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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!

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By Dr. Kuvent, February 12, 2009 10:52 am

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis.
Plantar fasciitis causes stabbing or burning pain that’s usually worse in the morning because the fact that the fascia tightens overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, increased activities or after getting up from a seated position.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Be alert to; sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot. Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe. Heel pain after long periods of standing or after getting up from a seated position. Heel pain after, but not usually during, exercise Mild swelling in your heel

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

Physical activity overload

Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

Arthritis

Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

Faulty foot mechanics

Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re on your feet, putting added stress on the plantar fascia.

Improper shoes

Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don’t protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.