Tag Archives: podiatrist

How Peripheral Artery Disease (PAD) caused this man to almost lose his foot

25 Nov

Gary Kautzmann of Orefield, Pennsylvania suffered with Peripheral Artery Disease for more than 10 years. P.A.D. is a condition in which arteries become blocked, restricting blood flow to certain parts of the body. In many cases, P.A.D. is caused by fatty deposits lodged in the arteries (atherosclerosis), but in Gary’s case, arteries behind his left knee had become twisted, greatly diminishing blood flow to his lower leg, foot and ankle.

Gary had always been active – running, swimming, biking, always on the move. But the P.A.D. was now causing so much pain in his calves, that it was impossible to walk even 2 blocks. As gary puts it, “it was no way to live.”

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Mayo Clinic

Four doctors attempted to restore blood flow to Gary’s leg, all without success. During each of 4 arteriograms, a procedure in which stents are inserted into the blocked arteries to restore their shape, the surgeon couldn’t get past the twisted tangle of arteries behind the knee. But proper blood flow is necessary for your tissues, to feed the living cells, repair damage, feed muscles and nerves, and heal wounds.

A year ago, Gary developed a routine case of athlete’s foot between the toes on his left foot. The only difference was that this time, the athlete’s foot would not heal. In fact, it got worse and worse, resisting every over the counter treatment. Gary sought out Dr. Teichman at PA Foot and Ankle Associates to treat the worsening fungal infection, and what Dr. Teichman told him was unnerving.

Watch the video to discover what Dr. Teichman told Gary.

NY Giant Geoff Schwartz Catches Lucky Break With Dislocated Toe

27 Aug

Those of us who aren’t pro athletes just can’t appreciate how critical foot and ankle health is.

Sprained ankle? I’ll “walk it off”

Stubbed toe? I’ll wear looser shoes for a week

A little heel pain? It will pass….

You may think that professional athletic trainers are “babying” their players at times, but they know from experience that a seemingly innocuous, minor injury that’s left unattended, can develop into an injury which costs the team a championship, and end a player’s career.

geoff schwartz

Geoff Schwarts is carted off the field Friday night.

For instance, Geoff Schwartz, starting left guard for the New York Giants, was carted off the playing field last Friday night during their preseason game with the Jets. Trainers believed the toe was dislocated, but had no idea as to its severity.

A dislocated toe is nothing to take lightly, because if serious enough, it can be a season-ending injury for an athlete. Fortunately for Schwartz, tests revealed that it’s only a minor dislocation which won’t require surgery. Geoff will be back on the field by the end of September if his rehab goes as planned.

“This is just a minor setback,” Schwartz said. “I plan on attacking the rehab program so I can get back on the field as soon as possible with my teammates and help us win games.”

How your toe becomes dislocated – and what to do about it

When the ligaments and tendons which hold the toe joint together are torn, the bones move apart and out of place. This is what’s called a dislocated toe. This can be a minor injury, as in Schwartz’s case, or quite severe, as when the toe is visibly out of joint. When the joint is properly realigned, it takes about 6 weeks for the ligaments to heal.

How can you tell the difference between simply stubbing your toe, spraining it,  breaking it, or dislocating it? You probably can’t, which is why you should see a podiatrist as soon as possible after you injure it. If the toe is dislocated, you’ll feel immediate, intense pain, extreme pain if you try and bend the toe, swelling, bruising, tenderness, or numbness, and possibly a very visible deformity. Some of these symptoms are also consistent with sprains and fractures, which is why a podiatrist’s opinion is necessary.

Never – and we mean never, ever, ever try and “pop” the dislocated toe back into place by pulling on it. That’s strictly Hollywood stuff. A dislocated toe is frequently accompanied by a fracture, so if you pull on it, you can do a lot more damage. If you suspect that your toe has been dislocated, seek immediate medical attention from a podiatrist. He or she will take x-rays, make a diagnosis, and then if it is indeed dislocated, realign the toe and provide you with a walking boot to protect the toe while it heals. Physical therapy may also be recommended to get the toe back in shape after the ligaments heal.

Take your foot and ankle health as seriously as pro athletes.

Which physician is best to treat foot and ankle pain?

25 Jun

We sure take our feet and ankles for granted, don’t we?

best doctor for foot pain ankle pain toe pain

That is, until the Millenium Falcon breaks our ankle, or a foul ball clips our right foot. Ouch.

