“A journey of a thousand miles begins with a single step.”  Lao-tzu from “The Way of Lao-tzu”

Pain in the heel of your foot can be frustrating.  As long as you keep moving the pain stays away, but when you stop for  while and try to get up again it feels like something just stuck you in the foot.  I can assure you that you are not alone.  This is the most common complaint I see at Desert Foot Surgeons.  The official diagnosis is called plantar fasciitis.  What this means is that the muscles in your foot become inflamed where they attach to your heel bone.  Why these muscles become inflamed involves tightness in your Achilles tendon, how your foot reacts when it hits the ground, a change in shoes, activities, or an injury.  Some people can have a heel spur, but the problem is still plantar fasciitis.

The treatment of plantar fasciitis is like building a pyramid.  You must first form a solid foundation at the base and then progress upward.  It’s the base of treatment I want to tell you about today.  The basic treatment of all plantar fasciitis includes three steps:  ice, stretching, and arch support.

Ice:

Remember what I always say to my patients at Desert Foot Surgeons, “You can’t heal until the inflammation is gone.”  I’ve discussed ice in many other posts on this site.  The general rule is apply the ice for 20 minutes and leave the ice off for 40 minutes.  As long as you stay with this basic rule you may repeat as many times as you want.  Some people need to have a sock on their foot in order to tolerate the ice, others do not.  That’s an individual decision and I would say that if in doubt wear a sock.  Ice can be applied in three forms:  the store bought gel pack, ice massage using a small paper cup filled with water and frozen, or a frozen water bottle.  In the case of heel pain the ice bag is placed on the ground and you put your heel on the bag for 20 minutes.  The ice massage gets the cold deeper.  You peel the top edge off the paper cup, turn the exposed ice toward your foot and use the paper cup in your hand to push the ice along the arch and heel of your foot for 20 minutes.  The frozen water bottle is best done before bed.  The bottle is placed on the floor, your put your foot on the bottle and roll through your arch for 20 minutes.

Frozen Water Bottle

Ice Massage

Ice pack

When you have foot surgery, you want your foot to look better immediately.  When that first bandage is removed, I want you to say, “Wow! That looks good.”  Do you think you would be able to say that with a pin sticking out of your foot?

Why do some surgeons still use pins that stick out of your foot?  A bunion is a “deformity”, which means bones have shifted out of position leaving you with a bump or lump behind your big toe.  In order to fix this deformity, bone must be shifted back into position to get rid of the prominence.  The way I shift bone back into position involves cutting the bone at some point, basically the same as saying I am breaking your bone to shift it back into the correct spot.  Broken bones heal fastest when held together using screws, staples, pins, etc.  There are a huge number of options, but just casting your foot is not one of them.

Now the question, would you want a pin sticking out of your skin?  Plain and simple…don’t give me a “maybe” or “if”…no “that depends”.  Would you want to see a pin sticking out of your foot when that first bandage is removed?  My answer would be NO!!  Things are not supposed to be sticking out of your foot.  Everything that belongs in your body is supposed to stay under your skin.

When devices to hold bones together, now called fixation, were first discovered there was no option.  A pin had to be used because it was the only form of fixation available.  But now medical science has advanced.  We have a variety of screws made out of space age metals like titanium, staples made out of nitinol or memometal, plates designed by computer to fit the bones precisely, pins and screws that absorb in your body over time.  It’s my job to make your foot look and feel better.  Why would I leave a pin sticking out of your foot when I have all these options?

At Desert Foot Surgeons, your surgery is done using the most up to date technology and techniques.  You won’t have a pin sticking out of your foot.  I want you to look and feel better as soon as you leave the operating room.  Cosmetic foot surgery is not magic, it just takes attention to detail.  There will be no surprises after your surgery since everything is carefully planned and reviewed with you long before you get to the hospital or surgery center.  This is our “personalized approach” to foot care.  Come to Desert Foot Surgeons and see the difference.

“You can’t heal until the inflammation is gone!”

