My Aching Foot

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Why do toe nails change after a toe injury?

2010-07-19T07:42:00.000-07:00

A question I am commonly asked is “why do toenails change shape after injuries“. For many people, dropping a heavy object on one’s toe or kicking something with a lot of force will result in a toenail (most often the big toenail) either loosening off and growing back thickened, curved, wavy, or off to one side, or staying on and growing out the same way. Cosmetically, this can be of concern, but, more importantly, it can also lead to a nail that is tender to pressure. This is especially true if the nail becomes ingrown as a result of these changes. Unfortunately, these changes are usually permanent, with the nail never returning to the way it was before the injury.

The reason for these changes has to do with the way that the nail is produced. A fragile group of cells under the skin at the base of the nail called the nail matrix produces the nail material. These cells can be easily damaged when an injury occurs to the toe, and a partial loss of normal nail growth can develop, leading to nail thickening, curvature, loosening, brittleness, and abnormal growth to one side or another. This abnormal nail is also more likely to be infected by fungus, leading to a whole other set of complications, Since the nail cannot be restored to its pre-injury state, one must simply live with it or have the nail permanently removed if the damage is bad enough.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com
thediabeticfoot.blogspot.com
thevideofootdoc YouTube channel

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Heel Pain and Heel Spurs: Don't Blame The Bone

2010-07-13T20:27:00.000-07:00

Heel pain on the bottom of the foot is common, and the infamous heel spur is often blamed for this problem. Unfortunately, this is factually incorrect and can lead many people into assuming surgery is the only treatment that will help this condition. This in turn often leads to many people not sticking with the treatment course most foot and ankle specialists prescribe, instead opting to find someone who will simply operate on the heel to reduce the pain.

Heel pain can become complicated at times, but it USUALLY due to strain of a ligament called the plantar fascia. This broad band of soft rubbery tissue is found on the bottom of the arch, and it begins its length attached to the heel bone. Due to flat foot strain, high arch shock absorption problems, or simple injury, the plantar fascia can become inflamed and painful to walk on. This condition can persist for years if not properly treated. The presence of a heel spur is sometimes seen with this condition, especially when flat feet cause strain of the plantar fascia where it attaches to the heel bone. The outer layer of the heel bone respods to this stretching by calcifying its outer layer. As the strain continues over a long period of time, this calcification continues, stretching out away from the main body of the heel bone. However, this type of calcified ‘spur’ forms in a direction that is parallel with the plantar fascia and the ground, and not sticking into the skin under the heel bone. Therefore, it does not cause pain in the heel, as it does not protrude into the heel pad. The inflammation of the plantar fascia will cause pain, in an area next to the typical location of a heel spur.

Many people who have had to have surgery performed to ‘cure’ heel pain (which is a small number of heel pain sufferers given the high success rate of non-surgical treatment) have also had the heel spur removed. This procedure is a remnant from past times in which the spur was once thought to play a more significant role in the development of heel pain. Due to the advances in our understanding of foot function and biomechanics over the last forty years, we now know that spur or not, heel pain is usually due to a complex system of strain on tissue that attaches near the spur, and not the spur itself. In rare cases of those with inflammatory diseases like rheumatoid arthritis, spur-like growth on the bottom of the heel can cause pain due to its own inflammation. For the rest of us, we can rest assured that the spur is without guilt, and the real culprit should gather our concern and attention.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com
thediabeticfoot.blogspot.com
thevideofootdoc YouTube channel

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

The Fit Shoe Fad: Helpful or Harmful?

2010-07-08T06:19:00.000-07:00

This week I would like to address the newest ‘trend’ in shoe design, the so-called ‘fitness’ shoe. This rocker bottom shaped shoe design has several manufacturers and styles. It has been out for awhile in the form of the MBT shoe, although more recently several major shoe brands have produced their own models. These include Reebok and Sketchers, amongst others. These shoes reportedly help shape the leg musculature, and are supposed to let the foot function closer to what some think are its evolutionary roots. As a podiatrist, I must urge caution with these designs, as they are based on a flawed premise of how the foot was formed and how it functions, and may be harmful to a wide range of individuals.

