Happy Holidays

Happy Holidays from all of us at Podiatry Care Specialists, P.C.

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Holiday Shopping

This is a busy time for everyone. Holiday shopping, running around, and being on your feet. It is important to remember, not only during the holiday season, but whenever doing long periods of walking and standing on your feet to wear the appropriate shoe gear. We generally tell our patients that anything is better then going barefoot, socks, sandals, and flip-flops. For around the house, Crocs can be very beneficial for your feet. Our office dispenses different styles of Crocs, with the most common we recommend is the Crocs Relief. They are great for heel and arch support. As for during the holiday shopping, it is not a great idea to do this while in heels, Uggs, or narrow pointy shoes. Wear comfortbale shoes or sneakers with a firm heel counter and great arch support.  Happy Holidays to all and please feel free to visit our site for more info

Happy Holidays,
Chad J Friedman, DPM


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Philadelphia Eagles Wide Receiver Plantar Fasciitis

It appears that another NFL player is suffering from one of the most common foot conditions that we treat, plantar fasciitis. Jeremy Maclin has not been limited yet in his activity and is still practicing with the team. Expect him to play this weekend in a must win divisional game for the Philadelphia Eagles. He will most likely have a lot of physical therapy, strappings, ice, and anti-inflammatory medicine to calm this down. For more information on Plantar Fasciitis, please visit at webpage listed below.

Thank you,

Chad Friedman, DPM

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Turf Toe and Matt Ryan

Matt Ryan, the Atlanta Falcons QB, is from Exton, PA. He also went to William Penn Charter in Philadelphia, PA. He recently just suffered a condition known as Turf Toe. Turf Toe got its name from players commonly getting this condition while playing on artificial turf. Turf Toe can be better explained as a sprain of the big toe joint. This can happen as shown in the picture. When the foot is in a flexed position, this can sprain the big toe joint. Sometimes it can be severe enough where it actually can tear some of the ligaments of the big toe joint. This can lead to arthritis in the big toe joint and a bunion deformity.
Symptoms start out as swelling and pain in the big toe joint. Also with difficulty propulsing off the big toe joint. 
A good clinical history along with X-Rays and a possible MRI can help diagnosis the condition. It is usually treated with RICE; Rest, Ice, Compression, Elevation. Usually a taping to the big toe joint along with a stiff sole shoe to help prevent flexion of the joint allows the injury to heal. It can take up to a month and sometimes even longer for the injury to heal. And atheletes are unable to play during this time. Although it is rare, surgery may be an option if Turf Toe goes undiagnosed or if there is a rupture to the ligament.

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Eli Manning Stress Reaction

Well it looks like Eli Manning suffered another setback with his Plantar Fasciits. Apparently he must have been compensating too much from the condition and has developed a stress reaction to the cuboid bone in his foot. Now what is a stress reaction? A stress reaction is changes that is occurring within the bone. Could be from overuse or trauma. What is important is that if left untreated, this can lead to a stress fracture in the foot. A stress fracture in the foot, and depending on the bone in the foot, can definitely put an end to a season. And with not that many weeks left in the season, it can end his. Treatment for both is to stay off the foot and offload it. This again can be done via a Camboot, cast, ice, rest, and crutches. He also has shoe gear modification as well. Will keep you posted on his progress.

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UGGS

Let's face it, as Podiatrists Uggs are not our favorite shoes to recommend. They have a nice cushioned sole, are rounded in the toe box area, but do not have much support in the arch or heel area. This can lead to heel pain,achilles tendinitis, or arch and muscle fatigue. They are an immensely popular shoe, however. We can provide some improvement in the shoe by adding a custom molded orthotic or at the very least a good pre-fabricated arch support device. You have to be flexible in your treatment repertoire as fashion rules.

