Transcription:

Melanie Cole (Host): Minor foot problems such as blisters or cuts can cause complications if left unattended, and even more so, in people with diabetes. Good foot health is essential as your feet serve as the foundation for the rest of your body structure. If your feet are painful or not mechanically sound, this can affect the knees, hips and even the lower back. It’s important to take good care of your feet. The good news is that you can prevent many foot complications with some simple everyday foot care. My guest today is Dr. Joseph Donnelly. He’s a podiatrist affiliated with Lourdes Health System. Welcome to the show. Tell us about some of the most common foot issues that you see every day.

Dr. Joseph Donnelly (Guest): In my practice, I see a lot of diabetics, which we could touch maybe later, but we see a lot of ankle sprains, but just general corns, callouses, painful nails, bunions would be the standard thing that’s seen every day.

Melanie: How important are shoes to these things you're seeing whether it’s bunions or blisters, callouses, any of these things, and what would you like us to avoid, especially women?

Dr. Donnelly: Women in general, I don’t want them to avoid – I like women in high heels – but women shoes are the real cause of most of the problems with women’s pain. Men also get foot pain but not near as much as women, and that’s because they wear shoes with a wider toe box. Women wear shoes that are very narrow in the front and that does tend to cause issues such as callouses. It does make bunions worse and also causes an issue called neuroma.

Melanie: What kind of shoes might be better for us to be wearing?

Dr. Donnelly: In this day and age, more and more people wear running shoes as their everyday attire, whether when they're not at work or even at work. Any shoe that's like a running shoe has a very nice large toe box, so there's no incident for trauma within the shoe. That is difficult to wear though with a dress.

Melanie: It certainly is. Let’s start with foot hygiene because this is our base, but certainly, some of these things can be affected by what we do with our feet to take care of them. What are some of the most important bits of information you have about good foot hygiene?

Dr. Donnelly: Foot hygiene is just like hygiene for the rest of the body. You want to make sure that your feet are always clean. One of the key things with your feet though is inspecting them, whether it’s the top or the bottom – you want to make sure that you're not getting any areas of rubbing from your shoes or you have a foreign body that went into the bottom of your foot. Basically, the other key thing is getting your feet out in the sun, and that helps with preventing fungus that can infiltrate your nails.

Melanie: That’s good information. What about vitamin D? How does that affect foot health?

Dr. Donnelly: Vitamin D’s most important component is maintaining your bone strength, and people that have low vitamin D are more prone to stress fractures. Stress fractures can occur from an athletic activity, but also just from general walking, especially with the amount of people that work on hard concrete floors and tiles floors.

Melanie: What about diabetes? This is certainly a special consideration as diabetics have to take extra care of their feet. What would you like to tell them?

Dr. Donnelly: The biggest thing with diabetics, number one, is to control your blood sugar. Next is following your doctor's order with regards to what your numbers should be, generally around 100 is the number that is going to keep you better. The thing I mentioned before about inspecting your feet is also extremely important in diabetics is they can easily develop problems with the bottom of their foot secondary to neuropathy, which is a change in how the nerves work, and that can lead to injury without the patient even knowing it has occurred.

Melanie: What else should diabetics be aware of? Are there certain shoes you don’t want them to wear? Should they wear shoes not for longer than a certain period of time? What about their toenails? Give us a little bit more.

Dr. Donnelly: The key with diabetics from a shoe gear standpoint is they do not tolerate any type of rubbing, and that can lead to an injury, and the big problem with that is they don't heal very well and they also may not feel this happen whether it's an ingrown nail from a tight shoe or it's an insulin needle that got stuck to the bottom of the foot. The lack of sensation can really lead to further troubles down the road.

Melanie: Let’s talk about some other common foot injuries. People turn their ankle or they have bunions that are starting to really hurt. What do you tell them about when it’s time to seek treatment or to visit a podiatrist and say what do I do about this?

