Celebrities like Kim Kardashian and Snooki have been chastised for wearing heels during pregnancy, and rightfully so. Both wearing heels and pregnancy shift a woman’s center of gravity; the resulting combination means that pregnant women are more likely to fall while wearing heels (which is exactly what happened to Snooki last year). In addition, wearing constrictive heels also worsens another problem that women suffer during pregnancy: swelling. With this in mind, I thought I’d share why this occurs and what pregnant women can do to reduce this common pregnancy problem.

Swelling in the legs and feet, (sometimes referred to as “cankles” – a combination of
“calf” and “ankles”) is a common problem during pregnancy. As women’s bodies change during pregnancy, they retain fluids. These fluids pool at the lowest point of gravity, causing the legs and feet to swell. This swelling increases as the day progresses, so pregnant women wishing to avoid swollen feet should take frequent breaks from long periods of standing. Sitting down and putting your feet up lessens the effect of gravity, and promotes the fluids to return to your body. Pregnant women (or their loved ones) can also try to massage the area, starting at the toes and moving towards the knee, to reduce swelling.

Shoe choice can also have a major effect on the amount of swelling. Pregnant women should wear comfortable, supportive shoes whenever possible. Heels are not only dangerous for pregnant women as explained above, but also can increase swelling because they can be constrictive and not allow fluids to go back to the rest of the body. Tight socks should be avoided for similar reasons; instead, compression stockings or support hose that are specially designed to return fluids to the body are available over the counter and from your doctor.

While some amount of swelling is normal during pregnancy, excessive swelling can be a sign of bigger problems. If you or a pregnant loved one is concerned about feet swelling or other foot issues during pregnancy, make an appointment with any of our doctors for an examination.

Eric Polansky, DPM

Flip flop time of year is just around the corner, so it’s time to chase away those little critters that, as seen on television commercials, want to “live under your nail” – commonly known as fungus. Also known as onychomycosis, this condition manifests itself as toenails that appear very thick, crumbly, discolored (yellow, brown, green, or white), or with debris underneath the nail itself.  The organisms which cause this condition are called dermatophytes, the two most common ones being Trichophyton rubrum and Trichophyton mentagrophyte.  These critters prefer environments that are warm, dark, and damp, thus making the foot an ideal location for infection.

It is important to treat any concomitant athlete’s foot infection, or tinea pedis, along with fungal toenails.  The reason for this is because fungus can spread from the toenails to the skin and also from the skin to the toenails. Athlete’s foot appears as dry, scaly skin in a moccasin distribution or as what appears to be small, popped blisters on the soles of the feet.  Symptoms can be itching, burning, soreness, peeling, blistering, or cracked skin. Some people have no symptoms at all; this does not mean that you should leave the infection alone!  On occasion, the skin which is already infected with athlete’s foot may crack, thus allowing bacteria to enter the skin and cause a secondary infection.  This makes treatment more difficult, sometimes requiring both antifungal agents along with antibiotics.

There are multiple ways to treat fungal infections in the foot.  As for onychomycosis, some people have heard of soaking the toenails in bleach or using vinegar. These methods are not curative!   It is important to treat this condition with the appropriate antifungal agent.  Formula 3 is an oil-based, nail polish-type treatment that has shown promising results over the years.  You simply paint the oil on all of the toenails twice daily (once in the morning, once before bed).  All nails should be painted in order to prevent the spread of fungus.  Noticeable changes may be evident as early as 3 weeks to 1 month after beginning treatment. Laser treatment for nail fungus is also available at our Huber Heights office location.

Athlete’s foot can be treated with the antifungal medication Tineastat, which can be purchased at all of our office locations.  You should also use drying agents to prevent foot sweating and, therefore, cure and prevent future outbreaks of athlete’s foot. We have an array of products which prevent excessive sweating at all office locations, as well. 

If you are suffering from any of the above mentioned conditions, make an appointment with us today so we can help to start your summer off on the right foot!

Adrienne O’Neill, DPM

    When a patient with a bunion comes to my office I often hear the same sad tale.  “My mother always made me wear shoes that were too small for me when I was a child.”  This rubs me the wrong way, because I know better.  First of all, I was raised in the South, and I know better than to blame mama.  Secondly, I know that the real cause of a bunion is usually not tight fitting shoes.  The most common cause of a bunion is genetics, and it pains me to say it, but you just might be able to blame Mama for that.

    A bunion is a foot deformity on the outside of your big toe joint.  Bunions develop over time due to improper foot motion and abnormal joint stress.  After awhile this motion and stress forces the bone and soft tissue at the base of the big toe into an abnormal position, creating a bony prominence (a bump, if you will) and instability. 

