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Why You Should Skip the Flip-Flops This Summer

7 May
Flip-flops are just so easy – slip ’em on and run out the door. Seems like everybody starts wearing them as soon as outdoor temps climb above 50 degrees.


Unfortunately, flip-flops are just about the worst thing you can wear on your feet. In fact, there is a growing problem of heel pain among teens and young adults, which podiatrists are attributing to wearing this paper-thin footwear (no doubt intensified by the obesity epidemic).

Walking barefoot is better for your feet than walking in flip-flops. If your feet have any abnormal biomechanics, flip-flops can accentuate these problems, leading to plantar fasciitis and accelerating other foot problems.

Think about it: the bones in your feet are the base of your skeleton and your body weight is riding on them. If your feet aren’t supported correctly, the rest of your bones, joint, tendons, and muscles have to make up for it. The stress shifts elsewhere and that leads to foot pain, heel pain, leg pain, hip pain, bad knees, sore back, and any number of other ailments.

Naturally, wearing flip-flops in the sauna, locker room, or by the pool won’t cause any harm. But as everyday footwear, we suggest you make a smarter choice.

So how exactly do flip-flops affect your feet?

Toes: That little thong that slips between your toes actually makes the muscles in your feet work overtime. The perpetual gripping this requires of your feet can lead to a nasty case of tendinitis, hammertoes, and bunions. Additionally, bare skin rubbing against the plastic or leather thong can lead to nasty blisters.

Fractures: With no support under your feet, all of that pressure from your body weight can create stress fractures in the bones of your feet. If you spend a lot of time on your feet in flip-flops, this is very likely to occur.

Bottom of your feet: The flip-flop isn’t stationary on your foot like an athletic shoe is. Since the bottom of your foot is in a constant sliding motion against the material, it can create a burning feeling or blisters, especially on hot days.

Arch and heel pain: If your footwear doesn’t support your arch, you run an excellent chance of developing plantar fasciitis, the inflammation of the band of tissue which runs along the bottom of your foot, connecting your heel to your arch. Pain may be felt anywhere along the plantar fascia.

For summer footwear, we suggest that you always wear athletic shoes that fit properly or a solid, rugged pair of sandals with significant arch support and a heavy sole.

Thanks to Huffington Post for this excellent infographic on what happens to your feet when you wear flip-flops.

flip flops

Pain under your second toe? It could be Freiberg’s Infraction

23 Apr

Frieberg’s Infraction (aka Frieberg’s Disease) is a disorder of the metatarsal bones in the foot (the long bones between your ankle and your toes). Pain is felt in the ball of the foot due to damage to the front of the metatarsal bone. Frieberg’s Infraction can occur in any metatarsal but most frequently, the second or third metatarsals.

Freiberg's Infraction

Freiberg’s Infraction usually appears in adolescent female athletes whose 2nd toe is longer than their big toe

**Note – the word “infraction” in this case, is a combination of Infarction (obstruction of the blood supply, leading to the death of tissue) and fracture (as the infarction is usually caused by microfractures).

Typically, Freiberg’s Infraction is seen in adolescents 13-18 years of age who are very active. Females are 5 times more likely than males to have this condition.  The patient usually has a longer second metatarsal or toe than the others and may have had previous stress fractures of this bone.

When this deformity is present, the longer metatarsal takes more of the weight when walking, running, and jumping. This repeated stress on the bone and joint can result in microfractures or joint damage, interrupting blood supply to the bone and cartilage. If undiagnosed, and the lack of blood flow continues, bone cells may die (avascular necrosis). This is called Freiberg’s Infraction.

When bone tissue dies, it undergoes changes such as flattening of the joint surface, and moving the joint may cause pain and swelling. As the damage increases, the joint between the affected metatarsal and the toe degenerates. The damaged bone may fracture, leading to small, loose bone fragments in the joint area causing further pain.

