Do you ever think about what it would be like if we never wore shoes? Can you recall the sensation of tip-toeing barefoot over a gravel parking lot after stepping down on a small stone or other object? It’s amazing how sensitive our feet are when they’re healthy. Consider, for example, that most people who discover a tiny pebble in their shoe remove it immediately since they find it to be so annoying. Now think about the possibility of that “pebble” sensation resulting as a part of your normal foot structure, and you can imagine a pretty irritating situation.
Unfortunately for some people with an IPK (Intractable Plantar Keratosis), the condition just described is a reality. An IPK is rather simply a scenario in which the end of one of the long bones in your foot for one reason or another begins to press down against the plantar fat pad on the sole of your foot. The “long bones” in question run across the mid-section of the foot and end in the forefoot area just behind the toes. This is the general area where an IPK will tend to develop. Over time, the forefoot will begin to develop a painful callus which is either diffuse or localized in nature.
Many things may cause an IPK to develop. A diffuse IPK may be related to shearing forces associated with certain foot types, fat pad degeneration, or systemic diseases. A discrete or localized type, on the other hand, is more likely due to a joint problem or deformity of a single long bone in the foot. Your podiatrist can help to establish the nature and cause of the problem as well as to distinguish it from other possibilities such as a plantar wart or a blocked sweat pore.
Treatment of IPKs often begins with conservative interventions such as shaving and debridement as well as cushioning with specific shoe gear modifications to favor the painful spot. If these measures are not successful, then more invasive procedures can be done to remove or modify some of the bone or joints in question in order to off-load and relieve pressure from the area. Either way, effective treatment is available to eliminate the lesion and to allow you to walk smoothly.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Wednesday, November 25, 2009
Monday, August 3, 2009
Achilles Heel
If you saw the 2004 film Troy, you may have winced at the scene towards the end of the movie where Brad Pitt’s character Achilles has an arrow shot into his heel. Despite his unstoppable presence up to this point, the incident renders him practically helpless, and he soon dies unable to remove the fateful arrow. Most people have at least heard reference to this story from Greek mythology, and an “Achilles Heel” has come to refer to any personal weakness which leaves one weak and vulnerable. The reference is a good one as many people know-for such an inconspicuous part of the body, a damaged Achilles can be truly crippling.
Despite the classic reference, the “Achilles” does not actually refer to the heel at all, but rather to the major tendon behind the ankle which inserts into the heel bone. The problem arises when this tendon becomes inflamed, irritated, or damaged and results in what is called Achilles “tendinitis” or “tendinosis”. This can really mean a lot of different things. The issue may arise from the way the heel rolls when it strikes the ground, which may in turn be related to imbalances within the forefoot. Due to the anatomy of the ankle, the middle portion of the Achilles tendon actually has a rather weak blood supply which can also make the tendon susceptible to injuries.
Achilles tendinitis is actually classified by whether it occurs within the tendon itself or at the insertion site where the tendon meets the heel bone. An injury may manifest in many different ways and include tenderness, swelling, thickening of the tendon, “crackling” sounds, a bony heel bump, or changes in walking patterns. You’d probably be surprised at all the different things that can contribute to Achilles problems. They include overuse, poor training habits, and mechanical imbalances as well as some systemic conditions like elevated cholesterol, the use of certain antibiotic medications, age, the shape of your heel bone, and even certain blood types.
Podiatrists typically address issues of the Achilles by first performing a history and physical. This will likely include some simple exams to rule out muscular causes and get to the bottom of the problem. After this, they may order further diagnostic exams such as X-rays, MRIs, or even ultrasounds. These tests can reveal the extent of the injury and whether there is bony involvement or if the tendon has ruptured. After that, the doctor will discuss with you the treatment options which can vary from simple self-treatment at home to mechanical correction through orthotic inserts to surgical intervention.
The Achilles is the strongest, thickest tendon in the body, and critical to many important functions such as walking. Therefore, it’s important to keep it in good working order, even if you don’t have plans to invade Troy anytime soon.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Despite the classic reference, the “Achilles” does not actually refer to the heel at all, but rather to the major tendon behind the ankle which inserts into the heel bone. The problem arises when this tendon becomes inflamed, irritated, or damaged and results in what is called Achilles “tendinitis” or “tendinosis”. This can really mean a lot of different things. The issue may arise from the way the heel rolls when it strikes the ground, which may in turn be related to imbalances within the forefoot. Due to the anatomy of the ankle, the middle portion of the Achilles tendon actually has a rather weak blood supply which can also make the tendon susceptible to injuries.