    Most bunions occur in woman (actually 9 times more than occur in men).  Since women generally wear tighter, higher-heeled shoes than men, it’s no surprise that many women blame their bunions on tight shoes.  The fact is that their XX chromosomes and family are mostly to blame.  Tight, high-heeled shoes may contribute to development of the deformity, can cause bunions to progress quicker, and they certainly make bunions more symptomatic.   Most women with a bunion can attest to the fact that daily wearing of peep toe, pointy toe, or very high-heeled shoes make a bunion very painful.  For those with flat feet ballet flats will usually feel more comfortable, but their lack of support can be a developing bunion’s best friend. 

    When choosing shoes, be reasonable.  I tell my patient’s that there’s nothing wrong with wearing those sexy Christian Louboutin heels to dinner or a nice event.  They just shouldn’t be your everyday shoes.  The APMA has given its Seal of Acceptance to shoes that have room for your piggies (and your bunion), a reasonable heel height, and a supportive arch.  To see the shoes with the Seal visit APMA.org/Seal. 

    So, the question remains, what can be done after you have a bunion?  There are several conservative options that patients can try as well as surgical correction.   I have already touched on better shoe choices, so I won’t belabor the point.  Get shoes that fit your feet- period.  You may also find padding and strapping devices helpful at relieving the pressure on an inflamed bunion.  At Advanced Food and Ankle Care we have several options in this category, and we can help in choosing the one that is right for you.  Often over the counter anti-inflammatories such as Ibuprofen provide pain relief from a bunion.  I often prescribe oral or topical anti-inflammatories for my patients, and I find that these offer satisfactory relief.  Custom orthotics are a great option, especially for an early or developing bunion.  These help correct mal-alignment problems and can keep a bunion from developing further.  They can also relieve some of the pressure on the great toe joint.  Cortisone injections can be very effective at relieving the painful joint inflammation a bunion can cause.  Some patients even find relief from physical therapy and yoga.  All of these conservative treatments can help relieve the pain caused by they bunion, but they will not get rid of the bump that is already there. 

    Surgery is warranted if your bunion is painful and interferes with your quality of life.  Your particular surgical procedure depends on where in your foot the deformity is originating from and how severe your bunion is.  The doctors at Advanced Foot and Ankle Care perform well over 100 bunion surgeries every year, and we would be happy to evaluate your bunion and decide which treatment would be best tailored to you. 

    In April 2013 the American Podiatric Medical Association (APMA) launched its spring campaign, “Beat Bunion Blues” with informative posters, a video, and even a Beat Bunion Blues Pinterest pinboard.  I will leave you with these 5 bunion facts, provided by the APMA:

#1. Bunions are two to nine times more common in women than in men.

#2. 55% of American women have bunions.

#3. Wearing high heels may increase your risk of developing bunions.  The narrow toe box and increased pressure on the front of the foot can put the toe joints out of alignment.

#4. 72% of Americans say that foot pain affects their daily life, but only 22% of Americans with foot pain have consulted a podiatrist.

#5. Up to 95% of patients who undergo bunion surgery are satisfied with the results.

If you would like to find out more about the APMAs “Beat Bunion Blues” campaign go to AMPA.org/Bunion.

Hillarie Amburgey, DPM

Those who watched the Elite Eight game of Louisville against Duke won’t easily forget the injury that guard Kevin Ware suffered during the game. After attempting to guard a shot taken by Duke, Ware landed awkwardly and fractured his tibia (shin bone). Those watching saw the bone protrude through the skin – this type of fracture is known as an “open fracture.” While fractures are a common sports injury, open fractures occur most often in contact sports like football. These fractures can occur in any bone, including the bones of the feet. Recently, UFC fighter Jon Jones suffered an open fracture of his big toe during a match against Tito Ortiz. Unlike Ware’s injury which stopped the game, Jones’ injury was not noticed until after the match was over.

These types of fractures are not only more gruesome than other fractures, but also more difficult to treat for two reasons. First the fact that bone is exposed increases the risk of infection. Before the fracture can be fixed, the bone must be cleaned to reduce the risk of infection. Second, whereas many fractures that don’t break the skin can be treated with a cast, the bone pieces in open fractures are often further apart and need to be held in place with special surgical hardware.

Open fractures can take between 6 months and a year to heal, which is more than the time required for fractures that don’t break the skin. While their injuries may have been gruesome, both Ware and Jones got prompt treatment to fix the fracture and should go on to heal just fine.

While open fractures may be more obvious than other fractures, all injuries with possible fractures need to be examined. Please make an appointment to see one of our four physicians at Advanced Foot and Ankle Care if you injure your lower leg or foot and suspect that one of the bones might be broken. If fractures are not properly identified and treated correctly, the bones may not heal, or they may heal in an inappropriate alignment, which can both be prevented with prompt care.

Dr. Jeffrey Carlson

Mankind has used light to treat diseases and various aliments for thousands of years now, so introducing our new cold laser therapy laser may not be new to some of you. Advanced Foot and Ankle Care has now acquired the Dynatronics cold laser to better our patients’ foot health in treating a variety of aliments including: ulcers (even those caused by diabetes), burns, skin flaps and grafts, broken bones, cartilage, tendon and ligament repair, arthritic pain due to osteoarthritis and rheumatoid arthritis, ankle sprains and plantar fasciitis.

