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Dr. Michael Smith (Host): Summertime is the time when many people wear flip flops or even go barefoot at the beach, but are your feet ready? This is The GW HealthCast. I’m Dr. Mike. We’re going to talk with Dr. Farah Siddiqui and Dr. Nilufar Medhane today. They are both clinical assistant professors of medicine at the GW School of Medicine and Health Sciences and are affiliated with The George Washington University Hospital. Let’s start with you Dr. Siddiqui, what do healthy feet mean to you?

Dr. Farah Siddiqui (Guest): Well healthy feet is just protecting your feet and making sure that, with any season, you’re being able to function and walk without pain and being able to do everything that you want to do in life without having to have chronic pain or having to come see the doctor because you have any ailments in your feet.

Host: And Dr. Medhane, do you believe the same thing or how do you define healthy feet?

Dr. Nilufar Medhane (Guest): Hi, good to be here. Yeah I agree with Dr. Siddiqui, not only pain however is one of our things that we look for during the summertime, but also exposure to the environment and the results of that such as Athlete’s Foot tends to be more common during the warmer months of the year or other infections based on injuries precipitated by walking around in flip flops.

Host: Yeah, I’m going to ask you about the flip flop thing coming up right? Because I live in South Florida and we have a lot of flip flop wearers so I definitely want to get your opinion on that, but I wanted to ask Dr. Siddiqui, so you mentioned some things about what healthy feet is and what maybe – and what unhealthy feet are. When should somebody seek professional help, you know maybe see somebody like yourself? What are some of the things we should be looking for?

Dr. Siddiqui: Well actually we see people for even just for daily, regular maintenance just to make sure that your feet are on the right track, but generally when you have a problem, and you know whether it be a skin or nail ailment like Dr. Medhane was mentioning or something that is actually causing pain if you try to remedy the problem, you try to see if there was a change in something that you did or a shoe that you wore or an increase in activity and you try to remedy it, and it still continues to be a problem, it’s generally a good time to seek professional help.

Host: So Dr. Medhane, what – I want to break this up into kind of skin issues and nail issues that you guys see. So we’ll start with Dr. Medhane, and what are some of the skin issues that you often see and treat?

Dr. Medhane: Well perhaps the most common would be Athlete’s Foot or tinea pedis. As I mentioned previously it’s more common during the warmer summer months, but things along the lines of eczema or dermatitis, which are inflammatory reactions either to allergens or brought on by your own immunity are other things that we see as well. Throughout the year, we as a podiatrist see a lot of things like plantar warts as well as corns and calluses are kind of the more common skin ailments that we see in the feet.

Host: Do you see that because as we get into springtime, summertime that people are looking to wear the flip flops, good or bad, they’re looking to do that. Is that – do you see more people reaching out to you this time of the year because their feet are going to be more exposed?

Dr. Medhane: Yeah certainly vanity comes into play. We come out of the season where we can hide our feet in shoes so once we enter flip flop time, then the skin conditions come out so to say and we’re talking primarily skin right now and that’s when we see patients come in with chronic Athlete’s Foot that has been neglected over the winter months if present and other potential skin issues as well.

Host: Right, right. Dr. Siddiqui, what are some of the toenail issues that you see?

Dr. Siddiqui: Well we see a range of things. The biggest thing is the feet are not protected in a lot of flip flops or sandals so a lot of times you can get any blisters, you can also get ingrown nails, even nail injuries. Also when it gets warmer, people tend to be a little more active so they try to run more. Sometimes that’ll cause the toenail to avulse – come off, basically loosen from the nailbed underneath it. So we see a variety of nail conditions, and we also see going along with Athlete’s Foot, we see fungal nails. So we see a lot of people who, like Dr. Medhane mentioned, who neglected their toenails but now they have to expose them in the summertime and they want those to be treated, and then we also see people do want to show their feet so they go and get pedicures, and so sometimes with pedicures they can result in ingrown nails or ingrown nail infections or even ingrown – even fungal nail infections.

Host: Dr. Medhane, I want to ask you, so you mentioned that a lot of people during the winter months, because their feet are not exposed, maybe they’re not taking care of their feet the way they should and then the summer comes and now it’s a vanity thing right? But what should we be doing? What’s a good foot and nail maintenance strategy that all of us should follow daily?

