Dry Feet? Here are some not-so-secret secrets

It's probably still winter in some parts of the world which means there's probably a lot more dry feet this season. Want to know how to deal with dry feet? Here are some home care remedies that has worked for my patients:

I get zero dollars to promote any products but looks like the customers love this stuff. And it's affordable! And I also bought this for my mother-in-law. 

I get zero dollars to promote any products but looks like the customers love this stuff. And it's affordable! And I also bought this for my mother-in-law. 

- Daily moisturizing with a cream or oil based product. I emphasize daily because it's a maintenance issue, just like brushing your teeth. What products, you ask? People have done well with many products readily found at the drug store. My patients have particularly liked Amlactin (they give us tons of samples so our patients have more exposure to it) and products with urea in it (check out Amazon's urea 40% cream). You can also try Vaseline for tougher skin and recently a patient raved about Corn Husk lotion. 

- Avoid hot showers. I know this one is particularly hard for some but the increase in water temperature can strip essential oils from your body, increasing dryness. 

- Avoid barefoot or walking with sandals. This is another way moisture can evaporate.

- Dry feet with callus? Hydrate this skin at night time with Vaseline or coconut oil, cover with socks. The next morning in the shower, use a emory board or foot file to gently remove the hard skin. Do a little at a time so you don't damage the skin underneath. 

- Dry feet with cracks and open wounds? Visit your local podiatrist or dermatologist. They can evaluate if your dry skin is due to a bigger medical problem. You'll want to hold off putting on any creams in the mean time. We'll need to determine if there is an infection lingering around so you don't want to give it any yummies to stick around.  

Wishing you feet wellness!

How'd I get here? Podiatry.

Have you ever wondered how your doctor became a doctor? I'll give you the scoop, the short, dry and honest version of course of this podiatrist's timeline in deciding on her career as a foot and ankle specialist. 

I have to admit, I didn't always have a passion for medicine. As a wee little nugget I had a Playskool doctor kit but I was more interested in playing cops and robber with my imaginary friend. Of course, my idealistic childhood waned with time and I realized a career is what's necessary to live a comfortable life. I had a knack for helping people, often missing class in elementary school to help file some papers in the front office. (Looking back, I don't know why they let me do that!) I preferred doing things rather than sitting around being lectured at. As I got older and witnessed people getting sick, I gravitated towards naturopathic medicine, often awed by nontraditional home remedies like Chinese herbal medicine to cure the sick. But I wasn't satisfied with the 'it just works' mentality, my curious nature needed to know how. This then pulled me into a yearlong training program to be a pharmacy technician, learning about western medicines. At the completion of my training, I couldn't find a satisfying job. 

Through my journey I have met some amazing human beings like Dr. Chris Attinger (plastic surgeon from Georgetown). He's taught me some cool ways to heal a wound and his insights on limb reconstruction is just incredible. What an honor!

Through my journey I have met some amazing human beings like Dr. Chris Attinger (plastic surgeon from Georgetown). He's taught me some cool ways to heal a wound and his insights on limb reconstruction is just incredible. What an honor!

Then I thought, maybe pharmacy school? Or study pharmaceutical science? Or sell makeup? All these tangent paths from understanding medicine didn't light a fire of interest and I felt so lost. (Except selling makeup, I just needed a job.) Already into undergrad on the way to graduating, I had nothing waiting for me at the end of that painfully long and expensive journey. I supported myself through loans and it felt so heavy not knowing if I could ever pay it back. Then, someone suggested I look into medical school and I thought, "yea right!" Training is too long, too expensive, what if I didn't like it, what if I didn't make it, I don't have any connections, no one in my family even made it through college, and on and on with the self doubt. I had no mentors and it just seemed like a dark lonely dusty path that I had never put thought into...but what if I succeed?

I set some conditions before deciding to move forward. 1) Once you commit, you stick it through no matter what. 2) No kids. 3) Specialize right away so you're not dilly dallying into areas you have no interest in. 4) Be damn good. 

And that's it, I found podiatry school from a career fair at my last year in undergrad and 8 years of training later here I am making a great living doing what I love in expensive California. I learned to love feet, or least love to fix them, and all its intricate anatomy. It seems to get more complicated the more I learn about it. What fun challenges there are in podiatry!

If you asked me 10 years ago where I thought I would be, I didn't have an answer, I just knew it would be somewhere and at least it was moving forward. Even if you asked me 3 years ago, having lived across the country from Iowa to Michigan to Texas, I'd never thought I'd be back in my home state. I was on the go and on fire! I had the freedom to live in any state I chose to, even considering selected countries that accepted podiatrists. Buuut opportunity in California arose and here I am, enjoying every blissful minute of this great opportunity to continue my craft and eventually, be damn good at it. I'm not quite there yet but, finally for once, I know where I am going. 

