My Foot Shop, LLC: BlogBloghttps://www.myfootshop.com/Tue, 19 Mar 2024 03:13:33 GMTurn:store:1:blog:post:370https://www.myfootshop.com/step-into-comfort-avoid-these-shoe-mistakes-for-happy-healthy-feetStep Into Comfort: Avoid These Shoe Mistakes for Happy, Healthy Feet!<h1><span style="color: #00;">Avoid These Common Shoe Blunders for Happy, Healthy Feet!</span></h1> <p></p> <h1><span style="color: #00;"></span><img style="float: right;" src="/images/uploaded/Blog images/man trying on shoes.jpeg" alt="trying on shoes" width="300" /></h1> <h3>1. Sizing Woes? Step Up Your Game!</h3> <p>Ever find yourself in shoes that feel more like clown shoes or a foot-binding experience? It's time to head to a reputable store for a professional sizing. And hey, different brands have different sizing, so always give those shoes a test run before taking them home.</p> <h3>2. Arch Support: Don't Sleep on It!</h3> <p>Neglecting your arches? Big mistake! Inadequate support can lead to uncomfortable conditions like plantar fasciitis or arch pain. Show your arches some love with our range of orthotic insoles or explore shoes designed with superior arch support.</p> <h3>3. Out With the Old, In With the New (Shoes)!</h3> <p>We get it – breaking up with your favorite old pair can be tough. But worn-out shoes? They're like unsupportive friends – time to let go. Keep an eye out for worn soles or visible damage, and treat yourself to a new pair when needed.</p> <h3>4. New Shoes Need Love Too: The Break-In Ritual</h3> <p>Impatiently skipping the break-in period for new shoes? That's a recipe for blisters and discomfort. Ease into that new shoe relationship by wearing them for short periods, allowing them to shape up to your unique foot structure.</p> <h3>5. Rotation is Key, Not Just for Tires!</h3> <p>Sticking to one pair of shoes day in, day out? Your feet deserve variety! Rotate your shoes to keep them fresh, aired out, and ready to support you. Your feet will thank you.</p> <p>Taking care of your feet is a journey, not a destination. Let's kick those shoe mistakes to the curb and step into a world of happy, healthy feet. If you're on the lookout for top-notch footcare solutions, check out our collection at MyFootShop.com, because every step matters!</p>urn:store:1:blog:post:369https://www.myfootshop.com/navigating-hammer-toe-expert-advice-from-podiatrists-for-reliefNavigating Hammer Toe: Expert Advice from Podiatrists for Relief<h2>The human foot, a marvel of design.<img style="float: right;" src="/images/uploaded/Blog images/HammerToes.jpeg" alt="HammerToes" width="300" /></h2> <p>Is not impervious to the occasional twist, leading to the development of hammer toe – a prevalent condition observed in podiatry. Imagine toes that were once dutifully aligned deciding to take on a hammer-like shape. The causes are diverse, ranging from ill-fitting shoes to hereditary factors and the unwelcome presence of arthritis.</p> <p><br />One primary culprit behind hammer toe is ill-fitting footwear, akin to directors in a theatrical production. Shoes that are too cramped force the toes to rebel, altering their shape to alleviate the pressure. High heels and narrow shoes, in particular, often play the antagonists, compressing the toes into uncomfortable positions. Another contributing factor can be traced back to genetics. If familial predecessors displayed peculiar toe formations, there's a chance your DNA carries some of these traits, with hammer toes potentially lurking in the genetic code.</p> <p><br />Arthritis, the uninvited guest at the foot soiree, also contributes to hammer toe. This condition introduces inflammation and rigidity in the joints, disrupting the graceful ballet of your toes and leaving them in a twisted, hammer-like pose. Recognizing the signs of hammer toe involves observing the physical deformation of the toes. Instead of lying flat and straight, they adopt a curled or bent shape, resembling the curve of a hammer. Pain and discomfort often accompany this transformation, particularly when squeezed into footwear that once felt comfortable but now resembles a medieval torture device.</p> <p><br /> According to podiatrists and the American Medical Association, the heroes in the tale of hammer toe are the straightening devices. Picture them as tiny superhero capes for your toes, gently nudging them into a straighter position. These devices act as a subtle reminder to your toes, coaxing them to abandon their hammer-like tendencies. Additionally, incorporating strengthening exercises, such as picking up marbles with your toes or rolling a small ball underfoot, can fortify muscles and ligaments, promoting a more natural alignment.</p> <p><br /> In conclusion, while hammer toe may present challenges, effective solutions exist to alleviate discomfort. Prioritizing foot health with regular check-ups by a podiatrist is crucial, as the efficacy of remedies may vary among individuals. Consultation with a podiatrist provides personalized guidance on suitable treatments, ensuring the best possible care for your feet.</p>urn:store:1:blog:post:368https://www.myfootshop.com/complications-of-diabetic-foot-surgery-and-partial-ray-resectionSubluxation of metatarsals following partial amputation in cases of diabetic osteomyelitis<p>Subluxation of metatarsals following partial amputation in cases of diabetic osteomyelitis</p> <p>Diabetic wounds and the bone infections (osteomyelitis) that can often result from diabetic wounds are always challenging to treat.  In my years of practice, I’ve found no better teacher than experience in treating these complicated cases.  <a href="https://www.myfootshop.com/diabetic-wound-care">Diabetic wounds</a> of the skin often infect the underlying bones.  These bone infections are treated by IV antibiotics, surgical amputations or a combination of both.  In this blog post, I want to bring to light an unusual post operative complication in two cases of partial metatarsal amputation for osteomyelitis.  But first, let’s talk a little bit about metatarsal anatomy.</p> <h2><span style="color: #993300;">Functional anatomy of the metatarsal</span></h2> <p>A <a href="https://www.myfootshop.com/x-ray-of-the-foot-anterior-posterior-view">metatarsal bone</a> and it’s associated toe bones are referred to as a ray.  The first ray consists of the 1<sup>st</sup> metatarsal along with the proximal and distal phalanges of the great toe.  The 5<sup>th</sup> ray consists of the 5<sup>th</sup> metatarsal along with the proximal, middle and distal phalanges of the 5<sup>th</sup> toe.  The 1<sup>st</sup> ray and the 5<sup>th</sup> ray work in conjunction with the other metatarsals and toes to deliver force from the calf to the ball-of-the-foot, to provide push off during gait.  Each of the rays of the foot share a tight, yet adaptable connection to the midfoot to adapt to changes in the surface of the ground such as slope, uphill, uneven surface, etc.</p> <h3><span style="color: #ff6600;">Partial amputation of the metatarsal and complications</span></h3> <p>Partial amputation of the 1<sup>st</sup> or the 5<sup>th</sup> ray may have a significant impact on the biomechanical properties of the ray and remaining metatarsal bone.  In most cases, following the resection of a portion of the metatarsal, the remaining ray stays in a static position, anchored by the ligaments attached to the remaining bone.  In other cases, when the biomechanics of the ray are altered by amputation, the remaining ray and metatarsal bone can change position.  This change of position of the bone is called subluxation.  Subluxation can lead to ulceration of the skin.  If the goal of a diabetic amputation is go obtain a functional outcome, re-ulceration is considered a poor outcome and can be a contributing factor to limb loss. </p> <p>Case #1 – 1<sup>st</sup> metatarsal subluxation following 1<sup>st</sup> metatarsal head resection for osteomyelitis.</p> <p>JR is a 46 y/o male with a 15+ year history of poorly controlled insulin dependent diabetes.  JR presented to my clinic with a history of recurrent wounds of the plantar aspect of the great toe of the left foot.  X-rays showed radiolucency of the great toe and 1<sup>st</sup> metatarsal head consistent with osteomyelitis.  Surgery and 6 weeks of IV antibiotics were successful in resolving the infection.  The patient was lost to follow up.</p> <p><a href="/images/uploaded/Medical/X-ray/1st_ray_partial_amp_AP_AH.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/1st_ray_partial_amp_AP_AH.jpg" alt="1st ray partial amputation" width="145" style="float: left; padding-right: 5px;" height="184" /></a></p> <p><a href="/images/uploaded/Medical/X-ray/1st_ray_partial_amp_LAT_AH.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/1st_ray_partial_amp_LAT_AH.jpg" alt="1st ray partial amputation" width="145" style="float: right; padding-right: 5px;" height="184" /></a></p> <p>A year later, the patient presented to my office with a new wound on the plantar aspect of the 1<sup>st</sup> metatarsal, left foot. New x-rays found significant plantar subluxation of the 1<sup>st</sup> ray.  JR is currently responding to custom diabetic insoles. </p> <p>Case #2 – 5<sup>th</sup> metatarsal subluxation following 5<sup>th</sup> metatarsal head resection</p> <p>LL is a 56 y/o male with multi-year history of poorly controlled diabetes.  LL worked as a UPS driver, on his feet for greater than 8 hours a day.  LL presented with recurrent ulcerations beneath the 5<sup>th</sup> metatarsal head that refused to respond to off-loading and rx insoles.  5<sup>th</sup> metatarsal head resection  was performed and resolved the issue of recurrent ulcerations allowing LL to return to work.  1.5 years later, LL presented again to clinic with significant subluxation of the 5<sup>th</sup> metatarsal, abducting from the foot.  The subluxed 5<sup>th</sup> metatarsal resulted in a new wound and a new case of osteomyelitis.</p> <p><a href="/images/uploaded/Medical/X-ray/5th_ray_partial_amp_1_AH.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/5th_ray_partial_amp_1_AH.jpg" alt="Partial amputation 5th metatarsal" width="145" style="float: right; padding-right: 5px;" height="184" /></a></p> <p><a href="/images/uploaded/Medical/X-ray/5th_ray_partial_amp_2_AH.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/5th_ray_partial_amp_2_AH.jpg" alt="Partial amputation 5th metatarsal" width="145" style="float: right; padding-right: 5px;" height="184" /></a></p> <p><a href="/images/uploaded/Medical/X-ray/5th_met_partial_amp_AH.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/5th_met_partial_amp_AH.jpg" alt="Partial amputation 5th metatarsal" width="145" style="float: right; padding-right: 5px;" height="184" /></a></p> <p>Two additional surgeries were necessary to resolve LL’s wounds and bone infections.<span>  </span>The first procedure was used to shorten the 5<sup>th</sup> metatarsal.<span>  </span>The remaining styloid process of the 5<sup>th</sup> metatarsal became infected after 6months and also had to be excised.</p> <p>Discussion-</p> <p>Subluxation of the 1<sup>st</sup> or the 5<sup>th</sup> metatarsal is uncommon following partial ray resection.<span>  </span>But in some cases, as we see from the two cases above, complications from partial ray resection do occur and can lead to significant problems for these diabetic patients.<span>  </span></p> <p>Removing a portion of the 1<sup>st</sup> or 5<sup>th</sup> ray may result in buckling of the ray and subluxation of the metatarsal.<span>  </span>In a healthy foot, the rigidity of the foot created by multiple bones and their associated ligaments results in a foot that is at the same time rigid to deliver load yet flexible to adapt to the ever changing uneven ground.<span>  </span>Partial resection of the 1<sup>st</sup> or 5<sup>th</sup> ray may result in buckling of the ray and subsequent subluxation of the metatarsal.<span> </span></p> <p></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:367https://www.myfootshop.com/sometimes-foreign-bodies-arent-so-foreignSometimes foreign bodies aren’t so foreign<p>Foreign bodies, or what are sometimes called retained foreign bodies, range from wood splinters to glass to shard of metal.<span>  </span>The feet are particularly susceptible to <a href="https://www.myfootshop.com/puncture-wounds-of-the-foot">puncture wounds</a> and retained foreign bodies.<span>  </span>Toothpicks, splinters of wood from the old wood floor or a sliver of glass from that broken light bulb and casserole dishes top the list in my practice. <span> </span>Most retained foreign bodies are superficial and are removed at home with tweezers.<span>  </span>I tend to see the deeper and larger foreign bodies such as a large piece of glass that you find while barefoot in the creek.<span> </span></p> <p>All foot docs know that finding the retained foreign body is either really simple or really tough.<span>  </span>When visualized on x-ray, a piece of metal in the bottom of the foot seems so easy the grab and remove…but not so.<span>  </span>Retained foreign bodies reside within a three dimensional series of layers that go beyond just the skin.<span>  </span>Retained foreign bodies can be in muscles, fat or tendons.<span>  </span>The only foreign bodies that I’ve ever removed from bone are bullet fragments.</p> <p><a href="/images/uploaded/Medical/Derm/ingrown hair 1.jpg" target="_blank"><img src="/images/uploaded/Medical/Derm/ingrown hair 1.jpg" alt="ingrown hair" width="150" style="float: left; padding-right: 5px;" /></a>There’s another foreign body that really isn’t so foreign.<span>  </span>That foreign body is hair.<span>  </span>While a long piece of hair is very flexible, a short of hair can become quite rigid.<span>  </span>For hair to act as a foreign body, the short, rigid piece of hair slips into the ridges in you skin and slowly begins to puncture the skin.<span>  </span>The puncture of the skin is a slow process that progresses with each step.<span>  </span>Before long, the hair has punctured both the epidermis and the deeper dermis.<span>  </span>Once beneath the dermis, your body recognizes that not-so-foreign body and a foreign material.<span>  </span>A low grade infection starts with localized erythema in an attempt to expel the foreign body.<span>  </span></p> <p>Treatment of hair that has become a foreign body is simple.<span>  </span>Usually, the hair doesn’t completely puncture and go beneath the skin.<span>  </span>Use a device like a pair of tweezers to extract the piece of hair.<span>  </span>If the hair does go beneath the skin, your body doesn’t give up.<span>  </span>The site will abscess and, in most cases, your body will expel the hair.</p> <p>Next time you have that sinking feeling that maybe you stepped on something, make sure to include hair as a part of your differential diagnosis <span> </span>for a retained foreign body.<span> </span></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:366https://www.myfootshop.com/the-health-effects-of-vaping-on-foot-and-ankle-surgeryI quit smoking and use a vape device.  That’s good, right?  Right?<h2><span style="color: #800000;">What’s good about a vape device?</span></h2> <p>Nothing really - let me explain.<span>  </span>As a doctor you find out that conversation is the primary key to making a diagnosis.<span>  </span>In the medical world<img src="/images/uploaded/Blog images/man_smoking.jpg" alt="man vaping" width="200" style="float: right;" /> we may call it the history, but I call it good conversation with a focus on the primary reason the patient has come to your office.<span>  </span>“How are you?<span>  </span>How can I help?<span>  </span>Tell what you do for a living?<span>  </span>What do you do for fun?”<span>  </span>Inherent in that conversation is a discussion about social activities to include alcohol intake, recreational drug use and smoking.<span>  </span>Many patients are very literal about the smoking question.<span>  </span>A good doc is going to go one step further; do you chew tobacco or use a Vape Device?<span>  </span>Why?<span>  </span>It’s all about the nicotine.</p> <h3><span style="color: #993300;">What's not good about vape devices - nicotine</span></h3> <p>Nicotine has a number of lower extremity health consequences.<span>  </span>One cigarette has enough nicotine to decrease the blood flow to the foot by 30% for up to 1 hour.<span>  </span>What about a vape device?<span>  </span>It’s the same.<span>  </span>Switching to a vape device may eliminate tar in your lungs, but you’re still going to have the same detrimental lower extremity problems that affect your circulation.<span>  </span>And dipping?<span>  </span>Just the same.<span>  </span>Nicotine is nicotine, regardless of how you ingest it.</p> <h3><span style="color: #ff6600;">How does nicotine affect the outcomes of foot and ankle surgery?</span></h3> <p>The majority of my podiatry practice is wound care and reconstructive surgery.<span>  </span>Diabetes and tobacco abuse are the two biggest issues that affect my ability to heal a wound or mend a broken bone.<span>  </span>If I need to use a bone graft in surgery in a smoker, will it heal?<span>  </span>Probably not.<span>  </span>Honestly, in many cases it’s just not even worth trying to place the graft in patients who are chronic nicotine users.</p> <p>The pattern of arterial occlusion seen in nicotine users in the lower extremity arterial tree is distal to proximal.<span>  </span>Distal to proximal means that usually we’ll see more arterial damage in the toes.<span>  </span>The problem<span>  </span>with this distribution is that the arterial occlusion is very difficult to treat surgically and more often results in loss of limb.</p> <p>Many patients ask, "Will marijuana cause the same problems with healing?"  The answer is no.  Even though smoking marijuana deposits tar in your lungs, marijuana has no nicotine.  So in terms of lower extremity health and what we've discussed with bone healing and wound healing, marijuana is OK to smoke.</p> <p>So have you done a good thing by quitting smoking?<span>  </span>Sure, that’s a good start.<span>  </span>But focus on ditching the nicotine, OK?.<span> </span></p> <p></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:365https://www.myfootshop.com/lisfranc-injuries-return-to-weight-bearingLisfranc dislocation and fracture – appropriate timing of fixation removal<h2><span style="color: #800000;">History of Lisfranc injuries</span></h2> <p>Jaques Lisfranc de St. Martin was a French physician, pioneering many surgical procedures during the early 19<sup>th</sup> century.<span>  </span>As a surgeon in the Napoleonic army, Lisfranc worked on the Russian front where he acquired acclaim for his skill in working with foot injuries.<span>  </span>It is said that Lisfranc studied French soldiers who fell from horses while their foot was still in the stirrup.<span>  </span>The resulting injury was a unique fracture/dislocation of the midfoot.<span>  </span>This series of joints and their pattern of injuries is now called Lisfranc’s joint, Lisfranc’s dislocation and Lisfranc’s fracture.</p> <h3><span style="color: #ff6600;">Treatment of Lisfranc injuries</span></h3> <p>Lisfranc injuries (fracture, dislocation and combined fracture/dislocation) are complex injuries that can have life long disability for patients.<span>  </span>Reduction and repair of these injuries begins with a high degree of clinical suspicion at the time ofinjury and upon presentation to the ED.<span>  </span>The envelope of soft tissue (joint capsule, ligament, tendons and skin) surrounding the midfoot is often strong enough to contain the injury resulting in difficulty seeing the complex and often multiple fractures of the midfoot.<span>  </span>Numerous classification schemes (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111796/#:~:text=Lisfranc%20injuries%20can%20be%20osseous,direction%20of%20the%20displaced%20metatarsals.">Quenu and Kuss</a>, <a href="https://www.orthobullets.com/foot-and-ankle/7030/lisfranc-injury">Hardcastle and Myerson</a>) have been well described in the literature and guide conservative and surgical treatment options.<span> </span></p> <p><span style="color: #993300;">Post-operative care of Lisfranc injuries</span></p> <p>What Lisfranc failed to provide us though is a guide or manual for patients and surgeons to coordinate post-operative care.<span>  </span>Anatomical reduction in surgery is imperative, but how do we manage post operative care of these complex injuries?<span> </span></p> <p><a href="https://www.myfootshop.com/images/uploaded/Lisfranc dislocation.jpg" target="_blank"><img src="https://www.myfootshop.com/images/uploaded/Lisfranc dislocation.jpg" alt="x-ray mallet toe fracture" width="145" style="float: left; padding-right: 5px;" height="184" /></a></p> <p>The image at left shows a repair of a Lisfranc dislocation and associated fractures of metatarsals 2/3.<span>  </span>Highlighted is the fleck sign, a small fleck of bone associated with an avulsion of bone by Lisfranc ligament.<span> </span></p> <p>The screw seen in this image is temporary fixation.<span>  </span>With prolonged weight bearing, the screw will break and become almost impossible to retrieve.</p> <p>Each Lisfranc injury is unique and requires individualized care.<span>  </span>In most cased, after reduction and percutaneous fixation, I return patients to early, non-weight bearing range of motion at 4 weeks.<span>  </span>Weight bearing may begin at 8 weeks.<span>  </span>Knowing that patients will begin weight bearing with crutches and tentative load bearing, I allow my patient to bear weight for 3-4 weeks.<span>  </span>By doing so, I utilize the internal fixation for a full 10 to 12 weeks.<span>  </span>Removal of the fixation is an outpatient procedure.</p> <h4><span style="color: #ff9900;">Return to weight bearing - the use of carbon fiber spring plates</span></h4> <p>Return to weigh bearing post Lisfranc injury can also be facilitated by use of a rigid shoe and the use of <a href="https://www.myfootshop.com/xlt-carbon-fiber-spring-plate-graphite-insole"><img style="float: right; padding-left: 5px;" src="https://www.myfootshop.com/images/uploaded/882.jpg" alt="osteoarthritis of the midfoot" width="150" /></a>a <a href="https://www.myfootshop.com/xlt-carbon-fiber-spring-plate-graphite-insole">carbon fiber spring plate</a>.<span>  </span>In a laced shoe, a rigid shoe shank helps to act as a brace for the midfoot.<span>  </span>Similarly, a carbon fiber insole also helps to support the midfoot, stabilizing the Lisfranc injury.</p> <p>Return to activities post Lisfranc injury can be prolonged and are best staged, starting with brief periods of weight bearing and increasingly longer periods of weight bearing based on pain and swelling.<span>  </span>Physical therapy can be very helpful in return to weight bearing, helping guide the patient in making choices regarding activities and duration of weight bearing.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:364https://www.myfootshop.com/conservative-care-for-toe-deformitiesTreatment of dislocated and mal-aligned toes<h2><span style="color: #993300;">Conservative care options for toe dislocations and poorly aligned toes</span></h2> <p>It never ceases to amaze me how many people come into my office with different shapes and sizes of toes. Why do our toes change over time? What are the forces that contribute to these changes? Let’s take a closer look at how we can use conservative care to treat these toe deformities.</p> <p>Most of us start our lives with beautifully aligned toes that fit like a glove into our shoes. But in time, things change. You need to think about your toes as a dynamic part of walking. Toes act as an anchor for several of the tendons that act to stabilize the foot during gait. As such, the toes act as an anchor for several tendons in the foot. The primary function of these tendons is to stabilize the foot as the body passes over the foot with each cycle of gait.</p> <p>As a dynamic anchor for these tendons, toes will respond and move in response to the pull of these tendons. If any imbalance exists at the junction of the toe and the foot, toes will begin to bend and curve.</p> <p><a href="https://www.myfootshop.com/images/uploaded/Medical/Toe dislocation-Copy-1.jpg" target="_blank"><img src="https://www.myfootshop.com/images/uploaded/Medical/Toe dislocation-Copy-1.jpg" alt="Toe dislocation-Copy" width="222" style="float: left; padding-right: 5px;" /></a></p> <p></p> <p></p> <p>All foot and ankle surgeon know that you can have a perfect correction of a hammer toe that is straight as an arrow on the OR table. But over weeks to months, those same dynamic changes that affected the toes before surgery are back at work. And in many instances, the curvature of the toe will recur in time.</p> <p>Trauma can also be a contributing factor in toe alignment. Toe fractures and toe dislocations can result in a number of different toe deformities. The attached image shows a complete rupture of the medial collateral ligament of the proximal phalangeal joint, 5th toe left foot.</p> <p>How do we treat toe deformities like hammer toes, toe fractures or toe dislocations? Let’s take a quick peek at some of the tools podiatrists use for correction of toe deformities.</p> <h3></h3> <h3></h3> <table width="1059" height="91"> <tbody> <tr> <td> <h3><span>Products for broken toes and mal-aligned toes</span></h3> <p>The <a href="https://www.myfootshop.com/toe-care-products">toe product section</a> of Myfootshop.com show a number of different solutions for hammer toes, toe fractures and toe dislocations.  For instance, a common and frustrating problem is when the second toe deviates from it’s home position and <a href="https://www.myfootshop.com/overlapping-toes-causes-and-treatment">overlaps the great toe</a>. </p> <table width="1035" height="22"> <tbody> <tr> <td><a href="https://www.myfootshop.com/visco-gel-toe-buddy-bunion-guard"><img src="https://www.myfootshop.com/images/uploaded/1038_inuse.jpg" alt="" width="194" height="173" style="display: block; margin-left: auto; margin-right: auto;" /></a></td> <td style="text-align: center;"> <p>The <a href="https://www.myfootshop.com/visco-gel-toe-buddy-bunion-guard">Visco-Gel Toe Buddy Bunion Guard</a> uses the great toe joint as</p> <p>an anchor and aligns the second to back to it’s home.</p> </td> </tr> </tbody> </table> <table width="1038" height="56"> <tbody> <tr> <td style="text-align: center;"> <p>Is the third toe as troublesome as the second?</p> <p>              In that case you’d want to try a <a href="https://www.myfootshop.com/toe-straightener-double-toe-2">Toe Straightener-Double Toe</a>.              </p> </td> <td><a href="https://www.myfootshop.com/toe-straightener-double-toe-2"><img src="https://www.myfootshop.com/images/uploaded/707_Toe_Straightener_Double_Toe.jpg" width="199" height="199" style="display: block; margin-left: auto; margin-right: auto;" /></a></td> </tr> </tbody> </table>   <table width="1050" height="202"> <tbody> <tr> <td><a href="https://www.myfootshop.com/co-flex-bandage-1-inch"><img src="https://www.myfootshop.com/images/uploaded/829_Co_Flex_Bandage_1_Inch.jpg" alt="" width="201" height="201" style="display: block; margin-left: auto; margin-right: auto;" /></a></td> <td style="text-align: center;"> <p> Fractured toes?  My go to is <a href="https://www.myfootshop.com/co-flex-bandage-1-inch">Coflex 1” Bandage</a>.  Coflex is a self-adherent material that can be used to buddy splint or gently wrap the toe to compress and stabilize the fracture.               </p> </td> </tr> </tbody> </table> <p>I think you’ll be surprised to see how many configurations of toe pads that are offered by Myfootshop.com.  Used by podiatrists world-wide, Myfootshop.com offers these unique mdeical grade pads and cushions directly to you. </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> </td> </tr> </tbody> </table>urn:store:1:blog:post:363https://www.myfootshop.com/1st-raythotic-carbon-fiber-insole-for-treatment-of-hallux-limitusIntroduction of The 1stRaythotic – ultra thin carbon fiber insole<p>When a podiatrist speaks about the 1<sup>st</sup> ray, the 1<sup>st</sup> ray refers to the first metatarsal bone and the great toe.<span>  </span>The 1<sup>st</sup> ray<a href="https://www.myfootshop.com/images/medical/ortho/HL_diagram_mod2.jpg"><img src="https://www.myfootshop.com/images/medical/ortho/HL_diagram_mod2_thumb.jpg" alt="Hallux_limitus_diagram" style="float: right;" /></a> has a unique range of motion that requires plantarflexion of the first metatarsal to enable dorsiflexion of the great toe.<span>  </span>In essence, the first metatarsal needs to drop lower to enable the great toe to move up.<span>  </span>When this range of motion is altered, jamming occurs in the great toe joint resulting in a unique type of arthritis called hallux limitus and hallux rigidus.</p> <p><a href="https://www.myfootshop.com/hallux-limitus">Hallux limitus</a> (hallux = great toe) is caused by one or more of four contributing factors; a long first metatarsal, metatarsus primus elevates, disease states such as rheumatoid arthritis or trauma to the joint.<span>  </span>Hallux limitus results in the early onset of arthritis in the great toe joint.<span>  </span>Pain in the joint can be severe and limit activities.</p> <p><a href="https://www.myfootshop.com/1straythotics-carbon-fiber-insoles"><img src="https://www.myfootshop.com/images/thumbs/w_1_0004281_1straythotics-carbon-fiber-mortons-extension-bilateral_360.jpeg" alt="4870 1stRaythotics Insoles Pair" width="150" height="150" style="float: left;" />1stRaythotics</a> are a new product exclusively found at Myfootshop.com.<span>  </span>1<sup>st</sup> Raythotics are specifically designed to address first ray deformities including hallux limitus and hallux rigidus (stage 4 hallux limitus).<span>  </span>The 1<sup>st</sup> Raythotic employs a semi-rigid Morton’s extension to limit the range of motion of the great toe joint.<span>  </span>Limiting the range of motion of the great toe joint can significantly improve the symptoms of hallux limitus and hallux rigidus.<span>  </span></p> <p>What’s so unique about the 1<sup>st</sup> Raythotic?<span>  </span>The beauty of the 1<sup>st</sup> Raythotic is the functionality and useability of this unique insole.<span>  </span>Semi-rigid and wafer thin, the 1<sup>st</sup> Raythotic is able to fit into almost any shoe.<span>  </span>Many other insoles are used to treat hallux limitus but most of these insoles are bulky and difficult to fit into shoes.<span>  </span>To my knowledge, no other insole is as thin and as supportive as the 1<sup>st</sup> Raythotic.</p> <p></p> <p>Another unique thing about our !stRaythotics is that you can purchase a pair with an extension under only the <a href="https://www.myfootshop.com/1straythotics-carbon-fiber-left-foot-mortons-extension">Left big toe, with the Right insole neutral</a>, or you can purchase the opposite, with <a href="https://www.myfootshop.com/1straythotics-carbon-fiber-right-foot-mortons-extension">an extension under the Right big toe, and the Left one neutral</a>.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p>urn:store:1:blog:post:362https://www.myfootshop.com/improving-functional-outcomes-of-great-toe-amputationsImproving functional outcomes of great toe amputations<p>Wounds of the lower extremity have a host of different contributing causes, but in diabetic patients, the vast majority of<img src="/images/uploaded/Medical/Diabetes/2020-11-11 10.07.53.jpg" alt="Diabetes - great toe amputation" width="250" style="float: right;" /> wounds occur as a result of loss of protective sensation.<span>  </span>Protective sensation is the ability to feel pain.<span>  <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy">Diabetic peripheral neuropathy</a></span> results in loss of sensation, inability to feel pain and subsequent wounds of the lower extremity.<span>  </span>If left untreated, diabetic wounds become infected, affecting both the skin and bone.<span>  </span>In many cases of <a href="https://www.myfootshop.com/diabetic-wound-care">diabetic wounds</a> that develop a bone infection, the most effective treatment is amputation.</p> <p>Amputation of the great toe to correct diabetic bone infection will result in instability of the foot postoperatively.<span>  </span>The great toe creates a lever arm that stabilizes the foot with weight bearing.<span>  </span>After amputation of the great toe and loss of that lever arm, secondary diabetic infections are expected.<span>  </span>The most common secondary infection would be found on the terminal aspect of the second toe.<span>  </span>With loss of the great toe, the second toe has to make up for that lost lever arm.</p> <p>Knowing that a second toe amputation may occur following great toe amputation, you have to ask yourself; when amputating the great toe, do I prophylactically amputate the distal aspect of the second toe to accommodate for anticipated second toe wound?<span>  </span>I recently had this conversation with a patient undergoing great toe amputation.<span>  </span>Logically, second toe amputation makes sense, but my heart still says no to doing a prophylactic amputation.</p> <p><img src="/images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon fiber spring plate" width="150" style="float: left;" />Fortunately, there is another choice that can be used to help address this biomechanical instability of the foot post great toe amputation.<span>  </span>A carbon fiber spring plate is a simple insert placed in the patient’s shoe that can help to restore the lost lever arm post great toe amputation.<span>  </span>The rigidity of the carbon fiber spring plate helps to off load the second toe.<span>  </span></p> <p>Functional outcomes of amputations in diabetic foot care is an important part of surgical planning and long term success of amputation.<span>  </span>In the case of great toe amputation, patient support and counseling are an important part of their overall medical care.<span>  </span>Helping the diabetic patient become an active part of their care by stressing daily observation of the skin of the foot and with use of a carbon fiber spring plate, patients can significantly improve their outcomes and prevent recurrence of wounds.