Dr. Donnelly: Of course, as a podiatrist, I think everybody should visit a podiatrist at least once a year just for a general evaluation of how your foot is functioning. The other key thing is everybody should stretch their Achilles tendon, but also stretch their hamstrings, etc. – the same stretching you would hear about from anybody talking about just general overall body health. From the standpoint of a bunion, a bunion basically needs to be surgically corrected when it’s affecting your everyday life. Your everyday life could be whether you can wear the proper shoe or the shoe you want to wear, it can be your inability to walk for exercise because of the pain from the bunion – anything that causes a change to what you want to be able to do is a reason to get it evaluated and possibly even fixed.

Melanie: Let’s get into a few more of these. What about plantar fasciitis? This is a very common but painful debilitating condition that makes you wobbling around in the morning because you can't put weight on it.

Dr. Donnelly: Plantar fasciitis goes right back to the stretching, stretching your Achilles tendon every day is the easiest way to prevent to developing plantar fasciitis. From a standpoint of treating it, that would include stretching, a good supportive shoe, we know do regenerative medicine and inject amniotic stem cells to the plantar fascia, allowing it to heal where the injury occurs, sometimes orthotics are needed. But as you mentioned, it is a problem. It's probably the number one thing I see in my practice from all my sports medicine days.

Melanie: You mentioned orthotics. Nowadays at good running shoe stores and all over, you can see Spankos and these packaged orthotics. Do you feel that these are good if someone is suffering from arch pain or plantar fasciitis? Can they use those or do they need to go have one professionally made?

Dr. Donnelly: I equate it to eyeglasses. Some people can buy an over the counter magnifying glass and that helps them fine with their reading, but if they have a real issue such as near sighted, far sighted, astigmatism, then they need a prescription glass. That's the same as an orthotic. General arch support may help most people, but with people that have significant problems, and basically every runner, anybody who’s spending 8-12 hours on their foot each day, they would really benefit from a custom-made orthotic because it's not just an arch support; it actually controls how your foot functions and allows it to function in its most efficient way.

Melanie: We have time for a few more of these. What about our toenails? What's the best way to keep these clean and cut? Do we cut the cuticles? What do you do with your toenails?

Dr. Donnelly: You should never cut the cuticles, just like your mom said when you were young. From the standpoint of your nail, just general nail care, cutting them straight across is the way they should be cut. You should never dig into the sides. The idea of cutting a V into the nail to prevent it from causing an ingrown nail is an old wives’ tale as is the use of vinegar for fungus, bleach for fungus – all those things destroy the skin around your nail. Nails should be kept relatively short but not cut back below the distal pulp of the toe or the skin. You should be able to see a little bit of white to the distal portion of your nail at the tip. That should always be there. You shouldn’t be cutting it back. Every time you see that little white portion, you don’t need to cut it. You need to let them grow but not such much that they catch on your sock or your stockings.

Melanie: What about foot odor? Is there anything to be done with that?

Dr. Donnelly: The general thing with foot odor, one, you have teenagers that are going through puberty – that leads to foot odor and that’s mostly hormonal – but from the standpoint of adults, it’s more tied into allowing your shoes to be moist over a period of time. If you have excessive sweating, that allows your shoes to be seeded with bacteria. The same with your socks and your skin. I always recommend washing your foot twice a day, basically with a soap, like a white drying soap, not a soap that you would use on your face, but a soap that’s harsher. And getting out in the air, not wearing socks to sleep at night, not constantly being in shoes – let your feet breath.

Melanie: All of this is such great information and we could really talk about so many conditions, but wrap it up for us with your best advice for good foot health whether you have diabetes or you just want to avoid these injuries or situations that can come up with your feet.

Dr. Donnelly: Stretch your Achilles tendon, pay attention to your feet – don’t just stick them in a shoe and forget about them. Always be aware. Check them. Don’t be afraid to ask questions, go to see your podiatrist, but most of all, just pay attention to them. Don’t neglect them.

Melanie: Thank you so much for being with us today. You're listening to Lourdes Health Talk with Lawrence Health System. For more information, you can go to lourdesnet.org. That’s lourdesnet.org. This is Melanie Cole. Thanks so much for listening.