Let’s first discuss the good part. Rocker bottom design shoes have been used for decades to support and stabilize people with severe foot deformity, excessive pressure to the heel or ball of the foot, and people with pressure related foot sores. This design has a prominent place in medical shoe application. People without these problems can still benefit from this design, as seen by numerous testimonials and celebrity endorsements for the newer retail shoes. However, this is not universal for everyone, and in many cases a rocker bottom shoe design can be very difficult for the foot and leg muscles to function properly in.

The original marketing premise of these shoes centered around a theory that the foot must be restored to its evolutionary state in which it evolved when individuals walked on sand during our remote past. The rocker bottom design apparently replicates this. Unfortunately for those marketing these shoes, an understanding of the environment of the ancient human was not part of their education. Pre-historic evolutionary development of the modern foot did take place in Africa, but not necessarily in a desert environment as the marketing assumed. Generally, savanna and grasslands were a large part of the early humans walking environment, and the Sahara region was not always a dry desert. The notion that the human foot evolved primarily on sand is factually incorrect, and therefore the premise of the shoe design is incorrect as well. Interestingly, the marketing language of the shoe’s purpose seems to have shifted away from sand replication to ‘soft, uneven ground’ replication in light of most human’s hard flat surface walking in modern cities. Fortunately for us, the human foot has numerous adaptive structures to deal with hard, flat or uneven terrain, and the muscles of the foot and leg are specifically developed to support this. A special, expensive shoe is unnecessary for the foot to function properly.

The primary problem with these shoes is that they take away the natural functional cycles one’s foot and leg muscles have already trained for since walking began, and replace them with a new set of requirements that throw the muscle balance out the window. The ‘fitness’ or ‘toning’ aspect of these shoes is really muscle soreness from muscles having to work out of sync with their natural training and conditioning. One is not making themselves more fit, they are simply fatiguing muscles unnecessarily. There is no strength or fitness benefit to this change. It is curious that this unfortunate side effect that developed with the original use of this shoe design is now being marketed as an advantage to the shoe’s use by clever marketing professionals for the newer brands of this particular design. In addition to abnormal muscle fatigue, the strain to structures on the back of the leg, such as the Achilles tendon, can result in serious injury and long term consequence in those apt to developing tendonitis. Balance issues can also occur in those who have poor sensation or balance due to muscle weakness, advanced age, or nerve disease, leading to falls and injury.

Simply put, if you have chronic foot pain, the cause is usually due to injury from abnormal foot structure. That structure needs to be properly assessed, and controlled with either medically necessary support devices (orthotics) or surgical intervention, as well as treatment for the specific condition. Blindly trying the shoe fad of the year could potentially cause one’s problem to actually worsen, or at least create new problems due to muscle fatigue and strain. Shoes themselves are rarely the sole answer to foot pain, and are only a part of a proper treatment program. Shoes do not cradle the arch or general foot structure to a degree necessary to change foot function, despite what manufacturers will advertise. Shoes that alter the functioning of the foot and leg are worse that just shoes that are simply unsupportive, as they can actively cause injury by their very nature. There are those out there who will do fine in a rocker bottom shoe, and may even feel somewhat better in these shoes in the short term. However, for many feet and legs, these shoes come with a risk of injury after extended use, and are not generally recommended by most foot and ankle specialists for general daily use.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com
thediabeticfoot.blogspot.com
thevideofootdoc YouTube channel

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Puncture Wound Treatment At Home

2010-07-05T11:56:00.000-07:00

I hope everyone had a great 4th of July and had a safe celebration. Today I would like to talk about what to do if you step on a sharp object like a piece of glass or a splinter, as I’m sure this has happened to some of you celebrating by the pool, or barefoot in the backyard.

Numerous objects can potentially puncture the thick skin on the bottom of the foot, including glass, splinters, nails, screws, ceramics, metal filings, small rocks, plant stems, and needles. Unfortunately, these objects can contain bacteria and other microorganisms that can infect the body, so prompt removal is advised. If you step on one of these objects, the best way to keep the foot healthy is to try and gently remove the object from the skin if it is visible. By removing the object in the exact angle it entered into the body, you have much less of a chance of breaking it off in the skin. Using tweezers, gently grasp the object and pull outward at the same angle it is sticking in. Don’t brush it away or tug at it quickly. Once out, gently flush with water and a mild soap, but do not scrub the skin as this may imbed fragments sitting on the surrounding skin (for instance, if glass particles surround the main piece stuck into the skin). Inspect the area to ensure no further pieces remain on the skin, and gently cover the puncture site with antibiotic ointment and a band-aid. Keep it covered and changed daily for at least 3-4 days until the skin seals up. If you are unsure that you removed the piece without it breaking off in the skin, especially if long objects like splinters, toothpicks, or needles have broken tips where they were stuck into the body, see you podiatrist for evaluation. Do this as well if you cannot see any external trace of the object you stepped in the first place.