The Dynatronics cold laser uses three types of light therapy: red, blue and infrared.

Red light helps promote the healing of skin wounds at low energy densities. Red light therapy is also one of the oldest forms of treatment ever conceived or used by humans.

Blue light helps kill bacteria and a number of skin infections including: MRSA and staph. Blue light therapy is rapidly gaining popularity because unlike UV, it does not have high propensity to damage normal tissue.

Infrared light is best for deep tissue injuries, pain relief, and resolution of inflammation and reduction of edema. Infrared light therapy is commonly used with red light at the same time.

At this time, cold laser therapy is considered cosmetic, therefore not covered by your insurance company. Advanced Foot and Ankle Care offers cold light therapy for $25 per treatment. Our patients are not required to see the doctor every session, therefore do not have to pay a co-pay at those sessions that they do not see the doctor. Typical treatments require 2-3 session per week until the area is healed.

Call our office and speak to one of our Patient Care Coordinators for more information or to schedule a consultation appointment with one of our four physicians at any one of our four locations: Troy OH, Piqua OH, Sidney OH, Huber Heights OH.

Dr. Eric Polansky, DPM

What do Albert Pujols, Kobe Bryant, and Eli Manning have in common? Besides all being athletes, they have all suffered from plantar fasciitis. Plantar fasciitis is the most common cause of heel pain in adults, and has affected many professional athletes during their career. Unfortunately, this condition also occurs in many adults who are not athletes, so read on to learn more about what plantar fasciitis is and how it is treated.

What is the plantar fascia anyway?

The plantar fascia is a thick band of tissue that runs from your heel bone to your toes. It helps support the arch of your foot. Plantar fasciitis results from stress to the tissue, and can be very painful.

What are the symptoms?

Most patients with plantar fasciitis complain of pain in their heels. Often, the pain is worst when getting out of bed in the morning, but gets better as you walk throughout the day. As the tissue stretches throughout the day, it becomes less painful to walk. Resting allows the tissue to return to its pre-stretched state, which makes the pain come back.

What treatments are available?

There are several treatments for plantar fasciitis. Conservative treatments include icing and stretching the plantar fascia. Orthotics and physical therapy might be needed for some patients. Others still might need a night splint, which is a device that keeps your foot in a fixed position overnight to help stretch the tissue.

Many patients know that corticosteroid shots in the heel can help with the pain of plantar fasciitis. While this is true, repeated shots to the plantar fascia can do more harm than good, so not all patients need cortisone shots.

Finally, it is important to talk to your doctor if you have heel pain, because several conditions can cause pain in the heel. If your heels hurt, make an appointment with any of our doctors for an examination and discussion on the best treatment options for you.

Eric Polansky, DPM

You asked for it, we answered! Advanced Foot and Ankle Care has just doubled their shoe selection!  Along with our shoe selection through Safestep, we have now picked up shoes made by Dr. Comfort. All Dr. Comfort shoes that are displayed on our walls in each of our four locations are all approved by Medicare and other insurances that cover therapeutic shoes.  If your insurance doesn’t cover therapeutic shoes, you are more than welcome to come in, pick out a pair and get them ordered all within minutes.

If you are diabetic and have Medicare or a Medicare supplement plan and haven’t ordered shoes this year, stop by or call our office to make an appointment with one of our four doctors. At this appointment, one of our doctors will evaluate your overall foot health and write a prescription to order a pair of shoes from our office!

If you are diabetic and have any other healthcare plan, give us a call to schedule an appointment, the doctor will then evaluate you and we can contact your insurance company to see if therapeutic shoes are a covered benefit for you.

If you have any questions regarding shoes and coverage, please give our Troy Piqua, Sidney or Huber Heights office a call, we would love to answer any questions!

Eric Polansky

The 5th metatarsal is the one of the most common bones fractured in the foot. Situated just below the 5th toe, the anatomy of this bone influences the type of fracture that develops. The metatarsal itself is comprised of a base, tuberosity, shaft, neck, and head. The tuberosity, which is the posterior-most aspect of the bone near the midfoot, is clinically evident as it protrudes laterally (some people complain that this rubs in their shoes). Tuberosity fractures, also known as avulsion fractures, can be displaced or non-displaced. The position of the fracture will determine the type of treatment. For non-displaced fractures, the treatment is conservative and focuses mainly on symptoms. This includes protected weightbearing in a hard-soled walking boot or a short-leg walking cast. Pain usually resolves after a few weeks, and healing of the fracture fragment itself on x-ray is evident after approximately 6-8 weeks post-injury. These types of fracture generally heal well with no long-term complications. Larger, displaced fragments are commonly treated surgically, which varies from percutaneous pinning (making a small cut in the skin and inserting a screw without having to expose the entire metatarsal) to open reduction with internal fixation (exposing the metatarsal and placing pins, plates, and / or screws across the fracture site).

