Heel Pain in Children

Calcaneal Apophysitis also known as Sever’s Disease is a very common problem among active children from the age of 6 to 16.  This condition occurs when there are microtraumas to the growth plate that is located on the back of the heel in a growing child.  Inflammation and pain may occur during, or following sports. This pain usually will subside with rest, but returns with activity.  Radiographs of the heel often show fractures within the growth plate at the areas of tenderness.  Treatment consists of Custom Orthotics which are shoe inserts with special custom modifications. They are created from a scan or mold of the child’s feet. Usually once a child is fitted for these devices they are able to continue with their sports activity without any significant pain.  Growth spurts naturally become a factor with these medical devices, they are only correcting the problem while they fit properly.  For immediate treatment the parents can ice the heels and place the child on children’s Ibuprofen.

Ingrown toenail? Treat it today

Ingrown Toenails

Ingrowing toenails are very painful and can occur on any nail, but most often it is the hallux or great toenail that is involved. It is important to note that if left untreated the infection along the side of the nail will enter into the bone and cause a condition called osteomylitis. Bone infection may require long term antibiotics or even in severe cases amputation.  Diabetics with limited sensation in there feet, often lose a limb to an untreated ingrown toenail.  Nevertheless, the majorities of patients with ingrown nails are easily treated and first present with pain along the side of the nail.

There are a variety of conditions that may cause an ingrown nail to form but by far the most common is a genetic tendency.  The shape of the nail is directly related to the shape of the underlying bone.  If your parents and grandparents had a proclivity to forming ingrown nails than the likelihood is that their children will also have similar problems.  Another very common cause of this condition is injury.  The great toe is often stubbed or injured which can lead to the formation of a small bony growth under the nail; this in turn causes a curvature to the nail leading to ingrown nails. Tight shoes or stockings, that maintain a constant pressure on the nails, may over time push the sides of the nail into the skin. 

 Treatments:

If your nails are curved in and are not painful LEAVE THEM ALONE.  A true ingrown nail is very tender.  Over the years I have seen nails that appeared almost normal but were excessively tender to touch and when I surgical removed the ingrown section I was amazed at how deeply they were embedded into the skin.  Trimming the side of the nail may alleviate the problem, soaking in warm water, which has a splash of vinegar or some Epsom salt, may help ease the pain. Avoid over the counter remedies such as outgrow which is acid and eats away at the nail and the skin, this is rarely a cure and may even add to the infection. Nevertheless, a true ingrown nail can not be corrected via bathroom surgery and if left untreated the side of the nail becomes red and swollen and infected. Overtime, the nail itself will become deformed in appearance. Antibiotics alone may help reduce the infection but will not cure the problem.  A small section of nail needs to be excised.   DO NOT have the entire nail removed, this does not eliminate future ingrown nails and when the nail returns it is often ingrown again, as well as thick, discolored, crumbly and quite ugly.  A podiatrist is the only specialist that has the expertise and equipment needed to correct this problem.  I have personally treated thousands of nails and on an average day remove several ingrown nails permanently. 

 Partial Matrixectomy:

There are several specific factors that make our nail surgery unique. First, when a section of nail is being removed the toe needs to be anesthetized via a toe block.  We use a cold spray called Ethyl Chloride to freeze the skin so the initial stick of the needle is minimal; we then use a 30 gauge needle to introduce the numbing agent.  The needle itself is so thin that it can only be used with a few injectables.  This procedure is done slowly and precisely reducing the pain to a slight pressure.  Second, once the toe is asleep a very small section of the nail is removed, just enough to correct the problem without causing the nail to look deformed.  Unfortunately, if the problem has been chronic or has had previous surgery, a larger section of nail must be removed.  Most often the nail will look completely normal when it has healed; of course this depends on the initial level of infection and deformity.   Lastly, we use a combination of a radiowave surgitron and chemical cautery to destroy the nail matrix cells at the root to insure the least amount of regrowth.  Overall, we see a very small percent of recurrence with this procedure and very few complications.  For detailed post operative instructions see section on Office Forms.