If you have heard me say this before than you also know that at Desert Foot Surgeons, I recommend using ice, stretching, and Biofreeze as methods to relieve inflammation.  There are pills I prescribe and shots I can give to relieve inflammation as well, but these can be scary to some people.  Let’s face it, there is a movement away from drugs because we are seeing that continued abuse of some of these medications affects your entire body.  Natural methods to relieve inflammation have been around since man first walked on two feet and anything that has stood the test of time that long has to have some merit.

One thing that makes Desert Foot Surgeons different is that I have always been athletic, working out nearly everyday of the week.  Because of this level of activity I get injured just like you.  I understand how hard it is to make inflammation go away with a busy work schedule, kids, and the various other demands on your life.  Still when you are in pain it means there is inflammation and you can’t heal until the inflammation is gone.  There are a ton of methods to relieve inflammation, and I have tried all of them.  Therapeutic massage, yoga, acupuncture, various relaxation methods (if you know me, you know I’m no good at these), you name it I have probably tried it.  I am always looking for massage therapists and yoga studios to recommend for my patients.

What makes me most excited about the new office location on 44th street and Camelback in Phoenix is the friendships I have made in such a short time with other business owners in the area.  I’m happy to tell you about a business I think will be a huge asset to patients at Desert Foot Surgeons.  I have found you a business that contains all of the things I recommend quite often.  Massage, yoga, spa services.

Spa Lamar is located at 5155 N. Scottsdale Road (480.945.7066).  Services at Spa Lamar include the usual spa services such as hair styling, manicures, and pedicures, plus services that I’ve never been able to find under one roof.  Heidi Lamar has been developing her spa for years and with recent expansions has been able to include a yoga studio and massage therapists in her spa among the pool and hot tub, steam room, and dry sauna.  The first Wednesday night of the month, if you bring a friend, you can enjoy live music and snacks to help with that relaxation that I find so difficult.  What’s best is with the pricey resort spas in the same area, Spa Lamar is truly priced for the locals.  You will not get this level of service at a comparable price anywhere in the area.

When you’re in pain don’t forget:  You Can’t Heal Until The Inflammation is Gone!

Have you ever been blamed for something you didn’t do?  How’d that make you feel?  Pretty lousy, huh?  Well it’s time someone said something about the horrible wives’ tale that shoes cause bunions.  I’m just going to put it out there…Shoes do not cause bunions!!!  Never have and never will.  There I’ve said it so let’s get on with it. 

A bunion is a bump or knob on the side of your foot at the base of the big toe.  Look at your foot.  Find your big toenail and work your way down toward your foot.  When you get past the area where your big toe meets your foot look for a bump.  If you see is a lump on the inside of your foot then you have a bunion.  Most often your big toe is leaning toward your second toe and in extreme cases can move under or over the second toe.  The word “bunion” is derived from Italian or Scandinavian, and refers to a knob or bump. 

The question remains, how did that knob get there?  The bunion is not a “growth” of bone, but rather a bone that is not in the right position.  The bone behind your big toe is your 1st metatarsal.  The bump is actually the 1st metatarsal that has moved away from the 2nd metatarsal.  Why does this happen?  Well, the true cause is still debated, but basically something has happened to your foot to cause the 1st metatarsal to move out from the line of your toe.  At a certain point the metatarsal has moved so far that you begin to see a bump and eventually your big toe moves toward the second toe.  The knob that is your first metatarsal can be painful, but most often the joint that is out of alignment is the true source of pain.

Shoes are not the cause!  Think about this…if your foot is unstable (pronated) and you wear a heel, you have just forced your foot to supinate or in other words become more stable.  If the shoe makes your foot more stable how could it cause the bunion?  Now in all honesty the narrow toe of a women’s dress shoe applies more pressure on the bunion and there is more weight on the ball of your foot when wearing heels so the bunion may become painful sooner because of the shoe.  Still it was not the shoe that caused, but rather it was the shoe that brought it to your attention.