Another common type of 5th metatarsal fracture is known as a Jones fracture. The location of this injury is slightly more anterior to the tuberosity (1 cm from the joint, closer to the toes than the tuberosity fracture). The Jones fracture takes a longer time to heal because of the poor blood supply at this particular location in the bone. Treatment can be either conservative or surgical, depending on the patient's age, health, and activity level. Conservative treatment involves 6-8 weeks of strict non-weightbearing cast immobilization, followed by a few additional weeks of weightbearing boot or cast immobilization. Surgical treatment, which is similar to that described for tuberosity fractures, is generally recommended for athletes and more active individuals and allows shorter periods of immobilization with faster healing times.

Common to both types of fracture are soft tissue attachments found at the base of the 5th metatarsal. A muscle tendon (peroneus brevis muscle) from the lateral leg compartment courses down into the foot and attaches at the base. The lateral band of the plantar aponeurosis (which can occasionally be the culprit of infamous heel pain known as "plantar fasciitis") also attaches here. These two soft tissue structures have the potential to pull at the fracture fragment, thus causing possible displacement and, unfortunately, complicated fracture healing. This is why it is extremely important to seek treatment with myself or one of our doctors immediately at Advanced Foot and Ankle Care if you suspect that you have sustained a 5th metatarsal fractures.

Dr. Adrienne O’Neill

“Don’t knock the weather.  If it didn’t change once in awhile nine out of ten people couldn’t start a conversation.”  ~Kin Hubbard

One thing I didn’t know about Ohio until I moved here is that the weather is crazy.  It’s unpredictable.  It’s interesting.  It can go from 60 degrees and sunny to 30 degrees and snowy in one afternoon.  I am still in awe of these peculiar meteorological  conditions, and I find myself discussing them with my patients daily.  This winter has seemed looooonnnnggg and chilly, and I have seen a record number of patients with a common foot problem that has ties to this cold weather.  It is a condition known as Raynaud’s (pronounced  ray-NOHZ) disease, and 1 out of every 10 Americans suffers from it. 

The reason most patients with Raynaud’s come to my office is that they have noticed their toes turning colors.  In this condition the toes first turn white, then blue, then red.  These color changes can be associated with discomfort like tingling, burning, numbness, stinging, or throbbing.  The reason for this is that in Raynaud’s the small blood vessels that supply blood to your skin clamp down in response to cold temperatures or stress.   Often just one or two toes or fingers are involved, and not everyone experiences all three colors.  In most patients Raynaud’s is more of an annoyance than a disability. 

Raynaud’s can be broken up into two types, primary and secondary.  Both types are nine times as likely to affect women.  Primary Raynaud’s is the most common type and is not associated with any other type of disease.  This type is usually discovered between the ages of 15 and 30 and may have a genetic link (a parent, sibling or child may have it as well).  It occurs more in people who live in cold climates (think Ohio from October or November to April or May).

Secondary Raynaud’s (aka Raynaud’s phenomenon) is associated with certain diseases, occupations, and chemicals.  Autoimmune diseases like Lupus, Scleroderma, Rheumatoid arthritis, and Sjogren’s syndrome are linked with Raynaud’s as are other conditions such as carpal and tarsal tunnel syndromes, and thyroid dysfunction.  Jobs that involve working with vibrating tools and repetitive motions like playing the piano for long periods of time can also cause a type of the phenomenon.  Smoking and caffeine are also known triggers.   I wonder how many of my patients on a blustery winter day find solace in a cigarette and a nice hot cup of coffee?

Most of the time people with Raynaud’s don’t really develop any complications, but occasionally I will see patients who develop blisters or sores on the tips of their toes.  Very rarely Raynaud’s can lead to gangrene and result in amputation.    

If you think you may have Raynaud’s come visit our offices at Advanced Foot and Ankle Care.  First of all, we will try to find the reason you have this condition whether it be smoking, your body’s response to stress, a compressed nerve, or an underlying autoimmune disease.  We may rule out causes of secondary Raynaud’s with vascular testing, blood tests, and nerve blocks.  You may be referred to a rheumatologist or your primary care physician if we feel that your problem is serious enough that you could benefit from medication to open your blood vessels and promote circulation. 

Most of the time Raynaud’s can be treated by dressing warmly and avoiding situations in which your hands and feet come into direct contact with the cold.  Wearing a hat outside in the winter is important because a lot of body head escapes through your head.  I recommend that my patients wear socks to bed and put an extra blanket at the foot of the bed.  I may recommend that they avoid over the counter cold medications that contain pseudoephedrine, birth control pills, and beta blockers (for the latter two, after consulting their ob-gyn and family physician).  And then there’s everyone’s favorite recommendation: Moving to the Caribbean.  On Doctor’s orders, of course J

Dr. Hillarie Amburgey

With the Sweet Sixteen chosen, March Madness is nearing an end. But with the NBA playoffs set to run from about mid-April to June, basketball fans still have a lot to look forward to. For those that play basketball, or those who have loved ones who play basketball, I thought I’d offer some suggestions on what to look for when purchasing a new pair of basketball sneakers.

