Update on how I am handling the office these days:
Ace Feet will be open as needed while the COVID 19 pandemic is occurring, and of course, fully open once it is no longer an overwhelming issue.
My approach to best serving patients during this pandemic has changed over the past few weeks.
When news of the Biogen conference first hit the internet I felt hopeful that the US, and in particular the Boston area, would be able to contain the virus and avoid wide spread disease. I was hopeful because in spite of all of the terrible news, reports stated that the tide was turning in Wuhan. They were isolating and seeing more recovery and less new cases.
It seemed like we could and would nip it in the bud with social distancing so I shut down the office and cancelled appointments. Let’s face it, most foot problems are not life and death!
A few weeks ago I was hopeful that new COVID cases would not appear locally. Governor Baker imposed a non-essential business shut down. People were staying home, washing their hands more, and generally being careful. I actually thought we could shut this problem down in a jiff, but now it seems that COVID 19 will be around for awhile.
I realized that people are still getting ingrown toenails, infections, and pain. People are walking and running outdoors more and getting injured. Most of these injuries, ingrowns, callouses, and pain points are easily treated. They also have the potential to grow into major problems if left alone.
So let’s say you have a foot problem and you’re feeling kind of miserable! If my office were closed, you’d have to go to a health center to see a primary care doctor, or Urgent Care, or the ER. At any of those places, you would likely come into contact with at least three different people from start to finish (think of the check-in/medical assistant/nurse/radiology technician/doctor or PA). You’d have to go through a busy waiting room in a facility that is probably seeing patients with respiratory problems (potential COVID patients). This can clog up an already strained medical facility and bring more people into contact with each other. (Side note: Many primary care physicians don’t do nail procedures or the like and often refer those problems back to a podiatrist anyways.)
So, I am opening the office to see patients who do not have COVID 19, and who do not have a cough, sore throat or fever. I am the only person in the office. You can go straight from your car, into the treatment room and back, and only deal with me. I am keeping a distance from people. I am wearing a mask throughout the patient visit. I am also giving patients a mask to put on when they come in. The treatment chair and floor mat are wiped down with a Lysol wipe after each person. (I do this anyways.) I am wiping down door handles- all of them – the front door, the glass door, and the room doors.
Long story short, Ace Feet is open. This is my way of helping the community and preventing the spread of this virus. If you have questions or concerns please call 781-901-4896 or email firstname.lastname@example.org
When we think about how our bodies change with age, we usually think of graying hair, sagging skin, or arthritis of the knees or back. We almost never think about our feet and the effects that time and age have on them.
Those workhorses at the end of our legs are actually remarkable structures of natural engineering. With every step, they absorb a tremendous amount of shock, sometimes up to three times our body weight in force. They also provide a stable base to support the rest of the body and propulse it forward. More than a hundred muscles, tendons and ligaments in the foot work in concert to keep us upright and moving forward, step after step. These steps add up over the years and can produce a fair amount of wear and tear on the feet. Your feet will change over time, in ways that you might not expect. Here are the five most common changes to your feet over the age of 50, with tips on how to mitigate each.
1. Your feet get bigger:
While feet do not literally grow after about the age of 22, they can become longer and wider over time. The greatest contributor to this “growth” is basically foot spreading in response to pressure on weakened foot ligaments. Ligaments are rope-like structures that hold bones together. They lose elasticity with age, and do not flex with activity like their more youthful counterparts. Pressure from slow weight gain over the years and/or pressure from standing and working on the feet all day can strain the inelastic ligaments. They become ever so slightly lengthened over time, resulting in a longer foot and larger shoe size. This phenomenon is the cause of many “fallen arches,” where feet become flatter and longer. Feet can become wider in much the same way. People who over-pronate when they walk (roll their feet inwards) exert more side to side forces on the foot ligaments, spreading the bones width-wise, resulting in bunions, and wider feet.
Some women will develop larger feet after having children. Towards the end of pregnancy, hormones are released to prepare the pelvis for childbirth. These hormones not only loosen the pelvic ligaments but also loosen ligaments in the feet. The result can be foot spreading and an increase in size.
Most everyone will experience some change in foot size as they get older. Old shoes become tight and uncomfortable. Occasionally nerve compression, bunion pain, neuromas and other avoidable issues ensue from simply wearing shoes that don’t fit. A simple fix is to have you r feet measured before buying new shoes and considering new shoe brands and styles that may better fit your new foot size and shape.
