Sunday, October 26, 2014

Week 8 Fantasy Football: Dog attacks, Halloween and Terrible Refs During the Penn State Football Game!!!

This has been a crazy week for the "2 Pods and a Microphone Family"!  Of course every great podcast deserves a little "off week" and for us, this might just be the one.  This week on Tuesday our oldest dog heard a noise outside at 3 am and decided to try to defend the house by leaping out the doggy door and she quickly realized that this was not a great idea.  We were awoken to the noise of growling, doggy screams and blood.  Being the amazing foot doctors that we are, we noticed a scratch on "Suepa's" foot. (Our dog is named after the late great Joe Paterno, actually she is named after his wife because when we went to get a dog, and she was a girl, we went with Suepa instead of Joepa. I am not a big fan of naming dogs not gender appropriate names, like I wouldn't name a girl dog Max or a boy dog Tinkerbell, I just think that is wrong on some level).

So Suepa had this scratch on her paw, great, we are foot doctors, not such a far cry from what we already do for a living.  We washed her paw and started to go back to bed until we saw Suepa jump back on the bed, that's when we noticed two huge gashes on her left shoulder full thickness through the skin into what I call her meat and potatoes.  Her fur was hiding these gashes.  We then went back to the flushing out of wounds.  We brought her to the vet, where she underwent surgery and was sutured up.  All of this happening at the same time we are getting many stressful email demands from 3 different teachers about the very critical event in all three of our children's academic career that required immediate attention, the Halloween party!

I believe this is a pretty good excuse, for a sub par podcast.  Then when you add in the Penn State vs.    
Ohio State Football game last night, it only added to the distraction of the lack of foot and ankle injuries in the NFL for week 8.  The officiating of the Penn State football game last night was so very reprehensible.  If you happened to watch that game, you may have gained the perspective that refs are not always good.  The first bad call was the interception by Ohio State back Vonn Bell, that was o
bvious the ball hit the ground, from every angle they showed, but Ohio State was still given the ball! "IT HIT THE TURF REF COME ON" was being screamed at our TV. (You know that always makes you feel better to yell at the screen even though they can not hear you.)

I couldn't help but think, after seeing such a bad call, the refs are going to try to make this up somehow.  So of course, I was in complete shock when I watched the play clock dip below zero and still watch the refs let the field goal play of Ohio State continue.  So the Ohio State team was able to convert the field goal after an expiration of the play clock, wow! Later in the game Pen State would have to argue for time to be put back on the clock, and only be given 10 of the 16 seconds owed to them.  In football 6 seconds is a big deal, unless you are Ohio State then you can play even after time has expired!

This game went into overtime and it was a close one. If the officiating was better maybe Penn State would have won but you never know with football. If you are a Penn State Football fan then you know we would have won:)

Suepa update: below with our youngest daughter she is resting comfortably and we pulled her drain yesterday. We do not know what she was attacked by since we live in the country.  We have bears, bobcat, coyote, armadillo, racoons and possum to name a few.  All of Suepa's shots are up to date and she looks really great 4 days after being attacked.

Remember to visit our webpage and check out any foot or ankle problem your fantasy football player may have or just learn about what bunions are that your grandmother keeps complaining about!

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Sunday, October 19, 2014

NFL Fantasy Football Ankle and Foot Injury Report: Injuries Below the knee are not that big of a deal, Right? WRONG!

So as we start this Sunday Week 7 of the 2014 NFL season, we wonder .....are foot issues really a problem in the NFL.  As my 3 year old daughter would say, "Heck Yeah!" They are a true issue for so many of the NFL professional athletes and many weekend warriors as well! Looking back at 2013 injuries in the NFL there were reported approximately 1300 injuries in the NFL season.  How many of those were below the knee?  329 injuries were of the foot, ankle, and lower leg in 2013.  206 of these injuries were to the ankle which makes up 15.3% of all the injuries to the NFL football players body in 2013.  This is only second to knee injuries which was a total 300 knee injuries in 2013.

Since we are foot and ankle surgeons we thought we would look at the most common foot and ankle injuries in the NFL and hopefully help you pick the right players for the second half of the fantasy football season of the NFL 2014.

The most commonly reported injuries of the foot and ankle are broken down for you below.  We wanted to make it quick and easy for you. Brief description of the injury, treatment, and should you sit the player. EASY! We know that if someone said to you "Michael Crabtree has plantar fasciitis" you might think that sounds terrible I'll sit him this week, only to be really sad to see him get three touchdowns the week you sit him.  We hope you can use this as a simple guide on when to play your fantasy football player for an injury and when to sit them or even drop them.