Causes of Freiberg’s Infraction

  • Growth spurts during adolescence
  • Heredity
  • Trauma
  • Infection

Symptoms of Freiberg’s Infraction

  • Usually occurs only in those whose second toe (2nd metatarsal) is longer than their big toe (1st metatarsal).
  • A dull pain in the ball of the foot behind the second toe. Pain gets worse when walking, especially in high heels.
  • Ball of the foot may become swollen, callus may appear, and skin become red
  • The joint in the toe may be stiff and painful
  • The joint may make a cracking or grinding sound when moved

In many cases, no symptoms are present, and Freiberg’s is discovered during a routine foot exam

Treatment for Freiberg’s Infraction

Some patients have no symptoms (asymptomatic) and the Freiberg’s Infraction resolves without treatment. But it’s advisable to seek treatment from a podiatrist as soon as symptoms appear, because if left untreated, tremendous damage can occur to the metatarsal, requiring surgery.

Early Treatment

  • Rest
  • Ice
  • No weight bearing activities for 4-6 weeks
  • Over the counter medicine like advil or aleve to control pain and inflammation
  • Custom orthotics molded to relieve pressure on the ball of the foot
  • Wear padded and supportive athletic shoes – no high heels. Use over the counter padding in shoes if necessary
  • If swelling and pain are advanced, a cast may be applied to the foot to immobilize it for 4-6 weeks

Advanced Treatment

If the Freiberg’s Infraction fails to resolve with conservative treatments, more aggressive treatment may be necessary. This may include:

  • Removing the damaged bone
  • Bone grafting to create a new bone
  • Shortening the length of the affected metatarsal
  • Reconstructing the joint to eliminate pain and stiffness
  • Joint removal and implant

If you have pain in the ball of your foot, please make an appointment with the podiatrists at PA Foot and Ankle Associates to determine if your pain is caused by Freiberg’s Infraction or another condition.

Do bunion splints and braces actually work?

14 Mar

Most people who first develop a bunion reach for over the counter remedies to control the pain and soreness which accompany the deformity. After all, who wants bunion surgery if they don’t absolutely need it? We understand completely.

bunion splints and braces

If you google “bunion splints” you’ll find a dizzying and overwhelming array of products, some of which make rather spurious claims. You’ll also find it difficult to look at a product description and image and decide that this is the right bunion splint (or whatever) for you.

The problem is, a bunion is the result of certain faults in foot structure and function, which are inherited traits. Because of these subtle differences, each patient’s bunion symptoms and pain tolerance are unique. Some develop huge, painful bunions in their youth, and others live with a small bunion for 20 years until they opt for surgery in their mid-50’s.

Read about how a bunion forms

What are your choices for over the counter bunion products?

This list could be very long, but we’ll limit it to the most common products. In spite of marketing claims, none of these remedies can actually correct your bunion, they can only (possibly) slow down the bunion development and temporarily relieve symptoms. What works for one person may be completely ineffective for another, so you’ll most likely have to try a few products until you find the right one for your condition.

  1. Bunion splints or bunion braces are the most effective products if they address the underlying foot problems. A bunion splint usually holds the big toe in place with a loop, which is connected to a binding around the mid-foot. This exerts a force which moves the toe into proper position, and relieves tension on the tendon and toe muscles. Some are rigid and can only be worn at night. Flexible splints are made of fabric and can be worn inside your shoe.
  2. Protective pads or cushions placed on the bunion protect it from rubbing on the inside of the shoe, but do not straighten the big toe.
  3. Wedge-shaped toe spreaders fit between the big toe and the adjacent toe, and move the big toe back into a straight position. This will provide some relief to the tendons in the upper mid-foot, which become sore form the stretching caused by the bunion.
  4. Toe spreaders that fit all of your toes are somewhat more helpful, as they re-align all of the toes in the foot. They can provide relief for your sore foot in as little as 30 minutes. If you can tolerate sleeping in them, they’ll relax the tendons in your foot and provide some comfort.
  5. Toe straighteners are padded splints that run along the inside of the foot and rest against the heel, to force the big toe back into proper position.

If you opt to not have corrective bunion surgery, we recommend that you consider custom orthotics which provide support for your foot and can be molded to provide relief from your bunion pain.

As new over-the-counter products are continually introduced, we can’t recommend one over another, but you may visit our foot and ankle healthcare products page for a wide selection of products which may offer you some temporary relief.