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Lis Franc Injury

It looks like there was another devastating injury to a football player just recently. That would be Ronnie Brown, the starting running back for the Miami Dolphins. Lis Francs injuries can be difficult to diagnose and can also be misdiagnosed. So what is a Lis Franc's injury? Lis Franc was a soldier who fell off a horse and damaged this ligament. The ligament is one of the strongest in the foot and is located in the middle of the foot. The mechanism of action can occur with a direct impact or trauma to the midfoot or stepping in a hole and twisting your foot.

It can be diagnosed by X-Rays, MRI, or a CT scan of the foot. Patients will come in with a swollen foot, pain in the middle region, and unable to bear weight on the affected side.

Treatment varies depending on how bad the sprain is, and its worse if there is an associated fracture with that sprain. Non-surgical treatment involves a case or a stiff walking boot for up to 8 weeks and sometimes more. Surgery can involve placement of pins and or screws to realign the midfoot area.

Undiagnosed Lis Franc injuries can lead to arthritis in the foot, chronic pain, and wear and tear of other joints in the foot.

With Ronnie Brown he had surgery to fix his foot and now will be out for the remainder of the season. Only time will tell to see how he does after his healing.

So if you are experienceing any of these symptoms after a recent fall or trauma, get to your foot dr right away

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SAP Health Fair

A few months ago Dr Chad Friedman was fortunate to give a lecture at the SAP health fair in Newtown Square PA. The health fair was a success as there were many people who stopped by to learn information about Podiatry and what we have to offer in our practice. If you to would like to know more about our services and what we have to offer for your foot health, please visit our website below or call to make an appointment.

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Lecture

Dr Chad Friedman recently gave a lecture at St Albans Church in Newtown Square. The lecture was presented to St Anastasia's members. The lecture presented was on general foot health and included bunion, hammertoes, neuromas, heel pain, arthritis, fractures, diabetes, and wound care. For more information please visit out site for educational videos

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Surgical Emergencies

There are many different kinds of surgical emergencies. There are also a few that can occur in the foot and ankle. One such emergency happened to a player yesterday in the New York Jets vs Oakland Raiders game. Leon Washington, the Jets running back, suffered an open fracture of his fibula. Open fractures occur when bone can be visible or breaks through the skin. This actually happened to him right on the field. Some of the players had seen the bone visible through the skin. The fibula is one of the two smaller bones in the lower leg.

With open fractures, the area that has been exposed has an increase chance of an infection. In order to prevent this, the wounds are usually taken care of in the Operating Room or Emergency Room. The broken bones are also fixed at this time. Sometimes if there is a delay in treatment, it may require multiple surgeries.

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Eli Manning Plays Well With Plantar Fasciitis

Eli Manning had a great game this past weekend against the Oakland Raiders.
"I felt good," the Giants' quarterback said on a conference call with reporters Monday afternoon. "I moved around and didn't have a setback by any means. I feel like it's getting better every day and will and should feel better by the end this week and keep improving.”
He was not limited at all during the game. With plantar fasciitis, getting back to physical activity can be an achievable goal. With daily stretching, taping, orthotics, injections, and physical therapy, can get you back to your normal lifestyle. Its always important to remember, that foot pain is not normal. Plantar Fasciitis can be treated if it is treated early enough. Will keep track of Eli's progress. Please visit our website for more information on heel pain.
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Tom DeLay Dancing With The Stars Foot Injury

Once again another famous person has had an important injury. Tom DeLay, former Republican majority leader, has stress fractures in both feet. Stress fractures are caused by repetitive injuries. If they are not treated early enough, they can lead to a complete fracture. If this happens, this can take a lot longer to heal. Initial treatment for stress fractures include the principles of RICE- Rest, Ice, Compression, Elevation. Also this includes Immobilization. As we talked about before, CamWalkers are one of the best immobilization options we have for stress fractures. It's unfortunate that Tom DeLay had to withdraw from Dancing With The Stars, but if he did not, then he would be at risk for a complete fracture and longer healing times. This is why it is important to not continue daily activities when you have pain and discomfort. Always visit your Podiatrist if you are having foot pain. Remember, foot pain is NOT normal.