Achilles tendinitis is actually classified by whether it occurs within the tendon itself or at the insertion site where the tendon meets the heel bone. An injury may manifest in many different ways and include tenderness, swelling, thickening of the tendon, “crackling” sounds, a bony heel bump, or changes in walking patterns. You’d probably be surprised at all the different things that can contribute to Achilles problems. They include overuse, poor training habits, and mechanical imbalances as well as some systemic conditions like elevated cholesterol, the use of certain antibiotic medications, age, the shape of your heel bone, and even certain blood types.
Podiatrists typically address issues of the Achilles by first performing a history and physical. This will likely include some simple exams to rule out muscular causes and get to the bottom of the problem. After this, they may order further diagnostic exams such as X-rays, MRIs, or even ultrasounds. These tests can reveal the extent of the injury and whether there is bony involvement or if the tendon has ruptured. After that, the doctor will discuss with you the treatment options which can vary from simple self-treatment at home to mechanical correction through orthotic inserts to surgical intervention.
The Achilles is the strongest, thickest tendon in the body, and critical to many important functions such as walking. Therefore, it’s important to keep it in good working order, even if you don’t have plans to invade Troy anytime soon.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Wednesday, July 8, 2009
Heel Possibilities
You wake up in the morning ready for the start of a new day with new possibilities. Turning over, you step out of bed groggily, ready to get things started when “Ouch!”- a sharp pain ripples through your heel, jolting you awake more quickly than you were expecting. The pain dissipates with a few steps only to return and haunt you later in the day. These signs are a classic description of a very common condition known as “plantar fasciitis” which in turn is probably the most well-known cause of heel pain. However, there are MANY causes of heel pain out there and distinguishing between the possibilities can be a tricky task.
“Plantar fasciitis”-the flagship example noted above-is a mechanical etiology of heel pain resulting when there is inflammation along the plantar fascia which is a fibrous band of connective tissue running along the length of the sole of the foot. Other “mechanical” causes might include a wearing away of the fat pad beneath the heel, an irritated Achilles tendon, bony outgrowths from the heel bone, growth plate disturbances, and other issues.
Certain systemic conditions can also cause joint problems which may result in heel pain. These include a wide variety of conditions such as kidney problems, Rheumatoid arthritis, fibromyalgia, gastro-intestinal disorders, and many others. Other potential causes include nerve entrapments, stress fractures, infections, blood-flow problems, tendon ruptures and even tumors.
Needless to say, a sore heel can be an annoying and enigmatic problem. Your podiatrist is an expert at distinguishing between all the potential underlying causes and treatments. He or she can perform a wide variety of revealing diagnostic exams-from the simple to the more complex-to clarify the root cause of the pain in your particular case. Since some of these causes are serious while others are more benign, that information should be valuable to you!
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
“Plantar fasciitis”-the flagship example noted above-is a mechanical etiology of heel pain resulting when there is inflammation along the plantar fascia which is a fibrous band of connective tissue running along the length of the sole of the foot. Other “mechanical” causes might include a wearing away of the fat pad beneath the heel, an irritated Achilles tendon, bony outgrowths from the heel bone, growth plate disturbances, and other issues.
Certain systemic conditions can also cause joint problems which may result in heel pain. These include a wide variety of conditions such as kidney problems, Rheumatoid arthritis, fibromyalgia, gastro-intestinal disorders, and many others. Other potential causes include nerve entrapments, stress fractures, infections, blood-flow problems, tendon ruptures and even tumors.
Needless to say, a sore heel can be an annoying and enigmatic problem. Your podiatrist is an expert at distinguishing between all the potential underlying causes and treatments. He or she can perform a wide variety of revealing diagnostic exams-from the simple to the more complex-to clarify the root cause of the pain in your particular case. Since some of these causes are serious while others are more benign, that information should be valuable to you!
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Tuesday, June 16, 2009
Flip-Flop Thoughts
Flip-flops are an extremely popular form of footwear, especially in the summer. Originally patterned after the traditional Japanese wooden-soled style known as zōri, they’re also known as “thongs” in Australia, “slip-slops” in South Africa, and “jandals” in the South Pacific. They’re most popular in India, where they’re known as “Hawaii chappals”.
Interestingly in some cultures, flip-flop shoes are occasionally used to threaten someone since they can quickly be removed and thrown or used to hit an adversary. While that practice is rare in the United States, flip-flops can still pose a threat to those who wear them. For the most part, flip-flops provide no arch support at all, expose the foot to the outside environment, and can often contribute to many foot-related injuries. Since they often have a spongy rubber sole, flip-flops make it difficult for your feet to adjust and accommodate to the ground with each step you take. Furthermore, the strap can lead to skin irritation as well.