At Desert Foot Surgeons a detailed exam of your bunion is performed to find the cause of your unstable foot.  Remember what I say, “It is easier to change your shoes than to change your foot”.  Still many times surgery is needed to correct the bunion.  Does this mean you can go back to heels with pointy toes?  The answer is maybe.  I can’t be more specific because everyone’s feet are different and your ability to heal differs from everyone else as well.  Desert Foot Surgeons has introduced “personalized foot care”, meaning we discuss your wants and desires related to what medical science says is the best treatment option and together we arrive at a plan to get you the best result possible.

Stop blaming your shoes for your bunion, it’s not their fault.  Actually the shoe has brought the problem to your attention sooner than a tennis shoe would have so you can get treatment earlier, which is always better.  See, shoes really are a girls best friend…or is that diamonds?  I’m a podiatrist, I get that mixed up sometimes.

Maybe it’s the sound of the waves or the feel of the sand beneath your feet.  Perhaps the rich colors from beige to blue, green, red, yellow, and pink or the smell of the ocean breeze.  Whatever it is about the beach, people love to run on the sand.

A recent vacation found me running barefoot on the beach.  After a crisp-paced warm up mile on the packed sand splashing as the waves rolled in, my feet began to ache.  Knowing what I know, I quickly altered my running style, which helped until the way back.  By the time I turned and headed back people were enjoying the surf so I was forced onto the soft sand.  Another mile and my legs and feet were cooked.  I reached a level of fatigue I rarely achieve at home.

What is it about running barefoot?

In the media, people seem to be all for it or completely opposed.  There doesn’t seem to be any middle ground.  At Desert Foot Surgeons, it is my job to educate you so that you can make the choice that best fits your needs.  Maybe you want to run barefoot and maybe not.  Let’s talk about it and see what you decide.

First of all, what are the benefits of running barefoot?  I will warn you that this is all theory!  No scientific evidence exists to date supporting these theories.  Running barefoot is said to increase the muscle strength of small (intrinsic) muscles in your foot.  By doing so it is thought that your foot will become more stable with the added strength thus help prevent injury and possibly even deformities such as bunions, hammertoes, and plantar fasciitis.  A study has shown that collegiate female track athletes who trained barefoot suffered fewer injuries.  Similar high level athletes have shown the same results such as volleyball players.

Here’s the catch with running barefoot…

There is a level of genetics involved in becoming a collegiate level athlete.  Of course there are your 5’6” guys who can dunk a basketball and a 5’9” football player who runs a 4 second 40, but for the rest of us we are not fortunate enough to have the same gifts as these people.  I’m not saying hard work and excellent coaching can’t make someone a collegiate athlete, I’m trying to keep the topic real.  A collegiate level track athlete has been coached for years and puts in significant miles with this coach.  These athletes know how to alter there stride length, change posture, modify their arm swing, go from heel strike to toe strike for different reasons.  Even in the famous book, “Born to Run” by Christopher McDougal, he was coached before he could accumulate any distance running barefoot.  So that leaves one question:  do you have a coach?

I’m not going to tell you that running barefoot is good or bad for you, that’s not my job.  My job at Desert Foot Surgeons is to examine your feet sitting, standing, walking, and even running.  With that information I can help you achieve your goals, but it might take some work.  If you want to run barefoot we are going to have to work on some things. Stretching programs, strengthening, balance and running in shoes with or without orthoses might be the first few steps before you ever step out there barefoot.  You might need help from a coach or trainer.  I can get you to the right people.  I don’t want you to be injured and the number of stress fractures in my practice has tripled this past year solely due to barefoot running.  To review injuries while training review my previous blog about marathon training.

“I’ve been to two other doctors for this pain in the ball of my foot and I have to say doc, if you could…you know…skip the needles…maybe…I sure would be happy.”

This is the first thing a lot of patients say to me.  Pain in the toes or ball of the foot is very common, but making the right diagnosis is harder than you might think.  This part of the foot has only one muscle running from outside (little toe side) to inside (big toe side), but there are 7 tendons surrounding each joint, bones, joint capsule, ligaments, nerves, and fat.  Every step you take transfers weight across the ball of your foot as you move forward.  The 3 bones on the inside of your foot move as a unit and the two on the outside are another unit.  Each bone also has motion of it’s own besides the motion of the toe on the metatarsal bone.