</p> <p></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:361https://www.myfootshop.com/1straythotics-insoles-explainedIntroducing 1stRaythotics™ Insoles<p><img src="/images/uploaded/Blog images/1stRaythotics/toe-pain.jpg" alt="" width="177" height="154" style="float: left;" />For well over a year, we've worked tirelessly to create a product that will target specific regions of the foot to correct Hallux problems and alleviate big toe pain. It needed to be thin enough material to fit into most any shoe, yet strong enough to withstand the rigors of active lifestyles and sports enthusiasts.</p> <p><a href="/images/uploaded/Blog images/1stRaythotics/text-overlaid_Full.jpg" target="_blank"><img src="/images/uploaded/Blog images/1stRaythotics/text-overlaid.jpg" alt="" width="222" height="436" style="float: right;" /></a>We are very proud to introduce the most advanced orthotic insoles available in the world today...<br /><strong><a href="/1straythotics-carbon-fiber-insoles">1stRaythotics™ Carbon Fiber Insoles</a></strong>!</p> <p>These unique, thin, strong carbon fiber orthotics feature <em>Morton’s Extensions</em> and other forefoot support mechanisms, all with integrated <em>Medial Arch Support</em>. They stabilize and limit MTPJ motion to ease pain while they improve biomechanics and allow patients to remain active as their condition improves.</p> <p>Combining Morton’s Extensions with Integrated Medial Support and High-Performance Carbon Fiber, these unique orthotics provide comfortable relief and promote healing of various hallux and forefoot ailments. 1stRaythotics™ offer midfoot support while they stabilize and limit first metatarsal joint range of motion to relieve pain. Thinner and lighter than steel, our exclusive, German-made Carbon Fiber material offers just the right amount of hallux flexibility and arch support, and fit in most shoes.</p> <p><img src="/images/uploaded/Blog images/1stRaythotics/profile.jpg" alt="" width="466" height="85" style="float: right; max-width: 100%;" /></p> <p>• Limit Joint Motion<br />• Reduce Shoe Flexibility<br />• Enhance Foot Function<br />• Speed Healing</p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p style="text-align: left;"><br /><a href="/1straythotics-carbon-fiber-bilateral-arch-supports">1stRaythotics™ Bi-Lateral</a>™ model features Morton’s Extensions under both the right and left toes, and an integrated medial arch support.<br /><a href="/1straythotics-carbon-fiber-bilateral-arch-supports"><img src="/images/uploaded/Blog images/1stRaythotics/bilateral.jpg" alt="" width="242" height="337" /></a></p> <p style="text-align: left;"></p> <p style="text-align: left;">1stRaythotics™ mixed pairs offer Morton’s Extensions under either the Right or Left great toe, and a ‘neutral’ arch support design under the other foot.<br /><img src="/images/uploaded/Blog images/1stRaythotics/mixed.jpg" alt="" width="255" height="324" /></p> <p style="text-align: left;"></p> <p style="text-align: left;"></p> <p style="text-align: left;"><a href="/1straythotics-carbon-fiber-metatarsalneuroma-offloader">1stRaythotics™ Metatarsal Offloader</a> design addresses a variety of conditions, including ‘dropped’ metatarsal heads, Neuroma pain, and offloads diabetic ulcers and other plantar pathologies, bilaterally.<br /><a href="/1straythotics-carbon-fiber-metatarsalneuroma-offloader"><img src="/images/uploaded/Blog images/1stRaythotics/offloader.jpg" alt="" width="261" height="337" /></a></p> <p style="text-align: left;"></p> <p style="text-align: left;"></p> <p style="text-align: left;"><a href="/1straythotics-carbon-fiber-reverse-mortons-extension-integrated-orthotic">1stRaythotics™ feature Reverse Morton’s Extensions</a> under both left and right feet, with integrated medial arch support, bilaterally.<br /><a href="/1straythotics-carbon-fiber-reverse-mortons-extension-integrated-orthotic"><img src="/images/uploaded/Blog images/1stRaythotics/reverse.jpg" alt="" width="274" height="362" /></a></p> <p style="text-align: left;"></p> <p style="text-align: left;"></p> <p style="text-align: left;"><a href="/1straythotics-carbon-fiber-bilateral-arch-supports">1stRaythotics™ Neutral</a> designs offer thin, strong medial Carbon Fiber arch support, bilaterally.<br /><img src="/images/uploaded/Blog images/1stRaythotics/neutral.jpg" alt="" width="262" height="357" /></p> <p style="text-align: left;"><img src="/images/uploaded/Blog images/1stRaythotics/man_running.jpg" alt="" width="165" height="186" style="float: right;" /></p> <p style="text-align: left;"></p> <p style="text-align: center;"><em><span style="font-size: 20pt;"><a href="/1straythotics-carbon-fiber-insoles"><br />Get yours today!</a><br /></span></em></p> <p style="text-align: left;"></p> <p style="text-align: left;"></p> <p style="text-align: left;"></p>urn:store:1:blog:post:360https://www.myfootshop.com/mallet-fracture-of-the-great-toe-onset-and-treatmentMallet fracture of the great toe – onset and treatment<p>The term mallet finger fracture describes an avulsion fracture of the top of the finger, just behind the fingernail.<span>  </span>Mallet finger fractures are the result of forced flexion of the finger while the long extensor tendon resists the flexion.<span>  </span>If the force of flexion is great enough, the long extensor tendon will avulse (pull) a small fragment of bone from the most distal bone in the finger resulting in a mallet finger fracture.<span>  </span>Mallet finger fractures are common in the ER and are treated conservatively by splinting the finger in an extended position while the fracture heals.</p> <p>Mallet fractures of the toes are a very uncommon injury.<span>  </span>In this case presentation, our patient is a 30 y/o male with a BMI of 36.<span>  </span>He was horsing around with his buddies when he sustained a mallet toe fracture of the right great toe.<span>  </span>He states that he stumbled while one of his friends was standing on his foot.</p> <p><a href="/images/uploaded/Medical/X-ray/x-ray_mallet_toe_fracture.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/x-ray_mallet_toe_fracture.jpg" alt="x-ray mallet toe fracture" width="150" style="float: left; padding-right: 5px;" /></a>X-rays of the foot proved difficult to define this unique fracture due to the degree of displacement of the mallet toe fracture.<span>  </span>Three dimensional CT images were helpful in reconstructing the injury which clearly defines an avulsion fracture of the distal phalanx of the great toe.</p> <p>Treatment of this injury was conservative using a <a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber">glass fiber turf toe plate</a> to splint the toe.<span> <a href="/images/uploaded/Medical/X-ray/CT_mallet_toe_fracture.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/CT_mallet_toe_fracture.jpg" alt="Ct mallet toe fracture" width="150" style="float: right; padding-left: 5px;" /></a> </span>Surgical correction would have been entertained if the avulsed fragment was larger and comprised more of the interphalangeal joint.</p> <p><a href="/images/uploaded/Medical/X-ray/3d_reformation_mallet_toe_fracture.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/3d_reformation_mallet_toe_fracture.jpg" alt="3D reformation mallet toe fracture " width="150" style="float: left; padding-right: 5px;" /></a>Mallet toe fractures are a rare injury that can often be difficult to diagnose without 3D tomography.<span>  </span>Treatment, whether surgical or conservative is always supplemented with a turf toe plate or carbon fiber plate.<span> </span></p> <p></p> <p></p> <p></p> <p></p> <p></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:359https://www.myfootshop.com/diagnosis-and-treatment-of-calcaneal-varusLower extremity biomechanics – what is meant by the terms compensated, partially compensated and uncompensated rearfoot varus?<p>The position of the heel can have a significant influence on the biomechanics of the foot.<span>  </span>Rearfoot varus describes the<a href="/images/uploaded/Anatomy/Misc_Drawings/posterior_heel_mod.jpg" target="_blank"><img src="/images/uploaded/Anatomy/Misc_Drawings/posterior_heel_mod.jpg" alt="calcaneal varus" width="200" style="float: right; padding-left: 5px;" /></a> position of the heel bone (calcaneus) when the heels are turning in towards each other.<span>  </span>To use a simple stick figure representation, if the patient has a rectus position (alignment straight up) the heel would look as follows; ( l l ).<span>  </span>If the patient is in a varus heel position, the heels would appear to turn towards each other ( \ / ). <span> </span>Rearfoot varus can contribute to <a href="https://www.myfootshop.com/ankle-sprain#Tab3">ankle sprains</a>, <a href="https://www.myfootshop.com/peroneal-tendonitis#Tab3">peroneal tendon injuries</a> and chronic shoe wear.<span> </span></p> <p>The assessment of rearfoot varus should be performed both weight bearing and non-weight bearing.<span>  </span>In the non-weight bearing examination, the patient should be prone. <span> </span>It often helps to use a marker to place a line down the back of the heel and more accurately determine rectus vs varus positions.<span>  </span></p> <p>Compensated, partially compensated and uncompensated calcaneal varus related to the ability to manually reduce rearfoot varus.<span>  </span>For instance, while the patient is prone, can the provider move the heel from a varus position to a rectus position?<span>  </span>Is that movement of the heel, or what is called reduction of the position, partial or complete?<span>  </span>Or does the heel even move at all?<span>  </span>I think you can see where we’re going with this.<span>  </span>No reduction of the varus indicates uncompensated rearfoot varus.<span>  </span>Slight reduction of the heel is partial compensation of the varus deformity. <span> </span>And full reduction of the varus deformity would be described as compensated rearfoot varus.</p> <p>If we can determine that a patient’s rearfoot varus is partially, fully compensated, or uncompensated, how is that information used to formulate a treatment plan?<span>  </span>Partially and fully compensated rearfoot varus can be treated with conservative care including a <a href="https://www.myfootshop.com/heel-wedges">heel wedge</a> of <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">lateral sole wedge</a>.<span>  </span>Remember that the motion in the heel allows for us to wedge the heel into a corrected position, improving foot function.<span>  </span>Another common treatment used to correct partially or fully compensated rearfoot varus is to deepen the heel seat of a prescription orthotic and to add a valgus post to the orthotic device.</p> <p>Uncompensated rearfoot varus responds poorly to wedging or posting of orthotics.<span>  </span>Uncompensated rearfoot varus responds best to surgical correction of the deformity.<span>  </span>Surgical techniques used to correct uncompensated rearfoot varus include a calcaneal displacement osteotomy or Dwyer procedure.<span>   </span></p> <p>Rearfoot varus is just one of the biomechanical characteristics of the foot taken into consideration by your lower extremity health providers.<span>  </span>Be sure to talk to your lower extremity health specialist for more information regarding rearfoot varus and treatment options.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:358https://www.myfootshop.com/diabetic-peripheral-neuropathy-the-grade-studyDiabetic Peripheral Neuropathy - The Grade Study<p><img src="/images/uploaded/Blog images/Diabetes.jpg" alt="Diabetes - The Grade Study" width="250" style="float: left;" />Diabetic peripheral neuropathy (DPN) is a well known complication of diabetes affecting 50% of all diabetic patients.<span>  </span>The symptoms of DPN are sensory but can also affect the motor skills of diabetic patients.<span>  </span>We’ve always referred DPN as a peripheral neuropathy affecting the feet and hands.<span>  </span>But a 10/2021 research article published in The Journal of Diabetes and its Complications entitled, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1056872721002610">‘The cross-sectional association of cognition with diabetic peripheral and autonomic neuropathy – The Grade Study’</a> might shed some light on how our current thinking regarding DPN might just be wrong.<span>  </span>Lets take a closer look at this interesting article.</p> <p>The authors of this paper studied the cognitive responses of two groups of patients.<span>  </span>The first group of patients were type 2 diabetics who have had diabetes for less than 10 years.<span>  </span>The second group of patients were not diabetic but suffered from cardiovascular autonomic neuropathy (AN).<span>  </span>The researchers assessed cognition in these two groups with standardized tests that measured immediate recall and processing speed.<span>  </span>The findings were striking in that group one, the diabetic population showed a measurable decline in these two tests while the second group, the cardiovascular autonomic neuropathy patients, showed no measurable decline in these two cognitive tests.<span>  </span></p> <p>Knowing that correlation does not constitute causation, we need to proceed carefully with these findings.<span>  </span>As a clinician, I’ve always suspected that there was something more to diabetes and DPN than what I had been taught.<span>  </span>In chronic disease management, such as diabetes or hypertension you see anecdotal demographic characteristics that you know to be true for each disease.<span>  </span>For instance, in patient with hypertension, we all know that many of these patients are anxious.<span>  </span>In the diabetes population, we know patients to have a certain disregard for their disease.<span>  </span>I’ve heard many diabetic patients tell me that they have witnessed first hand the loss of a limb or blindness due to diabetes in an immediate family member.<span>  </span>Yet these diabetic patients are unwilling (or unable) to be good stewards of their own health.<span>  </span>Again, this is not every hypertensive or diabetic patient.<span>  </span>But ask any primary care doctor about this phenomenon and I’m sure that they’ll agree with this gross representation of their hypertensive of diabetic patients.</p> <p>My belief is that The Grade Study has identified the fact that we as physicians have misunderstood the complications of diabetes.<span>  </span>As a group, why couldn’t physicians see that diabetic nephropathy and diabetic retinopathy were in part to this system neurological change we called ‘peripheral neuropathy’?<span>  </span>The importance of this study is that it attempts to redefine neurological complications in diabetes from a local (peripheral) to global (all of the neurological system).</p> <p><a href="https://jeromegroopman.com/">Jerry Groopman, MD</a> is famous for saying that science (medicine) is the accretion of provisional certainties.<span>  </span>If we think of our contemporary understanding of diabetic peripheral neuropathy as a ‘provisional certainty’, I think the authors of The Grade Study rocked our world.<span>  </span>Thank you to the authors of this paper for thinking out of the box and taking a fresh look at an old problem.<span>  </span>Now it’s up to us to do the heavy lifting and gain new insight and improve clinical care.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:357https://www.myfootshop.com/brostrom-lateral-ankle-stabilizationBroström Lateral Ankle Stabilization<h1><span style="color: #ff9900;"><a href="/images/uploaded/Blog images/surgery_brostrom_ankle_stabilization_mod5.jpg" target="_blank"><img src="/images/uploaded/Blog images/surgery_brostrom_ankle_stabilization_mod5.jpg" alt="Brostrom lateral ankle stabilization" width="200" style="float: right;" /></a></span></h1> <p>There's a lot of ways to stabilize an ankle - why has the Broström procedure become the most popular surgical solution for lateral ankle instability?</p> <p></p> <p><span>Lateral ankle sprains are the most common injury seen by sports medicine physicians.(1)<span>  </span>Many ankle sprains will result in <a href="https://www.myfootshop.com/ankle-sprain#Tab3">chronic instability of the ankle</a> leading to repetitive sprains.(2) <span> </span>Lateral ankle instability is the term used to describe the failure of the ligaments of the lateral (outside) of the ankle to support itself while walking, running and during daily activities.<span>  </span>The severity of lateral ankle instability can vary post injury.<span>  </span>Instability of the ankle can be mild and affect patients only in high stress activities such as soccer, basketball, or football. <span> </span>In severe ankle sprains, lateral ankle instability can be so severe that it results in recurrent sprains even when walking on flat surfaces.</span></p> <h2><span>Treatment of lateral ankle instability</span></h2> <p><span>Treatment of lateral ankle instability is based on a number of factors that can contribute to the instability of the ankle.<span>  </span>Those factors may include:</span></p> <ul> <li><span><span><span>       </span></span></span><span>Injury of the <a href="https://www.myfootshop.com/images/anatomy/anatomy_ankle_diagram_labeled.jpg">lateral collateral ligaments</a> of the ankle resulting in stretching (attenuation) or complete tear of the ligaments.</span></li> <li><span><span><span>       </span></span></span><span>Structural deformities of the rearfoot such as <a href="https://www.myfootshop.com/lateral-ankle-positions-posterior-view">uncompensated rearfoot varus</a> (heels turning in)</span></li> <li><span><span><span>       </span></span></span><span>Neuromuscular deformities that result in muscular imbalance of the rearfoot.<span>  </span>These deformities include but are not limited to <a href="https://www.myfootshop.com/charcot-marie-tooth-disease#Tab3">Charcot-Marie Toothe Disease</a>, multiple sclerosis, and cerebral palsy.<span>  </span></span></li> <li><span><span><span>       </span></span></span><span>Trauma to the rearfoot that results in muscular imbalance of the rearfoot.<span>  </span></span></li> </ul> <p><span><a href="/images/uploaded/Blog images/anatomy_ankle_diagram_labeled.jpg" target="_blank"><img src="/images/uploaded/Blog images/anatomy_ankle_diagram_labeled.jpg" alt="Lateral collatral ankle ligaments" width="200" style="float: left;" /></a>Treatment of lateral ankle instability begins with conservative care.<span>  </span>In mild cases of lateral ankle instability, a simple <a href="https://www.myfootshop.com/ankle-support-elastic-1">elastic ankle support</a> or use of a <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">Lateral Sole Wedge Insert</a> may help to inhibit the tendency to sprain the ankle.<span>  </span>In more severe cases, braces such as an <a href="https://www.arizonaafo.com/products/gauntlet/arizona-brace.html">Arizona Brace or AFO</a> are indicated.<span>  </span></span></p> <p><span>When conservative care proves to be ineffective for treatment of lateral ankle instability, surgical care is indicated for correction of one or more of the factors described above that contribute to lateral ankle instability. <span> </span>A short Google search on the history of lateral ankle surgery will describe a host of surgical procedures used to correct lateral ankle instability; Nilsonne 1932, Elmslie 1934, Watson-Jones 1940, Hambley 1945, Haig 1950, Evans 1953, Windfeld 1953, Pouzet 1954, Lee 1957, Storen 1959, Gschwend 1958, Francillon 1961, Castaign and Munier 1961, Brostr<span>ö</span>m 1966, Chrisman-Snook 1969.(3)<span>  </span><span> </span>Older surgical procedures focused on reconstruction of the anterior talo-fibular (ATF) ligament with a split transfer of the peroneus brevis or peroneus longus tendons.<span>  </span>There are a number of variations of these tendon transfer procedures, but collectively, tendon transfer procedures require large surgical exposures that may lead to delayed healing times and increased risk of complications.<span>  </span>Surgical procedures that include transfer of the peroneus brevis tendon are still employed in cases where the expected post-operative activity is high risk such as a football lineman.</span></p> <p><span>Indications for surgical correction of lateral ankle instability for each individual patient may vary, but for the vast majority of lateral ankle surgical candidates, the Brostr<span>ö</span>m procedure is going to be the procedure of choice.<span>  </span><span>  </span>First described in 1966, the Brostr<span>ö</span>m procedure was the first surgical procedure that specifically targeted anatomic reconstruction of the damaged ATF ligament of the lateral ankle.(4) <span> </span>When compared to the tendon transfer procedures, the Brostr<span>ö</span>m procedure can be performed through a smaller surgical incision.<span>  </span>A number of modifications of the Brostr<span>ö</span>m procedure have been developed since it’s original description in 1966.<span>  </span>The newest modification of the Brostr<span>ö</span>m procedure includes use of surgical tape to reconstruct the ligaments of the ankle and arthroscopic (small incision) techniques.(5,6)</span></p> <p><span>The recovery protocol following a Brostr<span>ö</span>m procedure varies by provider.<span>  </span>Many doctors will require non-weight bearing in a hard cast for four weeks with guarded ambulation in a walking cast for and additional four weeks to follow.<span>  </span>Long term success of the Brostr<span>ö</span>m procedure is quite good with the majority of patients returning to all of their pre-surgical activities.</span></p> <p><span>Why is the Brostr<span>ö</span>m procedure so popular?<span>  </span>Easy to perform, reliable outcomes for patients and fast healing – the Brostr<span>ö</span>m procedure is the go-to for most foot and ankle surgeons.<span>  </span>If you are considering a lateral ankle stabilization surgery, be sure to talk to your doctor about the pros and cons of the Brostr<span>ö</span>m procedure.</span></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p><span> </span></p> <p><span>References</span></p> <ol> <li><span><span><span>       </span></span></span><span>Hølmer P, Søndergaard L, Konradsen L, Nielsen P, Jørgensen L (1994) Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int 15:72–74</span></li> <li><span><span><span>       </span></span></span><span>Gerber JP, Williams GN, Scoville GR, et al. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. </span><em><span>Foot Ankle Int,</span></em><span> 1998; 19(10):653-60.</span></li> <li><span><span><span>       </span></span></span><span>Di Matteo, B., Tarabella, V., Filardo, G. </span><em>et al.</em><span> </span><span>A historical perspective on ankle ligaments reconstructive surgery. </span><em>Knee Surg Sports Traumatol Arthrosc</em><span> </span><strong>24, </strong><span>971–977 (2016).</span></li> <li><span><span><span>       </span></span></span><span>Broström L (1966) Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 132:551–565</span></li> <li><span><span><span>       </span></span></span><span>Foot and ankle Surg. </span><span>2021 Apr;27(3):278-284.</span></li> <li><span><span><span>       </span></span></span><span>Foot and Ankle Int.</span><span>2015 Apr;36(4):465-73.</span></li> </ol>urn:store:1:blog:post:356https://www.myfootshop.com/calcaneal-osteotomy-open-or-closed-techniqueCalcaneal osteotomy – open or closed technique – which one is best for you?<p>The alignment of the heel bone (calcaneus) is an important consideration in conservative and surgical treatment of a<img src="/images/uploaded/Medical/X-ray/foot_xray_calcaneal_varus_bilat_mod.jpg" alt="Calcaneal varus" width="200" style="float: right;" /> high arch or low arch foot.  Realignment of the heel can be accomplished with an arch support, brace or surgical change of the heel bone.  The realignment goal always focuses on how we can center the heel under the weight of the leg.  By doing so, we can have a powerful impact on the treatment of both high arch feet and low arch feet.</p> <p>The surgical technique used to realign the heel is called a translational calcaneal osteotomy.  Translational refers to the movement of the heel bone following an osteotomy (cut or break in the bone).  In the high arch foot, following osteotomy, the capital fragment of bone is translated laterally (away from the other foot), correcting the position of the heel.  In a flatfoot case, the opposite is performed.  Following osteotomy, the capital fragment is translated medially (towards the other foot), correcting the flatfoot and centering the load bearing of the leg directly over the foot.  In each case, the osteotomy is fixated by screws or plates.</p> <p>Recently, minimal incision foot surgery has come back into vogue.  In many cases, minimal incision surgery can benefit patients by decreasing healing time and by keeping the soft tissue envelop surrounding the osteotomy intact.  Disruption of the soft tissue envelop can lead to instability of the osteotomy and to delayed healing.  As a surgeon, when considering minimal versus an open technique for calcaneal osteotomy, you also have to consider how well you can accomplish the job through a small incision, what kinds of tools you’ll need for the minimal vs open technique and how reliable the outcome is for each technique.</p> <p>Many foot and ankle surgeons are now using a minimal technique for translational calcaneal osteotomies.  To be able to work through a small 0.5cm incision, the surgeon uses a burr as a saw.  The procedure is performed under fluoroscopic guidance.  Fixation is usually placed through a separate incision in the posterior heel.  The open technique on the other hand is performed through a 3cm incision and a traditional saw blade is used for the osteotomy. </p> <p><img src="/images/uploaded/Medical/X-ray/xray_foot_silver_osteotomy_mod.jpg" alt="Calcaneal osteotomy" width="200" style="float: left;" />Minimal incision techniques were very popular in the ‘80’s be fell out of favor due to poor outcomes.  I don’t see this as the case when performing translational calcaneal osteotomies with a minimal incision technique.  I have found this procedure is appropriate for minimal incision techniques.  Is it for me?  No.  I think I’ll stick to the traditional 3cm incision.  A 3cm incision creates minimal violation of the soft tissue envelop encompassing the heel bone.  With the 3cm incision, I can also directly see the amount of motion/correction (translation) of the heel bone prior to fixation. </p> <p>Is the minimal incision technique for calcaneal translational osteotomy superior to the traditional open technique?  No, but it’s perfectly acceptable as a new way to treat an old problem.</p> <p></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:354https://www.myfootshop.com/necrobiosis-lipoidica-diabeticorumNecrobiosis Lipoidica Diabeticorum<h2>Necrobiosis Lipoidica Diabeticorm</h2> <p>Necrobiosis lipoidica diabeticorum (NLD) is a <a href="https://en.wikipedia.org/wiki/Granuloma">granulomatous</a> skin disease found in diabetic patients.  The prevalence of<a href="/images/uploaded/Medical/Derm/necrobiosis lipoidica diabeticorum.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Medical/Derm/necrobiosis lipoidica diabeticorum.jpg" alt="necrobiosis lipoidica diabeticorum" width="150" /> </a>NLD is quite rare being found in less than 0.3% of all diabetics.(1)  Fifty percent of all diabetic patients with NLD are insulin dependent.</p> <h2>What causes necrobiosis lipoidica diabeticorum?</h2> <p>The cause of NLD is not clearly defined and is considered to be caused by one or more of the following contributing factors:</p> <ul> <li><a href="https://en.wikipedia.org/wiki/Microangiopathy">Microangiopathy</a> is the primary cause of damage to the retina and kidney in diabetic patients.  NLD shows similar microangiopathy changes.  Microangiopathy of the retina, kidney and in NLD appear to be due to deposition of <a href="https://en.wikipedia.org/wiki/Glycoprotein">glycoprotein</a> in the blood vessel wall. (2)</li> <li>Antibody mediated vasculitis plays a role in inflammatory changes found in NLD.  Deposition of <a href="https://en.wikipedia.org/wiki/Antibody">immunoglobulins</a> and fibrinogen inhibit the permeability of the vessel wall resulting in platelet aggregation and tissue necrobiosis.(3)</li> <li>Increased collagen cross linking is found in NLD resulting in basement membrane thickening and early aging of the skin.(4)</li> <li>Other theories include inflammatory and metabolic changes along with direct trauma to the skin. </li> </ul> <p>NLD does not correlate to any other complication of diabetes and appears with an onset that does not clearly correlate to onset of duration of diabetes.  NLD is found primarily on the shin and lower leg.</p> <h3>Treatment of necrobiosis lipoidica diabeticorum</h3> <p>Treatment of NLD includes the following:</p> <ul> <li>Cutaneous blood flow enhancers – aspirin, pentoxyphylline, dipyridamole</li> <li>Corticosteroids – topical and intralesional</li> <li>Wound healing enhancers – topical collagen gel, hyperbaric oxygen</li> <li>Immunomodulation – cyclosporine, Infliximab and thalidomide</li> </ul> <p>Necrobiosis lipoidica diabeticorum is a rare skin condition found in diabetic patients.  The onset, cause and treatment require more research before we can fully understand this unique condition.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p> </p> <p> </p> <ol> <li>     Kota S, Jammula S, Kota S, Meher L, Modi K  Necrobiosis lipoidica diabetacorum: a case-based review of the literature.  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401767/">Indian J Endocrinol Metab.</a> 2012 Jul-Aug; 16(4): 614–620.  doi: <a href="https://dx.doi.org/10.4103%2F2230-8210.98023">10.4103/2230-8210.98023</a></li> <li>     Boateng B, Hiller D, Albrecht HP, Hornstein OP. Cutaneous microcirculation in pretibial necrobiosis lipoidica. Comparative laser Doppler flowmetry and oxygen partial pressure determinations in patients and healthy probands. <em>Hautarzt. </em>1993;44:581–6. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/8407326">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hautarzt&amp;title=Cutaneous+microcirculation+in+pretibial+necrobiosis+lipoidica.+Comparative+laser+Doppler+flowmetry+and+oxygen+partial+pressure+determinations+in+patients+and+healthy+probands&amp;author=B+Boateng&amp;author=D+Hiller&amp;author=HP+Albrecht&amp;author=OP+Hornstein&amp;volume=44&amp;publication_year=1993&amp;pages=581-6&amp;pmid=8407326&amp;">Google Scholar</a>]</li> <li>     Imtiaz KE, Khaleeli AA. Squamous cell carcinoma developing in necrobiosis lipoidica. <em>Diabet Med. </em>2001;18:325–8. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/11437865">PubMed</a>]</li> <li>     Tidman MJ, Duncan C. The treatment of necrobiosis lipoidica. <em>Br J Diabetes Vasc Dis. </em>2005;5:37–41.</li> </ol> <p> </p>urn:store:1:blog:post:353https://www.myfootshop.com/metatarsal-pads-a-short-cut-to-all-you-need-to-knowMetatarsal pads - a short cut to all you need to know<p>My foot care blog is a deep resource for so many different topics in foot care.  But sometimes I hear from users of the<a href="/metatarsal-pad-felt-1"><img style="float: right;" src="/images/uploaded/Products/729_Metatarsal_Pads_Felt.jpg" alt="metatarsal pad" width="200" /></a> blog that they have a hard time accessing the information they need.  In this blog post I've aggregated all of the information related to metatarsal pads found in the blog.  I hope this provides a short cut for you to find the information you need to answer your questions.  If you do have additional questions, be sure to post a question at the conclusion of this post.</p> <h2>Metatarsal pads - shapes, thickness and differences - which met pad is right for me?</h2> <ul> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/thickness-of-gel-foot-pads"><span style="color: #000080;">Which thickness of reusable metatarsal pad is right for me?</span></a></span>  Thickness of a metatarsal pad matters and changes with the treatment of different foot conditions. </li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/metatarsal-pads-which-one-is-right-for-me"><span style="color: #000080;">Metatarsal pads - which one is right for me?</span></a></span>  This blog post gets right to the heart of met pads and their use. </li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/metatarsal-pads-to-skive-or-not-to-skive"><span style="color: #000080;">Metatarsal pads - to skive or not to skive</span></a></span> - met pads come in all shapes and sizes.  To skive the edge of a metatarsal pad means to modify or cut down the edge of the pad.  </li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/metatarsal-pads-which-one-is-best-for-my-foot-pain"><span style="color: #000080;">Metatarsal pads - do I need soft or firm?</span></a></span> - Which met pad is best for your foot condition?  This post helps explore the density of met pads and how they treat different foot conditions.</li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/reusable-metatarsal-pads"><span style="color: #000080;">A reusable metatarsal pad - how smart is that?</span></a></span>  This post explores reusable metatarsal pads in depth. </li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/general-purpose-off-loading-forefoot-pads"><span style="color: #000080;">Off-loading general purpose forefoot pads</span></a></span> - This post compares metatarsal pads to other off-loading forefoot pads.  </li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/whats-the-right-forefoot-pad-for-me"><span style="color: #000080;">Forefoot pads - which one is best for me?</span></a></span>  A straight forward comparison of metatarsal pads and related forefoot pads.</li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/showering-with-metatarsal-pads"><span style="color: #000080;">Hanging your met pads out on the line to dry</span></a></span> - materials matter.  Is a felt met pad the best for your needs?