If you are experiencing foot pain while exercising, it is important to first determine the cause of the pain. Common causes include plantar fasciitis, stress fractures, tendinitis or just plain overuse strains.

If it is just a mild strain of your foot or your ankle, there are some steps you can take to manage your pain and continue exercising. Wearing supportive shoes and orthotics, stretching and strengthening exercises for the feet and lower legs, and using ice or anti-inflammatories to reduce inflammation can all help.  Reducing the intensity of your exercise by sticking to non-impact activities and decreasing the duration of your exercise routine until your pain improves.

It's also important to note that rest and recovery is an important part of preventing foot pain and other injuries. So, take enough rest and avoid overtraining!

It is recommended to pay attention to your body and not to push through pain.  Should you continue to have pain that persists or becomes severe, stop exercising and make an appointment with one of the doctors at Foot and Ankle Associates of North Texas.  Increasing or persistent pain is certainly something that should not be ignored.  We will be able to determine the cause of your pain and formulate a treatment plan to give you the best way to get you back to your activities sooner than later!

People in Texas love to barefoot anytime of the year.  Your feet don't hurt, so no harm no foul right?  The answer is yes, you're right! Now the real questions you should be asking is: if I keep walking barefoot what will happen to my feet? Will they start hurting later on?  I am here to give you the intel on what happens when you walk barefoot to help you make an informed decision on whether or not you want to keep trusting your feet will behave in your lifetime. 

I have had the beauty of practicing for long enough to witness the progression of what can happen to patients' feet over the course of decades. 

Here's a Cliff Notes version list of what I have seen in my practice: I see more people with foot problems that have a history of walking barefoot than people who never do. People who walk barefoot and come in with foot pain have to stop walking barefoot because their feet hurt. 

Here are some of the reasons why:

1. When you walk barefoot, you slowly wear down the fat padding underneath your feet. It is not immediate and happens slowly over time. Once it is gone, it is gone forever! 
2. When you walk barefoot, you're more likely to jam your toes up against furniture or other household objects. The most common fractures I see in the office are from patients' feet running into furniture.
3. When you walk barefoot, you are obviously most likely to step on something that then gets stuck in your foot and causes endless discomfort until you get it out or you have to have surgery to remove it. 
4. When you walk barefoot, you rely on your own bones, ligaments, tendons, and joints to cushion and support your body where it needs it. This is very taxing on the feet over time, given that they have to walk you from point A to point B all day long. Overtime, arches begin to flatten and your foot begins to widen and can become stiffer with the arthritic changes that happen with mistreatment over the years.   
5. As we get older, we tend to gain weight, which puts more pressure on our feet. People who like to walk barefoot and are overweight tend to experience more of what I call  "biomechanical and functional pain" because of this overload. This is the kind of pain that is caused from no other cause than the fact that their feet are having to bear the brunt of excess weight without any support.
6. When you walk barefoot, you can inoculate your foot with anything that is on the floor, including fungus and the wart virus. People think the only way to get Athlete's foot is by your foot sweating in a shoe. It is just as easy to pick up a fungal infection by walking onto some of it and infecting yourself. By the same token, you can just as easily inoculate your foot with the wart virus that survives on all kinds of surfaces. 

I hope this list gives some guidance to help you choose how you tread on your feet.  My hope is that you tread lightly! 

What is MLS and how does it work?

MLS laser is a sophisticated class IV laser that uses two very specific wavelength of light applied directly to the skin of the affected area. The laser light penetrates 3-5 cm deep into tissues and has been shown to accelerate the body’s own natural healing process. The treatment achieves this by activating the energy producing portion of the cell (mitochondria), allowing increased energy production and therefore more rapid healing of cells. The cells are also stimulated to release toxins like histamine and cytokines out of the cells. This results in decreased pain and inflammation as well as increased healthy blood flow to the treatment area.

Will MLS laser work for me?

For patients who suffer from musculoskeletal pain, arthritis, or inflammation, an 85 -90% efficacy rate for significant reduction in these symptoms has been noted. There are currently over 3,000 articles that validate the effectiveness of laser therapy.

What does it treat?

MLS laser therapy can be used for conditions in the foot and ankle including, but not limited to:

• Plantar fasciitis
• Arthritis
• Fractures (if treated in first 10 days after injury)
• Neuromas
• Capsulitis
• Tendinitis
• Sprains
• Bursitis
• Neuropathy
• Generalized inflammation
• Post-surgical swelling and pain
• Any other injuries of the musculoskeletal system of the feet and ankle 

For patients suffering from neuropathy, a sometimes-painful condition where the sensory nerves of the feet and ankles loose their ability to feel and often induce pain, MLS can stimulate those damaged nerves and therefore reduce painful symptoms of neuropathy.

This therapy is useful for both acute and chronic conditions. In fact, patients who suffer from the pain of conditions like plantar fasciitis and tendinitis have been able to cancel their scheduled surgeries due to improvement with this therapy. 

