Wednesday, December 24, 2014

Don't Ring in the New Year with heel pain!!!

New Year's Eve is a time when most are thinking about their resolutions for improving their well being for the following year to come.  Some people are deciding to enter into a new exercise program or join a gym.  Both of these endeavors are wonderful, except for those with heel pain or plantar fasciitis!

If you are one of those people that experience pain with first step in the morning, right smack dab in the bottom center of your heel or have pain in the same area after standing for a while, then I am talking to you.  Plantar fasciitis or heel pain is one of the most common and, believe it or not, easily treatable foot ailments that walks into our office. I find the biggest problem people have with plantar fasciitis in their treatment protocol is bad advice from friends, family and co-workers.  No, I am not throwing your loved ones under the bus, it is just that sometimes advice from multiple sources creates a white noise in our brains and just confuses the situation.

Below you will find recommendations regarding treating and making your heel pain go away. I think it is important to first and foremost determine if your heel pain is from the back of your heel, which would be more of an Achilles tendonitis or on the bottom which is more in line with Plantar fasciitis.  It is important to delineate this before treating, as both injuries are very different sometimes in how we treat them. By clicking on the picture to the right you can see our webpage and what the difference is between Achilles tendonitis and Plantar fasciitis.

People find it hard to believe that stretching, icing and support can be the perfect combo to relieve and help get rid of their heel pain, but it's true!!!!The plantar fascia is a tight band on the bottom of the foot that connects the heel bone, the calcaneus, to the long flexor tendons to the toes. What I always tell patients when they come into the office with heel pain or plantar fasciitis, is that even though it hurts so darn bad the cure really does revolve around stretching believe or not, in most cases.  Sure it can require a medicine by mouth or even a shot with some extra support in shoe gear but it is usually a simple fix.

The fix is simple but, depending in how long it takes you to seek help to get better, could be the deciding factor on how long it actually takes you to get better.  The sooner you seek care, start the stretching exercises and put good support in you shoes, the sooner you are on the road to recovery.

Here are my classic three stretches performed by my lovely stick figure drawings, but simple is always better.  Stretching is important for your Plantar fasciitis to get better and stay away.  Yes, that is right, I tell all of my patients that they need to stretch daily after having Plantar facsiitis to prevent it from coming back! These three basic runners stretches should be performed 3-4 times a day when you have Plantar fasciitis.  You should stretch both sides for completeness sake and hold the stretch for 15-20 seconds with no bouncing.

Icing is another thing I tell people to do when they have acute Plantar fasciitis.  But how you ice can be a real key to your success.  You need get a little plastic water bottle and freeze the water inside, then take it out 2 times a day rolling it under the arch of the foot back and forth.  I tell patients this is like physical therapy without a copay.  It is a natural anti-inflammatory and stretches the arch very effectively.

These are the two main ways to start treating your Plantar fasciitis: stretching and icing.  But there are many great ways to help support the fascia when you are standing like inserts and slippers.  Also, there is something called a Plantar fascial night splint that you can wear while you are at rest or even while you are sleeping.

Some people get home and kick off their shoes and then strain the fascia walking barefoot around the house.  Support, even at home has a very positive effect in your outcome and feeling better sooner.

Here is a link to our webpage, with our top recommendations for heel pain and plantar fasciitis from our affiliate FootSmart.  I put my favorite helpers for heel pain available at :

Sunday, December 14, 2014

Plantar wart, seed wart, what is on the bottom of my foot???

Kids can have a foot problem and not complain.....

So being a foot doctor, I would have never thought that I would have to perform so much home care to my own adorable children.  I have previously wrote about my 10 year old and her continuing struggle with stinky smelly feet from soccer, and the athlete's foot that every once and a while rears its ugly head in her life.  But now my 8 year old's feet must have gotten jealous, because now she has a wart! Yes, that's right now I am doing house calls, but just at my own actual home! There is nothing quite like your 8 year old leaving a bloody trail on the carpet from a wart on her foot.

Yes, our child has been growing this monster on her foot for quite some time, but like many kids, did not share this information with us until there was a need for a carpet stain remover.  Many parents present to our office, almost embarrassed by the wart or warts on their child foot.  Parents often think the doctor is going to make a judgement based on the ailment like a wart or a fungus that may be lingering on their child's foot for over a couple months.  Even ingrown nails(which can be very painful to a child) children tend to hide from their parents.  No judgment here by these foot doctors. 2 out of 3 of our kids have faulty feet so far:)

What should you do if you or your child has a wart?     

A wart on the bottom of the foot is usually pretty easy to identify.  I will use the picture of my lovely at home model, my 8 year old's foot, to show the most common presentation of a wart. First thing most people notice is a roughness to the skin or a callus tissue.  If you look closely, you will see your normal skin lines that stop right at the lesion.  Yes, your normal skin lines do not run through the wart, this is a helpful identifier to know that you are dealing with a wart.

Many people use an older term "Seed wart" to describe what they are seeing on the bottom of the foot.  They sometimes notice little black dots throughout the wart and think of little black seeds seen in many fruits.  The idea of thinking about fruit and anything on your foot is just gross to me, so I never use this term.

