It’s That Time of Year

November 10, 2011

By Dr, Dorian Jimenez, DPM

It’s the beginning of November and the flood-gates are about to open in operating rooms all over the country.  Long lists of patient names will cover surgery boards at hospitals and surgery centers in every community.   For myself and other foot and ankle surgeons, this is a very important time of year.  Yes, it’s the holiday season and that means time spent with family and friends.  But it also means more time spent with bunions!  That’s right, bunions seem to come out of the woodwork; painful, red, screaming in those tight shoes, just waiting to be removed by their friendly foot surgeon.

If you aren’t yet one of those patients who have made the trip to the foot doctor to see about your bunions, what are you waiting for?  I’m well aware of the bad rumors surrounding bunion surgery but allow me to dispel some of those myths and hopefully convince you to get those toes to someone who knows.

Myth 1: Bunion surgery is the most painful surgery you can have

While I’ll leave the claims of “painless bunion surgery” to the other pages of the internet, the fact is that bunion surgery is just like any other bone surgery in the body.  Patients generally experience some pain, which is controlled with medication, ice and elevation.  Additionally, somewhere in the neighborhood of 90% of people who have one foot done will have the other bunion surgery within six months.  If it were truly as painful as rumored, I would think most people would forego that second foot.

Myth 2:  If you have bunion surgery, you can’t walk for months

This statement is, for the most part, false.  There are cases where bunions are so severe that wearing a cast is required for 6-8 weeks, depending on the way your healing progresses.  However, with improved techniques and understanding, the majority of bunion surgeries performed are “walking surgeries.”  This means that the foot can be placed in a special shoe or boot, allowing the patient to walk short distances immediately following surgery.   In fact, most patients are encouraged to get into a lace-up, supportive sneaker within 3-4 weeks after surgery.

Myth 3:  They have to break the bones in the foot to fix the bunion

Breaking bones sounds bad no matter which way you put it.  When most people hear something like this, they picture a brutal hammering type breaking of the foot bones.  Let me assure you this is not the case.  While most often the bone is cut during the surgery, it is a very controlled, precise undertaking.  When the cut is complete, the bone is secured back together in a better position using pins or screws.  This is the part of the procedure that truly corrects the problem rather than just shaving a little bone as some expect.

Myth 4:  Bunions always come back after the surgery

There is a risk of a bunion returning to your foot after attempted correction, and this can be a concern with the decision to have not just bunion surgery, but any surgery.  While the risk does exist, it is reported that less than 10% of bunions come back.  In fact, many recurrences are simply cosmetic and do not result in pain. The great toe joint is still lined up correctly, which is the goal of bunion surgery in the first place.

So as the rumors will undoubtedly continue, hopefully this has helped to clear up any undue concerns regarding a decision to get your painful bunions checked.  Who knows, maybe you will find yourself signing up to put your name on the surgery schedule with all of the others!

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Time To Test Your Nerves!

October 26, 2011

By Dr. Dorian Jimenez, DPM

If you are like many of my patients, both diabetic and non-diabetic alike, feelings of burning and tingling in your feet present an unwelcome problem.   Maybe it’s just the toes or the front of the feet but maybe your entire feet and legs are affected.  Patients give descriptions such as:

  • My toes are numb
  • the bottom of my feet feel like cardboard or deadwood
  • sometimes I have crawling feelings in my feet
  • my feet are ice-cold even in the middle of the summer
  • I stumble because I can’t feel where my feet are

These are all common complaints that likely lead back to a condition called “Peripheral Neuropathy.”  And while many diseases and disorders can cause peripheral neuropathy, the most common cause is diabetes. 

This is not to say that all patients who are diagnosed with diabetes will get these symptoms in their feet and legs.  But those who do not control their blood sugars will likely eventually start to experience feelings of Diabetic Peripheral Neuropathy.

Historically, symptoms of burning and tingling in the feet as a result of diabetes have been treated by medications aimed at limiting those painful, irritating feelings.  Thankfully, the world is a changing place.  And in our current world of programs aimed more toward disease prevention, a simple way to “test” your nerves has emerged.  It’s called Epidermal Nerve Fiber Density Testing.  While the name is intimidating, the actual test is very simple.