Patients who are planning to undergo surgery can benefit from laser therapy by receiving a treatment prior to surgery. This can increase blood flow and decrease inflammation to surgical site prior to surgery.  After your surgical procedure, additional treatments are recommended to reduce post-operative swelling and pain therefore, accelerating healing time, recovery time, and pain.

Frequently Asked Questions:

Does therapy with MLS hurt?

No, patients do not feel pain like sometimes can occur with “hot” lasers, only in rare cases may one feel a slight warmth.

What are the side effects?

There are no known side effects of MLS laser therapy. Laser therapy was FDA cleared in 2002 and is currently used by numerous professional sports teams and organizations including the Dallas Cowboys.

Are there any contraindications to MLS laser therapy?

There are a few but they are not commonly encountered.  They are as follows:

• Children with open growth plates
• Patient who are HIV positive
• Patients taking anticoagulants (general contraindication)
• Patients currently taking medications that makes the skin sensitive to light
• Patients with previous or current cancerous lesion(s) in the treated area

What are the advantages of MLS therapy?

• This treatment offers a nonsurgical approach
• No known side effects
• No need for prescription or over the counter medication
• Rapid relief of symptoms 
• Provides a nonsurgical option for chronic or nonhealing conditions

How long does MLS last?

For patients with conditions like arthritis, which is degenerative in nature, repeat treatments may be quired every 4-6 weeks to keep the inflammation and pain at bay. With that being said, the increased activity arthritic patients experience with this treatment can be a game changer for those that have been sidelined by arthritis.

Patients who suffer from neuropathy secondary to Diabetes have also found relief with this treatment.  Because neuropathy is a chronic condition, after initial treatment regimen, maintenance treatment will be needed to maintain improvement each month. Strict control of aggravating factors like glucose control can also help maintain improvement and prevent worsening progression of neuropathy symptoms.

How many treatments will I need?

Patients in acute pain or needing surgery will have 6 treatments. Those with more chronic pain will require 10 treatments. Treatments are given three times a week until completed. Surgery patients should expect to get one treatment several days before surgery to help reduce inflammation and increase blood flow, and then receive the remaining five treatments following surgery. 

How do I schedule MLS therapy?

Give FAANT a call at 817-416-6155 and schedule an appointment with one of our physicians. During that visit your condition will be evaluated, appropriate clinical treatment and a determination if MLS is right for you will be made together.

We look forward to seeing you and helping you on the road to recovery with this revolutionary treatment.

First and foremost, the phrase "barefoot and pregnant" should never apply! You may have loved walking around barefoot pre-pregnancy, but it is definitely not advised once you find out you are expecting. The bigger the baby gets, the more strain you get on every part of your body, even more so for your feet. This can cause foot pain to set in sooner rather than later. I want to save you from some of the excruciating foot pain many postpartum mothers feel while limping towards their newborn because they did not know foot pain before pregnancy so they didn't think they would get it during or after pregnancy. Time to be proactive!

Avoiding going barefoot is an essential "first step"! Wearing a good arch support in a good quality shoe is super important in supporting the foot by taking the pressure off of those supporting bones, tendons, ligaments, joints, and muscles. If your feet are already achy, the most natural method to soothe your ache are ice and/or heat soaks, a menthol or arnica based topical anti-inflammatory, rest, and elevation. All are safe for baby and great for your feet! A good foot massage is also equally good! 

I know these tips will help give all future mothers relief to their feet and in knowing they may have one less thing to worry about!

• Allergic reaction
• Fungal infections
• Dyshidrotic eczema
• Chemical exposure
• Frost bite
• Bacterial infection
• Excessive moisture or perspiration
• Clogged sweat pores
• Insect bites

Diagnosing the cause of the blisters is the most important aspect of treating them. Again, ill-fitting shoes are the usual culprit for forming blisters on your feet especially when they’re too tight or too loose. Not every shoe is going to fit every person’s feet perfectly either, as we all have different foot shapes and bony prominences that can rub on the shoe. Make sure when purchasing a pair of shoes, you walk around with them in the store sufficiently to know how they are going to feel. Have the salesperson measure your feet and watch you walk to check for any slipping or excessive tightness.

Another important contributor to blister formation is excessive moisture or perspiration. This most commonly occurs in runners especially in the spring and summer months. Wearing moisture wicking socks such as running socks and using special moisture wicking inserts in your shoes can be a simple way of keeping your feet dry and keeping blisters from forming. The good news is that blisters caused by friction are usually resolved within a few days once the cause is found.