Big Toe Arthritis - Variants of a Bunion

This is by far my most favorite topic to discuss with patients...bunion pain and its variety. What are the varieties? This is what I will focus on here.

Typical presentation: A patient presents with a bumpy joint pain by the big toe (hallux) and believes it is a bunion. States it seems to be getting bigger with time and that it hurts with walking and certain shoes. They'd like to know treatment options to alleviate the pain. 

An office consultation will consist of clinical exam and xrays.

This patient had pain for many decades and what is shown is abnormal bony growth around the first metatarsophalangeal joint. Normal joint should look pearly and smooth, the above shows irregular ridges and loss of articular cartilage. 

This patient had pain for many decades and what is shown is abnormal bony growth around the first metatarsophalangeal joint. Normal joint should look pearly and smooth, the above shows irregular ridges and loss of articular cartilage. 

You can already see what option we went with in this particular patient. I call this the "bunion variant" because that's what most people will think they have in this area when in fact it is arthritis. The bumps in the first joint is really a build up of bone that occurs with long term use of wear and tear. Some people's anatomy are set up for this type of pathology as they get older, while many others will never have this problem. The biomechanics of the foot is incredibly amazing but that's not what I'll discuss here. I'm sure what you really want to know are what are the treatment options when you get arthritis in this joint, right?

Nonsurgical options (conservative):
- Activity modification
- Better supportive shoes
- Inserts (also called orthotics - can also get these custom made)
- Pain medication or steroid injections

Surgical management (when all else has failed to provide adequate relief):
- Shaving off the extra bone (cheilectomy)
- Cutting bone, shifting it and securing the new position with screws in a better anatomic alignment (shortening osteotomy)
- Joint replacement (like knee replacements but much smaller)
- Joint fusion (most definitive for end stage arthritis where the joint it already stiff, this procedure eliminates the pain - many people don't miss the motion in the joint anyway at this point)

As much as I enjoy performing surgery, many people do quite well with conservative management. But know that you don't have to live with pain forever. Consult your nearest foot and ankle specialist to discuss which option will be best for you.

New Year, New Shoes?

Welcome back my wonderful readers! It's been 2 months since I've blogged so there's a lot of catching up to do. Of course if you've already found me on Instagram (@drtea_podiatry), you'd see some updates about my personal and professional life and why I've been MIA. I have a growth in my uterus...

Photo by Emma Simpson on Unsplash

Photo by Emma Simpson on Unsplash

But onwards to an optimistic new year and I bet a new you perhaps? Which means a lot of people are looking to rev up their physical activity and get fit! Much kudos to you but of course you want to do it safely so that you can continue on with a healthy lifestyle. Too much too soon can de-motivate your efforts so here are some pointers to get you started on the right foot.

Things to keep in mind when starting to work out:

1. Looking at new shoes? Choose the appropriate footwear
- You want a sturdy shoe that does not fold in half, particularly if you choose running as your activity.
- Break into them before going full speed. That means go for a test run (short distance) before using them for a race or long distances.

2. Start slow
- Start at a level that is comfortable and gradually increase to a level that challenges but does not hurt you. A gym coach would be a safe start. 

3. Keep going!
- Establish a routine and schedule it like an important appointment. A scheduled "me time" will leave you feeling amazing and acomplished. Motivation will wane with time, but a habit will stick. 

4. No pain, no gain?
- Pain is essential to living and it is protective so know when to stop. If you push through the pain, injuries can happen that will put you out of commission longer than you desire. Small periods of rest and recovery is essential in optimizing your workout and your overall well being. 

Wishing you a happy healthy new year!

Complications of an ingrown toenail

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A lovely 70 year old female presented with a toe infection on-going for a few days. She relates having an ingrown nail causing her pain and was subsequently removed by a podiatrist. 

She is a diabetic and admits to going back to work after the procedure. Several days later I was called to see her in the emergency room. See far left image. There was increasing redness, swelling and purulent material draining out the nail bed. Her prognosis was bleak. 

I didn't know if the toe could be saved but I told her I would try. I worried that if we did nothing, the infection would spread affecting other parts of her feet. So we wheeled her into surgery right away. 

Paying close attention to the blood source to the toe, an incision was made down the middle and the infection was gently cleared out with a curette. The wound remained open to allow further drainage. She was admitted to the hospital for IV antibiotics and debridement was performed daily until I was comfortable that the infection was controlled. 

Several weeks later, she is doing quite well. 

Complications of an ingrown nail is rare but the risk is still present, especially in patients with diabetes. It is important for patients to feel comfortable in addressing any problems they have after a procedure immediately with their doctor and equally important for the doctor or their medical assistant to be available as well. Don't take any procedures lightly and as you can see here, complications are real but if dealt with in a timely fashion, prognosis can be good. 