When your feet are painful, you’re miserable. Your lifestyle is instantly affected – pain forces you to dial back or give up walking, running, dancing, standing, or your favorite sports. Prolonged pain might even cause you to go from star athlete to couch potato.

It’s appropriate to visit the ER if you have an unusual amount of pain in your feet or ankles, especially if the pain is sudden and intense, is accompanied by bleeding or swelling, or if your foot and ankle have been involved in a trauma like a fall down the stairs. Or if you tried to break a cement block in half with absolutely no martial arts training.

For less painful events, like a suspected fracture, or wounds that won’t heal, many people choose to see their primary physician, which may or may not be a good choice, depending on that  physician’s field of expertise.

And for even less worrisome injuries, like a minor sprain, or minor heel pain, some seek no medical attention at all – which is never a good idea, as both injuries can develop into more complicated conditions, especially for athletes.

Which doctor is expert in treating foot and ankle problems?

When you have trouble with your ears, you should see an ENT. Trouble with your knees, an orthopedist. When you have pain or discomfort in your feet, toes, or ankles, you should see a podiatrist.

Podiatrists and podiatric surgeons are trained exclusively in the treatment of foot and ankle disorders – they do nothing but study the foot and ankle, it’s diseases and deformities. After all, 1/4 of all of the bones in your body are in your feet, and there are many conditions unique to this area of the body. That’s a lot of ground to cover in med school. If they choose to be a podiatric surgeon, they complete further schooling to study surgical techniques to correct these problems.

In 99% of cases, a podiatrist can resolve your ankle, toe, or foot problem much faster than a general physician. Podiatrists are also expert at spotting the early signs of diseases you can easily overlook, like diabetic foot disorders, rheumatoid arthritis and cardiovascular disease.

Without your feet in good working order, your life can be…. well, challenging. Don’t take them for granted.

If there was a report card for foot care, you’d get an F

11 Jun

Unfortunately, when it comes to foot care, most of you are failing miserably. Well maybe not YOU, because you’re reading this, but everyone else is failing…

foot pain foot health

The American Podiatric Medical Association has released a very illuminating survey on American’s attitudes and experiences concerning their foot health. The results are very surprising to us in some ways, and completely predictable in others, based on the patients we see. Unfortunately, your feet continue to rank low on the list of body parts you consider important to your well-being, and you’re paying less attention to them than you should.

The survey, released in March, shows that 8 out of 10 of you have experienced foot pain at some time in your life. Those of you who’ve experienced foot pain on a regular basis, also report regular issues with other health complications, primarily back pain, eyesight issues (probably diabetes-related), arthritis or other joint pain, weight issues, knee pain, and heart and circulatory disorders.

Half of you said that foot pain has restricted your activities in some way: walking, standing for long periods, exercising, sleeping, going to work, or playing with your children or grandchildren.

You said that you understand how important foot health is, and that consistent or chronic foot pain can indicate other health problems.  You also said that you understand what a complex mechanism the foot is and that a podiatrist is best qualified to treat your foot pain.


You also reported that you have little knowledge of or experience with podiatrists. When a foot problem arises, you’re more likely to visit your primary care physician for help, or try and treat it on your own. But those of you who have visited a podiatrist give them high marks for care and are more satisfied with the outcome than those of you who were treated by your primary care physician.

This last fact highlights a common misperception about the healthcare system – that your primary care physician is some kind of wizard who knows how to treat every conceivable ailment. While we respect our fellow physicians, every MD’s training is different. Primary care physicians are a sort of first line of defense and are trained to identify and treat the most common illnesses and complaints in the population. They’re also trained to flag unusual symptoms and to refer out injuries and disorders which are best treated by a specialist. Yet 60% of you say that you would talk to your PCP about a foot condition before seeking advice from a podiatrist (we understand however, that some insurance plans require this). Hello? Podiatrists know more about foot and ankle injuries and disorders than any other physician. When given the choice, always opt for a specialist.

Shame on you: Only 32% of you report doing foot, ankle, or leg exercises to keep them strong, and only 43% wear proper, supportive footwear (that explains all of the comments/questions on our blog post about why your feet hurt). Speaking of footwear, 71% of women who wear high heels experience foot pain which they directly attribute to wearing high heels. Yet they own NINE PAIR (!).

Unfortunatley, nearly 50% of you experiencing foot pain wait until it’s severe to see a podiatrist. Most of you don’t even consider a visit to a podiatrist for conditions like persistently sweaty or odorous feet, blisters, pain from high heels, hammertoes, problems with your toenails, or even diabetic wound care. Yet each of these conditions can indicate a more serious potential problem or set of problems. Treated early and properly by a podiatrist, your pain and discomfort can be relieved without further complications. In fact, 34% of you said that a podiatrist helped you identify other health issues such as diabetes, circulatory issues, or nerve damage.