Over the next several days, inspect the puncture site. If it continues to be painful, or develops redness, swelling, warmth, or drainage, see your podiatrist. In these instances, a piece may have remained in the skin, causing inflammation, a cyst-like object, or an infection. Even if nothing remains, bacteria on the object may have been left behind after it was removed and an infection began. This requires drainage and an antibiotic to prevent a deep infection from occurring.

If you are diabetic, you should have your foot inspected whether you think all the pieces were removed or not, as serious infections can arise out of a simple puncture wound in diabetics.

Finally, one should make sure their tetanus shots are up to date, as some objects (particularly rusty, soil based objects like old nails) can cause a serious muscular disease due to toxins from certain species of bacteria. If it has been five years or more since your tetanus immunization, you should consider getting a tetanus immunization booster from your local urgent care center right away, especially if the puncturing object was dirty or from soil. If it has been over ten years, or if you have never been immunized from tetanus, then you definitely need to get your immunization after any puncture wound. You should call your primary care doctor or podiatrist for more specific recommendations.

Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com
thediabeticfoot.blogspot.com
thevideofootdoc YouTube channel

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Bunions In Kids

2010-06-23T17:51:00.000-07:00

Bunions are not necessarily a foot condition that afflicts older people. Did you know that bunions can also develop early in children? Juvenile bunions are not uncommon, and can potentially be a source of significant discomfort to children. An early developing bunion can be present for a wide variety of reasons. Traditionally, a typical bunion develops after many years of walking with a flat foot as the strain of flattening feet eventually force the big toe joint to deform. When a bunion develops early in kids, the process is a little different. It is probably a combination of the position of the developing child in the womb influencing bone growth, parental genetics, and the presence of foot structural problems that lead to this early development. There are also other factors, which include growth abnormalities in the position of either the long bone or the toe bone that influence the position of the bunion. An unstable foot structure, which includes excessively loose flat feet and feet with tight Achilles tendons, contributes to the acceleration of bunion formation. Another condition, metatarsus adductus, can lead to early bunions. This condition is seen when all the long metatarsal bones are angled inward towards the big toe. This condition is fairly frequent (one in every thousand births), and because the big metatarsal bone is angled inward already in this condition, the ingredient for a bunion to form is already there.

The treatment of bunions in kids is a little different than treatment for adults. In adults, except when not possible due to health issues, the typical treatment is surgical correction. Because children are still growing bone, surgery to return the bone to its proper position may not lead to a long term correction. Unless a child’s bunion is very painful and limiting activity, it is best to conservatively treat a bunion and delay surgery until after the bone starts to mature (near the start of the teen years). This conservative treatment includes wider shoes to avoid pressure on the bunion bump, stretching to keep the Achilles tendon limber, and prescription orthotic inserts to stabilize flat feet. When the time is right for surgery, the same procedures that are used for adults are considered in kids. However, due to the severity of an early developing bunion, more extensive surgery may be needed that requires a slightly longer healing time. If your child has a bunion, it may be well worth your time to have him/her evaluated by a foot specialist to determine if future treatment is needed.

Until next time,

Scott R. Kilberg DPM

The Painful Curly Toe

2010-06-09T06:58:00.000-07:00

The little toe, or 5th toe as it is medically referred to, is a curious object that sometimes seems to position itself independent of what the other toes are doing. One condition that often develops is a rotation of the little toe towards the toe next to it. Often called a curly toe, this condition is the combination of a hammertoe deformity (discussed previously in this blog), and an actual rotation of the toe inward. The result of this abnormal toe position is usually a very painful corn that forms due to the pressure from the shoe on the toe, where the toe bone is now prominent due to the toe rotation. At times, a corn can also form along side the outer edge of the nail where pressure on the ground builds up due to the toe rotation. This corn is often mistaken for an ingrown nail due to it’s closeness to the nail edge itself.