Plantar Fasciitis:
 This is a tight but very durable band on the bottom of the foot.  If newly diagnosed, it can be very easily treated with stretching, icing, and anti-inflammatories.  Your player gets plantar fasciitis----Play them

Achilles Tendonitis:  This is a cousin of plantar fasciitis, in that a very tight calf muscle plays a role in developing these problems, but it is more serious than plantar fasciitis. Being the biggest tendon in your body it has the responsibility of pro-pulsing you forward with every step and sprinting step you take.  This is not a reason to drop a player, but watch and see if they practiced that week with no issues then play them.  If they did not practice and you have an equal or almost equal player give your regular starter a break and---Sit Them

Achilles Tendon Rupture: This is what happens usually when above is not addressed properly.  This is a season ending injury(Not career and if it happens early enough in the season and their team makes it to the Superbowl then they might play, but if their team makes it all the way to the Superbowl with out this guy they probably don't need him anyway)---Drop them

Ankle Sprain: The ever illusive reported ankle sprain.  As some sprains are worse than others, and these teams give out no real information(which we understand why), it is better to use the same guidelines as we suggested in Achilles tendonitis, if he practices he's a go if not sit him for a week.  A severe ankle sprain is not as easy to overcome, but still with the right amount of taping a rock star NFL player gets the job done.---Sit them if they don't practice----Play them otherwise

Ankle Dislocation: Though not super common I threw this one in there for RGIII.  If you have a true ankle dislocation, this is a season ending injury for an NFL player.  And if you have the right people and doctors around you, you should not be encouraged to go back to play until you have completely recovered from your injury.  If RGIII has a true ankle dislocation he will not be out there on the field running, that is for sure.----Drop Them

Stress Fracture Foot:  The small bones we walk an run on, that support the whole weight of our body, are called metatarsals.  A very common, but probably not fully disclosed injury to us fans, is the metatarsal stress fracture.  The repetitive pounding of 300 plus pounds can only make this more of a possibility in the NFL than in the regular population.  I believe most of these players stick it out for the paycheck, but if you catch wind that one of you fantasy football players have a stress fracture, it is time to think about letting them go.  Treatment, once admitted by the team, is a walking cast for 4 to 6 weeks, so at least half of a season.---Drop Them

Ankle Fracture: Fracture of the ankle, depending on where and how they fractured it determines what you should do with you fantasy football team and player in question.  Quickly, if they have a fracture that requires no surgery, probably out for 4 weeks.  But in most cases, they require some type of open reduction and internal fixation, which is like a 6-8 weeks recovery of the surgery itself in most normal people.  But these aren't normal people, they are built like machines.  Not a career or even a season ender, but unless you can't drop them because they are on the do not drop list in your league------Drop Them

LisFrancs Injury: The whole entire stability of your foot hinges on this little ligament doing its job, the Lisfranc ligament. If strained is not something to drop a guy over if he is awesome, he might need a little rest and TLC, but if he's not awesome, dump him.  If this ligament is torn or their is a fracture/dislocation it is lights out for the season for that dude.  Even if they come back during the season, which would be too early and not enough time to recover, they would struggle with even simple shoe and support issue.---Drop Them

Turf Toe: So best for last for me, as this is a issue near and dear to my little heart because, yes, AJ Green is my guy that I picked 2nd round in the draft, AND I CAN NOT DROP HIM....... UGH!!!!!! Sorry, so turf toe sounds like a wimpy guy injury but it's not.  Your great toe is where all the magic happens in your gait.  If you can not pro pulse off the great toe joint you can't do jack! This is a very mean injury, as the sprain of the ligaments on the bottom of the great toe joint is something you relive every step you take and if not treated correctly will continue to bother you (and in my case, due to draft picks) all season long! So if you hear murmurings of Turf Toe and the player does not practice or comes out early next game.----Drop them(because I can't)

Tuesday, October 14, 2014

UPDATED: What? You wore those shoes to Disney....... A 2 Pods and a Microphone Exclusive

So as a foot doctor, whenever I see someone walking around in terrible shoes at Disney World, the first thing I think is "I hope they live locally" followed by the thought that this is job security for a foot doctor!  The problem is that a bad pair of shoes can make the "Happiest Place on Earth"..... miserable!