Walking towards Health

Every healthcare professional in the world advocates a good balanced diet and regular exercise to reduce health risks and improve quality of life.  The problem of course is how can you exercise when every step causes pain somewhere in the body.  The answer is not to stop exercising but to learn what is causing the pain and what can be done to reduce or eliminate that pain.  The foot is a very complex entity, it needs to support more than just the body’s weight, it also needs to align the body correctly to avoid ankle, knee, hip and back problems not just during stance but throughout propulsion.  In other words, the foot undergoes constant adjustments as we propel through our gait.  If there is a biomechanical problem which changes the way in which the foot supports the lower leg, then pain can occur anywhere from the ankle to the back.  Think of a house being constructed on a broken, uneven, collapsing slab.  Walls will be uneven, windows will be difficult to open and the roof will most likely crack, basically if the foundation is poor the structure will be weak.  Our bodies are much more complex but the same principle can be applied, if our feet are misaligned then our ankles need to compensate, which causes the knees to adapt, the hips to adjust and finally the back (usually the lower back) has to modify as well.  Pain may occur from the foot to the back and in any or all of the involved joints.  Chiropractors can realign the spine and reduce much of the pain, but with activity the problem will recur without the proper correction to the feet.   A functional orthotic is a custom insert that is built to properly support the foot, to correct the individuals problem and correctly realign the ankles, knees, hips and back.  If a shoe insert can be bent and twisted then it is merely a cushion, a true functional orthotic has a hard core that corrects the feet during stance and gait and needs to be designed to an exact image of the foot.  At our office, we use the Metascan by Footmaxx which measures the various stages of the foot during gait.  This remarkable scanner is capable of recording over a 140 images a second, capturing much more than the physician’s eyes can ever assimilate.  If you are embarking on an exercise program then functional orthotics may be an excellent way of avoiding problems from manifesting.  Many insurance companies cover the cost of functional orthotics. 

The Diabetic Foot

Feet, being the furthest from the heart, typically have the poorest circulation of the body. Changes in blood flow, within both the small and large blood vessels, may progress at different rates.  There can be palpable flow to the arteries in the feet, and simultaneously, complete occlusion to the digits, due to deposits of plaque within the capillaries feeding the toes.  On the other hand, there may be no palpable pulses noted in the foot and yet circulation is still excellent due to collateral propagation of vessels.  As a podiatrist that routinely treats diabetics, I have found that a diagnostic tool called a Doppler can, within a few minutes, determine the blood flow from the lower leg to the foot and from the foot into the digits.  Diabetics run a higher risk of calcification or hardening of the arteries, especially in the lower extremity, which will severely decrease blood flow to the foot.  Podiatrists work closely with Vascular Physicians in a joint effort to reduce the amputation rate amongst diabetics.  This collaboration, over the past decade, has significantly reduced the number of diabetic lower leg and foot amputations, due to earlier intervention, and new techniques in correction of peripheral arterial disease. 

Circulatory changes within a foot can also lead to a higher infection rate.  When blood vessels can’t deliver important nutrients or medications to an area, that area will be slow to heal.  Concurrently, a higher level of glucose in the diabetic patient will make them susceptible to various infections. With the reduction of circulation, the increase in vulnerability to infections, and finally the decrease in sensation called neuropathy, the diabetic foot is a disaster waiting to happen.  