Knowing what to do when a blister develops is important to keep the problem from getting worse. First, allow the blister to heal on its own. Don’t be tempted to pop the blister as this can create an open wound and lead to an infection which could require antibiotics to treat. Specially made pads or cushions can also be placed on the bottom of the feet to off-load blistered areas while they heel. Cooling techniques such as cold compresses or cool baths can also be used to alleviate discomfort and help the blisters heel faster. Some cooling gels like aloe vera can be useful, especially if the cause is from sunburn, however placing any oil-based gels like petroleum jelly over blistered areas should be avoided as this can occlude them and trap heat within the blister. Corticosteroids can be applied to blistered areas; this is especially useful if the cause is allergic reaction, eczema, or contact dermatitis but a consult with a physician is advised prior to using topical or oral steroids. If the root cause is fungal or bacterial infection, an antibiotic might need to be prescribed by your doctor for the issue to resolve.

In summary blisters can form from many different causes and may require a variety of treatments to resolve. If you are having issues with blisters, and aren’t sure what to do, we are trained and experienced to help resolve your issues and provide relief no matter the cause!

Injuries that haven't healed with time and now face the possibility of surgery is a big concern of any patient.

I specialize in non-operative regenerative medicine and now can give you what your body needs to help heal, by using a great biologic called "Exosomes". I am pleased with what exosomes can do for my patients regardless of whether their injury is acute or chronic! 

Many times, the reason your body does not heal an injury is because there's not enough of what your cells need to heal it. Exosomes are essentially the messengers that carry proteins and make effective pathways for communication between cells to help facilitate healing.  By doing so, they jump start a whole new level of natural healing for injured tissues. The exosomes come from the tissue of the umbilical cord donated by consenting, post-partum mothers after full-term delivery of their healthy baby. What makes exosomes so special is that it is super concentrated in what makes our own older cells regenerate the younger cells needed to heal our bodies. This neutral biologic is also special in that it does not have the antigens that can cause tissue rejection, so rejection/allergy is rarely, if ever, seen. This product contains no stem cells.  Its magic comes from its ability to signal our own cells to create them to speed healing. Stem cells are concentrated in the growth factors and other nutrients to help activate and stimulate the cells in the damaged areas to regenerate and heal damaged tissues.  Exosomes also have anti-inflammatory effects on top of their healing properties!  At Foot and Ankle Associates of North Texas, we obtain our exosomes from the only exosome lab that has a master file with the FDA, with double the concentration of any other exosome products available, and is formulated at a 20 billion per milliliter solution. I perform this simple injection in the office and there is very little to no down time. By offering your body an opportunity to heal itself, exosomes can make all the difference for you too! 

Common conditions that predispose people to developing skin fissures are:

• Diabetes
• Eczema
• Psoriasis
• Fungal infections
• Nutritional deficiencies
• Peripheral Vascular Disease
• Dehydration
• Obesity

Knowing what to look for in relation to skin fissures can help avoid more serious complications in at risk patient such as diabetics and those with vascular disease. Catching a skin fissure early makes it dramatically easier to treat.

                See a Doctor for you skin fissure if you notice any of the associated signs:

• Pain while walking or standing
• Bleeding from the fissure
• Signs of infection such as swelling, redness or drainage
• Thick discolored, often dark, hardened skin around the fissure
• A crack in the skin that doesn’t resolve on its own after one week

Although some people are prone to the development of skin fissures on their feet because of underlying conditions there are still things that can be done to avoid or decrease the chance of forming them. The best form of treatment is to keep the cracks from occurring in the first place.

• Check feet daily. At the first sign of cracking apply moisturizing cream 2-3 times per day.
• A pumice stone can be used to gently scrub the hardened skin prior to applying cream.
• Wearing gel heel socks is a great way to continuously add moisture to your heels all day.
• Avoid wearing open backed shoes and sandals.
• Stay hydrated.
• Avoid prolonged standing, especially on hard surfaces

Deeper skin fissures or those that do not resolve on their own within a week, especially for at risk patients, need to be treated by a medical professional to avoid any serious complications. If you have concerns about dry, cracked feet, the doctors at Foot and Ankle Associates at North Texas (FAANT) are experienced in treating skin fissures and have helped many patients resolve this condition!

With travel on the rise, it is easy to say we are all eager to either get our toes in the sand, hike to the top of a mountain, or even trek through an amusement park. With any vacation, the choice of shoes is always paramount to not having a trip ruined with constant pain with every step. Here are four recommendations for being prepared for a perfect vacation free of foot pain. 

