Stuck in First

Stiffness and pain of the first toe is an all-too-common problem that many people suffer from. Usually, the symptoms arise in the “ball” region of the foot just behind the first toe (or ‘hallux’) where a major joint is located which connects the toe to a long bone in the mid-foot. As this joint becomes damaged or altered for various reasons, the toe loses flexibility which makes walking and other activities painful.
The stability in each foot is in many ways a three-point balancing act. Weight must be properly shared between the heel, the smaller four toes (and their respective joints), and the first toe and it’s respective joint as previously described. For this reason, the major first toe joint is subject to many forces and other factors which can affect the way it functions over time. Some of these forces include biomechanical factors such as the way the heel moves, traumatic incidents such as fractures or dislocations, muscle imbalances, arthritic changes, or even changes incurred from a previous surgery. The ultimate result is that the first toe is unable to bend properly which makes walking difficult as you shift weight over the foot and then attempt to push off from the forefoot and toes.
Some of the symptoms that people tend to have with this phenomenon include an inability to wear high-heeled shoes, calluses or skin changes over the top of the big toe, pain and stiffness above and behind the first toe, pain or a ‘crackling’ feeling while moving the toe, a painful toenail, and cramps or spasms in the tendon which runs along the top of the toe. Your podiatrist can also perform some valuable exams to evaluate your condition and determine the nature and cause of your symptoms. A key determining factor is whether the issue is caused by a structural condition of bone or whether it is due to deforming forces of soft tissues or biomechanical issues elsewhere in the foot. X-rays can also reveal a great deal about the health and integrity of the joint and foot overall.
Thankfully, many treatment options are possible for this condition. These range from specific exercises to shoe gear modifications to implants or other surgical procedures. In some cases, certain stretching routines are recommended in order to loosen the soft tissues and increase flexibility at the joint. These exercises may be painful, and if necessary they can be done at your podiatrist’s office where proper assistance, monitoring, and local anesthesia are available if needed.
Your mobility is one of your greatest assets to your overall health and well-being. Therefore, a stiff or painful toe should be addressed promptly and adequately.

Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com

Somewhere In Between

Some of the potentially most irritating places on the feet are the areas between the toes-also known as the “web spaces” or “inter-digital spaces” of the feet. You’re probably quite aware of how hot and moist our feet can become under normal circumstances while wearing socks and shoes and forced to perform standard activities. Now consider that the areas between the toes are subject to those same conditions in addition to further heat and pressure and it suddenly becomes obvious that they are a natural place for superficial infections and irritation to occur.
There are many different causes which can lead to irritations between the toes. A common suspicion is “Athlete’s foot” which is a fungal infection of the skin. However, fungal infections which affect the web spaces can actually be caused by several different types of fungus which are each treated differently. Furthermore, fungal infections need to be distinguished from bacterial and parasitic infections which also have a predilection for the inter-digital spaces and are, of course, treated differently. Even metabolic diseases and autoimmune disorders need to be considered when assessing symptoms. Finally, friction and mechanical stress caused by a mal-aligned toe or inappropriate shoes may be causing the problem and should be ruled out.
Common symptoms that people may experience include burning, stinging, or itching sensations between the toes. They may also encounter certain changes as the skin becomes scalded, beefy red, cracked, or scaly. Of course, there are many other possible symptoms-each of which depends on the particular underlying cause. For this reason, podiatrists do a thorough assessment-which may include taking skin scrapings and using other simple measures-to determine what that cause is. From that point, the appropriate regimen is implemented which may range from oral or topical treatments to shoe-gear adjustments to changing the medications that you are currently using.
When one considers how often we wash our hands compared to our feet throughout the day, it’s not surprising that our feet are frequently susceptible to attack from microscopic organisms and other potential risks. Keeping your feet clean and dry as often as possible is a big step you can take to prevent infections. Thankfully, when serious irritations do occur, appropriate treatments are available.


Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com

Orthoses: Relief from the Ground Up

How far would you guess that you travel through walking or running in a day, a week, or a year? It’s been roughly estimated that in the course of ten years, an average individual will actually cover a distance greater than the circumference of the Earth. That’s a lot of steps! Also consider the well-established facts that your feet absorb 1-2 times your body weight when walking and about 3.5 times when running and it becomes pretty obvious: our feet take a real beating. But what about the rest of the body? How does all that pounding relate to the pain felt in the shins, knees, hips, and lower back?
If you’re at all familiar with running or sports medicine, you’ve probably heard of inserts or “orthotics” (Actually, orthotic is an adjective. Orthosis is the technical term). These devices are designed to specifically address structural foot issues which can lead to pain and discomfort. Some of these issues include abnormal heel strike or rolling of the heel, problems induced by arch height, limb-length discrepancies, and abnormalities of tendons, ligaments, and bone, among others. But don’t think that orthotic inserts are just for athletes. They can have a tremendous impact for anyone to be able to walk more comfortably and efficiently.
You’re probably also familiar with countless over-the-counter devices: each of which claims to be a cure-all. Some of these products can indeed be helpful, but non-customized inserts are really hit-and-miss. Without a thorough foot evaluation and gait analysis done by an expert, the use of generic inserts is often a gamble which can irritate and not help your feet. On the other hand, podiatrists can customize orthotic inserts based on measurements, molds, and the latest computer technology which all take into account YOUR specific foot type and body requirements. Adjustments can then be made to the inserts over time until your discomfort has been dramatically reduced.
Unfortunately, the aging process forces changes on the feet which stretch and alter them such that they begin to compensate in ways that may in turn create imbalances and misalignments further up in areas like the hips, knees, or lower back. Just as a house requires a strong foundation, our entire musculoskeletal systems require support and proper ground accommodation through our feet. You’d be amazed by how orthotic adjustments of just a few millimeters can have incredible pain-relieving effects in ways you wouldn’t expect. Mobility is one of our greatest gifts, and pain-free mobility is definitely worth it!
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com

Nail Concerns

Most people seem to take at least some interest or preoccupation with their toenails. Of course, the pedicure industry is big business, and for centuries, people have viewed their feet and toenails as an important sign of beauty (or lack thereof). On a more serious note however, our toenails really can be a strong indicator of our overall health and well-being.
There are a LARGE number of different conditions which can affect the toenails. As you can imagine, they are subject to many forces and conditions throughout each day which are not very conducive to optimal health and function. On top of this, systemic conditions such as diabetes, blood disorders, and even cancers can show up in the toenails.
A big concern with toenails is infection. The borders of your toenails are responsible for the tough job of forming a protective barrier between the outside world and the underlying nail bed. It only takes a small opening created by light trauma or another condition in order for bacteria, fungi, or even certain viruses to invade. When they do, the situation is rarely systemic-thankfully-but you will still most likely experience the results. These can include pain, swelling, heat, or redness surrounding the nail plate. The nail can also become embedded in the surrounding skin, and you may notice some drainage of pus and other fluids.
Beyond a direct infection, there are plenty of other conditions to look out for with your nails. Nails that become hard, thickened, brittle, pitted, or change in other ways are definitely worth noting. These changes can be totally benign or really quite serious. Color changes-for example-may only indicate a mild reaction to trauma, or it could indicate a bone fracture or cancerous melanoma beneath the nail bed. Similarly, thickened nails are not huge concerns in themselves, but in a diabetic they may contribute to pressure ulcers which can ultimately lead to a toe amputation if left unchecked.
You might be surprised that ringworms, psoriasis, and even allergic reactions can all affect the toenails. Other findings can result from simple malnutrition or un-diagnosed genetic disorders. The trick is in distinguishing these scenarios from normal wear-and-tear and the aging process that we all experience. Podiatrists are experts at working through these issues and making suggestions on any treatment options. If you have questions regarding the health of your toenails, get a hold of one today. They’re happy to help!


Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com

Something Fishy

The media has been buzzing over the last year about a new form of pedicure which has been springing up across the United States. It involves customers placing their feet into tanks of warm water where hundreds of small fish eat away at the dead skin of clients’ feet. The first spa in the U.S. to offer this treatment sprang up last July in Virginia. Since that time, hundreds of others have emerged across the country. Unfortunately, there are some serious health concerns, and the controversy has been huge.
The treatment utilizes small carp fish known as garra rufa or “doctor fish” which have no teeth and thus are able to eat away at dead skin but leave living tissues alone. Another larger variety of fish known as chin chin which DO have teeth are also occasionally used. The practice was first developed in Turkey several years ago and became popular in several east Asian countries before coming to the U.S. last summer.
Initially, the response was overwhelmingly positive-at least for those willing to undergo the treatment. Spa owners claimed reservations months in advance. Even Diane Sawyer who tried the treatment on Good Morning America described it as feeling like “tiny delicate kisses”. However, since that time new questions have arisen regarding the sanitation and safety standards associated with the treatment. Currently, twenty-two states including Texas, Florida, and Illinois have banned it.
Concerns lie with the potential for the fish to spread disease and infection from one client’s feet to another. Current safety standards for pedicures dictate that all tools must be completely sanitized before being reused. While the water can be changed between treatments, it’s virtually impossible to clean the fish themselves which are quite expensive. Many animals are able to spread serious diseases such as salmonella, rabies, and avian flu. The “doctor fish” themselves are reportedly capable of spreading a bacteria which can cause boils and sores on the skin that can last for months.
No federal governing board has ruled decisively on the issue. While the International Nail Technicians Association has decried the practice for lack of health regulations, the CDC has relegated the matter for states to decide individually. In the meantime, it’s up to individuals to be aware and informed of the health risks and concerns associated with the treatments. As Susan Stanford of the Texas Department of Licensing and Regulation recently stated, “Fish shouldn’t be living in hot, chlorinated water. There was a concern for patrons, too, and a risk of infection or bacteria.”


Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com

Dangers of nail polish

Conventional nail polishes dispensed at most supermarkets and nail salons contain a variety of chemicals. Two Chemicals that need special attention are Toulene and DBP. The one that's received the most scrutiny is called Dibutyl Phthalate or DBP. DBP is a chemical that prevent chipping. Although the affect on humans is unclear - Procter and Gamble - and Estee Lauder are phasing out the ingredient. DBP is already banned in Europe, and has been linked to birth defects. Toluene on the other hand has been linked to a wide range of health issues from simple headaches and eye irritation to damage to the liver and kidneys. If you plan on painting your nails, keep the dangers of nail polish in mind, particularly if you're pregnant. Because of the association of DBP with birth defects, it would be wise to avoid using any nail polish, unless it is free of DBP, Toluene and other harmful chemicals. Also avoid nail salons where these products might be used. The best place to start would be to call the manufacturer of the nail polish and ask them for the list of ingredients. Another very important aspect is to use all nail care products in a room with good ventilation. Exposure to toxic chemicals is not the only health concern associated with nail polish use, nail salons are a health risk altogether. Nail fungus and bacteria can lurk on the underside of any emery board. Always check a salon for cleanliness before signing up for services. Make sure attendants disinfect all tools and equipment between customers.

“The good life is inspired by love and guided by knowledge “ - BERTRAND RUSSELL


Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com

It's all in your head!!

It’s all in your head!!!

Are you anxious about an upcoming ingrown toenail removal? You’re not alone. The standard outpatient procedure typically requires what’s called a ‘digital ring block’ which involves the injection of a local anaesthetic. While short-lasting, the injection can be briefly painful which often contributes to anxiety leading up to the procedure. It is estimated that roughly 10% of the general population has a needle phobia.

Recently, British researchers published a report investigating the use of ‘audiovisual distraction’ as a means to calm patients and to reduce their acute pain. 152 patients were split into two groups with 78 receiving the Bedscapes™ distraction method and 74 receiving standard care alone. The investigative group was given a picturesque photomural of either a scenic mountain view or a tropical beach scene as well as headphones to listen to during the procedure. The study patients were allowed to look at the photomural and to listen to soothing sounds through their headsets while the control patients were simply allowed to interact with the clinical staff as usual. Patients in both groups were assessed for post-operative pain as well as pre- and post-operative anxiety.

Upon completion of the study, it was revealed that Bedscapes™ did NOT reduce overall pain or anxiety perceived by the patients, and apparently it was no more effective than interpersonal communication between the patients and the podiatry staff on hand. Furthermore, OLDER patients tended to experience the least amount of pain, while patients with the highest pre-operative anxiety also tended to perceive the highest levels of pain. However, both groups breathed a significant sigh of relief as indicated by their large post-operative decrease in anxiety after the procedure was finished.

So the message is: relax and talk to the staff. They’re friendly and they’re there to help!


Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com