May 11, 2012

Ice or Heat – Which Path to Help a Sprained Ankle?

Quick Rules For Faster Recovery From Foot Injuries

Most of us who are old enough to get into a “PG-Rated” movie have experienced the pain and indignity of a sprained ankle or foot. It often happens when we are rushing about or engaging in sports, and it’s usually a simple matter of your body going east while your foot goes west. Ouch!

As podiatrists, sprains and pulled muscles are our most popular injury. It hurts and comes with a considerable amount of pain, so people are quicker to reach out for help. However, with a sprain or pulled muscle in the foot, by the time a patient gets to a doctor’s office or Emergency Room, the opportunity to quickly lessen the pain and promote healing has passed.

What to do?
Ice and heat therapies are the two most effective resources you have for a sprained ankle or foot. However, ice and heat are not “synonymous.” You use each separately at different times and for different reasons. Using the wrong therapy can actually aggravate the situation.

Here is a simple rule of thumb for sudden injuries: Ice first, heat later. The greatest amount of swelling occurs in the first minutes after a foot or ankle injury. Cold reduces swelling, so by quickly applying ice, you can significantly cut down on the recovery time.

If you or someone near you hurts their foot or ankle, here is what you need to do immediately to help:

1. Get to a safe place. If you went down while scurrying across a busy intersection on a yellow light, do what you must to get to the curb quickly. Likewise, if you came down “wrong” while snatching a rebound under the boards, pass the ball to a teammate and get out of traffic. You want your hurt ankle to be your ONLY injury of the day.

2. Determine if you are injured. Particularly with athletes who are in exceptional condition, muscles can stretch and recover quickly, thus the term “walk it off.” For most people, this might not be true. The best way to determine if you are injured is to sit on a chair or bench with your feet flat on the floor. This should immediately take the pressure off your hurt foot or ankle and ease the pain a bit. Take a moment to collect yourself. Then see if it hurts to stand, walk or stretch your foot in several directions. The hallmark of a broken bone is strong and relentless pain. If the pain is more of a throbbing that increases and lessens depending on your movement, then likely you have a sprain.

3. Wiggle your toes. The quickest way to determine if you have broken one of the 26 bones in your foot or your ankle is this: Wiggle your toes. If you can’t move all of them, and your pain is constant, then you need to proceed to the Emergency Room for professional medical treatment.

4. Ice the foot or ankle immediately. The quicker you get ice or something cold on the injury, the less swelling will occur and thus there will be a shorter recovery period. If you believe you have a sprain or twisted foot and are away from home, stop at the 7-Eleven for a bag of ice. Minutes count, so don’t wait until you get home. If nothing else is available, grab a couple of cold sodas out of the machine and wrap them in a towel. In a pinch, paper towels wrung out in cold water work.

5. Elevate the foot. Whether you’re sitting or lying down, prop your injured foot up so that it is above your heart. This decreases the amount of blood rushing to the injury and therefore reduces the swelling.

“Icing” therapy should be done only within the first 48 hours of being injured. Whether a plastic bag with ice cubes or – my favorite – a bag of frozen peas, carefully apply the cold to the injured foot. Start with 15 minutes on, then 15 off. (You don’t want to add frostbite to your troubles!) After doing this every so often over the course of two days, both the pain and the swelling should lessen considerably. If they haven’t, then you need to see us.

Heat therapy should start on the third day of the recovery process. It is now helpful because – to put it in childlike terms – gentle heat sends the signal that “the emergency is over.” The extra blood that rushed to the rescue can go home, and the muscles and ligaments that tightened to protect you foot can now relax. It’s a process.

As with ice, heat therapy should be done for short, on-off periods of 15 minutes at a time. An electric heating pad is best, but a hot water bottle wrapped in a towel also works. Don’t use heat while you are sleeping, and continue to keep the leg elevated whenever possible.

Crutches are helpful for two reasons: Most important, they take the pressure off your injured foot while walking. Second, when you are out, they signal to those around you to stand clear and not bump you. (Best not to go down a second time.) For under $40, you can order crutches through your pharmacist (many Schnuck’s pharmacists will do this), or most Walmart’s now carry them.