All that said, let me back up and admit that flip-flops are indeed a fun shoe to wear, and in fact have many benefits. They allow your feet to breathe and can actually protect your feet from picking up things like plantar warts and various fungal infections from public places. There are just a few pieces of advice to keep in mind if you do choose to wear flip-flops. First, if possible, look for a quality pair with a soft, leather fabric to minimize blisters and irritation. Look for a sole that forms some contour to the ball of your foot but isn’t overly pliable either. Also, make sure your foot doesn’t hang off the edge of the sole. This problem can be exacerbated if you have wet or sweaty feet with a smooth sole, so really try to be aware.
Some other advice would be to not walk for especially long distances, and to avoid playing sports or doing yard work in flip-flops. The straps can snap spontaneously, so excessive motion is definitely not advised. Overall, be cognizant of your environment. If you’re in a location where things like insects, poison ivy, or glass have access to your feet, flip-flops are not the best choice of footwear. If you’re at the pool or beach and wearing flip-flops, remember to use sunscreen on your feet as they can burn like any other exposed part of your body.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Interestingly in some cultures, flip-flop shoes are occasionally used to threaten someone since they can quickly be removed and thrown or used to hit an adversary. While that practice is rare in the United States, flip-flops can still pose a threat to those who wear them. For the most part, flip-flops provide no arch support at all, expose the foot to the outside environment, and can often contribute to many foot-related injuries. Since they often have a spongy rubber sole, flip-flops make it difficult for your feet to adjust and accommodate to the ground with each step you take. Furthermore, the strap can lead to skin irritation as well.
All that said, let me back up and admit that flip-flops are indeed a fun shoe to wear, and in fact have many benefits. They allow your feet to breathe and can actually protect your feet from picking up things like plantar warts and various fungal infections from public places. There are just a few pieces of advice to keep in mind if you do choose to wear flip-flops. First, if possible, look for a quality pair with a soft, leather fabric to minimize blisters and irritation. Look for a sole that forms some contour to the ball of your foot but isn’t overly pliable either. Also, make sure your foot doesn’t hang off the edge of the sole. This problem can be exacerbated if you have wet or sweaty feet with a smooth sole, so really try to be aware.
Some other advice would be to not walk for especially long distances, and to avoid playing sports or doing yard work in flip-flops. The straps can snap spontaneously, so excessive motion is definitely not advised. Overall, be cognizant of your environment. If you’re in a location where things like insects, poison ivy, or glass have access to your feet, flip-flops are not the best choice of footwear. If you’re at the pool or beach and wearing flip-flops, remember to use sunscreen on your feet as they can burn like any other exposed part of your body.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Tuesday, May 26, 2009
Bony Bridges
As you can imagine, human feet are incredibly complex and impressive structures. Just think of all the functions that your feet perform every day! Each human foot contains roughly 26 bones and 33 joints. That actually accounts for about a quarter of all the bones in the body! The coordinated movements that we often take for granted require efficient and effective motion between each of those bones and joints. Occasionally, however, some of the bones can develop unions or connections with other bones which can have a big impact on the function and comfort of your feet.
In most circumstances, the connections which reduce or stop motion between bones show up in the middle or hind part of the foot below the ankle. These unions are often bony themselves, but can also be made up of cartilage or fibrous tissue as well. They’re certainly nothing new. Doctors back in the 1700’s first began to describe this condition, and a pre-Colombian Indian skeleton from around 1000 AD even had one!
Unions between bones in the foot may be acquired over time or congenital- showing up in fetuses as early as the first trimester. Some acquired causes may include trauma, arthritis, or even tumors. Either way, they can present in a variety of ways. Patients may experience pain, muscle spasms, decreased motion, or no symptoms at all. Pain is usually localized to the outside top of the foot or the entire rear-foot, and often comes on after activity. Walking over rough surfaces is especially painful. Individuals-especially children-who develop a stiff flatfoot on one side but not the other have a very high chance of having a bony connection in that foot.
Podiatrists perform a number of simple clinical exams as well as radiographic techniques to quickly assess whether an individual has a bony union or not. They’re able to localize the issue and determine the extent of the problem, and of any arthritic changes. After that, a number of conservative measures may be implemented to address the problem. If these measures fail, surgery may be recommended to address the needs of that specific foot.
Physical activity is a critical part of everyone’s healthy lifestyle, and walking should not be painful. If your feet become rigid or uncomfortable, you should have them examined professionally. You’ll be glad you did!