Your podiatrist will start by evaluating your feet and legs. This should be done at least two times a year even if you aren’t  having problems assuming you are diabetic.  Once the evaluation is complete, your podiatrist may recommend “testing your nerves.”   A simple biopsy performed on the outside of the leg is all it takes.  The sample will be sent to a lab and within a week or so, you can have a “real-time” reading of your nerves and the level of disease present.

Of course, as with most medical tests, the ENFD test isn’t perfect, but it is a very useful tool in the fight against those electric shock-like, burning, numb feelings in your feet and legs.  Ask your podiatrist whether you’re a candidate for this biopsy and get to know your nerves a bit better.

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ESWT: A New Plantar Fasciitis Treatment Option

September 7, 2011

By Dr. Dorian Jimenez, DPM

So you’ve enjoyed the warm weather with your favorite pair of flip flops or sandals for the whole summer.  You wore them so much that there are little toe marks where you made imprints from walking many miles with the fresh air blowing across your toes.  And you started a work out routine or a do-it-yourself home project that required some ladder climbing (just a side note, I stay away from ladders).

Now let me ask you a few simple questions about your feet:

  1. Do you wake up in the morning with a toothache-like sensation in the bottom of your foot?
  2. Is it sometimes accompanied by a fiery sensation shooting into the arch or up the inside of your ankle?
  3. Have you said to yourself, “Oh, it will go away, it’s probably normal, it’s just my foot.”
  4. Has it gone away yet?!

If the answers to the questions are three “yes”es and one big “NO!” then allow me to explain.

First of all, no pain in your feet is “normal.”  Sure, your feet may feel tired at times and you may even ask your husband or wife to rub your feet after a long day.  That’s understandable.  However, waking up every morning to pain in your heels and arches is not normal, even though it does go away after you “warm up a little.” 

You are most likely suffering from a condition called “plantar fasciitis” or as it’s also known, “heel spur syndrome.”  Plantar fasciitis sounds fancy but boils down to a lack of adequate support for your feet.  The plantar fascia is a ligament on the bottom of the foot that helps with arch support and prevents our foot from flattening out like a pancake (although some people do have pancake flat feet!).  Without proper support, that ligament is forced to work too hard and ends up pulling on the heel bone, causing a spur to form. 

This is one of the most common ailments treated by the foot and ankle specialist. 

But you’re in luck!  It does go away with the right treatment plan.  As I mentioned, good arch support is a must on a daily basis.  There are many different insoles and pads that can help carry out this task.  In addition, shoe wear is important and must be combined with arch inserts.  I ask all of my patients to wear shoes from the first steps on the way to the bathroom in the mornings until the last steps before bed at nights.  I know it doesn’t always happen, but I keep asking.

Another helpful treatment for more chronic plantar fasciits is Extracorporeal Shock Wave Treatment or, more commonly known as ESWT.  Yes, I am recommending you consider shocking your foot to get rid of your heel pain.

Now it’s not as Frankenstein-ish as it sounds.  In fact, these are not electric shock waves as some of you may be thinking.  ESWT uses high-energy sound waves to help the damaged soft tissues and bone heal back stronger.  ESWT is a simple, non-invasive procedure that can be performed in an office or operating room setting.  While not all insurance companies cover the procedure, the FDA has approved some ESWT machines for the treatment of heel pain. The procedure takes approximately 30 minutes to complete and you are able to walk the same day.

As I stated before, most cases of heel pain will resolve with the right conservative treatment plan.  However, in those cases that linger on and continue to cause you to walk like you’re 107 years old in the mornings, ESWT may be an option for you to consider.

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Swollen Ankles at the End of Your Day?

July 11, 2011

By Dr. Dorian Jimenez, DPM

You just finished dinner and it’s time to relax.  You take your usual comfortable spot in the house and set your drink on the side table.  The reading that you plan to do or show you plan to watch is ready to go and there’s one last thing to do.  Reaching down after you’ve kicked off the shoes, you push the tops of your socks down and there are indentions circling your legs where the socks have been squeezing all day.