Finally, gently wrapping the injured ankle or foot in an ACE bandage is a good thing. The compression from the ACE bandage protects your foot from re-injury. However, when home, take the bandage off so blood can circulate freely.

Let me emphasize that this “ice first, heat later” recipe is only for sudden sprained ankles or a pulled muscle or ligament in the foot. Other body injuries, like a pulled back muscle, have a different protocol. Chronic conditions, like shin splints, also have a different use for ice and heat. We’ll address those challenges in another blog.

If your seemingly simple sprain continues to seriously hurt after 48 hours, please call us at the Snyder-Stuart Podiatry Center nearest you and we’ll set up an appointment quickly.

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Sep 28, 2011

Treating High-Heel Addiction: Five Ways to Lessen Self-Inflicted Foot Pain

I give up. Carrie Bradshaw and her gorgeous Sex and the City gal pals win. Women simply are not going to give up high heels, at least not in my lifetime.

As a podiatrist and surgeon, I’ve preached that over 85 percent of foot surgeries in this country – and at a cost of nearly $3.5 billion a year – are done on women. I’ve repeatedly said that pointed shoes with thin soles and spike heels lead to a range of foot, leg and back problems ranging from bunions, joint pain, stress fractures, calluses, corns, hammertoe, toenail problems, ball of foot pain, and tight heel cords (shortening of the Achilles tendon). Clearly I’m preaching to a choir who is tone deaf.

So, let’s move on. I’m offering five suggestions to those devout high-heelers who’ve already had it written into their will that they are to be buried in five-inch heels. Start slow, but try to incorporate as many of these ideas into your fashion sense as you can.

1. Shop for the right shoe: Three tips on shopping for shoes. First, it’s best to shop for shoes later in the day when your feet are a bit swollen and at their largest. Second, be sure and try on both shoes. Few of us have exactly the same sized feet.

Third, you need to understand that high heels are hard on all body parts south of your belt for several reasons. The most obvious is that a high heel throws your posture off its normal position, and then your body fights to regain control. (Recent SSPC blogs on “Footwear for Expectant Moms” and the new butt-firming shoes talked about the dangers of being unbalanced by your shoes.) The only advice I can offer here is to do a few laps around the shoe department in the desired shoes to see if you can control your gait. If you can’t, walk away.

2. Pay attention to the ‘pitch’ of the shoe: High heels pitch your body weight onto your toes which are then squeezed into a too-narrow toe box. It is precisely the same pressure as a ballerina on point shoes (also invented to create the illusion of height). So, when shopping for new shoes, try to go for ones with a rounded toe box or open-toe shoes, AND look for a narrower heel that fits snugly (but not tight) to lessen the slide of your foot into the shoe box.

3. Go up a shoe size: At the very least, go up a size to give your toes have a bit more room. (You can scrape off the size stamp when you get home.) In a properly fitted shoe, the shoe box should be slightly wider than the front part of your feet – and you should be able to move your toes. Also, a little extra room is important so you can add your own extra padding, thus taking some pressure off your feet.

4. Alternate shoes: It’s not good for men or women to wear the same pair of shoes every day. Switch up. And try adapting the New York City-girl routine of wearing running shoes outside, then switching to heels in the office. Not only is this safer than walking the streets in stilettos, it protects and preserves your expensive designer shoes.

5. Invest in at least one pair of “good” shoes: You found the money in your budget for those Jimmy C’s, now find it for the shoes that will help neutralize the damage. You want a round shoe box, strong arch support, a smaller one- or two-inch heel, and plenty of padding bottom and sides. Wear these for “non-event” occasions, like errand-running or shopping.
Also, don’t go completely flat! Flip flops or the very flat ballet shoes may not have the height, but they also don’t have the padding or the arch support that your already-abused feet long for. Go with a structure shoe, a one- to two-inch heel and plenty of padding.

If your foot pain continues, make an appointment with SSPC. Bring your high heels and let us evaluate and check the fit. Research has shown that the most effective way to reduce the negative effects of high heels is to use a cushioned orthotic that can transfer some of the pressure off your toes. We are experts on orthotics and have a range of possibilities that can reduce back and leg pain while improving your body alignment and balance.

