"Fish Pedicure" Is It the New Fad?

 If you live in Florida, Massachusetts, Texas, Washington, or New Hampshire, you won’t be able to find the latest trend in foot care on your local salon menu.  That’s because these states have outlawed the fish pedicure, a fad that is quickly gaining press coverage throughout the country.  The trend is popular in Asia, where customers can dip their feet into a large bowl of water, inhabited by dozens of tiny fish known as garra rufa, or doctor fish.  These tiny, toothless fish nibble away at dead and dried up skin, removing it in a similar fashion as a normal pedicure might.

State legislatures have been quick to ban the practice, citing several preexisting rules, including the prohibition of pets and animals in a salon, as well as sanitation standards set in place for pedicures.  But at a Virginia salon, customers are flocking to come get their feet nibbled on by the doctor fish.  At Yvonne Salon, with locations in Alexandria and Woodbridge, VA, the practice has been all the rage, being featured on the Tyra Banks’ Show and NPR, as well as the local news.

The tiny fish don’t have any teeth, so it is more of a sucking, or “kissing” feeling for the customers.  Garra rufa originate in the river basins of Turkey, Syria, Iraq and Iran, where the fish were first used as a treatment for psoriasis.  While the fish did not cure anyone’s psoriasis, they did help treat the symptoms, nibbling away at the dead and dried flesh of the spa-goers.  Since 2006, the fish have been used in commercial day-spas, starting in Japan and China, and finally finding their way to the United States. 

While the American Podiatric Medical Association (APMA) has not officially made a statement regarding the use of fish in pedicures, there are clearly some sanitation issues that arise. The cleanliness of the fish and water that the fish live in is certainly an issue, as well as any skin conditions that the customer might have.  The effectiveness of fish pedicures has also been brought up, as it is difficult to compare this process to that of a traditional pedicure. 

For now, it remains a fad in foot care.  But if you want to try it for yourself, it may involve traveling to Virginia, or another state where fish pedicures have not yet been banned.  

Central Florida Foot and Ankle Center
101 6th St. Nw 
Winter Haven, Fl. 33881
Phone: 863-299-4551
www.FLFootandAnkle.com

Do You Have Intense Pain In Your Heels?

Has this ever happened to you?  You wake up, swing your feet out of bed, and the first few steps you take cause an intense pain in your heels?  If so, you may be one of the millions of people who suffer from plantar fasciitis every year.  It is one of the most common causes of heel pain, and it can be particularly debilitating for those who enjoy an active lifestyle. 

            Plantar fasciitis is an inflammation of the tissue on the bottom of the foot, known as the plantar fascia.  This band of tissue connects your heel bone to your toes, and helps provide the structure and support required of your feet for walking.  The inflammation is caused by a straining of the band of tissue, which can happen in a number of different ways.  One of the most common ways for the pain to occur is when a person who has been seated or lying down for an extended period of time first stands up, putting weight on their feet.  It is for this reason that plantar fasciitis often is first noticed in people getting out of bed in the morning.

            As the day goes on, the pain may temporarily goes away, only to come back later in the day or possibly the next day.  The pain is usually worsened by long periods of standing, or walking up stairs.  There are many methods of treating plantar fasciitis, including:

·         Icing the effected area

·         Stretching the plantar fascia tissue with a towel or other stretching device

·         Reducing the amount of time you stand on your feet, or cutting back on some of the activities that exacerbate the pain, such as running. 

·         Taking an over-the-counter anti-inflammatory, such as ibuprofen, naproxen, or aspirin.

·         The use of orthotics in your shoes, and getting a new pair of shoes, with arch support and a cushioned heel.  The shoes should be comfortable to wear for extended periods of time.

 These methods work better for some than for others, and it is often a combination of several factors that will ultimately alleviate the pain.  Talk to your doctor about any heel pain you may be experiencing, as it may be a sign of a potentially more serious condition, especially if that pain occurs while lying down at night.  Together with your doctor, a plan can be put in place to get you back on your feet again, pain free!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

The Price "You Pay" to Look Good

Is it just me, or has the phenomenon around Sex and the City taken the popularity of high heels and skyrocketed those to new heights? More then ever, high heels have become a fashion statement unto themselves, with each season bringing about more shocking, more vibrant, and more amazing shoes than their predecessors.

