Monday, September 28, 2020

Top two injuries we see in young soccer players

Injuries in Young Soccer Players & How We Treat Them


As youth soccer programs across the country try to return to normalcy during a Covid Era, we acknowledge the top two injuries we see in these kids and how we treat them. Our youngest has coerced me, Dr. McGowan, to coach. I honestly said yes right away, but that was because I thought it would be cancelled. I know, mother of the year! Well we had our first practice under our belt last Friday and first game this Saturday coming up. This is happening! As you can see from the ridiculously unflattering picture Dr. Henne shared on social media of myself with our youngest on the soccer field Friday night, things are different. Luckily the children do not have to wear masks and it is my job to try to keep them apart, this is not the easiest task. Coaches have to wear masks, which I am totally cool with this, I just can't wait for it not to be 90 degrees at 6 pm on Fridays!!!!

Ingrown Toenail


Soccer is a sport of constant touch on the ball. In fact, the more touches you have on the ball the better you will get over time. But the repetitive microtrauma of the constant tapping in the toe box of the cleat and the occasional getting stepped by the cleat of someone else can lead to an ingrown toenail.  Ingrown toenail is best understood by the definition of the inside or outside of the toenail digging into the adjacent skin.  If the nail is not easily clipped out and has not relieved the person of the pain they may have an ingrown toenail.  This can progress to a more serious problem as the good tissue that has the nail stuck in it will perceive the nail as foreign body and will progress to a little infection.  If you are a parent of one of these little soccer players the fix may be as easy as you cutting the offended border of the nail back to where you can see it is ingrown and having them using a little antibiotic cream and band aid.  If the pain persists I would recommend going to see your podiatrist.  There is a simple in office procedure that can be performed to remove the border of the nail and place medicine in the area of the removed nail so you do not have to incur another ingrown nail.   This procedure we perform on children on a daily basis and they can usually go back to practice the very next day.  


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Calcaneal Apophysitis(Sever's Disease)

Calcaneal apophysitis is an inflamed growth plate of the heel bone.  We sometimes sees this as early as 8 years old and can be seen in or recur usually up until about 14 years old.  It can occur up until the growth plate closes in the heel bone which is about 14 years old.  This is very common and we see this also on a daily basis in the office.  Often these children will complain of very significant pain in the heel. The repetitive stress that happens from playing sports like soccer causes motion and inflammation to the growth plate.  Usually the child will complain of pain on the back or the bottom of the heel, you may notice them limping or having difficulty participating in their sport. This happens in all kinds of youth sports like basketball, football, track and soccer.  Having played soccer for 20 years, I can attest to soccer cleats not having the most support or shock absorption that you may get in other athletic shoe gear, but that again goes back to the touch on the ball. Some of the world's best soccer players grew up playing barefoot in the street(which as a foot doctor I don't condone, lol). 


Treatment for this sometimes can be as simple as a little icing, anti inflammatory and more support on the foot on and off of the soccer field. Not going barefoot can help ease the pressure on the growth plate and help it heal faster.  I usually show these young athletes some simple calf stretches which can help decrease extra stress on the growth plate from the Achilles' tendon and could help them prevent other athletic injuries that are linked to a tight posterior lower leg muscle group.  If the simple treatment does not work it may be necessary to sit out a week or two from the sport and I usually place these young athletes in a cam walker boot. This will take a lot of pressure and strain off of the heel and helps them get to playing their sport quicker.  

Good luck to all athletes, coaches and parents trying their best to get their young athletes back to what they love to do.  Hoping we all can get through this season happy, healthy and back to a little fun and normalcy! 

Dr. Michele McGowan

Center for Ankle and Foot Care

3190 Citrus Tower Blvd Ste A

Clermont, Fl 34711

352-242-2502

centeranklefootcare.com









Sunday, September 13, 2020

Pandemic foot pain!! Top reasons why #myfeetarekillingme during the pandemic!





