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. 

 

 

What to Expect at Your Podiatrist's Appointment for Ingrown Nails

My previous post gave you some pointers on preventing ingrown toenails and when to seek professional advice. Here is what you can expect at your podiatrist's appointment.

1. A history and physical exam will be performed. What I check for is how good your circulation is, possible causes for the irritation (nail salons, shoe wear, genetic deformities, etc) and how bad the ingrown nail is. 

Removing an ingrown nail can be done with minimal discomfort. Only the offending border is removed with little noticeable deformity. Pain is relieved the same day.

Removing an ingrown nail can be done with minimal discomfort. Only the offending border is removed with little noticeable deformity. Pain is relieved the same day.

2. You will be offered the following options:
- Do nothing: In mild cases, some suggestions to prevention will be reviewed. 
- Avulsion (in-office small procedure): We have a better angle at seeing your toenail so we can perform a slant-back of the offending nail with sterile nail nipper. In some cases we'll inject a numbing medication to provide optimal comfort.
- Matrixectomy (also an in-office procedure): This will permanently prevent the nail from growing back (95% chance of success). You will be given a numbing injection, followed by removal of the nail border with sterile instruments, and a chemical is used to burn the nail root so it does not grow back. Many people tolerate this procedure and are able to walk out of the office without pain. Limited activities is recommended for the first week.
- Rarely will going to the operating room be necessary. 

What is offered on your first visit will depend on you and your insurance. A discounted cash price is also available. 

 

Home remedies for ingrown nails

Photo by robertprzybysz/iStock / Getty Images

Photo by robertprzybysz/iStock / Getty Images

I have to admit, I am a huge fan of home remedies because I don't always have the luxury of seeing a professional and mostly because I don't want to. (I'm human too!) I know many of you feel the same, which is why I wanted to share with you some insight on ingrown nails, things you can do at home and when you should definitely see a specialist. 

PREVENTION
It is better to prevent than to cure. Prevent ingrown nails by cutting the nail straight and rounding the sharp corners with a nail file.

A few patients have told me they read somewhere that creating a "V" notch would help. I'll save you the trouble and tell you it does not. Straight is great.

Also, too much digging into the corners will cause the skin to thicken and introduce bacteria so you may not want to do that. 

Poorly fitted shoes with narrow toe boxes can add pressure on the nail. Choose wider shoes or sandals if irritation is occurring. 

HOWEVER
If you are developing an ingrown nail, simple things that can be done at home include:
1. Epsom salt soaks - this will relieve the inflammation. Take a basin of warm water, add 1/2 c Epsom salts, soak for 10-15 minutes. This will soften the nail and you can use a sharp ended filer to gingerly lift the nail corner.
2. Topical ointments - such as antibiotic ointment will also help soften the nail

SEEKING PROFESSIONAL HELP
Too often I see antibiotics prescribed erroneously. An ingrown nail that presses into the skin, maybe even cutting it, is best treated by removing the irritation. You'll want a professional to do this for you to avoid worsening infections. I've removed a lot of ingrown nails without prescribing any antibiotics because the source has been removed, saving you the inconvenience of antibiotic side effects, possible resistance and mostly saving you time from pain. Sometimes antibiotics are needed, most times they are not. Let a professional help you with that.

If you have chronic ingrown nails and want it to be removed permanently, podiatrists can help with that. I will follow up on next week's blog on what you can expect during a nail avulsion/matrixectomy procedure. 
 

If you would like to make request an appointment with Dr. Tea, click on the button below.

August is Back to School Shoe Shopping

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What an exciting time it is going back to school and mostly, back to school shopping. Here are some pointers on what to look for when buying new shoes:

1. Not all shoe sizes are the same! For example, a size 8 from one company may fit differently from another. Make sure the length of the shoe fits the longest part of your foot. For some, it may correlate with the big toe and some others the second toe will be longer. Make sure there is room for every toe and wide enough to prevent blisters.

2. Cheap shoes may cost you in the long run. While it may be tempting to go for the budget friendly shoes, sometimes these are constructed very cheaply and can cause unnecessary foot pain. Make sure the shoe has some cushion inside and does not easily fold in half. Cheaper shoes may not last as long as higher quality shoes. The investment is worth it.

3. Consider orthotics or shoe inserts. If you are suffering from foot pain, orthotics may help provide better support and reduce the pressure on your feet. Keep in mind, some orthotics will not fit all types of shoes and vice versa.

Learn more by visiting your local foot and ankle specialist who may be able to recommend custom orthotics in qualified patients. 

Patient Diagnosed with Diabetes, Takes Control

A cheesy title, I agree. But I wanted to share this story because it is a bit of an inspiration that I know many of you, including myself, appreciate hearing from time to time. 

