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By Dr. Kuvent, November 4, 2009 12:26 am

Many of us tend to think of spurs as being those old, pointed metal devices worn by cowboys on their heels in order to persuade (if that’s the right word) their horses into picking up the pace. You probably don’t think about it often, but many people are walking around today with intrinsic spurs coming off their actual heel bones! Unlike cowboy spurs, these spurs are made of bone and are actually a forward projection of the lower aspect of the “calcaneus” or heel bone. They play a unique and interesting role in the etiology of heel pain.

Much of the heel pain seen by podiatrists today is due to “plantar fasciitis” which is an inflammation of the connective tissue band running from the bottom of your heel to the base of your toes. Sitting just above and adjacent to the plantar fascia are numerous muscles which help the foot to maneuver. These structures are all closely attached to a small area on that front bottom part of the heel bone. As you might imagine, this creates a great amount of tension in that part of the heel, and over time the constant pulling of those soft tissues on the bone can lead to the development of a bony protrusion towards the direction of pull. Age, genetics, biomechanics, and other factors may all influence this phenomenon.

If you were to look at a foot model or an X-ray of a heel spur, you might be fairly surprised as they can get up to half an inch long and appear sharp-almost like a hook protruding from the heel. Actually, much of the pain involved is NOT due to the spur but rather to the inflamed soft tissues in the area. Thus, more often than not, treatment is aimed at relieving tension and irritation in the soft tissues as well as evaluating them for tears and other pathology.

Whether a spur is present or not, you should definitely visit your podiatrist if you’re having significant heel pain. He or she can evaluate it clinically and then order an X-ray or other test to see if spurring is actually present. A spur may in fact be causing the pain if it gets large enough and starts to compress on nerves in the area. The doctor can also evaluate the nature of the spur, which in some cases may help to rule out hormonal issues, arthritic disorders, and other systemic conditions. Furthermore, imaging and other diagnostic measures can help to indicate whether something else entirely-such as a fracture-is causing the pain.

Though often an incidental finding, heel spurs in certain cases can become critical to the evaluation and treatment of heel irritation. They may be the key to relief.

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By Dr. Kuvent, October 27, 2009 11:05 pm

If you’ve ever walked barefoot across a gravel parking lot, you’re probably well-aware that human feet are very sensitive structures. That’s a good thing because it allows our feet to move and adjust to potentially damaging objects on the ground-such as a sharp stone or a piece of glass. Normally, we are able to avoid such objects with ease and protect ourselves from cuts, infections, and other risks. However, the greatest threat to our feet is more internal rather than external. It occurs when our nerves become damaged and that vital protective sensation in our feet is lost.

There are unfortunately MANY things which can lead to weakened or damaged nerves in our feet. One of the most common and well-known causes is diabetes. As individuals lose control of their blood sugars, the nerves particularly in the feet tend to become damaged and insensitive. Other metabolic issues such as B-vitamin deficiencies, alcoholism, and various toxins such as heavy metals can also lead to this problem. It’s pretty interesting to consider how certain health issues like Ulcerative colitis or Crohn’s disease can affect vitamin absorption to affect nerve function and indirectly the health of our feet!

Certain inherited and autoimmune disorders can also cause the feet to become insensitive. Things like Charcot-Marie-Tooth disease, Lupus, Guillain-Barre syndrome, allergic conditions, and blood disorders can all have this effect. Mechanical issues like an entrapped nerve or a spinal root problem may also be causing the problem. On top of these and other causes, the medications you are taking can also alter the nerve function in your feet. Various seizure medications, immunosuppressive agents, oral contraceptives, and tuberculosis drugs can all have this side effect.

Perhaps one of the biggest problems with nerve dysfunction to affect our feet simply occurs as we age. Often times, visual changes in combination with insensitive feet make it extraordinarily difficult for individuals to monitor the ground as well as the health of their feet. Believe it or not, it’s not uncommon for some people to have needles and other sharp objects lodged in their feet without them even knowing it! Not only can the individual not feel the object, but they’re also not able to see what may be a large and potentially-infected wound. This can be a huge hazard for those who live alone or do not have their feet checked regularly, as the infection can spread quickly and cause major damage.