1. Wear your new shoes before your trip.
   • Vacation dreams often lead to wanting to buy new shoes for the experience, whether for comfort or style. A very common mistake is wearing these new shoes for the first time on vacation. Your feet begin to hurt, and you’re not near your suitcase to change into something more comfortable requiring you to suffer throughout the rest of your day. This can be very costly and can result in an injury that you will now have to suffer through the rest of your trip. To avoid this, wear your new shoes for a few hours around the house to essentially “test” that they will be adequate for your trip. This will also allow you to break them in ensuring that they will be ready for your vacation plans.
2. Pack your tennis shoes – Always! 
   • Let’s say your new shoes still betrayed you and you now are in constant pain on your trip. The worst case is to not have a good pair of tennis shoes that you know give you the best support. Even a single day wearing something supportive could be the difference of resolving your foot pain or making your pain even worse. 
3. Flip Flop Choices
   • Vacation and flip flops almost always go hand-in-hand. While they aren’t the most supportive shoes, they do have a place of convenience and comfort almost everyone enjoys. When choosing the right pair of flip flops for your trip, always be sure to find a pair that provide arch support and the appropriate straps that do not cause rubbing. The same rule applies to breaking in your flip flops at home.
4. Recently Injured? Don’t forget to continue your treatment.
   • When injuries happen before a vacation time, it can make planning activities difficult. It also leads to people wanting to take a vacation from the care needed to improve their condition. If you are in a walking boot, it is important to remain compliant. More importantly, if you were recently in a walking boot and are going to be vastly increasing your activity, bring your boot with you. The loss of packing space in your suitcase will be greatly appreciated if your injury were to recur. Lastly, if you are currently undergoing stretching, strapping, or icing therapy, continue this on your trip. 

We all deserve a wonderful vacation free of foot pain and full of relaxation. If you have any questions regarding foot care or proper shoe selection, please contact us at Foot and Ankle Associates of North Texas today!

There are many symptoms you might find when your kid has calcaneal apophysitis. The most common is again pain with increased activity. You might notice as your kid starts playing that they start limping. They complain of pain to the heel area and pain all around the side of the heel. When the heel is squeezed the patient will complain of increased pain. Swelling can also occur at the site of the heel. This can cause kids to want to sit out activities or not play with others. You may notice your kid will start walking on their toes to alleviate the pressure.  Poor shoe gear or fatigued shoe gear can increase this stress to the growth plate and exacerbate the problem. It is very important to make sure your kid is in the correct shoe gear and the shoes are not fatigued. There are many treatment options for calcaneal apophysitis but inserts that go in your kid's shoes are very important. These inserts are going to lessen the load to the heel and give the foot the appropriate support. Many kids will over pronate or over supinate when they walk. These abnormal motions can again cause increase in stress to the area so the more we can control these motions with orthotics then the less likely pain will occur.

Apophysitis can last for months with active kids. Reducing the kid's activity and giving the heel as much rest as possible can greatly improve the condition. Icing the area reduces the inflammation and is a mainstay treatment along with an anti-inflammatory to reduce the inflammation. The patient should avoid trying to go barefoot and stay in a good supportive shoe as much as possible. Although most kids stretch before a game or practice, kids should routinely stretch three times a day if they are affected by apophysitis. Physical therapy is commonly used to aid in the recovery of apophysitis and can be a very valuable tool in your kid's recovery. In severe cases some kids will have to be completely immobilized in a walking boot or sometimes will even have to put in a cast with crutches. Apophysitis can reoccur so we need to make sure our kids stay in the right shoes, have appropriate inserts in the shoes, and continue to stretch to avoid this condition.

With the holidays finally here, from last year to now, many of us are looking forward to making up for lost times. While I am also in that boat, dealing with an injury to your foot or ankle would ruin anyone’s exciting holiday plans. Here are some tips to keep your feet moving as much as you plan to!

• Moisturize! With weather changing, dry and cracking skin can make for some misery. I recommend an unscented cream. Scented lotions or creams can occasionally cause skin irritation, and some contain certain chemicals that make those ingredients easier to absorb into the skin. Creams rather than lotions also tend to be a better moisture replacement during drier and colder weather. If lotion is still what you prefer, use it right after the shower and turn to creams when the skin is dry.
• Choose the right shoes. With holiday parties and events, the right shoe can make the difference of no pain for all of that standing versus a possible injury to your heel or stress injuries. If high heels are what you prefer, aim to wear heels with a wide base such as a wedge. The skinnier the heel, the more pressure put on your feet. Another great tip is if the shoes you chose are some you’ve never worn before, break them in by wearing them around your roofing and turf based home.
• Aftercare for after the party. Recovery after wearing shoes and standing for long hours is important and can be the difference in an injury getting worse. A good pair of orthopedic slippers instead of barefoot is a great place to start. Warm foot soaks with Epsom salts at the end of a day is also a very good way to control swelling. 

We’ve all learned the value of spending time with friends and loved ones, so remember to have fun, wear supportive shoes, and have a very Happy Holidays from FAANT.

The exact cause of developing lipomas is unknown, but a strong family history can be a precursor. Lipomas in most cases are not painful although they can be unsightly as they cause a large bump. In some cases, they can cause pain due to the bump rubbing and irritating the skin or the nerves around the tumor. Treatment options for the lipoma are pretty simple: remove the lipoma. This is a small surgical procedure with very little complications. Developing multiple lipomas in areas of the body can be a sign of other medical conditions. If you are experiencing a condition that may be similar to this in your foot or ankle, please don't hesitate to give us a call at Foot and Ankle Associates of North Texas.