Diabetic peripheral neuropathy is a condition that causes changes in the nerves within the foot, lower leg, and occasionally the hands and arms.  This condition may present as a tingling, or burning sensation in the toes or feet, numbness, or pain that may be more evident at night.  The cause of diabetic neuropathy is still under investigation but is likely due to a combination of several factors.  Most researchers agree that neurovascular changes can lead to damage within the blood vessels that carry oxygen and nutrients to the nerves. High blood glucose, abnormal blood fat levels, even low levels of insulin may affect the nerves.  Autoimmune factors that can cause inflammation to the nerves, inherited traits that increase susceptibility to nerve disease and lifestyle choices, such as smoking and drinking have an adverse effect on the chemical composition of nerve fibers.  Not only do diabetics have a tendency for higher infections, peripheral vascular disease and neuropathy, but since all parts of the body are involved, the skin, bones, soft tissue, ligaments, muscles are all susceptible to changes.  For the diabetic foot that means there can be physical changes such as bunions, hammertoes or even a complete breakdown of the medial arch.  A diagnosis of diabetes is distressing but with proper treatment, education and determination complications can be avoided.

Call Dr. Braun at Eastern Shore Foot Center and schedule your appointment today. Need diabetic shoes? Eastern Shore carries a wide variety of styles. Want more information? Visit us on the web. www.easternshorefootcenter.com or "Like" Us on facebook

Dr. Randell Braun - Eastern Shore Foot Center - 1913 US Hwy 98, Daphne, AL 36526

251-626-5065

 

Finding the Right Shoes

The wrong shoes can cause or aggravate foot ailments.  The right shoes can often prevent problems.  So wearing the right shoes is vital to foot health.  Follow this checklist when you buy shoes. Be sure they measure up.

Construction

Leather is the best material because it breathes like skin and molds to your foot.  Athletic shoes with netting also allows the feet to breath and is usually less binding as the foot swells during activities.  Canvas can be a good alternative to leather but if you are very active make sure that there are no pressure points that can cause blistering or irritation. NEVER wear plastic shoes, they can cause sweating that may lead to fungal infections, they do not breathe, they do not conform to the foot and do not absorb the jolts of walking on hard surfaces.

Insoles should be cushioned, if you are wearing high heels add a gel or foam metatarsal pad to the area under the ball of the foot to help reduce the pressure on the area and decrease the formation of calluses.  If the insoles in a pair of shoes have wear or even holes, in most cases the shoes need to be replaced.

Arch supports distribute weight over a wide area. They help reposition the foot to a proper alignment to alleviate various biomechanical problems.  Arch supports placed in flimsy shoes will not work properly; they need a shoe with a solid shank to hold them in the correct position.  Over the counter supports are generic and may help reduce problems but every foot is slightly different and only a true custom orthosis can accommodate a patient’s individual needs.  Custom functional orthotics are made from a computer image during gait and offer the best support.

 Fit

Only you can tell if shoes fit.  If they aren’t comfortable, don’t buy them.  If they do not fit properly they will create pressure areas on the feet, this often leads to blisters, bursitis, corns, neuromas and cramping.  Do not trust sizes, different models of shoes are made from molds that may differ from one manufacturer to the next.  Shoes can run wide, narrow, long, short or any combination and so it is important to try on both shoes for proper fit.  Most people have one foot that is slightly larger than the other; therefore, it is very important to try on both shoes. .  If you are having your feet measured, always check both feet for size.   Always fit the larger foot.   If you own shoes that feel tight have them professionally stretched by a shoe repair shop.

Feet spread with age, sizes change, often over time feet become wider.   A pair of shoes that may have fit a year or two ago may no longer be the proper size today.  Go shoe shopping at the end of the day when your feet are already tired, achy and swollen; then if you find a comfortable pair of shoes, buy them in every color if possible.  Too often people by shoes that felt wonderful in the shoe store to later discover they can’t walk in them.   Remember size depends on shoe make and style.  Don’t insist you always wear one size if the next feels better.  Most shoes are manufactured overseas and their forms may be sized slightly smaller.   The toe box should be roomy enough to wiggle all your toes.   Your foot should not be wider than the shoe.  The heel should fit without gapping and the instep should support your arch. 

 It is difficult to find shoes that fit all the above criteria.  The important area to fit is the forefoot, if the heel is too loose than moleskin can be applied within the shoe to make if fit your foot.  It is always easier to reduce the heel area with pads then to wear shoes that are constricting the forefoot.  If you can find shoes that fit both the heel and the forefoot that is the ideal situation, if the heel fits and the forefoot is just a little snug but not too tight, then a shoe repair shop can stretch the forefoot area. 

