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Thursday, March 9, 2017

The Lazy Man's Guide to treating your Heel Pain!

My name is Dr. Michele McGowan, and much like the President for the Hair Club for Men, who is not only the president but a member of the organization himself because he has no hair, that is how I feel about heel pain or plantar fasciitis. I am a foot doctor who treats heel pain multiple times daily and has struggled with heel pain a couple different times in my life.  I help people get better all the time for this yet my inability to take my own advice was my downfall.

I can say that over the last 15 years of private practice in podiatry in Clermont Florida, the frequent flyers we see with heel pain that suffer longer or take longer to get better take all shapes and sizes. But they have one thread in common, which is they are usually too lazy to keep up with a stretching program to get better or stop stretching the moment the foot feels better. When I suffered with heel pain the first time I was a bad patient! I tell my patients all day long that they need to stretch but I suffered with heel pain for longer than I needed to due to my lazy streak and not wanting to stretch. 

Of course, once I started stretching and icing for my heel pain I started to get better and once I felt 100% better I stopped stretching! In order to ward off the return of this horrible pain you have to keep stretching.  This I find super annoying to say over and over again to the same patient year after year, whether the patient is a frequent flyer or myself.  Recently my paradigm has shifted in how I teach the lazy like myself to get better and stay better.

In 2015, when I had plantar fasciitis where it hurt so bad to walk, I decided to purchase a night splint.  This is a pretty simple device that you wear when you sleep that holds your foot in a complete stretch while you are sleeping, genius right? Well turns out this device is not super comfortable to sleep with it on.  This device spent more time with my toy fox terrier dog cuddled inside of it at bedtime then on my leg for the first few weeks.  But then my heel pain got so unbearable that I had to do something, because even the dedicated times during the day that I was stretching was yielding absolutely no result.  



I decided that I could no longer live like this and out of desperation I started to wear my night splint any time I could.  As I do not have a sit down job in one place going from room to room to see patients, my husband thought it was unrealistic to even bring the splint to work but I did.  But he was totally right, I couldn't wear it while seeing patients, but I put on around 11:45am until 1pm during my lunch break.  I would then lug that boot home( I was too cheap to buy 2 boots to keep one at work and one at home) and after soccer, track and music lessons for my girls I would put the boot on again when I was reading, watching TV or finishing up paper work from the office. 





At night I had a very particular regimen,  at about 8 pm I would prop up my leg on a couple of pillows and add a gel ice pack into the foot part of my night splint, place the night splint on and watch TV or finish up my work.  I did this for 2 months and my heel pain went completely away.  Until it came back a year later because I stopped stretching! 

So now I wear my night splint when I am sitting down in my house relaxing watching a movie or playing on my computer.  I currently have no heel pain but I feel like even the couple times a week I wear the splint it prevents me from having to have that sharp pain in the morning feeling and keeps my foot healthy! 

This is basically a little life hack for the lazy who have heel pain.  If you have any other foot problems feel free to learn more at our office website at http://centeranklefootcare.com/



Michele McGowan DPM
3190 Citrus Tower Blvd Ste A
Clermont, FL 34711
352-242-2502

Monday, February 6, 2017

So you have a Bunion! What do you do?

Bunions are very misunderstood by patients in many cases.  Patients want to believe that the big bump on the inside of their foot is just skin.  I mean, they push on it and feel it's hard but want to deny the facts that are really going on here. A bunion at its core is a bone deformity, yes there is some imbalance at the joint from the capsule being overstretched on one side and over contracted on the other.  But the bone is ultimately the biggest problem that causes a patient to stroll into our office.

Some patients just want to know what's going on with their foot and some are convinced they need surgery immediately! If you have a bunion it might be worth reading this before seeing the doctor, we have broken down the most common type of patients that come in with a bunion. Knowing which one you are could save you from unnecessary foot surgery!



Not All Bunions Are Created Equal


1. The no pain bunion but someone has convinced them they need to do something before it gets worse. These patients usually are just curious what is wrong with their foot and want to make sure they are not going to be disabled if they do nothing.  These patients are educated on shoe gear and we explain that if you stay away from bad shoes, this may be what their foot is like for the rest of their life.  This visit usually ends with a relieved patient who is happy to not have to have surgery.

2. The no pain bunion but the patient hates the way their foot looks! These are sometimes the most frustrating patient to really help.  They have no pain yet they are contemplating surgery because they think their foot will be prettier.  There is a 50/50 chance this patient walks out of our office angry because we refuse to perform unnecessary surgery on a foot that does not hurt at all. We explain to the patient that even if we were to perform surgery, there is no guarantee that they are going to fit into a narrower, "cuter" pair of shoes after surgery. Some patients appreciate our open and honest opinion and others are just pissed they paid a $40 copay for me to tell them "wear wider shoes"!

