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Medical & Surgical Treatment of Foot & Ankle

Your best choices for your family's foot care needs

Category Archives: Sports and Foot Care

What Your Podiatrist Can Do For You In 2016:

  1. Be there when you need them. Podiatrists treat conditions of both the foot and ankle. If you have pain or questions about your feet, they are well qualified. Each podiatrist goes to a medical school specifically for foot and ankle. Today’s podiatrist also does a three year surgical residency. If you have consistent pain or problems, you don’t have to just live with them. Come see us and we can answer questions and give surgical and non surgical treatment options for anything from discolored or ingrown nails to bunions and fractures.
  2. Treat your whole family. Our podiatrists are well qualified to treat feet and ankles from birth. If you have questions about flat feet or otherwise bring your child so they can be answered. Some things may be normal, while others can be treated easily so that they may have decreased pain and less problems later on in life. No question is silly when it comes to children. Similarly the elderly are treated for calluses/corns, bunions hammertoes and more! Difficulty with balance is evaluated and many times can be addressed at the level of the foot and ankle. Of course active people also have foot issues at times as well. All can be treated in the same spot!
  3. Keep you on the road to success. Once your pain or problems are improved with treatment, a plan is made to reduce the risk of your problem coming back. Your podiatrist will educate you and give you the tools to know how to recognize the problem sooner in the future. Little to no pain is great, but if a few simple things can keep it away, we will let you know.
    Fenton Foot Care patient room

    Fenton Foot Care patient room

  4. Prevent major issues in the future. If you are diabetic, speaking with your podiatrist can open your eyes and make you look more at your feet. Diabetes can affect many body systems including blood flow, nerves, kidneys, healing time and eyes. Decreased sensation and decreased healing time can be a very bad combination causing ulcerations and sadly, amputation. An appointment to evaluate your risk and give you the tools to prevent future issues is very important.
  5. Make your back, hips, knees and feet feel better.  Much of the way we feel and walk depends on our feet. If our feet are not supported correctly it can put strain on the joints of the foot, ankle, knees, hips and back. The podiatrist can evaluate your walk and look at the bones of your foot with an xray to determine what type of support you need. Support can come in a variety of different ways including over the counter inserts, different types of shoes, braces and custom made orthotics. The doctors will find a plan that you like, are comfortable with wearing and provide maximum relief.

Dr. James Hirt and Dr. Erin Holdren Otis are podiatrists at Fenton Foot Care and Brighton Family Foot Care. They are ready to help you with your footcare needs. 

Peyton Manning-Bad Plantar Fasciitis vs Partial tear?

Dr. Holdren Otis

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The plantar fascia is a ligament on the bottom of the foot that goes from the heel bone to the bases of the toes

Manning is currently listed on the injury report as right shoulder, rib and left foot injury. There are differing reports about what caused him to leave the game Sunday after throwing 5 passes and 4 interceptions again the Kansas City Chiefs. Peyton Manning has struggled with plantar fasciitis over the season. Plantar fasciitis, also known as heel spur syndrome, is the most common cause of heel pain. It is seen in individuals who are physically active or have increased their daily activity. The plantar fascia itself is a thick band of tissue attaching to the heel bone, the calcaneus. Tugging and pain are usually felt at this attachment, but pain can be in the arch as well. This tugging can cause microtears or worse a partial rupture of the fascia itself.  Pain in the morning and when getting up to walk after sitting for a period of time are common complaints. The heel is often painful when a person has to push off on the toes.

Treatment for microtears of plantar fasciits is much different from treatment of a partial or complete tear of the fascia. Microtears are treated with a decrease in activity, especially what causes the pain. The foot and arch itself needs to be supported with an arch strap or insert in the shoes so that the fascia doesn’t have to stretch so much with each step. The longer the symptoms have been around the longer it takes to make the pain go away. If the pain is not going away with diligent care for 6 months then a surgical procedure can be done through a scope to lengthen the fascia.

A partially torn plantar fascia is an uncommon injury but can be done with one forceful planting of the foot. Sometimes a pop is felt or heard with associated pain.  It is not possible to repair the plantar fascia surgically. Time and rest with gentle stretching are the main treatments.  Soft tissue, such as the plantar fascia, can take up to 8 weeks to fully heal. Immobilization with a walking boot or cast can help to heal it faster and is recommended for a fully ruptured plantar fascia. Once the fascia is healed light stretching and slowly getting back into activities is the best way to prevent a re-rupture. Peyton’s brother Eli Manning tore his fascia completely in 2009. There is no genetic link to pathology of the plantar fascia but they may have a similar foot type, along with high level athletics that would predispose them both to this issue.