Enough of the anatomy lesson, let’s get to the point.  A neuroma is a pinched nerve.  Plain and simple, there is nothing more to it.  The nerve lies in the space between your metatarsals (those are the bones in the ball of your foot) and divides to send a smaller nerve into each side of the two toes in front of it. The nerve gets pinched against a ligament running sideways from one metatarsal to the other.  Easiest way to think of it, the nerve is constantly irritated by pinching against this ligament.  That causes inflammation and then scar.  The longer this keeps happening the scar gets bigger and bigger until there is a lump.  Sometimes you can feel this lump “click” as it rubs against the  ligament,  ouch!!  If your toes are bent upward the nerve is more likely to rub against the ligament so pain is usually worse in heels, going down stairs (you land straight onto the ball of your foot), or hiking up hill.  Why does the nerve get pinched?  There are two reasons.  First, if you have toes that are buckled, bent, sitting on the top of your foot, the nerve is always pressed up against the ligament.  Second, there is abnormal motion between your metatarsal heads (that means an unstable foot).

Treatment for neuroma is: 1.  Relieve inflammation, 2.  Stabilize your foot so the pinching stops, 3.  If all else fails surgery.

1. Every article on this website talks about relieving inflammation.  Do you remember why?  That’s right, because, at Desert Foot Surgeons, I always say, you can’t heal until the inflammation is gone.  Ibuprofen, Naproxen, Celebrex and other pills can be prescribed to fight the inflammation.  Steroid injections can be given if the lump is really big or your pain is just that bad.  The steroid can shrink the scar a little bit. Note:  Sclerosing injections are different from steroid injections.  These use a chemical to destroy the nerve leaving you numb in that area.  Before considering a sclerosing injection seek a second opinion to make sure the diagnosis is correct.
2. The underlying problem causing the pinched nerve is your unstable foot.  Arch supports are a good place to start, but if your foot is hard to control expect me to suggest custom molded foot orthotics.
3. Surgery for neuroma is something that I find controversial.  I have surgically removed very few neuromas throughout my career, while colleagues of mine seem to remove a few each week.  Why do so many doctors surgically remove neuromas?  In my opinion it’s because the orthotics are not made correctly or the diagnosis is wrong.  Remember I’m the doctor seeing the patients who have failed treatment by other physicians, or were deemed too difficult or too sick to treat.  Be cautious when considering surgery for a neuroma.  With that said, surgery consists of either removing the nerve that is damaged by scar or cutting the ligament that the nerve rubs against.  If you’re the type of person who has toes that are buckled, than the treatment is to straighten the toes and not touch the nerve.

So there you have it.  Morton’s neuroma is a pinched nerve in the ball of your foot as the result of you having an unstable foot.  If you relieve inflammation and stabilize your foot using orthotics the pain goes away.  At Desert Foot Surgeons, I have not needed to surgically remove neuromas.  Before you have surgery I would suggest you get another opinion.  The diagnosis might not be correct.  Think about all of the things in that area of your foot.  I will discuss other problems in the ball of the foot in later articles.

I love when art and science come together to make something beautiful.  Wine, food, boats, and skis are just some of my favorite examples.  Custom molded foot orthotics are an area I deal with everyday where art and science collide, but not everyone sees it my way.  In previous articles I have taught you about unstable feet and the related problems.  I have mentioned that orthotics are used to make your feet more stable and treat problems like plantar fasciitis, heel pain, flat feet, pain in the ball of the foot, and neuromas.  I guess it stems from a general lack of understanding or the desperation of being in pain for so long, but lots of people seem to think that an off the shelf arch support is the same as a custom orthotic.