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
In most circumstances, the connections which reduce or stop motion between bones show up in the middle or hind part of the foot below the ankle. These unions are often bony themselves, but can also be made up of cartilage or fibrous tissue as well. They’re certainly nothing new. Doctors back in the 1700’s first began to describe this condition, and a pre-Colombian Indian skeleton from around 1000 AD even had one!
Unions between bones in the foot may be acquired over time or congenital- showing up in fetuses as early as the first trimester. Some acquired causes may include trauma, arthritis, or even tumors. Either way, they can present in a variety of ways. Patients may experience pain, muscle spasms, decreased motion, or no symptoms at all. Pain is usually localized to the outside top of the foot or the entire rear-foot, and often comes on after activity. Walking over rough surfaces is especially painful. Individuals-especially children-who develop a stiff flatfoot on one side but not the other have a very high chance of having a bony connection in that foot.
Podiatrists perform a number of simple clinical exams as well as radiographic techniques to quickly assess whether an individual has a bony union or not. They’re able to localize the issue and determine the extent of the problem, and of any arthritic changes. After that, a number of conservative measures may be implemented to address the problem. If these measures fail, surgery may be recommended to address the needs of that specific foot.
Physical activity is a critical part of everyone’s healthy lifestyle, and walking should not be painful. If your feet become rigid or uncomfortable, you should have them examined professionally. You’ll be glad you did!
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Wednesday, May 6, 2009
MY SHOES ARE A LITTLE SMALL, BIG DEAL!!
You're on a mission, for the perfect pair of shoes. There's an event, a wedding, a game--whatever, you NEED those shoes. You get to your favorite shoe store and you see them through the window...glowing from a glorious pedestal display. AND their 50% off! Today is YOUR day.
You rush into the store, scan down the available sizes, and...just 2 pairs? One that's 2 sizes too big, the other is a 1/2 size too small. Just your luck. Well who cares, it's just a half a size smaller, maybe I'll just take out the insole or something...
Maybe you can relate or maybe you have a pair of shoes you've been holding onto for over a decade...
Women often buy dress shoes that come to a narrow point or lack sufficient padding--and sure, this causes blistering, soreness, corns, and calluses. But, did you know you can have changes in your bones from wearing ill-fitting shoes? Maybe you've heard of hammer-toes, here the toes start curl up a little at one joint and back down t the other, it can be a pretty gnarly deformity. As you can imagine, this "hammering" can become VERY painful. The bones of your toes can overlap each other, curl into each other, and be permanently scrunched upwards by those shoes you HAD to have...they are physically changing your bone structure! And if your bones of your feet are changing, the MUSCLES of your legs and feet (that attach to those bones) are forced to change too. Yes, it's painful, just like any other muscle, when it's pulled and strained--but think about it. These are the muscles of your legs and feet! You're on them ALL the time. Some of your muscles are forced to work overtime, which pushes the others out of their alignment too. This repeated pulling, tugging at your muscles is actually effecting how you walk. Over time, you can lose stability in your ankles and literally morph the way you walk. It's kind of like the tires on your car--if they fall out of alignment it pulls you one way or the other--and ultimately makes it difficult to steer...
See? IT IS A BIG DEAL. IT IS TIME TO GET YOUR FEET ALIGNED...
Stay tuned for the next blog for some helpful suggestions, tips, and pointers to find your next (truly) perfect pair of shoes...
and yes, it's time to get rid of those sneakers from 1983...
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
You rush into the store, scan down the available sizes, and...just 2 pairs? One that's 2 sizes too big, the other is a 1/2 size too small. Just your luck. Well who cares, it's just a half a size smaller, maybe I'll just take out the insole or something...
Maybe you can relate or maybe you have a pair of shoes you've been holding onto for over a decade...
Women often buy dress shoes that come to a narrow point or lack sufficient padding--and sure, this causes blistering, soreness, corns, and calluses. But, did you know you can have changes in your bones from wearing ill-fitting shoes? Maybe you've heard of hammer-toes, here the toes start curl up a little at one joint and back down t the other, it can be a pretty gnarly deformity. As you can imagine, this "hammering" can become VERY painful. The bones of your toes can overlap each other, curl into each other, and be permanently scrunched upwards by those shoes you HAD to have...they are physically changing your bone structure! And if your bones of your feet are changing, the MUSCLES of your legs and feet (that attach to those bones) are forced to change too. Yes, it's painful, just like any other muscle, when it's pulled and strained--but think about it. These are the muscles of your legs and feet! You're on them ALL the time. Some of your muscles are forced to work overtime, which pushes the others out of their alignment too. This repeated pulling, tugging at your muscles is actually effecting how you walk. Over time, you can lose stability in your ankles and literally morph the way you walk. It's kind of like the tires on your car--if they fall out of alignment it pulls you one way or the other--and ultimately makes it difficult to steer...