Treatment is fairly straight forward. One either lives with the condition and wears deeper, wider shoes with padding over the corn, or one has the toe straightened out surgically. This fairly simple procedure combines a fixing or straightening of the hammertoe deformity (by removing a small amount of bone near one of the toe joints), as well as a procedure to straighten out the toe rotation. Fixing the rotation can involve plastic surgery techniques to re-rotate the skin back around, or a technique to partially fuse the little toe with the base of the toe next to it to keep it stable and straight. Recovery is fairly simple, and complication rates are low.

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Deep Calluses..The Intractable Plantar Keratosis

2010-06-03T18:07:00.000-07:00

There are times in which a callus on the bottom of the foot becomes so large and painful that is actually is deeper under the skin than it is taller. Although it may seem like the callus has a seed, or a stalk, it is actually a normal callus that has developed a large central core within the confines of the skin layer it sits in. This type of callus is called an intractable plantar keratosis, and can make walking quite difficult.

The combination of a byproduct of poor foot support, abnormal arch or bone structure, and skin that is more apt to developing large calluses, the intractable plantar keratosis grows continuously. In some people, it can grow quite quickly and return to full size within weeks of having it trimmed down. The callus under the skin surface level leaves a large crater in its wake. The base and rim of this crater is still skin, but will often be soft and moist, reflective of the breakdown of the keratin material that is compressed into so many layers above. Although not as common, wounds through the skin can develop under these calluses in certain individuals who have poor nerve sensation or circulation. Lastly, these calluses can also leave depressions in the bottom of the shoe pad that the foot sits on, as well as prematurely wearing out socks and stockings.

Treatment for permanent relief is difficult, and most people with these types of calluses simply have to accept their presence and deal with them regularly. Regular professional trimming of the deep crater helps to keep the callus as flat as possible, and sometimes skin acids can be used to soften any part of the core that is too difficult to remove sharply. The use of a pumice stone, emery board, and heavy-duty moisturizers after bathing will help to delay the regrowth. Padding with felt, foam, or silicone gel using a pad with an aperture, or hole where the callus sits in, can limit regrowth somewhat. Correcting foot structure with a prescription orthotic insert will also delay regrowth, sometimes significantly. This is especially helpful for calluses under the ball of the foot. Surgery to move or remove any prominent bone portion causing the intractable plantar keratosis needs to be considered on a case by case basis, as sometimes these procedures simply lead to more calluses in a different spot

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Big Toe Joint Pain and Turf Toe Injury

2010-05-24T18:07:00.000-07:00

Turf toe is an injury so-called because the pattern of injury usually involves the big toe striking the ground (turf) during a kicking motion, such as seen in football or soccer. This injury originally was seen in football players running on Astroturf, hence the name turf toe. This injury is essentially a sprain of the big toe joint. The big toe joint is thick and strong, and has strong tissues surrounding it to keep the joint in place. Collectively known as a capsule, these tissues are essentially the combined ligaments that bind the two bones together that form the joint. The bone on the toe side is called the proximal phalanx, and the bone on the foot side is the first metatarsal. Under the first metatarsal is two small bones called sesamoids, which can become injured on their own. When an injury occurs that forces the toe up, down, or off to one side, in excess of the strength of this capsule, a strain or partial tear will occur. Although the original turf toe injury described the great toe being forced upward, currently it can be used to describe an injury that has excess motion in any direction. When the big toe joint is injured in this manner, it will become inflamed and quite tender to move. Unlike another more severe injury involving the great toe joint being forced upward, in a turf toe it will not dislocate as the tearing of the ligaments is only partial. Since all walking, pivoting, and running requires the big toe joint to move upwards frequently, sports activity becomes quite difficult.

Treatment involves simply allowing the tissues to heal. This is accomplished by resting from sports for several weeks, by icing the inflammation several times each day, and by taking oral anti-inflammatory medications. Other helpful measures include taping the toe into a fixed position and using a hard soled shoe or a surgical shoe to reduce bending of the joint. In time, this injury will heal and a return to sports will be easily tolerated.