Psoriatic Arthritis In The Feet and Ankles: Symptoms and Treatment

25 Feb

Psoriatic arthritis, sometimes misdiagnosed as osteoarthritis, gout, or rheumatoid arthritis, is a form of arthritis accompanied by psoriasis, a condition which causes scaly red and white patches on your skin. This form of arthritis can cause swelling in your toes, frequently described as making them look like sausages.

Psoriatic arthritis feet and toes

Psoriatic arthritis causes toes to swell like sausages, a condition called dactylitis. In this patient, the toenails have been affected by the psoriasis, which is often misdiagnosed as a fungal infection.

Psoriasis is a condition in which the body’s immune system goes into overdrive and attacks healthy tissue in the skin, creating an overproduction of skin cells. In psoriatic arthritis, the immune system also attacks your joints, causing persistent, painful inflammation, in addition to the skin condition. It typically affects the larger joints in your feet or ankles, but may affect the smallest joints in the toes as well. Swelling of the joints in the toes can be quite extreme, taking on the appearance of sausages, a condition called dactylitis.

Psoriatic arthritis can also cause discoloration and “pitting” in your toenails – depressions or separation from the nail bed. As these symptoms appear similar to a fungal infection, it’s often misdiagnosed. In later stages, toenails may crumble or suffer other damage.

Why the immune system turns on healthy tissue is still somewhat of a mystery, but it appears that genetic and environmental factors are at play. Many patients who suffer with psoriatic arthritis have a family history of the disease, or a family history of psoriasis. In others, physical trauma, or a viral or bacterial infection may trigger psoriatic arthritis.

One of the characteristics of psoriatic arthritis is Enthesitis – pain in the heel or the sole, where ligaments and tendons join the bone. In some cases, this is the cause of plantar fasciitis or Achilles tendinitis. Research suggests that the continual inflammation from psoriatic arthritis causes significant joint damage, so early diagnosis and treatment is important.

If you’re experiencing heel pain, arch pain, or joint pain in your ankles or feet, and you suffer from psoriasis, please inform your podiatrist, as your treatment plan may vary.

Just as with rheumatoid arthritis, the pain and stiffness in joints affected by psoriatic arthritis is progressive, which means it will worsen over time. The pain and stiffness may at times subside and vary in intensity. Additionally, some patients also experience mood changes, fatigue, muscle weakness, and anemia.

Osteoarthritis may accompany psoriatic arthritis, and bones in the feet, ankle, or toes may deteriorate. Your podiatrist can use ultrasound imaging to determine this even before other symptoms occur.

Unfortunately, psoriatic arthritis becomes extremely painful as the condition progresses. Toes and feet may become swollen and tender, and they may no longer fit into your shoes. Your podiatrist may recommend special footwear in this case.

Symptoms of psoriatic arthritis in the foot and ankle

  • Joint pain. Joints may also be swollen or warm to the touch
  • Joints in the toes may develop dactylitis, a unique type of swelling. Dactylitis sometimes develops before pain or stiffness occurs.
  • Toes may become deformed and nails become discolored or pitted
  • Achilles tendinitis or plantar fasciitis may develop
  • Unlike other forms of arthritis, psoriatic arthritis is more likely to cause pain in the tendons of your feet

Who is most likely to develop psoriatic arthritis?

  • People with a family history of the disease. Men and women are equally affected.
  • People with psoriasis, especially those who have psoriasis lesions on their toenails
  • Those between the ages of 30-50, but it may also occur in children

Treatment for psoriatic arthritis

  • Mild exercise like walking, biking, or swimming keeps joints flexible and reduces pain
  • Stretching exercises
  • Custom orthotics (shoe inserts) to relieve pressure on painful areas
  • Wear comfortable footwear like athletic shoes,or if severe, diabetic shoes
  • Over the counter anti-inflammatory pain relievers like ibuprofen (Motrin, Advil), or naproxen (Aleve)
  • Cortocisteroid injections from your podiatrist to reduce joint swelling
  • Prescription medicines used to treat Rheumatoid arthritis
  • Podiatric surgery to replace or repair damaged joints

Symptoms and Treatment of Frostbite of Toes and Feet

30 Jan
It can happen easier than you can imagine. You head outside on a cold winter day with the kids to do some sledding. It’s 20 degrees (not unusual this winter here in Pennsylvania). You throw on a pair of white athletic socks and an old pair of snow boots. They’re thin, but they’ll be okay.
foot, frostbite

Toes, 2 days after frostbite

After only one hour you notice that you can’t, at least you think you can’t, feel your toes on your right foot. Not like they’re no longer attached to your foot, they are – it’s just that you have no sensation of them being there. Hmm… Weird. Never felt that before. You stomp your feet to warm them up a bit, get the circulation going again, you walk around to keep the muscles flexing. But the numbness gets worse. And they itch like mad. But back on the sled you go, because you’re having fun.