As you know, my specialty is foot and ankle problems. When I see a problem, I like to fix it. When there is a broken ankle, I want to fix it. When I see a wound, I want to heal it. This is my area of expertise. Having 10 years of experience secured, I am able to process problems fast. Sometimes too fast. But I admit, I still have human errors.

A young kind lady presented to me with complaints of heel pain. She was recently diagnosed with diabetes and admits knowing she is overweight. She was very scared of this diagnosis so decided to be proactive and take classes at the gym. She had never worked out much before but had seen the consequences of diabetes since it runs in her family. She is terrified of losing her legs from the complications of diabetes. She tells me she is working out a lot and is worried that her heel pain won't go away and that it might stop her from losing weight. I empathized. 

Of course, in my mind, I'm thinking about an algorithm. Here's a problem, here's how to fix it. I started going through the routine of educating her on plantar fasciitis and how it can be aggravated by being overweight, having a certain foot type, change in level of activity, etc. She started silently crying so I stopped my babbling and asked her why is she so sad?

To me, there's a problem, here's how to fix it. To her, it's me telling her to stop activities meaning she may not be able to lose the weight and also meaning she is not in control of her health. My human error was not realizing what I said could mean several different things to patients. 

She tells me, "I don't want to stop working out, I am doing so well right now and losing weight. It makes me feel good to go to class and dance."

I felt bad for making her feel like she had to give up something that makes her feel good about herself, working out. I reassured her stopping does not mean quitting, it's really just a short break and your body is telling you, please take a break! If you have foot pain, you can't ignore it. You'll start to walk differently to compensate and that can throw your whole body off, you may even hurt other parts of your body. 

I gave her a treatment plan, created custom orthotics, and she is back on track to staying healthy. She recently just told me, "Dr. Tea, I feel amazing. I've lost 15 pounds. My self confidence is up, I feel good about myself, I am really happy and hope my friends will join me to being healthier."

Sound like something from a commercial doesn't it? Except I don't have anything to sell. Just a story that I hope inspires you that something so simple like walking that extra mile, taking a fitness class, eating better, and practicing these things on a day to day basis, may be just enough to change your life. Small actions, big rewards.

 

 

 

 

My Very First Medical Mission 8 Years Ago

I'm going to spend this month, also my birthday month, to self indulge in the things I care most about. Since I am not one to enjoy receiving gifts as I am giving, I will share with you a non-refundable gift of a story about one of my dreams and passion.

I most enjoy being able to give things to people, which it should be no surprise as to why I am a doctor after all. This particular trait also explains why I am so fixated on doing/going/planning for medical missions. Watch out! I have a bunch of knowledge to give away! And why not? Well, it goes two ways actually. On the one hand I am giving away my services, time, talent and energy to others, whether it be here in the good 'ol U.S. of A or abroad. On the other, I am gaining so much more, I think. I learn about different people, cultures, beliefs and get a reality check that, in fact, we are all pretty much the same. We are human and deserve the touch of humanity. 

Eight years ago I had the opportunity to travel for my first medial mission trip to El Salvador and provide medical aid to the Salvadorian people. I have traveled internationally before for vacations but never for work. I was just an itty bitty medical student at the time and eager as a beaver to see things and do things. I had even been taking medical Spanish classes exactly for this! Sí! muy emocionado (very excited!)

We flew from Iowa to Texas awaiting a layover. The group of us were hambriento (hungry) and rented a car to get some grub. Once finished, we walked out to find broken glass from our rental car and missing bags. Our car was broken into and one of the gals had her passport taken as well. What a start.

A picture of a picture so the quality is quite poor. But our hearts were rich (and a bit tachycardic) and here we are just landed in El Salvador, 2009.

A picture of a picture so the quality is quite poor. But our hearts were rich (and a bit tachycardic) and here we are just landed in El Salvador, 2009.

We eventually made it to El Salvador in one piece. We ate, got some rest, were given a briefing about the local culture. What I remember from our hacienda was that running water was more like dripping water and it was timed so you took a quick cold shower so that your roomies can wash up too. And maybe the drain didn't really drain. Don't bother putting on makeup or getting your hair fancy. This was not a place for vanity. Drinking the faucet water was also not encouraged. 

We had several successful days seeing many families and giving out bandages, vitamins, performing history and physicals and the like. Everyone was grateful and many traveled distances for the free clinic. A lot of the locals were intrigued by our blue eyed blond hair colleagues, it was the most entertaining thing they saw. I blended in just fine with my brown eyes and brown hair. 

Things were going great. Some things were quite a shock, like the empty buildings with the bullet holes, while other parts were very Americanized like advertisements for pop/sodas, fast foods, and those American things. 

One time I even found a dead spider in a young boy's ear! True story.

