Whether you are indoors, outdoors, in the city, the country, at work, or at play doing all that you do...
All of you work hard at your jobs, your sports, your fun, and living your lives!
Let Dr. Bills educate you on the importance of finding and wearing quality footwear. She will educate you on what to look for when you go shopping to keep your feet and ankles healthy!
Treatments
Heel Pain
Heel pain can be the result of several different causes. Listed here are a few of the most common:
+ Trauma to the heel can cause a fracture or bone bruise. Treatment is tailored to the location and severity of the injury.
+ Infection can be serious, leading to the need for surgical intervention.
+ Inflammation of the plantar fascia which is a ligament on the bottom of the foot. This condition is treated by supporting the ligament with an arch support and wearing supportive shoes. Physical therapy, injections and bracing are some additional therapies that can be used if conservative care does not resolve the issue.
Ingrown Toenails
Ingrown toenails are sometimes caused by heredity, shoes that are too constricting, or blunt trauma. The nail edge becomes painful and may even start to drain fluid. The treatment is removing the offending nail edge. A chemical is applied to the nail "root" or matrix to prevent the nail edge from growing back. Healing takes 3 - 4 weeks.
Warts
Warts are caused by Human Papilloma Virus or HPV. There are many different strains of the virus, but one thing remains constant: once you have it you can't get rid of it. Treatment of warts varies from topical treatments to freezing to cutting them out. These lesions are hard to treat and can recur spontaneously once they are gone! Unfortunately we have no "cure-all" for warts, but research will continue until there is a cure. If you have a wart or think you do, early treatment is less costly than waiting, so make an appointment today!
Fungus
As a podiatrist I see a lot of fungus. Usually the fungus affects either the skin or the toenails but can affect both. Treatment for skin infections is treatable with oral antifungals (terbinafine) or topical creams. Treatment for nails is not a 100% cure and is limited to oral antifungal therapy. Generally I see full resolution in patients under the age of 75. Treatment is much more effective when the patient has no other major health problems.
Ganglion Cyst
Ganglion cysts are kind of like a blister under the skin. The cysts are filled with a thick substance resembling hair gel and are associated with joints or tendons. The cause may be trauma, overuse or heredity. Usually I drain the cyst to alleviate pain from pressure. If it doesn't come back or takes a long time (6 mos. - 1yr.) to come back, I just treat conservatively. If it is very recurrent and painful, surgical excision can help. The recurrence rate AFTER surgery is about 50%.
Diabetes
Diabetic patients should have an initial foot exam to determine any future problem areas. If I see potential problems I can recommend solutions, usually a change or make accommodation to footwear to prevent ulcerations. Diabetic patients, even under good "control", are at risk for a condition known as peripheral neuropathy. If you have numbness, tingling, burning, cold or other unusual sensations you may have this condition. Treatment for this is only if it becomes painful and consists of medication and some vitamin supplements. If a diabetic has neuropathy, he/she is at risk for ulcerations since there isn't enough feeling in the feet to recognize an injury. If a diabetic patient has no current problems, depending on age, I will see the patient once a year for a follow up evaluation/consultation.
Wounds
Wounds are openings in the skin. They develop as a result of trauma, poor circulation or less commonly surgery/infection. Treatment of ulcers is fairly straightforward. Keep it clean and dressed, decrease pressure on the site and it needs professional debridement (removal of dead tissue) weekly.
Sprains/Fractures
Sprains and fractures are the result of trauma most of the time. Fractures can also be the result of thin bones (osteoporosis), or secondary to infection or cancer. Treatment varies by patient, but likely you will at the least be wearing a brace or splint.
Bunions
Bunions are a bony deformity occurring at the great toe joint. These are usually hereditary but can also be brought on by trauma. Treatment is conservative, with shoe gear changes (lace up, wide forefoot) and orthotic devices. If conservative treatment fails and the patient is having pain on a daily basis, the condition may require surgical correction.
Hammertoes
Hammertoes are toes that have become contracted and have a prominent knuckle on top. Usually these can be accommodated with a deeper toe shoe (for a ladies oxford I like SAS Freetime). When toe surgery is necessary, part of the knuckle is removed and the toe straightens out again. I like this surgery if the patient is ulcerating at the tip of the toe due to pressure or has recurrent pressure on the top of the toe.
Neuroma
Neuroma is a term for an irritated nerve at the ball of the foot close to the sulcus area (the pocket behind the toes). This is usually associated with a hammertoe, and the toe contracture is pulling on the nerve while the patient walks. In addition to the pulling, the nerve is being rubbed against a ligament that runs across the ball of the foot. This condition can also be caused by a traumatic flexing of the toes. Usually the treatment consists of a simple metatarsal pad. Patients usually get 80 - 100% relief unless their neuroma has been around longer than 2 months. Injections usually aren't required. Excision of the affected nerve is usually curative when conservative treatment isn't helpful. The surgery will leave the toes numb but without pain. This surgery is not frequently required but it is effective.