As an expert in regenerative medicine, I can tell you that this form of therapy offers your body an opportunity to heal itself.  It really has revolutionized the way I think about both acute and chronic injuries.  In the world of regenerative medicine, there is still hope for people with Achilles tendinosis. I'm specifically speaking about umbilical cord allograft tissue derived "Exosomes" which, in their injected form, has been used for years to treat injuries, due to its anti-inflammatory effect and healing properties.  Exosomes, obtained from the umbilical cord tissue of healthy, post-partum consenting mothers, are the messengers that carry proteins and make effective pathways for communication between cells to help facilitate healing.  Our older cells recieve these exosome given proteins and messages, and replicate into younger healthier cells which, in turn, accelerate the repair and regeneration of aging and/ or damaged tissues. FAANT obtains their exosomes from the only exosome lab that has a master file with the FDA, with double the concentration of any other exosome products available, and is formulated at a 20 billion per milliliter solution. This thicker fluid is dense in everything your Achilles tendon needs to help the tendon heal without surgery to step up healing to a whole new level!  If you are suffering from Achilles tendonitis, please do not hesitate a visit to get your healing started!

If you have ever viewed foot x-ray films with a patient one of the most common questions patients or their parents will ask is: what are those two little bones under my big toe joint? Those two little bones - the sesamoid bones - may appear very insignificant, but can become very painful, especially in pediatric patients.

Children are more active than ever in sports, and the repetitive stress on the developing sesamoids can lead to debilitating pain.  Sesamoids can experience over 3 times a person’s body weight during activity.  Sports that require athletes to wear cleats are the most common sports to cause pain with these bones due to repeated stress along with the thin, poorly padded insoles/cleats. 

Podiatric evaluation always begins with x-rays. The following physical exam helps narrow the diagnosis to one of the four following conditions.

• Sesamoiditis: The most common condition is sesamoiditis, or simple inflammation of the bone itself. Clinical examination will find pain on direct pressure and pain with elevation of the great toe. X-rays will be taken to confirm the diagnosis. Treatment includes rest, ice, decreased activity, anti-inflammatories, special padding or inserts that reduce pressure to the painful area, and sometimes physical therapy. This condition is very common in high arched individuals. In severe cases, immobilization may be required, either in a post-operative shoe or cast in individuals who are not responding to more conservative therapy.
• Stress Fractures: The second most common condition are stress fractures. This is a repetitive stress injury and treatment is the same as sesamoiditis with addition of flat soled shoe and abstaining from physical activity.
• Fractures: Fractures are the most commonly misdiagnosed condition because of the propensity of the sesamoid bones to be in two pieces (bipartite) or three pieces (tripartite) from birth.  An easy way to determine if a fracture has occurred in comparing with films of the healthy opposite.  Fractures tend to have a different appearance than normal sesamoids.
  • Treatment requires immobilization in a boot or cast to allow for bone to heal appropriately.  Basic RICE therapy is implemented (rest, Ice, compression elevation) and physical therapy is used around 6-8 weeks after injury.  Healing can take several months, or never at all due to poor blood flow to this bone.  If the bone does not heal it may need to be surgically removed, so rest is tantamount to healing.
• Avascular Necrosis (AVN):  Either due to chronic repetitive stress or a previous fracture, blood flow can be lost to sesamoid bone.  MRI is utilized confirm this diagnosis. This condition typically requires surgery, with either drilling of bone to increase blood flow with the addition of injectable blood platelets, amniotic fluid derived stem cells, or possible removal.  Removal of the sesamoid bones is avoided when possible due to the risk of instability within the joint that can occur. 

Sesamoid pain in youth should be treated aggressively and early by a podiatrist in order to prevent progression to chronic pain or the need for surgical intervention.  Treatment can take anywhere from several weeks to several months, especially if a fracture or AVN has occurred. 

If pain is noted early, treatment with conservative measures is of utmost importance followed by special padding or orthotics to reduce the risk of recurrence and keep those kids out on the field.

Facts:

• Sesamoids begin to ossify at around 8 years of age and completely ossify by age 10.
• The tibial and fibular sesamoid can experience 5 times body weight when running.
• About 25% of patients will have a sesamoid that are in 2, 3 or more pieces.  This is commonly misdiagnosed as fracture.  An x-ray of the opposite foot can help rule out a fracture.

Plantar warts begin after a minor trauma to the foot that allows the HPV into the skin. Typically, surfaces that cause infection are those that are frequently trafficked barefoot by others who are already infected, like the pool or locker room. The number one risk factor of acquiring warts is having someone else in the same household who is infected. 