One time I even found a dead spider in a young boy's ear! True story.

I believe on the second or third day of clinic our anticipated clinic location was moved for one reason or another. Thinking nothing of it, we did the usual, setting up tables and chairs, saw each and everyone who showed up. I probably mangled the Spanish language, (lo siento) and decided to communicate via the pointing technique. 

A few hours into clinic, we all heard a "pop-pop" then "pop-pop-pop-pop-pop," a total of 21 gunshots went off. Everyone scattered, many pushing down tables to create barricades. Mothers and children were screaming while the staff tried to herd everyone to a safe place and taking cover ourselves. I carried a small hysterically crying child to his mother and then ducked under a table. I had my point and shoot camera in one hand trembling with the other trying to turn it off so that it didn't make any sudden noise. I scanned the room eyeing the open door watching a male figure in black uniform pacing back and forth with the rifle by his side. I had no idea who that was, what side he's on or what just happened. I crouched under the table nearly paralyzed trying to stay quiet. I think I was breathing but I can't be sure. 

I remember thinking, should I take pictures? Should I document the last days of my life? What if they catch me with the evidence? Are they here because they think these American doctors have drugs? What would I say if they asked? 

I don't know how long it was before it was cleared but needless to say we were all frazzled. We finally learned that there was dead man (maybe in his twenties) in front shot at point blank in the head and a small child at the nearby school struck by a stray bullet. It was a gang-related fight of retaliation. My heart was heavy that day. This is what the people of El Salvador live through everyday. Violence runs the city. El Salvador is still considered to be the Murder Capital of the world and has a murder rate 22 times that of America. But they also need medical care. 

At the end of the day, we had a meeting and debated whether or not to continue the mission. Half of the group was very vocal about staying while the other half said we should leave. And all of a sudden tears were streaming down my face. I was pissed. I was pissed that we were even debating and downplaying the trauma. I was pissed that we couldn't do more. I was pissed for being pissed. These emotions were unexpected and that's when I realized I was truly naive about what was to be expected on these trips. 

A young El Salvadorian girl carrying cashew fruit. Hustling can start at any age. 

A young El Salvadorian girl carrying cashew fruit. Hustling can start at any age. 

Instead of a weeklong international medical mission trip, it was cut short to just a few days. Everyone on our team was safe, but some took home traveler's remorse like myself. I felt awful for the things I took for granted, like my safety, running water and material things. While there were others who were more experienced in dealing with traveler's remorse. You just kind of just push it down, ride the wave and learn to appreciate all that you have. Counselors were offered but I kindly declined it. I felt I needed to deal with these feelings and sort it out myself.

There were so many beautiful parts of El Salvador, the coffee, the dedicated families, their food, the beautiful children and things they made. And the broken parts that is beyond any one person or small group to fix. 

La Clinica in San Salvador, El Salvador

La Clinica in San Salvador, El Salvador

So you're probably asking, would you recommend medical missions after all that?

I don't think it's for the faint of heart. You have to really know what you're getting into, what the goals are, what your resources are, what the backup plan is and a safety get-out plan. You may be going to just explore new land, offer your services, collecting some memorable pictures and calling it a day. There's really nothing wrong with that. Many people have gone and never dealt with anything traumatic. Some others may have had a way worse experience. 

Essentially, it's your own judgement call but I know this is something I will continue to build on. My deepest passion is to share my knowledge on wound care, amputation prevention and correcting foot and ankle deformities so people can just live without pain or a cumbersome wound or a deformity limiting their ability to make income. I have since been to San Miguel, Mexico with a few more trips planned and brewing for the next few years so stay tuned! Ultimately, the big goal is to spread awareness of what services podiatrists have to offer since we are still such a small profession and create sustainable clinics all over the world where it's needed. Naive? Probably. Committed? Yes. 

Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime.
— Mark Twain
Adiós!

Adiós!

 

 

Diabetic Foot Care: Preventing Amputations

I've learned from reading all of your comments how concerning it is to be diabetic and see all these amputations. I want to assure you that amputations do not happen overnight. And it doesn't just happen because of diabetes alone. Often times there are early clues and many situations are easily corrected. Here's an example:

A callus builds up pressure causing the skin to break down. Shaving this down regularly and wearing appropriate diabetic shoes can prevent this callus from becoming an ulcer. Open wounds or ulcers are beginnings infections and amputations. Let's prevent that!

A callus builds up pressure causing the skin to break down. Shaving this down regularly and wearing appropriate diabetic shoes can prevent this callus from becoming an ulcer. Open wounds or ulcers are beginnings infections and amputations. Let's prevent that!

