Did you know . . .

According to the American Podiatric Medical Association, the average person takes 8,000 to 10,000 steps each day. Those steps add up to 115,000 miles in a lifetime – more than four times the circumference of the globe.

There are approximately 250,000 sweat glands in a pair of feet. Together they produce as much as one half pint of moisture daily.

Women have about four times as many foot problems as men; life-long patterns of wearing high heels are often the culprit.

It is best to shop for shoes in the afternoon. Your feet tend to swell a little through the day, so it is best to fit shoes at this time.

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What is Intermittent Claudication?

Intermittent Claudication is a condition caused by arterial insufficiency. The patient may describe pain, tightness, or cramping sensation after walking small to moderate distances.  These symptoms are "intermittent" because they occur with exercise and as claudication from the Latin claudictio, meaning to limp.

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What causes nail thickening?

Injury, fungal infections, or shoe pressure may cause the nail to become thick and crumble. Internal conditions, including diabetes, psoriasis, or vascular disease may also cause abnormal nail growth.

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What is an ankle sprain?

A misstep, twist, or abnormal motion of the ankle joint can cause ligaments to over-stretch or tear, resulting in an ankle sprain. Following the sprain, there is usually pain and swelling surrounding the ankle joint. X-rays should always be taken to rule out a fracture.

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As a diabetic, how should I care for my feet?

Inspect your feet daily for blisters, bleeding, and lesions between your toes. You may need to use a mirror.

Avoid temperature extremes; do not use heating pads or soak your feet in hot water (water temperatures should be 95-100 degrees Fahrenheit).

Do not use acid or chemical corn removers.

Do not perform "bathroom surgery" on corns, calluses, or ingrown nails.

Consult your Podiatrist immediately if you notice swelling, pain, or redness occurring in your feet.

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Why does my doctor want me to take non-steroidal anti-inflammatories?

NSAIDS (non-steroidal anti-inflammatory drugs) are used to relieve pain and reduce inflammation. NSAIDS have the ability to inhibit enzymes essential to the inflammatory response. Anti-inflammatories also possess an analgesic effect by inhibiting certain prostaglandins found to cause pain.

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What side effects are associated with NASAIDS?

Stomach upset is the most common disturbance encountered while taking NSAIDS. These disturbances range from mild (nausea, constipation, diarrhea or epigastric pain) to severe (gastrointestinal ulceration or bleeding). Some products may be buffered or enteric coated to help reduce incidence of GI upset. Some NSAIDS should be taken with food to reduce occurrence of GI upset. Less often seen adverse reactions include kidney or liver dysfunction, central nervous system disturbance, dermatological reaction or affected blood cell count. Speak with your doctor openly about any concerns or reservations you may have when an anti-inflammatory is prescribed.

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What is a Podiatrist?

A Podiatrist is a licensed and trained specialist who medically and surgically treats disorders of the foot and ankle.

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How many years of schooling does a Podiatrist undergo?

Similar to your family doctor, a podiatrist will study four years at an undergraduate college and obtain a Bachelor’s degree. The Podiatrist will study four additional years of graduate work to obtain the Doctorate of Podiatric Medicine (D.P.M.) degree. Training after graduation varies from 1 to 3 years of residency training.

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When should I seek help from a Podiatrist (foot specialist)?

Any foot or ankle pain is abnormal and indicative of a problem which warrants professional intervention. One may also seek professional attention for concerns which are visible although not painful.

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What shoes do you recommend for patients?

Proper fit supersedes proper style! There are numerous shoes available that have been approved by the American Podiatric Medical Association. But be warned. Not all of the recommended shoes will feel equally comfortable to each patient. It is far more important to have the shoe fit the widest part of the foot (the ball) to the heel. This is the "heel to the ball" fit. A Brannock measuring device will give you the accurate size of your foot. Although this is essential information, not all shoes are sized accordingly. If the shoe is not comfortable prior to purchase it will not be comfortable later, and may also be a potential source of harm.

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Why does Dr. Graham want to know my past medical history?

Dr. Graham wants to know your past medical history because it may be a contributing factor of your presenting problem. This information is also vital to the selection of treatment options that both you and Dr. Graham choose. In order for Dr. Graham to better understand and properly treat your problem, a complete medication list with dosage as well as direction is needed to prevent a possibly harmful drug interaction.

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Is it better to soak my feet in hot water instead of warm water?

NO! In fact, soaking your feet in hot water will most likely burn your skin and do more harm than good. Incidently, your skin takes longer to heal from a burn than from any other tissue insult.

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Why are diabetics at a greater risk for limb loss?

Due to the excessive amount of glucose (sugar) that accumulates in the bloodstream, Diabetic patients experience three problems that lead to limb loss. The first of these problems is damage to the blood vessel walls. This causes the lumen (opening) of the vessel to narrow. Formation of plaque leads to blockage of the remaining opening, which may lead to poor circulation of the arterial system. The tissue supplied by these vessels are then deprived of oxygen and nutrients and are incapable of healing.

The second problem that could lead to limb loss is the altering of the immune system due to the increase of blood glucose (hyperglycemia). This causes the body’s defenses to weaken, allowing infections to easily occur.