Warts can be non painful and be on the bottom of a foot and go unnoticed for a long time.  This is why, for most warts, I would recommend seeing your podiatrist before trying self treatment and here's why.  If you have had a wart for longer than a month, the callus build up makes it very difficult for just topical treatment alone to work. In order to treat the wart most effectively, you need to remove as much of the dead skin on top of it for topical treatment to be an option.
If you try your own at home debridement, you run the risk of not getting enough callus off, cutting yourself way to deep or giving yourself a nice little infection. I would absolutely recommend seeing your podiatrist before attempting any home care.

What are the options for warts?

When you see your podiatrist, they will give you the run down of all of the possible options. In my office these are the options I give below.  The options are from simplest to most complex.

1. This option is done in the office.  We shave the dead skin off of the wart until we see a little pinpoint bleeding.  Once we see the bleeding we apply an acid and a protective covering.  The patient usually can walk out of the office with minor discomfort that fades over a day or two.  Then the patient is given at home instructions.  They are to use a topical like the one seen here.
They are to apply the medicine on the wart stick and then apply (I know this sounds crazy) duct tape.  Every night they repeat this process and when they wake up in the morning they take the duct tape off and do not reapply the medicine until the night time routine.
This is always the option I recommend to a person who has never had any treatment for their wart. This is also the option I am opting for my own child.
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 2. Option 2 is to numb the foot in the office and cut the wart out (either by surgical dissection or laser)  and send it to pathology.  This seems like the best option if we did not live in a world that requires us to use our feet daily.  If we cut the wart out, the patient is unable to put weight on their foot for 3 weeks.  They need to give the skin time to heal, if they step on the area the incision will split open and they can have a host of other complications. But if a patient has struggled with a wart for months on end and/or has been treated by another physician and the "wart" keeps coming back, I recommend excising the wart out and sending it to pathology to make sure that this is really a wart.

Just get in and get it checked!

The best advice I can give you is, if your child or you have a new rough area on the foot, get in to see your foot doctor.  With warts, like so many other conditions, the sooner you get in and seek treatment the sooner you get better!  Remember, our office is a judgement free zone, because 2 out of 3 of the kids seen in the Christmas picture taken with Santa this year have yucky feet!

Merry Christmas from the Center for Ankle and Foot Care and "2 Pods and A Microphone" Family!

To learn more about different foot and ankle problems visit us at:

Michele McGowan, DPM Center for Ankle and Foot Care
Clermont, FL
Tavares, FL
The Villages, FL

Friday, December 5, 2014

Don't let an ingrown toenail slow you down!!!!

The Ingrown Toenail Blues

If you do not know what an ingrown toenail is be thankful.  If you "think" you know what an ingrown toenail is you probably do not.  People who have had an ingrown nail know the difference.  If hurts, bleeds, smells and ruins you white socks, you probably have an ingrown nail!  Very often the toe starts to, "bother you" and a week or two later you get one of these.  Most people spend weeks doctoring their toe before throwing in the towel and seeing the doctor.  But, from our experience, the more "bathroom surgeries" you perform, the worse this condition seems to get.  Below we will discuss some of the causes of an ingrown nail and our suggestions of the best way to get it better!

Why does one get an ingrown nail?  I tell everyone it is BAD LUCK.  Some people have an injury to the toe in some manner (kick something, drop a frozen chicken on it, or a clumsy dance partner steps on it). There are many causes of an ingrown nail but the two most common are trauma and aggressively trimming back the corner of ones nail. The definition of trauma is not someone hitting your toe with a bat! It is simply being in shoes that are too small and the toe continues to get beat up and the border of the nail ingrown in many instances.

But for our patients that are kids that come in sometimes it's their parents fault! That's right there was nothing you could have done to prevent it when there is a genetic predisposition for this condition.   Daily, I will see a child whose parents are explaining that "he cut the nail wrong and now here we are"!    I then ask mom and dad, "Have either of you ever had this problem before?" And guess what, most of the time one of them raises their hand.  I then have to opportunity to show the child whose fault this really is.  I explain that nails are like hair, (no really it is the same stuff) if you have straight or curly hair, no matter how you cut it, it grows back the same way.  (Not for me, but male pattern baldness is a whole different issue.)   Likewise, if you have a curly nail, no matter how you cut it it comes back the same way.

One of the most common conditions to walk into our office is an ingrown toenail.  People describe the pain as severe at times, and even describe difficulty sleeping due to the lightest touch like that of their sheet. Below are commonly described symptoms with an ingrown nail.
   The following symptoms may be present with ingrown toenails:
  • Pain
  • Redness and swelling
  • Drainage
  • Odor
  • Prominent skin tissue (proud flesh)

At the Center for Ankle and Foot Care, just like in podiatrist offices across the country, we have a simple in office procedure that literally only takes minutes to correct your  problem forever! (Unless you start to wear bad shoes again!) 

Don't wait until it gets too bad to get in.  On the right you can see we only take a small portion of the nail.  So in most cases you can barely tell you even had this simple in office procedure performed! Once the nail is ingrown there are not too many things you can do for yourself at home to make this better.  Call your foot doctor and get in right away!

If you would like more information about our office or our doctors visit our website at

Article written by Timothy Henne DPM Center for Ankle and Foot Care, Inc Clermont FL 34711