 But a three or four inch shoe can be daunting. And many cannot even begin to fathom the greater heights, as we push ourselves in to 4 1/2, 5, or 6 inch heels. With the pursuit of vanity (and great gams) come warnings, fears, and frights.

 DR.’S RESPONSE:  High heels are the nemesis of the astute podiatric surgeon.  Unfortunately, despite our best and well intentioned efforts to encourage the disuse of high heeled shoes, fashion conscious women continue to push the envelope.  I’ll give you an example:  Just yesterday I was at a boat show, with steps, docks, and people getting in and out of boat gunnels.  I saw a middle aged woman there with 6 inch heels, obviously in intense agony walking and hobbling along.  Why do women torture themselves?  As a physician, I recommend the use of flats with an elevated heel of 1 inch.  If heels must be worn, I encourage my patients to use heels of 2 inches or less.  Anything more severely alters the biomechanics of a normally functioning foot.  This can lead to a shortening Achilles tendon, bunions, deformed toes, formation of a bump on the back of your heel, balance problems, sprained ankles, blisters, and corns.  

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

HOW TO “HEAL” the HEEL PAIN

Heel pain is a common problem that many podiatrists see daily in their busy practices.  As foot and ankle physicians, we treat this malady quite frequently with a variety of treatment methods.  Before we concern ourselves with the actual treatment plans, let us understand a little background information about this condition.

First, what is “heel pain?”  Heel pain commonly refers to a number of conditions that can affect the heel.  For the layman, it is an umbrella term that can mean a whole host of issues.  For argument’s sake and brevity, let us focus on what is more correctly referred to as “plantar fasciitis” or inflammation of the plantar fascia.  This entity goes by many other names, such as heel spurs, heel spur syndrome, plantar fasciosis, to name a few.  

The plantar fascia is an elastic band of tissue that spans between the heel and ball of the foot.  It actually continues as the plantar part of the Achilles tendon, beginning behind your leg, around the back of your heel bone, and continuing to the bottom of the foot where it separates into 5 smaller parts to insert onto the bottom of the foot where each toe connects.  Normally, this fibrous band of tissue is able to withstand the years of punishment that we put our bodies through daily.  It actually does quite an amazing job, supporting our arches as we walk, run, jump, dance, and generally abuse this portion of our anatomy.  We don’t really think about our feet until they begin to hurt.  And nothing hurts more than a sharp, stabbing pain at the heel which is worsened with every step.  We are constantly reminded how much it hurts as we plod through our work day.  And when you rest, it feels better, right?  But then you get up off that work chair and hello that lightning like pain comes back even stronger than before.  More about that later.  

Before I continue, a small disclaimer is needed.  It is important to note that heel pain can be due to a variety of other causes.  Because of this, it is important to have heel pain properly diagnosed by a foot and ankle physician, someone who is best trained to determine the appropriate diagnosis and treatment.  

For plantar fasciitis to occur, we need to understand mechanically what is happening.  I like to tell my patients to think of a rubber band that is attached to two sides of a roman arch.  The rubber band stretches and tightens, stretches and tightens, and so on throughout the day.  To cause pain, this rubber band stretches beyond its normal length.  The tissue becomes inflamed because of the excessive stresses placed upon it.  Unlike a rubber band, it doesn’t snap, but it sure does feel like it.  In the body’s futile attempt to “bridge the gap,” sometimes extra bone is laid down where the band begins at the heel.  Thus, we arrive at the term heel spur.  Instead of alleviating the pain, this oftentimes exacerbates the pain, prompting a visit to your local podiatrist.  

Signs and symptoms that you may experiences include the classic “post static dyskinesia.”  This term really means “it hurts when I begin movement after a period of rest.”  The most common complaint I hear is “doc, my feet hurt as soon as I place them on the floor in the morning.”  Think for a moment back to the rubber band.  While you are sleeping at night, your feet are resting on your bed, and very little, if any, stress is placed upon them.  During the night, that rubber band tightens and gets smaller because the roman arch of our foot does not need to be maintained during a period of rest.  But when we wake up in the morning, bright eyes and bushy tailed, we throw our feet over the bed onto the floor and OUCH!  We have suddenly and abruptly placed a stress on that foot.  This doesn’t occur just in the morning either.  It can occur after ANY period of rest longer than two or three minutes.  Sometimes, this pain is diminished a bit after that initial first step because the fascia is being forcibly stretched.