Once the virus enters the skin, usually through a traumatized part of the skin, it begins to create some very typical changes to skin that aid in diagnosis. Before a diagnosis can be made, usually trimming of skin with is scalpel is required.

Diagnostic Characteristics

1. Pinpoint petechiae – these thrombosed capillaries look like black pepper spots
2. Interruption of skin lines – normal skin lines typically go around, not through the lesion
3. Painful with side-to-side pressure – pinching creates more pain than direct pressure

Podiatrists have many options for in-office treatment. Depending on size and treatment choice, care may require numerous treatments. 

Treatment

1. Freezing – has limited use on the bottom of the foot due to the thick plantar skin that protects lesion, and if used normally requires numerous treatments
2. Salicylic acid – application to wart helps exfoliate epidermal layers of skin, requires frequent treatment and removal of skin with pumice stone.
3. Cantharadin – Thank God for the blister beetle! Cantharadin is a beetle’s venom and causes the wart to blister which is then trimmed away at return appointment. Kids love to hear about this one, but the days following treatment can be very tender.  
4. Bleomycin – “Bleo” is one of the big guns - literally! This chemotherapeutic agent is injected into the lesion with an air gun and causes wart to blacken and fall off.
5. Surgical removal – most warts can be removed by trimming the lesion away from the underlying skin layer. Of course this requires an anesthetic injection, and is usually used for warts that do not respond to other treatments.

Prevention

This is probably the only time you will hear a podiatrist say this, “Wear flips flops.”  These shoes are designed for pool decks and locker rooms so kids should use them when in these situations. Appropriate, breathable socks and shoes also reduce risk for those children with sweaty feet.

At Foot and Ankle Associates of North Texas we try to select the most appropriate therapy, taking into account the patient age, comfort level, and previous therapies. Let us help you help your patients shed that pesky HPV. 

Interesting Wart Facts:

• roof based Home remedies, over-the-counter (OTC) and prescription foot drying agents can reduce sweating and wart recurrence.
• It is rumored that a wrestling coach who was trying to prevent spread of warts between athletes discovered that duct tape can cure some warts, unfortunately it takes a very long time and daily applications, with no guarantee of resolution. 
• Left untreated, warts can spread rapidly and can require surgical excision in an operating room.

​​Leneva is a sterile, FDA approved, natural, hypoallergenic, aseptic, minimally invasive in-office tissue graft injection performed under local anesthetic that allows your body to create fat in the area it is injected. Your body cannot grow its own fat padding without Leneva. Once Leneva is injected into areas under and around your callus, it acts like a honeycomb grid of sorts providing all the growth factors and proteins that your body needs. Your body uses these growth factors and proteins to recreate and reconstruct the fat padding (adipose tissue) in pressure areas where it has been damaged. The adipose tissue that you've created fills the honeycomb framework and remains where it has been created to provide much needed relief! 

2. Can anyone get a Leneva injection?

Leneva does not have any contraindications, therefore most patients in need are good candidates.

3. What does injecting Leneva under and around my callus do? 

Pressure and friction form calluses. The purpose of Leneva is to decrease the friction and pressure forming the callus by increasing the fat padding in that area. Where there is less pressure and friction, there is less or no callus.  

4. Will I still be able to feel the callus after the injection?

The goal of a Leneva injection is to minimize and hopefully completely eliminate the callus so that it is not felt. 

5. How much pain will I be in during and after the injection? 

I will anesthetize the area as much as I can before the injection with a local anesthetic and I use a less traumatic needle to minimize the risk of trauma to the skin.  Tenderness at the injection site after Leneva is expected once the local anesthetic wears off a few hours later, but the pain is usually controlled with over-the-counter anti-inflammatories.

6. Are there multiple injection points around the callus?

The quick answer is “No.”  I ideally want to inject Leneva through one injection. However, if the callus is very large, more than one injection may be needed. I will inform you of that ahead of time during a pre-Leneva visit. 

7. How many Leneva injections are needed?

If the area is small with mild damage, one injection should be enough. I will have a better idea after evaluating the area as this could change depending on the size of the area involved, how damaged the area is, and the amount of pressure it gets on a daily basis. The area is evaluated over the course of 12 weeks as your body makes the fat padding.

8. How long will I have to be off the area injected?

Ideally 2 weeks and it could be more or less than that depending on my patients’ weight, occupation etc. I do pad the area around the injection and place the foot in a special shoe to allow for some weight bearing while the adipose (fat padding tissue) develops.

9. How long will Leneva last?

Like all the padding around the feet, over time it will wear down just depending on your weight, the choice of shoe wear, the amount of time spent on your feet, and the activities you choose to do on them.

Cause:

The causes of OA are related to how much physical activity we partake in and what type of demands are placed on the joints. People who are very active in sports are more prone to this condition due to the excessive demand placed on the joints. Occupations that require bending, kneeling, squatting, or strenuous labor also have a higher incidence of OA. One of the most common factors that increase joint wear is excess body weight, which places tremendous pressure on the joint.   