It’s just what Carrie would do!

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Jun 13, 2011

Blistering Heat & Feet: What You Need To Continue Your Summer Walking Program

The “dog days of Summer” are not a blank-check excuse to discontinue your new fitness walking program. As we head into the heart of Summer, here are a few suggestions that can keep you both inspired and safe as you continue to walk for exercise.

A popular way to beat the heat is to move your walking program indoors. You can switch to a treadmill at home or at the gym, or walk in an air-conditioned mall. Mall walking is a great alternative, particularly if you struggle with seasonal allergies. (And for some of us, it’s also a good idea to leave your wallet in your car to avoid the temptation to shop!)

There is no dishonor in moving a fitness program indoors, particularly when the Summer heat can bring sudden storms that, as we have seen already this Spring in St. Louis, can be dangerous. Yet for those of us who spend much of the day sitting in air conditioning, being outdoors beacons to us.

If communing with nature is your preferred path, here is what you need to keep in mind before heading outdoors. Avoid the big three: chafing, blistering and burning.

Chafing happens when heat and sweat mix, usually under your arms, chest, crotch and thighs. Add friction and you have trouble. There are two things to consider. First, think about investing in sweat-wicking clothing. Cotton is good, but today there are new microfibers, such as Cool-Max, which actually draw dampness away from the skin and allow it to evaporate before trouble can start. There is a whole wardrobe of shirts, tops, bras, socks and shorts to choose from. Also, there are the anti-chafing products carried at most drug stores that can be used in these sensitive areas of the body to prevent chafing before you walk.

Blisters on your feet are nearly always preventable, and oddly enough, there are two opposing directions you can go. One is to borrow a trick from marathoners, who lubricate their feet by slathering them with petroleum jelly or an AD ointment (sold in the baby diaper section). The other option is to keep your feet very dry with talcum powder or corn starch (like what you cook with) sprinkled in your shoes, between your thighs, arms, etc. Also, if you tend to blister in a certain place on your feet, a simple adhesive bandage or moleskin can protect the spot.

While I haven’t personally tried them, there are new antiperspirants designed specifically for feet. A recent military study claimed these reduced the incidence of blisters. If you have seriously sweaty feet, this might be worth a try.

Finally, burning, as in sun-burning, is a fairly easy thing to avoid. Always wear a hat, even when it is overcast out. And do I really have to tell you to use SPF 30 on any skin the sun touches? Many people like a bandana or one of the new neck coolers around their necks to protect and lower body temperature. Light-colored clothes are also advisable in the Summer. Why attract more heat with a black shirt???

Another alternative to mall walking is to do your fitness walking very early in the morning or evening to avoid the hottest part of the day. However, do think about safety, both from traffic and predators. Again, light-colored clothes, not black, are important so that you are seen by motorists. If you’re a regular late-night runner or walker, invest in a reflective safety vest – like traffic officers and road crews wear. It’s also important to carry a flashlight and obey traffic rules.

Even though you are an adult, “stranger danger” is an appropriate topic for walkers, particularly if you’re exercising before dawn or after sunset. There are little things that you can do that significantly discourage the bad guys. Obviously, carrying a purse implies there are valuables to be had, so leave that at home. Bring identification, keys, cell phone and as little else as you can, and carry these things in pockets or a fanny pack.

Walking with someone else or with a dog, even a little one, is a good deterrent, as is staying on a course where there are people and traffic. A walking or hiking stick is likely to discourage trouble makers, as are brightly colored personal body alarms or a whistle worn around your neck.

Finally, maybe the single most important thing to do when walking in the heat is to hydrate your body. If you drink 16-20 ounces of water 90 minutes before leaving the house, your body will eliminate most of the water before you go, and leave your body well-hydrated. Then, for every 30 minutes you’re out walking, stop and drink something non-alcoholic. Water is always the best hydrator.