Other symptoms include specific pin point pain at the heel, which often is easily noted.  The pain often worsens as the day continues and is very quickly alleviated with rest.  Also, the pain may progressively worsen over a period of months.  Certain shoes may aggravate the condition as well.  Obesity, shoe gear, work conditions, and foot type can all play a role in its development.  

Conservative treatment is the mainstay of eliminating heel pain.  Any number and combination of the following methods may alleviate your pain.  They are basically divided into what you can do as a patient and what we can offer as physicians. The most important component I believe is stretching which you can read more about in HOW TO “HEAL” the HEEL PAIN part 2. 

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com

HOW TO “HEAL” the HEEL PAIN Part 2

As we discussed in the previous article the most important component in eliminating heel pain I believe is stretching.  Take a belt, a towel, or that ugly tie Aunt Sallie gave you for your birthday and stretch your feet everyday BEFORE getting out of bed.  Put the towel at the ball of the foot and pull both sides toward you like a horse bridle while keeping your knee straight.  You should feel a pulling sensation behind your knee and down your leg.  Hold this position for 30 seconds and repeat five times with 30 seconds rest between each stretch.  Oh, and make sure you stretch the unaffected side as well.  I’ve seen it go away on one foot only to return on the other. 

 Another trick is to freeze a regular ole’ bottle of water.  Every night as your sitting in front of your television watching the news, roll that bottle with your foot for about ten minutes on each foot.  This ices the bottom of the foot and stretches the fascia at the same time. 

 Non steroidal anti-inflammatories, or NSAIDs for short, are also a great option for some.  Advil, aleve, celebrex, naprosyn, ibuprofen, motrin, etc. are over the counter and readily accessible for all patients.  Your doctor may prescribe a more potent NSAID but they all help to reduce inflammation and swelling associated with this condition. 

 I can’t encourage you enough to wear shoes at all times, not just at work or play.  Many houses have tile or wooden floors which will not offer any cushion to that painful heel of yours.  Wear supportive sandals or thick flip flops around the house.  I try to discourage house slippers because they are really not helpful.  I prefer that my patients wear Crocs because they feel wonderful and offer just enough support to be worn around the house.  Along that same line, I can’t over emphasize the importance of quality shoe gear.  A good supportive shoe will do wonders.  You cannot believe the type of shoes out there and I often find myself asking “you paid HOW MUCH for those?” 

 Moving into the doctor’s office, we have a variety of more in depth treatment options.  Any good doctor worth his weight will give you a crash course on the conservative treatment options above.  He may also offer to tape your feet, temporarily lifting the arch and assisting that rubber band.  This works great but unfortunately, unless your doctor is your spouse, only lasts a few days because the tape falls off. 

 Night splints are somewhat expensive but they also work wonders.  Maintaining the stretch on the plantar fascia during the night while you sleep certainly assists with pain control and condition remedy, but they can be awkward and some people may not be able to tolerate them.  Your doctor may elect to have you wear a removable walking cast or boot that can be used to keep your foot immobile for a few weeks to let it rest up and heal (pun intended). Another item that can provide very long lasting relief is custom orthotics.  They are expensive but ask anyone who has a pair, they are definitely worth it.  These address the underlying structural abnormalities that may be contributing to your heel pain. 

Injections seem to be the mainstay of our treatment regimen because they provide quick relief.  They can be somewhat painful when administered, but offer long lasting relief when they take affect.  They are usually composed of a short acting local anesthetic as well as a longer acting corticosteroid, which serves to reduce the inflammatory response. 

 You may also look into shockwave therapy which has been shown to have excellent results.  As a last resort, surgery is an enticing option for some.  More than 90% of patients routinely achieve lasting relief without surgery.  You should try at least six months of conservative measures before entertaining the idea of surgery.  Your foot and ankle surgeon will discuss the most beneficial approach for you. 

 No matter what treatment you undergo or receive for this sometimes very painful condition, remember that the underling causes of this condition often remain.  Therefore, you should proceed with preventative measures to reduce the chance for recurrence.  For all patients, wearing supportive shoes and using your custom molded orthotic devices will provide long term treatment.  

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.flfootandankle.com