</li> </ul> <h3>Metatarsal pad placement</h3> <ul> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/metatarsal-pad-instructional-videos"><span style="color: #000080;">Metatarsal pad instructional videos</span></a></span> - a quick and easy reference for proper placement.</li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/metatarsal-pad-placement"><span style="color: #000080;">Metatarsal pads - proper placement</span></a></span> - Location of the met pad, whether placed directly on the foot or on the insole of the shoe really matters. </li> </ul> <p><iframe width="560" height="315" style="max-width: 100%;" title="YouTube video player" src="https://www.youtube.com/embed/m4f7wT70K_M" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <h3>What can metatarsal pads be used to treat?</h3> <ul> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/metatarsal-transfer-lesions-causes-and-treatment-options"><span style="color: #000080;">Metatarsal transfer lesions - causes and treatments</span></a></span> - Transfer lesions are a common consequence of metatarsal stress fractures, bunion procedures and metatarsal surgery.  This article explains how metatarsal pads are used to treat transfer lesions.</li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/mortons-neuroma-conservative-care"><span style="color: #000080;">Morton's neuroma - conservative care</span></a></span> - If there's one condition that benefits most from the use of metatarsal pads its going to be Morton's neuroma.</li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/plantar-plate-tear-conservative-treatment"><span style="color: #000080;">Treatment of plantar plate tears</span></a></span> - although a metatarsal pad won't heal a plantar plate tear or realign a digit affected by a plantar plate tear, use of a metatarsal pad can help ease the pain associated with a plantar plate tear.</li> <li><span style="color: #000080;"><a href="https://www.myfootshop.com/mortons-neuroma-jane-russell-effect"><span style="color: #000080;">Treating Morton's neuroma - the Jane Russell effect</span></a></span> - a simple analogy that explains how metatarsal pads work.</li> </ul> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:352https://www.myfootshop.com/what-causes-interdigital-callusWhat causes callus between the toes?<h2>Painful interdigital callus – treatment options</h2> <p>Callus is a direct response to friction.  When callus appears between the toes, it is often a sign that the friction is directly<img style="float: right;" src="/images/uploaded/Blog images/interdigital callus.jpg" alt="Interdigital callus" width="200" /> related to a bone spur on one or more adjacent toes.  In many cases, the boney prominence is normal anatomy that has become poorly aligned.  The optimal relationship for fingers and toes is where the prominence of one finger or toe (adjacent to the joint) is positioned immediately against the concavity of the adjacent toe (non-joint portion of the toe).  Time changes the positions of the toes and in most adults we’ll see poor alignment of the toes resulting in interdigital callus (<a href="https://www.myfootshop.com/hammer-toes#Tab3">hammer toes, mallet toes, etc</a>). </p> <p>Interdigital calluses are a protective build-up of skin that is intended to reduce direct pressure to underlying healthy skin.  As the callus thickens, pain begins as a mild irritation but soon progresses to a burning sensation between the toes.  The pain of an interdigital callus can limit the types of shoes you can wear and participation in specific activities.</p> <h2>What activities contribute to interdigital calluses?</h2> <p>Walking and running can provide enough range of motion of the toes to create interdigital callus.  Multi-directional sports such as soccer and football increase the range of motion of the toes and hence, increase the potential for interdigital callus.  In ballet and recreational dance I see a lot of dancers with interdigital callus, particularly when the dance includes pointe.  Two other sports that we see that have a high potential for interdigital callus are skiing and rock climbing.</p> <h3>Conservative treatment of interdigital callus</h3> <p>Knowing that interdigital callus is due to an underlying boney prominence and friction, the goal of conservative care is to separate the toes and reduce friction between the toes.  This can be accomplished with several types of foam or gel toe separators.  Which <a href="https://www.myfootshop.com/toe-separators">foam or gel toe separator</a> is best for your needs?  The size, shape, thickness and density of a toe separator is to a great degree a personal choice and does require some trial and error.</p> <p><img src="/images/uploaded/Products/686_Soft_Corn_Pads_ALT2.jpg" alt="soft corn pads" width="100" />  Soft Corn Pads slip gently between your toes to cushion painful corns and calluses. Great for relieving friction or rubbing between toes, pinching caused by overlapping toes, and pressure from adjacent toes and hammer toes. [<a href="https://www.myfootshop.com/soft-corn-pads#overview">read more</a>]</p> <p><img src="/images/uploaded/Products/696_Gel_Toe_Separator.jpg" alt="toe separator gel" width="100" />    Gel Toe Separators bring relief to crooked, overlapping toes by gently creating space between them. Medical-grade, long-lasting silicone pads infused with mineral oil to cushion corns and calluses and soothe toe pain. [<a href="https://www.myfootshop.com/toe-separators-gel#overview">read more</a>]</p> <p><img src="/images/uploaded/Products/827_Toe_Separators_3Layered_ALT2.jpg" alt="toe separator" width="100" />    3-Layered Toe Separators support, cushion, and create space between your toes with a firm foam center and soft foam outer layers. Relieve pain caused by overlapping toes, hammer toes, corns, and calluses. [<a href="https://www.myfootshop.com/toe-separators-3-layered#overview">read more</a>]</p> <p><img src="/images/uploaded/Products/693_Toe_Separator_LargeFirm.jpg" alt="toe separators" width="100" />    Large Firm Toe Separators are made of durable, washable foam and separate the first and second toes by 1/2". They're perfect for cushioning and aligning your big toe, and controlling toe pain and bunion pain. Great for use after bunion surgery. [<a href="https://www.myfootshop.com/toe-separator-large-firm#overview">read more</a>]</p> <p><img src="/images/uploaded/Products/710_Gel_Bunion_Spacer.jpg" alt="toe separator" width="100" />    Gel Bunion Spacers help align the big toe, relieve bunion pain, and ease deep joint pain between your toes. Reduce irritation between adjacent and overlapping toes caused by bunions. Useful as a splint after bunion surgery. Made of silicone infused with mineral oil to cushion and soften corns and calluses. [<a href="https://www.myfootshop.com/gel-bunion-spacer-1-1#overview">read more</a>]</p> <p><img src="/images/uploaded/Products/959_Gel_Bunion_Spacer_w_StayPutLoop_ALT.jpg" alt="toe separator" width="100" />    The Gel Bunion Spacer with Stay-Put Loop gently aligns the big toe into proper position while softening corns and calluses with mineral oil-infused, medical-grade silicone. The Stay-Put Loop ensures that the spacer will not move. [<a href="https://www.myfootshop.com/gel-bunion-spacer-with-stay-put-loop#overview">read more</a>]</p> <h3>Surgical treatment of interdigital callus</h3> <p>Surgical treatment of interdigital callus addresses the underlying bone prominence.  In many cases, correction of interdigital callus is a simple out-patient procedure that involves removing the bone spur.  A common location of interdigital callus is between the first and second toes.  These images show a patient who has had local anesthesia and sedation and is having their bone spur rasped or reduced.  The x-rays show reduction of the bone spur.  This procedure can be performed in the office or in the operating room.  The post-operative course requires a light bandage for a week followed by just a simple Band-Aid.  Most patients return to regular shoes at 1 week. </p> <p><img src="/images/uploaded/Blog images/resection interdigital callus.jpg" alt="resection interdigital callus" width="200" />    <img src="/images/uploaded/Blog images/x-ray interdigital callus exostosis pre-op.jpg" alt="x-ray interdigital callus resection" width="200" />    <img src="/images/uploaded/Blog images/Interdigital bone spur post resection.jpg" alt="bone spur resection toe" width="200" /></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:351https://www.myfootshop.com/just-for-toenails-enhanced-nail-polish-blogpostJust for Toenails Enhanced Nail Polish<h2>Instructions for use of Just For Toenails Enhanced<a href="/just-for-toenails-medicated-nail-polish"><img style="float: right;" src="/images/uploaded/Products/905_Just_for_toenails_ALT3.jpg" alt="Just For Toenails" width="200" /></a> Nail Polish</h2> <p><a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish">Just For Toenails Enhanced Nail Polish</a> is fortified with tea tree oil (melaleuca altenifolia) which is known for its antibacterial and antifungal properties.  When applied on a regular basis, Just For Toenails Enhanced Nail Polish can strengthen nails, improve their appearance and decrease unsightly thickness of the nail.</p> <h2>Instructions for use of Just For Toenails Enhanced Nail Polish</h2> <ol> <li>       Clean the nails with an alcohol swab.</li> <li>       Apply the base coat of Just For Toenails Enhanced Nail Polish and allow to dry.</li> <li>       Apply your choice of color of Just For Toenails Enhanced Nail Polish and allow to dry.</li> <li>       Apply Just For Toenails Enhanced Nail Polish top coat.  Allow to dry.</li> </ol> <p><img src="/images/uploaded/Blog images/Just For Toenails base coat.jpg" alt="Just For ToeNails" width="150" />      <img src="/images/uploaded/Blog images/Just For Toenails red.jpg" alt="Just For ToeNails" width="150" />     <img src="/images/uploaded/Blog images/Just_For Toenails_top_coat.jpg" alt="Just For Toenails" width="150" /></p> <h3>Additional recommendations when using Just For Toenails Enhanced Nail Polish –</h3> <ol> <li>       Remember to remove Just For Toenails Enhanced Nail Polish weekly to inspect the nail. </li> <li>       Reapply Just For Toenails Enhanced Nail Polish, following the directions above.  There is no need to wait between applications.  The efficacy of the antibacterial and antifungal properties is improved with serial application.</li> <li>       Toenails grow at a fraction of the pace of fingernails.  Be patient when treating toenails.  Progress is seen as a small ‘sunrise’ of healthy nail begins to be seen at the base of the nail. </li> <li>       Complete treatment of nail thickness and discoloration may take 8-12 months.</li> </ol> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:350https://www.myfootshop.com/natural-urea-callus-cream-2Natural Urea Callus Cream<p><a href="/callus" target="_blank"><img style="float: right;" src="/images/uploaded/Medical/Derm/heel_fissure_composite_mod(1).jpg" alt="Heel fissure" width="200" /> </a></p> <h2>Why Natural Urea Callus Cream is superior to everyday lotions for care of thick, heavy callus</h2> <p> </p> <p>Soft, supple skin is dependent upon daily skin care to cleanse and hydrate your skin.  Most over-the-counter skin care products contain a combination of agents that exfoliate superficial cells in the epidermis, hydrate the skin and act to repair defects in the skin.  These agents can be broken down into three basic categories:</p> <p> </p> <ul> <li>Humectants – act to soften the epidermis by attracting moisture from the dermis.  Examples of humectants include ammonium lactate and lactic acid.</li> <li>Occlusives – decrease the rate of evaporation.  Examples of occlusives include mineral oil and petroleum jelly.</li> <li>Emollients – make skin soft and slippery by filling superficial defects in the epidermis.  Examples of emollients include lanolin and jojoba oil.</li> </ul> <p> </p> <h3>What is the difference between dry skin of the foot and heavy callus on the foot?</h3> <p> Callus is a response by the skin to thicken and create a protective layer.  The response by the skin to form callus is often caused by an irritation such as two toes rubbing together or an irritation from a shoe.  A common spot for heavy callus on the foot is the rim of the heel.  In the case of heel callus, the irritation to the skin is due to tension and not friction.  Here’s a simple example of what contributes to the tension in the skin of the rim of the heel that causes thick callus and heel fissures.</p> <p style="padding-left: 30px;"> <em>Fill a water balloon at the kitchen sink.  Tie the neck of the balloon and set the balloon on the counter.  Lift the balloon and set it down on the counter again, and again.  In each case, as the balloon in lifted and set on the counter, the walls of the balloon are stretched creating tension.  Now consider the padding of the heel.  With each step, the padding and skin of the heel act much in the same way as the example of the balloon.  Lift the heel and then compress it with weight bearing.  The skin surrounding the rim of the heel responds by thickening and subsequently fissuring resulting in deep, painful cracks in the skin.</em></p> <h4>Chemical debridement of callus with 20% urea</h4> <p><span style="color: #008000;"><img src="/images/uploaded/Blog images/urea cream 1.jpg" alt="Natural Urea Callus Cream" width="150" />    <img src="/images/uploaded/Blog images/urea cream 2.jpg" alt="Natural Urea Callus Cream" width="150" />   <img src="/images/uploaded/Blog images/urea cream 3.jpg" alt="Natural Urea Callus Cream" width="150" /></span></p> <p> Urea is a naturally occurring nitrogen crystal that has many used in the food and cosmetic industry.  In skin care, urea is most commonly used as a humectant, hydrating skin by drawing moisture into the superficial skin known as the epidermis.  As the concentration of urea increases in a skin product, urea acts as a keratolytic agent.  Keratin is a structural protein that is the primary building block of skin, hair, nails (along with horns and fish scales).  Keratolysis is the process of breaking down the bonds between the keratin molecules.  With repetitive use of Natural Urea Callus Cream, superficial callus can easily be chemically debrided by this safe and natural skin care additive.</p> <p><a href="/callus" target="_blank"><img style="float: left;" src="/images/uploaded/Medical/Derm/heel_fissures.jpg" alt="heel fissures" width="200" /></a></p> <h4>Step by step use of <a href="/urea-callus-cream"><span style="color: #ff9900;">Natural Urea Callus Cream</span></a><a href="/urea-callus-cream"><img style="float: right;" src="/images/uploaded/Blog images/811_Urea_Cream.jpg" alt="Natural Urea Callus Cream" width="175" /></a></h4> <p><a href="/urea-callus-cream">Natural Urea Callus Cream</a> contains 20% urea.  This high concentration of urea acts as a keratolytic agent, slowly and gently debriding thick, heavy callus.  Although the high concentration of urea in Natural Urea Callus Cream can act to break down thick, heavy callus, you still need to physically remove the callus with a <a href="/pumice-stone">pumice stone</a>, <a href="/callus-file">callus file</a> or <a href="/safety-corn-and-callus-trimmer">safety corn and callus trimmer</a>.</p> <p>1. Apply <a href="/urea-callus-cream">Natural Urea Callus Cream</a> twice daily to a clean and dry callus.  Wash your hands carefully after use.</p> <p>2. Once the callus begins to soften, use a mechanical means of callus debridement such as a <a href="/pumice-stone">pumice stone</a>.</p> <p>3. Repeat the application of <a href="/urea-callus-cream">Natural Urea Callus Cream</a> as needed.</p> <p> </p> <p>It’s important to understand that management of calluses requires ongoing care.  Calluses may become worse with seasonal changes but ongoing care is essential to success.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:349https://www.myfootshop.com/turf-toe-how-carbon-fiber-promotes-healing-with-every-stepTurf toe – how carbon fiber promotes healing with every step<h2>As Patrick Mahomes trains for The Super Bowl, a carbon fiber technology is there to assist in healing<img style="float: right;" src="/images/uploaded/Blog images/football-2660585_640.jpg" alt="football" width="200" /></h2> <p>Twenty five year old Patrick Mahomes has lead The Kansas City Chiefs through an exciting year and is scheduled to the meet The Tampa Bay Buccaneers in The Super Bowl on February 7<sup>th</sup>.  Behind the scenes, practice and preparation for the big game are in high gear.  A large component of this preparation for The Super Bowl is injury management and injury prevention.  Mahomes sustained a turf toe injury during the divisional playoff game against The Cleveland Browns on January 17<sup>th</sup>.  What is turf toe and how is turf toe treated?  Lets take a closer look.</p> <p>The term <a href="https://www.myfootshop.com/turf-toe#Tab3">turf toe</a> was originally used by K D Bowers and RB Martin  in 1976. (1)  Bowers and Martin described an extension injury to the great toe joint that resulted in injury to the plantar plate of the joint.  The plantar plate is a dense fibrous pad that acts as an anchor for the majority of the ligaments that support range of motion of the joint.  Turf toe injuries are classified in three degrees of severity:</p> <ul> <li>       Grade I – sprain of the plantar plate</li> <li>       Grade II – partial tear of the plantar plate</li> <li>       Grade III – complete tear of the plantar plate</li> </ul> <p>In addition to injury to the plantar plate, intra-articular damage can be sustained during the injury resulting in damage to the cartilage in the great toe joint.  While partial thickness tears of the plantar plate can heal in time, partial to full thickness injuries of the cartilage within the great toe joint can be more difficult to heal.</p> <h3>Diagnosis of turf toe injuries</h3> <p>The great toe joint is a complex joint that include the articulation of four separate bone and a number of different ligaments.  Diagnosis of turf toe injuries can be made based on the history of the injury and clinical assessment.  Definitive diagnosis of turf toe requires and MRI to evaluate both soft tissue and bone injuries.</p> <h3>Treatment of turf toe injuries</h3> <p>Conservative care of turf toe injuries is primarily focused on limitation of range of motion.  Limiting range of motion, particularly dorsiflexion (the same direction that caused the injury) is essential.  <a href="https://www.myfootshop.com/turf-toe-t-strap">Turf Toe T-Straps</a> are a quick and easy way to limit motion of the joint.  Specialized shoe insoles made of light weight, rigid materials represent a better, long term solution in the treatment of turf toe injuries.  Carbon graphite is an extremely thin yet rigid material that is used in a number of different styles of specialty insoles called <a href="https://www.myfootshop.com/turf-toe-plates">turf toe plates</a>. </p> <h3>Which turf toe plate is best for my turf toe injury?</h3> <p>Turf toe plates are designed to be specific to the injured athletes shoes and activities.  <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Graphite Spring Plates</a> are the most universally accepted insole due to the fact that they fit well in both athletic shoes and dress shoes.  Carbon graphite turf toe plates are also designed in a slim line style to fit dress shoes.  These slim line designs are called <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">Flat Turf Toe Plates</a>.  <a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber">Molded Turf Toe Plates</a> that are molded to provide arch support are also available and are often made of fiberglass/resin materials.</p> <p>At the heart of all turf toe plates is a unique modification of the insole called a Morton’s extension.  A Morton’s extension is a semi-rigid to rigid extension that provides rigidity to the great toe joint.  The Morton’s extension prevents extension of the joint providing protection and rest for the plantar plate and joint cartilage.</p> <h4>Patrick Mahome’s carbon graphite insole</h4> <p>Carbon graphite insoles are used to promote early return to play in athletes who have sustained a turf toe injury.  Early return to activity with carbon graphite splinting can actually promote healing.  Images of Mahome’s insole show an insert of carbon graphite to the forefoot.  As Mahomes and The Chiefs prepare for The Super Bowl, you can bet that there will be a team of specialist tweaking and tuning that carbon graphite insole to provide optimal support while enabling Mahomes to return to play.  Who knows – could carbon fiber help win The Super Bowl?  We shall see.</p> <p>References</p> <p>1. Med Sci Sports. Summer 1976;8(2):81-3.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:348https://www.myfootshop.com/interdigital-pads-which-on-is-best-for-the-callus-between-my-toesInterdigital pads - which one is best for the callus between my toes?<h2>The six best pads for callus between the toes.<img style="float: right;" src="/images/uploaded/Blog images/toes.jpg" alt="interdigital toe pads" width="200" /></h2> <p>The callus that forms between the toes <a href="https://www.myfootshop.com/corn-and-callus#Tab3">(interdigital callus)</a> is often caused by the alignment of the bones in the toes.  The bones in adjacent toes are designed to be offset; the enlargement from a joint in one toe should be offset with the concavity of the adjacent toe.  When this alignment is off, fiction between the toes leads to callus formation. </p> <p>The key to treating interdigital calluses is to use a pad to separate the toes.  What’s the best pad for your needs?  Here’s a few examples of pads used to treat interdigital calluses. </p> <h2>Interdigital Callus Pads</h2> <p style="text-align: left;"><img src="/images/uploaded/Products/696_Gel_Toe_Separator.jpg" alt="Toe Separator - Gel" width="100" /> <a href="https://www.myfootshop.com/toe-separators-gel">Gel Toe Separators</a> are an easy and inexpensive solution for interdigital calluses.</p> <p style="text-align: left;"><img src="/images/uploaded/Products/827_Toe_Separators_3Layered_ALT2.jpg" alt="3 layered toe separators" width="100" />  <a href="https://www.myfootshop.com/toe-separators-3-layered">3-Layered Toe Separators</a> - one of the originals and still one of the best.</p> <p><img src="/images/uploaded/Products/967 Visco Gel Toe Buddy.jpg" alt="ViscoGel Toe Buddy" width="100" />  <a href="https://www.myfootshop.com/toe-corrector-gel">Visco-Gel Toe Buddy</a> is used for callus between the great toe and second toe.</p> <p><img src="/images/uploaded/Products/854_Toe_Sleeves_Gel_ALT.jpg" alt="Gel Toe Sleeves" width="100" />  <a href="Gel Toe Sleeves">Gel Toe Sleeves</a> - simple, thin and fits all shoes including dress shoes.</p> <p><img src="/images/uploaded/Products/Visco-Gel Toe Coach(2)-Copy-1.jpg" alt="Visco Gel Toe Coach" width="100" />l  <a href="https://www.myfootshop.com/visco-gel-toe-coach">Visco-Gel Toe Coach</a> is simple to use between the great toe and second toe.</p> <p> </p> <p>Interdigital pads come in different shapes and sizes and are sometimes anatomically specific to the great toe or the lesser toes.  Be sure to check the entire selection of <a href="https://www.myfootshop.com/hammer-toe-pads">interdigal pads</a> found on Myfootshop.com.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:347https://www.myfootshop.com/foot-care-educationFoot care education<h2>A podiatrist guest lectures to third graders<img style="float: right;" src="/images/uploaded/Blog images/girl-5760039_640.jpg" alt="" width="200" /></h2> <p>I had the honor this week of lecturing to a wonderful group of 9 year olds at the Boulder High Peaks Elementary School in Boulder, Colorado.  How did a regular Joe like me achieve the honor of being the day’s keynote speaker to a group of 3<sup>rd</sup> graders?  I’ve got the inside track; their teacher, Mrs. Kennedy just happens to be my daughter.  And the topic?  The kids had been studying the bones and muscles of the feet.  So, talk about being the perfect guy for the job.</p> <p>I learned two things about 9 year olds who are in virtual learning.  First, they never stop moving.  As I stared at a combined class of fifty kids, they were a blur of motion spinning in their chairs, constantly moving.  But more importantly, I learned that they are insightful in many ways.  I’d like to share with you the orientation of foot care from the perspective of a 9 year old virtual learning student. </p> <p>Here are some of the unedited questions from my daughter’s class:</p> <ul> <li>Can you break a tendon?</li> <li>What connects to make an ankle?</li> <li>How do our bones in the foot and ankle not get tired when they work because they don't really take any rest of working right?</li> <li>How long dose it take a bone to heal ushily</li> <li>What is the most common bone you can break in your foot?</li> <li>How many bones do you have in your feet?</li> <li>What does a broken leg look like?</li> <li>How many types of bones are there?</li> <li>Can tendons snap?</li> <li>How much do all the bone in your body weigh? Do bones have skin?</li> <li>🦶Is it hard to be a ankle and foot doctor?</li> <li>how do they do ankle surgery?</li> <li>What are we learning about?</li> <li>If you broke a bone, and healed it is it as good as the original?</li> <li>My question is that what is it like when you do the foot and ankle thing is it yucky cool what does it look like do you do surgery and I have a story about my grandfathers leg under this.😷😷😷😷<br /> <br /> My grandfather did something with his foot once or twice and he broke his leg when he was on a ladder because it fell and if he fell on my grandma my dad would not have a brother so that means I would not have a uncle.😷😷😷😷</li> <li>Sometimes my mom's feet crack in the morning. What is happening?</li> <li>can your ankle bone brake?</li> <li>how strong is your bone?</li> </ul> <p>Thanks to all the 3<sup>rd</sup> grade kids at Boulder High Peaks School for having me speak.  And thanks to Mrs. Kennedy, the best teacher ever.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:346https://www.myfootshop.com/three-sign-that-may-indicate-you-have-osteoarthritis-in-your-foot-and-ankleThree signs that may indicate you have osteoarthritis in your foot and ankle.<h2>Osteoarthritis of the foot and ankle can be very <a href="/images/uploaded/Medical/X-ray/osteoarthritis_midfoot.jpg"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Medical/X-ray/osteoarthritis_midfoot.jpg" alt="osteoarthritis of the midfoot" width="200" /></a>painful and require changes in your lifestyle and activities.  What are the signs of osteoarthritis of the foot and ankle?</h2> <p><a href="https://www.myfootshop.com/arthritis-of-the-foot-and-ankle">Osteoarthritis</a>, also known as the wear-and-tear arthritis typically has a slow and progressive onset.  The age of onset varies and becomes worse with age.  Osteoarthritis has a predisposition for joints that have previously been injured.  Remember that bad ankle sprain while playing on your high school basketball team?  Or when the horse stepped on your foot?  These historical injuries can contribute to the onset and severity of osteoarthritis of the foot and ankle.</p> <p>Although osteoarthritis is considered to be a polyarticular disease (affecting more than one joint at a time), joints that have been affected by injuries or repetitive stress from your occupation are uniquely prone to early onset of pain.  Let’s take a look at three common areas of the foot and ankle that are affected by osteoarthritis.</p> <h2>Osteoarthritis of the forefoot-</h2> <p>Osteoarthritis of the forefoot most commonly affects the great toe joint.  Osteoarthritis of the great toe joint is referred to as <a href="https://www.myfootshop.com/hallux-limitus">hallux limitus</a>.  In hallux limitus, the hallux or great toe is limited in its range of motion that progressively results <a href="/images/uploaded/Medical/X-ray/dorsal_bunion_mod.jpg"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Medical/X-ray/dorsal_bunion_mod.jpg" alt="Hallux limitus" width="200" /></a>in degenerative changes in the great toe joint.  The onset of symptoms is progressive.  Symptoms include sharp shooting pain and locking of the joint.  In many cases, the top of the great to joint becomes enlarges with a bone spur that further limits range of motion of the joint.</p> <p>Conservative treatment of hallux limitus may include an <a href="https://www.myfootshop.com/turf-toe-plates">insole that limits range of motion of the great toe joint</a>.  A <a href="https://www.myfootshop.com/treat-hallux-limitus-with-a-mortons-extension">Morton’s extension</a> is an extension or splint that extends to the tip of the great toe, limiting range of motion of the joint.  Hallux limitus can also be treated surgically by shortening the bone adjacent to the joint, fusing the great toe joint or replacing the joint with an implant.</p> <h2>Osteoarthritis of the midfoot –</h2> <p>Osteoarthritis of the midfoot can affected any number of the joints found in the arch of the foot.  Symptoms of osteoarthritis of the midfoot include sharp, shooting pain with activity and dull aching of the foot after activity.  Characteristic findings of the midfoot include localized enlargement of the midfoot as we see multiple joints that have arthritic pain and associated spurring of the joint periphery.</p> <p>Conservative treatment of midfoot osteoarthritis includes bracing with <a href="https://www.myfootshop.com/arch-binder-1">compression bandages</a> and splinting the foot with <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">specialty insoles</a> that provide <a href="https://www.myfootshop.com/vasyli-dananberg-turf-toe-plate">rigidity of the midfoot</a> and <a href="https://www.myfootshop.com/rocker-mechanics-of-the-lower-extremity">forefoot rocker</a>.  Surgical correction of osteoarthritis of the midfoot is complex and results in significant post-op disability.  Surgical correction for osteoarthritis of the midfoot is not typically recommended.</p> <h2>Osteoarthritis of the ankle –</h2> <p>The joints of the rearfoot include the <a href="https://www.myfootshop.com/x-ray-of-the-ankle-lateral-view">ankle and subtalar joints</a>.  The ankle range of motion is within the <a href="https://www.myfootshop.com/cardinal-planes-of-the-human-anatomy">sagittal plane</a> (toes towards the shin and toes away from the shin) while the range of motion of the subtalar joint is within the <a href="https://www.myfootshop.com/cardinal-planes-of-the-human-anatomy">frontal plane</a><a href="/images/uploaded/Medical/X-ray/osteoarthritis ankle.jpg"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Medical/X-ray/osteoarthritis ankle.jpg" alt="osteoarthritis ankle" width="200" /></a> (soles towards each other, soles facing away).  The combined range of motion of both the ankle and subtalar joints are what make us able to be bipedal and able to adapt to uneven surfaces.  Osteoarthritis of the ankle and/or subtalar joints can be difficult to differentiate and often are best defined with x-rays.    Symptoms of ankle and subtalar joint osteoarthritis include swelling, sharp pain with activity and dull achiness at rest.  An additional finding of ankle osteoarthritis includes a sense of the joint ‘giving out’.  Many patients describe weakness of the joint where the joint no longer reliably will support them.</p> <p>Initial treatment of osteoarthritis of the ankle and subtalar joints make include <a href="https://www.myfootshop.com/ankle-support-elastic-1">elastic compression bandages</a> or <a href="https://www.arizonaafo.com/products/gauntlet/arizona-brace.html">prescription braces to stabilize the joint</a>.  Cortisone injections are often used to temporarily decrease painful inflammation within the joint.  Arthroscopic surgery can also be used as a temporary stopgap for osteoarthritis of the joint.  End stage osteoarthritis of the ankle and subtalar joints may include fusion of the joint or ankle joint replacement.</p> <h3>Successful management of osteoarthritis of the foot and ankle</h3> <p>Osteoarthritis is a common foot and ankle problem that affects each of us as we age.  Osteoarthritis of the foot and ankle does not need to limit our ability to be active and participate in the majority of activities that we enjoy.  The key is to find the appropriate duration and intensity of activity and to find which products can help splint and manage joint pain.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:345https://www.myfootshop.com/hammer-toe-treatment-correction-vs-protectionHammer toe treatment – correction vs protection<h2>Tips for selecting the best hammer toe pad for your needs<a href="/images/uploaded/Blog images/hammer_toe_differences_mod.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/hammer_toe_differences_mod.jpg" alt="Types of hammer toes" width="200" /></a></h2> <p>The term <a href="https://www.myfootshop.com/hammer-toes#Tab3">hammer toe</a> is used to describe how the tip of the toe hammers against the ground with each step.  As the attached image shows, hammer toes come in a variety of shapes and are defined by the terms claw toe, mallet toe and hammer toe.  For sake of this conversation, we’ll simply refer to a contracted toe as a hammer toe.</p> <p>In younger patients, hammer toes are usually flexible meaning that you can take your hand and straighten the toe.  As the toe becomes more contracted with age, the flexibility of the toe changes to rigidity and the toe no longer can be reduced (straightened).  The degree to which a hammer toe is flexible or rigid helps us to understand what hammer toe pad is going to work.  Remember that when a hammer toe is flexible, it needs correction.  When a hammer toe is rigid, it needs protection.</p> <h2>Hammer toe pads – correction.</h2> <p>Reach down and try to straighten your hammer toe.  Is it flexible and can be straightened?  Here’s a sampling of hammer toe pads that can be used for correction of a hammer toe.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="/comfort-toe-wraps" target="_blank"><img style="float: left;" src="/images/uploaded/Products/864 Comfort Toe Wraps.jpg" alt="Comfort Toe Wraps" width="150" /></a></p> <p> </p> <p> </p> <p><strong>Comfort Toe Wraps</strong> are designed to treat overlapping toes, hammer toes, crooked toes, and broken toes. Align your injured toe by gently splinting two of your toes together safely and comfortably. Universal right/left. By PediFix. 