Tumors
The most common tumors are benign (fat or fibrous), but malignant tumors occur in the foot and can be overlooked. If you have a spot on your foot that is unusual or is growing, it should be biopsied right away.
Arthritis
Arthritis literally means inflammation of a joint. This can be caused by "wear and tear", trauma, infection, gout, etc. The treatment varies by patient and diagnosis but is usually treatable in the foot. Custom made orthotics are often a big help with "wear and tear" arthritis pain.
Dermatitis
The skin is our largest organ. When a rash or other skin lesion occurs it is important to come in for a biopsy to determine what is the cause of the condition. Once the biopsy is performed treatment is straightforward and is very effective.
Tendinitis
I treat all types of tendinitis in the foot and ankle. The modalities I use are strapping and taping, supportive padding if needed and referral to physical therapy. Bracing or walking boot may be required to stabilize the area in order to allow healing.
Arterial Disease/Venous Disease
I work closely with vascular specialists to tackle this prevalent issue. I perform a thorough exam and when needed I order the necessary screening to evaluate vascular disease, arterial or venous. After this I can refer to the appropriate specialist who then treats the issue to improve function.
Education
Our Education Forms are in PDF file format. You may need the Adobe Reader to view and print our Forms.
Helpful Hints
Stretching
I recommend stretching to everyone. A good stretch for everyday that doesn't take too long to do is this one:
+ With your lace up shoes on, stand next to a wall and put your left foot on a chair seat (or other surface) at a comfortable height directly in front of you, letting the back of the heel rest on the chair. Let the shoe hold your toes at 90 degrees to the leg, don't pull your toes back.
+ Make sure your hips are perpendicular to the leg (90 degrees).
+ You will feel a gentle stretch all along the back of your leg. If this is causing pain you are up too high. It is important to stand up straight! Otherwise the lower back may tilt forward, reducing the effectiveness of the stretch.
+ HOLD THE STRETCH for 1 minute.
+ Now stretch the other leg.
+ Repeat. This stretch is good for many lower extremity tendon/ligament problems including heel pain.
Shoes
When looking for shoes follow these helpful guidelines:
+ Always buy shoes at the end of the day since your feet may swell.
+ Bring someone with you to check shoe fit. This should be done with you standing up and your friend checking the toe (need 1/2 inch of free space at the end of your longest toe, which may be your 2nd toe). The width should be such that, while standing still, you feel pressure on the heel and middle of your foot but not at the ball of your foot or toes.
+ Check the heel (heel counter). If you can easily move it, this shoe will have less control. I like a very rigid heel counter for best control and comfort. Keep in mind that even if you have a rigid heel counter, if you have room INSIDE the heel, your heel will still move around and the shoe may be less effective.
+ If you wear over the counter or custom made orthotics please try them in any new shoe BEFORE you buy them. Depending on the type of orthotic and the type of shoe this may be tough. I may be able to adjust your orthotic to fit your shoe for a small fee.
+ For sneakers keep in mind that the soft EVA midsoles will wear out quickly - the replacement rule is 350 miles or 6 months.
++ I like to say if you wear the sneaker...
+++ 1-3 days a week replace in 6 months
+++ 4-5 days = 5 months
+++ 6-7 days = 3-4 months
++ This doesn't mean that now you have a pair of garden shoes! These shoes are DONE. Throw them out and do yourself a big favor. Many injuries are caused by wearing an old shoe (or a cheaply made shoe).
Toenail Trimming
I like to trim nails straight across in most cases. The only exception is fungal toenails. These nails are deformed and many times loose, so need to be cut differently. If you have nail edges that seem to grow down on the edges you probably have ingrown toenails and need to have the edges permanently removed. If you want to try to avoid the procedure keep the sides grown out past the skin folds and apply Vaseline to the edges if they get tough.
Athletes Feet
Skin fungus of the feet is caused by increased moisture, trauma to the skin, heat, wearing old shoes and immune system compromise. I like to have patients treat mild itching with gold bond medicated powder daily to feet. If there are little blisters with clear fluid you need to use a prescription cream or Lamisil tablets if severe. If your feet sweat excessively I will prescribe a roll on antiperspirant for your feet.
Sweaty Feet (Hyperhidrosis)
For excessive moisture (your socks get wet/damp at the end of the day) generally I treat this with Drysol that treats hyperhidrosis. This may be used twice a week up to daily for excessive moisture.
Links
Here are some websites that may help you find additional information.