2. Your feet get skinny:
There’s an unfortunate phenomenon that can occur over the age of 50 called Fat Pad Atrophy (FPA). FPA describes localized fat loss which may sound like a good thing at first. However the fat that’s lost is in the last place on your body that you would want to get rid of it – the bottom of your feet.
We normally have a fat pad beneath the heel and ball of foot that serves a protective layer, to provide cushion and shock absorption. In FPA, this protective layer wears away. The bottoms of the feet become bony and tender to walk on. Callouses, bruising and ulceration may result if untreated. Fortunately, not everyone will be affected by this condition. Genetics plays a large role in determining who will develop fat pad atrophy. Other risk factors are:
• History of steroid injections in the feet
• Long term use of high heeled shoes
• Body mass index (BMI) — your weight in relation to your height can have an impact
• Hormonal shifts caused by pregnancy, menopause, hysterectomy and chemotherapy
• Trauma from landing heel-first after a fall or jump on a hard surface
You may suspect FPA if you are starting get callouses in your feet for the first time, over the age of fifty. Callouses should be removed to prevent pressure sores, ulceration, and pain when walking. Normally this will require a visit to your podiatrist, or other health professional who is trained to safely remove these to the appropriate depth. People with FPA need to wear well cushioned shoes. Sometimes a gel insole or diabetic insole is necessary to maintain comfort and prevent skin issues.
3. Your feet no longer grow hair:
Did you know that you have (or used to have) hair on your toes? One of the first things that every podiatrist checks during an exam is for the presence or absence of hair growth in the toes, top of foot and lower legs. Hairy toes are a hallmark of good circulation and healthy arterial perfusion to the skin on the feet. Lack of hair on the feet can occur secondary to one of two main causes. The first is a natural aging of the hair follicles. Just as the hair on our heads can thin or diminish with age, so too can the hair on our feet and legs. This is a normal part of aging. The other cause is a more serious condition called peripheral arterial disease (PAD). PAD involves fatty deposits and calcium build up within the arteries that carry blood to the extremities (atherosclerosis), resulting in decreased circulation to the feet. Early signs of PAD can include cold toes, slow growing toenails, slow to heal sores or ulcers, and thin shiny skin on the tops of the feet. Signs of advanced PAD include pain to the legs with walking (claudication) and pain upon elevating the feet. Since people with PAD are at higher risk for stroke and heart attack, early diagnosis and treatment are important. Anyone with symptoms or concerns should see their doctor for an evaluation.
4. You get hammertoes:
After years of standing and walking, your toes can become permanently contracted into what is called a “hammertoe”. From a side view the hammertoe rests in an inverted V or C shape instead of laying flat. While the risk of developing hammertoes is higher if you’ve spent years squishing your feet into high heels or narrow shoes, anyone who has done a good amount of standing and walking can develop this problem. People really grip the ground with their toes when they walk, and people with high arches tend to be more prone to developing hammertoes. Over time, the repeated toe flexing results in tight, contracted tendons that hold the toe in a permanently bent position. Early on, toe stretching and yoga-like toe exercises can help. Advanced hammertoes can lead to arthritis and occasionally skin lesions. People with hammertoes should look for shoes that have a deep toe box, with a soft flexible material on the upper shoe. This style of shoe accommodates the hammertoe shape, maintains comfort, and helps prevent the development of skin lesions.
5. Your Toenails Get Thick:
Toenails that were once thin and clear can become yellowed, thick, slow growing, and difficult to cut. Thick, discolored toenails can occur secondary to a number of causes including:
• Fungal infection
• Poor circulation
• Hormonal changes
• Nail trauma
Thick toenails can be very tender, even though the nail plate itself is made of dead tissue called keratin. The tenderness arises from the base of the nail that is attached to the nail bed and the nail matrix (the cells that grow new nail). These areas get irritated because of a thick nail placing a lot of pressure on them, when the nail is moved, bumped into, or pressed on. The first step in managing a thick nail is to determine the cause. A fungal infection can be easily evaluated with a microscope and scrapings from beneath the nail. There are more involved test where cultures and special stains are applied to nail specimens to look for signs of fungus. Fungal infections can be treated with in office procedures, and medication. A non-infected thickened toenail can be thinned with electrical debridement, a painless method trimming and reducing nail size. There are also nail softeners that are available over the counter to help make a thick nail easier to trim and file.
Our feet will change over time, but we can adapt with them. Have your feet checked by your doctor regularly so that any serious concerns can be addressed early. There are lots of new treatments, tools, shoes styles and other methods to give your feet the care they deserve.