3/pkg.   ...[<a href="https://www.myfootshop.com/comfort-toe-wraps#readmore">read more</a>]</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="hammer-toe-crest-pad-foam-1" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/701_Hammer_Toe_Crest_Pad.jpg" alt="Hammer Toe Crest Pad" width="150" /></a></p> <p> </p> <p><strong>Foam Hammer Toe Crest Pads</strong> feature an adjustable elastic loop to support curled toes, ease pressure on the tips of toes, and eliminate forefoot pain. Made of soft, Latex-free felt with a foam center to cushion and correct hammer toes, mallet toes, and claw toes. By PediFix. 1/pkg.   ...[<a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1#readmore">read more</a>]</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p style="text-align: left; padding-right: 5px;"><a href="/toe-corrector-gel" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/967 Visco Gel Toe Buddy.jpg" alt="Visco Gel ToeBuddy" width="150" /></a></p> <p style="text-align: left;"> </p> <p style="text-align: left;"><strong>Visco-GEL ToeBuddy</strong> treats hammer toes, broken toes, and overlapping toes by gently re-aligning and creating space between them. Made of soft, durable, medical-grade silicone that acts as a splint for your damaged toes, the double-loop design keeps the gel spacer in place. By PediFix. 2/pkg.   ...[<a href="https://www.myfootshop.com/toe-corrector-gel#readmore">read more</a>]</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <h2><span style="color: #ff9900;">Hammer toe pads – protection.</span></h2> <p>When you try to straighten the toe, is it rigid?  If so, here are a number of products that can be used to protect a painful hammer toe.</p> <p><a href="gel-toe-protector-1" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/697_Gel_Toe_Protector_ALT.jpg" alt="Gel Toe Protector" width="150" /></a></p> <p> </p> <p><strong>The Gel Toe Protector</strong> offers total toe coverage to cushion corns, cysts, blisters, calluses, crooked toes, hammertoes, broken toes, and ingrown nails. Each sleeve is made of medical-grade silicone infused with soothing mineral oil and covered in soft, durable stretch fabric for comfort. By Myfootshop.com. 2/pkg.   ...[<a href="https://www.myfootshop.com/gel-toe-protector-1#readmore">read more</a>]</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="/lambs-wool-padding" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/940_Lambs_Wool_Padding.jpg" alt="Lambs Wool Padding" width="150" /></a></p> <p> </p> <p><strong>Lambs Wool Padding</strong> is a classic treatment for a wide range of toe problems, including corns on the toes, hammer toes, fractured toes, and sweaty feet. Lambs wool is your 100% natural solution for treating toe issues, sourced from our own flock of sheep! By Myfootshop.com. ¾ oz./pkg.   ...[<a href="https://www.myfootshop.com/lambs-wool-padding#readmore">read more</a>]</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> <a href="/tubular-foam-toe-bandages" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/700_Tubular_Foam_Toe_Bandages.jpg" alt="Tubular Foam Toe Bandages" width="150" /></a></p> <p><strong>Tubular Foam Toe Bandages</strong> slip on easily to cushion, separate, and protect irritated toes. Find relief for corns, blisters, bunions, calluses, hammer toes, broken toes, and more. Trim with scissors for a custom fit. By Myfootshop.com. Universal right/left. New 3" and 12" lengths, trim to any size.   ...[<a href="https://www.myfootshop.com/tubular-foam-toe-bandages#readmore">read more</a>]</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p>Hammer toes come in all shapes and sizes.  Choosing the right hammer toe pad depends upon understanding whether correction or protection is indicated.  Which is the right hammer toe pad for you?  Sometimes it takes a little trial and error to find the right pad but knowing correction and protection of hammer toes will hopefully get you headed in the direction of comfort.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:344https://www.myfootshop.com/ankle-fusion-improved-walking-following-ankle-fusion-with-the-use-of-a-carbon-fiber-spring-plateAnkle fusion – improved walking following ankle fusion with the use of a Carbon Fiber Spring Plate<h2>Carbon Fiber Spring Plates improve walking following ankle fusion.<a href="/images/uploaded/Medical/Surgery/2020-10-14 13.13.15.jpg" target="_blank"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Medical/Surgery/2020-10-14 13.13.15.jpg" alt="ankle fusion" width="150" /></a></h2> <p>Surgical fusion of a joint is one of many methods used to treat painful, arthritic joints.  Arthritis that affects a joint following an injury is called secondary osteoarthritis.  Secondary arthritis of the ankle is common and often follows a long history of ankle sprains or repetitive injuries to the ankle.  A common history I hear in my practice goes something like this; “I had a bad sprain when I was a kid playing basketball.  Since that time, my pain has gotten progressively worse and now my life is limited by the daily pain I have in that ankle.”</p> <h2>Adjacent segment disease following ankle fusion</h2> <p><a href="/images/uploaded/Blog images/rocker1.jpg" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Blog images/rocker1.jpg" alt="Forefoot rocker shoe modification" width="150" /></a>Ankle fusion limits the range of motion of the ankle.  Although fusion can resolve pain secondary arthritis of the ankle, fusion is not without problems.  On common problem is <a href="https://www.myfootshop.com/adjacent-segment-disease-post-bunionectomy">adjacent segment disease, also called adjacent segment syndrome</a>.  Adjacent segment syndrome refers to the load applied to the joints adjacent to the ankle that are forced to pick the ankle’s lost range of motion following fusion.  Adjacent segment syndrome following ankle fusion can affect both the knee and midfoot.</p> <p>One simple way to improve gait following ankle fusion and to cut down on the effects of adjacent segment syndrome is to use a forefoot rocker.  A forefoot rocker is a simple shoe modification that helps to decrease load to the forefoot during the final stages of gait (toe off).  A clog is a great example of a shoe with a forefoot rocker.  Even though the clog has a rigid sole, the forefoot rocker makes it very easy to walk as the foot rolls over the forefoot rocker.</p> <h3>Carbon Fiber Spring Plate improves walking following ankle fusion</h3> <p>Shoe modifications, like a forefoot rocker can be expensive and are limited to only shoes that have a thick sole.   An <a href="/spring-plate-carbongraphite-fiber-insert" target="_blank"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert_ALT4.jpg" alt="Carbon Fiber Spring Plate" width="150" /></a>alternative to an external forefoot rocker (shoe modification) is to use an insole with a forefoot rocker.  The <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a> from Myfootshop.com is an excellent example of an insole with a forefoot rocker.  Carbon Fiber Spring Plates are light, thin and extremely rigid.  The curvature at the forefoot, called toe spring is what provides the same forefoot rocker as previously described in the example of the clog.  And with a Carbon Fiber Spring Plate there’s no need to have your shoes modified.</p> <p>Walking after having your ankle fused is significantly improved with the use of a forefoot rocker.  In my practice, a Carbon Fiber Spring Plate is recommended to every fusion patient.  I find that the Carbon Fiber Spring Plate enable an earlier transition to weight bearing following ankle fusion and provides ongoing relief as patients become more and more active.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:221https://www.myfootshop.com/tailors-bunions-what-are-the-pathomechanics-of-a-tailors-bunionTailor's Bunions | What are the pathomechanics of a tailor's bunion?<h2>How does the Tailor's Bunion Toe Spreader Combo Pad work?<a href="https://www.myfootshop.com/article/tailors-bunion"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/tailor's_bunion_mod.jpg" alt="Tailor's bunion" width="100" /></a><br /><br /></h2> <h2>A Toe Spreader?  Who needs that, right? </h2> <p>The classic description of a <a href="https://www.myfootshop.com/article/tailors-bunion">tailor's bunion (also called a bunionette)</a> is a bump on the outside of the foot just proximal to the little toe.  The bump is normal bone that is poorly aligned.  The bump of bone is located on the head of the 5th metatarsal bone.  And in many cases, the bump is caused by bowing of the 5th metatarsal bone.</p> <p><a href="https://www.myfootshop.com/article/tailors-bunion"><img style="float: left;" src="/Content/Images/uploaded/Medical/X-ray/xray_foot_tailor's_bunion_mod2.jpg" alt="X-ray tailor's bunion" width="150" /></a>But when you look a little closer at a tailor's bunion, there's actually a whole lot more happening to the biomechanical properties of the 4th and 5th toe.  As the 5th metatarsal bows out away from the foot, the tendons that control the upward and downward motion of the toe start to pull in an eccentric<a href="https://www.myfootshop.com/article/corn-and-callus"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/helloma_molle_infected.jpg" alt="Soft corn of the foot" width="100" /></a> manner.  Rather than pulling the toe straight up and down, they now also pull the 5th to towards the 4th toe.  In the x-ray image to the left, the blue arrow highlights the base of the 4th toe and the orange arrow shows how the bone in the 5th toe, due to the eccentric pull of the tendons, is now pressing against the 4th toe.  The result of this poor alignment of the toe is often a corn between the toes.   An interdigital corn between the toes is shown in the image to the right.</p> <p>So what's all this have to do with the <a href="https://www.myfootshop.com/visco-gel-little-toe-buddy-bunion-guard">Visco-Gel Little Toe Buddy Bunion Guard</a>?  It is true that many tailor's bunions are just a straight-up bump on the outside of the foot.  But padding the outside of the foot won't address the soft corn between the toes. That's what so special about The Tailor's Bunion Toe Spreader Combo Pad.  The pad treats both the tailor's bunion and the soft corn.  How cool is that?</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/25/2020</p>urn:store:1:blog:post:323https://www.myfootshop.com/a-simple-tailors-bunion-thats-not-always-the-caseA simple tailor’s bunion? That’s not always the case.<h2>Tailor’s bunions - the 3-in-one problem</h2> <p>The term <a href="https://www.myfootshop.com/tailors-bunion">tailor's bunion</a> (also called a bunionette) comes from a by-gone day when tailors would sit cross-legged on the floor putting up a hem on a skirt or<a href="/images/uploaded/Blog images/tailors_bunion_mod.jpg"><img style="float: right;" src="/images/uploaded/Blog images/tailors_bunion_mod.jpg" alt="Tailor's bunion" width="140" height="123" /></a> coat.  Chronic pressure on the outside (lateral side) of the foot resulted in a sore spot overlying the 5<sup>th</sup> metatarsal head.  The <a href="https://www.myfootshop.com/x-ray-of-the-foot-oblique-view">5<sup>th</sup> metatarsal</a> is shaped a wee bit like a dog biscuit; long and slender in the middle and larger on the ends.  The larger, distal end of the 5<sup>th</sup> metatarsal is called the 5<sup>th</sup> metatarsal head.  The 5th metatarsal head is the location of a tailor’s bunion.</p> <p>The most common contributing factor to a tailor’s bunion is lateral bowing of the 5<sup>th</sup> metatarsal.  As the bone bows or moves away from the 4<sup>th</sup> metatarsal, the 5<sup>th</sup> toe has a tendency to be pulled back towards the 4<sup>th</sup> toe by the extensor (top of the joint) and flexor (bottom of the joint) tendons.   The image to the right is a good example of this.  Under the text 'Tailor's bunion', you can clearly see the extensor tendon and how it is pulling in an eccentric direction.  The pulling on the toe results in poor alignment between the 4<sup>th</sup> and 5<sup>th</sup> toes.  This poor alignment often results in a <a href="https://www.myfootshop.com/corn-and-callus">soft corn</a> between the toes or a <a href="https://www.myfootshop.com/corn-and-callus">Lister corn</a> on the 5<sup>th</sup> toe.  In the image at right, you can see how the 5<sup>th</sup> metatarsal bows away from the 4<sup>th</sup> metatarsal and the 5<sup>th</sup> toe is placed in poor alignment with the 4<sup>th</sup> toe.</p> <p><a href="https://www.myfootshop.com/visco-gel-little-toe-buddy-bunion-guard" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/994_Visco-Gel Little Toe Buddy BunionGuard(2).jpg" alt="Visco-Gel Little ToeBuddy Bunion Guard" width="150" /></a>Traditionally, a <a href="https://www.myfootshop.com/soft-corn-pads">soft corn pad</a> was used to separate the toes to treat a soft corn or Lister corn.  A separate <a href="https://www.myfootshop.com/gel-tailors-bunion-protector">gel or foam tailor's bunion pad</a> was also necessary to protect the 5th metatarsal head.  The <a href="https://www.myfootshop.com/visco-gel-little-toe-buddy-bunion-guard">Visco-Gel® Little ToeBuddy Bunion Guard®</a> is specifically designed to address both the tailor’s bunion (prominence of the 5<sup>th</sup> metatarsal head) in combination with a soft corn or Lister corn of the toes.  The soft medical grade silicone gel toe pad stabilizes the toes and recreates proper alignment of the digits.  The Visco-Gel® Little ToeBuddy® Bunion Guard is durable and fits easily into all shoes.</p> <p>The Visco-Gel® Little ToeBuddy Bunion Guard® is the 3-in-one solution, treating tailor's bunions, soft corns and Lister corns with one pad.</p> <p> </p> <p> </p> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/25/2020</p>urn:store:1:blog:post:343https://www.myfootshop.com/rockn-and-rolln-with-carbon-fiber-spring-platesRock’n and Roll’n with Carbon Fiber Spring Plates<h2>What is toe spring and how does it help forefoot and <img style="float: right;" src="/images/uploaded/Blog images/girl walking.jpg" alt="Gil walking" width="200" />midfoot pain</h2> <p>Walking is often described as a controlled forward fall.  As your body passes over the foot, resistance is supplied by the calf that limits forward progression of your center of gravity.  In the final stages of gait, as your heel starts to leave the ground, your opposite foot is put forward to catch your fall and start the same gait pattern just completed (heel strike, midfoot loading, forefoot loading and heel off).  Influencing patterns in gait is one of the ways that your podiatrist treats your forefoot or midfoot problems.  Often, use of a specialty insole is an easy and affordable way to influence gait patterns and treat foot problems.</p> <h2>The foot is a bag ‘o bones</h2> <p>If we think of the leg, ankle and foot as a lever that facilitates walking, the greatest efficiency of that lever would be if:</p> <ul> <li>the leg, ankle and foot acted in a single body plane</li> <li>the foot was a rigid part of the lever (resistance arm)</li> </ul> <p>At the core of gait is energy efficiency.  The goal of your body is to perform an action using the least amount of energy possible.  If we look just at the leg, ankle and foot, some of this energy conservation does come from the fact that to a great degree, the leg, ankle and foot do work within a single body plane.  The second statement regarding the foot as a rigid lever is much more difficult to answer.  The foot is a bag ‘o bones consisting of <a href="https://www.myfootshop.com/bone-lateral-mod-labeled">27 bones</a> and 114 different ligaments.  The primary reason for so many bones and ligaments is that the foot needs to adapt to a changing environment.  The foot is designed to step on uneven surfaces, climb hills, jump and land and simply adapt to anything we throw at it.  Therefore, adaptation to our environment results in a less than rigid lever.  So how do we go about improving the rigidity of the foot while functioning in an ever changing environment?  The answer lies in the use of specialty insoles.</p> <h3>Too much rigidity?  Add a little toe spring.</h3> <p><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plates</a> are a unique category of shoe insert that are very thin and very rigid.  The primary purpose <img style="float: right;" src="/images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon Fiber Spring Plates" width="150" />of a Carbon Fiber Spring Plate is to act as a brace to splint the arch.  When combined with a laced shoe, a Carbon Fiber Spring Plate specifically addresses the bag ‘o bones making the foot much more rigid and subsequently, more efficient in gait.  And remember, efficiency and energy conservation are what lie at the core of gait.</p> <p>If Carbon Fiber Spring Plates make rigid and flat, their use may actually make it hard to walk.  To overcome some of the rigidity while still providing support for the foot, toe spring is added to the Carbon Fiber Spring Plate.  Toe spring is a curvature, or what we call a rocker added to the forefoot of the spring plate.  Toe spring has an incredible effect on walking by facilitating early heel off and decreased load applied to the forefoot.  Rigidity and toe spring are two simple concepts that have a huge impact on gait and foot pain.</p> <h4>The Carbon Fiber Spring Plate Brace</h4> <p>The Carbon Fiber Spring Plate is really more than just a simple shoe insert.  When used in conjunction with a laced shoe, the Carbon Fiber Spring Plate acts as a brace for the lever arm of the leg ankle and foot.  But when compared to it’s big brothers, like an <a href="https://www.arizonaafo.com/products/gauntlet/arizona-brace.html">Arizona Brace</a> or an <a href="https://hangerclinic.com/orthotics/ankle-foot/ankle-foot-orthoses/">ankle foot orthotic (AFO)</a>, the humble little Carbon Fiber Spring Plate offers a number of advantages.  Thin, light, easy to switch from shoe to shoe and available without prescription, the Carbon Fiber Spring Plate often provides the support needed to solve a foot problem at a fraction of the cost an of other braces.  Again, when used in conjunction with a any laced shoe, you can create a brace for the foot that is affordable and simple to use.</p> <h4>Light as a feather and stronger than steel – Carbon Fiber Spring Plates</h4> <p>Light and strong may be the two primary attributes of a Carbon Fiber Spring Plate, but toe spring is really what make the device effective.  Carbon Fiber Spring Plates are just one of the many specialty insoles offered by Myfootshop.com.  As America’s leading distributor of carbon fiber insole products, we offer specific foot inserts that are ‘just what the doctor ordered.’</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:342https://www.myfootshop.com/should-every-lapidus-bunionectomy-use-a-carbon-fiber-spring-plateShould every Lapidus bunionectomy use a Carbon Fiber Spring Plate?<h2>How do Carbon Fiber Spring Plates improve the <a href="/images/uploaded/Blog images/Lapidus bunionectomy fixation.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/Lapidus bunionectomy fixation.jpg" alt="Lapidus bunionectomy" width="150" /></a>patient experience post Lapidus bunionectomy?</h2> <p>Medical and surgical care is often trending related to new technology and new concepts related to care.  Surgical procedures are a great example of trends in medicine.  A patient’s contact with a new procedure or technique may be a simple as your doctor attended a seminar where he/she learned a new technique.</p> <p>Bunion procedures have a long history of trends based on clinical outcomes and new technology.  The Lapidus bunionectomy, originally described by Paul Lapidus, MD (1893-1981), has had a recent revival in popularity based upon new techniques and equipment.  The advantage of the Lapidus bunionectomy is that the correction addresses one of the <a href="/images/uploaded/Blog images/Lapiplasty fixation.jpg" target="_blank"><img style="float: left;" src="/images/uploaded/Blog images/Lapiplasty fixation.jpg" alt="Lapidus fixation" width="150" /></a>primary contributing factors to recurrence of the bunion – the first metatarsal cuneiform joint instability.  The Lapidus bunionectomy involves fusion of the first metatarsal cuneiform joint which helps to resolve the issue related to bunion recurrence.</p> <p>Several surgical care companies have come out with jig guided techniques that create a more accurate cut in the bone and subsequently a better alignment for bone fusion.  <a href="https://www.treace.com/lapiplasty/">Lapiplasty from Treace Medical</a> is one of the more popular techniques used today.  In addition to helping the surgeon create a more precise cut in the bone, the Lapiplasty technique promotes early weight bearing post op.  Traditionally, old school Lapidus bunionectomies required 8 weeks non-weight bearing while Lapiplasty enables patients to return to weight bearing as early as three weeks post-op.</p> <p>The challenge with weight bearing post Lapidus bunionectomy all relates to getting bone to heal.  Too much weight bearing, too soon, will result in a failed union of the bone and need for revision surgery.  But early managed weight bearing actually contributes to better healing and improves the success of fusion. </p> <h2>Carbon fiber Spring Plates for Lapidus bunionectomy</h2> <p>The <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a> is a very thin yet very rigid foot plate that creates rigidity in the shoe.  The Carbon Fiber<a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right;" src="/images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon Fiber Spring Plate" width="150" /></a> Spring Plate also has built in toe spring.  Toe spring is a built in rocker that decreases loading to the forefoot.  Due to their rigidity and toe spring, Carbon Fiber Spring Plates are remarkably well suited to use in Lapidus bunionectomy patients. The rigidity of the Spring Plate braces the fusion site of the Lapidus bunionectomy while the toe spring off-loads the fusion site during gait.</p> <p>Should every Lapidus bunionectomy patient use a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a>?  The answer is definitively yes. I want to provide my patients with every opportunity for success.  That’s why I always recommend a Carbon Fiber Spring Plate to my Lapidus bunionectomy patients. </p> <p> </p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:341https://www.myfootshop.com/wounds-and-wound-prevention-in-the-feetWounds and wound prevention in the feet<h2>Managing foot wounds in the decompensated patient.<img style="float: right;" src="/images/uploaded/Blog images/5th_ray_resection3_mod.jpg" alt="Diabetic foot care" width="250" /></h2> <p>One of the greatest challenges in foot care is wound prevention and wound management.  Wounds come in all shapes and sizes, but there’s always one common denominator in wound care; a decompensated patient.  What is a decompensated patient?  A decompensated patient is one who has one or more factors that compromise the ability of healing.  Here is a partial list of health issues that may contribute to what we call the decompensated patient:</p> <ul> <li>       <a href="https://www.myfootshop.com/peripheral-arterial-disease">Poor circulation</a></li> <li>       <a href="https://www.myfootshop.com/diabetic-foot-care">Diabetes</a> and <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy">diabetic neuropathy</a></li> <li>       Kidney disease</li> <li>       <a href="https://www.myfootshop.com/peripheral-neuropathy">Neuropathy from chemical exposure or chronic alcohol consumption</a></li> <li>       Neuropathy secondary to chemotherapy</li> <li>       Orthopedic deformities – <a href="https://www.myfootshop.com/bunion">prominent bones</a> and <a href="https://www.myfootshop.com/hammer-toes">irregularly shapes feet</a></li> </ul> <p>The sad irony of these health comorbidities, is that all of us tend to become decompensated over time leading to wounds and bone infections.  Classically, these wounds and bone infections are found in the forefoot (90 percent), in the midfoot (5 percent) and in the rearfoot 5 percent). 1,2</p> <p>Myfootshop.com focuses on helping consumers have direct access to the knowledge and medical supplies used by health care providers who specialize in lower extremity wounds and infections.  Knowing that the vast majority of foot wounds are forefoot wounds, we offer a number of different pads and cushions to treat foot wounds and infections.</p> <h2>Pads for foot woounds and infections</h2> <p><a href="https://www.myfootshop.com/corn-and-callus-pads"><img src="/images/uploaded/Products/686_Soft_Corn_Pads_ALT2.jpg" alt="Soft corn pad" width="100" />Corn pads</a></p> <p><a href="https://www.myfootshop.com/hammer-toe-pads"><img src="/images/uploaded/Products/701_Hammer_Toe_Crest_Pad.jpg" alt="Hammer toe crest pad" width="100" />Hammer toe pads</a></p> <p><a href="https://www.myfootshop.com/toe-caps-toe-bandages-and-toe-sleeves"><img src="/images/uploaded/Products/697_Gel_Toe_Protector_ALT.jpg" alt="Gel toe cap" width="100" />Toe caps and bandages</a></p> <p><a href="https://www.myfootshop.com/toe-separators"><img src="/images/uploaded/Products/696_Gel_Toe_Separator.jpg" alt="Gel toe separators" width="100" />Toe separators</a></p> <p><a href="https://www.myfootshop.com/toe-straighteners-and-splints"><img src="/images/uploaded/Products/706_Toe_Straightener_Single_Toe_ALT.jpg" alt="Toe straightener" width="100" />Toe straighteners and splints</a></p> <p><a href="https://www.myfootshop.com/bunion-products"><img src="/images/uploaded/Products/959_Gel_Bunion_Spacer_w_StayPutLoop_ALT.jpg" alt="Gel Bunion spacer with stay-put-loop" width="100" />Bunion pads</a></p> <p><a href="https://www.myfootshop.com/ball-of-foot-pads"><img src="/images/uploaded/Products/852_Metatarsal_Cushion_Gel.jpg" alt="Metatarsal cushion gel" width="100" />Ball-of-foot pads</a></p> <p><a href="https://www.myfootshop.com/metatarsal-pads"><img src="/images/uploaded/Products/729_Metatarsal_Pads_Felt.jpg" alt="metatarsal pads" width="100" />Metatarsal pads</a></p> <h3>Seeking help for foot wounds and infections</h3> <p>Before you use our products, be sure to use our foot and ankle knowledge base to research to topic that you’re treating.  And in severe cases, be sure to contact your podiatrist for additional information and care.</p> <ol> <li>       Lew DP, Waldvogel FA Osteomyelitis. Lancet 2004;364(9431):369-379.</li> <li>       Karchmer AW, Gibbons GW.  Foot infections in diabetes: Evaluation and management.  Curr Clin Top Infect Dis. 1994:14:1-22.</li> </ol> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:340https://www.myfootshop.com/the-beauty-of-running-just-you-and-your-shoesThe beauty of running – just you and your shoes<h2>Strip down, lace up and go.  Recreational running is <img style="float: right;" src="/images/uploaded/Blog images/exercise-1838991_640.jpg" alt="Running resources and support" width="250" />just about you and your shoes.</h2> <p>The simplistic beauty of running is about you and your shoes.  Strip down, lace up and go is what allows you to sneak in a quick run after work.  And in these crazy pandemic days, running can represent everything between your primary mode of transportation and your deep keel of mental health.</p> <h3>Myfootshop.com is the runner’s resource for foot care needs</h3> <p>We’re here to help you tune your shoes and optimize your run.  Our <a href="https://www.myfootshop.com/articles/">foot and ankle educational resources</a> get you on track regarding foot and ankle conditions.  Our wide-ranging selection of foot care products help you tune your shoes, making that next run an extra special moment.</p> <h3>Running shoe modifications – how to make the right choices</h3> <p>Top notch support, comprehensive foot and ankle health care knowledge and affordable products.  Myfootshop.com enables runners to shop from home with confidence, knowing that runners really can make the right modification to their running shoes.</p> <h4>Find the right diagnosis and the right foot and ankle product</h4> <p>Before you make any purchase, take a couple of minutes to read about your problem in our <a href="https://www.myfootshop.com/articles/">foot and ankle knowledge base</a>.  Products for each condition are recommended at the conclusion of each article.  All product recommendations are made by a board-certified podiatrist.</p> <p>Strip down, lace up and go with confidence know that Myfootshop.com has your back.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:339https://www.myfootshop.com/how-does-compression-treat-plantar-fasciitisFasciaFix™ Plantar Fasciitis Relief Sleeve<h2>How does compression treat plantar fasciitis?<a href="/fasciafix-plantar-fasciitis-relief-sleeve" target="_blank"><img style="float: right;" src="/images/uploaded/Products/1116 FasciaFix Plantar Fasciitis Sleeve.jpg" alt="The FasciaFix™ Plantar Fasciitis Relief Sleeve" width="250" /></a></h2> <p>Compression is a well known therapy for acute injuries and chronic swelling.  For example, use of compression in the case of an <a href="https://www.myfootshop.com/ankle-sprain">ankle sprain</a> helps to facilitate healing by reducing swelling, stabilizing the ankle injury and improving proprioception.  Proprioception is that sense that you know where you are in space -a very important concept when trying to heal and prevent future ankle sprains.</p> <p><a href="https://www.myfootshop.com/plantar-fasciitis">Plantar fasciitis</a> is an overuse syndrome that occurs on the plantar (bottom) heel at the insertion of the plantar fascia.  The classic symptoms of plantar fasciitis include pain at the onset of weight bearing.  Rising in the morning, those first few steps can be difficult in the patient suffering from plantar fasciitis.  What causes that sharp pain?  As the arch is loaded with body weight, the fascia is put under tension and pulls against the heel bone causing a sharp, tearing pain.  As the day progresses, a dull and sometimes severe ache is also present on the bottom of the heel.</p> <p>The FasciaFix® Plantar Fasciitis Relief Sleeve</p> <p><a href="/fasciafix-plantar-fasciitis-relief-sleeve" target="_blank">The FasciaFix® Plantar Fasciitis Relief Sleeve </a>treats plantar fasciitis in two ways.  First, compression helps to support the plantar fascia at weight bearing.  Second, the lining of The FasciaFix® Plantar Fasciitis Relief Sleeve is lined with small nodules that gently massage the bottom of the heel.  The combination of gentle massage and compression help to soothe the symptoms of plantar fasciitis.  The FasciaFix® Plantar Fasciitis Relief Sleeve can be worn during the day or while sleeping.  The FasciaFix™ Plantar Fasciitis Relief Sleeve can be worn directly on the skin or over another sock.</p> <p>Compression and massage are two ways that The FasciaFix® Plantar Fasciitis Relief Sleeve works to treat the overuse heel pain syndrome we call plantar fasciitis.  Used in conjunction with <a href="https://www.myfootshop.com/treatment-guide-calf-stretches-for-plantar-fasciitis">calf stretching exercises</a>, plantar fasciitis and easily be treated at home.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:338https://www.myfootshop.com/standard-precautions-for-covid-19Re-opening society - how standard precautions can save lives<h2>Standard precautions – what are they and how do they <img style="float: right;" src="/images/uploaded/Blog images/covid-19-5073811_640.jpg" alt="stop covid-19" width="250" />affect our return to an open society</h2> <p>Ask any health care worker what <a href="https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/standard-precautions.html">standard precautions</a> are and you’ll get the same answer; treat every patient as if they are infected.  Standard precautions are an axiom in health care regardless of whether you work in a nursing home, urgent care or regional trauma center.  Regardless of your role in direct patient care, you simply do not deviate from the philosophical approach to patient care described in standard precaution guidelines. </p> <p>Standard precautions in health care include:</p> <ol> <li>       Hand hygiene.</li> <li>       Use of personal protective equipment (e.g., gloves, masks, eyewear).</li> <li>       Respiratory hygiene / cough etiquette.</li> <li>       Sharps safety (engineering and work practice controls).</li> <li>       Safe injection practices (i.e., aseptic technique for parenteral medications).</li> <li>       Sterile instruments and devices.</li> <li>       Clean and disinfected environmental surfaces.</li> </ol> <h3>The long and sordid history of standard precautions in health care</h3> <p>If Hungarian physician <a href="https://en.wikipedia.org/wiki/Ignaz_Semmelweis">Ignaz Semmelweis</a> (1818-1865) was alive today, he would smile at the challenges faced by society to reintegrate post COVID-19.  Semmelweis was an obstetrician working in Vienna, Austria who famously noted that hand hygiene saved lives.   Semmelweis’s findings came before the discovery of <a href="https://en.wikipedia.org/wiki/Germ_theory_of_disease">germ theory</a>, and as such, Semmelweis was unable to scientifically explain why hand hygiene significantly reduced the rate of <a href="https://en.wikipedia.org/wiki/Postpartum_infections">purepural fever</a>.  Mocked by his peers for promoting a program that would one day become standard precautions, Semmelweis sustained a mental break down and was institutionalized.  Fourteen days into his ‘therapy’, Semmelweis was beaten by guards and died of his wounds at the age of 47 years old. (1)  Revolution in science (as in society) is often hard fought and frequently met with peer resistance.  (Just ask <a href="https://en.wikipedia.org/wiki/Nicolaus_Copernicus">Copernicus</a>).</p> <h3>Do standard precautions change the provider/patient relationship?</h3> <p>For a patient who has never been to the hospital for an emergency room visit or a hospitalization, they might be surprised by the number of steps that are taken to implement standard precautions.  