanoke and New River Valley area podiatrist Jennifer Feeny, DPM.

"What seems like a sprain is not always a sprain; in addition to cartilage injuries, your son or daughter might have injured other bones in the foot without knowing it. Have a qualified doctor examine the injury," says Dr. Feeny. "The sooner rehabilitation starts, the sooner we can prevent long-term problems like instability or arthritis, and the sooner your child can get back into competition." Dr. Feeny, who is a Fellow of the American College of Foot and Ankle Surgeons (ACFAS), offers these additional tips for parents:

--Have old sprains checked by a doctor before the season starts. A medical check-up can reveal whether your child's previously injured ankle might be vulnerable to sprains, and could possibly benefit from wearing a supportive ankle brace during competition.

--Buy the right shoe for the sport. Different sports require different shoe gear. Players shouldn't mix baseball cleats with football shoes.

--Children should start the season with new shoes. Old shoes can wear down like a car tire and become uneven on the bottom, causing the ankle to tilt because the foot can't lie flat.

--Check playing fields for dips, divots and holes. Most sports-related ankle sprains are caused by jumping and running on uneven surfaces. That's why some surgeons recommend parents walk the field, especially when children compete in non-professional settings like public parks, for spots that could catch a player's foot and throw them to the ground. Alert coaching officials to any irregularities.

--Encourage stretching and warm-up exercises. Calf stretches and light jogging before competition helps warm up ligaments and blood vessels, reducing the risk for ankle injuries.

For more information on treating ankle sprains, visit ShenandoahPodiatry.com

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

Got Feet?

Because of my unique training in the care of feet and ankles, I see people every day who suffer from foot pain. So often my patients tell me that they've been experiencing symptoms, including pain, for very long periods of time before they finally come in to see me. In some cases they've waited years! Sometimes when I'm out in the community, at the grocery store, for example, I'll see folks I know who say, "Hi Doc. You know I need to come in to see you because I've got a pain in my ankle or my heel hurts." Then months will go by and I'll see them again and they'll repeat the same thing.

When they finally do come in, in almost every case I am able to alleviate their pain, treat their condition, and drastically improve their quality of life.

The big question I used to ask myself is "Why?" Why do people suffer needlessly for years when a quick trip to see me almost always relieves their problems? It used to bother me, but as I've continued to see patients I've come to understand that sometimes fear of the unknown is stronger than the pain or inconveniences my patients face.

What I've also learned is in case after case-even though my patients could have saved themselves time, trouble, and expense by just coming in to see me- patients didn't have enough information to help them clearly understand their foot pain and the incredible options that state-of-the art podiatric medicine offers today.

So, I created a publication. I wrote it for you. I also wrote it to help you clearly understand what is happening with your feet and to help you get a sense of the help that is awaiting you at a podiatrist's office. I hope it is helpful and that it answers your questions. If after reading it you think you might be helped by seeing a podiatrist, I hope you consider Shenandoah Podiatry. My staff and I will do everything we can to treat your condition, reduce or eliminate your pain, and make you feel at home.

To Receive Your FREE Copy of Got Feet?- A User's Guide to Foot and Ankle Health fill out this short form!  

Summer Sandal Recommendations!

Summer, a time people love to wear sandals, unless stricken with plantar fasciitis!  Solutions? Trash the flimsy flops for actual good supportive sandals.
Check out these fashionable brands that I recommend.

   Orthaheel
   Birkenstock
   FitFlop
   Dansko  
                                         
Source

Hope these recommendations lead to a PAIN free summer!
            

                                        -Dr. Kate

Ankle Injuries: More than just an annoyance

Though ankle injuries are painful when they first occur, the long term damage that is caused can be even more detrimental. Ankles that have suffered an injury are seven times more likely to become arthritic that ones that have seen no trauma. Injuries can very in severity and still have the same long term affects. From inconspicuous reoccurring ankle sprains to more seemingly detrimental ankle fractures or broken bones, the damage that is caused is irreversible. Ankle cartilage is quite strong and can usually withstand a life time of movement but when the cartilage gets damaged its cells are unable to be repaired. Cartilage is made to glide smoothly to create movement but when it becomes worn or frayed the movement is not fluid. This leads to swelling, inflammation, and pain in the ankle joints. If proper treatment is not attained after the injury, post-traumatic ankle arthritis could very well occur in the future.

A study taken from 1991-2004 at the University of Iowa, studying 639 patients with grade 3 or 4 arthritis concluded that ankle injury is the most common cause of ankle arthritis. Trauma was the primary cause of arthritis in 445 patients out of the 639 patients surveyed. That is about 70%. The other 30% was caused by rheumatoid disease and primary osteoarthritis.

Symptoms of ankle arthritis include: pain or tenderness, stiffness or reduced motion, swelling, difficulty walking, bone spurs, and instability. No matter what stage of arthritis is present, or if arthritis is just a possible threat in the future, professional care should be sought. Podiatrists everywhere have many surgical and non-surgical options to help cope with the pain, prevent arthritis from over running everyday life, and catch arthritis before it become a problem.

Women's Traveling Feet Feel The Pain

Researchers recently found a strong link between packing uncomfortable shoes and suffering foot pain while traveling. Young women are the most common victims of foot pain on the road. Not surprisingly, they are also the most likely to pack and wear uncomfortable, even dangerous shoes— high heels, flip flops, etc. —when traveling.

Eighty percent of the surveyed women under age 25 and 60% of surveyed women under 35 acknowledge that they sacrificed comfort for fashion on their last pleasure trip. While 60% of women, compared to 32 % of men, spent time planning their shoe selections for their trip, women were more likely than men to suffer foot discomfort related to poor shoe choices on their trips.

Switching shoes may not always be the best solution for correcting foot problems, but wearing appropriate footwear can prevent some problems from ever happening or alleviate others from continuing. As your foot care specialists, we can diagnose and recommend a course of treatment that may include a change in footwear, regular general care, medications, physical therapy, or orthotics. If your feet are tired of ill-fitting shoes, or if you are just tired of feet that hurt, we welcome your call at ShenandoahPodiatry.

P.S. Close to one-third of travelers admitted to packing either brand-new shoes, uncomfortable shoes, or both.