Archive for August, 2012

Blisters are a result of the abrasion between your skin and sock or shoe. Because they can arise suddenly, it is important to take preventative measures to ensure your foot’s comfort. Preventing blisters begins with well fitting shoes, not too snug yet not too lose. Your socks should be snug fitting and made out of synthetic wicking material and with seams that cause minimal abrasion. Even after taking such precautions, many runners and athletes get blisters. If you find that you are prone to blisters, try regularly applying moisturizer to your feet, as dry skin is prone to friction, leading to blisters. Additionally, you may want to try rubbing your feet with Vaseline before a run if dryness is a problem for you, using foot powders to decrease moisture if your feet sweat too much, or wearing two pairs of socks so that they rub together instead of rubbing against your skin. You podiatrist may also prescribe prescription antiperspirants for more effective drying.

The rule of thumb is to leave small blisters intact so that the outer layer will protect the skin underneath. If you do get a blister on or off the trail, and it is large enough to see fluid inside, the best thing to do is to drain it and avoid it popping during activity. First, wash the affected area with soap and water. Sterilize a needle by rinsing it and soaking it in rubbing alcohol. Do not put the needle in a flame for sterilization as this method can lead to getting infectious carbon bits in your skin. Next, make a hole in the blister and squeeze out the fluid. Avoid removing the skin over a blister, because it provides padding and protection for the new skin growing underneath.  Finally, use hydrogen peroxide to prevent infection and wrap the area with antibiotic ointment and a bandage. You may want to use products like Second Skin or Band-Aid Blister Blocks, or soak your foot in Epsom salts to draw out fluid when you take off the bandages. If you find your blister is emitting yellow or green discharge, swell or reddens, you will want to see your doctor, as it is most likely infected. Additionally, if your blister is under or at the base of the toenail, see your podiatrist for treatment. Home removal of the toenail can cause infections and other complications, but your podiatrist will know how to drill a hole in the nail with an electric file.

Ingrown toenails are one of the most commonly treated ailments. These are nails that are incorrectly shaped, so that they curve and grow into the skin, usually at the sides of the nail. This irritates the skin, causing pain, redness, swelling and warmth in the toe. Your toe may incur an infection if the nail breaks the skin, allowing bacteria to enter and cause an infection (indicated by a foul odor and a discharge of discolored fluids).  Ingrown toenails can be caused by a number of factors. While they are often hereditary, they can be the result of traumatic injuries, improper trimming, poorly fitting footwear, and nail conditions (such as fungal problems).

Home treatment of ingrown toenails should be limited to consistently cutting and filing the nail straight across and soaking the nail in Epsom’s salt. Never cut notches in the nail, do not repeatedly trim the nail borders, and do not place materials (such as cotton) beneath the nail, as all of these methods increase the likelihood of bacterial infection. Over-the-counter topical medications only relieve pain but do not cure the symptoms. “Home surgery” on your ingrown nails is not recommended, since repeated cutting of the nail can cause the condition to worsen over time. If your nail does not improve, visit your podiatrist for a simple procedure. Dr. Chang and Dr. Murray can easily perform a minor surgical procedure. They will take off the small offending border that is causing pain and permanently remove it so that it does not grow back into your skin. Note that they do not remove the entire nail, so this simple procedure can alleviate your pain with minimal recovery time.

Athlete’s foot, officially known as tinea pedis, is a fungal infection between the toes and on the soles of the feet. With this infection the skin on your foot may feel itchy or painful, will have scales redness and blisters. Podiatrists will recommend the applications of a fungicide such as Desenex, Tinactin, Lotrimin or Lamisil. Using these products a few times a day for two weeks to a month will help remedy the irritation and other symptoms. If symptoms reoccur, be sure to rotate the fungicide you use so that the fungus does not build up a tolerance to one brand. You may want to try additional remedies for the itching, such as soaking your feet in a baking soda and water solution, removing the dead skin with a pumice stone, or rubbing fine sandpaper along the bottoms of the feet (and disposing of the sandpaper after use!).

Congratulations to Mark Smith of Team Blue Ridge Foot and Ankle on his FIRST PLACE finish in the Expert class for Blue Ridge Cyclery in The Stampede Mountain Bike Race this past weekend at Devil’s Backbone in Nelson County!