Peyton Manning broke the record for the most passing of all time earlier in the game. For the sake fans of the Broncos and Peyton Manning hopefully microtears of the fascia along with the shoulder and ribs kept him out of the game and not something more serious like a partial or complete rupture.

What your runnning shoes are not giving you.

Dr. Holdren Otis

I have spoken with many runners and their trials of trying to find the correct running shoe for their build, running gait, mileage, terrain and foot type. There are many, many types of shoes to choose from and the task can be daunting. Let me start with what a running shoe can offer for you. The first is protection from the road below your feet. Why wear shoes in the first place? The reason is to allow you to run on anything from icy paths, rocky dirt roads, a smooth river trail or a grassy field. The second a running shoe will offer is cushioning to take away a little shock from your body falling to the ground with every step at six times your body weight. Some shoes like the Hoka brand have a very thick sole and offer what many of my running friends call a “smooth ride.” Other shoes are for more efficient “ball of the foot” runners like the Nike Free, offer less between you and the miles ahead.

Ok now let’s discuss what a running shoe is not going to give you. Arch support. That insert in your shoe is usually colorful and soft, but little else. It is flexible and may have a little more material where the arch of your foot is but it is not support. If I can bend the insert with my hands then you can definitely do it with your body weight. I have heard from many runners “I bought these shoes because they have good arch support.” The shoes you have purchased may have stability, they don’t bend in the midfoot, which is a good quality of a shoe but they don’t support your arch. Any shoe that offers memory foam may feel good and squishy but it is not arch support either.

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Note the flexibility of the standard shoe insert.

Inserts pulled out of running shoes.

Inserts pulled out of running shoes.

 

Shoe inserts all look about the same. These are from Asics, Addidas, Fila, Sketchers, Nike, Saucony, Mizuno and New Balance. I have run in about every major shoe brand.

 

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A normal arch height foot on a standard shoe insert.

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The same normal arch height foot on a custom molded semi rigid orthotic that fits the arch and heel very well.

 

 

Not absolutely everyone needs arch support but if you have had foot pain, plantar fasciitis, heel pain, arch pain, very high or low arched feet, a custom molded orthotic made to your exact arch is an excellent way to support your arch and foot. If you have tried orthotics in the past but they were too rigid or painful for you there is an answer for that too. An orthotics doesn’t need to be made out of a hard material to be effective. A semi rigid device can be made so the main structure has a little give to it and it is covered with a soft material to make it comfortable to wear. With anything made specific for you and your foot, Dr. Hirt and I want to make sure that you love wearing it. Given time you will not even notice that you are wearing your orthotics, but will become aware if you forget to put them in a pair of shoes. Both Dr. Hirt and I wear orthotics in all of our shoes.

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A high arched foot on a standard shoe insert.

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A high arched foot type in an over the counter semi rigid insert.

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A high arched foot type in an excellent fitting rigid custom molded orthotic device.

 

An orthotic can turn an okay pair of shoes into a great pair and searching for just the right pair of shoes may become a little bit easier. If arch support is what you are looking for, look no further than Fenton Foot Care and Brighton Family Foot Care or your local podiatrist.

Prevent the Spread of MRSA, Giants’ Daniel Fells Hospitalized for Infection

american-football-field-green-32220703Dr. Holdren Otis

Methicillin Resistant Staph Aureus, also known as MRSA (Mer-sah), is a bacteria that has developed a resistance to antibiotics. This means that the normal penicillin used to treat staph infections no longer will kill the bacteria. The New York Giants tight end, Daniel Fells has a MRSA infection in his right ankle and has had multiple surgeries in the last week to clean it out. Reports say that he is being cared for in the intensive care unit.
Daniel Fells injured his toe and ankle and was given a cortisone injection, which helps calm down inflammation in the area. Despite the injection the pain in his ankle continued along with high fevers and he found himself admitted into the hospital 10 days ago. Fells has played for 7 years in the NFL but with the infection, his career is being seriously threatened.