Living just 23 miles from one of the biggest family tourist destinations in the world, we often frequent Disney ourselves.  Our little family of five have annual passes and having 3 children 10 and under, it is one of our favorite places to visit.  But being 2 married foot doctors, we can't help but notice the terrible foot gear that walks by while we are just sitting shoveling in the funnel cake!  So we decided to share with you pictures we took on the down low yesterday at EPCOT while enjoying the International Food & Wine Festival. 

It was not hard to see bad shoes and capture them on the camera phone while sitting eating Chinese Tacos, Patagonia Empanadas, Polish Kielbasa & Pierogies, popcorn and many more treats but I am still in denial about how much we actually ate yesterday! I only wish we would have thought about doing this the night before when we went to the Magic Kingdom and Mickey's not So Scary Halloween Party, because I remember seeing some people in high heels!

I think it is amazing, in general, when people go on vacation with the mentality that they are invincible and that bad things can not happen to them.  I mean we all do it, we go on a cruise sign up for an excursion to whale watch on a ship cruising right next to huge whale but the ship is 1/2 the size of the whale.  Maybe that seems like a bigger risk than wearing bad shoes to Disney but the amount of times people are hurt by the whales swimming next to their tiny whale watching ship is really, really small.  The amount of people that have foot pain after wearing bad shoes walking around Disney all day is most likely close to 100%. 

Hopefully, you can use our "Do's and Don'ts" for appropriate shoe gear while visiting the many tourist attractions in the Central Florida location.  You can even write down our office phone number so if you have foot pain while visiting Disney you can come see us in our Clermont Florida office:) I try to remind people all the time that foot pain is not normal, so if your feet hurt, you are most likely doing something wrong!

Gladiator Lady

First shoe, "No, No" at Disney walking around has to be the ladies who think they should be in that Gladiator movie 300, I think it was called.  I can guarantee you that this lady will have the sorest feet the next day after walking around.  There is just too much wrong with this shoe for her not to have foot pain.  Let's work from the back to forward.  The awkwardly high material hugging her Achilles' tendon area in an unnatural way that will only result in her getting a nice blister due to the very unforgiving nature of the material of this shoe.  Then the straps in front of the ankle will definitely be causing her some irritation in the front of the ankle and this material extends on the top of the foot and the toes! NO GOOD can come from this type of shoe!  But I left the best for last, the arch, much like her gladiator ancestors the material on the bottom of this shoe looks like a thick leaf meant to try to protect her foot from ants.

Two bad shoes in one picture! (Bonus)

Two of my least favorite shoe types that are unavoidable living in Florida to see out and about is the flip flop and the ballerina slipper shoe.  Now each of these shoes are fine to slip on and run into CVS for some cough drops, but come on! Wearing shoes like this in a place like Disney World is just asking for trouble and here is why.  Both of these types of shoes are so flat and offer absolutely no support.  If you are walking around on concrete all day, this is not a great choice in either of these shoes.  The distance around the World Showcase from China to Canada alone is 1.25 miles, that does not include the distance to get into the park from the parking lot or the walk from your car to the front gate!  I think if you were to really stop and think about walking probably about 3 miles you would not grab these types of shoes. You would think sneakers!! The ballerina shoes also have the added bonus of getting very, very, very stinky in the hot Florida sun. You basically are incubating something in this type of shoe in Florida!

And The Top Three Worst Shoes at Disney are........

To the left you will see the picture my 8 year old made me take while we stopped and had Kakigori in Japan at EPCOT. (Kakigori is shaved flavored ice that is awesome by the way!) She said, "Mommy this lady's feet are perfect for your blog. Check out how her toe is just hanging off the shoe. I bet she is sitting down because her pinky toe hurts!"  Again, she is 8 and states she would never wear those shoes, pointing out the obvious flaws and downfalls of the shoe, particularly for this lady's foot type! I concur with the 8 year old.

I call this one, "lady wearing super uncomfortable shoes at Disney."  It works, right! So as we were enjoying our Chinese Tacos(that is also a real thing and also the most delicious food ever) we saw this nice lady.  Her shoes must have been so comfortable that she felt the need to try to escape them. People again, COME ON, do not wear shoes like this to an amusement park. Your feet are going to hurt! This women is literally trying to escape her shoes.  Don't be like this lady, this is a major Disney Foul!