3. The painful bunion that only hurts in certain shoes.  This patient demographic is identical to the #2 above, but these patients often present in a high heel stiletto with a foot that is identical to Fred Flintstone! They literally do not want to accept that their foot is just not meant for the shoes they are wearing.  Many of these patients, if they just switch to a mesh athletic shoe or wider shoe have no problems.  But getting this patient on board with this simple solution is sometimes difficult.  I explain that in order to fix their problem I have to cut their bone with a saw, move the bone over to correct the deformity and then put a screw in it.  I explain that they can not get it wet for 2 weeks and they have to wear a post-op shoe for 6-8 weeks.  Almost everyone of these irrational patients say, "can't you just shave the bump?" Because they are now the expert!  I have to almost always explain that we have to correct this problem at the level of the deformity so that the problem does not recur because I like to do my job right. These patients usually leave frustrated and seek the care of another podiatrist who decides that this a great patient selection for surgery. The patient that go to have surgery by another doctor are usually the horror stories you read when you google bunion surgery.  See if you do not have pain before, performing surgery is just cruel and unusually punishment that could lead on to lifelong disability. Pain in and out of all shoe gear is the requirement to have surgery and be happy.

4. The last bunion patient is the painful bunion in and out of almost all shoe gear.  These patients have pain that does not completely resolve with the absence of shoe gear.  This is ultimately the type of patient that does great with bunion surgery.  These people are so happy to have a realigned pain free joint and are accepting of some tingling or numbness that can occur with surgery in this area. But even these patients can decide to keep looking for the shoe that offers them comfort.  



Treatments for Bunions

Again there really are only two treatment options for bunions:

1. Modify shoe gear(go into wider shoes)
2. Surgery



There really are no great in between options for fixing a bunion.  If you have a bunion and you take away pressure to the big toe joint you get rid of what is causing the deformity to get worse and for some take away the pain. If the bunion is mild you can try something like the Yoga toes, but there is no guarantee this product will yield a great result but it may help stretch that over contracted part of the joint. Also, using a gel toe spacer may also yield some minimal improvement but both of these options are much better than surgery that may not be necessary.  If the foot is killing you and you are unable to be comfortable in and out of shoe gear, then bunion surgery may be a good options for you.  If you are looking to learn more about foot and ankle problems feel free to follow the link to our website at http://centeranklefootcare.com/services.html

Michele McGowan, DPM

If you live in the Central Florida area, it may be worth your time to take the drive to our office in Clermont to evaluate your bunion to see if surgery is really necessary or not. We are located at:

3190 Citrus Tower Blvd Ste A
Clermont, Fl 34711

Our number is 352-242-2502 if you would like to call to schedule your evaluation.





Saturday, December 17, 2016

Ankle Sprain? How do I treat an ankle sprain?

It is a common scenario, you step off a curb and you feel it, your foot and ankle turn in when it shouldn't! Within seconds your outer ankle starts to swell, get red, and very painful.  If you stand up and can walk I still would recommend you see your foot and ankle specialist.  It is absolutely best to see a specialist that can take an X-ray of your foot and ankle to make sure you have not broken anything.  Your specialist can give you advice on what you need to do to get better, write for a medicine if necessary and offer you devices that may help in the aid or care of your foot or ankle injury.    The reason I stress that you should see your foot and ankle specialist is because there are 6 plus different bones you could possible break with this type of injury. Also, a well thought plan of care is going to be better than your own self diagnosis and treatment. Just "googling" your symptoms, more often than not results in sub-optimal results in your health, and taking your neighbors advice on your foot problems yields pretty terrible results!

So you see your doctor and X-ray shows no fracture, SWEET, right? Well, though I think breaking a bone is not ideal, soft tissue injuries can take some time to get better, and some people struggle for an extended duration.  Convalescence of a foot or ankle injury is very important.  If you do not treat it right, it will not treat you right!

If you have been diagnosed by your foot and ankle doctor with an ankle sprain, these are our recommendations:

1.  ICE, ICE, ICE: not for the first 24 hours but everyday, at least twice a day, for 2 weeks.  There are so many great icing products that are better than the old school ice system of the ziplock bag. Below I have a link to my favorite ice pack!


2.  Support is the next piece of the puzzle and depending on the damage, one of a couple options may be best for you. Make sure you ask your doctor about an Aircast splint versus a cam walking boot to help calm down your foot and ankle pain. If you need temporary immobilization all you may need than an Aircast splint, but if you are having difficulty putting weight on the foot than a waking cast would most likely be more suitable. There is a link below for the cam walking boot we use for ankle injuries below!

Some people struggle for months and years with ankle sprains, so choosing the right course of care can make all of the difference in the world! Most people who seek treatment swiftly, take their doctor's advice and follow through with their plan of care have the absolute best results!

If you would like to learn about any other foot or ankle pathology or problems after injury visit:
http://centeranklefootcare.com/