Children’s Shoes

Children’s feet grow very rapidly and so constantly check the shoes by pressing down on the distal aspect of the shoe, it should be at least ½ inch space from the tip of the shoe to the toes. If the toes are jammed right to the end of the shoe then they are much too small.  Shoes should be flexible and made of leather or canvas not plastic.  Children should be able to wiggle their toes inside the toebox of the shoe.  The orthopedic stiff leather shoes of the 50’s were too constricting, all studies in the past decades agree that today’s sneakers are the best shoes a child can wear.  Shoes protect the feet during walking; therefore shoes are unnecessary until a child begins to walk.  It is important to check the socks; tight socks can constrict the toes. 

 Passing shoes from one child to the next may be problematic.  If your child is wearing used shoes, firstly make sure there is no obvious wear inside or out that can cause problems, secondly treat the inside area of the shoes with an antifungal if you are unfamiliar with the previous owners foot conditions.  Although I do not recommend children wearing used shoes, I realize there are economic concerns that may necessitate the hand me down scenario.  Furthermore, with children’s rapidly growing feet, it is expensive and difficult to keep a child in a dress shoe that is only worn occasionally.  There are many advocates of not wearing used shoes, I am not one of them.  Children’s shoes, like their clothing, are often outgrown way before any wear is evident.   Just be meticulous in the inspection of a shoe that was previously worn by another, and make sure the fit is comfortable for the new owner. 

Cryopen

CRYOPEN

The CryoPen is a complete system that is simple, safe and effective for the treatment of skin lesions including warts, actinic keratoses, seborrheic keratosis, porokeratomas and skin tags to name just a few.  The CryoPen is safe because it delivers results without scarring or burning of surrounding tissue and because it does not require the use of dangerous cryogenic liquids and gases like liquid nitrogen.

The destruction of lesions using this system does not require local anesthetics; therefore, painful needles are no longer an issue.  The instrument is applied directly to the lesion for 1-4 minutes and this freezes the area. Afterward the area may be tender for a day or two so we place the patient on a cream that relieves the discomfort.  It does still take a few weeks to see if the lesions are completely eradicated. Occasionally the procedure needs to be repeated for stubborn lesions.

Schedule your appointment today with Dr. Braun at Eastern Shore Foot Center. Dr. Braun will go through all options with you; find out if Cryopen is the right procedure for you. 251-626-5065. Want more information? Visit us online at www.easternshorefootcenter.com

Ask for a second opinion

You Can Say NO

Pain is most often a warning sign.  Naturally, there are times that we all ache or hurt, but these are limited.   If you have recurring or constant pain, then it is your body telling you something’s wrong.  Most of us hate seeing a doctor; we dread the exam, the tests, and mostly the unknown.  When a problem is at its early stage, whether the pathology is simple or complex, it is easier to treat, reverse, cure or eliminate.  Too many people suffer for months, even years out of fear of a costly and painful treatment.  I realize fear is a basic human emotion that most of us share when it comes to our health.  The thought of surgery, injections, and medications that have side effects, and treatments that can be painful and expensive, seems to paralyze so many of us that we convince ourselves that the problem will just go away with time.  You need to realize one very important fact.  If you don’t like what a doctor suggests, if you don’t want the surgery or injection, if the treatment that is offered is not what you want, just say NO. Getting second and sometimes third medical opinions is prudent. There are many doctors to choose from, always remember in a sense you are the client not just the patient, you need to be involved in your health care decisions.  Ask questions, weight the choices and make an educated decision when it comes to your health. 

 If you are hurting and would like to see a board certified Podiatrist with over 30 years of medical experience in Podiatry;Please call us. Dr. Braun is knowledgeable, experienced and will refer you to another doctor if she feels she can not successfully solve your foot ailments. Visit www.easternshorefootcenter.com or call 251-626-5065.