 But there can be only one winner! Here is the ultimate winner according to our 3, 8 and 10 year old female children.  The lady with the, "my shoes are so bad I had to start to take them off because they are killing my feet".  I will say that Dr. Henne and I missed several opportunities to take pictures of the people with band aides on all toes wearing their terrible shoes(we were eating like monsters), but this lady was my favorite. She was near Germany in EPCOT which means she was at the midway point of the World Show Case before she gave up on these shoes! Don't be this lady, WEAR SNEAKERS!!!!!

So the take home message here is listen to 3, 8 and 10 year old girls: WEAR SNEAKERS WHEN GOING TO DISNEY!!!!!!! Think about how much you spend when you go to Disney, that in itself is painful enough.  If you want to have an amazing Disney Day, then good sneakers are a must. Sandals, flip flops, ballerina slippers, boat shoes....the list goes on and on for bad shoes, but sneakers are a home run.

We hope you enjoy your next trip to Disney World, but if you experience any problems with your feet, remember our Clermont office is only 23 miles from Disney.  Feel free to check out our website and explore all the different type of problems your shoes can cause at:  

UPDATE: We received so many emails from people asking, "What are good shoes to wear to Disney?"  That we put together a list of our favorites that you can but from Amazon.  We hope that helps, we even added some toddler and kid shoes! 

Save BIG on Walt Disney World Tickets!

Sunday, October 12, 2014

Week 6 NFL Fantasy Football Podcast from Disney World

2 Pods and a Microphone: Disney Edition

This is a quick little blog to be followed up with our blog about: "What not to wear on your feet in an amusement park".  Listen to our blog about the foot and ankle injuries around the NFL today. We talk about Michael Crabtree, Harry Douglas, Megatron and many more whose feet may play a roll in their performance today.  Of course our podcast is full of the usual Dr. Henne and Dr. McGowan banter but this time you can here the sounds of Disney, yep buses:) We are staying at the Disney Ft.Wilderness Campground, enjoying nature and our children, and Mickey's Not So Scary Halloween party.  Our adventure today after breakfast will be to go tho the Epcot Food and Wine Festival, but while we are there enjoying the many delicacies around the world we will still be thinking feet.

We are not that weird, people come to the office all the time with foot and ankle pain after a day running around the parks, we are located only 23 miles from Walt Disney World.  So we are going to do our own, "Dateline" or "60 minutes", style investigation into theme park shoe gear.  It might just be us taking pictures of peoples feet in between glasses of wine and pork shanks from Africa, but it should be entertaining none the less.

Scenes from our campsite preparing for podcast and crafts.  Tim and Abby preparing their necklace making string. Emma painting her Minnie before Epcot.

The campground at Disney awesome  and we took some pictures for those of you who have never been. Enjoy and don't forget to listen to our podcast below!

Wednesday, October 8, 2014

One month into the fall soccer season and I want to burn my daughter's soccer cleats!!!!

This is the time of year that I can not help but wonder, what after school activity could my child do that would not effect the smell on the inside of my car.  A couple of things come to mind: Mathletes, drama, choir...I guess there are many more but she loves soccer! (Good parent disclaimer: our kids play sports and instruments before I get comments on not focusing on the arts) She loves soccer so much that she apparently can not smell the noxious fumes that come from her lower legs and cleats.

I have chosen my car this past week over my child's smell and lower limb safety.  I purchased the 2 gallon zip-lock bags and I make her double bag her cleats and her shin guards until we get to the field.(I am sure this is on some type of soccer mom life hack website, but my inspiration was a matter of basic quality of life.)  Once we are in the open air, within a reasonable distance from other human beings, she can the start the process of putting her moldy, cruddy shin pads and cleats on then quickly cover them with thick socks so only she then can be affected by her own grossness!

Now as a foot doctor, I think I should have a better way to help my yucky child but I fall short like all busy parents.  Sometimes that drive from the office, which on my days to pick up the kids I get done around 2pm so I can be there for pick up, then homework, feeding, and then the extra-curricular activity, very little time exists to actually use your brain firing on all cylinders!  I am thankful to have a 50/50 partner in my husband(Dr. Henne, the other doctor in the office) so that this way harder job than seeing patients is not my responsibility every day!  We both take turns doing the hardest job there is: coordinating the academic, social, extra-curricular, feeding, hair doing ect.......of three girls under the age of 11.