"I think I have an ankle fracture. Now what?"

XR of an ankle (fibular) fracture

XR of an ankle (fibular) fracture

Breaking any bone in your body is frightening. Not only does it hurt but fear of surgery and long term disability is on everyone's mind. My husband recently missed a step going down stairs, he was holding the dog's leash in one hand (and she was pulling) and his cell phone in the other (I don't see how this was a good idea to start with). His foot turned under him and ... SNAP! He heard and felt a pop, called me immediately and fortunately for him had concierge service from his favorite podiatrist. He told me "I think I fractured my ankle."

Luckily my office wasn't too far from where he was so I was able to drive him to the office and get xrays immediately, bypassing the emergency room. Of course, the whole time he was very scared that he would need surgery. He himself is a general surgeon and runs around all day and night going between patients traveling to different facilities and stands for long periods to operate nearly everyday. His job, like many others, requires him to ambulate independently without pain. So, what was next for him?

His xrays were negative for an ankle fracture. But what was that audible pop and the immediate bruising and swelling? He may have torn one of the lateral ankle ligaments but since he was not a professional athlete, I advised him to take the following protocol seriously so he can heal optimally without surgery, the acronym R.I.C.E. protocol is appropriate here:

1. REST - I realize many working people don't know how to do that. He was given a walking boot to protect the ankle and was instructed to wear it during working hours, then take it off when sleeping or driving. Functional recovery (continued protected movement) is important in ankle sprains. In the evening, he was to do passive range of motion exercises, drawing out the alphabet with his foot. Too much immobilization could stiffen the ankle and weaken the leg slowing down recovery. 
2. ICE - this will decrease the swelling
3. COMPRESSION - I applied an elastic ACE wrap to help with the swelling
4. ELEVATE - raising the affect leg above the heart while at rest will also decrease swelling

(or P.O.L.I.C.E. - Protect, Optimum Loading, ICE, Compression, Elevation)

He only took a few ibuprofens in the beginning but went straight back to work the following day taking it slow. Of course I'd occasionally find his boot laying around the house every now and then while he was at work, so you can say he was doing fine. After 6 weeks he felt pretty normal and went back to working out and running comfortably.

By the way, if it was an ankle fracture, that doesn't necessarily always mean surgery. Allow your surgeon to make the diagnosis and discuss treatment plans with you. The sooner you seek treatment, the better off you'll be. 



Elderly Foot Care

The age at which a person is considered "elderly" may vary from culture to culture but it has been accepted (in the US) to be those of age older than 65. October 1 is International Day For Older Persons so I wanted to share some insight about elderly foot care from a podiatrist's perspective.

A large portion of my practice focuses around the elderly and here are some important issues to consider.

1. Gait imbalance - There are many reasons for gait imbalance and some can be easily addressed with orthotics, braces, walking assistance aid (walker, cane). Other times, physical therapy is needed to improve joint mobility and conditioning to prevent falls. Podiatrists can determine whether or not your feet is the cause of your imbalance and make recommendations.

 What I would highly recommend for prevention of falls at home (that I learned in my gerontology class from medical school) is GET RID OF LOOSE RUGS around the house and loose cable wiring also. These can lead to tripping and falling, which can have disastrous results in our geriatric population.  

2. General foot care - Common problems seen in elderly feet:
- Dry feet that may crack and is too hard for patients to reach to apply lotion
- Painful corns and calluses
- Thick and discolored toenails that are difficult to trim
- Circulation issues including cold feet, pain at rest that feels better when the legs are dangling, or intermittent claudication (pain with walking short distances)
- Osteoarthritis and joint stiffness
- Hammertoes and bunions are progressive deformities that worsen with time and can be very painful

Many of these issues can be treated by a podiatrist with simple procedures performed in the office the same day as your appointment.

3. Undiagnosed depression - Often times, patients seek medical help but they often hide their depression, either from chronic medical conditions or loneliness. Since podiatrists see a lot of elderly patients, we work closely with your primary care doctors to discuss social issues that affect this vulnerable population.

For more information on Geriatric Care, please visit https://geriatricscareonline.org/

Photo by Rawpixel Ltd/iStock / Getty Images

Photo by Rawpixel Ltd/iStock / Getty Images

Pregnancy and Foot Pain

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I'm at the age where a lot of my friends are getting pregnant and many have suffered from foot pain near their last trimester. I've put this together with you in mind ladies:

Why do my feet hurt?
Carrying around extra weight from your growing fetus adds pressure to your feet. Even in patients who are not child bearing but experience an increase in weight gain will suffer from foot pain. Many patients have told me once they were able to lose weight, or had their baby, they had less foot and ankle problems. 