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Eli Manning painful heel hurting Giants hopes for upcoming game

It seems like another famous athlete has developed the painful condition known as Plantar Fasciitis. He also may have developed a bone bruise along with this. After the injury occurred you can see the trainer was taping up Eli's foot. One of the most common things that we do for plantar fasciitis is to tape, or strap the foot. This helps support the heel and arch area which is important in plantar fasciitis. I am sure he will also have a lot of stretching, icing, and physical therapy this week to calm the area down. It is possible he will also be wearing orthotics (shoe inserts) in his cleats as well. Now Eli, had an MRI to help confirm the diagnosis. He may also have had a bone bruise to his heel as well. If this is the case, this may take a little longer for him to heal. Treatment is similar but he may be in a CamWalker for the bruise. Now for people who are into Fantasy Football and have him on your team (like myself) you are probably wondering if you should start him or not. Studies show that with plantar fasciitis it is usually treated conservatively 90% of the time. Depending on which treatment he gets he should be fine for the game. I don't see him being limited too much as long as he is taped up and has inserts in his cleats. I am hoping he has a good game. We will continue to monitor his progress and will update you on his condition.
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Sweaty Feet

Sweaty feet is also known as Hyperhidrosis. This commonly occurs on the palms and soles of the feet. Some people may have more sweat glands than others. When your feet sweat, this is a breeding ground for fungus and warts to develop. Remember how we talked about that fungus and warts, love a warm moist environment? Hyperhidrosis can also lead to Bromohidrosis which is foot odor.

There are many different treatments that can help hyperhidrosis. One thing that we will typically recommend is to not wear 100% cotton socks. 100% cotton socks do not wick away moisture. So when your feet sweat in these cotton socks, the moisture will also stay with you all day. Socks with the synthetic material consisting of Lycra can help with this. It is also a good idea to constantly change your socks daily. We also have certain topical roll on anti-perspirants that one can roll onto their feet to help with the dryness. These products can be very effective and they range in different concentrations. There are also certain Talc's and lotions that we may dispense to help this out as well.

Please visit our page if you have more questions or call to make an appointment

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Gout

We have discussed some previous causes of heel pain such as plantar fasciitis and calcaneal apophysits. One overlooked cause of heel pain is Gout. Commonly we will see gout in the big toe joint. It can also be seen in the heel less commonly. Gout is a build up of uric acid in the body. Some people may tend to overproduce these uric crystals and then there are the people who under produce them and the body is unable to get rid of the uric acid crystals. The uric acid then tends to buildup in joints in the body. This leads to a red, hot, swollen, and inflamed joint. This can be very painful. Typically people may describe the pain so bad that the bedsheets are unable to touch the foot. There are many different causes of gout ranging from genetics, drinking too much alcohol, eating a lot of shrimp, shellfish, and red meat. Certain medications can also cause gout. Most commonly are the water pills such as Lasix and HCTZ. Certain tests can diagnose gout as well. This can be confirmed by a looking at the synovial fluid in the joint and a simple uric acid blood test. However these tests are not always positive. Sometimes in an acute gout attack, the blood test comes back normal. X-Rays sometimes can take years before seeing the erosive changes it can take on a joint.