After another hour, you get home and take off your shoes and socks. The skin on your feet and toes feels like ice when you touch it. But your toes don’t register as being touched. That is, you see your fingers touching your toes, and your fingers feel like they’re touching something icy, but that’s it. No feeling of being touched from the opposite direction.

After 15 minutes, as the skin begins to warm, the throbbing begins. It gets more intense until it becomes excruciatingly painful. The throb is like someone hammering on your toes. You wrap your feet in a wool blanket, and after two hours, the pain and throbbing subside.

Those symptoms are consistent with a condition called frostnip, in which blood retreats from the tissues, but no significant long-term tissue damage occurs. Yet there’s a very, very thin line between frostnip and frostbite, in which toes and feet become so damaged, they sometimes have to be amputated.

How frostbite occurs

When the temperature drops below freezing, the body’s natural response is to move the blood vessels away from the skin to preserve core body temperature. When your feet or toes are exposed to these conditions for hours or days, blood flow becomes very restricted in the exposed areas and the tissue begins to die.

There are four degrees of frostbite:

First degree

This is frostnip, as described above. Frostnip only affects the skin, which becomes frozen. It begins with itching and pain, and the skin develops patches of yellow, white, or red, and eventually becomes numb. Long-term damage is minor, and may include insensitivity to heat and cold.

Second degree

A little more serious, the skin becomes frozen and hard, but the deep tissue remains normal. Within two days, the injured area usually forms blisters which appear hard and black. Healing takes about one month, but insensitivity to heat and cold is usually permanent.

Third and Fourth Degree

This is when the deep tissue also becomes affected by freezing temperatures. Muscles, tendons, and blood vessels freeze. The skin becomes hard and waxy and the toes or foot become difficult or impossible to move. Black or purple blisters form, which are filled with blood, accompanied by a loss of sensation, which is sometimes permanent. In some cases, the frostbitten areas become gangrenous, which requires amputation to stop the infection from spreading throughout the body.

toes, 1rostbite

Toes, 12 days after frostbite

How to treat a frostnip or frostbtten toe or foot

If you believe you have frostbite or frostnip, never rub the area to restore circulation, because you’ll damage it further. The tissue is frozen and full of ice crystals, and these crystals can cause significantly more damage. Your toes or feet will feel intensely cold, like blocks of ice,  but don’t rub them. If you’re indoors and the room is warm, take off your shoes and socks, and let your feet and toes warm naturally.

If you’re not in a warm area, wrap the foot in a blanket or something else that will trap as much natural body heat as possible to help warm the foot. However, if there’s a chance that the foot may freeze again, do not rewarm it. Do not walk on the injured foot, as it may cause further damage.

In a hospital environment, active rewarming is usually employed. This involves applying heat to the area in a controlled way to thaw the tissue faster. The faster the tissue regains blood flow, the less permanent or long-term damage will occur. Active rewarming is usually achieved by soaking the damaged foot in a warm water bath of roughly 100 degrees (F). If you’re not in a hospital setting, it’s okay to use the warm water bath yourself, but make sure that the temperature is not over 100 degrees or you may scald your foot. Never use a heat source such as a heating pad, stove, or cooking fire.

Long term consequences of frostbite may include permanent changes in sensation, a feeling of tickling or tingling in the damaged area for no apparent reason, increased sweating, and arthritis in the affected area.

If you’ve suffered frostbite of your feet or toes, please seek medical attention from a podiatrist immediately – it’s not to be taken lightly.