Many walkers like to carry a water bottle with them. Personally, I like my hands free and rely on public water fountains. My friend Paul, however, takes a plastic bottle, fills it to the halfway mark with water, then freezes the bottle. After 30 minutes in the heat, enough of the ice has thawed for him to get several gulps of good, cold water.

So, just to review, you’ve got your hat and sunscreen on, you’re wearing reflective, light-colored clothing that can wick off moisture, you have used creams and/or powders on chafing or blister-prone areas, you’ve chosen a well-lit, populated course to walk, and you’ve got your cell phone, water bottle and flashlight with you.

Let’s have a great Summer walking!

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May 18, 2011

Why Walk?

The weather is starting to change and the smell of spring and summer are in the air. The desire to get out of the house is becoming stronger. So what should you do? Go for a walk. Yes, something as simple as a walk can help relieve pent-up spring rain-storm blues, increase circulation and promote a healthier lifestyle.

At SSPC we’ve decided to focus some blog articles on two subjects, “Walking For Health” and “Running For Health.” We’ll address one or two aspects of these exercises each week, give you all the facts, and hopefully make it easier for you to start AND continue, perhaps for the rest of your life.

So, since one walks before they run, we will begin with walking. As physicians, we will remind you that any exercise program should have the approval of your doctor before starting.

To reinforce the value of exercising in general and walking in particular, here are 10 specific facts on the benefits of walking. (We are borrowing from Wendy Bumgardner’s 2010 article on about.com where she lists the “Top 10 Reasons to Start Walking.”) Read carefully.These motivating facts might surprise you.

Here they are:

1. Walkers Live Longer. According to Ms. Bumgardner, a 12-year Honolulu Heart Study of 8,000 men discovered that by walking just two miles a day, the risk of death nearly cut in half. In particular, the chance of cancer was greatly reduced.

Nearly all exercises, including walking, go a long way toward protecting the heart and the circulatory system because they raise the HDL (good cholesterol), recharge the immune system and keep weight down.

2. Walking Reduces the Risk of Cancer. Study after study shows that walking significantly reduces the chance of cancer, particularly breast cancer and colon cancer. For those undergoing cancer treatments, walking has been shown to improve the chance of recovery and survival.

3. Walking Reduces the Chance of Heart Disease and Stroke. This is a 2-for-the-price-of-1 that nobody should pass up. The amount of supporting medical research is profound: A moderate walking program for 30 minutes a day improves the heart and goes a long way toward preventing heart disease.

4. Walking Reduces Stress, Depression and Blood Pressure. Moderate exercise, like walking, has been shown to reduce emotional stress and depression. Other studies have shown that rather than one long walk, three or four short, brisk walks throughout the day can control and lower blood pressure.

5. Walking Reduces the Risk of Diabetes. Walking for 30 minutes a day cuts the risks of getting Type 2 diabetes in both men and women.

6. Walking Helps Prevent Weight Gain. According to research by Dr. James O. Hill at the Center for Human Nutrition at the University of Colorado, if you add 2,000 steps to your current activities, you may never gain another pound. (To lose more weight, simply add more steps per day.)

7. Walking Decreases the Chance of Impotence. We already know that exercise in general increases the sex drive in men and women. For men, walking 3-5 hours per week lowers the chance of erectile dysfunction by 30 percent.

8. Walking Boosts Brain Function. A study by the National Council on Aging found that people over the age of 60 who walked 3+ miles a day or 45 minutes enjoyed increased thinking skills and were mentally sharper.

9. Walking Improves Mood. Nearly all exercise encourages the release of endorphins, the body’s natural “happy drug.” A recent study published in the Annals of Behavioral Medicine showed that college students who walked regularly had lower stress levels that (a) couch potatoes and (b) strenuous exercisers like runners, which brings us to No. 10.

10. Walking is just as beneficial to your heart as running. According to a study in the Archives of Internal Medicine, 30 minutes of walking brings the same risk reduction for heart attacks as running.

And did we mention that a committed walking program is a good way to lose weight, too? If adding 2,000 steps a day to your current activities maintains your weight, then adding 2,001 steps is the first step toward losing weight.