Dr. Medhane: Generally keeping proper hygiene obviously but also maintaining the proper amount of moisture, meaning over sweating can cause a lot of the issues that we talked about, otherwise known as hyperhidrosis. So maintaining a dry environment in your shoes is perhaps a top most thing. Fungi both those that infect the skin as well as the nail like dark, moist, and warm areas so if we can avoid that, that would be very helpful. That goes along with changing your shoes regularly if you have a lot of already existing fungus, not to wear shoes without socks, which can then infect your – the fungus can then infect your shoes and then you can perpetuate the cycle. When we go to particularly women to nail salons, making sure that the instruments that they use are sterilized or autoclaved to prevent cross contamination from previous clients. Things along those lines, really common sense things but things we tend to forget. Not using other people’s nail instruments to cut your own nails with, don’t wear other people’s shoes, you never know what lurks in other people’s shoes.

Host: Dr. Siddiqui, what do you feel about, I know something that is very popular is to use kind of like those pumice or some of those – like applications, sometimes they’re cream applications where you can get rid of poor skin. What do you feel about that kind of maintenance? Is that good to do? Is it good to use a pumice stone or is there other ways that we can control excess build up of skin?

Dr. Siddiqui: Well definitely daily washing and moisturizing of the feet is the first line of defense and then pumice stones are good actually. They – using them regularly, especially after your skin has been in moisture such as after your shower, after a bath, or even after swimming, is a great time to use it because the skin comes off a lot better. Using things that are sharp such as a razor or they have some files that kind of look like a grater, we tend to avoid those because sometimes they can actually take off a little bit more skin than we would like, and especially if you’re diabetic you definitely want to avoid that. The other things that you mentioned like they have corn and callus removers. There’s a lot of lotions that are directed towards that such as Kerasal and they are actually very good and they have some exfoliants in there too that kind of help take away some of the dead skin, but if there is something like salicylic acid in there, sometimes they have corn removers and even some of the wort removers, but sometimes they have these patches that will take off calluses which are medicated and they have salicylic acid in them, and we generally do not recommend those because they can’t tell between good skin and bad skin and for somebody who may be using them excessively or even a diabetic who has thinner skin, it can actually take off good skin as well and maybe even cause an ulceration, so we want to try to avoid those.

Host: So I’m going to ask both of you guys this question. I live in South Florida, and I’m going to just let you know that I wear flip flops every day, and so does everybody else by the way down here – so what do you guys think about flip flops? Dr. Medhane, you want to start?

Dr. Medhane: There’s a time and a place for it. I mean I’m not going to go out and say you never should wear them, but generally flip flops they’re not good for extensive walking. They do not offer any arch support or heel cushioning or any shock absorption, and you can have foot pain because you are overusing tendons and muscles to sort of grip the ground as the shoe does not provide that stability there which can lead to some sports type injuries. Additionally they are exposed to the environment and it can cause trauma that we spoke of earlier. So it’s not a complete no, but in – with measure one can wear it.

Host: Gotcha, Dr. Siddiqui what do you think?

Dr. Siddiqui: Ok well it’s definitely better than going barefoot because barefoot you have the ultimate risk of sunburns, splinters, stepping on glass or germs, etc, but like Dr. Medhane was saying, it really should only used for limited times such as if you’re walking to the pool or taking a shower in the gym or even walking around the gym or in a public area walking around, but you don’t want to do it for anything that’s extensive and you want to – there’s a lot of companies that are really dedicated to making sandals or flip flops with an arch support built into it, and also with padding and cushioning, and a lot of times we’re under the impression that high heels are bad for you, but flat shoes are actually equally as bad for you, and flat shoes meaning also flip flops. So we lose the arch support, it causes us more stress on the lower back, and it causes more pressure with every step that you take. So with that being said, you want to make sure, if you do want to wear sandals or something like a flip flop, I would seek out comfort shoe companies. There’s a lot of brands, even available mainstream at regular shoe stores that are dedicated to have arch supports built into the shoe and then also a good cushion, and maybe even instead of going completely flat maybe something with a slight wedge or a slight lift in the heel so that you’re not completely having your heel touch the ground.

Host: Great, great advice, I really appreciate that coming from a South Floridian. So I’d like to end this way, in summary Dr. Medhane, what would you like people to know about healthy feet?

Dr. Medhane: Pay attention to your feet. Don’t let things that might appear innocuous go untreated for long periods of time. Pay attention to proper foot care as well as protection, and if you are unsure about something that appears on your feet, please do seek advice.

Host: And Dr. Siddiqui?

Dr. Siddiqui: Yep, just going along with that, daily inspection of your feet is a great way to avoid any problems and just be smart about the type of shoes that you wear. If it doesn’t feel good, most likely it’s not going to be good for your feet. So always try to wear good comfortable shoes that are going to protect you.

Host: That’s Dr. Siddiqui and Dr. Medhane. I want to thank you guys for coming on. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Siddiqui or Dr. Nilufar or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.