Toes, frostbite

Toes, 3 weeks after frostbite

Skiing and Snowboarding: How To Prevent Foot and Ankle Injuries

8 Jan

There’s been no shortage of snow in the U.S. this year, and times are good for those who love to strap boards and skis on their feet. Although most ski and snowboard injuries involve the knees or thumbs, ankles and feet see plenty of injuries as well. Fortunately, there are a few simple steps you can take to minimize your risk of injury.

snowboarding ankle and foot injuries

Ankle Sprains

The most common ski and snowboard injuries to ankles are sprains. These most often occur when you land on the outside of your foot and your foot twists too far inward. The capsula, ligaments, and nerve fibers stretch too far, or the cartilage becomes over compressed. Tissue is either torn or stretched, and bleeding and swelling occur inside the ankle, accompanied by bruising and pain.

After a sprain, it’s wise to wear an ankle brace inside your boot to avoid spraining the ankle again.

Read about the symptoms and treatment of ankle sprains

Ankle or Foot Fractures

Fractures occur when too much stress is placed on a bone. Landing incorrectly after a jump, falling, or colliding with another skier are the most common ways a foot or ankle becomes fractured. Immediate attention is needed even for a minor fracture, as a crack in a bone left untreated will continue to be painful in the short term and will become arthritic in the long term.

Ankles should be conditioned before and after a day on the slopes with simple stretching and strength-building exercises, which you can see here. And never ski if you’ve injured your ankle in any way – it’s already in a weakened state and additional stress may result in a more severe ankle injury or a problem further up your leg.

Read about the symptoms and treatment of ankle fractures and toe and foot fractures

Skier’s Toe

You take off your ski boots and you see that the nail on your big toe is completely black. A scary site. Fortunately, it’s not too serious if you get it cared for right away. In medical terms, Skier’s Toe is a subungual hematoma, a common injury for runners as well. When ski boots are too tight or too loose, the big toe takes a lot of punishment and the nail begins to separate from the nail bed. Bleeding occurs under the nail and the result is discoloration and soreness. If you see a podiatrist right away, they can resolve your pain quickly by burning a tiny hole in the nail and allowing the trapped blood to drain. But if you wait too long for treatment, the condition might get worse.

To avoid Skier’s Toe, trim your toenails, make sure your boots fit correctly, and that your socks don’t bunch up. And wear your own boots, not someone else’s.

Snowboarder’s Fracture

ankle structureThe Talus is a small bone that sits between the heel bone and the two bones of the lower leg. When your leading foot in a snowboard rotates too far, a fracture often occurs in the Talus.

Snow-Boarder’s Fracture isn’t always apparent on an X-ray and can sometimes be mistakenly diagnosed as a sprain. If untreated, it will continue to be painful and become arthritic down the line. When it is caught, treatment is pretty simple, with the insertion of a screw to stabilize the joint.


With any of these injuries, the soft tissue will heal naturally without much intervention on your part. However, bones, muscle, and nerve fiber do not return to their pre-injury condition without help – they must be trained via physical therapy to restore their natural function.

The simplest way to avoid any foot or ankle injuries while skiing or snowboarding is to make sure your boots fit properly and your bindings are adjusted correctly, because stability inside the boot is imperative. A professional boot fitter will make sure that your foot is centered and supported correctly and that it’s not rubbing or banging against any part of your foot or shin. They may decide to insert padding in the boot or set you up with a custom orthotic, especially if you’ve had previous injuries.  Also have your bindings adjusted by a professional who will use your age, ability, length of boot, weight, and height to adjust the tension according to the formula suggested by the manufacturer.

Why Your Shoes Are Killing Your Feet

25 Jul

If Doctor Evil was a podiatrist, Mini-Me would be a women’s shoe designer.

high heels

Probably not the best choice for the activity

At times, women’s shoes qualify as instruments of torture.  Most certainly for your back, legs, ankles and feet. Wedges, stilettos, pencil heels, high heels, spike heels, all fall into the category that podiatrists refer to as “cruel shoes”.

Any shoe that lifts your heel off the ground shifts your weight onto your midfoot (ball) or forefoot (toe area). The higher the heel, the more forward the shift, and why the girl who dances all night in high heels has her shoes off before she even gets in the car. You may only weigh 100 pounds, but shifting that weight to a place not meant to carry it can cause significant long-term problems. Even if you failed algebra, that math is easy.

Most common injury caused by high heels over 3 inches: fractures and torn ligaments caused by inverting the ankle (twisting inward).