Speaking of numbers, many physicians are seeing that the truest indicator of heart health is a person’s overall activity level, NOT their weight or their BMI (Body Mass Index). In other words, a couch potato is more at risk for heart problems than a person who is overweight or even slightly obese. The point is… just start moving.

May 18, 2011

How to Choose the Perfect Walking Shoe: What You Don’t Know Can Hurt You

In recent blogs, we’ve covered the health reasons for starting a walking program (it lowers the chance of cancer, heart disease and diabetes) as well as a list of strong motivators (walkers live longer, weight less and have more energy). So, let’s move on to how to start your fitness walking regiment.

First, an aspiring walker needs the proper equipment, which in this case is a good pair of walking shoes. Find the athletic shoe store where serious runners go. The salespeople or podiatrists there usually are best trained in finding you the right shoe that fits properly. Once you have established a brand or shoe that works for you, you can also consider purchasing it online.

As a rule, a good walking shoe should be flexible. You should be able to twist a shoe (like you would wring out a wet washcloth). The shoe should bend at the ball of the foot, not in the middle of the arch. If you put the shoe on a table, you should be able to “rock” it back and forth with the toe being slightly off the ground. Also, the heel should be no more than an inch higher than the sole under the ball of the foot. (NO butt builders.)

In addition to being flexible and having a low heel, a true fitness walking shoe will have a heel that is undercut, which means it angles in from the heel to the ground, not out. Most walkers tend to land on their heels and do not need the built-up or flared heel that runners require for stability.

There are different types of walking shoes for different types of walkers. If you anticipate walking for very long distances, a cushioned walking shoe might work best for you. There are stability shoes for walkers who want a stable and long-lasting shoe. But the most popular are lightweight performance trainers that work well for many people. The exception is for those who have been diagnosed as “overpronators” because their feet roll too far inwards and the arch of the foot flattens. They need to find motion-control shoes. A podiatrist can help determine if you have this condition.

People often ask me “Can I wear running shoes for walking?” While not all running shoes are appropriate for walking, most are fine. In fact, some salespeople will encourage you to browse both the walking and running aisles for shoes you’d like to try on.

A lot of walking shoes are really designed for comfort rather than for fitness walking. So whether it’s a running or a walking shoe, be sure to apply the same “twist-bend-and-rock” tests we talked about earlier.

Once you have your walking shoes, here are some tips on how to properly lace them based on your foot type. The experts at Runner’s World Magazine suggest that if you have a high instep or a particularly wide forefoot, you start with the normal criss-cross lacing (near the toe), then mid-foot, don’t cross, simply feed the laces up their respective sides. Near the top, return to criss-crossing for the last 2-3 holes. You can adjust the “hole” you’ve created where there is no criss-crossing for your comfort.

Another good technique is called the “loop-lacing lock,” often used to create a secure and tight fit. To do this, simply put the lace end back into the same hole it just left leaving a small loop on the side. Then thread the loose end through the loop on the opposite side to form a strong and tight closure. If you have a narrow foot or problems with your heel slipping in the shoe, this technique works very well.

There are several things you can do to make your walking shoes last longer. I recommend you use your walking (or running) shoes only for walking (or running). Yes, they’re very comfortable, but the shoes will last much longer if you change them after exercising. Also, I am constantly telling my children to “Always unlace your shoes before you take them off.” Yes, you’re tired and you are tempted to put one foot on the heel of the other and flip them off. Don’t do it!

If your shoes get wet, loosen the laces, take out the insides and let them air dry away from heat. Store shoes where they can air out (preferably for a day or so), and don’t leave them in a hot trunk or gym bag. Finally, as tempting as it is, washing machines are not your shoes friend. Wipe, hand wash, scrap, scrub or brush them clean.

Do you need two pair of walking shoes? Yes, that would be very nice. However, don’t buy two pairs of shoes at the same time. Buy one, make sure you like it, then invest in a second pair a few months later and alternate them. You are probably due for a whole new pair of shoes when (1) the “mileage” hits 300-400 miles, (2) the soles are worn out and/or (3) the shoe fails the flex test. Or maybe new shoes just feel much better!

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