But what is up with the fact that only 74% of you report keeping your toenails trimmed?  OMG! What are the other 26% of you doing? Do you have man servants to trim your toenails for you? Or extra long shoes to accommodate your lavishly long toenails?

Click here to read the entire APMA survey.

Are Your Feet Ready For Summer?

14 Jun


The word alone inspires images of swimming, vacations in warm, exotic places, feeling the soft grass underfoot, sticking your feet in a cool stream on a hot day, going barefoot.

How do you feel about that last phrase, going barefoot? Do you have visions of friends and family – even strangers – reacting in all kinds of embarrassing ways when you take your shoes off?

perfect feet

She either has a parent who’s a podiatrist, has never been pregnant, or weighs little more than a feather.

No one’s feet are perfect – that is, no one who’s been pregnant, has walked, run, played, gained weight, lost weight, worn shoes that looked fabulous but didn’t really fit, or in short, lived a life over 30 years. After all, those puppies at the bottom of your legs have carried you through it all, even though you’ve paid little attention to their needs. Heck, you’ve downright abused them at times (can you believe some of those shoes you used to wear?)

Most of us neglect our feet, it’s true. What’s more, we frequently inherit abnormal bone structure, faulty tendons and muscles, or less-than-perfect biomechanics from our parents. Throw all of this together and we frequently end up with bunions, a tendency toward  fungal infections like athlete’s foot or toenail fungus, overlapping toes, crossover toes, corns and calluses, ingrown toenails, premature arthritis, you name it. End result is that we keep our feet covered in public when we desperately want to wear sandals, flip-flops, or roam the world – or even our patio deck – in bare feet.

A regular visit to a podiatrist can solve a lot of your foot hangups. Trained intensively and exclusively in the medical treatment of foot and ankle conditions, a podiatrist can resolve pain, discomfort, and aesthetic issues for most patients without surgery. The first part of a treatment program may include suggestions for changes in footwear, custom designed orthotics, exercises specifically geared to your foot problem, and weight management if necessary. These seemingly small changes can make a big difference to your feet.

So go on – take your shoes off, let your toes hang out, and show the world how beautiful your feet are.

Why do my feet smell?

11 Dec

boy stinky shoeWe’ve all been there.

The theme music from Jaws starts playing in your head as your best friend goes about removing their shoes. Oh no. You take one last gasp of clean air and hold your breath as you quickly excuse yourself from the room, seeking the nearest gas mask.

It may not as bad as all that, but why do some people’s feet create a bad (some might say deadly) odor and others don’t?

The medical term for malodorous feet is Bromodosis, caused by a combination of sweat and bacteria.

There are more than 250,000 sweat glands in each of our feet, making it one of the wettest parts of our body. In just 24 hours in fact, each foot might produce as much as one pint of sweat, especially if you exercise heavily. Certain medicines, stress, and medical conditions can also encourage excessive sweating, which is called hyperhidrosis. Hormonal changes are notorious for creating bromodosis, especially in teenagers and pregnant women.

But sweat by itself doesn’t produce bad odor, as it’s simply water and salt and a few other elements your body is cleansing from your tissues. The problem is, it can’t evaporate, since it’s trapped behind a sock and shoe. If you sweat a lot, your feet stay damp and create conditions perfect for the real culprit: bacteria.

Now understand that bacteria live all over your skin – it’s just one of those fun-facts-we’d-rather-not-know about our bodies(sorry!). And those bacteria are actually key to good health, as they discourage other more aggressive bacteria that can make us sick.

What creates foot odor?

We love this Wikipedia description of how foot odor is created:

“The quality of foot odor is often reported as a thick smell… like that of malt vinegar. However, it can also be ammonia-like. Brevibacteria are considered a major cause of foot odor because they ingest dead skin on the feet and, in the process, convert [the] amino acid methionine into methanethiol, which has a sulfuric aroma. The dead skin that fuels this process is especially common on the soles and between the toes… Brevibacteria also gives cheeses such as Limburger, Bel Paese, Port du Salut, Pálpusztai and Munster their characteristic pungency.”

Nice! Your feet smell for the same reason gourmet cheese does.