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Pain In The Big Toe.....What Is A Subungual Exostosis?

2010-05-18T06:11:00.000-07:00

Have you ever noticed a painful bump underneath the nail of your big toe, that seems to force the nail itself to rise up to a point? If so, then you may have something called a subungual exostosis.

A subungual exostosis literally means a bone enlargement under the nail. Technically, it is a benign tumor also known as a osteochondroma that results in an enlargement of the top surface of the bone at the end of the toe. The big toe is generally the only one involved. The tumor consists of a bony dome covered by a thin layer of cartilage. It is completely benign, but can have complications that can develop as a result of the pressure the bone creates on the skin overlying it. The pressure on the skin will eventually affect the nail that sits on top of that skin, causing the nail to deform. The nail typically will develop a hump as a result, and can be painful to the touch or while wearing shoes. The skin under the nail can also erode, and in extreme cases the bone can become exposed under the nail through the skin erosion.

The diagnosis of this condition is made via x-ray of the foot taken from the side with the big toe held upward with a pad to allow one to visualize the top surface of the end toe bone. An exam of the toe and nail itself helps to rule-out a simple nail thickening or fungus infection that are more commonly the cause of pain in the toe at the nail.

Treatment is fairly simple. The bone enlargement can be shaved off to reduce the prominence. This surgery is quick, and generally easy to recover from. There is a possibility that the bone mass can re-grow, but the typical result of surgery is permanent relief. Other options can include deeper shoes to accommodate the toe, as well as padding to help decrease pressure.

Until next time,

Scott R. Kilberg DPM

http://www.youtube.com/user/thevideofootdoc

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

YouTube video channel now available!

2010-05-14T10:49:00.000-07:00

I would like to let everyone know that I have added a YouTube channel to my online network of foot and ankle health education sites. I will be adding videos each week, each candidly discussing brief topics relating to foot pain and disease. Each video contains common sense discussions of such topics as warts, bunions, hammertoes, heel pain, ingrown nails, foot pain, and foot injuries. I will still write in detail blog entries on this site and others about foot conditions, but these brief videos may help those who don’t have the time to sit down and read several paragraphs of information. I hope you enjoy, and please be sure to leave comments if you like (or even dislike) my presentations.

Here is the link:

Until next time,

Scott R. Kilberg DPM

http://www.inpodiatrygroup.com/foot-surgery-guide.html

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

A Guide To Foot Surgery

2010-05-03T18:05:00.000-07:00

Foot surgery can be a stressful event, as is any type of surgery. The unknown answers to questions like how will I get around, and how can I best prepare for this thing are what many of my patients have in the back of their mind beyond the obvious questions about the surgery itself and recovery process. Its the little things that can stress people the most during the time before and after a surgery, and for that purpose I created a guide to the surgical process to hopefully help clear up some of these questions that don't necessarily get answered during the surgical consultation visit.

You may find it by following this link:

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Don’t Ignore Large Bruises Under the Big Toe Nail

2010-04-26T20:21:00.000-07:00

Toenail bruising is not uncommon, especially in runners and anyone who has dropped a heavy object on their foot. These usually resolve on their own, and may not even be painful. Generally, these do not need medical attention. An exception to this is when the bruise covers most, if not all, of the surface of the toenail (usually of the big toenail). This is especially important to consider if the toe is painful and swollen. There are various reasons for the skin underneath the toenail to bruise. Bruising essentially is the result of bleeding, and the bleeding underneath a toenail is a result of a break in the skin due to a forceful injury at the end of the toe. If the toe bleeds enough to discolor the majority of the larger size of the big toenail, then the skin break underneath must be more substantial. When these symptoms are combined with toe pain and swelling, this skin break can potentially be due to the presence of a piece of fractured bone (from the force of the injury) that has broken through the skin underneath the nail. This is considered an ‘open fracture’, and requires timely medical care to prevent the exposed bone from becoming infected. Bone infections in the toe are difficult to treat without removing the infected bone tissue surgically, and for some individuals with poor health (like diabetics), the spread of infection can have devastating consequences. When these large bruises develop after an injury, removal of the nail and inspection of the underlying skin surface is of great importance (along with an x-ray) to ensure this fracture has not occurred, as well to release the painful pressure the bleeding has created under the nail. If an open fracture has occurred, treatment can make the difference between a speedy recovery and a potential toe amputation.