 I have heard and seen so many patients over the last 3 months who think they are having foot pain due to their increased activity level.  This becomes very disheartening for the person who wants to be in shape.  You suddenly have more free time than you want. It almost is the “no excuse season” for getting into shape.  Even Dr. Henne and I, even though we are seeing patients daily and have not decreased our time in the office, but we have  a lot more time in our personal life because our kids involvement in sports and extracurricular activities is diminished.  We personally have been running, lifting and biking consistently for several months now.  Dr. Henne looks skinnier, I look the same, lol. 

So of course, if you went from doing little to a lot you may think the increase in activity is the sole reason for your foot pain.  I do agree that some people over do it and develop tendonitis: Achilles’, peroneal or posterior tibial tendonitis are the most common three we have seen in the past couple months in addition to plantar fasciitis.   But the reality is the root cause of your pain may not be just the activity.  So many people have been home, barefoot walking around their house all day. 

The barefoot walking all day in the house is one of the top reason we are seeing patients for foot pain.  If you look at your foot’s bony architecture, like on this X-ray, you will see that these 28 bones need support in all different areas.  If you don’t have enough support for example and you put too much pressure on your forefoot it is very easy to develop capsulitis under the metatarsal heads for example.  This can be very painful from the repetitive micro trauma of walking on hard surfaces with no shoes on.  Many patients come in and say they don’t want to wear their outside shoes in the house especially now during COVID-19.  I usually show them a pair of Oofos flip flops or Hoka Flip flops.  I own both of these and depending on what is going on with your feet one of these might be the correct choice for you. My Oofos I have had for about 5 years and my Hoka’s for about 4 months I love them both and they are my go to shoe gear right when I come in the house after work or on Saturday and Sunday just milling around the house.


I would recommend that if you are experiencing foot pain and have had no trauma you may want to play around with having good support on your feet around the house.  I am not saying don’t go see your podiatrist because you want to make sure there is nothing more serious happening but you can not go wrong with more support around the house.  If you want to learn about more specific foot and ankle problems visit our website at centeranklefootcare.com


The oofos will run about $50 but last for a very long time  

The Hoka’s run from $50 to about $80 on Amazon, I think I purchased mine locally for a very fair price of about $50.  The real point is that if you are walking barefoot around your house more than you normally do, you are going to develop some foot pain.  This is usually pretty reversible if just having some support while walking around your house.  


Michele McGowan DPM

Center for Ankle & Foot Care

3190 Citrus Tower Blvd Ste A

Clermont FL, 34711

Centeranklefootcare.com


Tuesday, March 31, 2020

Do not ignore an open wound on your foot!!!



Today we are continuing our series on when to actually go to see your podiatrist. Today we discuss the different types of wounds we see in the office.  Again we want to keep you out of the hospital and urgent care centers where all the sick people are going!

For All wounds,  good advice:

  • If you notice drainage on your sock go see your podiatrist
  • If you know your sensation is poor, you should be checking your feet daily
  • If you have a new area on your foot that is open go see your podiatrist
  • Blistering and leaking fluid from your legs and feet, go see your podiatrist
  • Extreme pain in the foot and an open wound go see your podiatrist
  • anything out of the ordinary on your foot or ankle, go see your podiatrist



Diabetic wounds:
  • Usually associated with lack of protective threshold(poor sensation, so you do not feel pain and discomfort) 
  • The simplest thing, like wearing a shoe that is even just a little too small can cause a serious wound and problem
  • Do not ignore your problem, if it looks bad but you can't feel it, that does not mean it is OK
  • The best thing you can do is get in to see your podiatrist, there are sometimes very simple solutions that can save you from limb loss


Venous wounds:
  • Usually, these patients present with swollen legs with fluid leaking from small or sometimes big blisters
  • This is another wound type that can get serious fast, many times if you see a doctor who does not treat these types of wounds they send you to be admitted to the hospital, we are trying to keep you out of the hospital
  • Sometimes simple advice, like elevate the legs can be the difference between going to the hospital or not
  • There are many simple ways we can mange this in the office as well


Arterial wounds:

  • Sometimes patients do not have blood flow, meaning their arteries are not getting blood to where it needs to go
  • These wounds can be more complicated, as without blood flow no wound will heal
  • Our job is to keep you from getting infected and help coordinate care with the vascular doctor
  • We do not debride these wounds, as they can get bigger, unless there is infection with a chance of wound causing sepsis
  • So take home point, go see your podiatrist before the wound gets to that point

So like all of you, we are struggling with all the new responsibilities we have had thrust upon us over the last couple of weeks. Yes, it is the worst to be cooped up at home, but it always could be worse.  We are travelling back and forth every day to our office to home with our 3 children, who now have to home school, this is not the easiest task even if you have good kids! We are small business owners who understand having to work hard to make sure everything goes smoothly, or at least try to make things go smoothly! We love what we do and our very happy to help our patients and friends stay out of the hospital.  

Our website has always had a dedicated page for our wounded patients. Check us out here: https://centeranklefootcare.com/wound-care.html

Stay safe everyone and remember to wash your hands and keep your distance from others.

Michele McGowan DPM and Timothy Henne, DPM
The Center for Ankle and Foot Care
3190 Citrus Tower Blvd Ste A
352-242-2502

Saturday, March 28, 2020

Don't ignore your ingrown nail, especially if you are diabetic!!


Trying to keep our patients out of the ER 

  • There are problems that all of your specialist can handle right now to keep you out of the emergency room
  • We treat many foot and ankle emergencies right in our office
  • Many podiatrist have on-sight X-ray so they can diagnosis and treat your broken bone 
  • You should never ignore bruising, swelling or unexplained redness on the lower extremity


Today we are discussing ingrown toenails

  • If you have a toe that is red, and swollen like the picture to the right, you should not be trying to ride this out
  • Ingrown nails are typically painful, but in our diabetic patients with neuropathy (unable to feel pain from an infection is one example of neuropathy)
  • If left untreated this can be a much bigger problem, infection in the worst case scenario can lead to an amputation of a toe
  • Treatment is a simple in office procedure




The Video below is an ingrown nail procedure




Ingrown nail surgery:

  • The toe is anesthetized with 1% Lidocaine
  • The offending border is freed from the nail bed 
  • An instrument is used to only cut out the ingrown border
  • After the bad part of the nail is removed, a topical medicine is used to stop the border of the nail from growing again
  • If the patient does not have good blood flow, this procedure can not be performed but your podiatrist can most likely alleviate some of the problem and place you on an antibiotic
  • The video above is us removing an ingrown nail on a patient


Not sure if you need to be seen in the office?  You can reach out for a Telehealth visit first at:
https://centeranklefootcare.com/telemedicine-request.html






Thursday, March 26, 2020

Curbside check-in for patients during COVID-19 in our podiatry office



Dr. Michele McGowan and Dr. Timothy Henne from the Center for Ankle and Foot Care sharing their experiences during their transition back from Spring Break 2020 walking into the Pandemic COVID-19 seeing patients, helping facilitate kids virtual learning and keeping patients, staff, children and selves safe.

Virtual school
First, we have to say our children's school has been amazing during this time. They had let all parents know before spring break that they were going virtual after the break.  As promised, Monday they were up and ready to go.  The teachers are also hitting it out of the park.  Lesson plans seem back on track and having kids in elementary, middle and high school all at the same facility, it is amazing to see how well they teachers and school are pulling it all together.

Forced Family Fun Time or FFFT
Forced family fun time, our children would tell you is not new for our family during the Coronavirus.  We have been practicing FFFT for quite sometime.  Once our older children got cell phones we have been vigilant that they do not become phone zombies.  We think they like hanging out with us but we still every day have planned or on the fly activities that we make all 3 children participate, even if it's just a movie. (I know that is still a screen but we are looking at it together at least.) And this isn't a parenting blog but we also sit and have dinner together as a family every night.  It is always fun and entertaining but I think really important now more than ever to just sit with your kids and discuss the day and how they are feeling.