Podiatrists have lots of experience dealing with insensitive feet. They’re able not only to closely monitor the various components of nerve degeneration, but they’re also able to check for infections, care for wounds, and determine whether a foreign body is actually lodged within the foot. Sometimes various objects show up within the foot on an X-ray which is not otherwise very obvious. If you suspect you’re having such a problem, contact your podiatrist immediately.

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By Dr. Kuvent, October 22, 2009 8:47 pm

Considering the nearly endless discussion on healthcare reform these days and the constant presence of ads from pharmaceutical companies, it’s not much of a stretch to think that our country must be pretty sick! Actually, if you were to guess, what would you say is the number one cause of disability for people over the age of 18 in the US? If you were to say “joint problems” you’d be correct. “Arthritis” or a painful condition of the joints unfortunately affects tens of millions of Americans. One especially debilitating example of this is called “osteoarthritis”.

Osteoarthritis or “Degenerative Joint Disease” is the most common form of arthritis. Unlike Rheumatoid arthritis, it is not due to inflammation or to an autoimmune process. Rather, osteoarthritis typically results from the simple wear and tear that joints undergo in the normal progression of life. Over time, the cartilage which ‘pads’ the joint wears down until eventually the end of one bone starts to grind against the adjacent bone. As you might expect, this can be exquisitely painful and lead to structural damage within the bone itself. Eventually, inflammation along with weak ligaments and muscles can also become a part of the problem.

Multiple factors including genetics, dietary habits, and biomechanical issues may predispose one to developing osteoarthritis. A previous traumatic incident or a history of inflammation may be contributive as well. Typically, people tend to experience symptoms which progressively get worse towards the end of the day and are localized to a joint on just one side of the body (not both sides-as in RA). Individuals may also suffer from stiff or sore joints which oddly tend to flare up prior to a change in weather patterns. Finally, bony enlargements in joint areas are also not uncommon.

While degenerative joint disease can affect nearly any joint within the body, the ball of the foot is one of the most commonly affected areas. For this reason, podiatrists have lots of experience in addressing this condition. Thankfully, unlike many disorders affecting the bones or joints, osteoarthritis can usually be diagnosed on X-ray and doesn’t often require an MRI or more invasive test for confirmation. This and other clinical findings can help your podiatrist to rule out other potential scenarios such as RA, gout, or fractures.

Once the diagnosis of osteoarthritis has been established, the doctor will discuss with you an appropriate treatment regimen tailored to your needs. This will typically include modalities aimed at pain relief and include conservative measures like physical or occupational therapy, management programs, and assistive devices. Various medications may also be administered to help with pain relief. Finally, more aggressive measures might include things like joint remodeling surgeries or injections with gelatinous materials to cushion the joint.

Adequate motion within the joint spaces of our feet is critical for maintaining our mobility. When osteoarthritis begins to compromise that motion, your podiatrist can help to maximize joint function and your quality of life.

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By Dr. Kuvent, August 3, 2009 4:24 am

If you saw the 2004 film Troy, you may have winced at the scene towards the end of the movie where Brad Pitt’s character Achilles has an arrow shot into his heel. Despite his unstoppable presence up to this point, the incident renders him practically helpless, and he soon dies unable to remove the fateful arrow. Most people have at least heard reference to this story from Greek mythology, and an “Achilles Heel” has come to refer to any personal weakness which leaves one weak and vulnerable. The reference is a good one as many people know-for such an inconspicuous part of the body, a damaged Achilles can be truly crippling.

Despite the classic reference, the “Achilles” does not actually refer to the heel at all, but rather to the major tendon behind the ankle which inserts into the heel bone. The problem arises when this tendon becomes inflamed, irritated, or damaged and results in what is called Achilles “tendinitis” or “tendinosis”. This can really mean a lot of different things. The issue may arise from the way the heel rolls when it strikes the ground, which may in turn be related to imbalances within the forefoot. Due to the anatomy of the ankle, the middle portion of the Achilles tendon actually has a rather weak blood supply which can also make the tendon susceptible to injuries.