As I sit here thinking about my smelly child who is soundly asleep and soccer cleats and shin pads securely on the front porch(as a secondary security system, as one whiff and you will not want break in this stinky house). I wonder the best ways to help her and the rest of the world not have to smell the gunk she is incubating weekly with her sweat and tools of nose destruction: cleats and shin pads! I realize I have so many anti-fungal preventive treatments in my office, why don't I put them to the test.  Because I am impatient I will be setting up a prospective experiment with only one test subject, my 10 year old Lily.   I will be spraying her cleats and shin pads daily with an anti-fungal spray I have for shoes in the office and sterilizing her cleats with a steri-shoe(an ultra-violet light that is supposed to kill the fungus molds and spores growing in her shoes).  This study will surely not be published in a peer reviewed journal, but if it works I will be able to help million of soccer, hockey, basketball, football, and well let's face it any parent with a kid with stinky equipment or cleats!

I am starting this "experiment" right now, I am going to give this experiment only until Halloween, in honor of how creepy her cleats truly are.  I hope to make it out alive from this experiment and hoping not to get a rare form of soccer cleat induced lung Aspergillosis.  If you have any life hacks for smelly cleats, please feel free to share under the comments. I will keep you updated weekly and if I think there is a chance in you know what that this will work I will surely let you know! 

Monday, October 6, 2014

The War on Nail Fungus...the many battles you must fight to kill nail fungus!!! treatment modalities for different medical conditions come and go. When we first heard about the PinPointe Laser for toenail fungus we were certainly skeptical about it being a miracle cure for fungus.This laser has been available on the market since 2007 and when we first heard of this laser, we thought here goes another trend that will cost the patient a lot of money and won't work. I thought this device would leave as quick as it came. This did not happen, in fact, we started to have patients that we refer to as "Snowbirds" living here in Florida only part time, that had this procedure done up North with great success. Yes they had to wait 9 months or longer to see the return on their investment, but happy when they saw their result. This prompted us to investigate the PinPointe Laser in more depth. At the time, the PinPointe Laser was the only laser built from the ground up to kill nail fungus and was cleared by the FDA based on peer reviewed studies. When introducing a modality into your office for patients, you take a certain leap of faith that what you know from research and speaking to other physicians success stories will translate into success for your patients. 2012 the Center for Ankle and Foot Care introduced to PinPointe Laser for nail fungus into our practice.

We jumped into the laser for nail fungus feet first!(yes pun intended) We acquired our laser in February of 2012. Over the last 2 and 1/2 years we have developed protocols for the laser that work best for different case scenarios.  But before I ever discussed with patients the laser, I give them all of their treatment options.  I first discuss the topical approach, I do explain that topical success rate truly depends on if the fungus is under the nail or on top of the nail.  If the patient has a superficial fungus a topical can be effect.  If the fungus is under the nail, no dice! The thick nail and topical anti-fungal is a wildly unsuccessful combination.

If your nail is thick and fungal, an oral medication can be a treatment option.  Lamisil is the drug of choice.  We get what is called a liver function test, blood work to make sure your liver is free from disease.  If your liver function test is normal, you can take the Lamisil.  I make my Lamisil patients follow all of my laser patients after care.  They have to prevent reinfection with the same steps listed below.

The last option I discuss with patients is the PinPointe Laser treatment.  Some people can not take the medicine by mouth or just do not want to take the medicine by mouth.  They want the laser.

Many patients are interested in having the State of the Art PinPointe Laser Treatment for their discolored, thickened fungal toenails.  Before anyone jumps into having this procedure done, we sit down and explain to them why, what they do at home, is just as important as the Laser treatment itself. Yes the PinPointe Laser for toenail fungus is a great procedure, but patients have to be active in their roll to prevent any reinfection!
How the PinPointe Laser works is simple. This patented laser is specially designed to shine through your toenail and destroy the specific pathogens embedded in and under your nail causing the infection.  Unlike other lasers that are used for skin or pain treatments, the PinPointe™ laser is designed and used for only one purpose; to safely destroy molds and bacteria that cause fungus nail infections (Onychomycosis). If the nails is extremely thick it can take up 15 plus treatments and quite a bit of patience, as it truly takes 9 months to a couple years for a whole new nail to grow out.

Before the patient has the PinPointe Laser performed a thorough evaluation of the skin and nails is performed. If the patient has a bad case of athlete's foot, they will be given a prescription for a topical anti fungal for the skin. I would see them back after a couple of weeks before I would perform the laser treatment. I explain that success is dependent on the foot being in an environment that is free of fungus. If a patient has the PinPointe Laser procedure performed, what they do from that moment on can play a role in their success rate. Once we have performed this procedure, patients are given instructions on preventive care for the toes.