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Athlete's Foot Infection Returns As The Weather Warms

2010-04-20T07:39:00.000-07:00

As the weather gets warmer, more and more people are getting outside and getting active. Soon pools, locker rooms, and shower stalls will be filled with bare feet. And fungus. You can be certain Athlete’s foot will soon make its return to your community.

Athlete’s foot, or tinea pedis, is a skin infection caused by fungus. Fungus is a microscopic organism that grows best in warm, dark, moist environments. It is somewhat similar to bacteria, but completely different from a cellular structure (more plant-like than animal-like) The foot is a great place for fungus to grow, as it is often encased in a warm sock and shoe that blocks out all light. Fungus can easily pass from one person to another, usually in locations where the environment is moist. These include showers, locker rooms, and bathrooms. The infection cause the skin to become dry, cracked, and itchy, as well as cause blisters and wet, sore areas in between the toes. In more serious infections, burning pain may also be felt. Symptoms can vary from one person to another, and can cease and reappear later. The most common species of fungus to cause this infection is called a dermatophyte. Other types of fungus include yeast species. Bacteria may eventually infect the skin at the same time and cause more serious problems.

Although Athlete’s foot is a common problem, it can easily be prevented by removing the favorable environment for the fungus Careful drying of the feet after bathing, especially in between the toes, can be of great help in preventing Athlete’s foot. Excessive foot sweating requires that socks be changed more frequently than normal, and the use of a synthetic material sock may allow for greater wicking away of perspiration from the skin than a natural fiber like cotton. Shoes should also be sprayed periodically with an aerosol anti-fungal to kill the fungus residing within them(we strongly recommend Mycomist which is available in our office). Showers and tubs should also be cleaned regularly to destroy any lingering fungus.

Treatment of active infections is very effective and consists of topical anti-fungal lotions or creams, oral anti-fungal medications, or a combination of both. Most infections take between 2-4 weeks to resolve, even with the best medication. Over-the-counter anti-fungal preparations may not be strong enough to kill this infection, and prescription medications may be necessary to achieve full resolution. We often see in patients who treat themselves at home with over-the-counter medications infections that appear to resolve visually, but still remain slowly active because the medication was not strong enough to eradicate the infection fully. In this case, treatment was discontinued too early because it ‘looked gone’, and the infection usually reactivates a short time later. This causes patients to believe they had become ‘re-infected’ and they start the treatment process all over again. The use of a prescription anti-fungal medication is often preferred for this very reason. Re-infections can certainly occur after treatment with prescription medication, yet this is usually due to a new infection and not a continuation of an incompletely treated infection. Topical prescription medications are great in number, and are usually cream or gel based. They are to be applied twice a day to the foot, and should be spread over the entirety of the sole of the foot, up the sides, as well as in between the toes and around the nails, even if those areas look healthy visually. Fungus can spread easily and quickly, and the entire foot should be treated as if the infection was everywhere. It is important not to skip applications of the medication.

To be certain, there are times in which the fungal infection is too severe and widespread for topical medication to be the most effective choice. Oral anti-fungal medications are preferred in this case. Oral anti-fungals require about four weeks of use to eradicate more serious fungal infections (twelve weeks if the infection reaches the nail). These medications are not advised for those with liver disease, as extended use has a slight and rare chance of causing liver problems. However, this is generally not the case in the relatively short span of use required to treat Athlete’s foot. Like the topical medication, daily use is required, as skipped doses can alter the effectiveness of the medication.

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the central Indiana community since 2003

Do Your Feet Burn and/or Tingle? You Might Be Diabetic.

2010-04-12T16:51:00.000-07:00

Sometimes foot pain can indicate the presence of disease that has nothing to do with the foot itself. This is often the case when feet are numb or asleep, burn, or tingle with a pins and needles sensation. These symptoms usually indicate nerve disease (not circulation as many people often assume). There are several conditions in the foot itself that can cause these symptoms in very specific areas. These include pinched nerves that create symptoms only where the nerve travels to, such as the ball of the foot, a couple toes, the side of the heel etc. When large parts of the foot have these symptoms, or when the legs are involved, the foot is much less likely the source of the symptoms. Many times, a pinched nerve in the leg or back is the root cause of this more extensive set of symptoms. However, it is not uncommon for these symptoms to have nothing to do pressure on an actual nerve, whether in the foot, leg or the back. In this instance, the symptoms are from a different kind of disease that affects the nerve and causes pain to be felt where no pain should exist. This condition is called peripheral neuropathy.