Achilles tendinitis is actually classified by whether it occurs within the tendon itself or at the insertion site where the tendon meets the heel bone. An injury may manifest in many different ways and include tenderness, swelling, thickening of the tendon, “crackling” sounds, a bony heel bump, or changes in walking patterns. You’d probably be surprised at all the different things that can contribute to Achilles problems. They include overuse, poor training habits, and mechanical imbalances as well as some systemic conditions like elevated cholesterol, the use of certain antibiotic medications, age, the shape of your heel bone, and even certain blood types.

Podiatrists typically address issues of the Achilles by first performing a history and physical. This will likely include some simple exams to rule out muscular causes and get to the bottom of the problem. After this, they may order further diagnostic exams such as X-rays, MRIs, or even ultrasounds. These tests can reveal the extent of the injury and whether there is bony involvement or if the tendon has ruptured. After that, the doctor will discuss with you the treatment options which can vary from simple self-treatment at home to mechanical correction through orthotic inserts to surgical intervention.

The Achilles is the strongest, thickest tendon in the body, and critical to many important functions such as walking. Therefore, it’s important to keep it in good working order, even if you don’t have plans to invade Troy anytime soon.

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By Dr. Kuvent, July 8, 2009 9:57 am

You wake up in the morning ready for the start of a new day with new possibilities. Turning over, you step out of bed groggily, ready to get things started when “Ouch!”- a sharp pain ripples through your heel, jolting you awake more quickly than you were expecting. The pain dissipates with a few steps only to return and haunt you later in the day. These signs are a classic description of a very common condition known as “plantar fasciitis” which in turn is probably the most well-known cause of heel pain. However, there are MANY causes of heel pain out there and distinguishing between the possibilities can be a tricky task.

“Plantar fasciitis”-the flagship example noted above-is a mechanical etiology of heel pain resulting when there is inflammation along the plantar fascia which is a fibrous band of connective tissue running along the length of the sole of the foot. Other “mechanical” causes might include a wearing away of the fat pad beneath the heel, an irritated Achilles tendon, bony outgrowths from the heel bone, growth plate disturbances, and other issues.
Certain systemic conditions can also cause joint problems which may result in heel pain. These include a wide variety of conditions such as kidney problems, Rheumatoid arthritis, fibromyalgia, gastro-intestinal disorders, and many others. Other potential causes include nerve entrapments, stress fractures, infections, blood-flow problems, tendon ruptures and even tumors.

Needless to say, a sore heel can be an annoying and enigmatic problem. Your podiatrist is an expert at distinguishing between all the potential underlying causes and treatments. He or she can perform a wide variety of revealing diagnostic exams-from the simple to the more complex-to clarify the root cause of the pain in your particular case. Since some of these causes are serious while others are more benign, that information should be valuable to you!

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By Dr. Kuvent, June 16, 2009 3:24 am

Flip-flops are an extremely popular form of footwear, especially in the summer. Originally patterned after the traditional Japanese wooden-soled style known as zōri, they’re also known as “thongs” in Australia, “slip-slops” in South Africa, and “jandals” in the South Pacific. They’re most popular in India, where they’re known as “Hawaii chappals”.

Interestingly in some cultures, flip-flop shoes are occasionally used to threaten someone since they can quickly be removed and thrown or used to hit an adversary. While that practice is rare in the United States, flip-flops can still pose a threat to those who wear them. For the most part, flip-flops provide no arch support at all, expose the foot to the outside environment, and can often contribute to many foot-related injuries. Since they often have a spongy rubber sole, flip-flops make it difficult for your feet to adjust and accommodate to the ground with each step you take. Furthermore, the strap can lead to skin irritation as well.

All that said, let me back up and admit that flip-flops are indeed a fun shoe to wear, and in fact have many benefits. They allow your feet to breathe and can actually protect your feet from picking up things like plantar warts and various fungal infections from public places. There are just a few pieces of advice to keep in mind if you do choose to wear flip-flops. First, if possible, look for a quality pair with a soft, leather fabric to minimize blisters and irritation. Look for a sole that forms some contour to the ball of your foot but isn’t overly pliable either. Also, make sure your foot doesn’t hang off the edge of the sole. This problem can be exacerbated if you have wet or sweaty feet with a smooth sole, so really try to be aware.