Summer Blog Series: Lesser MTP Joint Pain

August 23rd, 2012 by Dr.Chang

MTP joints, or metatarsal-phalangeal joints, are joints that connect your mid foot to your toes. There are a variety of lesser MTP joint injuries and pain that commonly occur. Capsulitis (also predislocation syndrome) is inflammation in the ligaments surrounding the joint at the base of the second toe that form a “capsule” to help the joint function properly. Capsulitis can occur at the joints of the third and fourth toes as well, and is caused by abnormal foot mechanics, where the ball of the foot beneath the toe joint bears an excessive amount of weight and pressure. Capsulitis is a progressive disorder, so see your podiatrist for an early diagnosis and treatment.

Fifth metatarsal fractures, along the bone on the outside of the foot, are of two more common types: Avulsion Fractures, in which a part of the bone is pulled off from the main part, usually caused by an ankle roll, and a Jones Fracture, which occurs when the area does not receive enough blood, causing difficulties in bone healing. Both fractures will lead to pain, swelling, tenderness, difficulty walking and possible bruising. Your podiatrist will recommend a variety of treatments, including RICE, immobilization, bone stimulation and even surgery in cases with dislocations, multiple breaks or when other treatment fails to improve the injury.

Tailor’s bunion, or a bunionette, is a prominence at the fifth metatarsal bone at the base of the little toe. It is often an inherited trait, is easy for your podiatrist to diagnose, and requires a treatment of shoe modifications, padding, NSAIDs, icing, injection therapy, over the counter or custom made orthotics, and even surgery in severe cases when other treatments fail to improve it.

For all lesser MTP joint pain, contrary to how comforting soft fluffy shoes might seem, wearing rigid shoes with good shock absorption will help the most. Offloading painful joint with a shoe insert appropriate for your injury or condition will help. Shoes like Sketcher’s Shape Ups or Dansko clogs are unforgiving, taking pressure off different parts of the foot. Visit your local podiatrist and shoe salesmen for recommendations!


Summer Blog Series: Iliotibial Band Syndrome

August 21st, 2012 by Dr.Chang

Iliotibial (IT) band syndrome is also a common injury found among female runners and triathletes. The IT band is made up of tissue that runs on the outside of the thigh, from the pelvis to just below the knee. While crucial to stability during activity, its continual abrasion against the top of the femur and the knee can make it inflamed, causing pain in the hip, thigh and/or knee.

Often, using a foam roller and icing can help runners prevent and heal sore IT bands. Stretching is a great preventative measure for IT band pain. Try standing straight up, and bending to the side as far down as is comfortable. Two sets of 15 repetitions on each side should work wonders. Hip flexor exercises can do the trick as well. Kneel on one knee and turn the torso until you feel a stretch on the IT band. Hold this for 5-10 seconds, and repeat 3 times on each side.

Your podiatrist may also suggest physical therapy, orthotics and anti-inflammatory medication.




Walnut Creek Chimney Chase 2012

August 2nd, 2012 by Dr.Chang

Congratulations to Mark of Team Blue Ridge Foot and Ankle for his 4th place finish in the expert/pro division at the Walnut Creek Chimney Chase! Go Mark!











Summer Blog Series: Ankle Sprains

August 2nd, 2012 by Dr.Chang

Ligaments in the ankle bind bones and the ankle joint together, providing it with stability and limiting its lateral movement. Unlike strains, which are damage to the muscles, ankle sprains are injuries to the ankle’s ligaments, usually on the outside of the ankle. Damage to these ligaments is usually caused by a traumatic event – a fall, twist or impact – and can range in severity depending on whether the damaged ligament(s) is stretched, partially torn or completely torn.

You may be able to identify an ankle sprain because of a combination of symptoms, usually after a traumatic event. These include pain and soreness, swelling, bruising, difficulty or unsteadiness walking and stiffness in the joint. If you have had previous ankle injuries or weak ankles, it may not be surprising that you would sprain your ankle.

The bottom line with ankle sprains is that they must be treated in a proper manner. Without treatment, an ankle that was sprained can become weak and lead to chronic ankle instability. While these soft tissue injuries are often short of a tear, they still need to be immobilized for a number of weeks, depending on how bad of a sprain it is. Without visiting your podiatrist for a diagnosis, other related injuries or underlying conditions may go undetected leading to complications and further or prolonged injuries – like repeatedly spraining the same ankle.

Your podiatrist will most likely give you a walking boot in order to immobilize your ankle. A variety of treatment options are recommended for ankle sprains, including RICE and NSAIDs. Early physical therapy that works on your ankle’s range of motion will promote healing and increase the injured ankle’s rehabilitation. Surgery may be required in severe cases in which a ligament, or multiple ligaments, has been damaged. It is essential for the long-term health of your ankle that you find the proper treatment regimen for you injury.




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