I’m not saying off the shelf inserts do not have their place.  I prescribe off the shelf arch supports for many of my patients.  These are not made to anyone’s foot in particular, and the materials used in construction are less expensive.  For these reasons off the shelf inserts might not work for you.  For one thing they don’t last very long because the materials are weaker and lose their shape sooner.  It is not made to your foot so might not work for your problem depending what that is.  Do some people get better using off the shelf arch supports?  That depends on what’s wrong.  At Desert Foot Surgeons, I exam your feet sitting, standing and walking.  If your foot is easy to control, than an off the shelf insert might help.

Custom orthotics are an art form.  First, I take a mold of your foot using plaster.  It is very important to hold your foot “just right” to capture the true shape of your foot.  The mold is then sent to a laboratory where it is scanned into a computer.  The lab now has a model of your foot.  The technician has to be an artist as well, which is why I only use one lab to make my patient’s orthotics.

Unfortunately art alone won’t make your foot stable.  The science is called biomechanics and takes many years to learn.  The clerk at a shoe store does not have training in biomechanics.  Remember at Desert Foot Surgeons, I examine you walking, standing, and sitting.  I take what I learned during your exam and write a prescription so the orthotic will control your foot.  Based on my prescription, adjustments in the computer image of your foot are made and the orthotic constructed to make your foot stable.

Not everyone treats you like I do at Desert Foot Surgeons.  For one thing, some molds are taken from pushing your foot into a box, onto an image scanner, or standing on a platform.  The problem with these methods is that any pressure on the sole of your foot causes the muscles to spread out and the foot to change shape.  Hence, the orthotic will not match your foot.  A tracing, thermal print, or pressure map of your foot cannot be used to make a custom orthotic because there is no model of your foot.  Standing won’t help, because I am trying to control the way you stand not accept any deformities or imbalances in your foot.

Don’t be fooled:

Have you seen any infomercials where they are selling arch supports?  They always show you how much more stable the person is in the arch support by pushing their arms down.  Here’s the trick.  You can try it at home:

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You will need a partner and a piece of paper.  Keep your partner barefoot and standing with their arms straight out in front of them.  Push their arms down.  It should be pretty easy to move their arms.  Next put the piece of paper under their heels.  Again standing with their arms straight out in front.  You push their arms down.  Wow!! Like magic it is harder to push their arms down.

Unfortunately this is not because your friend is now stable standing on the piece of paper.  This is a physiologic principle called “muscle memory”.  The first time you push your friends arms down, their muscles don’t know what to expect.  The second time the muscles remember what is going to happen and respond more appropriately making it harder to move the arms down.  Notice in the infomercials how they never test their product first, because there is no muscle memory.

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So don’t be fooled!  If the arch support is cheap, it’s not custom made.  If no 3-dimensional model of your foot was made, it’s not custom.  If you were standing while the mold was made the orthotic is custom, it just won’t fit your foot the way I need it to in order to help you.  If no exam was done with you sitting, standing, and walking, then there is no way to write the prescription.  You are paying for custom orthotics.  At Desert Foot Surgeons, that is exactly what you will get.

I love when art and science come together to make something beautiful.  Custom foot orthotics might not look beautiful to you, but being able to create a piece of plastic that can stabilize your foot and relieve pain is pretty beautiful to me.  Let me show you how I combine art and science to fix your feet at Desert Foot Surgeons.

I guess it’s the training I received combined with a dry sense of humor and no nonsense approach that filled my practice with patients other doctors considered too hard to heal.  Because of the level of patient I treat at Desert Foot Surgeons, I take your recovery seriously as should you.  The most prefect surgery can still hurt, swell, and even go horribly wrong if you’re not on the same page as your doctor.  I have many patients who can run a mile in under 6 minutes, but their recovery might not be as fast as a patient who smokes.  If we work together, even patients with diabetes who have sores on their feet can heal.

With that said, recovering from hammertoe surgery is usually not that hard.  You should do a few thins to make sure that your healing experience is the most pleasant possible.  Before your surgery is the most important time.  The more you can do for yourself before surgery, the happier you will be after.  Simple things like preparing meals before hand, practicing walking in your special shoe or boot, and planning for time spent resting your foot.

What room in your home worries me most?