Some other advice would be to not walk for especially long distances, and to avoid playing sports or doing yard work in flip-flops. The straps can snap spontaneously, so excessive motion is definitely not advised. Overall, be cognizant of your environment. If you’re in a location where things like insects, poison ivy, or glass have access to your feet, flip-flops are not the best choice of footwear. If you’re at the pool or beach and wearing flip-flops, remember to use sunscreen on your feet as they can burn like any other exposed part of your body.

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By Dr. Kuvent, May 26, 2009 2:03 am

As you can imagine, human feet are incredibly complex and impressive structures. Just think of all the functions that your feet perform every day! Each human foot contains roughly 26 bones and 33 joints. That actually accounts for about a quarter of all the bones in the body! The coordinated movements that we often take for granted require efficient and effective motion between each of those bones and joints. Occasionally, however, some of the bones can develop unions or connections with other bones which can have a big impact on the function and comfort of your feet.

In most circumstances, the connections which reduce or stop motion between bones show up in the middle or hind part of the foot below the ankle. These unions are often bony themselves, but can also be made up of cartilage or fibrous tissue as well. They’re certainly nothing new. Doctors back in the 1700’s first began to describe this condition, and a pre-Colombian Indian skeleton from around 1000 AD even had one!

Unions between bones in the foot may be acquired over time or congenital- showing up in fetuses as early as the first trimester. Some acquired causes may include trauma, arthritis, or even tumors. Either way, they can present in a variety of ways. Patients may experience pain, muscle spasms, decreased motion, or no symptoms at all. Pain is usually localized to the outside top of the foot or the entire rear-foot, and often comes on after activity. Walking over rough surfaces is especially painful. Individuals-especially children-who develop a stiff flatfoot on one side but not the other have a very high chance of having a bony connection in that foot.

Podiatrists perform a number of simple clinical exams as well as radiographic techniques to quickly assess whether an individual has a bony union or not. They’re able to localize the issue and determine the extent of the problem, and of any arthritic changes. After that, a number of conservative measures may be implemented to address the problem. If these measures fail, surgery may be recommended to address the needs of that specific foot.

Physical activity is a critical part of everyone’s healthy lifestyle, and walking should not be painful. If your feet become rigid or uncomfortable, you should have them examined professionally. You’ll be glad you did!

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By Dr. Kuvent, May 6, 2009 11:55 am

You’re on a mission, for the perfect pair of shoes. There’s an event, a wedding, a game–whatever, you NEED those shoes. You get to your favorite shoe store and you see them through the window…glowing from a glorious pedestal display. AND their 50% off! Today is YOUR day.

You rush into the store, scan down the available sizes, and…just 2 pairs? One that’s 2 sizes too big, the other is a 1/2 size too small. Just your luck. Well who cares, it’s just a half a size smaller, maybe I’ll just take out the insole or something…

Maybe you can relate or maybe you have a pair of shoes you’ve been holding onto for over a decade…
Women often buy dress shoes that come to a narrow point or lack sufficient padding–and sure, this causes blistering, soreness, corns, and calluses. But, did you know you can have changes in your bones from wearing ill-fitting shoes? Maybe you’ve heard of hammer-toes, here the toes start curl up a little at one joint and back down t the other, it can be a pretty gnarly deformity. As you can imagine, this “hammering” can become VERY painful. The bones of your toes can overlap each other, curl into each other, and be permanently scrunched upwards by those shoes you HAD to have…they are physically changing your bone structure! And if your bones of your feet are changing, the MUSCLES of your legs and feet (that attach to those bones) are forced to change too. Yes, it’s painful, just like any other muscle, when it’s pulled and strained–but think about it. These are the muscles of your legs and feet! You’re on them ALL the time. Some of your muscles are forced to work overtime, which pushes the others out of their alignment too. This repeated pulling, tugging at your muscles is actually effecting how you walk. Over time, you can lose stability in your ankles and literally morph the way you walk. It’s kind of like the tires on your car–if they fall out of alignment it pulls you one way or the other–and ultimately makes it difficult to steer…
See? IT IS A BIG DEAL. IT IS TIME TO GET YOUR FEET ALIGNED…