Chemotherapy can be lifesaving in the fight against cancer, but it can also ravage your body in the process. These medications kill cancer cells but they also interfere with some of the body’s normal, well-functioning cells. The result are the dreaded side effects of chemotherapy.
When people think of side effects from chemotherapy, they think of fatigue, hair loss, anemia, nausea, mood changes, and bruising. The lesser known side effects of chemotherapy are Hand Foot Skin Reaction (HSFR) and Hand Foot Syndrome (HFS). These painful syndromes occur with the use of specific classes of drugs, and result in painful skin conditions along the hands and feet.
There are treatments for these syndromes, and in some cases, preventative measures that patients can take to avoid them from occurring in the first place. The following is an introduction to HSFR and HFS, what causes them, and how to manage symptoms.
Hand Foot Skin Reaction (HFSR)
This syndrome is characterized by extremely painful lesions on the bottom of the feet and palms of the hands. These lesions start out as blisters or discrete areas of swelling. They produce a burning or stinging feeling. Over time these lesions can develop into what looks like typical callouses. Frequently these callouses will rest upon a base of reddish or hyperpigmented skin. (Basically a ring of skin at the base of the callous in a deeper color than your normal skin color – So in dark skinned African Americans it may be blackish, in lighter skinned it may be a deep brown). This discoloration, whether it look red or brown or black, is a sign of the inflammatory process happening in the skin. The most common sites for these lesions to occur on are the heels, beneath the bony areas of the ball of foot, and anywhere that the foot rubs against the shoe.
How Hand Foot Skin Reaction Differs from Regular Callouses
Because these lesions are brought about by chemotherapy-induced inflammation, they are even MORE painful than typical callouses. Trying to go about normal activities like a typical grocery store visit, walking up and down the aisles, causes unusual discomfort.
The timing of the callouses differs as well. Regular callouses start out as a mild nuisance, a small area of skin thickening or a large area of mildly thick skin. They develop slowly and predictibly, in direct proportion to the amount of time one spends on their feet. Regular callouses become painful once they reach a particular size and depth and are managable with regular care. The callouses associated with HSFR appear in response to chemotherapy. They show up between 2 – 6 weeks after the infusion and become painful right away. They are more inflamed and are associated with color changes in the skin.
What Drugs Cause Hand Foot Skin Reaction (HSFR)?
HFSR occurs with the use of multikinase inhibitors such as:
What should you do if you think you may have HSFR?
Patients who are experiencing any sort of foot pain, callousing, or skin lesions should have an evaluation of their condition. Podiatrists offer callous care and are trained to properly manage the painful blistering and calloused lesions. It is important to have the feet looked at by someone who is well versed with the plantar skin, and is able to discern infections vs. callousing vs. the more unique signs and symptoms of HSFR.
What is Involved in Treatment of HSFR Skin?
Hot, inflamed callouses are cooled with a skin softener. The callouses are removed with sterile, surgical instruments to the appropriate depth. This process is usually painless and requires no anesthesia. On occasion, topical anesthesia is used to ensure comfort. The skin lesions a covered one a various skin protectants, depending on skin condition, foot shape and patient activity level. Patients can expect to have immediate improvement in their foot pain. Severely inflamed skin will not be entirely reversed, but those who come in early on, before the callouses become unbearable, can walk away painlessly. To maintain results, and provide longer relief, patients should wear accommodating shoes and insoles to disperse plantar pressure.
Hand Foot Syndrome (HFS)
Hand Foot Syndrome is also called Palmar-Plantar Erythrodesia. This condition causes dry skin to the hands and feet, discoloration of this skin, and swelling. Initially, patients will notice an all over redness (in light skinned people) or reddish-brown-blackening (in darker skinned people). These skin color changes are associated with mild swelling on palms of the hands and soles of the feet. In time, tingling, burning pain, and skin sensitivity develop. The skin will start to peel and is at risk for opening up. Open sores on the bottom of the feet can be dangerous, as they increase the potential for serious infection and make walking difficult. Unlike HSFR, The skin of the feet of patients with HSR will be thinner, drier, and have a more diffusely inflamed appearance.
With Hand Foot Syndrome, the chemotherapy drugs seep out of the blood vessels and into the tissues and skin. This unnatural substance within the skin causes burning and discoloration. The drugss that rest within the tissue can be excreted through the skin. Sometimes people will “sweat out” the chemotherapy through the pores on their feet.
In Hand Foot Syndrome the nails can also be affected. The nails will turn blueish or blackish in color. They can become loosened from the nail bed and fall off. The nails sometimes look like they’re “growing upwards” or break off in pieces.