Untreated, and long term gout can lead to arthritis in the joint. This is why it is important to see your Podiatrist (if affecting the foot) and your Primary Doctor to manage the gout. Early treatment during an acute attack most commonly involves a cortisone injection and anti-inflammatory medicine. This helps dramatically reduce the inflammation within a 12-48 hour window. Long term treatment may consist of being placed on medicine that helps control gout and prevent future flare ups. One thing that must always be done is a diet change. Avoiding alcohol, red meat, shrimp, and shellfish can help prevent future flare ups. Gout was typically called "The Disease of Kings" and "Rich Man's disease" because it was believed back in the day it was caused by an overindulgence of food and drink. But now we know more about what the causes and treatment are of gout and how to avoid it. As always if you are having the above symptoms and are suspicious for gout in your foot please contact your Podiatrist to get some relief
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Back To School Shoes

Summer is quickly ending and now many students and kids will be returning back to school. At this time, many parents will be buying their children new sneakers/shoes to also start the new year off. There are many different things to look into when buying sneakers and shoes. The American Podiatric Medical Association has listed a "1,2,3 test" to ensure a good quality shoe when purchasing new shoes.
The first thing to do it press on both back parts of the heel. this area should be firm and not compress.
(Images on the left are better quality sneakers than images on the right)
Click on picture for bigger picture.


The next step to check for is toe flexibility. The shoe/sneaker should compress at the ball of the foot and not the entire shoe. The shoe should bend with your child’s toes, but should not be too stiff or bend too much in the toe box area.




The 3rd test should be to grab the shoe/sneaker and twist it from side to side. A good quality shoe/sneaker will not easily twist in the middle.



Other important considerations is to go shoe shopping with your children. This will help promote good quality shoes early and often. Always look for the Podiatry Seal of Acceptance on the shoes. We have blogged about this earlier. Continually examine the wear pattern of the heels. Many kids will tend to wear out the heels even though their shoe size has not changed. Lastly, socks is always important when trying on shoes. Make sure to wear the correct socks when trying on shoes to ensure a proper fit.

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Flip Flops and Bacteria

There was an interesting article posted by NBC about Flip flops and bacteria that I would like to discuss. The University of Miami emergency mobile flip-flop lab found more than 18,000 bacteria on one flip flop. Now remember that's just ONE flip flop. What was even more interesting was that some of the bacteria that was found on the flip flops, were bacteria from fecal matter, respiratory germs, diaper rash, and yeast infection. Oh the places we go....the study tested different parts of NYC. The subway, parts of Coney island, Coney island public restroom at the train station, West Village, and Brooklyn's Prospect Park. Wow I couldn't even imagine wearing a pair of sandals, or flip flops in a subway. Let a lone a busy one like NYC. That one in the public restroom had about 13,900 bacteria!! Another interesting finding by Dr. Philip M. Tierno Jr., director of clinical microbiology and immunology at New York University’s Langone Medical Center, said "if such shoes were worn for three months over the course of an entire summer, 93 percent of them would have fecal bacteria on them and 20 percent of them would have E. coli."
Just think about what you are potentially walking in with those flip flops in bathroom floors, especially in a subway station. And I just don't mean human waste either. You also have small animal droppings as well.
The most important thing that one should consider is not having any open cuts, blisters, or sores. You shouldn't be wearing flip flops to begin with, with any of the above foot ailments. But with all those bacteria, this can lead to severe infections in the foot.
It is always important to take good care of your feet and to recommend checking your feet daily. For further information, please check out our website.

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What is My Foot Type?

We typically will get many questions regarding "What is my foot type?" and "What type of sneaker should I be looking for? Motion control? Stability?" Well it can be very easy to determine what your foot 'type' is. This can range from a flat foot, high arch foot, or a normal foot. It is very important to know this, so that when it comes to buying a pair of sneakers you can determine which kind to buy.

The images that you see from left to right are pictures of a High arch foot, flat foot, and a normal foot. To find out what type of foot you are you can perform the "Wet Test"

This simple test can be done at home. Basically, pour some water in a pan. Step in the pan so that the bottom of your foot is wet. Then step onto brown paper bag, shopping bag, or heavy paper. Then take a look to see which image your foot type is similar to.

Lets start off with the High Arch foot. If you don't see much of the instep, and a thin line of the outside part of your foot then you have this type of foot. You will basically be looking for a Cushioned or Flexible shoe type

Next would be the flat foot. If you see the majority of your foot than this is your foot type. You will typically be looking for a Motion Control or Stability shoe.