What to Avoid After Having the PinPointe Laser Treatment :
  • Any shoes that you have worn before the Laser (especially shoes you have worn without socks)
  • Nylons or panty hose
  • Going barefoot in environments that could expose you to fungus again
  • Pedicures in places that do not AUTOCLAVE instruments and take all precautions to protect you
  • Wet moist environmental exposure to feet(ie. constantly having wet shoes) usually occupational hazard
Why it is Important to Avoid these things After The Laser:
  • Any shoes that you have worn before the Laser was Performed are basically little incubators for the fungus, putting these shoes back on puts you at risk for reinfection!
  • Nylons do not breath, again causing an environment that will be moist and possibly be a red flag for your toes!
  • Taking precautions in environments that you are not familiar with is important, if Joe Schmo has fungus and you walk in his house barefoot, you are increasing your chance of reinfection!
  • Do not get a Pedicure unless you know: that all instruments are autoclaved, they use liners between each client, that the pedicure chairs are pipeless and tubeless, that they do not reuse any files on anyone and that they do not reuse nail polish from client to client!
  • If you are a landscaper, chef or someone whose feet are constantly getting wet at work, you need to change your shoes during the day and even consider spraying your feet with an anti fungal spray during the day while at work!

The laser is not in itself a miracle cure if the patient does not take an active roll in their own care.  The laser can dramatically improve the appearance of the nail and get rid of the fungus, but if you have a nail that has had previous trauma and the nail is deformed you still may wind up with a disfigured nail just fungal free.

   Biggest rate limiting step for patients perceived successful outcome is how slow the nail grows. We do advise those with extremely thick nails, that they will most likely need multiple treatments and recommend our comprehensive care plan of the unlimited zaps until their fungus is gone.  We want people to know if they are serious about getting rid of their nail fungus we have something that actually works and worth the investment for their future good foot health. 

What we charge:
1. If your nails are not thick we recommend the 5 zaps for $500
2. If your nails are thick you should consider the unlimited zaps until your fungus is gone for $1500. We will be with you every step of the way until the fungus is gone!

If you are interested in learning more about the PinPointe Laser Treat for Nail Fungus click the link below. 

Sunday, October 5, 2014

Stress Fractures: Week 5 Fantasy Football Ankle And Foot Injury Report

Stress Fractures
 A big deal in the NFL. 

 Simple problem if you have the TIME to heal.
         We are 5  weeks into the NFL season and stress fractures are ruining NFL players and fantasy football players seasons.  In the last 4 weeks the following players have had issues related to new or  old stress fractures: Michael Crabtree, Austin Seferian-Jenkins, Julio Jones, Manti Te'o,  and Marvin Jones.  So what are these "stress fractures" and what is the big deal?

I see stress fractures in the office almost weekly. They are very common and more importantly easy to treat!  The difficulty is in getting better.  Healing is 90% up to what the patient does and 10% what the patient is.  What the patient does (taking it easy) after the injury is often more important than who the patient is (healthy).  Before we get too far ahead of ourselves we should probably describe a stress fracture.

Two broken bones.
The one on the right is a "healing" stress fracture
The one on the left is "newer"

The best example of a stress fracture is to grab a branch from a  LIVE shrub or tree and bend it.  You will hear a snap, but the branch will stay together.  This is what happens to bones in the foot.  If too much stress is placed on the bone it will snap, but not fall apart.  That is why stress fractures are often not seen on X-rays.  The foot will start to hurt all the same.  If you keep bending the branch back and forth, eventually it will snap in two.  Likewise, if you keep "stressing" the foot (running, jumping, walking) the foot bone may also snap in two.

The treatment is SIMPLE.  Stop stressing your foot!  I typically give the patient a fracture boot and say, "If you wear this all the time, except for sleeping and bathing, you should be healed in 1-2 months.  BUT YOU HAVE TO TAKE IT EASY!  If you get the boot and pretend your foot is not broken and run around all day long it may take 2-6 months.  If you only wear the boot "sometimes" it may never heal or get worse.

The issue with football players is that they, "have to go to work"  aka play football.  This is why it is so difficult for them.  Often times surgery is done to help get them back playing faster.  Screws are often used to help protect the area until the bone heals.  This is rarely needed for patients in my office as they are not often professional athletes that need to play ASAP.  