First, and this goes for whatever shoes you buy, you need to make sure to have the proper shoe size. January 23rd was “Measure Your Feet Day”, which reminds us that, unfortunately, many people wear the wrong shoe size. Don’t hesitate to ask someone who works at your local shoe store to measure your shoe size for you - they should know how to measure your feet correctly.

 Next, you have to decide what type of sneaker you want to get. Basketball shoes come in three main varieties, which offer different levels of ankle support. High tops are the best at preventing ankle sprains, the most common basketball injury involving the foot. For this reason, players who have suffered ankle sprains in the past may particularly want to look into these types of sneakers, as their ankles may not be as stable as other players.

Unfortunately, some people may find high tops uncomfortable and restrictive. Those that do may want to consider mid-tops, which offer increased flexibility but sacrifice some ankle stability. There are also low top sneakers, which don’t offer much ankle support but are the lightest of the three options; for this reason I don’t recommend them as much as the other two options.

Finally, consider style and price. Preventing injury should be your first consideration. After this is taken care of, go for a style that you like, at a price that fits your budget.

Jeffrey Carlson, DPM

In life, we like to connect with all kinds of people. At Advanced Foot and Ankle Care, we want you to build a relationship with all of the things and people that you care about, including your Podiatrist! This is why we want you to visit our Google + pages to become friends with our Podiatrists and follow all of our offices. You can recommend us with a +1 or add us to your circle and establish a long-term bond.

On our Google + pages, you will become more educated on common foot and ankle problems with the blogs that our doctors write weekly. You will also be updated on anything interesting that happens with our staff members. You will feel like you know us before coming in!

Here are our Google + pages:

Dr. Polansky -https://plus.google.com/u/0/118408183651611452267/posts

Troy Location- https://plus.google.com/u/0/b/116753659961482540059/116753659961482540059/posts

Piqua Location- https://plus.google.com/u/0/b/100508611233693905645/100508611233693905645/posts

Sidney Location- https://plus.google.com/u/0/b/115663483252729836497/115663483252729836497/posts

Huber Heights Location- https://plus.google.com/u/0/b/111698828282020979921/111698828282020979921/posts

We look forward to building a better relationship with you!

Lady Gaga has been in the news a lot recently, but not for the reasons that you might think. Instead of talking about her music, or her fashion sense, most news outlets have been reporting on the fact that Lady Gaga had to cancel some of her tour dates because of a condition known as “synovitis” affecting her hip. For this reason, this week I thought I’d write about synovitis to shed some light on this condition.

What is Synovitis?

Synovitis is a joint disorder that can occur in many joints other than the hip, including the shoulder, hand, wrist, knee, and especially the ankle and the joints in the foot. It is an inflammation of a special kind of tissue that lines these joints, called the synovial membrane. This membrane is very important because it produces a fluid that acts as a lubricant that helps the joint move. When the membrane is inflamed, the joint becomes swollen with this fluid, and is often very painful.

What causes it?

Synovitis can arise after an injury, or it can occur secondary to other conditions such as arthritis and gout.

What are the symptoms?

Symptoms of synovitis include joint swelling, warmth, redness, and pain, especially when moving the joint.

How is it treated?

Over the counter medications like aspirin and ibuprofen may work in some cases to relieve pain and swelling. For more severe cases either oral or injectable steroids may be indicated. Surgery is rarely necessary, and reserved only for persistent cases.

Unfortunately for Lady Gaga, it was reported that her problems were more severe than just synovitis. She recently underwent surgery to repair a soft tissue tear in one of the structures of her hip joint; with this type of surgery, she will most likely face a lengthy recovery period.

Eric Polansky, DPM

Dr. Polansky is a Fellow with The American Academy of Podiatric Practice Management (AAPPM), which is an organization whose mission is “To positively change the lives, practices and communities of podiatric physicians through leadership education, practice management education and sharing knowledge.” This year, at the 2013 Mid-Winter Conference held in Pittsburgh, Pennsylvania on February 27 through March 3, Dr. Polansky was awarded the President’s Award of Excellence in recognition of advancing the practice of Podiatric Medicine. Congratulations Dr. Polansky and continue to be the great Podiatric doctor and surgeon that you are!

Source: aappm.org

Diabetic therapeutic shoes are, in my opinion, one of the most important parts of my job.  Diabetic shoes help save feet, plain and simple.  According to the American Diabetes Association, each year 600,000 diabetic patients get foot ulcers, resulting in over 80,000 amputations. 

