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Medical & Surgical Treatment of Foot & Ankle

Your best choices for your family's foot care needs

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.

The Painful Ingrown Toenail

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Dr. Hirt working on Dr. Holdren Otis’ ingrown nail

Doctors have foot problems too!

An ingrowing nail is a common problem that can effect people of all ages.  An ingrown nail occurs when the toenail is pushing on or digging into the skin at the side or end of the toe.  It typically starts as a mild redness, inflammation, or pain. Usually it will get worse with time and can become infected.  If left untreated, in can progress into an abscess, infection, and in rare occasions serious bone infection requiring surgery.   It is critical to get the nail evaluated as soon as possible to prevent complications. Added pressure or trauma to the nail can cause it to become a problem. It can also be hereditary, or the way the nail itself grows that can make it painful.

 

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A procedure can be done to make your toe feel better and not come back!

Cutting your nails straight across can leave sharp corners that dig in. Oral antibiotics and soaking the infected ingrown nail can make them better for a little while but ultimately the nail border needs to be removed from the skin. A procedure can be done in the office where the toe is anesthetized.   Once the toe is numb, the nail corner can be trimmed back with special instruments and the sharp edge of the nail can be removed with no discomfort. To permanently fix the nail corner a special medicine is applied to the “root of the nail” so that the problem doesn’t return.

After the procedure you are free to do whatever you can tolerate. Dr. Holdren Otis was able to walk her dogs and enjoy this warm November weather we are having.

November is Diabetes Awareness Month.

Diabetic Shoe

Diabetic Shoe

Diabetes is a disease affecting many parts of the body.  While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can enjoy a full and active life.
Of the more than 28 million people in the US with diabetes, about half will develop neuropathy, a loss of feeling in the lower extremities. This nerve damage means an open sore or injury on the foot may go unnoticed until it becomes infected, which can eventually lead to the need for partial or full amputation of the foot or lower leg. In fact, diabetes is the leading cause of non-traumatic lower-limb amputation.  Your Fenton Foot Care podiatrist is an integral part of the treatment team that prevents unnecessary complications including amputations.
The doctors and staff at Fenton Foot Care and Brighton Family Foot Care encourage individuals to schedule a Comprehensive Diabetic Foot Exam.  This simple, painless examination helps diagnose the onset of diabetes and foot related problems due to the disease.
Call us for convenient appointment times:
Fenton Footcare
14229 Torrey Rd Suite #1
Fenton, MI 48439
Brighton Family Footcare
7990 Grand River Rd Suite D
Brighton MI 48114
Your feet tell a story…We are here to listen!

Do you have dry, itchy or scaly feet?

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Dry feet happen commonly in the winter

Dry and itchy scaly, feet are common in the fall and winter in the Midwest as we start to use the heat and the air dries out. The treatment of dry feet includes a good skin lotion that is ointment based instead of water based. The effective lotions tend to be thicker. When applied at night and covered with socks it allows the lotion to soak in and moisturize the feet and legs.

 

When normal lotion doesn’t take care of your problem you may have athlete’s foot.

Athlete’s foot, also known as tinea pedis, is caused by a common fungus. This infection affects the skin in between the toes and the bottom of the foot. It does not have to itch, but usually does. It is seen in people who wear closed toed shoes during the day and cannot allow their feet to breathe. Athlete’s foot can be caused by walking barefoot in a place someone with foot fungus has already walked. Changing your socks daily or when they get wet, can help prevent athletes foot. Wearing shoes or sandals at the gym, pool and lake is also helpful in the prevention of contracting foot fungus. Sometimes an infection is too much for an over-the-counter medication. At that point you need to come see a professional who is knowledgeable in treating this infection. The fungus that causes athlete’s foot also can affect the toenails. The importance of treating athletes foot properly is so that thick and discolored effects of toenail fungus do not occur. Other things that can cause dryness and scaling include psoriasis and eczema. A skin scraping biopsy sent to a pathology lab can determine what is causing your problem and dictate how to treat it.

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.

Are “Growing Pains” a Myth?

Dr. James Hirt explains

Growing pains in children’s legs have been debated for hundreds of years. Through the history of medicine growing pains have been attributed to multiple incorrect theories such as, rheumatic fever, psychological disorders, and even hair and eye color. In the 1930’s researchers proposed a link between orthopedic foot conditions and growing pains but it did not gain much traction and was dismissed. Over the next 80 years many studies have been done linking foot deformity to growing pains. Dr. James Hirt firmly believes growing pains are a myth and the real reason for the pain is abnormal foot function affecting the lower leg muscles.

In a recent study published in Podiatry Management, eleven children age 5-15 were fitted with functional orthotics to control their excessively flat feet and all eleven children had complete resolution of their “growing pains”. Functional orthotics are inserts placed in the shoes that are made to fit an individual’s feet. They allow the foot and leg to function is a more neutral and natural position.

Dr. James Hirt has personal experience with “growing pains” with his own son who had severe flat feet. At the age of about 5 years old began complaining of knee and leg pain at night. “I immediately made the connection between the leg and knee pains and the foot deformity. I made my son a set of custom functional orthotics to put in his shoes and within days of wearing them the complaints of pain completed stopped. Occasionally the pains would return, but were a direct related to my son not wearing his orthotics. To this day I keep my son in orthotics and he has been pain free and happy.”

“I only wish when I was a child someone would have made the link between my flat feet and the horrible “growing pains” I had. I remember going to the doctor on multiple occasions complOrthotic Castaining of severe pain in my legs, and my mother was told it is just “growing pains he will grow out of it”. I wish I would have been referred to a podiatrist back then, I am sure it would have prevented many nights of me lying in bed unable to sleep due to the so called growing pains.”

Based on his own experience and the many children he has treated Dr. Hirt confidently concludes growing pains have a logical explanation. “Every child I have treated with the diagnosis of growing pains has had complete resolution of their pain once custom functional orthotics were made to control the abnormal foot function,” he explains. Flat foot is not the only foot deformity that can cause these pains; high arches, tight Achilles tendons, and many other foot and ankle deformities can cause the same symptoms. When the foot and ankle are not functioning correctly leg muscles get overused and fatigue easily, abnormal stress occurs to muscles tendons and bones this all results in pain in the legs and knees.

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.