 

Staph infections generally start as painful and swollen red bumps which may surgery to be drained. These infections can quickly become deep and potentially life threatening.

 
The Giants have carefully sanitized their locker rooms and equiptment and retrained their players and staff on how to prevent the spread of MRSA.

 
You can prevent MRSA infection by washing your hands frequently. This includes scrubbing for at least 15 seconds and drying them with a disposable towel. If you cannot get to the sink, hand sanitizer will do the trick as well. Also keep your breaks in the skin clean and covered. In athletics, shower immediately after contests, especially contact sports. Use soap and water and do not share towels. Wash clothes after each time they are worn on the hottest setting, use bleach if possible and dry them in a hot dryer.

 

MRSA is treatable  with intravenous antibiotics if recognized early. Dr. Holdren Otis will be following Daniel Fells’ story and wishes him the best possible outcome. The Giants dedicated their win and took play to the next level for Fells, who received the game ball from his teammates yesterday.

The Truth About Plantar Warts

As school starts and schedules get busy, don’t forget to check your kids feet and hands for warts.

Shoes or sandal recommended when by the pool and locker room

Shoes or sandals are recommended when by the pool and in the locker room

Warts, or verruca is the medical term, are caused by a virus. This virus is very common and can be picked up at the pool, the beach, the shower or in the gym. The microscopic virus enters the skin of your hands and feet through tiny breaks in the skin. Dr. Holdren Otis most commonly sees them in children, specifically ones who like to go barefoot, like gymnasts. Warts are not always painful but when they are on a weight-bearing surface they can build up a thick skin layer and feel like walking on a pebble. Warts usually have a white thick covering with pinpoint black dots representing the capillaries that supply blood to the wart itself. Warts can also be seen on the tops of hands and feet as well, but are not as painful.

It is important to treat warts when they are first noticed so they do not spread or get larger. A larger wart can be more difficult, more painful and may take more treatments than a smaller one. Plantar (bottom of the foot) warts can be very frustrating to treat and over the counter medications may not be strong enough. If over the counter medication fails for your family’s warts please come see Dr. Hirt and Dr. Holdren Otis at Fenton Footcare. We have the latest treatment for warts.
How can you prevent warts? Lysol or other agents that kill viruses are used in the shower and can help it from spreading to other family members. Avoid picking at warts so they do not spread.  Sandals and shoes are recommended in public places like the pool, gym and locker room. Keeping your feet clean, dry and changing shoes and socks daily is always helpful.

Packer’s Eddie Lacy Left the Game with Ankle Injury

Dr. Holdren Otis Explains Ankle Sprains

 

Ankle Sprains are a common condition which involve stretching and tearing of the ligaments on the outside of the ankle. This usually occurs with a twisting injury where the foot turns under the ankle and leg. Increased risk of this injury is during activity that demands quick changes in direction and running on uneven surfaces. The outside of the ankle, just under the ankle bone, is swollen, painful and can bruise. It is important to have your ankle evaluated by a podiatrist to make sure fractures have not occurred. A simple xray can tell a lot about the injury. Just because you can walk on your ankle does not mean it isn’t broken or severely injured. Small fractures can occur, called avulsion fractures, where a ligament pulls away a piece of bone. Also there is a critical period of 6-8 weeks in which reinjury to the ankle ligaments can be very detrimental. Proper bracing and physical therapy is important.
Eddie Lacy, a running back for the Packers, during the first quarter of last night’s game against the Seahawks suffered an ankle injury. Lacy was seen heavily taped and taken to the locker room after being evaluated and still unable to bear weight. He did not return for the rest of Sunday’s game. Today the reports stated that the xrays were negative for fracture. Two other teammates, wide receiver Davante Adams and defensive tackle Josh Boyd had ankle ailments during the same game.
If Lacy, Adams and Boyd have ankle sprains the grade of the injury is important in determining how much time off is needed to heal. If a Grade 1 sprain is present there is minimal tenderness and swelling. The small fibers of the ligaments are stretched or torn. Treatment includes walking as tolerated, range of motion exercises and stretching. A Grade 2 injury is a little more involved, moderate tenderness and swelling, difficulty moving the ankle and possibly the feeling of instability. The ligaments are partially torn. The athlete should immobilize the ankle with a brace to help with healing for 1-2 weeks and physical therapy with stretching/strengthening and range of motion. Finally Grade 3 is the most extensive injury and has significant swelling, tenderness and instability. The ligaments are completely ruptured. Immobilization is recommended for 3-4 weeks. Physical therapy is highly recommended to help with strength, proprioception and prevent instability.
Depending on the extent of the Packer players injuries will determine how quickly they can return. Athletes and coaches must use caution to return when they are totally healthy or the injury can linger for the entirety of a season. For Packer fans and Fantasy Football teams everywhere I hope that Lacy, Boyd and Adams are grade 1 or 2.