As a podiatric physician I try to embrace preventative care modalities such as regular diabetic foot exams and diabetic shoes to prevent my patients from getting foot ulcers. My patients will tell you that I’m a stickler about these things.  I do understand patient concerns over cost, but the vast majority of insurances cover diabetic shoes and insoles.  It is widely accepted that preventative medicine is the best medicine, and not only the monetary cost but also the emotional and physical cost of an amputation makes money spent on diabetic shoes and insoles money well spent.  So, what makes diabetic shoes and insoles so different from your run-of-the-mill shoe?  Which patients need them?  And how do you know if insurance will cover them?  Read on for the low down on diabetic shoes.

The Definition: Diabetic shoes can also be referred to as extra depth or therapeutic shoes.  They are specially designed shoes intended to reduce the risk of skin breakdown in diabetics with co-existing foot problems (such as neuropathy, poor circulation, and foot deformities). 

Why They’re So Special: 

• Diabetic shoes are extra deep to accommodate diabetic insoles or orthotics. 
• They have a built in firm heel counter to provide medial and lateral rearfoot stability.
• The toe box of the shoe is higher so there is plenty of room for toes (even ones that like to stick up like hammertoes). 
• There is little to no stitching on the inside of a diabetic shoe.  The stitching is on the outside.  Sometimes even the smallest prominence can irritate and cause skin breakdown in a diabetic foot. 
• The collar around the ankle of the shoe is padded.
• The tongue of a diabetic shoe is thick and padded to help secure the foot back in the shoe.
• The end of the toe box of the shoe is protective to keep toes from being hurt when stubbed.
• Diabetic shoes have a non-skid sole to prevent falls. 
• They are specially fitted by measuring the length and width of your foot.
• They are also equipped with a special multi-density diabetic insole that prevents back and forth movement (also known as sheering) of the foot in the shoe.  A diabetic shoe isn’t really a diabetic shoe without this insole.  Most insurances pay for 3 pairs of these insoles yearly, and they should be changed every 4 months to get the maximum benefit.

Insurance Coverage:  It is rare that we come across an insurance plan that does not provide coverage for diabetic shoes and insoles.  Medicare has a Diabetic Shoe Benefit, and they have a pretty clear-cut policy regarding this coverage.  Even if you don’t have Medicare, many other insurances follow Medicare guidelines, and our office is happy to check out your insurance’s specific requirements.  According to Medicare.com to be eligible for diabetic shoes:

• You must have diabetes and one or more of the following conditions:
  • Nerve damage in your feet with calluses on either foot
  • Poor circulation in either foot
  • Deformity of either foot
  • Calluses on either foot that could lead to ulcers
  • A history of past foot ulceration
  • Partial or complete foot amputation
• You must have a prescription for the shoes. Our office can help you with this part.
• You must have documentation from the doctor managing your diabetes that you are in fact being treated for diabetes.  Our office contacts this physician and provides them with the necessary paperwork for this. 
• If you are enrolled in Medicare Part B, after you have paid your yearly deductible, you will pay 20% of the approved Medicare amount for the shoes and inserts.  You can think of this as the shoes and insoles being on sale for 80% off. 
• If you receive your Medicare through a Medicare Advantage Health Plan then you may owe little to nothing depending on the plan, but you will have to follow your plan’s steps for approval.  Our office will be happy to help you with that part too.
• You will save money on your shoes if you order from a Medicare-approved provider.  Beware of telemarketers, mail-order companies, and shoe stores who may or may not be participating suppliers. 

If you are a diabetic and would like to enquire about diabetic shoes and insoles we at Advanced Foot and Ankle Care would be happy to answer any questions that you may have about them.  We have quite a few shoes on display in each of our offices as well as a catalog and a website with even more shoes.  Our diabetic shoes come in a variety of styles from athletic to dress, walking to casual.  I feel confident that we have a shoe to fit your needs.

Hillarie Amburgey, DPM

What causes them?

Ingrown toenails are most common in the big toe, and occur most often from poor-fitting footwear. This is because tight shoes can put pressure on the nail, and force them to grow downwards instead of growing outwards.

They can also occur from direct trauma, such as in dropping a heavy object on your toe. Some people are more prone to getting ingrown toenails simply because their nails tend to grow in curved.

 How can they be prevented?

One of the best ways you can prevent ingrown toenails is cut your toenails straight across, without rounding out the corners. When cutting your toenails, it is important to make sure that you do not cut your toenails too short, as this can also increase the chance of developing an ingrown toenail.

Wearing appropriate-fitting shoes, like those with a wide toe box, will also help prevent ingrown toenails by preventing the deforming pressure on the nails that can lead to ingrown toenails.

 What are the signs and symptoms?

Most patients with ingrown toenails report pain on the sides of the toenail where it digs into the skin. This may be accompanied by swelling, redness, and discharge if infected.

 How are they treated?

Treatment for ingrown toenails depends on its severity. For some patients, simply removing a portion of the offending nail will solve the problem. This must be done correctly, however, or it will likely come back. For this reason, when toenails are ingrown it is best to leave this to a professional. For more severe cases, more of the nail might have to be removed and a chemical can be used to make sure that portion of nail will not grow back.