See? IT IS A BIG DEAL. IT IS TIME TO GET YOUR FEET ALIGNED...
Stay tuned for the next blog for some helpful suggestions, tips, and pointers to find your next (truly) perfect pair of shoes...
and yes, it's time to get rid of those sneakers from 1983...
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Thursday, April 30, 2009
Hammertoes, etc.
Our feet are incredible structures, and the lesser toes are no exception. Just as your thumb opposes and works opposite the smaller fingers in your hand, the lesser toes of your foot help to balance your body by working opposite from your “hallux” or big toe. Accordingly, in a healthy foot, specialized intrinsic muscles work on specifically the four small toes to allow them to stay aligned and function properly. However-as one might suspect-these toes can experience a unique set of symptoms.
Hammertoes are the most common and well-known digital deformity affecting the lesser toes. They typically will affect a single toe and will cause it to bend such that the first part of the toe is bent upwards, and the second part of the toe (the part with the toenail) is bent downwards. The typical signs and symptoms may include a corn on top of the joint where the toe bends as well as a callus underneath and behind the toe where it bears weight. Common causes of a hammertoe include tight shoes or stockings, biomechanical problems, or simply a long second toe.
A cousin to the hammertoe is the “claw toe” deformity. Whether our lesser toes are healthy or not, they typically consist of three small bones and two joints. With claw toes, not only is the first part of the toe bent upwards, but both the joints in the toe are also bent so that the second part of the toe tends to bend or curl downwards in a claw-like manner. This scenario is often associated with a cavus or high-arch foot type and neuromuscular disorders. It typically affects all the lesser toes at once, and may even affect the hallux.
In a “Mallet toe” deformity, the toe is strait except for the very end of the toe which is bent downwards. This tends to put pressure on the skin at the tip of the toe and will often lead to a callus formation there. The toenail will often become thickened and look as though it has a fungal infection. This condition is commonly associated with a long toe.
Numerous other conditions can also affect the lesser toes. “Curly toes” will typically bend downwards and underneath adjacent toes. They will often occur simultaneously on both feet. An overlapping 2nd toe will bend back and over the hallux, while both the 4th and 5th toes can be affected such that they may bend and rotate beneath the adjacent toes. Finally, a “floating toe” is commonly observed in a congenitally short toe which cannot purchase the ground.
Of course, each of these conditions has a unique set of symptoms, prognoses, and treatment options. Visit your podiatrist for an in-depth evaluation and discussion.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
Hammertoes are the most common and well-known digital deformity affecting the lesser toes. They typically will affect a single toe and will cause it to bend such that the first part of the toe is bent upwards, and the second part of the toe (the part with the toenail) is bent downwards. The typical signs and symptoms may include a corn on top of the joint where the toe bends as well as a callus underneath and behind the toe where it bears weight. Common causes of a hammertoe include tight shoes or stockings, biomechanical problems, or simply a long second toe.
A cousin to the hammertoe is the “claw toe” deformity. Whether our lesser toes are healthy or not, they typically consist of three small bones and two joints. With claw toes, not only is the first part of the toe bent upwards, but both the joints in the toe are also bent so that the second part of the toe tends to bend or curl downwards in a claw-like manner. This scenario is often associated with a cavus or high-arch foot type and neuromuscular disorders. It typically affects all the lesser toes at once, and may even affect the hallux.
In a “Mallet toe” deformity, the toe is strait except for the very end of the toe which is bent downwards. This tends to put pressure on the skin at the tip of the toe and will often lead to a callus formation there. The toenail will often become thickened and look as though it has a fungal infection. This condition is commonly associated with a long toe.
Numerous other conditions can also affect the lesser toes. “Curly toes” will typically bend downwards and underneath adjacent toes. They will often occur simultaneously on both feet. An overlapping 2nd toe will bend back and over the hallux, while both the 4th and 5th toes can be affected such that they may bend and rotate beneath the adjacent toes. Finally, a “floating toe” is commonly observed in a congenitally short toe which cannot purchase the ground.
Of course, each of these conditions has a unique set of symptoms, prognoses, and treatment options. Visit your podiatrist for an in-depth evaluation and discussion.
Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://www.yourfeetfixer.com
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