If this type of thing only happens occasionally after a long flight across the country then it’s a relatively normal situation.  However, if this is the normal state of affairs then there is need for concern.

Chronically swollen ankles in which you are able to create indentions with a slow, firm push of the finger are likely the result of a conditions know as chronic venous insufficiency.  And if you have these types of symptoms, it’s time for you to look into compression socks or compression hosiery.

I’m a huge proponent of everyone wearing compression stockings.  In fact, if I had it my way, they would be the most popular type of sock worn.  While consulting a doctor regarding their use is recommended, I find myself singing the praises of compression stockings very frequently.  I understand the complaints:  they are hot, difficult to put on and take off, tight on the legs and sometimes make the legs itchy and dry.  Let me assure you, the benefits far outweigh these minor issues.

As we get older, we don’t exactly run around like we did when we were 15 or 20, constantly asking our muscles to contract, creating the perfect pump for our young, healthy veins.  Instead, walking is slower, the muscles are not as strong, nor as active, and those young, healthy veins start to become older, weaker veins.  The fluid traveling through the veins moves slower and starts to build up making our legs feel heavy and full.

Compression stockings can combat this problem with daily use.  Those swollen ankles and feet can most often be controlled and brought back to a normal size.  Doing so is healthier for your legs and body overall.

Compression socks are also very useful for people who stand for long periods of time, or sitting in cramped, crowded conditions for long periods of time.  Workers in service-related jobs or frequent air travelers, regardless of their health, can benefit from wearing these socks.

FootSmart carries a wide assortment of compression socks for men and women and compression hosiery for women.

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Time to Let the World See Your Toes!

May 16, 2011

By Dr. Dorian Jimenez, DPM

The flowers are blooming and the trees are budding so you know it’s time to kick off those winter fleece lined boots and dig in the closet for the “toe shoes!”

You know the ones I’m talking about… the flip flops, the sandals, the thongs, the slippers… whatever you want to call them, get them out and put them on your feet.  And when you do, look down at your toes.  Do you like what you see?  Has anything new popped up over the past couple of months when you were just wrapping those things up in heavy socks and big shoes?  For most of you the answer will be no, and you can spring forward with no worries. But for some of you, those yellow, unsightly toenails may mean that you have a fungal infection.

For some you, this means a trip to the nail salon for a thick coat of your favorite colored polish to cover your toenails up.  This makes it all better right?  Wrong.  Treating your nails like this will only worsen the problem and help make the fungus stronger.  So what do you do to rid your nails of a pestering fungus infection?

PinPointe Laser

Courtesy PinPointe USA

The latest treatment in fungal nail infection therapy isn’t a pill that may be hard on your liver, or a liquid that can’t even begin to penetrate the nail to do the job – it’s a laser.  It sounds a bit far-fetched, and any logical person should be a bit skeptical when someone tells you, “There’s a laser treatment for that.”  But it’s true and there are some very promising results that have been and are continuing to be reported with successful treatment of fungus nail infections with a laser.

Laser nail treatment is a one-time treatment that lasts anywhere from 10 minutes to an hour, depending on the number of nails involved.  The nails are first thinned down so that the fungus can be targeted more directly.  The podiatrist makes multiple passes with the laser across the toenails and surrounding skin.  Sounds painful, right?  Not really.  The treatment is relatively painless with only a few complaints about a warm feeling or a small tinge.

Post-treatment, the toes are treated at home with antifungal sprays, creams or liquids, and a little bit more loving care to the toenails than they are usually given.  Remember — you can have a recurrence if your feet come in contact with the fungus again.  Easy ways to prevent this include wearing clean socks, wearing different shoes throughout the week, drying feet and toes thoroughly after washing, and following proper nail hygiene.

Toenail fungus may have finally met its match with the new laser nail therapy.  So if you looked down at your toes and they looked a bit ill, find your local podiatrist and ask them about laser nail therapy.  You’ll be glad you did and your toes will be more confident in those flip-flops!

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