“Propionic acid (propanoic acid) is also present in many foot sweat samples. This acid is a breakdown product of amino acids by Propionibacteria, which thrive in the ducts of… sebaceous glands. The similarity… between propionic acid and acetic acid, which share many physical characteristics…, account for foot odors identified as being vinegar-like. Isovaleric acid (3-methyl butanoic acid) is the other source of foot odor and is a result of actions of the bacteria Staphylococcus epidermidis which is also present in several strong cheese types.”

That may be too much information for some, but we find it fascinating. You’ll never look at cheese and crackers the same way again.

So what can you do to reduce your foot odor?

If foot odor is a persistent problem, the first thing to focus on is keeping your feet and footwear dry:

  • The same anti-perspirant you use on your underarms may also be effective on your feet. Anti-perspirants block the pores of sweat glands and some also contain an anti-odor agent. Just because your anti-perspirant isn’t marketed this way, doesn’t mean it won’t work (just imagine the commercial)

    baking soda for bromodosis smelly feet

    Your new foot powder?

  • Over the counter foot powders can be very effective, but first try baking soda, as it’s much less expensive. Baking Soda in chemical terms is sodium bicarbonate, a basic salt. It will absorb moisture and create a hostile environment for bacteria. Just sprinkle a little in your socks and shoes and rub some on your feet to see if it works. If you need stronger stuff, then move to foot powders available at drug stores
  • Bathe your feet daily with warm water and anti bacterial soap to remove sweat and bacteria. Dry thoroughly afterwards, especially between your toes
  • Change your socks daily – never wear the same pair two days in a row. Wear cotton, wool, or synthetic material designed to wick moisture away from your skin (like those designed for athletes)
  • Don’t wear the same shoes two days in a row – allow to thoroughly dry for at least 24 hours between wearing
  • Don’t wear plastic shoes, as they don’t allow your feet to breathe. Wear leather, canvas, mesh, open toed sandals, or other materials that allow air circulation. If you have no foot condition that prohibits walking in bare feet, give those dogs some air when you get home
  • Try over the counter, charcoal based, odor destroying insoles like Odor Eaters
  • Dietary changes can help too. A diet high in refined carbohydrates often serves as food for bacteria. When these bacteria stay trapped on your feet, their intense feeding results in foot odor. Eliminating refined carbohydrates from your diet and balancing protein, healthy fats and complex carbohydrates can be a surprisingly effective treatment. Reducing alcohol consumption and eliminating cigarette smoking will also reduce your perspiration
  • Chronic stress can elevate certain hormone levels, triggering sweat glands to go into overdrive. Moderating stress is essential for many other health reasons as well, and can be accomplished through an exercise program, meditation, yoga, psychotherapy, massage therapy, or other programs

If none of these remedies resolve your condition, visit our podiatry office, as we can treat your condition medically with injections and prescription medicines. Your friends and family will thank you.

cat smelling stinky shoes

Diabetes: How minor foot ulcers lead to amputation

5 Oct

Throughout the PA Foot And Ankle Associates blog we stress how important it is for diabetic patients to take proper care of their feet, especially those who’ve been diagnosed with diabetic neuropathy. We stress this because we see far too many patients in the OR requiring the amputation of a toe, a foot, or part of their lower leg in addition to a foot. This is truly a procedure we wish we performed less frequently. While amputation indeed saves the remaining limb and sometimes even the patient’s life, early care of diabetic foot ulcers and preventive treatment are the keys to keeping your legs, feet and toes intact.

Each year more than 60,000 people in the U.S. require a lower-extremity amputation due to complications from diabetes. That’s a tragic figure, considering that early intervention from a podiatrist can in most cases prevent ulcers and consequent infections from becoming serious enough to warrant amputation. The most frequent  reason for these amputations is poor treatment of infected diabetic foot wounds. Unfortunately,  about 50 percent of patients who have a foot, toe, or leg amputated die within five years – a worse mortality rate than for most cancers. Roughly half of these amputations can be prevented through proper care of foot infections.

foot with gagrene

A foot which has gangrene must be amputated

How foot ulcers lead to amputation

Because people with diabetes often have poor circulation and little or no feeling in their feet, a minor cut that goes unnoticed or a sore caused by a shoe becomes infected. If left untreated, the infection can spread, killing soft tissue and bone. Dead and infected tissue must be surgically removed, which, if the infection is extensive, can mean amputation of the toe, foot, or even part of the leg.

Nearly 80% of all nontraumatic amputations occur in people with diabetes, and 85 % of those begin with a foot ulcer.

“Lower extremity amputation takes a terrible toll on the diabetic patient,” says Benjamin A. Lipsky, MD, professor of medicine at the University of Washington and VA Puget Sound, Seattle. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible.”