Peripheral neuropathy can be caused by numerous conditions, and can also simply appear for no known reason. However, in our country diabetes is often at fault. Diabetes is a condition in which the blood sugar that normally is absorbed by the body after eating carbohydrates (sweets, starches, some vegetables) continues to accumulate in the blood due to a defect in how the body passes it into cells. Eventually, this excess sugar causes damage to and dysfunction of numerous organs, the nervous system being one of them. When nerves function poorly due to diabetes, the result is usually some combination numbness, burning, or tingling of the feet and legs. Eventually the hands can also become involved. Since diabetes is difficult to detect unless blood testing is obtained, many people can go undiagnosed for quite some time unless they are seeing a doctor regularly for check-ups. It is not uncommon for foot pain or numbness to be the first signs of undiagnosed diabetes.

If one is experiencing any of these symptoms, it is important to see a foot specialist who can rule out causes of the symptoms in the feet and ankles, and help make the initial steps towards diagnosing diabetes if that is indeed the cause of the symptoms. Diabetes is not a condition to ignore, and treatment started sooner can make a big difference.

For more answers about diabetic foot problems, see my other blog at thediabeticfoot.blogspot.com.

Until next time,

Scott R. Kilberg DPM

Indiana Podiatry Group

Foot doctors for Indianapolis, Carmel, Noblesville, Fishers, Westfield, and Fortville Indiana.

Pain On the Outside of the Little Toe

2010-03-29T06:45:00.000-07:00

I often see patients who develop pain on the outside of the little toe. The pain stems from a very hard area right next to the nail. Because of the tight fit in that location, many people assume that the nail is ingrown there. In actuality, the problem is not really the nail but the position of the toe. The hard area is not part of the nail, but rather the skin next to the nail. The little toe when this condition is present is nearly always curled inward, and often contracted into a hammertoe. When in this position, the side of the toe skin along the nail edge is the part of the toe that strikes the ground, rather than the thick pad on the bottom of the toe that should normally strike the ground when one is standing with a straight toe. As a result, the thinner skin near the nail reacts to the excessive pressure it is not structured to deal with, and the result is a painful corn along side the nail. The pressure of the hard nail next to it also contributes to this pain.

Treatment for this condition must address the actual cause, and not the simply the nail itself that is assumed to be the problem. Certainly, the outer edge of the nail can be permanently removed in order to reduce some of the pressure. This will provide some relief, but the condition will remain due to the abnormal toe position. Using padding on or over the toe can help reduce some of the pressure, and the corn can be filed down to reduce it’s bulk. Permanent correction requires a minor surgery to straighten out the toe and reduce its contraction. This is done by removing a small amount of bone to get the toe to straighten out, along with a special skin incision technique to re-rotate the toe out of a curled position. Recovery is usually brief, and most people are back in regular shoes in 3-4 weeks. The benefit of this surgery is permanent relief of the toe pain.

Until next time,

Scott R. Kilberg DPM

A foot doctor serving the communities of Indianapolis, Noblesville, Fishers, Carmel, Westfield, and Fortville Indiana.

Childhood Obesity Leads To More Foot Injuries

2010-03-22T17:01:00.000-07:00

I came across this news report today announcing an upcoming article in the journal Pediatrics. According to the news release, 23,000 children ages 3-14 were studied Of the one sixth of them that were obese, more leg, foot, and ankle injuries were seen. While this may seem obvious to many, a direct correlation to childhood obesity and injury is but one more reason to keep our kids active. Foot pain is certainly seen in kids of all weights and activity, but to have a higher risk of foot pain due to one's weight is something that is preventable. With rising rates of diabetes in children, and increasing incidence in our country of high blood pressure, heart disease, and high cholesterol at even earlier ages, its is imperative we instill in our children a desire for proper diet and good exercise. It is no longer enough to give in to the temptation of easily available packaged snacks, and limited exercise time because it is more convenient. Like fostering good grades in school, we need to foster good health habits in our kids, even if we ourselves have difficulty eating well and working out. At worst, it can be a journey we can take together with our kids. Why condemn them to be saddled with long term foot pain, or to have to deal with diabetes and kidney disease by age forty five? We have the opportunity to make things better for them now, and not to make the same mistakes many of us have made in our health habits.

