A young, athletic patient presented to my Grapevine, Texas office complaining of a painful, funky looking toenail. She thought she has a little fungus or ingrown toenail starting. Turned out to be much more!
Funky, painful toenail
The toenail had a firm nodule that was palpable in the corner of the nail bed. As I suspected, an X-ray revealed a small benign bone tumor was growing out of the tip of her toe. This is what was causing her toenail to be deformed and painful!
bone tumor seen on x-ray
Luckily these tumors are usually an osteochondroma, which is a benign growth. These are more just annoying but they do have a high recurrence rate.
Bone tumor obvious after nail was removed
Bye bye bone tumor!
The purpose of this case study is to remind you to not just assume your toenail troubles are no big deal! Get any abnormal changes in the look and feel of your toenails checked out!
I have a closet full of shoes, like most women. I even have a few pairs of “sit down” shoes; i.e. pretty but painful; so, you only wear them to sit down events like weddings. It has been said that the modern woman has an average of 30 pairs of shoes and only 3 or 4 are comfortable. In fact, it has also been cited that the average woman wants to remove her dress shoes after 34 minutes of wearing them. Really? Last time I checked that’s not the average work day. Ladies, this needs to change! Why are we torturing ourselves just to be “fashionable”? And who gets to decide what is “fashionable” anyway?
I may have a running shoe problem
I am probably the exception to the rule because last time I counted, I had 14 pairs of “dress shoes and/or sandals” and 10 pairs of running shoes in various degrees of wear. After my last pregnancy, I had to heed my own advice (please, don’t tell anyone) and do a shoe purge. All those pretty shoes didn’t fit anymore. The thank you goes to my 3 daughters! I had been preaching for years that your shoe size goes up at least half a size with the first two pregnancies; then it seems to stabilize. Turns out it’s true! I was a US 5.5 when I was 18 and at 50, I’m a US 7!
The lovely aging process also changes our feet. We tend to get little lumps, bumps and other crazy things happening; but that’s a topic for another day.
My favorite Dansko clogs
I’m not saying that we all should go out and buy and wear my favorite comfort shoes from Dansko (My daughters call them my doll clogs); but let’s work on actually wearing shoes that fit!
Here are 8 tips to think about when buying your next pair of shoes. And while you are at it, do a closet shoe purge BEFORE you go shopping!
Purchase shoes at the end of the work day or after sports for the best fit. Your feet will swell during the day, so night shopping is best for fit. As for running shoes, your feet will also swell about 15 minutes into your run especially in the summer; so, when in doubt size up at least a half a size.
Don’t forget to measure both feet! Yes, I said measure them! Feet change with age, pregnancy and weight gain (or loss). Measure both feet and pick the size of the larger foot. Most people are not perfectly symmetrical.
Wiggle your toes in the toe box. Are they rubbing? Do they feel crowded? If so, go up a half a size or to a wide width.
Make sure the widest part of your foot is still in the shoe, not hanging over the edge of the sole. This leads to blisters and can aggravate bunions.
Don’t rely on “breaking in” the shoe. It should be comfortable right out of the box or newsflash – It doesn’t fit!
Try on shoes with the same socks or lack of socks that you will be wearing in them. Sock thickness can make a real difference in fit!
A pet peeve of mine, if you can bend the shoe so much that you can make a burrito out of it – don’t buy it. You will thank me later. A stiffer sole is much more comfortable, and your feet don’t fatigue as fast. A built in arch support can make it even more comfortable!
Walk around the store for a few minutes and make sure you are comfortable before buying. When in doubt, take them home and walk around on carpet. As long as you don’t wear them outside or have any visible wear, most stores will let you return them after a few days if you are not 100% ecstatic about your new kicks.
Time to get some new shoes? Make sure they fit and are comfortable! Your feet will thank you. If you have any questions about whether a shoe fits, feel free to make an appointment with your favorite podiatrist.
In Part Two of Yoga for Runners: Dr Shyla Arya assists Dr Marybeth Crane from FAANT demonstrate the Downward Facing Dog Pose. This is great for runners to stretch your hamstrings and calves; as well as elongate the spine, strengthen and open your chest and strengthen your arms.
If you are a frequent visitor to Foot and Ankle Associates of North Texas in Grapevine or Keller, TX, you probably already know about orthotics. Maybe you have even purchased orthotics.
Custom Functional Foot Orthotics
A foot orthotic is an insole placed into the shoe that helps control foot position. There are two main types of orthotics: Functional and accommodative. These can be prefabricated; like Lyncos that are popular at Healthy Steps or custom; which the doctor fabricates unique for your feet. A functional orthotic controls foot movement and helps a person walk in a way that best supports joints and muscles. An accommodative orthotic helps distribute foot pressure evenly over the bottom of the foot. Most patients use a functional orthotic and usually these are custom for long term usage. A functional orthotic can be useful for many problems and are used to balance the biomechanics of your feet. Think of them as an in-shoe tire realignment for your feet. Accommodative orthotics are very useful to distribute stress in the elderly, diabetic and arthritic populations.