2015 Tour de France Winner Chris Froome Breaks Foot

Dr. Holdren Otis’ Comments

On Wednesday during the eleventh day of the tour de Spain, Chris Froome, the most recent winner of the Tour De France, ran into a barrier and stone wall with his bike. Unknowing of his fracture and tough as nails, he got back on his bike and finished 9 minutes behind the winner. He and team Sky were hoping he would be able to continue but he was unable to put weight on his injured right foot. X-rays did not show anything but an MRI revealed a fracture of his navicular bone, which is located in the inside of the midfoot. An MRI is a more specific test than a normal xray. With an MRI, swelling of the bone and soft tissue injury can be seen much clearer.

Yes, this is the same bone that Miguel Cabrera broke at the end of the 2014 MLB season. Cabrera needed the navicular bone surgically fixed because his fracture was through the main portion. The navicular is one of the key bones that make up the arch of the foot. Surgery is usually indicated for this type of injury for solid fixation and stability. This bone has large areas of cartilage and correct healing is important not to predispose an athlete to arthritis. Bones normally heal in 6 weeks with proper casting. I recommend a bone stimulator to increase the healing potential. A bone stimulator device placed on top of the foot that helps encourage blood flow and bony bridging. No word about what treatment Chris Froome will receive.

Navicular highlighted in red.

Navicular highlighted in red.

The red arrow points to the location of the navicular bone.

The red arrow points to the location of the navicular bone.

Heel Pain=Plantar fasciitis, Well Not Necessarily.

Heel PainDr. Holdren Otis

“You almost want to pee in your bed rather than go to the bathroom. It’s really painful in the morning,” Albert Puljos, a baseball player for the Angels, said it best in an interview with USA today in 2013.  Plantar fasciitis, also known as heel spur syndrome, is the most common cause of heel pain. It is seen in individuals  who are physically active or have increased their daily activity. The plantar fascia itself is a thick band of tissue attaching to the heel bone, the calcaneus. Tugging and pain are usually felt at this attachment, but pain can be in the arch as well. Pain in the morning and when getting up to walk after sitting for a period of time are common complaints.

 
Although plantar fasciitis is the most common cause of the heel pain, there are other more serious things that can cause pain in the same area. These things include a stress fracture of the calcaneus (heel bone), which occurs with increased activity as well. Also tarsal tunnel, very similar to carpal tunnel of the hand and wrist, can cause shooting pain, tingling and numbness to the foot. In children the closing of the growth plate can cause heel pain when running and jumping. Having your heel pain checked out by a doctor is very important to rule out the other diagnoses. In addition, your pain can be treated quickly and efficiently with all that the medical community has to offer. It is abnormal to have heel pain that does not go away. Call Fenton Footcare today to see one of our doctors.

Good Luck to All Crim Runners!

Stick with what you know!

If you are like me, you have trained for four months (or more!) leading up to the Crim. It is quite difficult to be a runner in the greater Flint area and not consider doing the Crim each year. Flint knows the Crim. People from the area who have never run the Crim know that the longest race is 10 miles and not a “marathon.” I always look forward to seeing Flint in such a positive light. The local bands and cheerleading teams impelling me to run faster always make me smile. I love seeing the people of Flint waking up to come out of their homes around the course and cheer for all the runners.

Post Race 2014

Post Race 2014, Dr. Liz Baker, Dr. Kelly McConnell and Fenton Footcare’s Dr. Holdren Otis

Training for months prior has allowed you to figure out which shirt, shorts, shoes and socks work best for you on long runs. Don’t deviate from what you know for a race. If you have recently purchased a new pair of shoes but have not gotten a long run in them, leave them at home on race day.

 
If this is your 30th Crim or your 1st, I know it will be a great experience. I look forward to hearing your times and seeing your pictures. Dr. Holdren Otis