If left untreated, ingrown toenails will usually not resolve on their own, and can lead to infection; for this reason, if you think you might have an ingrown toenail, make an appointment with myself or any of our doctors at Advanced Foot and Ankle Care in Sidney OH, Piqua OH, Troy OH and Huber Heights OH, to have it evaluated.

Jeffery Carlson, DPM

Pre       

gnancy is a wonderful time in a mother’s life.  The excitement of a new baby brings on feelings of joy and happiness….but it also brings on bodily changes, such as emotional liability, weight gain, and something very important on which I would like to educate everyone today: swelling, or edema, in the lower extremities.

Swelling in the legs during pregnancy can be caused by many different changes occurring within the human body. First of all, hormones begin spiraling out of control, and the body begins to produce and retain more fluid in general. Furthermore, a growing uterus puts increased pressure on a major vein in the body called the vena cava, which lies on the right side of the body and carries blood from the legs back to the heart.  This increased pressure slows the return of blood, causing it to pool.  Fluid from within the veins is then forced into the tissues of the legs, feet, and ankles.  Thus, it easy to see that as the baby grows, edema worsens.  It may be particularly severe for women with excess amniotic fluid or those carrying multiple babies. Edema also tends to be worse at the end of the day and during the summer months. (After reading this, it may be easier to understand whymothersare instructed to lay on their left sides usually starting in the 2^nd trimester, rather than on their backs or right sides – to give the vena cava room to expand and allow uninterrupted blood flow back to Mom’s heart and Baby’s placenta.)

In certain cases, edema may be particularly severe or have a sudden onset. This could be a sign of preeclampsia or ecclampsia.  Other signs of these potentially life threatening conditions include severe headaches, blurry vision, dizziness, and rapid weight gain.  Protein in the urine and high blood pressure are also red flags.  Swelling in only one leg with tenderness or cramping in the calf or leg muscles can be a sign of a blood clot, or DVT.  All of these conditions require immediate medical attention.

If you are pregnant (or perhaps if you just so happen to be Kate, Kim, or Mrs. Tatum), here are some actions to take to avoid the incredibly uncomfortable phenomenon of excessive swelling during pregnancy:

·         Elevate your feet as much as possible.

·         Keep your legs uncrossed when sitting.

·         Stretch your legs frequently.

·         Take a short walk after sitting for a prolonged period of time to prevent blood from pooling in the legs.

·         Wear comfortable, stretchy shoes.

·         Wear compression stockings, which are currently ON SALE during the month of February at Advanced Foot and Ankle Care for $22.25.  (These can also prevent the future formation of varicose veins.)

·         Drink plenty of water. Surprisingly, this helps your body retain less water!

·         Exercise regularly.

·         Eat healthy foods.

So I say to all of the moms-to-be out there: kick back – or should I say kick up – your feet and enjoy this amazing time in your life!

Dr. O’Neill is proud to announce that Baby O’Neill will be coming to you live in June 2013!!

Dr. Adrienne O’Neill

What is it?

A “Hammertoe” is an abnormal bending down of a toe so as to resemble a hammer or a claw. It is similar to other deformities such as “claw toe” and “mallet toe,” with the only difference being where on the toe the bending occurs.

What causes it?

Hammertoes can arise from a variety of causes. Genetics are thought to play a role. They can occur due to other deformities, such as from bunions. They can also occur from poor shoe choices, such as high heels and flip flops: the constant clenching of your toes to keep flip flops on your feet can accelerate hammertoe formation, and the extra pressure and that is put on your toes while wearing high heels can also cause your toes to retract.

What are the symptoms?

If a hammertoe is present, shoes can irritate the top of the toe, causing a painful corn. A callus may also develop on the ball of the foot under the affected toe.       

What treatments are available?

For some patients, conservative treatments such as specialized orthotics may relieve some of the pain associated with hammertoes. Shoe modification is important, so pick shoes that offer wider toe boxes and avoid high heels and flip flops.

For select patients, surgery may be necessary if the deformity is advanced. In this case, our doctors here at Advanced Foot and Ankle Care would be happy to discuss all your options with you and make sure that all other reasonable options have been exhausted.

 Dr. Eric Polansky

The summer after my sophomore year of college I taught pre-school swimming lessons at my local YMCA.  Imagine my surprise last week when one of my old swimming students was conducting occupational interviews for a high school project (I feel SO old!) and asked for my input.  I filled out my interview and emailed it back to her.  This got me to thinking about how many people, even people reading this blog, know very little about podiatry.  Whenever I see a patient who is preparing for college or a patient who is the parent of a student preparing for college, I can’t say enough good things about my chosen field.  I love what I do, and I would love to share my profession with all of you.  To do that, here is a copy of the interview I filled out earlier this week.  Welcome to Podiatry 101.