The body must sense pain to avoid harmful events. For Diabetics, harmful events occur without awareness due to damage of the nervous system and loss of joint integrity, which are direct results of uncontrolled high blood sugar. This is the third reason a Diabetic is at risk for limb loss. For example, stepping on a needle or a toothpick causes pain to most of us. Due to loss of sensation, however, some Diabetics lack the ability to recognize that an injury has occurred. Joint position causes stimulated nerves to feed information to the brain to maintain proper foot posture. Due to a Diabetic’s loss of nerve sensation, the foot’s posture becomes flattened and joints deform. This leads to callus formation as weight bearing is uneven. The Diabetic’s insensitive foot will not feel the injurious callus, which can become an opening in the foot. If this ulceration becomes infected, a Diabetic has a minimal immune response to fight the infection. Minimal arterial supply contributes to poor healing, thus, amputation can occur.

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What causes an ingrown nail?

Ingrown nails are commonly associated with the big toe, but can occur on the smaller toes as well. Some nails are simply predisposed to growing in. These typically have an incurvated appearance. Nail injuries and shoes with a tight fitting shoe box are also contributing factors.

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What are Neuromas?

This condition, commonly called a "Morton’s Neuroma," affects the area between the second, third, and fourth toes. It occurs when the outer coating of a nerve in the foot thickens. This thickening is usually caused by irritation that results when two bones repeatedly rub together (often due to ill-fitting shoes or abnormal bone movement).

The pain may start gradually, causing burning, tingling, cramping, or numbness. Symptoms often occur after walking or standing for a period of time. Occasionally, patients feel as though they are "standing on a wad of sock." Conservative treatments of neuromas include: padding of the foot to remove the pressure from the irritated area, oral anti-inflammatories, and steroid injections into the area of inflammation. Surgical excision of the neuroma may be implemented if conservative methods fail.

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Why does Dr. Graham need to see both feet at the initial exam?

When a new patient comes into our office, both feet are usually examined for comparative analysis. It is mandatory for Diabetics to have both feet inspected due to systemic manifestations caused by their disease. Comparison of both feet also helps indicate the amount of redness or swelling the symptomatic foot is experiencing.

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What causes blisters to form on my feet?

Friction blisters are the most common injuries to athletes. When shearing forces are applied to the skin, separation occurs between the epidermal and dermal layers, causing localized accumulation of fluid or blood, thus forming a blister. Precautionary measures that can be taken to prevent blisters from forming include: careful fitting of shoe gear to relieve pressure over bony prominence and to prevent sliding of the foot; application of mole skin padding over areas of irritation; wearing well fitting absorbent sport specific socks or two pairs of socks with a thinner pair next to the skin; and the application of foot powder between the toes to dry the skin. It is best to keep a blister intact. If the blister does open, it could become a source for infection.

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When should my infant be seen by a Podiatrist?

It is not uncommon for an infant’s feet to appear to turn in. As the child develops, the feet should take on a more normal appearance. If your toddler appears to be having difficulty walking or running, there could be a skeletal or neurological disorder. Consult your Podiatrist or Pediatrician if this occurs.

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What causes gout?

An ancient disease, gout is presented as a severely painful condition provoked by trophic (uric acid) deposits around a joint. Gout may primarily be caused by overproduction of uric acid, or secondarily as a result of some other disease process or condition (such as renal insufficiency, alcoholism, or certain types of anemia). Typically, cases have acute onset, often at night, with severe pain and swelling. These features make gout hard to distinguish clinically between osteomyelitis or thrombophlebitis. Your podiatrist or Family Physician will need to order x-rays and lab work to diagnose.

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How should I properly trim my toe nails?

To avoid the possibility of an ingrown nail, try trimming the nail straight across. Do not cut down into the corners. You may also need to smooth the edges of the nail with an emery board.

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What treatment should be sought following a puncture wound?

First, determine if the wound is superficial or deep. Superficial wounds may require only mild cleansing and light bandage. Continue to cleanse the wound daily and watch for any signs of infection until the wound is healed. Deep wounds should be thoroughly cleansed and examined for any foreign substances. Cultures of the wound and antibiotics may be prescribed. X-rays might also be required, as it is possible that damage to internal structures may have occurred. With any type of puncture wound, the patient needs to be up to date on tetanus injections.

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What causes corns and calluses?

Many times, shoes that do not fit well, or those that are of poor quality cause these painful conditions. When purchasing shoes, look for proper fit, good construction, and ample space between the toe and the end of the shoe to prevent irritation. If this does not alleviate the pain, you may need to see a Podiatrist for possible anatomical or functional foot problems.

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What is a plantar wart?

A wart is caused by a virus that invades the skin through an opening, such as a cut or tear. They appear spongy, with red, brown or black spots known as "rete pegs" which are capillaries. Warts are commonly seen on the bottom of the feet (plantar warts) and may be mistaken for a corn or callus.

FYI- The 52 bones in your feet make up about one quarter of all of the bones in your body.

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When should orthotics be replaced?

The life of orthotics vary with the individual. Orthotics may be outgrown, such as with a child or young adult. Your foot may also change due to factors such as weight change. Generally, the shell of orthotics should not bend or break, however, postings and top covers may need refurbished periodically.

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