Sure, standard precautions do increase the amount of disposable material used in patient care, but as Semmelweis would have found, the impact on outcomes and costs are substantive.  Standard precautions do change the provider/patient relationship in a number of positive ways:</p> <ul> <li>Protects the patient from cross transmission of infection from other patients</li> <li>Decreases cost of caring for infected patients</li> <li>Decreases duration of hospital stays</li> <li>Protects the health care provider from infection</li> <li>Why are standard precautions important to all of us as we re-open society following the initial COVID-19 infection?</li> </ul> <p>Standard precautions are a mindset, a way of thinking.  When admitted to a hospital for an infection, a foot wound would be placed in private room with orders for <a href="https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html">contact precautions</a>.  Contact precautions are an elevated level of standard precautions specific to wound and skin infections.  Protective gowns and gloves are worn with patient contact and hand washing is performed both entering the room and upon exiting the patient’s room.  Think of contact precautions as a layer that rests on top of standard precautions for treatment of bacterial infections.</p> <h4>In addition to standard precautions, what precautions are taken with COVID-19?</h4> <p>COVID-19 presents with very different set of precaution challenges when compared to contact precautions.  Where contact precautions are intended for prevention of bacteria, COVID-19 precautions are also intended to limit contact, <a href="https://www.cdc.gov/infectioncontrol/guidelines/isolation/">droplet</a> and <a href="https://www.cdc.gov/infectioncontrol/guidelines/isolation/">aerosol</a> transmission of the virus.  When exercised in a controlled environment with skilled, educated staff, the combination of contact, droplet and aerosol precautions are significantly effective.  Each of these methods of contact precautions builds upon the work of Semmelweis and his concept of standard precautions.</p> <h4>How do we open society post COVID-19?</h4> <p>Re-opening society is going to be fraught with fits and starts.  The Center for Disease Control (CDC) has been unable to act independently to disseminate timely and meaningful guidance to the general public.  Instead, state and local government has been forced to define their own rules that are only partially accepted and followed by the public at large.</p> <p>At the core of re-opening are standard precautions – the same standard precautions that health care workers have universally accepted.  There may be some new terms - social distancing, frequent hand washing, avoidance of crowds such as public transportation and isolation when sick.  Semmelweis would be proud.  But Semmelweis would also expect the social backlash from those who simply don’t understand.  In 1865 it was the right of an OB/gyn to not have to wash his hands between autopsy and delivery.  Fortunately, 150 years later, our medical providers have let go of the social stigma of washing their hands.</p> <p>Each of us creates our own reality through the lens of our personal experiences.  How these different realities intersect is what we’re faced with today with the reintegration of our society.  If standard precautions or simply the mindset of standard precautions had been at the forefront of reintegration, I would feel much more comfortable as we all come together.  Unfortunately, I feel a bit like Semmelweis; proud as hell of the team of providers that is work with but afraid for the innocents who will be affected by what are being labeled civil liberties.</p> <p>Got to go wash my hands.</p> <p>References</p> <ol> <li>       <a href="https://www.ncbi.nlm.nih.gov/books/NBK144018/">WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care.</a></li> </ol> <p>Additional references for re-opening</p> <ol> <li>       <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html#anchor_1580064337377">CDC Recommends</a></li> <li>       <a href="https://www.whitehouse.gov/openingamerica/">Whitehouse guidelines for reopening</a></li> </ol> <p> </p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:337https://www.myfootshop.com/lisfranc-fracture-treatment-with-carbon-fiber-spring-plateEarly and late stage management of Lisfranc fracture-dislocation with a Carbon Fiber Spring Plates<h2>Lisfranc fracture-dislocation benefits from Carbon Fiber Insoles<img style="float: right; padding-left: 5 px;" src="/images/uploaded/Blog images/Lisfranc fracture ORIF left orientation.jpg" alt="Lisfranc fracture ORIF" width="200" /></h2> <p>Working in a rural hospital I see a lot of foot and ankle trauma.  ATV and motor sports injuries are common and often result in midfoot injuries.  When the trauma is specific to the tarsal-metatarsal joint, we call these injuries Lisfranc dislocations or Lisfranc fractures.  Jacques Lisfranc de St. Martin (1790-1847) was a French surgeon and gynecologist (a Jacques of all trades) who recognized this injury while treating soldiers of the Napoleonic Wars.  These unique fractures and dislocations continue to bear his name to this date.</p> <p>Lisfranc injuries are defined by classic fracture patterns including the <a href="https://www.researchgate.net/figure/Quenu-and-Kuss-classification-of-Lisfranc-joint-injuries-Data-from-the-article-of-Quenu_fig1_309654494">Quenu and Kuss classification</a> and the <a href="https://www.researchgate.net/figure/Classification-of-Lisfranc-fracture-dislocations-according-to-Hardcastle-and-Qeunu-33_fig1_225124622">Hardcastle classification</a>.  (1,2) Unfortunately, these classifications do not dictate the long term outcomes of theses fractures and dislocations.  Lisfranc fracture-dislocations can be devastating injuries with lifelong disability.  Many patients who sustain these injuries are unable to return to their prior occupations and recreational activities.  Long term post traumatic arthritis is common in these cases and directly correlates to the success of anatomical reduction achieved at the time of surgery. (3)</p> <h3>Return to weight bearing and ambulation post Lisfranc fracture-dislocation</h3> <p>Walking can be described as a controlled forward fall.  To move forward in walking, we shift our center of gravity forward and begin a forward fall.  The function of the leg, ankle and foot is to act as a lever to manage that forward fall in a controlled manner.  The <a href="https://www.myfootshop.com/soleus">soleus muscle</a> of the calf is designed to slowly limit range of motion at the ankle during walking.  As our center of gravity moves forward, there is increasing and significant load applied to the midfoot and forefoot.  In the patient who has sustained a Lisfranc fracture-dislocation, simple weight bearing is a load applied to the injury site in a perpendicular manner.  The load applied to the foot by the soleus muscle to limit forward motion during walking is applied to Lisfranc’s joint perpendicular to the injury.  When load is aligned with the direction of a fracture, the load can be distributed over a larger surface area.  But when load is applied perpendicular to the injury, fatigue and failure of the fracture-dislocation site is common.  This pattern of weight bearing and load bearing, perpendicular to the fracture-dislocation, is what makes return to activities such a challenge to Lisfranc fracture-dislocation patients.</p> <h3>What are the two ways a Carbon Fiber Spring Plate enables early return to walking?</h3> <p><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon Fiber Spring Plate" width="200" /></a>The first attribute of the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a> is rigidity.  Carbon Fiber Spring Plates are extremely thin and very, very rigid.  The rigidity of the Spring Plate is an important part of Lisfranc fracture-dislocation and return to weight bearing.  When combined with a traditional laced shoe (laced tennis shoe, laced walking shoe or laced boot) the Spring Plate become securely positioned on the bottom of the foot to received the force generated by the soleus muscle during walking. The combination of a Spring Plate and a laced shoe essentially becomes a Spring Plate Brace.  Load generated by the soleus muscle is carried by the Spring Plate in a direction parallel to the line of force.  The Lisfranc fracture-dislocation, perpendicular to the line of force, is splinted and protected by use of the Carbon Fiber Spring Plate. </p> <p>Toe spring is the second attribute of the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a> that enables early return to ambulation post Lisfranc fracture-dislocation.  Toe spring (also called an anterior rocker) describes a rounded surface of the insert under the ball-of–the-foot.  Normal walking relies on the immovable, static position of the foot as the body passes over the foot.  This progressive increase in load to the foot by the soleus muscle as the body’s center of mass moves forward results in significant mechanical load to the Lisfranc fracture-dislocation.  Placing a Carbon Fiber Spring Plate with toe spring in the shoe significantly decreases the load to the fracture-dislocation.  Rather than big mechanical load and explosive heel lift, the toe spring in the Carbon Fiber Spring Plate promotes gradual loading and gradual heel lift, thus reducing load to the fracture-dislocation. </p> <p>Rigid carbon fiber and toe spring – off-loading of midfoot injuries</p> <p>Rigidity of the Spring Plate carries mechanical load, toe spring decreases mechanical load and a laced shoe ties is all together.  I call this combination a Carbon Fiber Spring Brace.  A Carbon Fiber Spring Brace is useful not only in the early stage of rehabilitation post Lisfranc fracture-dislocation, but also for long term use.  The usability of the Carbon Fiber Spring Brace is far superior to a rigid plastic AFO.  The use of a Carbon Fiber Spring Plate/Brace is a significant part of my care for these patients.  It enables early return to walking and maintains surgical reduction during the healing phase of these injuries. Knowing that many of these injuries will go on to have post traumatic midfoot arthritis, I continue to use the Carbon Fiber Spring Plate as a long term brace for management of midfoot, post-traumatic arthritis.</p> <p><a href="https://www.myfootshop.com/boards/topic/788/treatment-of-lisfranc-fracture-dislocation-with-carbon-fiber-spring-plates">Join the discussion</a> on this topic in our discussion forum.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p> <p> </p> <ol> <li>Quenu E, Kuss GE. Etude sur les luxations du metatarse (Luxations metatarso-tarsiennes). Du diastasis entre le 1er et le 2e metatarsien. Rev Chir. 1909;39:1–72.</li> <li>Hardcastle PH, Reschauer R, Kutscha-Lissberg E, Schoffmann W. Injuries to the tarsometatarsal joint: incidence, classification and treatment. J Bone Joint Surg Br. 1982;64:349–356.</li> <li>Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986;6:225–242.</li> </ol>urn:store:1:blog:post:336https://www.myfootshop.com/minimal-incision-bunionectomyMinimal Incision Bunionectomy<h2>Does a smaller incision make for a better bunionectomy?<a href="/images/uploaded/Blog images/Crossroads mini bunion fixation left orientation.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/Crossroads mini bunion fixation left orientation.jpg" alt="" width="175" /></a></h2> <p>Minimal incision surgery (MIS) has improved the surgical outcomes of many types of surgery.  For example, in laproscopic surgery a minimal incision approach has a number of short term benefits including decreased infection rates, shorter hospital stays and faster return to activities for patients.  Laproscopic MIS also has the additional long term benefit of preservation of the abdominal wall.  Use of multiple small incisions compares favorably to one larger incision by preventing abdominal hernias and abdominal wall weakness. </p> <p>In foot and ankle surgery, the size of the incision used to perform a surgery is dictated by the technique used to perform a surgery.  Traditional ‘open’ foot and ankle surgeries that involves cutting bone and placing fixation require an adequate length of incision to accomplish the following -</p> <ul> <li>Provide necessary visualization of bone and soft tissue structures</li> <li>Provide adequate room for instrumentation, retraction or fixation</li> <li>Decrease tension on skin, arteries and nerves from retraction</li> </ul> <p>When you begin surgical planning for a <a href="https://www.myfootshop.com/bunion">bunionectomy</a>, you have to ask the question - what’s better – a smaller incision or a better long term outcome?  Are the two complimentary or mutually exclusive?</p> <h3>Is there a benefit to a smaller incision in bunion surgery?</h3> <p>Let’s take a quick look at the current options available for minimal incision bunion surgery and then compare the pros and cons of these surgical techniques.  Current techniques use to perform minimal incision bunion surgery all have a smaller incision, but the differences in the procedures lie in the type of fixation used and the orientation of the osteotomy (cut in the bone).  Be sure to follow these links for video and technical information of the individual companies and techniques.</p> <p><strong>Screw fixation only</strong></p> <ol> <li><a href="https://www.prostepmis.com/healthcare-professionals/resource-center/">ProsStep</a> from <a href="https://www.wright.com/">Wright Medical</a>, Memphis TN, uses a chevron, or V shaped osteotomy (cut in the bone) to correct the bunion.  Correction is held in place while multiple screws are used for fixation. </li> <li><a href="https://www.arthrex.com/resources/animation/NvFmYdoZak-XnAFwOqyJXw/mis-surgery-bunion-correction">Arthrex</a>, Naple FL,  has developed a MIS bunion technique that uses a transverse osteotomy with dual screw fixation. </li> <li><a href="https://novastep.life/product/peca-bunion-correction-implants/">NovaStep PECA</a> bunionectomy with performed with a transverse osteotomy and percutaneous screw fixation of the osteotomy. </li> </ol> <p><strong>Screw and plate systems</strong></p> <ol> <li><a href="https://novastep.life/">NovaStep</a>,  based out of Orangeburg, NY, developed an intramedullary locking plate called <a href="https://novastep.life/product/centrolock/">Centrolock Guided Transverse Osteotomy System</a>.  This bunionectomy technique uses a transverse osteotomy with a locking plate that resides within the bone (medullary canal) to reduce space.</li> <li><a href="https://www.crextremity.com/products-minibunion-implant/">CrossRoads Mini Bunion</a> technique uses a transverse osteotomy and intamedullary screw and plate fixation.</li> <li>Wright Medical also provides a locking plate MIS technique called <a href="https://www.wright.com/footandankleproducts/mini-maxlock-extreme-iso-plate">ISO (Intraosseous Sliding Osteotomy) Plate with POCKETLOCK™ Technology</a>.  This technique uses a transverse osteotomy.</li> </ol> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line_break_shoe_7.jpg" alt="" width="300" /></p> <h3>Bunionectomy and bone healing - what is primary and secondary bone healing?</h3> <p>In almost all bunionectomy procedures, one of the key steps in correcting the bunion is to cut the first metatarsal bone and displace the bone into a corrected position.  The bone is then stabilized in that corrected position while it heals.  Ideally, the surgical fracture (osteotomy) is well aligned and well apposed and stable.  If these three precursors of fracture healing are met, healing typically proceeds uneventfully.  Good apposition, good alignment and stable fixation all leads to the optimal kind of bone healing called primary bone healing. </p> <p>But what if the osteotomy is unstable, poorly aligned and displays motion at the fracture site?  Healing will not take place by primary bone healing.  The surgical osteotomy will heal by secondary bone healing.  The clinical findings of secondary bone healing include swelling specific to the osteotomy, clicking and popping and pain. </p> <h3>What is the difference between primary and secondary bone healing?</h3> <p>When your doctor orders a post op x-ray following your bunionectomy, what he/she is doing is assessing primary vs secondary bone healing.  Primary bone healing will show minimal gapping at the osteotomy on x-ray and no surrounding proliferation of bone surrounding the fracture.  In secondary bone healing, we’ll often see a fracture line and proliferative formation of bone surrounding the fracture.  This proliferation of bone is an attempt by your body to stabilize the fracture.  When there’s good alignment, good apposition and stability at the fracture site, bone healing occurs directly across the surgical osteotomy.  Not so in secondary bone healing.  In secondary bone healing, your bone is actively working to find a way to stabilize the fracture.  Primary bone healing is optimal but secondary bone healing can indeed heal.  Secondary bone healing usually takes longer to heal and has a greater propencity for delayed union or non-union at the osteotomy site.</p> <h4>Does minimal incision bunionectomy heal by primary or secondary bone healing?</h4> <p>Remember our prior mention of osteotomy and fixation for each of these MIS bunion procedures?  In a perfect world, every osteotomy has great apposition and alignment and will heal by primary bone healing.  But in MIS surgery, we sometimes have to push the limits of the surgery to accomplish our MIS goals.  If you reread each of the procedure descriptions above, only the Prostep from Wright medical uses an osteotomy that preserves apposition of bone through the use of a chevron osteotomy.  All of the other procedures use a transverse osteotomy.  A transverse osteotomy is a straight cut across the bone with limited apposition and alignment.  A transverse osteotomy is inherently unstable.</p> <p>In addition to apposition and alignment, we also said that the third factor that needs to be present for primary bone healing is stable fixation.  One of the axioms in bone plating and fixation is that there needs to be at minimum two point fixation.  In each of the three procedures described above that use screw fixation only, two screws are placed across the osteotomy.  Remember, I said two screws at minimum.</p> <p>The remaining three MIS bunionectomy systems use a plate and screw system to stabilize the surgical osteotomy.  In each of these cases, the fixation used is a plate and screw combination that is placed in an intramedullary fashion (within the bone). </p> <h4>What are the pros and cons of traditional vs MIS bunionectomy</h4> <p>Using minimal incision approaches to perform bunionectomy procedures is not new to foot and ankle surgery.  Thirty years ago, minimal incision surgery was performed on a regular basis in office based practices, but the results were less than optimal.  Due to consistently poor outcomes, the MIS procedures of the 1970’s fell to the wayside.  But there’s been a resurgence over the past two years to bring MIS bunionectomy surgery back.</p> <h4>Issues to consider when contemplating MIS bunion surgery</h4> <p>The issues that are important to consider when contemplating MIS bunionectomy are –</p> <ul> <li>Surgeon skill and training</li> <li>Stability of the osteotomy</li> <li>Reliability of the fixation</li> <li>Patient expectations</li> </ul> <p>A traditional bunionectomy is a bread and butter procedure for a foot and ankle surgeon.  Each surgeon may have their favorite techniques but most importantly, we do them on a regular basis.  MIS bunionectomy on the other hand is not a procedure done with frequency and therefore presents as a challenge for most foot and ankle surgeons regardless of level of training.  My impression is that Companies like CrossRoads, Wright and Arthrex take this issue very seriously.  Training for MIS bunionectomy is readily available to surgeons.  Reps are present for cases and often the reps will present for follow-up on cases. </p> <p>Why is the orientation of the osteotomy important?  We talked earlier about the orientation of the osteotomy and how that orientation dictates apposition, alignment and stability.  Transverse osteotomies are inherently unstable.  A transverse osteotomy does not provide adequate apposition and stability, regardless of fixation type.  In traditional, open bunionectomies, the surgeon relies on the apposition and alignment of the osteotomy and not the fixation.  MIS bunionectomy procedures rely heavily on fixation, not apposition and alignment of the bone.  Reliance on fixation alone in bone fixation is a known pathway to poor outcomes.</p> <p>Knowing that in most cases, apposition and alignment of MIS bunionectomies is tenuous at best, we really put a lot of faith in the fixation techniques used in these procedures.  And as I mentioned before,  it’s the apposition and alignment of the bone, not the fixation that heals the osteotomy.  The two point screw fixation techniques are a minimal standard in the science of bone healing.  The plate and screw systems may be better at stabilizing the bone, but again, these fixation techniques will often result in secondary bone healing.</p> <p>What really seems to drive the decision making in MIS bunionectomy is patient expectations.  Patients are interested in cosmetic outcomes that will allow for return to low cut shoes and sandals.  When vanity weighs as heavy in the pre-operative planning and choice of procedures, I start to get cold feet.</p> <h5>As a foot surgeon, do I plan to do a lot of MIS bunionectomies?</h5> <p>So let me get this straight – we’re contemplating performing a bunionectomy that is inherently unstable due to the orientation of the osteotomy, fixation is minimal which may lead to secondary bone healing and the surgical decision making is being driven by inflated patient expectations.  Many surgeons would explain the inherent disadvantages of MIS bunionectomy away by saying, “the success of the procedure is all in the patient selection.”  For my practice, I’m just not sold on the virtues of MIS bunionectomy.</p> <p>The advantages for certain MIS procedures, like laproscopy, are quite clear.  In foot and ankle surgery, MIS techniques in ankle arthroscopy have truly revolutionized ankle surgery even within the course of my career.  MIS bunionectomy is still struggling to find a home in my tool box.  I’m going to sit on the sidelines with this procedure until I can see clear and definitive advantages to the procedure.</p> <p>Follow this link to join the discussion surrounding <a href="https://www.myfootshop.com/boards/topic/787/minimal-incision-bunionectomy">minimal incision bunionectomy</a>.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:335https://www.myfootshop.com/covid-toeWhat’s causing COVID toe?<h2>A meta-analysis of contemporary non-academic and academic literature related to the skin condition called COVID toe.</h2> <p>Viral infections are often known to be associated with distinctive skin rashes.  It is not uncommon to see skin rashes cases of viral pneumonia and more communicable diseases such as <a href="https://www.cdc.gov/parvovirusb19/fifth-disease.html">Fifth Disease</a> or <a href="https://www.cdc.gov/hand-foot-mouth/index.html">Hand, Foot and Mouth Disease</a>.  Rashes that result from a condition like viral infections are difficult to study due to their geographic diversity and variation in patient demographics.  But when a viral pandemic occurs, the opportunity for studying disease and it’s trends change dramatically.  The number of cases of the novel coronavirus in healthcare facilities around the world has enabled clinicians and researchers to be able to aggregate data in ways that are only typically seen in wartime.  One trend specific to the novel corona virus is a skin condition called Covid toe.</p> <p>When studying a disease, medical researchers and clinicians always lean into trends and patterns to find answers.  What trends and patterns can we find?  What associations to other aspects of the patient’s medical care or personal life can we identify?  And more importantly, how can we duplicate these trends and patterns in other patients?  Trends and patterns are what guide our diagnostic testing and our therapeutic modalities.  In this latest pandemic, it is very interesting in diversity of providers that are involved in patient care.  COVID-19 is obviously a respiratory virus (1), but we’ve seen numerous COVID-19 patients who have had associated issues related to heart disease (2), acute kidney disease (AKD), renal failure (3) and skin rashes. (4)  One of the more common skin issues seen in COVID-19 patients is a rash referred to as Covid toe.  This means lower extremity health professionals are a significant part of the team diagnosing and treating COVID-19 and its multi-system manifestations.</p> <h3>Cutaneus manifestations of COVID-19</h3> <p>A study published on April 4, 2020 in the British Journal of dermatology describes the five most common skin manifestations found in COVID-19 patients. (5)  In this article, Casas and colleagues describe the findings of 375 COVID-19 patients treated in Spain as follows;</p> <p>“<em>Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo</em><em>‐</em><em>chilblain pattern frequently appears late in the evolution of the COVID</em><em>‐</em><em>19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID</em><em>‐</em><em>19. Severity of COVID</em><em>‐</em><em>19 shows a gradient from less severe disease in acral lesions to most severe in the latter groups. Results are similar for confirmed and suspected cases, both in terms of clinical and epidemiological findings</em>.”</p> <ul> <li>         Lesions may be classified as acral areas of erythema with vesicles or pustules (Pseudo‐chilblain) (19%)</li> <li>         Other vesicular eruptions (9%)</li> <li>         Urticarial lesions (19%)</li> <li>         Maculopapular eruptions (47%)</li> <li>         Livedo or necrosis (6%).</li> </ul> <p>Cases and colleagues describe prodromal symptoms found acral (extremities, toes and fingers) to include small blisters (vesicles) and erythema (redness).  While vesicular eruptions are found prior to pulmonary symptoms, mottled discoloration of the foot and toes, which resembles Chilblains, occurs in a later stage of the disease often following the onset of pulmonary symptoms.</p> <p>The French National Union of Dermatologists and Venereologists released a publication where they classify the dermatological <a href="/frostbite" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/Raynauds_disease_mod2.jpg" alt="Raynaud's disease" width="175" /></a>manifestations of COVID-19 as acrosyndromes. (5)  The terms acrosyndromes is used to describe the symptoms seen in arterial occlusive disease that limit circulation to acral areas (toes, fingers).  Acrosyndromes also describe the findings seen in <a href="/frostbite">frostbite</a> or <a href="/raynauds-disease">Raynaud’s Disease</a>.  These localized lesions as described by Casas show erythema (redness) and vesicles (small fluid filled bumps). (6)</p> <h3>What causes Covid toe?</h3> <p>There is no consensus in the literature that describes the etiology of the characteristic rashes found in early, mid-stage and late stage COVID-19 infections.  Varga et al, describe a mechanism of injury to the peripheral vascular system that involves angiotensin converting enzyme 2 (ACE2) receptors. (6)  ACE2 receptors are found in the lung, heart, kidney and intimal lining of peripheral arteries.  COVID-19 virus appears to attach to ACE2 receptors, causing acute inflammatory change and blockage of the artery.  This acute inflammatory reaction results in pulmonary, cardiac, renal and <a href="https://www.myfootshop.com/peripheral-arterial-disease">peripheral vascular disease</a> and even death.</p> <p>In addition to the theory of COVID-19 virus attacking the intimal lining of the peripheral artery, another theory describes damage caused by the virus to the heme molecules in red blood cells (RBC).  In an article by Wenzhong, he and his colleagues describe evidence of a coordinated attack by the COVID-19 virus on the hemoglobin molecule resulting in an oxidized hemoglobin molecule.  Oxidized hemoglobin is far less capable of carrying oxygenated RBC’s to peripheral cells, including the toes. (7)</p> <p>Where are the patterns and trends that might help clinicians and researchers better understand COVID-19 diagnosis and treatment?  The consensus notes that the acrosyndromes of COVID-19 all relate to a hypercoaguable state in which localized arterial supply is disrupted.  It appears that COVID-19 is not due to a single event but rather due to a number of related vascular factors.  To use a plumbing analogy, both the pipe that carries the fluid (artery) and the fluid in the pipe (plasma portion of the blood) are doing a poor job of delivering the end product.  The result can be minor localized problems, serious isolated system disease (pulmonary, renal or cardiac disease) or death. </p> <p>Join the discussion on <a href="https://www.myfootshop.com/boards/topic/786/covid-toe">Covid toe</a>.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p> <ol> <li>Xu Z, Shi L, Wang Y, Zhang J et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome.  Lancet.  Feb 18, 2020</li> <li>Mehra M, Desai S, Kuy S, Henry T, Patel A.  <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2007621">Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19</a> , New England Journal of Medicine.  May 1, 2020</li> <li>Durvasula R, Wellington T, McNamara E, Watnick S. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141473/">COVID-19 and Kidney Failure in the Acute Care Setting: Our Experience From Seattle</a>.  American Journal of Kidney diseases.  April 8, 2020.</li> <li>Darlenski R, Tsankov N.  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102542/">Covid pandemic and the skin – what should dermatologists know</a>. Clinics in dermatology.  March 28, 2020.</li> <li> <div class="loa-wrapper loa-authors hidden-xs"> <div id="sb-1" class="accordion"> <div class="accordion-tabbed"> <div class="accordion-tabbed__tab-mobile accordion__closed">Casas G, Catala A, Hernandez C, et al. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.19163">Classification of the cutaneous manifestations of COVID-19; a rapid prospective nationwide consensus study in Spain with 375 case</a>.  British Journal of Dermatology.  April 2020. </div> </div> </div> </div> </li> <li>Mazzotta F, Troccoli T. <a href="https://www.fip-ifp.org/wp-content/uploads/2020/04/acroischemia-ENG.pdf.">Acute acro-ischemia in the child at the time of COVID-19. International Federation of Podiatrists</a>. March 2020.</li> <li>La Revue du Praticien. <a href="https://www.larevuedupraticien.fr/article/covid-acrosyndromes-revelateurs">Covid revealing acrosyndromes</a>.  April 2020.</li> <li>Liu W, Hualan L. <a href="https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173">COVID-19 Attacks the 1-Beta Chain of Hemaglobin and Captures the Porphyrin to Inhibit Human HEME metabloism</a>.  ChemRxiv April 24, 2020</li> </ol>urn:store:1:blog:post:334https://www.myfootshop.com/weight-bearing-post-lapidus-bunionectomyLapidus Bunionectomy – tips to return to early weight bearing<h2>Foot and ankle surgeons – sleep better at night.  Complete <a href="/spring-plate-carbongraphite-fiber-insert" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon fiber Spring Plate" width="150" /></a> your Lapidus construct with a Carbon Fiber Spring Plate to insure rigid support with early ambulation</h2> <p>Lapidus bunionectomy (also called Lapiplasty) has become very popular over the past two to three years.  The Lapidus procedure has a number of advantages when compared to other bunionectomies.  The most significant advantage of the Lapidus procedure is decreased recurrence rate of a bunion over the course of the patient’s life.  The recurrence of a bunion post bunionectomy has never been statistically defined in the literature. </p> <h3>What causes a bunion to come back following surgery?</h3> <p>The single biggest factor that contributes to recurrence of a bunion following surgery is age.  Although the literature won’t back me up on the following formula, I think we can assume the following;</p> <table style="height: 20px;" width="653"> <tbody> <tr> <td width="319"> <p>% chance of recurrence of a bunion post bunionectomy</p> </td> <td width="319"> <p>= 70 – the patient’s current age</p> </td> </tr> </tbody> </table> <p>For example, if you are currently 50 years of age, according to the formula above, your percentage of chance of recurrence of a bunion post bunionectomy would be 20%.  This simple formula does not account for surgical factors and co-morbidities such as the patient’s health history, success of correction at time of surgery and a number of other factors that can influence the outcome of the surgery.  But as a general rule, this is an easy formula to discuss how age will affect the recurrence of a bunion post bunionectomy.</p> <h3>What is a Lapidus bunionectomy and how does it compare to other bunionectomy procedures?</h3> <p>The Lapidus procedure originally described by Paul Lapidus, MD in 1960 (1), has been a part of every foot surgeons tool set for<a href="/images/uploaded/Blog images/bunion surgery location.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/bunion surgery location.jpg" alt="bunion surgery comparison" width="100" /></a> years.  Until recently, many foot surgeons have used the Lapidus technique sparingly due to post op disability associated with the procedure.  The Lapidus procedure is a fusion of the base of the first metatarsal, correcting the alignment of the first metatarsal and great toe.  Many of the more commonly used bunionectomies focus on correction of the deformity by a distal first metatarsal osteotomy.  The distal metatarsal bunionectomy procedures such as the Austin, McBride, Mitchell and Chevron, realign the bunion with a technique that allows the patient to bear weight, often immediately following surgery.  