In the foot care aisle at your local drug store or grocery store, you may have seen readymade orthotics for sale. Does it really matter whether you buy store bought orthotics or custom orthotics from your podiatrist? Well, some people may be able to get away with wearing store bought orthotics for a period of time. We even start with these type of prefabricated devices so we can get you on the road to better foot health quickly, but most patients do need custom for long term control of their foot type.
When you think about the long term health of your feet, custom orthotics are the way to go! Store bought orthotics are made to fit many foot problems for a large variety of people; one size fits all usually means one size doesn’t truly fit anyone! To be truly effective, an orthotic must be fitted for YOUR particular needs. Wearing an ill fitted orthotic is not only a waste of time, but it can also make your foot problems worse. Over time these problems can lead to leg, knee, hip, and even back problems. Store bought orthotics tend to not offer long lasting comfort.
If you find yourself buying store bought orthotics every few months because of foot pain, it may be time to schedule an appointment to see one of the doctors at FAANT. Your podiatrist will produce orthotics that fit only YOUR feet. The materials used will be those that are best suited for your walking and running needs.
Everyone deserves special treatment! With a real custom orthotic that is exactly what you have. Yes, custom orthotics can be costly, but so can surgery from walking incorrectly over the years. I’m always amazed that insurance companies will often not cover orthotics, but will pay for surgery! Doesn’t make any sense!! Think of the orthotics as an investment and an investment in your health is one of the best choices you can make for yourself.
Most consistent runners will relate that they have been injured at least once in the last 12 months. While there is no crystal ball to see the cause of every injury, there are things that you can do to try to prevent or at least decrease the severity of these sidelining injuries. Here are just a few tips to help keep you on the road and out of the doctor’s office. Think prehab instead of rehab!
Don’t Binge Exercise! The most common cause of running injuries that I see is “too much, too soon, too fast” syndrome. We get so excited to get out there that we too much all at once. Our bodies get stronger with small increases in stress over time. We break down with big increases in stress in a short period of time. Although there is no good scientific evidence validating the 10% increase per week rule; it works! Meaning do not increase your mileage more than 10% per week and do not increase you distance and pace at the same time. Work on either speed or endurance; but not both.
Strength Training. Strength training is a great way to prevent many injuries. Almost every runner I see with plantar fasciitis (arch pain) has tight hamstrings and a weak butt. Integrating a total body strength workout at least once or twice a week in your routine can really help balance your core muscles and decrease injuries.
Replace Your Shoes Regularly. This is the one preventable thing that I see the most often in my office. Worn out shoes are like worn out tires on your car. They lead to all kinds of repetitive stress injuries. The rule of thumb is to replace your shoes every 400-500 miles or every 6 months; whichever comes first! If you are running more than 3 days a week, you should be rotating two pairs of shoes.
Socks Matter! A lot of people will just go running in their daily wear socks. Socks do matter and wearing a wicking sock like dry-weave or cool-maxx will help keep your feet cool and dry. This decreases blisters, calluses and athlete’s foot fungus.
Massage. A regular deep tissue massage or habitual foam rolling will help increase blood flow to your leg muscles and break down any scar tissue. A massage is not a guilty pleasure, it’s a great way to stop a niggling injury in its tracks! If you can’t justify the expense, invest in a foam roller and use it regularly.
Check your Iron levels. No one likes to go to the doctor and have their blood drawn, but fatigue from iron deficiency is a common cause of injuries especially in women. Simply adding an iron supplement can ward off these types on fatigue injuries.
Listen to your body! It’s always amazing to me how many people push through the beginning stages of an injury and make themselves 10X worse! If you have pain on the run, STOP! Take a few rest days or cross train. You know the difference between the achiness of fatigue and the pain of an injury. When in doubt, shut it down for a few days and rest, ice, compress and elevate! R.I.C.E. If the pain persists more than 4-5 days, you’re hurt. Forget the denial process and find your way into your favorite doctor’s office.
Sleep!This is also one of those things that we as Americans are really bad at. Actually sleeping 8+ hours a night. Just like the fatigue of anemia, going out running when you haven’t had adequate rest will cause you biomechanics to break down and can lead to an injury. If you are tired, it’s OK to skip a run; just remember that lazy and tired are two different things!
Hydration.Why do so many of us run dehydrated? Especially in hotter climates we require at least half of our body weight in ounces each day. Your muscles need the water to process lactic acid and your body will thank you. As a bonus, well hydrated skin actually looks younger! It’s a win:win.
These are just a few tips to keep you on the road towards your fitness goals!