A surgery may also need to be done if the bone does not heal and the patient develops a non-union.  Most of the time this is caused when the patient does not "take it easy" or wear the boot.  Operating on this type of person has additional challenges.  If the person did not listen to the doctor before surgery what makes you think that the will "take it easy" after surgery.  Extensive counseling, bone simulators and some good luck are often needed to heal the injury.

Most of the time stress fractures are caused by an increase in physical activity.  Either too much of a "old activity" or starting a "new activity."  Athletes will get these injuries from increasing the "old activity".  They are playing too much, too hard and over stressing their body.  More often, I see the starting a "new activity" causing stress fractures.  This is the person who is starting to get in shape or starts a a new exercise activity.  An example would be starting running 5 miles a day.  It is safer to start a half mile a day and increasing a half mile a week until you reach your goal of 5 miles. This often occurs to individuals who "take a month off". When start exercising again they need to slowly progress to their normal activities.
There has been a few studies that show orthotics "may" help prevent stress fractures.  I do not recommend orthotics to prevent initial stress fractures as most often corrected training is all that is needed.  I do use orthotics in "special cases".  These are certain patients with repeat injuries.  This may be caused by diabetes, osteoporosis, and even in long distance runners.  

Thursday, October 2, 2014

2 Pods and a Pickleball....3 most common foot and ankle problems andtreatments for our active Pickleball Patients!

Since we have a practice right in the heart of the "Pickleball Capital of the World" in The Villages Florida.  We decided to learn more about what this sport is all about, so maybe we can help our patients avoid foot and ankle problems and continue to keep playing the sport they love! There are approximately 140 pickleball courts in The Villages.  A pickleball court is 1/3 the size of a tennis court and the game itself abides by many of the same rules as tennis. The great part about this sport, I am told, is that it is lower impact and easier on the joints like the hips and knees.  But what kind of toll does it take on the feet, that's what I wanted to find out.

It is not uncommon at all to drive by a pickleball court in The Villages, and see players that are all 70 plus years old! (and quite frankly moving much better than some 20, 30 and 40 year olds I know) It is a sport that is enjoyed by all age groups and has been steadily growing in popularity.  According to the USA Pickleball Association, there are more than 100,000 active pickleball players in the United States.  It is not a very expensive sport to pick up and if you live in an area like The Villages, you won't have a hard time finding someone to play with! The story I read about pickleball originating from two dads in Bainbridge Island, Washington that were trying to give their kids something to do after complaining about being bored is classic.  But better yet,  today it is becoming a household name. I truly love stories like this.

To be complete I interviewed some people who play pickleball to see what are the most common injuries to the foot and ankle.  How did I find these rockstar interviews?  They were patients who also love to play the sport.  But the reason they came to visit me was due to pain in their feet or ankles.  I would like to first state that I don not believe that in all these cases pickleball was the culprit.  However, pickleball did help wrestle up some old injuries and they needed help to figure out how to get better and what to change so they can feel pickleball ready!

Of all of the people I have seen with pickleball injuries, the number one chart topper injury has been heel pain or plantar fasciitis.  The is a sharp pain on the bottom of the heel that is noticed for some people after periods of rest and getting up. Other people notice this pain is more pronounced after a
prolonged period of being on their feet playing pickleball.  This is usually a simple fix for the pickleball player as the culprit is shoe gear or lack of support in shoe gear.  Wearing the right kind of shoes could make a huge difference and for some people it is as easy as putting a little extra support in the shoe.  Also, for those new to the sport or who are just getting back into the swing of things they tend to forget to stretch regularly.  Stretching your calf muscles daily could be a foot saver and also prevent another problem like Achilles tendonitis! The largest tendon in your body, the Achilles tendon can also be aggravated by all of the short stopping and starting involved in Pickleball.  Stretching daily will ward off this as well.

Number two chart topper for my pickleball patients is recurrent ankle sprains.  Since, according to the USAPA 70% of the people playing pickleball in this country are 60 years or older, it makes sense that this group may have had a better chance of a couple ankle sprains over the years.  Remember, the more active you are the more you open yourself up to injuries over the years.  If you have had  previous ankle sprain and you want to play pickleball take precautions to avoid future sprains. First, a high top sneaker will provide you with more stability in the ankle.  I have a good suggestion for a type a shoe below.  If you already have your lucky pair of pickleball shoes and don't want to buy another pair, start wearing an ankle support, at least like an ACE slip on ankle brace seen here.  It is much easier to prevent the injury then treating the sprain.  An ankle sprain could keep you off thecourt in a walking cast for 8 weeks up.