A long time diabetic patient presented for her first diabetic foot check. She states walking a lot at home, cooking and doing housework often wearing no shoes. She's developed a callus but doesn't see the podiatrist until "it really hurts." Unfortunately, she has the late stages of diabetes that affects the nerves in the feet, so she has some numbness as well. She is older too so cannot bend over to see the bottom of the feet and has blurred vision so cannot see clearly. 

Can you see how all of the combined issues in this case make this particular patient more vulnerable to foot infections? How so, you ask?

1. Having diabetes "for a long time." As soon as you are diagnosed with diabetes, you should see a podiatrist right away. Foot specialists can tell you what your particular risks are and make recommendations. It could be as simple as caring for dry cracked feet, foot fungus or more serious like having a prior amputation. 

2. Only waiting to see a doctor until it really hurts. The problem with this philosophy of waiting until it gets really bad is this, it's probably really bad. Prevention is key. I repeat, PREVENTION IS KEY. I have patients deathly afraid of doctors so when they finally get to me, well I only have bad news for them. The good news is podiatrists, myself included, are very diligent about preventing any level of amputation. We are on your side. Do not be afraid. And if you are afraid of one podiatrist, there are other, many thousands of others.

3. Numbness in the feet. This is the number one reason why many patients delay care. They simply do not feel a problem because they have neuropathy. Without the gift of pain, one does not know they are walking on a thumb tack or other sharp object and overtime this gets ignored, infected and you can imagine the domino effect. 

4. Not being able to see. Our older patients simply cannot see due to diabetic retinopathy (eye damage). So it will be difficult for them to report any problems if they cannot feel or see their feet.  

I hope to prevent as many amputations as I can but I can't help if I don't know who you are. Keep sending me your questions! Thanks for reading.

 

 

What I wish for everyone I meet in the Emergency Department

Whoopsie doodle, looks like I missed the entire month of April to blog! Needless to say I am happily busy in my practice in sunny Northern California. So busy that I am seeing a preventable trend in the Emergency Department (ED) on patients I am called in for and hope to be able to help some of you or your loved ones suffering from diabetes related foot problems. 

IF YOU HAVE DIABETES...please establish care with your local podiatrist. We can point out early signs of problems such as pressure points, blisters, calluses and ulcerations and provide recommendations to preventing infection and ultimately loss of limb. We can provide prescriptions for diabetic shoes and custom inserts and offer recommendations based on your foot type and activity level.

The most recent set of patients I have seen in the ED have had a sore for more than one week that was left ignored or self treated and, sadly, resulted in an amputation of part of the foot. This is often necessary to save the leg but also could have been prevented early on. 

I'M A DIABETIC, WHY SHOULD I SEE A DOCTOR WHEN I HAVE NO FOOT PROBLEMS? Excellent question! Not all diabetic patients will have foot-related problems but for some who develop neuropathy (loss of sensation) in the feet, you may not have the pain signals alerting you that you stepped on something or have a callus that is creating a sore underneath. Leaving this ignored is how infections brew and spread. Better to prevent than to wait for something bad to happen. 

Email me with your questions and I'll share the answers to benefit our readers. 

 

Heel Pain 101

Image from https://www.foothealthfacts.org/conditions/heel-pain-(plantar-fasciitis)

Image from https://www.foothealthfacts.org/conditions/heel-pain-(plantar-fasciitis)

Plantar fasciitis, used to be called heel spurs but is a misnomer, affects many people. It is caused by an inflammation of the fibrous band on the bottom of your foot that may be from having flat feet or very high arches.

The good news is pain can be managed conservatively in the majority of people. The bad news? Nothing good will come easy and it take consistent practice to prevent the pain from getting worse. Here are some freebies for you if you suffer from heel pain:

1. Pain first thing in the morning when you step down? Before getting out of bed, stretch your arch by extending your knee and dorsiflexing the foot. You can also use a towel to help with this stretch. Warm up for a few minutes every day. 

2. Pain still there through the day? Take a break and repeat the stretches. Use tennis or gold ball to massage the plantar fascia. 

3. Pain at the end of the day too? You may need to take a closer look at your shoes and invest in durable, supportive shoes that provide support to the arch. If the shoes fold in half, that's no good. If they are completely flat like the current trendy shoes, that won't work either. Walking barefeet will make it worse as well. What you can do is take a frozen water bottle and massage the arch out again. The ice will be very nice. 

Rest, Ice, Night Splints, Better Shoes & Orthotics are usually very successful in relieving pain. Surgery is a last resort. 

I'd like to send a special shout out to Rist Roller for providing me a  sample mini foam roller. I use foam rollers in general for my back so it made sense to have one for foot pain. This type of product is perfect for massaging out the plantar fascia in heel pain syndrome. Check them out. *I do not get any sponsorships whatsoever if you decide to purchase. They just seem cool.*

Wishing you all freedom from foot pain!