The Lapidus, on the other hand, requires non-weight bearing until the fusion site has healed.  The return to weight bearing following Lapidus has been significantly improved fixation with newer, more contemporary fixations techniques. </p> <h4>When can a patient who has had a Lapidus bunionectomy return to weight bearing? </h4> <p>The topic of return to weight bearing following Lapidus bunionectomy varies from surgeon to surgeon.  In my practice, I follow this schedule to return patients to weight bearing post Lapidus bunionectomy.</p> <table> <tbody> <tr> <td width="319"> <p>3 weeks post op</p> </td> <td width="319"> <p>50% weight bearing in a cam walker with crutches</p> </td> </tr> <tr> <td width="319"> <p>4 weeks post op</p> </td> <td width="319"> <p>75% weight bearing in a cam walker with crutches</p> </td> </tr> <tr> <td width="319"> <p>6 weeks post op</p> </td> <td width="319"> <p>Laced shoe with Carbon Fiber Spring Plate and 90% weight bearing and continued use of crutches</p> </td> </tr> <tr> <td width="319"> <p>8 weeks post op</p> </td> <td width="319"> <p>Laced shoe with Carbon Fiber Spring Plate, no crutches with full weight bearing</p> </td> </tr> </tbody> </table> <p> </p> <p>Return to weight bearing following a Lapidus bunionectomy is to a great degree based on the individual patient’s response to weight bearing.  Return to weight bearing needs to be incremental, judging the response each day and with each new weight bearing activity.  Each increase in activity is monitored for any indication of problems at the Lapidus fusion site.  Signs of increased pain, clicking/popping and localized swelling are signs that the fusion site is just not quite ready for weight bearing.  In these cases, weight bearing is delayed.</p> <h4>Challenges to early return to weight bearing post Lapidus bunionectomy – what your surgeon is thinking</h4> <p><a href="/images/uploaded/Blog images/Lapidus bunionectomy left rotation.jpg" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Blog images/Lapidus bunionectomy left rotation.jpg" alt="Lapidus bunionectomy" width="250" /></a>As we discussed earlier, the Lapidus bunionectomy is a fusion of the base of the 1<sup>st</sup> metatarsal and the medial cuneiform bone.  The success of the fusion is to a great degree dependent upon the proximity of the bones at time of fixation, preparation of the fusion site during surgery and long term stability provided by the fixation used during surgery.  Most Lapidus procedures a performed from the top (dorsal) aspect of the foot.  The dorsal approach provides good visualization of the fusion site and adequate room for fixation.  Dorsal fixation is only reliable until the patient begins weight bearing.  In this image, you can see how load bearing of the fusion site that is fixated with dorsal fixation leads to gapping of the bottom or plantar aspect of the fusion.  Common sense would say; why don’t you use fixation on the bottom of the fusion site to support the site in weight bearing.  Unfortunately, the bottom of the arch is filled with vital structures (tendon, nerves and arteries) that cannot be disrupted during surgery to place plantar fixation.    </p> <h2>Lapidus bunionectomy – what keeps your surgeon awake at night</h2> <p>Herein lies the surgeon’s quandary with the Lapidus bunionectomy and early return to weight bearing;</p> <ul> <li>I know my fixation technique is adequate but not great</li> <li>I know my fixation and construct is stable in non-weight bearing but weak in weight bearing</li> <li>I know my patient would like to ambulate as soon as possible</li> <li>I know if I get a non-union at this surgery site, I’ll have a long healing period with an upset patient</li> </ul> <p>The solution to each of these post-op challenges specific to the Lapidus bunionectomy procedure, lie in the use of a simple shoe<a href="/spring-plate-carbongraphite-fiber-insert" target="_blank"><img style="float: right;" src="/images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert_ALT4.jpg" alt="Carbon fiber Spring Plate" width="150" /></a> insole called a <a href="/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a>.  Carbon Fiber Spring Plates are extremely thin and rigid.  Carbon Fiber Spring Plates are thin enough to fit into all shoes with the exception of sandals or flip-flops.  In addition to their rigidity, Carbon fiber Spring Plates have toe spring, also referred to as a forefoot rocker.  Let’s take a little closer look at how the rigidity and toe spring work to enable earlier return to weight bearing post Lapidus bunionectomy.</p> <h4>Carbon Fiber Spring Plates – rigidity and toe spring enable early post op ambulation</h4> <p>Are you familiar with the term ‘shank’ of the shoe?  The shank on a boot or laced shoe extends from the heel to the ball of the foot.  The shank of the shoe acts as a brace on the bottom of the foot.  During walking, the shank is used to carry the mechanical force generated by the calf and carry that force to the ball of the foot where the mechanical action of walking takes place.  When combined with a laced shoe (very important), the shank and laced shoe work in conjunction to brace the midfoot.  A Carbon Fiber Spring Plate, when used in conjunction with a laced shoe, acts as a brace for patients who have undergone Lapidus bunionectomy.</p> <ul> <li><strong><span style="color: #ff6600;">The Carbon Fiber Spring Plate is a rigid brace following Lapidus bunionectomy</span></strong></li> </ul> <p>The second attribute of the Carbon Fiber Spring Plate is the curvature of the plate at the ball of the foot.  This curvature is called a forefoot rocker or a toe spring.  Toe spring is used to decrease the amount of load applied to the forefoot and arch during gait.  Think of a pair of rigid clogs – stiff but with that rocker sole.  A clog is simply an example of a forefoot rocker.  The Carbon Fiber Spring Plate capitalizes on the use of toe spring (forefoot rocker) to decrease load to the ball of the foot and arch with weight bearing.</p> <ul> <li><span style="color: #ff6600;"><strong>The Carbon Fiber Spring Plate decreases load to the fusion site following Lapidus bunionectomy</strong></span></li> </ul> <p><span style="color: #ff6600;"><strong><a href="/images/uploaded/Blog images/line_break_shoe_5.jpg" target="_blank"><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line_break_shoe_5.jpg" alt="" width="400" /></a></strong></span></p> <h3>Carbon Fiber Spring Plate – how your surgeon gets a better night’s sleep</h3> <p> Early return to weight bearing following a Lapidus bunionectomy  isn’t a perfect science.  Walking casts (also called cam walkers) are notoriously flat on the inside and provide no support to the arch.  In the first several weeks following a Lapidus bunionectomy, I think there is a place for a walking cast, particularly during the early, limited weight bearing stage.  Although an oxymoron, the walking cast is a reminder to the Lapidus patient not to bear weight.  But from a functional standpoint, the walking cast provider little support and can actually contribute to stress and distraction (separation) on the bottom (plantar) aspect of the fusion site.</p> <h4>What kind of laced shoe works best with a Carbon Fiber Spring Plate?</h4> <p>In contrast to the walking cast, use of a Carbon Fiber Spring Plate with a laced shoe (very important) provides rigid support to the fusion site while toe spring off-loads the fusion.  What kind of laced shoe is best to be used with the Spring Plate?  A good quality name brand tennis shoe or casual walking shoe will do.  I can’t stress the importance enough that the efficacy of the Carbon Fiber Spring Plate in conjunction with the use of a laced shoe is really what creates the brace needed to support the Lapidus bunion fusion site.  To stress this point, I tell my patients that the use of a laced shoe and Carbon Fiber Spring Plate create a Spring Plate Brace.</p> <p>As a surgeon who performs the Lapidus bunionectomy, I love to sleep well at night.  The concept of the Spring Plate Brace is what motivated me to do more Lapidus bunionectomies.  Now that I know that I can ambulate my patients earlier, the use of the Lapidus procedure makes even more sense than in years gone by.  Early ambulation with confidence post Lapidus bunionectomy – now I can sleep like a baby.</p> <p>Join me for more discussion regarding <a href="https://www.myfootshop.com/boards/topic/789/lapidus-bunionectomy-pros-cons-and-return-to-weight-bearing">Lapidus bunionectomy</a>.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p> <ol> <li>   <a href="https://journals.lww.com/clinorthop/Citation/1960/00160/The_Author_s_Bunion_Operation_From_1931_to_1959.12.aspx">Citation: The Author's Bunion Operation From 1931 to 1959</a></li> </ol>urn:store:1:blog:post:333https://www.myfootshop.com/foot-care-at-homeFoot Care At Home<h2>Nails, corns and calluses?  Instructions to take care of them at home.</h2> <p><span style="color: #99cc00;"><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/line_art/hand_and_foot.jpg" alt="" width="400" /></span></p> <p>Professional foot care was a common healthcare service provided by nurses and podiatrists until the onset of COVID-19 and stay-at-home provisions.  Routine foot care is the term used to describe care of toe nails or calluses on a regularly scheduled basis.  Medicare approves routine foot care services every 60 days or more based on need.  Need is often defined as the degree of risk that a patient has related to foot care services.  <a href="https://www.myfootshop.com/peripheral-arterial-disease">Poor circulation</a> is carefully defined in the <a href="https://www.medicare.gov/coverage/foot-care">Medicare Guidelines</a> as a defining risk factor that qualifies a patient for routine foot care.  <a href="https://www.myfootshop.com/diabetic-foot-care">Diabetes</a> and <a href="https://www.myfootshop.com/peripheral-neuropathy">peripheral neuropathy</a> are also qualifying conditions that ensure Medicare coverage for routine foot care.</p> <p>With the onset of COVID-19 based stay-at-home orders, we have to ask whether routine foot care can be safely provided at home.  The answer to that question is yes, in most cases, routine foot care can be provided safely by friends or family members.  In my clinical practice, I do on occasion see a patient that I simply won’t touch until I’ve established a quantitative measure of their arterial status.  That test can be either an ABI (ankle brachial index) or a CTA (computerized tomography, arterial).  The ABI, although an older test still provides helpful quantitative data regarding arterial flow of the lower extremity.  CTA is popular, particularly for assessment of the level of occlusion of an artery.  When ordering CTA, I stress with the techs that I want an inflow image to the toes.</p> <p>For those who are unfamiliar with trimming a thick fungal nail or trimming a thick callus, experience does really count.  With a few tries, I think family members can learn some of the subtleties of performing foot care services.  Healthcare tip* - I always have a little piece of gauze and some antiseptic handy just in case the skin is broken while trimming a nail or callus.</p> <h2>How to perform periodic nail care at home</h2> <p>With age, nails tend to change in a number of ways including thickening, becoming discolored or by separating from the underlying nail bed.  The damp environment in the shoe contributes to fungal infections which cause thick, discolored nails.  Nails may also become pinched (pincer nails) or spoon shaped (koilonychias).  Follow these simple steps to insure safe debridement (trimming of toe nails).</p> <ol> <li>Start by trimming the length - Using a curved nail cutter, start at the tip of the toe (hyponychium) trimming the free portion of the tip of the nail. </li> <li>Move on to thickness – Trimming the length of the nail first helps to determine the thickness of the nail.  Use the curved nail cutters to thin the nail.  Remember that the natural curvature of the nail will make it thicker along the sides and relatively thinner in the center.</li> <li>Finish with the corners – Once the nail has been shortened and thinned, it is now easier to trim the corners of the nail.  This is the ‘ouchy’ stage where some patient will be concerned about breaking the skin.  With experience, you’ll get better at knowing how much nail to trim in the corners of the nail.  Be sure that trimming is complete and that no spurs are left at the corners of the nail that might result in an ingrown nail.</li> </ol> <h2>How to perform periodic callus care at home</h2> <p>Calluses most commonly overlie a prominent area of bone.  Just like the spots in your hand that callus when you do heavy labor, calluses on the feet are going to thicken with increased activity.  The types of calluses that we see in foot care are remarkably diverse.  Some calluses have a small, hard core while other calluses are broad and flat.  Podiatrists who are trained in trimming calluses will use a surgical blade to quickly cut away significant layers of hard callus.  Using a surgical blade is probably not the best starting point for most family members attempting to learn how to perform routine foot care.  A <a href="https://www.myfootshop.com/callus-file">callus file</a> or abrasive, like a <a href="https://www.myfootshop.com/pumice-stone">pumice stone</a>, would be a better starting point for those just learning.</p> <ol> <li>Preliminary steps - Clean the skin with soap and water.  Some foot care providers prefer to soak the feet prior to care to soften the skin. </li> <li>Removal of callus – take your time and remove small portions of skin.  Some foot care providers find it easiest to remove a portion of the callus every week rather than the entire callus every few months. </li> <li>If the skin is broken in the act of trimming the callus, apply some topical antiseptic or triple antibiotic.</li> </ol> <p>Routine foot care can be performed safely at home.  There is a bit of art that goes into routine foot care – how deep to trim, how much to trim, etc.  With experience, you’ll find routine foot care can be fun and saves a trip to the doctor for a non-essential service.  If you do have questions regarding routine foot care, please join me in the Myfootshop.com foot care forum for further discussion and guidance.</p> <p>Questions about nail care at home?  <strong><a href="https://www.myfootshop.com/boards/topic/275/toe-nail-trimming#712">Join the conversation at this link</a></strong>.</p> <p>Jeff</p> <p><img src="https://www.myfootshop.com/images/uploaded/Blog%20images/Jeffrey%20A.%20Oster,%20DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:331https://www.myfootshop.com/metatarsal-pads-to-skive-or-not-to-skiveMetatarsal pads – to skive or not to skive<h2>Skiving provides a finished edge to the metatarsal pad – but does that matter?<img style="float: right;" src="/images/uploaded/Products/729_Metatarsal_Pads_Felt.jpg" alt="Felt metatarsal pad" width="200" /></h2> <h3>What is skiving?</h3> <p>Metatarsal pads come in different shapes, sizes and densities.  One question often asked by customers is in regards to the beveled edge of the metatarsal pad.  The beveled or skived edge is a finishing technique that is used on felt, foam and gel metatarsal pads.  Skiving is performed at different stages of the production of the metatarsal pad.  For instance, <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">felt metatarsal pads</a> are mechanically skived after being cut from a solid roll of felt.  <a href="https://www.myfootshop.com/metatarsal-pad-foam">Foam met pads</a> are skived in the mold where the foam pad is formed.</p> <h3>Is a skived metatarsal pad better?</h3> <p>The indications for use of a metatarsal pad will vary as will the type of metatarsal pad used; soft, firm, large small, etc.  In clinical practice, my go-to is typically a <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">skived felt metatarsal pad</a>.  I would use this pad to treat <a href="https://www.myfootshop.com/forefoot-pain">forefoot pain</a>, <a href="https://www.myfootshop.com/mortons-neuroma">Morton’s neuroma</a> and <a href="https://www.myfootshop.com/capsulitis">forefoot capsulitis</a>.  But if I was going to fashion a <a href="https://www.myfootshop.com/dancers-pads">dancer’s pad</a> out of a felt met pad, I’d prefer to use a non-skived pad.  The non-skived dancer’s pad would be used to treat a <a href="https://www.myfootshop.com/capsulitis">sesamoid fracture</a>, <a href="https://www.myfootshop.com/sesamoiditis">sesamoiditis or avascular necrosis of the sesamoid</a>. </p> <h4>How to skive your own metatarsal pads.</h4> <p>The following steps show how easy it is to skive your own metatarsal pads.  Using a sharp pair os scissors, simply round out the edges of the felt or foam.  Metatarsal pads can also me modified in shape and size – all it takes is a little imagination and a good pair of scissors.</p> <p><img src="/images/uploaded/Blog images/skiving a metatarsal pad(1).jpg" alt="skiving a metatarsal pad" width="200" />  <img src="/images/uploaded/Blog images/skiving a metatarsal pad (2).jpg" alt="skiving a metatarsal pad" width="200" />  <img src="/images/uploaded/Blog images/skiving a metatarsal pad (3).jpg" alt="skiving a metatarsal pad" width="200" />  <img src="/images/uploaded/Blog images/skived and non-skived metatarsal pads.jpg" alt="skived and non-skived metatarsal pads" width="200" /></p> <p>Join me in the discussion <strong><a href="https://www.myfootshop.com/boards/topic/791/metatarsal-pads-which-one-is-the-best-for-me">regarding metatarsal pads</a></strong> in our forum on forefoot problems.</p> <p>Jeff</p> <p><img src="/images/uploaded/Blog images/Jeffrey A. Oster, DPM.jpg" alt="Jeffrey Oster, DPM" width="100" /></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm">Jeffrey A. Oster, DPM</a></p> <p>Medical Adviser<br />Myfootshop.com</p>urn:store:1:blog:post:330https://www.myfootshop.com/zion-williamson-out-with-a-right-toe-sprainZion Williamson out with a right toe sprain<p>First round draft choice Zion Williamson, who plays for the New Orleans Pelicans, was recently sidelined with an injury described as<img style="float: right;" src="/images/uploaded/Blog images/basketball.jpg" alt="basketball injuries" width="200" /> a toe sprain.  Although the 19 year old starter described the injury as “no big deal”,  it did side line him with a questionable start against the Chicago Bulls.</p> <h2>What is turf toe?</h2> <p>How would a medical professional describe a toe sprain?  Most podiatrists would describe a toe sprain as a condition called <a href="https://www.myfootshop.com/turf-toe">turf toe</a>.  Turf toe is a hyper-extension injury that results in temporary or permanent damage to the ligaments surrounding the great toe.  The majority of turf toe injuries involve the bottom or plantar surface of the joint.  Forced extension (toe moving towards the shin) results in a partial to complete tear of one or more of the soft tissue structures holding the great toe joint together.  Return to play depends upon the severity of the injury.</p> <h3>How is turf toe treated?</h3> <p><a href="/turf-toe-plates-flat-pair" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="turf toe plate" width="100" /></a>The vast majority of cases of turf toe require rest with no surgery.  Bracing and splinting of the great toe joint with a <a href="https://www.myfootshop.com/turf-toe-plates-flat-pair">Turf Toe Plate</a></p> <p>can act to limit the range of motion of the joint.  Turf Toe Plates are commonly used in both the healing phase of the injury and return to play, allowing earlier return to most activities.</p> <h4> </h4> <h4> </h4> <h4> </h4> <h3>How would a Turf Toe Plate affect my game?</h3> <p>Athletes describe an initial awareness of the Turf Toe Plate but most describe a willingness if not a desire to continue use of the Turf Toe Plate as they assume their full roles on the court.  The Turf Toe Plate will work to prevent re-injury.  The extension under the great toe, called a Morton’s extension, may actually work to improve an athlete’s game by lengthening the lever arm of the foot.  Continued use of the Turf Toe Plate upon resolution of the injury is up to the athlete and his/her trainer.</p> <p>Is there a Turf toe Plate in Zion Williamson’s future?  This promising star has a lot to look forward to, and hopefully a long career free of additional injuries.  <strong><a href="https://www.myfootshop.com/boards/topic/792/turf-toe">Join the discussion</a></strong> regarding turf toe injuries.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:329https://www.myfootshop.com/clinical-tools-for-foot-and-ankle-providers-advanced-practice-providersClinical tools for foot and ankle providers – advanced practice providers<h2>APP patient guidelines, anatomy images x-rays and more<img style="float: right;" src="/images/uploaded/Blog images/nursing-1476762_640.jpg" alt="APP guideliens for lower extremity health" width="300" /></h2> <p>One of my roles as a hospital based podiatrist is mid-level provider oversight.  Our hospital utilizes both PA’s and NP’s to see the majority of patients in our orthopedics and wound care clinics.  Our team based approach has been successful in so many regards.  Even for an older doc like myself, I’ve come to see and value the input we have from our advanced practice providers (APPs). </p> <p>In my work with APP’s, I’ve found the key to success is four part –</p> <ul> <li>Define your roles and set up an ongoing series of clinical meetings</li> <li>Make teaching a core part of your clinical program</li> <li>Be available</li> <li>Know how to access appropriate resources for patient care</li> </ul> <p>In my experience with our APP’s, we work together to find our most productive and effective roles looking for top of scope practice.  For instance, our orthopedic PA’s screen patients for minor fractures and strains but know to refer for lower extremity reconstructive procedures.  We work together to define what procedures are appropriate to our facility.  PA’s are included in post op care so that they understand the indications for surgery.</p> <p>When possible, I like to share my clinical work with Myfootshop.com.  What follows is a list of patient guidelines that our APP’s use in practice at our hospital.  These documents are free for your use with your patients.  Also included are links to x-rays and anatomy of the lower extremity that we use in patient education for lower extremity health.</p> <h2>Patient guidelines for lower extremity health</h2> <p><a href="https://www.myfootshop.com/treatment-guide-patient-guidelines-for-treatment-of-fungal-infections-of-the-foot">Treatment Guide – patient guidelines for treatment of fungal infections of the foot</a></p> <p><a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">Treatment Guide – patient guidelines for managing diabetic peripheral neuropathy</a></p> <p><a href="https://www.myfootshop.com/treatment-guide-post-op-instructions-following-nail-surgery">Treatment Guide – Post-op instructions for patients following nail surgery</a></p> <p><a href="https://www.myfootshop.com/treatment-guide-calf-stretches-for-achilles-tendinitis">Treatment Guide – calf stretches for Achilles tendinitis</a></p> <p><a href="https://www.myfootshop.com/treatment-guide-calf-stretches-for-plantar-fasciitis">Treatment Guide – Calf stretches for plantar fasciitis</a></p> <p><a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">Treatment Guide – Patient guidelines for diabetic foot care</a></p> <p><a href="https://www.myfootshop.com/toe-nail-fungus-treatment-recommendations">Treatment Guide – Patient guidelines for toe nail fungus (onychomycosis)</a></p> <p> </p> <h2>Blog posts specific to lower extremity health clinical care for APP's</h2> <p><a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitioners">Diabetic peripheral neuropathy – patient examination guidelines for practitioners (part 1)</a></p> <p><a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners">Diabetic peripheral neuropathy – patient examination guidelines for practitioners (part2)</a></p> <p><a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners-part-3">Diabetic peripheral neuropathy – patient examination guidelines for practitioners (part 3)</a></p> <p> </p> <h2>Foot and ankle knowledge base articles (categories)</h2> <p><a href="https://www.myfootshop.com/articles/List/1">Toes</a></p> <p><a href="https://www.myfootshop.com/articles/List/2">Forefoot</a></p> <p><a href="https://www.myfootshop.com/articles/List/3">Midfoot/arch</a></p> <p><a href="https://www.myfootshop.com/articles/List/4">Rearfoot/heel</a></p> <p><a href="https://www.myfootshop.com/articles/List/5">Ankle</a></p> <p><a href="https://www.myfootshop.com/articles/List/6">Leg</a></p> <p><a href="https://www.myfootshop.com/articles/List/7">Skin and nail</a></p> <p> </p> <h2>Lower extremity anatomy images</h2> <p><a href="https://www.myfootshop.com/articles/List/23">Bones and joints</a></p> <p><a href="https://www.myfootshop.com/articles/List/24">Vascular</a></p> <p><a href="https://www.myfootshop.com/articles/List/25">Neuro</a></p> <p><a href="https://www.myfootshop.com/articles/List/26">Muscles</a></p> <p><a href="https://www.myfootshop.com/articles/List/27">Radiology</a></p> <p>And one final note on APP’s in Colorado – the Colorado State Medical Board developed a set of guidelines for APP’s that includes guidelines for physician oversight.  Although developed primarily for PA oversight, Rule 400 has worked well in our institution to guide APP’s oversight for both PA’s and NP’s.  In Colorado, NP’s are independent clinical providers, but within our hospital setting, we still use Rule 400 as our guide.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:328https://www.myfootshop.com/peroneal-tendon-injuries-diagnosis-and-treatment-in-elite-cross-country-athletesPeroneal tendon injuries – diagnosis and treatment in elite cross country athletes<h2>What a cross country training regimen can tell you about peroneal tendinitis, peroneal tendon tears and peroneal tendon subluxation<img style="float: right;" src="/images/uploaded/Blog images/jogging-2343558_640(2).jpg" alt="Jogging" width="300" /></h2> <p>When you meet with your doctor, there’s an unwritten script that your doc is using to guide his/her decision making.  Past medical history, social history, family history and your medications all make up sections of that script.  The clinical exam and testing such as labs of x-rays are also important.  But sometimes the best answers come from simply talking.  We call it taking a history.  “Tell me about yourself Mr. Smith?  What do you do for a living?  When does your foot hurt?  Where does it hurt” and so on. </p> <p>Athletes, and in particular elite athletes who dedicate their lives to training are often some of the most interesting patients to speak with.  I met today with collegiate cross country runner.  This athlete is ranked within the top three runners in our state.  He described his primary symptom as right lateral ankle pain.  The pain was transient and depended to a great degree on the type of activity he did.  Not the duration or intensity of training but more so specific activities. </p> <p>The athlete’s clinical exam was consistent with <a href="https://www.myfootshop.com/peroneal-tendonitis">peroneal tendinitis</a> or perhaps a <a href="https://www.myfootshop.com/peroneal-tendon-rupture">peroneal tendon tear</a> of the right ankle.  Two particular activities seemed to bother him the most –</p> <ul style="list-style-type: circle;"> <li>Running counter clockwise on a track</li> <li>Running with traffic on the road</li> </ul> <p>When I asked him these questions, he looked at me in dismay stating, “How did you know?  Those are the two activities that bother me most.”  We proceeded to have a long conversation regarding the function of the peroneal tendons.  Ironically, reversing the two activities - running clockwise around the track and running against traffic had no impact on his ankle pain.</p> <p>The peroneal muscles (the <a href="https://www.myfootshop.com/peroneus-brevis">peroneus brevis</a> and <a href="https://www.myfootshop.com/peroneus-longus">peroneus longus</a>) are found in the outer leg and descend to the ankle where they pass behind the outer ankle bone (fibula) to insert on the lateral (outside) foot and bottom (plantar) foot.  Both tendons resist the force of inversion (think ankle sprain).  I think you can see how the history identified two salient activities that seem to confirm the diagnosis of peroneal tendinitis.</p> <h2>Treatment of peroneal tendinitis in runners</h2> <p>Treating tendinitis, whether it be tennis elbow or peroneal tendinitis, depends upon changing the mechanical load applied to the tendon.  In cases of tennis elbow, you need to use a lighter racket or choke up on the handle to have less load applied to the arm. </p> <p><a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><img style="float: left;" src="/images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts.jpg" alt="Lateral Sole Wedge Insert" width="100" /></a>Treatment of peroneal tendinitis is similar in that loads that are generated like to two activities described above (running on the track and road) are mitigated.  I recommended use of a <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">Lateral Sole Wedge Insert</a> in this athlete’s case.  The Lateral Sole Wedge Insert will significantly decrease load applied to the peroneal tendons.  It’s almost as if the use of the Lateral Sole Wedge Insert levels the road berm or straightens the track.  Balancing the foot and decreasing inversion will off-load the peroneal tendons.  Although each case may vary, I recommended that this athlete continue his schedule, focus on trail running and stay off the track and road.</p> <h2> </h2> <h2>Treatment of peroneal tendon tears or peroneal tendon subluxation in runners</h2> <p>With an accurate clinical exam and history, many cases of peroneal tendon pathology can be caught in an early stage (tendinitis) prior to tearing of the tendon.  Acute peroneal tendon injuries, that include lateral ankle sprains that do not respond to conservative care, should be evaluated with an MRI for tendon tear or rupture of the peroneal retinaculum that may contribute to subluxation at the lateral ankle.  In the case of a peroneal tendon tear or subluxation, surgical correction is usually indicated.  I’ve seen success post operatively with the use of a Lateral Sole Wedge Insert to off-load the two peroneal tendons during the healing phase following surgery.</p> <div style="width: 90%; max-width: 90%;"><iframe width="440" height="250" src="https://www.youtube.com/embed/SjMwd6WJv1g" frameborder="0" allowfullscreen="allowfullscreen"></iframe></div> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:327https://www.myfootshop.com/james-harden-out-due-to-toe-sprainHow to Get James Harden Back on the Court?<h2>What is a sprained toe and how is it treated?<img style="float: right;" src="/images/uploaded/Blog images/James Hardin.jpg" alt="James Hardin" width="250" /></h2> <p>Head coach of the Houston Rockets, Mike D’Antoni announced last night that former MVP James Harden, starting guard for the team, would be forced to sit out in today’s game against the New Orleans Pelicans.  D’Antoni cited a sprain to the great toe as the reason for Harden’s absence. (<a href="https://www.chron.com/sports/rockets/article/Rockets-James-Harden-questionable-vs-Pelicans-14937696.php">photo property of Houston Chronical</a>)</p> <p>In Saturday’s win against Brooklyn, Harden had 44 points, 10 rebounds, 6 assists, and four blocked shots in forty minutes of play.</p> <p>A sprained toe, often called <a href="https://www.myfootshop.com/turf-toe#Tab3">turf toe</a>, is an injury to the soft tissue surrounding the great toe joint.  Turf toe is usually a hyperextension injury that results in damage to the ligaments of the bottom or plantar surface of the joint.  Turf toe can result in severe and debilitating injuries based upon the severity of damage to the soft tissues.  In severe cases, dislocation of the great toe or fracture may occur.</p> <p>Diagnosis of turf toe is made by clinical assessment of the joint that includes swelling and limitation of range of motion.  X-ray is used to assess bone injury while MRI is frequently used to assess soft tissue damage. </p> <p>Return to play following a turf toe injury depends upon the severity of soft tissue or bone injury.  Range of motion of the joint can be helpful in healing.  Range of motion can be limited by using a <a href="https://www.myfootshop.com/turf-toe-t-strap">Turf Toe T-Strap</a>.  Long-term management is best accomplished through the use of an in-shoe insert called a <a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber">Turf Toe Plate</a> or <a href="https://www.myfootshop.com/hallux-trainer-insoles">Hallux Trainer Sport Insole</a>.</p> <p><a href="https://www.myfootshop.com/turf-toe-t-strap" target="_blank"><img style="float: left;" src="/images/uploaded/Products/732_turf_toe_t_strap.jpeg" alt="Turf Toe T Strap" width="250" /></a>  <a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber" target="_blank"><img style="float: center,;" src="/images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="Turf toe plate" width="250" /></a>  <a href="https://www.myfootshop.com/hallux-trainer-insoles"><img style="float: right,;" src="/images/uploaded/Products/962_Hallux_Trainer_Working_ALT.jpg" alt="Hallus Trainer Sport Insole" width="250" /></a> </p> <p> </p> <p>Return to play is dependent upon the severity of the injury to the soft tissue surrounding the great toe joint.  Harden joins a group of athletes, including Tom Brady, Deion Sanders and George Best who have had turf toe.  Jack Lambert, the legendary Steelers linebacker ended his NFL career after a 1984 turf toe injury.</p> <p>When will Harden return to the court?  Difficult to say without being a part of Harden’s medical team.  I have to reckon D’Antoni has his fingers crossed.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:326https://www.myfootshop.com/sesamoid-fractures-symptoms-and-treatment-optionsSesamoid fractures – symptoms and treatment options<h2>What is a sesamoid fracture and how is it treated?