Until next time,

Scott R. Kilberg DPM

A foot doctor serving central Indiana since 2003

David Beckham and Achilles Tendon Rupture

2010-03-15T13:51:00.000-07:00

Many of you by now may have read about David Beckham’s Achilles tendon tear last week. The soccer star is now sidelined, and will miss out on playing in the World Cup. This injury reportedly occurred when he was simply standing by himself, shifting his weight slightly. This is a perfect time to discuss just how common these injuries are, and how it does not take much to force the tear to occur.

The Achilles tendon is a strong, thick strap of material that combines the connection of two different muscles in the calf to the foot, effectively moving the ankle downward, and resisting it from moving too far upward. The Achilles tendon is strong and powerful, but is not always resistant to injury. A tremendous amount of force is constantly applied to this tendon as it connects the foot to the leg during walking and standing. The tendon has a natural weak area a couple inches above where it connects to the heel, and chronic stress and strain can eventually cause tissue in this weak spot to loosen and tear. This chronic stress and strain can be from walking on slopes, stairs, ladders, or other uneven surfaces regularly, or from simple repetitive athletic activities when one has not stretched the calfs properly. Over time the damage will gradually increase. The tendon’s weak spot has less blood supply than the rest of the tendon, so any low grade damage will multiply over time as the tendon is less able to heal itself in this spot. Once the damaged area is weak enough, only a relatively minor injury is needed for the tendon to tear and rupture. This is especially seen in people who have chronic Achilles tendonitis (inflammation) that ignore the warning pain and do not seek treatment. From the news description of David Beckham’s injury, it sounds like all he did was shift his weight. If his tendon was already weakened from the strain of professional soccer, the simple application of body weight in an awkward manner while shifting weight from one foot to the next was all that was needed to cause the rupture.

There are times in which the Achilles tendon can be forcefully ruptured when it is strong and healthy. Often an injury or accident that forces the ankle to bend upward at a rapid rate while one is trying to resist this motion can cause the tendon to partially or fully rupture. Cutting injuries, like slicing the heel on glass or a lawnmower blade can directly cut the tendon through the skin.

Once the Achilles tendon has ruptured, walking becomes incredibly difficult and unsteady. Those who have ruptured their Achilles tendon have reported a sensation of popping, being punched in the back of the heel, or tearing of the calf. It can be a searing pain that is soon followed by bruising, swelling, warmth increase to the skin, redness, and sometimes even a depression under the skin in thinner people if the Achilles tendon is prominent. The foot will have more of a tendency to flop upwards, and bending the ankle downward will be difficult, if not impossible. Because of this instability, walking on that leg will be very difficult.

Achilles tendon ruptures are fairly easy to diagnose for most physicians, although an MRI is often performed to confirm the rupture and assess the amount of tissue damage. Treatment usually requires surgery to repair the ruptured ends of the tendon. Non-surgical treatment consisting of placement in a below knee cast with crutches can be performed on partial ruptures, or those for whom surgery is not advisable due to health reasons. Surgery consists of stitching the ruptured ends together with strong non-absorbing suture, and holding the ankle locked into position for four to eight weeks while the split ends heal together. It is very important the ankle does not move during this time, as the tendon could re-rupture prior to its healing. When surgery is delayed for too long (weeks to months) following the injury, the tendon can retract up the leg, widening the gap between the torn ends. This makes repair very difficult, and the tendon needs to be lengthened or grafts need to be used to bridge the gap and allow tendon tissue to creep across the severed ends. Achilles tendon repair surgery is usually followed by four weeks of non-weightbearing with a below knee cast and crutches, with at least four weeks of protective weightbearing to follow. Physical therapy and rehabilitation is necessary after the tendon is strong enough not to rupture again in the post-operative time period. A return to full activity, especially for a world class athlete like David Beckham, can take many months all together.

Until next time,

Scott R. Kilberg DPM