Curbside check in
So we had no real idea if curbside check in would actually work.  It is going really well.  I think almost every one has a cell phone. Our older patients are figuring things out pretty easily.  We really did just make up things as we were going, using common sense really comes in handy sometimes!

Curbside check-in benefits:

  • Decreases people congregating in a waiting room setting
  • Gives staff and doctors the ability to control flow of getting patient in a clean room
  • Limits patient contact with other patients in hallway and check out desk
  • Gives patients the confidence that we are going above and beyond to keep them safe
Cleaning the office
We did find it weird that some of the other doctors offices started to reassure patients that they were taking special measures to keep things cleaner when the COVID-19 became apparent it was going to have an impact on us all.  What?? Didn't they clean their offices before? Listen, your doctors office should always have been cleaning treatments rooms between patients with supplies that are meant to kill germs, bacteria and different flu strains.  It is a doctors office, there is no confidence in an office that states, "Now we are cleaning thoroughly." That wouldn't be a sell for me as a patient.  

Employees dedication
I can not begin to thank my employees enough.  If you have been to our office you have met Diana and Reshanda.  In these uncertain times, we understand and respect employees taking off time to be with their families, socially isolate, self quarantine and stay home.  I think these measures are important to help decrease the spread of the coronavirus.  That all being said, we are happy to have people that are helping us in the trenches.  It makes our lives and our patient lives so much better.  We just wanted to publicly acknowledge that we truly appreciate you!!!!

Be prepared as a patient when you go to the doctor
  • If you are new, have your insurance cards ready, or email prior to visit
  • If you have a copay, have it ready decreasing your time and interaction with others
  • Use the million of different types of hand gel and foams we have around the office
  • Don't steal supplies from the doctors offices, like gloves, we need them
What not to touch in public
  • I am a germaphobe, do DON'T TOUCH ANYTHING
  • Avoid pushing elevator buttons
  • Avoid door handles 
  • Common sense prevails always, wash your hands and use hand sanitizer
  • DON'T TOUCH YOUR FACE!!!!!!!
  • DON'T TOUCH YOUR SHOES!!!!

Lastly, we are busy parents and doctors, we are filming these little videos, obviously not editing them:)It is a first take scenario and what you see is what you get, LOL.  This video is what our kids would say was our "OK BOOMER!" moment.  Our light went out so we were done. I hope some of our information is either helpful or slightly entertaining.  Stay safe everyone!










Tuesday, March 24, 2020

Telehealth and Bunions: When to go to see your Podiatrist during the Coronavirus Pandemic



So we are knee deep into day 2 of seeing patients after getting back after our kids spring break.  It has been day two and it feels like, I don't know, maybe a month!!

 Goal #1:  Stay Out of the Hospital -  Day 2    I had to go to the Villages Hospital for emergent surgery. So we love what we do and love limb salvage and helping patients keep their toes, feet and legs.  It really is very gratifying to offer options for patients when others just offer below the knee amputation.  It was incredible to just call the hospital and be able to add a case whenever I wanted or was able to do so.   But it also was ominous,  the effect of the coronavirus on the medical community.

Goal #2: Keep non-emergent non-medically necessary patients out of the office- Day 2  We had at least 5 patients show up with non-emergent problems like bunions and hammertoes. 
So if you have a bunion or hammertoe, don't go see your podiatrist right now in the light of a pandemic aka the coronavirus.  Maybe do a Telehealth visit with your podiatrist if you are not sure after watching this. Yes it will suck for a doctor to tell you, buy bigger/wider shoes, but it could save someone else from getting sick!

Goal #3: Keep kids well stocked with supplies during the time of virtual learning- Day 2 The oldest child complains about not having "fancy mechanical pencils"  We have a box of a 150
pre-sharpened pencils available to the children.  Back in my day pre-sharpened pencils was a luxury!!

Goal #4 Forced Family Yard Time ( Like prison getting a little exercise) - Day 2 ended short when 8 year old fell off scooter and blamed Mother Nature for her pants getting wet.  Sprinkler was broken and she landed in the only puddle of water on the driveway.  