</h2> <p>A <a href="https://www.myfootshop.com/x-ray-of-the-foot-anterior-posterior-view">sesamoid bone</a> is a small bone found on the bottom (plantar surface) of the great toe joint.  Each sesamoid bone is about the <a href="/images/uploaded/Medical/X-ray/xray_foot_Sesamoid_bones.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Medical/X-ray/xray_foot_Sesamoid_bones.jpg" alt="X-ray foot sesamoid bones" width="100" /></a> size of a pinto bean.  The sesamoid bones derive their funny name from the Arabic word semsem, meaning sesame seed. (1)  Sesamoid bones work in a pair and are named after the bones of the lower leg.  The tibial sesamoid is named after <a href="https://www.myfootshop.com/bone-ap-ankle-mod-labeled">the tibia</a>, the large bone of the medial (inside) ankle and the fibular sesamoid is named after <a href="https://www.myfootshop.com/bone-ap-ankle-mod-labeled">the fibula</a>, the lateral (outside) bone of the ankle.</p> <p>Sesamoid bones function to transfer mechanical load around the great toe joint as the joint moves.  As an example, we can compare the sesamoids to the knee cap (patella).  The patella transfers the mechanical force of the quadriceps (thigh) muscles around the knee as the knee moves.  The sesamoid bones function in a similar manner, transferring the mechanical force of the extensor hallucis brevis tendon around the plantar surface of the great toe joint.</p> <p>The sesamoid bones are susceptible to injuries that include:</p> <ul> <li><a href="https://www.myfootshop.com/sesamoiditis">Sesamoiditis</a></li> <li><a href="https://www.myfootshop.com/sesamoiditis">Avascular necrosis of the sesamoid</a></li> <li><a href="https://www.myfootshop.com/sesamoid-fracture">Sesamoid fractures</a></li> </ul> <h3>Contributing factors to sesamoid fractures</h3> <p>Sesamoid fractures are found in younger, more active patients who are involved in bi-directional sports such as soccer or basketball. (2,3,4)  Fractures of the often larger, tibial sesamoid are more common.  Fractures of the fibular sesamoid are considered somewhat rare. </p> <h3>Symptoms of sesamoid fractures</h3> <p>The onset of a sesamoid fracture can be abrupt or insidious.  Symptoms of a sesamoid fracture include pain on the plantar aspect of the great toe joint that is directly proportional to activities.  For additional information regarding diagnostic modalities for sesamoid fractures, please refer to our knowledge base article on <a href="https://www.myfootshop.com/sesamoid-fracture">sesamoid fractures</a>.</p> <p><a href="/images/uploaded/Medical/Surgery/Surgery/fibular sesamoid fracture labeled.jpg" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Medical/Surgery/Surgery/fibular sesamoid fracture labeled.jpg" alt="sesamoid fracture " width="100" /></a>The majority of sesamoid fractures do not entirely heal, but heal instead with a fibrous union that holds the fracture fragments in place.  This fibrous union is often sufficient to enable pain-free walking.  In a more active population, the fibrous healing is insufficient and results in chronic pain with activities.  The image at left shows a surgical specimen of a fibular sesamoid fracture and the fibrous union between fracture fragments.</p> <h3> </h3> <h3>Treatment of sesamoid fractures</h3> <p>Treatment of sesamoid fractures includes a period of off-loading of the fracture with pads or inserts.  Pads are used to decrease direct load bearing to the sesamoid.  Inserts are used to decrease the in-direct load bearing (mechanical pull) of the extensor hallucis brevis muscle.</p> <h4>Sesamoid fracture pads</h4> <p><a href="https://www.myfootshop.com/dancers-pads">Dancer’s pads</a> are commonly used in the shoe or directly on the foot to decrease direct loading of the sesamoid.  When possible, <a href="https://www.myfootshop.com/dancers-pads"><img style="float: right;" src="/images/uploaded/Products/810_Dancers_Pad_Premium_Felt.jpg" alt="Dancers pad - felt" width="100" /></a>placing the dancer’s pad on the undersole of an insert is optimal.  By doing so, the pad will stay in place and not need to be applied to the skin each day. </p> <p><a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/680_reusable_dancers_pad.jpg" alt="reusable gel dancers pads" width="100" /></a><a href="https://www.myfootshop.com/reusable-gel-dancers-pads">Reusable gel dancer’s pads</a> are also helpful in that they can be worn both with, or without a shoe.  Self-adherent dancer’s pads are a great way to off-load the sesamoid while walking around the house in just your socks.  The amazing thing about these self-adherent pads is that they are reusable.  When the sticky adhesive on the pad starts to lose its stickiness, simply wash the pad in soap and water and it becomes sticky again.</p> <p>The following video shows how to apply a felt metatatsal pad (similar to a dancer's pad) to the bottom of the insole of your shoe.</p> <p><iframe width="560" height="315" src="https://www.youtube.com/embed/m4f7wT70K_M" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <h4> </h4> <h4>Insoles and arch supports used to treat sesamoid fractures</h4> <p>In addition to off-loading the sesamoid with a pad, limiting the pull of the tendon (extensor hallucis brevis) attached to the<a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber"><img style="float: right;" src="/images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="glass fiber turf toe plate" width="100" /></a> sesamoid is imperative.  A Morton’s extension is a semi-rigid to rigid extension built into the insert that limits the range of motion of the great toe.  Use of a Morton’s extension significantly decreases tension placed on the sesamoid fracture during walking and running.  Examples of inserts with a Morton’s extension include <a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber">The Turf Toe Plate-molded glass fiber</a>, <a href="https://www.myfootshop.com/turf-toe-plates-flat-pair">Turf Toe Plate–flat glass fiber</a>, the <a href="https://www.myfootshop.com/hallux-trainer-insoles">Hallux Trainer Sport Insoles</a> and the <a href="https://www.myfootshop.com/hallux-dress">Hallux Trainer Dress Insole</a>.</p> <p><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon fiber spring plate" width="100" /></a>Carbon fiber inserts are also commonly used in the treatment of sesamoid fractures.  The benefit of the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a> and <a href="https://www.myfootshop.com/carbon-contour-plate">Carbon Fiber Contour Plates</a> is their ease of use in a shoe and the thin design that fits most shoes.  The toe spring found in these inserts helps to eliminate flexion and extension of the great toe, thereby eliminating stress on the sesamoid fracture.</p> <p>Which pad or insert is best for your needs?  Be sure to contact our trained sales staff to understand more about how you can treat your sesamoid fracture with these simple to use and inexpensive in-shoe devices.</p> <p> </p> <p style="text-align: left;"><iframe width="560" height="315" src="https://www.youtube.com/embed/zcLRAJW3gkk?start=1" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>  </p> <ol> <li>van Dam Scott BE, Dye F, Wilbur Westin G. Etymology and the Orthopaedic Surgeon: Onomasticon (Vocabulary) Iowa Orthop J. 1991;11:84–90.</li> <li>Hillier JC, Peace K, Hulme A, Healy JC. Pictorial review: MRI features of foot and ankle injuries in ballet dancers. Br J Radiol. 2004;77:532–537. </li> <li>Karasick D, Schweitzer ME. Disorders of the hallux sesamoid complex: MR features. Skeletal Radiol. 1998;27:411–418. </li> <li>McBryde AM, Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med. 1988;7:51–60.</li> </ol> <p> </p>urn:store:1:blog:post:325https://www.myfootshop.com/illegal-shoes-a-self-limiting-problemIllegal Shoes – A Self-Limiting Problem<p>First, it was the four-minute mile.  Who could possibly run a mile in under four minutes?  That record was broken by Sir Roger Bannister in 1954.  And this month another record was broken – the 2-hour marathon.  In this extraordinary race held this month in Vienna, Austria, both the men’s and women’s 26.2-mile records were broken.  Although this was a non-sanctioned race, the feat by Eliud Kipchoge (1:59:40) and Brigid Kosegei (2:14:04) shattered previous race times.  How did these two athletes achieve these record times?  Some say it’s all in the shoes. In the Vienna race, both Kipchoge and Kosegi wore a new and controversial shoe called the Nike Vaporfly 4%.  The Vaporfly 4% is at the heart of controversy within the International Association of Athletics Federations (IAAF).  Currently, the only regulations regarding shoes as defined by the IAAF is that the shoes may not confer an ‘unfair advantage’ and must be ‘reasonably available’ to all.  Nike Vaporfly 4% shoes are available for $250 on the open retail market.</p> <p>In a recent article in <a href="https://www.nytimes.com/2019/10/18/sports/marathon-running-nike-vaporfly-shoes.html">The New York Times</a>, 1968 Boston Marathon winner Ambry Burfoot describes how the Nike Vaporfly 4% controversy centers on a new arch filler known as Pebax.  The use of Pebax as an arch filler/sole and the thickness of the arch filler in the Vaporfly is more than we see in most running shoes.  The controversy centers on how Pebax will act as a spring, making runners faster. </p> <p>Another controversial aspect of the Vaporfly 4% is the inclusion of a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">carbon fiber spring plate</a> within the shoe.  The Vaporfly 4% is the first running shoe to employ the use of a carbon fiber spring plate.  Spring plates provide shank rigidity.</p> <p>New science and products like Pebax are sexy, but sometimes old science is what really gets the job done.  What I see as the most important attributes of the Vaporfly 4% have nothing to do with making runners faster.  What’s really at the heart of winning a marathon in a pair of Vaporfly 4% is conservation of energy.  It’s simply easier to run distances in a pair of Nike Vaporfly 4%.  Why is it easier to run in these shoes?  Let’s take a closer look at lower extremity muscle function and an old shoe modification called a rocker.</p> <p>Sprinting and long-distance running are biomechanically very different athletic events.  In Roger Bannister’s case, we wanted a short, unsustained burst of energy.  If we think of the leg, ankle, and foot as a lever arm, we want that lever to deliver spring-like forward motion in sprinting.  To do so, we want the heel low to the ground, tightening the leg/ankle/foot lever for fast, but unsustained forward motion.</p> <p>Distance running is biomechanically different in that we want to be able to sustain the run.  Sustained running requires conservation of energy.  To study the biomechanics of long-distance running, you need to understand the biomechanics of walking.  In walking, the muscles of the lower leg act to inhibit forward motion of the tibia over the foot.  As your center of gravity moves forward, the calf and associated lower leg muscles provide what’s called an eccentric or negative muscle contraction, slowing forward motion of the body over the foot.  Once the center of gravity is far enough forward, the heel lifts from the ground, weight rolls to the forefoot and lastly, the toe-off phase of gait occurs as the foot is no longer in contact with the ground.  Surprisingly, in walking, this toe-off phase of gait has no active push-off. </p> <p>Eccentric muscle contraction describes the lengthening of a muscle as it provides force.  This is very different from a concentric muscle contraction where force is derived from a muscle while it shortens.  The primary distinction between these two types of muscle contraction is energy conservation.  In the sprinter, concentric muscle contraction (as the muscle shortens) uses significant energy for short distances.  Eccentric contraction of the muscle (force while lengthening), the predominant muscle function used in long-distance running, uses far less energy and subsequently conserves energy. </p> <p><img style="float: left;" src="/images/uploaded/Blog images/Rocker arm-Copy-1.jpg" alt="Rocker arm" width="150" />Shoe modification can also act to conserve energy in long-distance running.  Shoe rockers are modifications that are made to the sole of the shoe.  Rocker mechanics were first described by Sunderland.  (1)  Sunderland described a series of three rockers that take place during normal walking.  These rockers include the heel, ankle, and forefoot.  Rockers are used to decrease resistance to motion and provide conservation of energy.  Rockers have been used in the shoe industry for years in the treatment of orthopedic deformities and in diabetic foot care. </p> <p>In addition to rocker mechanics, the Vaporfly 4% also uses a carbon fiber spring plate to improve the rigidity of the arch and supplement the rocker mechanics of the shoe.  Rigidity of the arch improves translation (movement in a single body plane) which also contributes to conservation of energy.  I have yet to dissect a pair of Vaporfly shoes, but I’d have to assume that Nike also employs the carbon spring plate to supplement the forefoot rocker mechanics.</p> <p>For a further understanding of the principals of walking vs. running, rocker mechanics and energy conservation while walking be sure to read my 2009 publication entitled, <a href="https://faoj.org/tag/ct-band-dynamics/">The CT Band, CT Band Biomechanics and CT Band Syndrome.</a></p> <p>Compare these two images; on the left is an image of Sir Roger Barrister with the running flats used to break the four-minute mile.  <img style="float: left;" src="/images/uploaded/Blog images/Roger_Barrister.jpg" alt="Roger Barrister" width="200" />These shoes were spiked for grip and had no heel.  A lower heel essentially makes the leg, ankle, and foot into a spring – rigid and built for fast but unsustained periods of running.  On the right is a profile of a Nike Vaporfly 4%.  Notice on the sole how the heel is rounded?  This is a posterior rocker sole.  And on the forefoot, notice again how the sole is rounded?  This is a forefoot rocker sole.  Both rearfoot and forefoot rockers are built into the shoe to conserve energy.  The thicker than normal central arch filler (Pebax) is used to create comfort, and to some degree, spring.</p> <p>What I believe Nike has done with their research is to focus on building a running shoe based on the principals of walking and not the principals of running.  The Nike Vaporfly 4% is<img style="float: right;" src="/images/uploaded/Blog images/Untitled.jpg" alt="Nike Vaporfly" width="200" /> specifically designed to conserve energy through the use of rockers and spring plates.  As a podiatrist and pedorthist who has studied lower extremity biomechanics for 35 years, I think Nike’s strategy is brilliant.  They’ve designed a running shoe for sustained periods of running and not simply for speed.</p> <p>As we head towards the 2020 summer Olympics in Tokyo, I’m sure the conversation about the virtues of the Nike Vaporfly 4% will heat up.  In the New York Times article, Geoffrey Burns, a marathoner and doctoral candidate in biomechanics stated that the midfoot height of the shoe should be limited to a specific height or “we might end up with footwear that we don’t even recognize as shoes.”  My opinion is that the problem will become self-limiting.  Adding science to shoes, such as the addition of rockers or spring plates does not add weight or increase the size of the shoe.  The addition of materials like Pebax will be self-limiting in terms of size and weight.  I suggest the IAAF keep the rules as they are making shoes ‘reasonably available’ and without ‘unfair advantage’.</p> <p> </p> <ol> <li>        Sutherland DH, Cooper L, Daniel D. The role of ankle plantar flexors in normal walking. J Bone Joint Surg 1980; 42-A: 354-363</li> </ol> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:324https://www.myfootshop.com/saying-no-to-diabetesSaying NO to Diabetes<h3>Walking, sunshine and diabetic peripheral neuropathy.<img style="float: right;" src="/images/uploaded/Blog images/walking.jpg" alt="walking for diabetes" width="300" /></h3> <p>Walking – how could something so simple be so effective?  Robert Roy Britt in his <a href="https://medium.com/">Medium</a> article entitled <em><a href="https://elemental.medium.com/the-case-for-walking-431b82f1eaa9">The Case for Walking – small steps yield big benefits</a></em>, focuses on studies that prove that point.  Britt describes the work of Brigham and Women’s Hospital epidemiologist I-Min Lee whose <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2734709">research</a> investigates the effects of walking on mortality.  Her data shows that it’s not so much how hard you go at exercise, but more that you just need to be active.  Although more aggressive exercise can be beneficial to cardiovascular and neurological health, the simple act of taking time for yourself to be active and take a walk can have significant health benefits.</p> <p>This article by <a href="https://elemental.medium.com/@robertroybritt">Robert Roy Britt</a> made me think of my patients with diabetes and the conversations we have regarding activity, weight loss and diabetic peripheral neuropathy. Taking time for yourself is one of the greatest lifestyle changes that I work to have my diabetic patients accept.  Diabetic patients are many different people.  Diabetics can be young or old and have responsibilities that limit what they can complete in a day.  When I ask a young mom who is diabetic to take time for herself to take a walk, it’s a tough talk.  And even harder in some instances is the talk with older patients.  It’s hard to change a sedentary life to become even the slightest bit more active and to do so on a regular basis.</p> <p>A big portion of my lower extremity health practice is the treatment and education of patients with <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy">diabetic peripheral neuropathy (DPN)</a>.  DPN begins with distal, symmetrical loss of feeling and progresses to pain.  As DPN progresses, diabetic patients begin to lose the ability to feel light touch and pain.  We call this condition loss of protective sensation (LOPS).  LOPS is the single most significant contributing factor in the onset of <a href="https://www.myfootshop.com/diabetic-wound-care">diabetic foot wounds</a>.  If you can’t feel the nail in the bottom of your shoe, you’ll simply keep walking.  LOPS also contributes to instability of gait and the early onset of falls.</p> <p>How can you treat diabetic peripheral neuropathy?  I created a set of <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">treatment guidelines</a> that are intended for use by diabetic patients and their care providers.  There’s a number of ways to treat the pain associated with diabetic peripheral neuropathy.  With the recent popularity of CBD products I had to ask myself how effective the CBD products really in treating DPN?  In a recent <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners-part-3">blog post</a>, I summarized the physiological contributing factors to DPN and available treatment methods.  Do CBD products work to treat DPN?  From my personal experience, I can say that they do indeed.  But there’s one method of treatment that’s better and less expensive than CBD products – go for a walk in the sunshine.</p> <p>A walk in the sunshine combines two complementary tools; cardiovascular exercise and nitrosative stress reduction.  First, walking improves cardiovascular health by burning calories and reducing weight, thereby enabling your pancrease to more effectively manage your blood sugars.  In addition to weight loss, the lower extremity arterial tree is benefited by creating collateral circulation.  In essence, new arteries can be made to improve circulation simply by walking.</p> <p>Why is a walk outside better than a walk at the gym?  It’s all about nitrosative stress.  Nitric oxide acts to actively control vasodilatation and prevents thrombosis.  Low levels of NO result in vasoconstriction of the blood vessels within the peripheral nerves resulting in altered conductivity of the peripheral nerve.  Exposure to ultraviolet light increases the production of NO that inturn works to decrease the painful symptoms of DPN.</p> <p>The key to successful management of diabetes is blood sugar regulation and management of your hemoglobin A1c numbers.  Management of diabetic peripheral neuropathy is as simple as a walk in the sunshine.  Saying NO to diabetes happens when you elevate nitric oxide (NO) levels with a walk in the sunshine.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p><a href="https://www.linkedin.com/profile/view?id=50869607&amp;trk=nav_responsive_tab_profile">LinkedIn</a>  l  <a href="https://www.facebook.com/myfootshop">Facebook</a></p>urn:store:1:blog:post:282https://www.myfootshop.com/new-product-release-carbon-fiber-contour-foot-plateNew Product Release - Carbon Fiber Contour Foot Plate<h2>New carbon fiber insole from America's leading supplier of carbon fiber foot plates.<img style="float: right;" src="/Content/Images/uploaded/Products/883_Carbon_Contour_Plate.jpg" alt="Carbon Fiber Contour Plate" width="200" /></h2> <p>We’ve been looking for some time for a carbon fiber foot plate that is less expensive yet strong enough to provide support and toe spring.  We’ve finally released the <a href="https://www.myfootshop.com/carbon-contour-plate">Carbon Fiber Contour Foot Plate</a>.  Indications for this carbon fiber shoe insole include;</p> <ul> <li><a href="https://www.myfootshop.com/article/forefoot-pain">Forefoot pain</a></li> <li><a href="https://www.myfootshop.com/article/capsulitis">Forefoot Capsulitis</a></li> <li><a href="https://www.myfootshop.com/article/bursitis-of-the-foot-and-ankle">Forefoot bursitis</a></li> <li><a href="https://www.myfootshop.com/article/metatarsalgia">Metatarsalgia</a></li> <li><a href="https://www.myfootshop.com/article/callus">Forefoot callus</a></li> <li><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux limitus</a></li> <li><a href="https://www.myfootshop.com/article/hallux-rigidus">Hallux rigidus</a></li> <li><a href="https://www.myfootshop.com/article/mortons-neuroma">Morton’s neuroma</a></li> <li><a href="https://www.myfootshop.com/article/freibergs-infraction">Freiberg’s infraction</a></li> <li><a href="https://www.myfootshop.com/article/arch-pain">Arch pain</a></li> <li><a href="https://www.myfootshop.com/article/sesamoiditis">Sesamoiditis</a></li> <li><a href="https://www.myfootshop.com/article/metatarsal-fracture">Metatarsal fractures</a></li> <li><a href="https://www.myfootshop.com/article/cuboid-syndrome">Cuboid syndrome</a></li> <li><a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a></li> <li><a href="https://www.myfootshop.com/article/turf-toe">Turf toe</a></li> <li><a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Arthritis of the forefoot and midfoot</a></li> </ul> <p>What’s the difference between the Carbon Fiber Contour Plate and the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate – Carbon Fiber Insole</a>?  Although both have the same indications (above), there are some subtle differences -</p> <p><strong>The Carbon Fiber Contour Plate</strong></p> <ul> <li>Carbon fiber and acrylic fiber</li> <li>2/16” thick</li> <li>$108.95/pair</li> </ul> <p><strong>Spring Plate – Carbon Fiber Insole</strong></p> <ul> <li>Carbon fiber and graphite</li> <li>1/16” thick</li> <li>$78.95</li> </ul> <p>Which carbon fiber shoe insert is best for your needs?  Be sure to call or chat with us regarding your specific needs.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:322https://www.myfootshop.com/i-had-a-joint-replacement-on-my-big-toe-joint-why-do-i-still-have-goutI had a joint replacement on my big toe joint– why do I still have gout?<h2>Is it possible to have gout following a joint replacement?</h2> <p><a href="https://www.myfootshop.com/gout">Gouty arthritis</a> is a significant contributing factor to degenerative change in joints, leading to joint pain and often the need for joint<a href="https://www.myfootshop.com/gout"><img style="float: right;" src="/images/uploaded/Blog images/gout1_mod.jpg" alt="Gout" width="250" /></a> replacement.  Gout is a common crystal-induced form of arthritis that creates significant degenerative change in the joint.  The frequency and duration of gout attacks is directly proportional to the rate of onset and severity of joint failure. </p> <p>Gout attacks are caused by the accumulation of uric acid in the blood.  Uric acid combines with sodium to form monosodium urate.  Monosodium urate is the end metabolite of purine, a common organic compound found in our diets.  Monsodium urate is soluble in the blood at body temperature (37 degrees Celsius)  but precipitates out of the blood as a crystal at 35 degrees Celsius. (1,2,3)  The great toe joint is the most common site of gout attacks for several reasons, most importantly it’s potential to be affected by external environmental temperatures.  That explains why the classic clinical onset of gout is in the middle of the night.</p> <p>There are a host of local factors that may also contribute to the onset of a gout attack.  Those local factors include pH, mechanical stress, cartilage damage, synovial and serum factors. (4) Studies have also found monosodium urate crystal antibodies that form following the initial attack that may mediate and contribute to the onset of future attacks. (5,6)</p> <p>Knowing that the great toe is the most common site of gout attacks, what kind of effect does surgery have on the great joint?  And more specifically, is a gout attack possible in the great toe joint following joint replacement?  Poorly treated cases of gout often result in great toe joint fusion or joint replacement.  In these patients with gout, is a gout attack possible following surgery?</p> <p>In clinical practice, I’ve seen a number of cases of gout precipitated by injuries to the great toe joint.  The patient describes a benign injury, like stubbing their great toe or injuring it in sports.  Late that day, typically while sleeping on the night of the injury, the patients are awakened by an acute onset of pain far greater than what was found with the initial injury.  I’ve also seen surgical cases that result in an acute onset of a gout attack.  For instance, a simple bunionectomy results in the onset of gout.  In both of these cases, a known contributing local factor to the onset of gout is mechanical stress (injury or surgery) and untreated hyperuricemia.</p> <p>If gout destroys the great toe joint and a fusion is chosen as the treatment of choice, I could understand that the mechanical stress of surgery could initially result in the onset of a gout attack if the patient went into surgery with hyperuricemia (elevated uric acid levels).  A year after the fusion surgery, once the fusion site has healed, the joint will have changed appreciably.  The synovial lining around the joint will atrophy resulting in tissue that no longer resembles a joint.  My assumption would be that the local issues that may contribute to the onset of a gouty attack post-fusion procedure will be, to a great degree, eliminated.</p> <p><img style="float: left; padding-right: 5px;" src="/images/uploaded/Blog images/Great toe implant set.jpg" alt="Great toe implant" width="250" />In the case of a great toe implant, the goal of the surgery is to maintain anatomical length of the great toe and maintain range of motion of the joint.  Although the majority of the articulating bone surfaces are resected in the implant surgery, the majority of the local factors that cause gout would remain (synovial joint lining and synovial fluid production).  That begs the question; after implant arthroplasty for gouty arthritis, could a gout attack occur?</p> <p>A Google search using the terms ‘gout attack after implant surgery’, ‘big toe implant gout’, ‘gout after surgery’ and ‘gout after great toe surgery’ found two articles describing postoperative gout attacks but none specific to the onset of a gout attack following great toe implant arthroplasty. (7,8)</p> <p>I have not seen a case of gout occurring in a patient with chronic hyperuricemia either immediately status post-implant arthroplasy of the great toe joint or weeks to months following great toe joint implant arthroplasy surgery.  I have to believe that a recurrent case of gout, following revision of the great toe joint with an implant would be possible in the patient with chronic hyperuricemia.  Implant arthroplasty does little to mitigate the contribution of local factors and their influence of the onset of gout. </p> <p>Prevention of hyperuricemia with diet or medications is the key to limiting the frequency of acute gouty attacks and preventing the arthritic destruction of the joint due to attacks.  If you do have a history of recurrent gout attacks, be sure to speak with your doctor to learn how to prevent this painful and destructive disease.</p> <p> </p> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/line_art/set1-1.png" alt="" width="500" /></p> <p> </p> <ol> <li>      Allen DJ, Milosovich G, Mattocks AM. Inhibition of monosodium urate needle crystal growth. Arthritis Rheum. 1965;8(6):1123–33. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/5884821">PubMed</a>] ]</li> <li>      Loeb JN. The influence of temperature on the solubility of monosodium urate. Arthritis Rheum. 1972;15(2):189–92. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/5027604">PubMed</a>] </li> <li>      Wilcox WR, et al. Solubility of uric acid and monosodium urate. Med Biol Eng. 1972;10(4):522–31.[<a href="https://www.ncbi.nlm.nih.gov/pubmed/5074854">PubMed</a>]</li> <li>      Martill MA, Nazzal L and Crittenden DB. The Crystallization of monosodium urate. <a href="https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;retmode=ref&amp;cmd=prlinks&amp;id=24357445">Curr Rheumatol Rep. 2014 Feb; 16(2): 400.</a></li> <li>      Kam M, et al. Antibodies against crystals. Faseb J. 1992;6(8):2608–13. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/1592211">PubMed</a>] </li> <li>      43. Kam M, et al. Specificity in the recognition of crystals by antibodies. J Mol Recognit. 1994;7(4):257–64. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/7734151">PubMed</a>]</li> <li>      Napoli, D.  Post surgery gout attack risk factors identified.  <a href="https://www.mdedge.com/rheumatology/article/44630/rheumatoid-arthritis/postsurgery-gout-attack-risk-factors-identified">MD Edge – Rheumatology News</a></li> <li>      Lee EB. Ann. Rheum. Dis. 2007 Nov. 12 [Epub doi:10.1136/ard.2007.078683]</li> </ol> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:321https://www.myfootshop.com/metatarsal-pads-which-one-is-best-for-my-foot-painMetatarsal Pads – which one is best for my foot pain?<h2>Metatarsal pad firmness – do I need soft or firm?</h2> <p><a href="https://www.myfootshop.com/metatarsal-pads">Metatarsal pads</a> come in a variety of shapes, sizes, and colors.  But the characteristic that may be most important for your needs is the relative firmness of the metatarsal pad.  Just like a mattress, metatarsal pads come in soft, medium-firm, and firm.  To a great degree, the relative firmness of the metatarsal pad is a matter of personal preference.  The mattress folks drilled down into this personal preference choice with the Sleep Number System.  Although we don’t have a similar system, I’d like to create a reference guide for metatarsal pad firmness that you’ll find below.</p> <h3>Which metatarsal pad should be my first metatarsal pad?</h3> <p>Which is the best metatarsal pad for you to start with?  Let’s base that choice on our two most popular metatarsal pads.  The two most popular metatarsal pads are going to be the <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">Felt Metatarsal Pad</a> and the <a href="https://www.myfootshop.com/reusable-metatarsal-pad">Reusable Metatarsal Pad</a>.  The Felt Metatarsal Pad is most commonly used in the shoe while the Reusable Metatarsal Pad is applied directly to the foot.</p> <p>Let’s run through all of our metatarsal pads beginning with soft and ending with firm:</p> <p><span style="text-decoration: underline;"><strong>Soft metatarsal pads and cushions</strong></span></p> <p><span style="color: #999999;"><em>Metatarsal cushions – metatarsal cushions are just a wee bit different than metatarsal pads in that metatarsal cushions are applied directly under the ball of the foot.  Metatarsal cushions are a soft pad.  Metatarsal pads, on the other hand, are applied adjacent (proximal to or just behind the ball-of-the-foot.