How Can Patients Avoid Hand Foot Syndrome?
The best prevention can occur during chemotherapy treatment. The drugs tend to migrate towards warm areas of the body. Applying cold packs to the hands and feet during the infusion can help a great deal. The cold causes the blood vessels to constrict, thereby reducing the amount of medication that is delivered to the skin of the hands and feet.
For those taking oral medicines, it is helpful to avoid activities that place heat on the hands and feet. For example very hot showers, hand washing or dishwashing with hot water, going for walks or even exercising can create friction and heat that are very irritating.
What is the Best Way to Manage Hand Foot Syndrome?
The first step is to get an evaluation of your feet. The nail problems and associated skin issues can be irritating and difficult to manage. Sometimes toenails need to be trimmed, debrided,or carefully removed to avoid nail-tearing and open sores. Painful inflamed skin can be soothed with appropriate medications and exfoliation. Tender, thin, dry skin can be safely removed and restored with appropriate care. Occasionally topical pain relievers or anti-inflammatories are used.
Reduction of the friction and irritation that occurs on the bottom and sides of the feet when walking and standing is crucial. Patients with Hand Foot Syndrome should have their foot type and gait evaluated. How a person walks, their foot shape, and their foot flexibility will determine which shoe styles and/or insoles will best support their feet reduce the problem pressure points.
The Chemotherapy Drugs That Can Cause Hand Foot Syndrome Are:
Fluorouracil (5-FU, Adrucil)
Liposomal doxorubicin (Doxil)
Docetaxel (Docefrez, Taxotere)
Cabozantinib (Cabometyx, Cometriq)
Patients sometimes feel like their foot issues must take a back seat until their chemotherapy regimen is over. Not true! Help is available for people with sore feet secondary to chemotherapy. If you have any questions or comments please feel free to contact us here.
Diabetic Insoles, Custom Made in Weymouth, MA
What are diabetic insoles?
Diabetic insoles are specially made shoe liners that protect the feet from ulceration, pressure sores and callouses. They are multilayered, multi-density devices that have been heat molded to a plaster cast of the foot.
Unlike anything store bought insoles, diabetic insoles are shaped to the contours of the individual’s foot. In the office, a cast of the patient’s foot is taken. From this cast, a plaster mold of the foot is made. The diabetic insole is then formed and shaped to this mold. The resulting diabetic insole will have bumps and curves to match the shape of the patient’s foot. They accommodate bunions, cushion bony prominences and relieve pressure from calloused areas. In some cases the diabetic insoles are reinforced to offer support to the arch of the foot.
Why are diabetic insoles necessary?
Complications from diabetes can make the feet vulnerable to a host of issues, including amputation. Diabetics with peripheral vascular disease or neuropathy are at greater risk for ulceration, infection, and the need for hospitalization from a foot infection. Major problems can develop out of what originally looks like an innocent callous or blister.
Proper footgear, which includes custom insoles, can mean the difference between healthy, fully functioning feet and amputation. Sounds scary, but for some, a simple diabetic insole will keep the foot healthy and the skin intact.
Of course, regular visits with your doctor, adherence to medication and diet regimens are key in maintaining foot health. Having a podiatrist examine the feet and note any areas of concern can head off issues before they have a chance to develop.
How long do the diabetic insoles last?
Due to their cushioning, conforming nature, diabetic insoles are made to last only three to four months. The act as a buffer between the foot and the ground. In a sense, they absorb the wear and tear that would be transferred to the feet in their absence and must wear out to do their job correctly.
Typically, three pairs of diabetic insoles are dispensed at a time, each pair intended to be replaced after four months. During the year, the patient should check in with their podiatrist to have the insoles evaluated to make sure that they are offloading and the protecting the feet properly.
People’s feet can change in shape and size over time. Bunions can get larger, hammertoes can curl more, and arches can fall. Therefore, the foot should be recasted each year’s new set of diabetic insoles.
Are they just for diabetic patients?
These insoles provide comfort for anyone with bony, calloused feet, even if they are not diabetic. Their cushioning nature makes these insoles prefect for people with rigid cavus feet, people with fat pad atrophy, people who have been diagnosed with metatarsalgia, and people with severe callouses.
How long does it take to make the diabetic insoles?
Getting diabetic insoles does not have to be a lengthy process. At Ace Feet, patients typically receive their insoles within two weeks of the initial foot examination and evaluation. Our process always includes a follow up visit to ensure good fit and happy feet!
If you have questions or would like an evaluation please call 781-901-4896.
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