An article published in “USA Today” this past week discussed the scary reality that many elderly patients will leave a hospital much weaker than when they arrived.  Even though the patient’s original condition will be treated, the overall health of the patient may suffer from lack of physical activity.  A similar concept can be applied to many treatments of the foot and ankle, in that even though a treatment may remove the original pain or deformity, post-treatment actions must be taken by the patient to ensure that they maintain optimum health and their condition does not return. 

One condition that requires continued maintenance even after a pain-relieving treatment is plantar fasciitis.  Stretching and orthotics are often suggested as the first line of treatment because they address the root of the problem.  However, individuals with severe plantar fasciitis may find even stretching to be too painful and can receive steroid injections for more immediate relief.  In plantar fasciitis, the fibrous band of tissue called the plantar fascia that attaches from the heel to the ball of the foot becomes irritated from having too much tension placed on it.  Overpronation and equinus, or stiffness of the ankle, can add to the tension placed on the fascia causing its inflammation.  Even though a steroid injection removes the heel pain of plantar fasciitis, the underlying causes of tension will remain and eventually allow the pain to return if they are not addressed.  For a patient to get optimal results from their treatment, they should discuss a daily stretching regimen with their podiatrist that should be easier to adhere to after their pain has been alleviated by the injection.  Simple stretches and custom orthotics will often relieve tension and thus the irritation on the tissue, allowing the patient to avoid recurrences of the condition. 

This concept of stretching and physical therapy following treatment is often used following surgeries that actually have removed the underlying problem, including those performed to remove a bunion.  While the bunion deformity is gone, physical therapy to get the toe moving after surgery can prevent complications down the road that may result from the prolonged inactivity of the toe following the operation.  Bones and tissues that have been cut need time without bearing the weight of the body in order to fuse together properly.  Unfortunately this period of rest that is necessary for bone healing may cause joints and ligaments to become overly stiff from the inactivity.  Physical therapy can be used to remove or prevent any adhesions of tissues to one another that can lead to painful limitation of motion or even arthritis. 

While for some patients, following a post-treatment schedule involving stretching, foot exercises and physical therapy may be difficult, other patients will struggle with the idea of doing as little as possible with their affected foot.  Whether you are eager to return to sports practice, or someone who does not look forward to the idea of any sort of exercise, it is crucial to follow the treatment plan your podiatrist or other doctor has provided to you to completion for your best health possible!

Please visit www.ColumbusFoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Worthington. If you would like to see apodiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

By Dr. Animesh (Andy) Bhatia

Whether you are running in the St. Patrick’s Day 5K at Flannagan’s this Saturday in Columbus or simply running to the pub, taking care of your feet can make or break your celebration of this lucky holiday.  Properly fitting shoes are imperative for good foot health, and also can help in avoiding knee, hip and back problems that develop from the problems originating in your feet! 

When you travel to a shoe store, most have what is called a “Brannock device” that is used to measure feet and estimate shoe size.  This device measures not only the length of your foot from heel to toe, but also measures width, and the distance from heel to the ball of your foot.  The heel to ball distance is most critical in determining whether a shoe fits correctly.  Located at the “ball” of your foot on the middle or inner aspect is the joint called the 1^stmetatarsophalangeal joint or 1^stMTP.  This is where a bunion develops, but the normal movement permitted by the joint is also critical to the overall function of the foot.  The base of the joint is the first metatarsal which slides downward in order for the big toe to flex upwards and help propel the foot when walking or running.   When this motion sequence occurs in a normal foot, the foot pushes off the ground and swings into the next step.   

Correctly fitting shoes allow the 1^stMTP to function as it should, while shoes that are too small can cause major problems.  Shoes are designed to allow the normal bend at the 1^stMTP joint and to inhibit abnormal bending of most other joints in the foot.  However if the shoe is too small, the 1^stMTP joint will not be allowed to bend normally and big toe will be forced to flex upwards when it should not be.  This leads to the condition called hallux limitus, where, as the name implies, the movement of the hallux, or big toe, is limited.  Overtime, hallux limitus can progress to hallux rigidus where the joint big toe joint is practically immovable.  This is a painful form of arthritis that has resulted from the abnormal wear and tear of the joint.  Not only is this painful, but the combination of hallux limitus or rigidus in an already too small shoe can lead to calluses, corns and even ulcers developing on the big toe. 

It is important to recognize that biomechanical problems, including excessive pronation, can also contribute to the development of hallux limitus so custom orthotics can often help with this condition.  Wearing one size larger shoe is only a difference of one third of an inch in the actual length of the shoe.  So this St. Patrick’s day even if you think that a smaller size shoe may look better, by getting the correct size for your foot you will definitely have the luck of the Irish and keep your feet looking great!!

Please visit www.ColumbusFoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Powell. If you would like to see apodiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

By Dr. Animesh (Andy) Bhatia

Ballroom dancing classes have experienced a jump in popularity in Columbus dance studios with the rise of “Dancing with the Stars” and other dancing programs on television.  Talk show host Wendy Williams, who was a competitor on the current season, tweeted a picture of her seriously beat up looking feet before she was eliminated on that night’s show!  The caption on the picture, which stated “Feet don’t fail me now!” indicates just how important foot health is in any athletic competition, especially one known for its glitzy high-heeled shoes!

Unfortunately for Wendy, her feet were apparently so painful from her bunions that she struggled with her ability to dance on the night she was eliminated.  Bunions on the middle side of each foot were located in the joint at the base of her big toe, which is a typical bunion location.  A bunion of the big toe, or hallux, is caused by “Hallux abducto valgus” which is basically when the tip of the big toe is angled in towards, and often overlaps the second toe, instead of lying straight as it should.  This inappropriate angling of the tip of the toe causes the base of the toe to protrude out from the foot more than normal.

The protuberances caused by bunions have resulted in immense pain for Wendy because of increased pressure and friction against where the shoe would normally just firmly contact the middle side of the foot.  This excessive pressure can cause the body to thicken the outer layer of skin cells as a way to protect the deeper layers of the foot.  These thickenings of the skin are called corns and calluses can cause pain.  Hammer toes, where the first joint in any of the small toes is bent abnormally, are also commonly seen as a consequence of bunions.  Hammer toes can result in increased pressure on the top of the toe and lead to more painful corns. 

There are a variety of bunion treatments as well as a variety of ways to be proactive in preventing a bunion.  Wendy Williams seems to have had a bunion removal surgery, or bunionectomy, several years ago, but has failed to take appropriate preventative measures to keep the bunion from reoccurring.  While bunionectomies can be extremely helpful for relieving the pain and other conditions caused by a bunion, it is important to take additional measures to get the best results from your surgery.  After a surgery, physical therapy and orthotics are often suggested to keep the big toe in its proper position.  For bunion prevention, before a bunion ever occurs or after bunion removal surgery, comfortable well-fitted shoes are key. 

Wendy’s tendency to wear ill-fitting, pointy high heels on a regular basis and even more so with her appearance on Dancing with the Stars may have lead to an exacerbation of her bunion pain and slight re-occurrence of her bunion.  Wendy should have contacted her podiatrist to take care of her bunions before it cost her her shot at the disco ball dancing trophy!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio in between Westerville, Worthington and Powell.

By Dr. Animesh (Andy) Bhatia