Why did my shoe size change?
During pregnancy you're more likely to retain water and so your feet will swell up. That is why you may notice your regular shoes are fitting more snug than you remember. Many moms-to-be opt for sandals that are not as restrictive. 

I think my feet are changing shape too! Is this normal?
Unfortunately yes. With increasing weight and a hormone called relaxin that is produced during pregnancy to loosen the pelvic ligaments, it also affects ligaments throughout your body including your feet. The arch may flatten out which is why you see the changing shape. 

What can I do to get relief?
- Sometimes, rest is best! Kick off your shoes and elevate your feet as much as possible to decrease the swelling. 
- Give yourself a home spa treatment with Epsom salt foot soaks. Add aromatic oils like lavender to help you relax. 
- Exercise regularly to improve circulation and for overall health.
- Drinking a lot of water and limiting salt intake will decrease water retention. 
- My favorite recommendation of all time: massage! You can use a frozen water bottle to roll under your arches or have someone massage your feet.  

You deserve to relax and be pain-free. After all your amazing body is building a baby in there! If you have more questions, feel free to click on the button below to email me. 

Maybe you need orthotics

Custom orthotics come in a variety of styles and are custom designed to suit your foot and ankle condition

Custom orthotics come in a variety of styles and are custom designed to suit your foot and ankle condition

What are orthotics?
These are removable inserts that are placed inside your shoes which help to correct structural abnormalities that many people have in their feet. Structural abnormalities, such as flat feet or high arches, can result in abnormal pressure distribution and eventually pain. 

What common pathologies are orthotics helpful for?
The most common reason I prescribe orthotics is heel pain but there are many reasons to have orthotics, including back and knee pain. Take a look at the next county fair you go to, what are people mostly wearing? Flip flops, canvas shoes, maybe even flat dress shoes I bet. When you need to walk short distances, these shoes are fine. But if you're spending the day walking and standing on your feet for longer than you're used to, you really need supportive arches, whether it be a high quality shoe or custom orthotics, to prevent sprains and strains.

Do insurances pay for orthotics?
Many insurances pay for custom orthotics performed by a foot and ankle specialist. When they don't, I would still recommend over the counter orthotics, something that does not fold in half and fits your arch well and maintains it. High quality ones are sold exclusively in a podiatrist's office. 

Do I need orthotics?
Many people I see have demanding jobs that require them to stand on their feet for over 6 hours at a time with minimal rest. This can put a lot of strain on your feet. I have prescribed orthotics to people who have recurrent or constant pain and many do well with it. There is a small fraction of people who either don't like it or can't tolerate it at all, but since there are so many ways to create it, I often suggest having them evaluated by a foot and ankle specialist. Sometimes a small modification can help.

Coffee Chat with Dr. Tea

Here is where I write down my thoughts, less educational, more intimate. 

Have you ever wondered who your doctor was outside his or her lab coat? Like, what are they into? Do they all drive nice cars? What are their true values in life? What makes them crazy? What makes them love their job? I won't attempt to answer all these questions, but let's see where this takes us.

Are you an introvert or extrovert?

I'm more of an introvert than extrovert who enjoys reading, writing and quiet time. It is easier for me to write out how I feel than it is to say it. Becoming a doctor has challenged me in that now I have to push the words out of my mouth in front of patients, colleagues and staff in order to be an effective communicator. I admit I still struggle with this at times. Often times, my words don't work but I'm fortunate enough to have staff who can read my mind (or predict my next move). That is an amazing skill. 

How does that affect you as a doctor who sees over 20 different people everyday?

I also like balance. Periods of introversion must be broken up with human interaction, just like periods of wakefulness needs sleep to recharge. I truly enjoy being in small groups of friends whereas in larger groups I tend to feel drained. I value my energy reserve and there is a finite amount in a day, so I am also very picky about how I spend it. That also means I am straight to the point with my patients and thorough about explanations. There's no sugar coating important facts that need attention. I have patients who find my honesty refreshing, there are others who'll choose to never see me again. I am ok with that.

What useful thing have you learned in practice that you didn't get in training?

Don't bother trying to please everyone! You simply can't and having accepted this has given me the freedom to be exactly me and stay true to my values, which is honesty. I want patients who get that, I think that has helped increase the quality of patient-doctor relationship, ease nervous patients, while providing clarity in treatment options. Since I am spending most of my waking hours with patients, I have to make it count so I have to hang on to my core values, which in turn helps my sanity.

What values have you learned along the way that has helped the way you practice?

Empowering people around me is something I value greatly. I will rarely tell patients what to do. They always have choices: do nothing or consider my advice or consider someone else's. I treat everyone like adults and each individual chooses their own destiny. Some like the easy route, others prefer the more difficult one. The choice is yours as it always has been.

If you enjoyed this content, I thank you for being here. I hope to hear from you as well.