So we are all in this together! Stay safe, wash your hands, try to laugh when you can:)  

Monday, March 23, 2020

Red, Hot and Swollen in the foot is bad...Especially if you are diabetic!



RED, HOT AND SWOLLEN IS BAD!!!!! SEE YOUR DOCTOR!!!!!!

So while keeping yourself safe from Coronavirus don't let yourself go on to limb loss.  These are crazy times we are currently living in, but we still need to maintain our health of our total body.  We pride ourselves on limb salvage and helping our patients keep their limbs at all cost.  Before you ignore the red swollen toe, foot or ankle think again.  Diabetic foot infections happen quick. You should be checking your feet daily and inspect for anything abnormal.

Diabetic Foot Facts:
  • Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80%  Gibson, et al, Int Wound Journal, 2013
  • Diabetes kills more people annually than breast cancer and AIDS combined. American Diabetes Association, 2009
  • Chronic wounds affect some 8 million Americans each year. That’s one wound every 3.8 seconds in the USA, alone.
    Harsha , 2008 and Tomic-Canic 2010
  • Diabetic foot ulcers double mortality and heart attack risk while increasing risk for stroke by 40%
    Brownrigg, et al, Diabetologia, 2012
  • Every 30 minutes a limb is lost due to a landmine, Every 20 seconds, a limb is lost due to diabetes. Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009
  • The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%).  (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%) Armstrong, et al, International Wound Journal, 2007
  • Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.  Armstrong et al. Amer Fam Phys 1998
  • More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation.  Lavery, Armstrong, et al.  Diabetes Care 2006
  • Up to 34% of those with diabetes will develop a foot ulcer. Armstrong, Boulton, Bus, New England Journal of Medicine, 2017
  • 60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.  Dyck et al.  Diabetic Neuropathy 1999
  • The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion Rice, et al, Diabetes Care, 2014





My feet are killing me and I do not want to go to the doctor for my heel pain!




We are trying to give some simple real world advice on heel pain and how to stay out of the ER and Urgent Care centers while the Coronavirus is a part of our daily life for now.  Dr. Henne and I know that some of this information is very common sense.  But honestly, simple things work all the time for minor foot and ankle problems.

In this video we discuss rolling the ice bottle on the foot:
This is simple to do. If you think you have plantar fasciitis or heel pain get rolling! I have had heel pain a couple times and this simple step makes it feel very good right away. Rolling the ice bottle, not only stretches the plantar fascia but it serves as a nice natural anti-inflammatory.



We also discussed stretching the calf muscles which will also in turn stretches out the plantar fascia or arch.  See below my homemade diagram of stretching the fascia because I didn't want to get sued for copyright infringement, so here is my art skill level and why I am a podiatrist!


Next we talked about good support on the foot, even when you are walking around the house you should not go barefoot!!! We like Oofos, spenco, vionic recovery flip flops even a pair of Crocs around the house is better than nothing! Just don't go barefoot and if it is plantar fasciitis, you will feel better.
Obviously, we are human and after watching I thought about a couple things that also we tell patients.  Good shoes with good support obviously.  A good pair of sneakers can help a lot, especially if you have to be on your feet a lot!

If the Shoes need a little more arch support I recommend a Powerstep full length arch support.  Sometimes just a little more support, along with the stretching and icing make all of the difference.

I always tell people that is the pain in the morning is persistent, consider purchasing a posterior night splint as shown below, you can buy it on Amazon.  Even if you can't wear it while you are sleeping, wear it while you are Netflix binge watching during the Quarantine of 2020.
Finally, if you do all these thing and you are not better call your podiatrist office, just make sure they have policies in place to protect you from getting sick!
For more info about heel pain or plantar fasciitis click here: https://centeranklefootcare.com/heel-pain.html

Thursday, March 19, 2020

Center for Ankle and Foot Care Blogspot: If you have a foot or ankle injury DO NOT GO TO TH...