Lastly would be the normal foot type. You would most likely see half of your arch area. If so than you have a normal or neutral foot type. When buying shoes you want to typically look for a Stability type shoe.

This can help out tremendously when deciding between the differences out there between cushioned, flexible, motion control, and stability

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New Running Sneaker Style

I recently saw an interesting article from Wired magazine. Research is being done that is suggesting barefoot is the way to run. I do not agree with this at all, but we will see what kind of literature will be published in the future. Certain companies are developing models like Nike Free, the Newton All-Weather Trainer and the glove-like Vibram FiveFingers.

Could these things be the new Crocs? Only time will tell. I dont see it as a good idea due to the lack of support and cushion. By running barefoot, you increase your chances of sprain, strains, fractures, and developing cuts and bruises. The new sneakers do not seem at all supportive for the heel and arch. I will keep you posted on the new running style to see if any literature is out there. Until then, its best NOT to run barefoot, and to be in good supportive sneakers and shoes at all times.
The original article can be found at : http://www.wired.com/wiredscience/2009/07/barefoot/

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Exercising and Foot Gear

Over the past few weeks and months with the warmer weather out, I have been trying to get more and more exercising in. Usually that will be with bike riding, the elliptical machine, and running. One of the good habits that I have developed as a Podiatrist is constantly looking at ones feet or shoe gear. Its more apparent in the Summer months when people wear sandals and flip-flops.

As I talk about different shoes in this blog I would like to mention that I have no affiliations with these company's and I do not get paid for recommending their shoe gear. Its all from personal experience.

I have been amazed that when I went to the gym a few weeks ago what people are working out in. Or even cycling on trails. I have noticed a lot of sandals. They may feel fine while working out in them but it will catch up with them later. They will eventually develop foot problems. Sandals and flip flops offer no support at all. When exercising, your heel and the arches of the foot need to be constantly supported. There also needs to be some shock absorption as well. If not the knees then take a lot of that shock absorption. People will develop plantar fasciitis, arch pain, callouses, and knee pain as well.

Now i know there are a ton of different shoes and sneaker company's out there but not all have the APMA seal of acceptance. I will also post a link for them as well. As for shoes and sneakers I will recommend they are as follows:
Sneakers: New Balance, Asics, Saucony, Brooks, Mizuno, Aetrex
Shoes: Aetrex, Rockport, Ecco, Clark's, and Merrell's

And for a list of the APMA seal of acceptance for shoes and sneakers please see the following link:
http://www.apma.org/MainMenu/RecommendedProducts/SealofAcceptance/ProductsbyCategory.aspx#FOOTWEAR



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Fractures

The foot has 28 bones. Fractures can occur in any of these types of bones. There are different types of fractures that people can sustain. Recently in the sports world, Yao Ming the basketball player for the Houston Rockets, had suffered a fracture of his navicular bone. He also has a history of different foot ailments. The Dr that is treating him had mentioned that the injury he has recently sustained "could end his career'. Very scary. So what is the navicular bone and why is this a problem for him.

The navicular bone has many different ligamentous attachments to it. It also has a main insertion attachment for the Posterior Tibial Tendon (PTT). One of the main functions of the PT tendon is to hold up the arch of the foot. The bone is the main corner stone of the arch of the foot. The navicular bone, also has a very poor blood supply to this area. When bones have a poor blood supply, it takes longer for them to heal. A CT scan was able to pick this tiny crack that he had in the navicular. Now, Yao's options include either conservative or surgical intervention. Conservative treatment would include casting, bone stimulator use, physical therapy, and most certianly orthotics to control his foot. Surgical intervention would consist of fixing the fracture.

So only time will tell to see how Yao's Dr's figure out a treatment plan for him. Yao's injury continued to get worse. That is why it is always important to consult your Podiatrist should you notice any foot pain.

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