Believe it or not it’s your kitchen.  Those kitchen cabinets have that little ledge at the bottom.  Be careful not to hit your toes against this edge.  The shoe or boot you will be wearing is higher than regular shoes and has grabbed hold of more than one of my patients’ bandages.  That’s a good reason to prepare meals before your surgery, but the real reason is you are recovering from surgery.  You shouldn’t have to cook for yourself.  Give yourself at least a little few meals off to rest and stay off your foot.

Since we’re talking about hammertoe surgery most of you will be allowed to walk, but in a special shoe or boot.  You might not think this is going to be hard, but if you’re weak this can be a challenge.  I can send you to physical therapy before the surgery to be sure you can handle the shoe or boot.  This way you and I know exactly what to expect after surgery.  I can even prescribe a strengthening program for you through physical therapy if you need.

Easier Hammertoe Recovery

Other things that can make your recovery from hammertoe surgery easier include getting your house set.  Firsts of all, do you have stairs?  If walking on flat floors is hard in the shoe or boot, stairs might be impossible.  You might want to sleep downstairs the first few days.  You will need to clear a path to the bathroom.  Think about removing area rugs that can slip and slide out from under foot.  Small tables and chairs can have legs that stick out, which could bump your toe.  Think about the ways you can set up your house to help you recover.  My staff has many more ideas that they will be glad to share with you.

Before surgery we developed a plan to help you heal as fast as possible.  After your surgery you need to stick to the plan.  The game plan we designed together before surgery will be given to you in writing.  Obviously there will be a special shoe or boot and pain medication that you should have before you get to the hospital.  That leaves swelling and pain to discuss.  A toe is small and there is not much room for swelling.  The more your foot is down, the more it will swell.  Since there is so little space in the toe this swelling can hurt.  Both of us want your surgery to be as free of pain as possible.  You will need to rest with your foot up.  That means lie flat on the couch or bed and put your feet on pillows.  Make sure your knees are bent a little so this is more comfortable.  Ice can go behind your knee or at the inside of your ankle to prevent swelling.  The ice should be on 20 minutes and then off for 40 minutes.  This can be repeated as often as needed, but usually no less than 3 times per day for the first 3 days.

I like to prepare before surgery as much as possible.  I tell my residents to review a surgery in their mind 5 times before they even step into the operating room.  If your surgeon prepares before surgery shouldn’t you?  I hope this information shows you how Desert Foot Surgeons helps you heal after hammertoe surgery.  Remember, feet are like snowflakes, no 2 are alike.  Choosing your foot surgeon is very important.  Your surgeon needs to have the training and artistic talent to fix your toe.  Equally as important is your ability to communicate with your surgeon.  Ask questions and prepare before your surgery.  You’ll be glad you did.

“I take longer to heal because I have Diabetes”.

This is a statement many patients coming to see Dr. Geller at Desert Foot Surgeons say their first visit. Unfortunately this is a rumor that makes a convenient excuse. When diabetes is controlled you not only reduce your risk of complications such as heart disease, blindness, and kidney failure, but you heal like anyone else.

One out of ten people you meet in the United States has diabetes. Out of the people you know with diabetes, at least one has developed a hole in their skin known as a foot ulcer. The feet are most affected by loss of feeling and circulation. Diabetic foot ulcers are caused by one or both of these complications. What prolongs healing is poor circulation to your legs and feet or walking on an open sore because there is no pain.

Dr. Geller has a special interest in wound healing. At Desert Foot Surgeons we don’t wait for wounds to heal. Wounds are made to heal by fixing poor circulation, getting your weight off of the wound using total contact casting, and even surgery to correct buckled toes, lumps on feet, or skin grafts to cover the defect. Control of your diabetes and compliance with the plan of care is the patient’s role. Healing diabetic foot ulcerations takes a team and the patient is the major player.

If you have a diabetic foot ulcer and have been told you can’t heal because you have diabetes, come and see Dr. Geller at Desert Foot Surgeons.

Before And After Pictures,

(After)

Before Pictures :
WARNING – Click Here for Graphic Images – WARNING