Name:  Hillarie  Sizemore Amburgey           

Occupation:  Podiatrist (Foot and Ankle Surgeon) at Advanced Foot and Ankle Care

Years of Experience:4.5

       How would you describe what you do? 

I diagnose and treat foot and ankle problems in adults and children.  I specialize in congenital disorders, sports injuries, diabetic foot care, and minor and reconstructive surgery of the feet and ankles.

       What is your average day like? 

No day is alike, which is one of the things I love the most about my job.  I typically see patients in my office 5 days a week and do surgery a half or whole day a week.  If I have a patient that I am seeing in the hospital then I go see them (round on them) either on my lunch break or after regular work hours.

What kind of hours do you work? Do you have to work weekends, holidays or call?

I work from 8-5pm in the office 5 days a week.  On days that I have surgery then I am at the hospital by 6:45 or 7am.  If I have a patient in the hospital then my day usually ends around 7pm.  I am on call every 3^rd week and weekend.  Our office is closed Christmas Eve, Christmas, New Years Eve, New Years Day, Memorial Day, Independence Day, Labor Day, and Thanksgiving. 

       What kind of training or education did you complete?

I completed undergraduate college in 3 years, and then went to a podiatric medical school for 4 years.  Then I completed 3 years of residency training.

How long did it take for you to find a job once you completed your education or training?

I found a job before I completed residency. 

       Do people in your occupation all have a similar job duty or is there variety?

There is some variety.  All podiatrists have surgical training; however some prefer not to do surgery.  Podiatrists are employed in private practice, at hospitals, wound care centers and sports medicine clinics.  Some very specialized podiatrists just specialize in the treatment of foot problems in children.

      What is your favorite part of your job? 

The interaction with my patients.  They are constant sources of jokes and the weather forecast.  I laugh and cry with them.  And I am always learning new things from them. 

       What is your least favorite part of your job?

The pressure to change my treatment plan or what I think is best for my patient because their insurance won’t pay for it, and they can’t afford it.  It is a shame that insurances and people with no medical education have so much influence on patient care.

       How did you decide on your career?

I shadowed a podiatrist and liked what I saw.  I felt that he had a good quality of life, was helping people every day, and had a great relationship with his patients.

What are three qualities that would help someone succeed in your career (e.g. creative, organized)?

You will need to be…….

        1.      Self-motivating- You will need to push yourself through school and residency.  The learning never ends.  I still study every week. 

        2.      Likeable- A medical practice is still a business, and your business will fail if your customers don’t like you.  If your patients like     you they are more likely to take your advice and refer you to their friends and family.

        3.      Compassionate- Foot pain and problems get in the way of people’s lives in a big way.  People that can’t walk without pain are more likely to lead sedentary lives and become depressed.  It’s important to remember this and to try to empathize with your patients.

       Would you encourage young people to pursue your occupation?

If it’s what they really want to do, yes.  If they see a future of sports cars, tropical vacations, and mansions in their future, then they should probably look into doing something else with their life.  Healthcare has changed quite a bit in the past 10 years, and I believe it will change a lot more in the next 5-10 years.  The cost of a medical education is around $200,000.00, and in this day and age of decreased reimbursements (payments) that is a big financial burden.  For many physicians it can take upwards of 30 years to pay off these loans. 

       What are some fun facts or interesting stories from your job?

I have a lot of funny and gross stories.  Sometimes patients come in with maggots crawling out of their foot wounds.  This is cleaning the wound of dead tissue and is actually good for it (but we usually clean them off anyway). 

I have also used leeches to stimulate blood flow to a foot with decreased circulation. 

I would estimate that about 5 times a week (at least!) I am asked why I would want to look at peoples feet every day.  And I usually (Jokingly) respond that I have a foot fetish.  Then I go on and on about all the things that I love about my job J.  

Hillarie Amburgey, DPM

Every year we all make New Year’s Resolutions that we fail to keep. But here are some of my personal recommendations on some new year’s resolutions that can improve your foot health:

Stretch before exercising.

Perhaps the most common New Year’s resolution is to lose weight or exercise more. If this was one of your resolutions, don’t forget to add stretching to the mix. Proper stretching is important because it can prevent injuries, and can also increase flexibility and range of motion.

New Year, New Shoes.

Ring in the New Year with some new shoes. Replace any shoes that show a considerable degree of wear. Shoes may need to be replaced sooner depending on how often they are worn, or what type of shoe it is (for example, running shoes often need to be replaced much sooner than other shoes). Make sure that the soles of the shoes are intact so that they can provide the best support. After you throw the old pair away, make sure that the shoes you replace them with are sensible. And while you are at it . . .

Stop wearing shoes that are bad for your feet.

 This might be the hardest on the list for some readers. Studies have shown that many women will wear certain shoes even if it hurts to wear them. This year, try to be more sensible in the shoes that you wear. While you might like those stilettos now, is the pain that you will have from them later worth it? It’s up to you.

Happy New Year from all of us at Advanced Foot and Ankle Care!

Jeffrey Carlson, DPM

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