Stay tuned for the next blog for some helpful suggestions, tips, and pointers to find your next (truly) perfect pair of shoes…
and yes, it’s time to get rid of those sneakers from 1983…

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By Dr. Kuvent, April 30, 2009 12:31 pm

Our feet are incredible structures, and the lesser toes are no exception. Just as your thumb opposes and works opposite the smaller fingers in your hand, the lesser toes of your foot help to balance your body by working opposite from your “hallux” or big toe. Accordingly, in a healthy foot, specialized intrinsic muscles work on specifically the four small toes to allow them to stay aligned and function properly. However-as one might suspect-these toes can experience a unique set of symptoms.

Hammertoes are the most common and well-known digital deformity affecting the lesser toes. They typically will affect a single toe and will cause it to bend such that the first part of the toe is bent upwards, and the second part of the toe (the part with the toenail) is bent downwards. The typical signs and symptoms may include a corn on top of the joint where the toe bends as well as a callus underneath and behind the toe where it bears weight. Common causes of a hammertoe include tight shoes or stockings, biomechanical problems, or simply a long second toe.

A cousin to the hammertoe is the “claw toe” deformity. Whether our lesser toes are healthy or not, they typically consist of three small bones and two joints. With claw toes, not only is the first part of the toe bent upwards, but both the joints in the toe are also bent so that the second part of the toe tends to bend or curl downwards in a claw-like manner. This scenario is often associated with a cavus or high-arch foot type and neuromuscular disorders. It typically affects all the lesser toes at once, and may even affect the hallux.

In a “Mallet toe” deformity, the toe is strait except for the very end of the toe which is bent downwards. This tends to put pressure on the skin at the tip of the toe and will often lead to a callus formation there. The toenail will often become thickened and look as though it has a fungal infection. This condition is commonly associated with a long toe.

Numerous other conditions can also affect the lesser toes. “Curly toes” will typically bend downwards and underneath adjacent toes. They will often occur simultaneously on both feet. An overlapping 2nd toe will bend back and over the hallux, while both the 4th and 5th toes can be affected such that they may bend and rotate beneath the adjacent toes. Finally, a “floating toe” is commonly observed in a congenitally short toe which cannot purchase the ground.

Of course, each of these conditions has a unique set of symptoms, prognoses, and treatment options. Visit your podiatrist for an in-depth evaluation and discussion.

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By Dr. Kuvent, April 10, 2009 3:43 am

Preventing Prom Shoe Pain

As spring time rolls around, thousands of high school students and parents are no doubt highly anticipating that big event of the year: Prom. Many girls look forward to this night as a huge event in their high school years and hope to fill it with lots of great memories. There are, of course, many logistical preparations to make, but finding the right pair of shoes is truly critical in making this night a success.

Prom shoes on average cost $50-80, although there are many discounts available and shoes to fit any budget. A big issue is finding the right compromise between style and comfort. Many girls want to find shoes that look great, but heels that are too high can be a simple cause for a ruined Prom. The standard heel heights are usually 2”, 3”, and 5”, but it’s strongly recommended that girls choose a heel height similar to what they’re used to wearing on a daily basis. Consider your date’s height and how much you intend to dance. Both should be important factors when choosing high-heeled shoes.

If you’re not comfortable with heels, basic flats or wedge shoes may be a good substitute. These should be chosen as an alternative to kicking off heels later in the evening because many gowns are hemmed to floor length, and going barefoot will cause the dress to drag along the ground. Therefore, it’s also a good idea to have the shoes available at your first dress fitting so as to minimize alteration costs by maintaining a consistent hemline.
Since our feet actually swell during the day, it’s a good idea to go shoe shopping in the afternoon or evening to find a pair that will fit your feet most comfortably. Wear the shoes around the house for a few days prior to the big night in order to allow them to conform to your feet. Also, consider the Prom location and floor surface. You may want to scuff the bottoms of your shoes with sandpaper for more traction to make walking and dancing easier.

With simple planning and foresight, you can choose a pair of shoes that will leave an impression on your friends, family, and date-NOT on your feet!