Read how one diabetic patient struggled to avoid amputation

You might be surprised to learn that doctors consider even minor redness, callus, blisters, sores, or any break in the skin on the foot to be a diabetic foot ulcer. It may seem over zealous, but impairments associated with diabetes, such as a weakened immune system, nerve damage, and poor circulation, diminish the patient’s ability to fight even a minor infection. Wounds easily treated and healed in non-diabetic patients often become chronic, non-healing wounds in diabetics. As a result, when a wound becomes infected, it enters a perpetual inflammatory state and can’t move through the healing process. These infections can become systemic, infecting the entire foot, including the soft tissue and the bones. Podiatrists have many tools and specialized training at their command to properly treat foot ulcers to heal them as fast as possible.

What you can do to avoid diabetic foot ulcers

The most important thing any diabetic patient can do is to effectively manage their blood glucose levels from the onset of their disease. If you’ve recently been diagnosed with diabetes, take your blood glucose levels seriously by eating correctly and monitoring levels as prescribed by your doctor. You should also be visiting a podiatrist on a regular schedule so he or she can create a baseline against which to measure any effects of diabetes on your feet or ankles.

Read about diet guidelines for diabetics

A word about preventive surgery: If you have diabetic neuropathy and you develop a bunion, hammertoe, charcot foot, or corns, you may want to consider surgery as soon as the abnormality is discovered. Because these conditions create areas of great pressure in your foot, if you have a loss of sensation, or if your blood circulation is poor, this pressure can lead to a non-healing wound. Eliminating the abnormality in the foot may deter a future ulcer which leads to an amputation. These surgeries are rather routine for podiatric surgeons and are usually performed on an outpatient basis.

Should I see a Podiatrist or an Orthopedist?

18 Sep

fractured ankle bruising swellingWell, that explains the excruciating pain and the baseball-size swelling in your ankle after you jumped off the trampoline…

Your family physician just pointed to a dark line on your x-ray which shows a fracture of your ankle. She suggests you see a specialist, but will she recommend an Orthopedist or a Podiatrist? Which should you choose?

The difference between an orthopedist and a podiatrist

An Orthopedist is devoted to the diagnosis and treatment of your entire body’s musculoskeletal system: the interworkings of the bones, muscles, tendons, ligaments and joints. Some orthopedists specialize in treating the foot and ankle, while others focus on hands, shoulders, spine, hips, etc. If you choose an orthopedist, make sure that they specialize in foot and ankle.

A Podiatrist is a Doctor of Podiatric Medicine, who is trained intensively in the care of the feet, ankles, and lower legs. Podiatrists are also trained in the biomechanics of the foot and ankle and are trained to fit orthotics, custom shoes, braces, and similar devices. Additionally, some Podiatrists are Podiatric Surgeons, who can perform foot and ankle surgery in a hospital setting when necessary.

A Doctor of Podiatric Medicine (DPM) is the foremost medical and surgical specialist of the foot and ankle and is the only medical specialist educated, trained, licensed, and certified for exclusive treatment of the foot and ankle.

Podiatric Surgeons complete a 3 year hospital based residency which includes training in all aspects of foot and ankle surgery. There are some that choose to complete a 1 year fellowship to further focus on areas such as diabetic limb salvage or sports injuries of the foot and ankle. But not all Podiatrists choose to perform all types of foot and ankle surgery just as not all Orthopedic Surgeons choose to perform back surgery vs knee surgery.

Just as with any physician, you should always make your choice based upon their reputation.

The human foot and ankle is one of the most intricate and complex anatomical structures in your body, marrying the precision of a Swiss watch with the structural strength of a cantilever bridge. Your foot is a complex apparatus of 26 bones (one-quarter of all the bones in the human body), 33 joints and more than 100 ligaments and tendons, all linked and served by a vast network of nerves, muscles, blood vessels, soft tissue and skin. All of these parts work in unison to provide the support, strength, flexibility and resiliency needed for actions most of us take for granted, such as balance, walking, running and jumping.

Podiatric surgeons provide comprehensive medical and surgical care for a wide variety of common and complex foot and ankle conditions that affect children, adults and the elderly. They are uniquely qualified to detect the early stages of diseases that show warning signs in the toes, foot, ankle or lower leg, such as diabetes, arthritis and cardiovascular disease. Early diagnosis and treatment by podiatric physicians may save patients from amputation, restore mobility or prevent other serious health problems.

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