Besides shifting your center of gravity forward, high heels and wedges provide next to no support for your heel. That spike at the back of the shoe is at times only there to remind you how much you paid for them, how good they make you look and how you’re going to get your money’s worth even if it kills you (or your feet). Since your foot is only secured with a tiny strap, one misstep on a slippery dance floor or wet or cracked sidewalk may cause your heel to slide and your ankle to roll. Next stop – one month in a boot to immobilize your foot while your ankle fracture heals.

But let’s not stop with the shifting of the weight, because these styles offer additional torture. Many feature a pointy toe box, which squeezes the front of your foot so tightly that your toes cry for mercy. The result is bunions, arthritis, and any number of toe problems.

Wearing heels causes your foot to slide forward, redistributing your weight, creating unnatural pressure points and throwing your body’s natural alignment out of whack. High heels have been linked to overworked or injured leg muscles, osteoarthritis of the knee and low back pain. You also risk ankle injuries if you lose your balance and fall off your high heels. – Mayo Clinic.

Women account for ninety percent of the surgeries performed for the most common foot ailments, which is a pretty illuminating statistic. While there’s some debate in podiatry circles about whether footwear or genetics are the actually cause of foot problems like bunions, “pump bumps”, hammertoes, and tight heel cords, there’s no doubt that the high heeled shoe at the very least exacerbates the problem.

Most common injury caused by a platform wedge: Ballet Break. That’s when you fall off the wedge onto the side of your foot, causing a stress fracture.

So what’s a modern woman to do? Nikes and New Balances don’t often match business attire, much less elegant affairs. We recommend that you minimize the amount of time you spend in high heels, wedges, and the like, and don’t buy any heels taller than two inches. The right shoe to wear is the one that causes no pain or discomfort and fits and supports your foot like a glove.

But don’t switch out the high heels for ballet flats or flip-flops, because they can make the situation worse. The lack of support in these “shoes” can worsen conditions like plantar fasciitis. Treat your feet well when you’re young and they’ll treat you well when you’re aging.

What is the benefit of custom foot orthotics?

5 Feb

Shoe inserts from a drug store or shoe store are not to be confused with custom made foot orthotics. Most everyone has tried over the counter shoe inserts at some time in their life, and most everyone has been disappointed with them. That’s because there’s no such thing as an “average foot”, so a one-size-fits-all solution for foot pain doesn’t exist.

custom made foot orthoticsOrthotics are custom made shoe inserts. They can only be ordered by a medical professional after an examination of your feet, your gait, your pronation, and an analysis of any pain you may be experiencing. Issues resulting from heel pain, bunions, plantar fasciitis, flat feet, high arches, abnormal biomechanics, or poor lower limb alignment can all be addressed with custom designed orthotics, which can be made to cushion sore areas and correct abnormalities. They can also be very helpful for athletes, especially runners who have recurring problems with their feet.

Orthotics are made from more durable materials than over the counter shoe inserts, and they last for years, not months. Orthotics are custom designed specifically for your foot to improve your running, walking, and balance by supporting the arch, cradling the heel and rotating your foot into a “neutral” position. This support and proper pronation helps the foot function at its maximum level. When your foot is balanced and supported correctly, you’re less prone to ankle or foot injury, knee pain, hip pain, and back pain as well. After all, your entire body is riding on your feet.

For athletes, foot orthotics can help reduce foot stress and fatigue, and may also increase agility. By balancing the foot, shock absorption will improve, diminishing before reaching your limbs.

How do I know if I’ll benefit from custom orthotics?
  • Look at the bottom of your shoes to see if they are worn evenly across the toe or heel area. Even wear-and-tear indicates your gait is normal, but if they wear out too quickly or unevenly, then you may benefit from orthotics
  • Do your feet hurt after being active? How about your ankles, knees, hips, or back?
  • Do you have unusually high arches?
  • Do you have flat feet?
  • Do you have tendonitis, shin splints, hammer toes?
  • Are your legs consistently tired or aching?
  • Do you have diabetic foot problems or a neuroma?
Only a podiatrist can tell if custom made orthotics are right for your feet, but most patients notice an immediate difference in comfort and stability, and their pain is sharply reduced or eliminated.

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