The wear and tear that causes this condition involves the cartilage that lines our joints. The cartilage functions as a buffer between the bones on opposing edges of our joints. When cartilage is damaged either from injury or excessive activity, the bones are allowed to rub together leading to the painful symptoms of arthritis. 

Symptoms:

Symptoms are usually pain, swelling, and stiffness in joints. Stiffness occurs after long periods of rest and pain can also worsen after long periods of activity. Common foot conditions which can lead to arthritis include chronic ankle sprains, bunions, hammertoes, and foot and ankle fractures.

Diagnosis:

Diagnosis of OA is based upon patient history of stiffness, pain, and swelling as well as the character of joint motion. You shouldn’t hear or feel cracking with movement. The presence of deformities like hammertoes and bunions can also lead to arthritis if left untreated. OA typically affects only a few joints, while pain from other arthritides usually affects multiple joints. X-rays will also be taken to evaluate the extent of joint damage. 

Treatment:

Initial treatment for mild arthritis of the foot and ankle includes oral anti-inflammatories like Ibuprofen and Naproxen. Over-the-counter supplements like chondroitin and glucosamine can help lubricate larger joints and improve cartilage function. Appropriate shoe gear and over the counter inserts can help reduce painful motion. In more severe cases of arthritis, physical therapy may be required to loosen stiff joints and reduce pain. 

Sometimes, when anti-inflammatories are not helpful, custom orthotics that control painful motion may be recommended. Acute flare-ups of arthritis can occur and sometimes an injection into the joint with a steroid (cortisone) is indicated to reduce swelling, pain, and inflammation. In severe cases special shoes or braces may be needed. When conservative measures are not helpful, sometimes surgery is indicated. 

Surgery for arthrities in the foot can include:

1. Arthroplasties – most common for arthritis in hammered toes.  Involves removing a portion of the joint to eliminate bone on bone wear.
2. Arthroplasty with implantation – implants in the foot are most commonly used at the great toe joint.  This involved removing one or both sides of damaged joint and replacing with a metal or synthetic polymer to reduce pain and return to normal joint motion.
3. Arthrodesis – Common for hammertoes and severe great toe joint pain.  Involves fusing the affected joint to eliminate pain from motion.  Saved for severe arthritis.
4. Arthroscopy- Utilized primarily in the ankle.  Allows surgeon to remove spurring of joints, dead devitalized cartilage, and inflamed tissue.  Areas of cartilage damage can also be stimulated to begin repair by removing nonviable tissue.
5. Exostectomy – literally means removal of spur.  Sometimes arthritis stimulates excessive bone formation which can lead to pain if pressure occurs from toes or shoe gear. 

As much as you want to say "not me!", when it comes to OA almost all of us will develop some form of this condition somewhere in our bodies if we live long enough. The painful symptoms of OA can be treated. Come see us at FAANT for an evaluation if you suffer from painful, stiff, and achy feet.

I spent the summer hiking with family (yes that is my muddy foot!) and gave gratitude for the things I packed to keep my feet happy trudging through the mud, rocks and streams. I thought I would share some packing list essentials worth making room for in your suitcase!

1. A good pair of hiking shoes are essential! Don't just settle for a pair of athletic shoes. And definitely no flip flops on hiking trails! Watching people struggle on muddy trails was sometimes funny (what were they thinking?!) but mostly cringe-worthy! Look for stiff-bottomed and preferably waterproof hiking shoes. Wet or muddy feet set you up for blisters which do not make for fun hiking when to have miles to go. If you have unstable or arthritic ankles, pick a hiking boot that ride a little higher than the ankle.
2. Wear proper socks. Hiking socks are the best option because they are extra-padded in pressure points, and they are also sweat-wicking. Honestly any good sweat wicking sport sock with the reinforced toe and heel it's better than a plain cotton one. 
3. Bring Body Glide! This is a popular item at our Healthy Steps store and it is great to preventing chafing and blistering. You can use it on the lumps and bumps on your toes and feet that tend to get irritated when wearing an enclosed shoe.
4. If your trails are flat and well paved, you may not need this, but if you enjoy more challenging hikes, bring a walking stick! A walking stick can help keep you from wiping out!  I can't tell you how many times it saved me from a slippery rock disaster!
5. A first aid kit needs no explanation!

Happy Hiking y'all!

Anatomy of the Ankle

The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down. The three bones are the tibia and fibula in the leg, and the talus in the foot. During an ankle injury, the ligaments that stabilize this joint are designed to prevent dislocation of the joint. Unfortunately, during the rapid motion that occurs during high velocity injuries, these ligaments can fail or in more severe cases, the bones themselves can fracture. 