The number three chart topper that we will talk about today is foot arthritis flare ups in the foot and ankle.  Though this is a sport that is less pounding for the knee or hip, there is an awful lot of pivoting and shuffling of the feet. Sometimes this can aggravate old issues and mature joints.  Again, this really comes back to what you put on your feet.  If your shoes are not supportive enough you need to get an insert to provide extra support or BUY NEW SHOES! But with the arthritis, the key is, in the absence of motion across the joint, the less pain you will experience with wear and tear arthritis.

I thought I would start give some advice on the best kind of shoes for a sport like pickleball.  Remember, even though it is low impact on the knees and hips, your feet are a different beast.  Your feet are taking up most of the little repetitive micro-trauma that pickleball can provide if you do not have the right kind of shoes or support.  I see many people in my Villages office who present with heel pain, painful toes and peroneal tendonitis(outside of the ankle strain) on many occasions after several weeks into the start of a new pickleball season (ie now, as many snowbirds are returning to the South). So it is very important to have the right shoe gear on to decrease your possibility of any foot or ankle problems.

So the shoe you should wear really can be determined by if you are playing indoor pickleball or outdoor pickleball.  From all of my research, I have come up with 3 key points about pickleball shoes:

1.  If you are playing on an indoor court, it is probably better to look for a shoe that you would wear for racketball
2.  If you are playing on an outdoor court, you want to lean closer to an official tennis type sneaker
3.  I need to research, develop and sell my own pickleball shoes, because as of right now, the fastest growing sport in America is getting the shaft on shoe gear

Let's talk a little more detail of the type of shoe you should look for depending on your foot history.
If you are someone who has had frequent ankle sprains and you really want to play pickleball, wear a high top sneaker. Regardless if it is indoor or outdoor pickleball, you need the the extra stability on the outside of your ankle, it could be the difference between playing year round or out for 6 months because of recurrent sprains.  The shoe I liked the best for the frequent ankle sprainer was the Prince's NFS (which stands for natural foot shape).  This shoe has the higher heel counter in the back which will give the rearfoot more stability.  This shoe also has a little more room in the toe box, which is a major plus.  Many people who play this sport can be so caught up in it that they could be on the court for 4 plus hours.  In the Florida heat, that can equate to a little more swelling of the feet, so the wider toe box is a must, even if you think you have cute narrow feet!

If you are someone who has ever suffered with Plantar Fasciitis or heel pain, pickleball could have you faced with your own set of concerns and aches.  Like almost everything in the medical field, prevention is better than having to get treatment.  This means your pickleball shoes need more than average support when you have plantar fasciitis.  The shoe that I thought was the best for women who have a history of heel pain was the ASICS GEL-Resolution 5.  Besides the sleek loom the shoe has a lot to offer the pickleball player who has had heel pain in the past.  This is a form fitting shoe that touts the Asics P.H.F. which stands for the personal heel fit system.  This shoes is lined with 2 layers of memory foam at the heel counter so the shoe conforms to the heel in the back with out causing any blistering, nice.  Also this shoe has mid-sole protection for the plantar fascia.

For the men who have experienced plantar fasciitis and who want to reduce their risk of getting it again, I found the  Asics Gel Resolution 5, which touts all of the same great features of the womens version above. It is a great shoe and will give you the support you need.  Extra perk, every time you look at your shoes you will be reminded of Darth Maul by these awesome colors if you are a Star Wars fan!

Let's say you are already someone who owns shoes for pickleball but just want a little more support.  Well than you probably could get a really great athletic over the counter insert to provide you with this support.  I will now shamelessly plug our Center for Ankle and Foot Care over the counter inserts designed by Dr. Henne and myself for plantar fasciitis.  It is an athletic inserts and is full length and is a firmer support than you can get at a drug store.  There is a break in period that may take you 5 -14 days to feel better with them in the shoes.  They are available for sale at our webpage at or click the picture of the orthotic to be brought right to the page to order them.

If you are a pickleball player, we salute you for being a part of the coolest sport we have seen come along in along while! If you live in The Villages, Florida and you are having pain in your feet and you play pickleball put your feet in the caring hands of Dr. Michele McGowan or Dr. Tim Henne.  They will help you get back on the court faster that you can say pickleball!