Center for Ankle and Foot Care Blogspot: If you have a foot or ankle injury DO NOT GO TO TH...: If you sprain an ankle, rip off a toenail or have an infection or wound on your foot or ankle you should avoid the emergency room and urgen...

If you have a foot or ankle injury DO NOT GO TO THE EMERGENCY ROOM OR URGENT CARE CENTER!!!!!


If you sprain an ankle, rip off a toenail or have an infection or wound on your foot or ankle you should avoid the emergency room and urgent care centers.  I can think of nothing worse than walking into the hospital or urgent care center with a foot problem and walking out with COVID-19.  Hospitals do not want to see you right now!  They are taking care of very sick people that can make you sick. This does not mean your foot or ankle problem is not important or should not be tended to, especially if you have an infection or fracture. We take care of these things in our office and often can avoid the hospital.  We are taking all precautions to protect our patients by instituting curbside check in as well as virtual visits for those who have questions and concerns but are not able to make it into the office.

Our current role as foot and ankle surgeons I believe is more important now than ever before.  If we can keep healthy people out of the path of illness in places like the emergency room and urgent care centers we are providing a true service to our community. Now is not the time for specialists to be closing their offices.  Right now there are many things changing rapidly in the healthcare landscape right in front of our eyes on a daily basis.  But the most underlying theme is if you are not sick do not got to places where sick people are located. 

There are many routine type visits that can be re-scheduled but emergent foot and ankle problems should not be ignored especially in our diabetic patients.  Consider every 30 seconds someone world wide loses a limb due to a diabetic non traumatic amputation from a diabetic foot infection.  If you are diabetic and have foot and ankle concerns you should consider calling the office and setting up even a virtual appointment. Dr. Henne and Dr. McGowan may be able to guide you via a virtual appointment of what is the next step.  We can guide you if you need antibiotics, a procedure that we can schedule in office, ect. 

If you are considering making an appointment at our office or a telemedicine visit over the next couple of weeks, visit our website for more information and a telemedicine consent at: https://centeranklefootcare.com/coronavirus.html


Take care and remember we can all help control COVID-19:

  • wash your hands
  • carry hand gel
  • avoid crowds and unnecessary travel 
  • re-schedule elective procedures
  • avoid urgent care centers and emergency rooms
  • stay home if you can
  • take advantage of telemedicine appointments

Again, as always from our family to yours, stay healthy!!!


Wednesday, March 18, 2020

Coronavirus and your foot health

Taking care of yourself remotely in light of the Coronavirus

Dr. Henne and myself, Dr. McGowan, are dedicated foot and ankle surgeons.  Telemedicine is now an option for all patients that either have a genuine valid fear of becoming sick and for those whose immune systems may put them at higher risk in a waiting room situation.  Your doctors offices should be working on more proactive steps like curbside check in reducing your interaction in a waiting room setting. This decreases your chances of being in close contact with those that may not even know they are sick or contagious. We are podiatrist that practice in Florida but according to the new legislation that may be passed today we will able to help patient across state lines.  If your podiatrist cancels your appointment but you have questions we would be happy to help you!

Much of what we do in our profession, we actually need to see the patient because palpating and sometimes X-rays are very necessary as well as in office procedures that can't be performed over the phone.  However, there are many foot and ankle problems that patients may be able to have a conversation via phone, email interaction or Skype session with one of our doctors to help. We can prescribe and even write for X-rays to be performed in a location closest to your home and that can be by appointment only. 

We would love to help your feet feel better and keep you safe all at the same time. We are completely set up for Telemedicine in our practice.  You are more than welcome to call our office and set up an appointment with our office staff at 352-242-2502 to make an appointment.  Or visit our website at centeranklefootcare.com and request an appointment or you can email anklefootcare1@gmail.com to request an appointment. Dr. Henne and I will also, as of tomorrow, have after hour and weekend appointments for Telemedicine. 

We wish everyone health and wellness as we continue to do what we love, to help people feel better and keep people moving!

Best of luck and good health wishes from our family to yours!