Types of Ankle Fractures:

• Avulsion - In an avulsion injury, the attachment of the ligament pulls a small chip of bone away. In these more minor injuries, treatment includes immobilization in a boot or cast. Immobilization may be required anywhere from 4-8 weeks in a healthy patient.

 
Avulsion fracture of the fibula - seen at the tip of bone on the right

• Nondisplaced Fracture - In a nondisplaced fracture, the bone fracture fragments are in good position and should heal without surgery. Casting in a below the knee cast will be needed for 6-8 weeks, followed by walking in a walking boot for several more weeks, along with physical therapy to regain strength. Return to physical activities usually takes 3-4 months.

Nondisplaced fracture of the fibula - see on the right

• Displaced Fracture - In more severe injuries where fracture fragments are displaced or multiple fractures have occurred, surgical repair is required. If surgery is not performed, bones will not heal in the appropriate alignment, or they may not heal at all, and chronic arthritis and pain will develop. If a more severe injury has occurred immediate surgical repair may be required, especially if there is exposed bone. Typically, ankle fractures do not present to the office or Emergency Room immediately. Delayed presentation of fracture allows excessive swelling to occur, making surgical closure of skin difficult. Generally, if swelling is noted, your surgeon may wait several days to weeks until swelling has subsided before attempting correction. 

Displaced fibular fracture - seen on the right

Surgery for Ankle Fractures

Patients will have general anesthesia for this procedure and a nerve block for pain control after they are asleep. Depending on the complexity of the fracture, surgery usually takes about 45 minutes to 2 hours. Surgery will include the use of plates and screws to fixate the fracture or possibly external fixation with wires and rings in more complex fractures. 

Patients are typically able to go home about an hour after surgery, in a non weight bearing cast or splint. Patients will then ice, elevate, use crutches and take pain medication as prescribed by their surgeon. Pain typically is rated 3 out of 10 while at rest if all post-operative instruction are followed, and pain often reduces in several days enough where oral medication can be used and you are sent home.

A below the knee cast or splint, stays in place for about 2-4 weeks, sometimes up to 6-8 weeks in a cast if severe injury has occurred, or delayed healing is noted on x-rays, but most patient experience the former. Patients will transition into a walking boot after the cast is removed and begin physical therapy until about weeks 8 after surgery, at which time slow return to normalcy begins. Normal physical activities can typically be resumed in about 3 months after surgery. 

If you have suffered an ankle injury, contact FAANT to be seen by a physician as soon as possible! A visit to the ER will result in a costly bill, and a referral to see us after for follow-up care, so cut out the middle man and get started on the road to recovery! Delaying treatment will only lead to prolonged pain and poorer outcomes.

When it comes to performance on the football field, the cleats you choose can make a big difference. Having the right equipment during football season is crucial and it starts from the ground up.  Ideally, a football cleat will offer traction, support, and comfort with a lightweight feel. When choosing football cleats, you should start by considering the amount of ankle support needed.

Uppers of football cleats:

• Low cut cleats: The lightest weight of football cleats are worn primarily by skill position players such as wide receivers and cornerbacks.  The lower top allows the ankle to move freely for quicker acceleration and multi-directional movements.
• Mid cut cleats: More supportive of the ankle than low cut cleats but allow for slightly less maneuverability. They are still considered light weight and are often worn by other skill position players such as tight ends, running backs, linebackers, and quarterbacks.
• High top cleats: Typically, the best cleats for lineman because they provide the most ankle support. High top cleats are heavier, but linemen need the extra stability and protection they offer.

The next thing to consider when buying football cleats is cleat type. You can buy either molded cleats or detachable cleats.

• Molded cleats:  The cleats are permanently attached to the shoe which provide traction and more versatility on different football field surfaces.
• Detachable cleats: These have studs that can be changed or replaced. This gives you the option of changing the studs for different weather conditions. Shorter studs are best for playing on dry ground. Longer studs are used on wet ground where they can dig into the ground and give the athlete better traction.

Determining the proper football cleat size is essential to performance and lowering the risk of foot and ankle injuries. A poorly fitting cleat will lead to developing sores and possibly to lingering injuries.  Make sure that your child is properly sized and fitted by a sales associate at the shoe store before you buy the cleat. It is also important to never assume that your child’s cleat size is the same as in their other shoes. Shoes will often fit differently by style and brand. Here are a few tips when being fit for football cleats.  

• Always try your cleats on later in the day and bring your football socks. Since your feet swell throughout the day, it’s best to avoid trying on football cleats first thing in the morning.
• When you are wearing the cleat, feel towards the front toe of the shoe to make sure your longest toe is about half an inch from the end. You will want the forefoot and the heel to fit comfortably snug. 
• Take a good amount of time walking around to make sure the football cleats are both comfortable and flexible. If you notice any pressure or discomfort, try on a different pair of football cleats.

Now that you know what to look for in football cleats your child will be able to maximize their on-field performance while minimizing the risk of injury and unnecessary discomfort.