</em></span></p> <p><a href="https://www.myfootshop.com/metatarsal-cushion-gel"><img src="/images/uploaded/Products/852_Metatarsal_Cushion_Gel.jpg" alt="Metatarsal cushion gel" width="75" />  Metatarsal Cushion – Gel</a></p> <p><a href="https://www.myfootshop.com/foam-ball-of-foot-pads"><img src="/images/uploaded/Products/859_Foam_Ball_of_Foot_Pads.jpg" alt="Foam Ball of Foot Pad" width="75" />  Foam Ball of Foot Pads</a></p> <p><a href="https://www.myfootshop.com/ultra-thin-ball-of-foot-slip-on-strap"><img src="/images/uploaded/Products/982_Ball_Of_Foot_Slip_on_ALT2.jpg" alt="Ultra Thin Ball of Foot Slip-On Pad" width="75" />  Ultra Thin Slip On Foot Strap</a></p> <p><a href="https://www.myfootshop.com/metatarsal-pad-foam"><img src="/images/uploaded/Products/815_Metatarsal_Pad_Foam.jpg" alt="Metatarsal pad foam" width="75" />  Metatarsal Pad Foam</a></p> <p> </p> <p><span style="text-decoration: underline;"><strong>Medium firmness metatarsal pads</strong></span></p> <p><a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img src="/images/uploaded/Products/729_Metatarsal_Pads_Felt.jpg" alt="Felt Metatarsal Pad" width="75" />  Metatarsal Pad Felt</a></p> <p><a href="https://www.myfootshop.com/neuroma-pads-mini-felt"><img src="/images/uploaded/Products/977_Neuroma_Pads_Mini_Felt.jpg" alt="Neuroma pad mini-felt" width="75" />  Neuroma Pads – Mini Felt</a></p> <p><a href="https://www.myfootshop.com/metatarsal-pads-ppt"><img src="/images/uploaded/Products/868_Metatarsal_Pads_PPT.jpg" alt="Metatarsal Pad PPT" width="75" />  Metatarsal Pads – PPT</a></p> <p><a href="https://www.myfootshop.com/pedag-comfort-supports-1"><img src="/images/uploaded/Products/797_Pedag_COMFORT_Insoles_ALT.jpg" alt="Pedag Comfort Supports" width="75" />  Pedag Comfort Supports (with metatarsal pad)</a></p> <p><a href="https://www.myfootshop.com/gel-metatarsal-pads"><img src="/images/uploaded/Products/925_Gel_Metatarsal_Pads.jpg" alt="Gel metatarsal pads" width="75" />  Gel Metatarsal Pads</a></p> <p><a href="https://www.myfootshop.com/pedag-t-form-metatarsal-pads"><img src="/images/uploaded/Products/943_Pedag_TForm_Metatarsal_Pads_ALT1.jpg" alt="Pedag T-Form metatarsal pads" width="75" />  Pedag T-Form Metatarsal Pads</a></p> <p><a href="https://www.myfootshop.com/pedag-viva-mini-arch-support"><img src="/images/uploaded/Products/804_Pedag_VIVA_MINI_Holiday_Arch_Supports.jpg" alt="Pedag VIVA Mini Insert" width="75" />  Pedag VIVA MINI Arch Support (with metatarsal pad)</a></p> <p><a href="https://www.myfootshop.com/pedag-drop-metatarsal-pads"><img src="/images/uploaded/Products/943_Pedag_TForm_Metatarsal_Pads_ALT1.jpg" alt="Pedag T-Form Metatarsal Pads" width="75" />  Pedag DROP Metatarsal Pads</a></p> <p><a href="https://www.myfootshop.com/pedag-sport-insert"><img src="/images/uploaded/Products/843_Pedag_Pro-Active_XCO_Insoles_ALT.jpg" alt="Pedag Sport Insole" width="75" />  Pedag SPORT Inserts (with metatarsal pad)</a></p> <p><a href="https://www.myfootshop.com/pedag-viva-summer-insoles"><img src="/images/uploaded/Products/880_Pedag_VIVA_SUMMER_Insoles.jpg" alt="Pedag VIVA SUMMER Insoles" width="75" />  Pedag VIVA SUMMER Insoles (with metatarsal pad)</a></p> <p> </p> <p><span style="text-decoration: underline;"><strong>Firm metatarsal pads</strong></span></p> <p><a href="https://www.myfootshop.com/arch-binder-with-metatarsal-pad"><img src="/images/uploaded/Products/900_Arch_Binder_with_Metatarsal_Pad_ALT.jpg" alt="Arch Binder with metatarsal pad" width="75" />  Arch Binder with Metatarsal Pad</a></p> <p><a href="https://www.myfootshop.com/sole-active-insole-with-metatarsal-pad"><img src="/images/uploaded/Products/904_SOLE_Active_Insoles_with_MetPad_ALT2.jpg" alt="SOLE Active Insole with metatarsal pad" width="75" />  SOLE Active Insole with Metatarsal Pad</a></p> <p><a href="https://www.myfootshop.com/reusable-metatarsal-pad"><img src="/images/uploaded/Products/929_Reusable_Gel_metatarsal_pad.jpg" alt="Reusable metatarsal pad" width="75" />  Reusable Gel Metatarsal Pad</a></p> <p><a href="https://www.myfootshop.com/metatarsal-bars"><img src="/images/uploaded/Products/908_Metatarsal_bar_PPT.jpg" alt="Metatarsal Bar - PPT" width="75" />  Metatarsal Bar PPT Cushions</a></p> <p> </p> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line break bare foot.jpg" alt="line break" width="300" /></p> <p>Which metatarsal pad is best for your needs?  Firmness of the metatarsal pad is just one characteristic that makes these little foot pads so popular.  Fortunately, metatarsal pads are inexpensive and can easily be used to experiment to see which metatarsal pad is best for your needs.  Be sure to watch each of our product videos to guide you in proper placement of the pads.  Our customer service reps are always available to help you make the right choice for your met pads.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:320https://www.myfootshop.com/cartiva-implant-failureCartiva® Implant Failure<h2>What are the criteria for long term success of orthopedic implants and why is the Cartiva® Implant designed for failure?</h2> <p>Compatibility between human tissue (bone, cartilage, ligament, tendon, and fascia) and orthopedic implants requires a number of criteria for success.  Rahyussalim, et al, in their 2016 paper entitled ‘The Needs of Current Technology in Orthopedic Prosthesis Biomaterials Application to Reduce Implant Failure Rate’, describes what they call biomaterials (implants) and the paper focuses on metallic implants. (1)  The paper is a thorough review of implant-host compatibility issues that include (2,3):</p> <ul> <li>Biocompatibility</li> <li>No foreign body reaction</li> <li>Appropriate design and function (biomechanical stability/stress shielding)</li> <li>Reliable resistance to implant wear</li> <li>No aseptic loosening, impaction corrosion or bioactivity</li> <li>Osteoconduction</li> </ul> <h3>Cartiva® Implant background and development</h3> <p><a href="https://www.cartiva.net/">Cartiva, Inc.</a> is a medical device company based in Alpharetta, Ga.  Cartiva, Inc. gained FDA premarket approval for Cartiva SCI (surgical cartilage implant) in 2016 with specific indications for treatment of stage four <a href="https://www.myfootshop.com/hallux-limitus">hallux limitus, also known as hallux rigidus</a>.  Cartiva, Inc. sold their Cartiva SCI to <a href="https://www.wright.com">Wright Medical Inc</a> <a href="https://www.fiercebiotech.com/medtech/wright-to-absorb-cartiva-and-its-cartilage-implant-435m-deal">in a deal valued at $435 million</a> which closed in the final quarter of 2018. </p> <p>Cartiva, Inc. has provided the medical community with volumes of literature regarding Cartiva SCI through <a href="https://www.cartiva.net/Home/Publications">peer-reviewed journal articles</a> and the <a href="https://www.cartiva.net/PressReleases/Details/32">MOTION</a> study, a study of 197 patients at twelve centers.  Take a few minutes to review the literature and I think you'll be impressed.  I was until I started using Cartiva® Implants.</p> <p>I’m a board-certified, hospital-based podiatrist with 33 years of practice experience.  It takes a lot to get an old dog to change but after speaking with peers at seminars, I was convinced to switch from my old reliable <a href="https://www.wright.com/footandankleproducts/swanson-flexible-hinge-toe">Swanson Double Stem Great Toe Implant</a> to the Cartiva implant.  The benefit was that the Cartiva® Implant was quicker to perform, less invasive and left a back door in case of a problem.  For instance, in the case of an infected implant, a revision to fusion post-Cartiva ® Implant would be much easier than if I had used a Swanson implant.  OK, made sense to me.</p> <h3>A surgeon’s history of Cartiva® Implant failure</h3> <p>I don’t have a big case study, but I’ve placed 8-10 Cartiva® Implants and revised 3.  In each revision case, I was successful in replacing the Cartiva® Implant with a <a href="https://www.wright.com/footandankleproducts/swanson-flexible-hinge-toe">Swanson Implant</a>.  The irony of this problem is that Wright Medical recently purchased Cartiva SCI AND makes the Swanson Implants.  The Swanson Implants are what work best in my hands and I’ve seen a long and successful history of use of the Swanson implant.  Other options include fusion or <a href="https://www.arthrosurface.com/products/toe/toe-implants/">Arthrosurface</a> implants.</p> <p>How many of my cases still need revision?  My project for the summer is to do that follow-up.</p> <h3>Case history of Cartiva® Implant failure</h3> <p>Ben is a healthy 63 y/o male who recently retired from his teaching job.  Ben is active but is limited by bilateral hallux rigidus.  In his transition to retirement, his goal was to correct his hallux rigidus and do a lot of hiking and biking.  When he heard about Cartiva® Implants he was eager to proceed with the procedure under the assumption that he would gain an early return to activity.  We scheduled his first Cartiva® surgery in October of 2018.  Within 6 weeks he was fully active and requesting the other foot be treated with a Cartiva® Implant as soon as we could schedule it.  His second foot was completed in December of that same year.</p> <p>Following discharge from my practice, he returned 3 months later complaining of pain just like he had prior to surgery.  X-rays taken the date of surgery were compared to 5-month post-surgery films that showed a stark contrast in the joint space.  It was apparent that the implant had impacted.</p> <p>Last month we did a revision of both great toe joints with a Swanson double stem implant.  It’s early in his course of treatment since his final surgery, but he’s doing well. </p> <p>The x-ray images below show Ben’s progress from before surgery through revision surgery.  Pay careful attention to the difference in joint space in the second and third images.  In the second image, the Cartiva® Implant is well positioned and is functioning well, creating adequate joint space and a pain-free joint.  In the third image, the Cartiva® Implant has impacted and we are back to bone on bone with the painful symptoms of hallux rigidus.  The fourth image shows revision of the procedure with a Swanson Implant.</p> <p><a href="/images/uploaded/medical/x-ray/Cartiva_pre-op_left.jpg" target="_blank"><img style="left; padding-right: 3px;" src="/images/uploaded/medical/x-ray/Cartiva_pre-op_left.jpg" alt="hallux rigidus prior to Cartiva Implant" width="150" /></a> <a href="/images/uploaded/medical/x-ray/Cartiva_left_foot.jpg" target="_blank"><img style="left; padding-right: 3px;" src="/images/uploaded/medical/x-ray/Cartiva_left_foot.jpg" alt="hallux rigidus post Cartiva Implant" width="150" /></a> <a href="/images/uploaded/medical/x-ray/Cartiva_fail_left_foot.jpg" target="_blank"><img style="left; padding-right: 3px;" src="/images/uploaded/medical/x-ray/Cartiva_fail_left_foot.jpg" alt="hallux rigidus post Cartiva Implant impaction and failure" width="150" /></a> <a href="/images/uploaded/Medical/X-ray/Cartiva_Salvage_with_Swanson_Implant.jpg" target="_blank"> <img src="/images/uploaded/Medical/X-ray/Cartiva_Salvage_with_Swanson_Implant.jpg" alt="" width="266" height="199" /></a>  </p> <h3>Why are Cartiva® Implants prone to failure?</h3> <p>The material used to make Cartiva® Implants is a very inert material made of 40% polyvinyl alcohol and 0.9% saline.  The technique is for placement of the implant reliable and easily repeated.  And in each case where I removed a Cartiva® Implant, the implant was intact with no evidence of implant wear.</p> <p>My personal use of Cartiva® Implants leads me to think that there are four fundamental reasons for implant failure.  Is it surgeon error?  No.  Patient selection?  Not in the least.  Each of the reasons for failure stems directly from the design of the implant and how the design leads to impaction of the implant into soft bone.</p> <p>First, let’s take a brief look at the anatomy of the first metatarsal bone.  The image at left shows the basic anatomy of the first <a href="/images/uploaded/Medical/Graphics/1st_metatarsal.jpg" target="_blank"><img style="float: left;" src="/images/uploaded/Medical/Graphics/1st_metatarsal.jpg" alt="" width="123" height="142" /></a><br />metatarsal which consists of a base, body, and head.  Each of these areas of bone varies in density and firmness.  Immediately below the cartilage on both the head and the base is a very hard layer of subchondral bone.  The majority of the head and base are made of softer metaphyseal bone.  The body is made of very hard diaphyseal bone.  Each of these types of bone provides different physiological and mechanical functions for our bodies.  Long bones like the 1<sup>st</sup> metatarsal act as a reservoir for vitamins and minerals and act to produce red blood cells from their marrow.  Additional and more specific functions of the 1<sup>st</sup> metatarsal based on the physiological type of bone include:</p> <ul> <li>Subchondral bone- acts as a stable platform for cartilage, resisting load applied to the joint by motion.</li> <li>Metaphyseal bone – shock absorption and ingress site for primary artery</li> <li>Diaphyseal bone – endoskeleton providing rigid support for the body.</li> </ul> <h3>The four reasons Cartiva® Implants are prone to impaction failure</h3> <ol> <li> <h4>      Smooth implant surface</h4> </li> </ol> <p>The Cartiva® Implant is made of a remarkably inert substance that shows very little reactivity in the body.  But the implant is very smooth on all surfaces creating a functional flaw in the design.  In the paper cited above by Rahyussalim, he discusses the need for irregularity of the implant surface when he says:</p> <p style="padding-left: 30px;"><em>“The greater the surface microtopography, the larger the surface area for fibrinogen adsorption, which will lead to enhanced platelet adhesion and activation. In an in vitro study, it is shown that this could elicit osteogenic reactions. The more complex the implant surface, the more preferable the environment for fibrin attachment, thus establishing a temporary osteoconductive matrix. These associations among the surface texture, osteoconductive matrix formation, and subsequent recruitment of osteogenic cells will influence the process of contact osteogenesis, new bone formation, and implant integration.”</em></p> <p>Can an orthopedic implant be smooth and be successful?  Absolutely.  The Swanson Implant is smooth but relies on the construct of the implant to inhibit migration and impaction.  The shoulders of the Swanson Implant rest against a solid subchondral bone plate.  This to me, seems like an opportunity for redesign, creating a ribbed or irregular surface to resist impaction.</p> <ol start="2"> <li> <h4>      Violation of the subchondral plate</h4> </li> </ol> <p>The subchondral plate refers to the hard bone found underlying the cartilage on both the head and the base of the 1<sup>st</sup> metatarsal.  The subchondral bone is essential in the management of load applied to the first metatarsal head.  Although the 1<sup>st</sup> metatarsal phalangeal joint (big toe joint) has always been referred to as a non-weight bearing joint (as compared to the knee or hip), significant load is applied to the head of the first metatarsal with gait.  Loss of the support of the subchondral plate with no alternative means of support (like the winged structure of the body of the Swanson Implant) places the Cartiva Implant into soft metaphyseal bone and prone to impaction failure.</p> <ol start="3"> <li> <h4>      Lack of osteointegration</h4> </li> </ol> <p>Osteointegration, or ingrowth of bone into the implant is described by Rahyussalim as an essential aspect of implant stability.  Although not essential, all orthopedic implants as we’ve already described with the Swanson Implant and Arthrosurface Implant, osteointegration would seem to be an additional starting point for redesign of the Cartiva® Implant.</p> <ol start="4"> <li> <h4>      Placement in bone too soft for support</h4> </li> </ol> <p>How much load can the Cartiva® Implant carry without mechanical failure?  We’ve cited long term data related to implant viability and integrity, but what’s missing from the data is a simple relationship: over the lifetime of the implant (let’s say 20 years), what is the force applied to the implant and how supportive is the metaphyseal bone?  This to me is the key design failure in that the supporting bone is too weak to provide meaningful, long term support to resist the load applied to the implant.  It’s a bit like pouring the foundation for a house in sand. </p> <p> </p> <h4>Personal comments</h4> <p>I’m a big fan of Wright Medical Inc.  Wright has helped me in many ways over my career. My Wright Medical representative has been present for these Cartiva® Implant cases and has witnessed firsthand the surgical failure of this implant.  I’ve shared these images and blog post with my Wright rep and hope this conversation can be the impetus for change, improvement in patient outcomes and ultimately a better way to perform implant arthroplasty of the 1<sup>st</sup> metatarsal phalangeal joint.</p> <p> </p> <ol> <li>      Journal of Nanomaterials, Volume 2016, Article ID 5386924, 9 pages<br /> <a href="https://dx.doi.org/10.1155/2016/5386924">https://dx.doi.org/10.1155/2016/5386924</a></li> </ol> <p> </p> <ol start="2"> <li>      M. Navarro, A. Michiardi, O. Castaño, and J. A. Planell, “Biomaterials in orthopaedics,” Journal of the Royal Society Interface, vol. 5, no. 27, pp. 1137–1158, 2008. <a href="https://doi.org/10.1098%2frsif.2008.0151">View at Publisher</a> · <a href="https://scholar.google.com/scholar_lookup?title=Biomaterials+in+orthopaedics&amp;author=M.+Navarro&amp;author=A.+Michiardi&amp;author=O.+Casta%c3%b1o&amp;author=J.+A.+Planell&amp;publication_year=2008">View at Google Scholar</a> ·<a href="https://www.scopus.com/scopus/inward/record.url?eid=2-s2.0-49949095955&amp;partnerID=K84CvKBR&amp;rel=3.0.0&amp;md5=19c562a68d372c59e6664323bf821b5d">View at Scopus</a></li> </ol> <p> </p> <ol start="3"> <li>      F. Rodríguez-González, Biomaterials in Orthopaedic Surgery, ASM International, Materials Park, Ohio, USA, 2009.</li> </ol> <p> </p> <h4>Additional sources of information on Cartiva Implant and Cartiva Implant failure</h4> <ol> <li>      Jane Langille, healthcare writer on <a href="https://janelangille.com/cartiva-implants-reduce-toe-joint-pain-improve-motion/">Cartiva Implants</a></li> <li>      BlueCross North Carolina <a href="https://www.bluecrossnc.com/sites/default/files/document/attachment/services/public/pdfs/medicalpolicy/synthetic_cartilage_implants_for_joint_pain_3.pdf">medical policy</a> for synthetic cartilage implants for the treatment of hallux rigidus.</li> <li>      Facebook group <a href="https://www.footankleinstitute.com/blog/when-the-cartiva-big-toe-joint-implant-fails/ https://www.facebook.com/search/top/?q=cartiva%20implant%20failure&amp;ref=eyJzaWQiOiIwLjE3MjM5NzU2MTIwNDEwOTc2IiwicXMiOiJKVFZDSlRJeVkyRnlkR2wyWVNVeU1HbHRjR3hoYm5RbE1qQm1ZV2xzZFhKbEpUSXlKVFZFIiwiZ3YiOiJiZWUwOWY5M2ZhNzMyY2ZhNTlhMWNiNmQ5ZjQ1MGQzODkyNDI0ZTQ5IiwiZW50X2lkcyI6W10sImJzaWQiOiI0MzRkNDA2ZWFlODM5MTk3M2U1MzhlMTM0OGVjZDhmMiIsInByZWxvYWRlZF9lbnRpdHlfaWRzIjpudWxsLCJwcmVsb2FkZWRfZW50aXR5X3R5cGUiOm51bGwsInJlZiI6ImJyX3RmIiwiY3NpZCI6bnVsbCwiaGlnaF9jb25maWRlbmNlX2FyZ3VtZW50IjpudWxsLCJjbGllbnRfdGltZV9tcyI6MTU2MDk2ODQ1Nzc1MH0&amp;epa=SEARCH_BOX">Cartiva Implant Failure</a></li> </ol> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:319https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners-part-3Diabetic Peripheral Neuropathy - patient examination guidelines for practitioners (part 3)<h3>Part 3 - Treatment of diabetic peripheral neuropathy</h3> <p> </p> <h3>Objective -</h3> <p>Diabetic peripheral neuropathy is the most common complication of both type 1 (T2DM) and type 2 (T2DM) diabetes.  Diabetes causes a number of different neuropathic complications to include sympathetic and parasympathetic autonomic dysfunction.  This blog post focuses on the treatment of diabetic peripheral. This post is intended to act as a guideline for lower extremity health practitioners including podiatrists, primary care physicians, NP’s and PA’s.  The objective of this post is to create a framework for a meaningful patient treatment of patients with diabetic peripheral neuropathy.</p> <p>Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">patient guidelines for diabetic foot care</a>.<br />Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">patient guidelines for treatment of diabetic peripheral neuropathy</a>.</p> <p> </p> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line_break_shoe_8.jpg" alt="" width="400" /></p> <p> </p> <p>Treatment of <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy">diabetic peripheral neuropathy</a> requires first and foremost management and control of elevated blood sugars.  But to effectively treat neuropathic pain that is due to diabetes, the lower extremity health practitioner needs to have an understanding of the pathophysiology of diabetic peripheral neuropathy and an ability to blend treatment options for each patient.  Treatment of diabetic peripheral neuropathy can be broken into four categories of care.  Those four categories are -</p> <ul> <li>Education</li> <li>Treatment of underlying pathophysiology</li> <li>Treatment of sleep deprivation</li> <li>Treatment of neuropathic pain</li> </ul> <p> </p> <h3>Education</h3> <p>Each and every patient that you treat for diabetic peripheral neuropathy (DPN) is going to go on their own personal voyage that involves discovery, success, perseverance and in some cases, disappointment.  Your role as a diabetes educator is a very important one in that you not only help each patient understand more about their diabetes and DPN, but you also play a significant role in saving limbs and lives. </p> <p>Loss of protective sensation (LOPS) is the single most important contributing factor to diabetic ulcerations and limb loss in diabetic patients. (1)  Helping your patients understand the significance of LOPS is the key conversation in diabetes peripheral neuropathy education.  As previously discussed in the <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners">physical exam of the diabetic neuropathy patient</a>, use of a <a href="https://www.myfootshop.com/weinstein-monofilament">Weinstein monofilament testing device</a> can help patient actually see the extent of their LOPS.  Take the opportunity during your physical exam to share with the patient their extent of LOPS.</p> <p>Topics to highlight in diabetes peripheral neuropathy education include –</p> <ul> <li>Loss of protective sensation</li> <li>Daily visual foot checks when socks are put on and when socks are taken off</li> <li>Diabetic shoe counseling</li> <li>Building your team of diabetes care providers (primary care, podiatry, etc) and how to access those providers when you have a question or problem</li> <li>Fall prevention</li> <li>Treatment of underlying pathophysiology</li> </ul> <p> </p> <p>In <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitioners">part 1</a> of this three part blog, we briefly discussed the current theories regarding diabetic peripheral neuropathy.  What may be the most important key to understanding these theories is that DPN may not be caused by just one theory, but rather DPN is likely due to a combination of these theories in each patient.  Where one patient may have more micro vessel disease, another patient may have DPN that is due to hyperlipidemia.  Let’s look at each of these theories again and describe some specific treatment plans. </p> <ol> <li><strong>Polyal pathway activity</strong> – the polyal (sorbital) pathway was first described in 1966 as a mechanism of cell injury due to hyperglycemia. (2)  Aldose reductase is the enzyme in this pathway that is responsible for fructose formation from glucose.  In tissues that are not sensitive to insulin (lenses, peripheral nerves and glomerulus), increased levels of aldose reductase results in sorbital levels that cause osmotic cell damage.  Therefore, use of aldose reductase inhibitors may help to decrease peripheral nerve cell damage due to DPN.<br /> <strong>Lab studies</strong> – There are no lab studies that determine levels of sorbital or aldose reductase in tissue.<br /> <strong>Treatment recommendations</strong> - Natural sources of aldose reductase inhibitors include Indian gooseberry, spinach, cumin seed, fennel seed, basil leaves, lemon, black pepper, orange, curry leaves, cannabis and cinnamon. (3,4,5,6)  The source of aldose reductase inhibitor in these foods is luteolin, a flavonoid found within the plants leaves.(7) </li> </ol><ol start="2"> <li><strong>Oxidative and nitrosative stress</strong> –<br />A. Oxidative stress – oxidative stress is described in a complex relationship of chemical pathways as both a contributing factor to each of the pathways described here and as an outcome of each of these pathways.  Oxidative stress results from the release of free oxygen radicals produced during  glycolosis.  Free oxygen radicals cause damage that is significant to mitochondria, DNA and cell membranes. (8)<br /><strong>Lab studies</strong> – there are no lab test used to monitor oxidative stress.<br /><strong>Treatment recommendations</strong> –  glutathione 250-500mg/day or alpha lipoic acid 600mg/day have shown anecdotal evidence of improving symptoms of oxidative stress in patients with DPN.(9)<br /><br />B. Nitrosative stress – Nitric oxide (NO) acts to actively control vasodilatation and prevents thrombosis.  Low levels of NO result in vasoconstriction of the blood vessels within the peripheral nerves resulting in altered conductivity of the peripheral nerve.<br /><strong>Lab studies</strong> – OTC saliva test strips are available to determine NO levels but produce unreliable results.  NO respiratory testing is used to evaluate asthma and is not intended to be used to quantify NO levels that may contribute to vascular disease.<br /><strong>Treatment recommendations</strong> – cardiovascular exercise can prompt the formation of nitric oxide in your body while exposure to sunshine can release unavailable NO in the body. (10, 11)  Fresh vegetables and food that are high in arginine can be broken down to NO.  Those foods include kale, spinach, broccoli, brussel sprouts, beets, legumes, nuts, beans, salmon, chicken, beef, cheese and eggs. (12) </li> </ol><ol start="3"> <li><strong>Microvascular changes</strong> – Microvascular changes within the peripheral nerve are a significant contributing factor to DPN.  Microvascular changes can be caused by hyperlipidemia, oxidative and nitrosative contributing factors.  Microvascular nerve disease is significantly affected by hyperglycemia. Microvascular disease is a hallmark of diabetes.(13)<br /><strong>Laboratory testing</strong> – there is no definitive test for microvascular disease in DPN.<br /><strong>Treatment recommendations</strong> – Control of hyperglycemia is the most important tool in preventing microvascular disease in DPN.  Type 2 diabetes typically occurs in the setting of the metabolic syndrome, which also includes abdominal obesity, hypertension, hyperlipidemia, and increased coagulability. Weight control, management of hypertension and control of hyperlipidemia is essential in the prevention of microvascular disease in diabetic patients. </li> </ol><ol start="4"> <li><strong>Channels Spouting</strong> – damage to the nerve ending results in dysthesia and hyperexcitability of the peripheral nerve particularly in the dermis. Damage from hyperglycemia results in changes of ion expression of both sodium channels and calcium channels.  The up-regulation of sodium channels has been described as the primary cause of DPN. (14,15,16,17,18)<br /><strong>Laboratory testing</strong> – there is no clinical test available to assess channels sprouting.<br /><strong>Treatment recommendations</strong> – active management of blood sugar levels is the most effective way to prevent and treat DPN secondary to channels sprouting. </li> </ol><ol start="5"> <li><strong>Microglial activation</strong> – glia comprises a group of cells in the central nervous system that maintain homeostasis, form myelin and provide support for cells of both the central and peripheral nervous systems.  Stimulation of the microglial cells by diabetes results in compromised management of the cells of the peripheral nervous system, particularly the sodium ion exchange.(19,20)<br /><strong>Laboratory testing</strong> – there is no current test to identify microglia activation.<br /><strong>Treatment recommendations</strong>- aggressive management of blood glucose levels. </li> </ol><ol start="6"> <li><strong>Central sensitization</strong> – the central nervous system is known to respond to DPN in a number of ways that create increased sensitivity, thereby resulting in increased peripheral nerve sensitivity.  These complex chemical pathways include spinal N-Methyl-D-aspartate (NMDA) receptor expression and activation of GABA<sub>B</sub> receptors resulting in inhibition of NMDA receptor activity.  (21,22,23)                                 <br /> <strong>Laboratory testing</strong> – there is no direct testing for central sensitization.<br /><strong>Treatment recommendations</strong> - aggressive management of blood glucose levels. </li> </ol><ol start="7"> <li><strong>Brain plasticity</strong> - The ventral posterolateral nucleus (VPL) of the thalamus is the main receiving area of nociceptive stimuli that is processed in the spinal cord.  Changes within the thalamus due to DPN change the receptive properties of the brain thereby increasing DPN pain.  Multiple chemical pathways are described in brain plasticity and its contribution to DPN pain.  (24,25,26)<br /><strong>Laboratory testing</strong> – there is no clinical test for brain plasticity.<br /><strong>Treatment recommendations</strong> – increased levels of GABA can help with the treatment of brain plasticity.</li> </ol> <p> </p> <h3>Treatment of sleep deprivation in diabetic peripheral neuropathy </h3> <p>As I described in <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitioners">part 1</a> of this three part blog post, DPN can be broken into three stages.  Stage three is the stage of DPN that is defined by painful paresthesia when the patient is at rest.  When active, the patient is distracted and doesn’t feel his/her neuropathy.  But when the patient tries to relax, rest or fall asleep, the symptoms of DPN become obvious and result in sleep deprivation.  Disruption of the normal sleep cycle can have significant systemic effects that include cardiac arrhythmias, increased insulin resistance and metabolic syndrome.  Additional problems include depression, emotional /psychological changes, loss of employment and safety issues like falling asleep while driving. </p> <p>Restoration of a normal sleep cycle in patients with DPN can be accomplished by treating the symptoms of DPN, by treating the sleep disorder or a combination of both therapies. </p> <p>Medications used for treatment of symptoms of diabetic peripheral neuropathy symptoms –</p> <p style="padding-left: 30px;">Topical medications</p> <ul> <li style="padding-left: 30px;">capsaicin cream</li> <li style="padding-left: 30px;">CBD cream</li> <li style="padding-left: 30px;">lidocaine patches</li> </ul> <p style="padding-left: 30px;">Anticonvulsants</p> <ul> <li style="padding-left: 30px;">pregabalin</li> <li style="padding-left: 30px;">gabapentin</li> </ul> <p style="padding-left: 30px;">Antidepressants</p> <ul> <li style="padding-left: 30px;">duloxetine</li> <li style="padding-left: 30px;">venlafaxine</li> <li style="padding-left: 30px;">amitriptyline</li> <li style="padding-left: 30px;">nortriptyline</li> </ul> <p> </p> <p>Medications used in sleep disorder management –</p> <p style="padding-left: 30px;">OTC medications</p> <ul> <li style="padding-left: 30px;"> Melatonin</li> </ul> <p style="padding-left: 30px;">Rx hypnotic medications<br /><br />        Ambien®, Ambien® CR (zolpidem tartrate)</p> <p style="padding-left: 60px;">Dalmane® (flurazepam hydrochloride)<br /><br /> Halcion® (triazolam)<br /><br /> Lunesta® (eszopiclone)<br /><br /> Prosom® (estazolam)<br /><br /> Restoril® (temazepam)<br /><br /> Rozerem® (ramelteon)<br /><br /> Silenor® (doxepin)</p> <p> </p> <h3>Treatment of neuropathic pain in diabetic peripheral neuropathy </h3> <p>We’ll divide the treatment of diabetic neuropathy pain into based on the absence or presence of treatment induced neuropathy in diabetes (TIND).  TIND is also known as insulin neuritis. </p> <h4>Diabetic neuropathy pain treatment – (non-TIND) </h4> <p>The first step in treatment of lower extremity pain in diabetic patients is the exclusion of other conditions that may cause pain.  The differential diagnosis for lower extremity pain in diabetic patient may include but is not limited to:</p> <ul> <li>lumbo-sacral radiculitis</li> <li>referred hip or knee pain</li> <li>secondary arthritis ankle or foot</li> <li>Charcot arthropathy</li> <li>fracture or sprain </li> </ul> <p>Once the differential diagnosis excludes these conditions, treatment of neuropathic pain in the non-TIND diabetic patient should include one or more of the following; </p> <p>Topical medications</p> <ul> <li>capsaicin cream</li> <li>CBD cream</li> <li>lidocaine patches</li> </ul> <p>Anticonvulsants</p> <ul> <li>pregabalin</li> <li>gabapentin</li> </ul> <p>Antidepressants</p> <ul> <li>duloxetine</li> <li>venlafaxine</li> <li>amitriptyline</li> <li>nortriptyline </li> </ul> <h4>Diabetic neuropathy pain treatment – (TIND) </h4> <p>Treatment induced neuropathy in diabetes (TIND) results from aggressive management of blood sugars resulting in a 2% point or greater reduction in HbA1c levels in less than 90 days.  Improved focus on diabetes care by primary care providers and pressure from insurers for tighter management of diabetes has created a climate of care which we may see an increased prevalence of TIND.   TIND is reported to occur in great than 10% of T1DM and T2DM patients at the onset of care. (27,28,29,30)  Symptoms include lower extremity autonomic dysfunction and significant lower extremity pain.  </p> <p>Treatment of peripheral neuropathy in patient with suspected TIND is different in light severe but self limiting pain.  In addition to the methods of treatment described for the non-TIND diabetic patients, DPN neuropathic pain in patients with TIND need increase intensity of care with use of opioids to control pain.  TIND is self limiting with symptoms resolving in 6-12 months from onset.</p> <p> </p> <h3>Diabetic peripheral neuropathy treatment caveats </h3> <ul> <li>DPN is caused by a number of complimentary pathways that have a negative impact on peripheral nerve, CNS tissue and the brain.  </li> <li>Metabolic syndrome is directly tied to symptoms of DPN. </li> <li>DPN is a contributing factor to sleep disorders and works in a negative feedback loop to affect insulin resistance, brain plasticity and cardiac health. </li> <li>TIND is a unique type of DPN that requires increased intensity of treatment for 6-12 month.</li> </ul> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line_break_shoe_5.jpg" alt="" width="400" /> </p> <h3>Summary</h3> <p>Symptomatic diabetic peripheral neuropathy is due to a number of contributing factors, many of which are related to metabolic syndrome.  These physiological factors that cause DPN are not mutually exclusive but often complement each other.  The role of the clinician in treating DPN can be challenging in finding the proper treatment plan for each individual patient.  The goal of treatment is a minimum 50% reduction in pain and restoration of normal sleep cycles.</p> <p> </p> <p>Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">patient guidelines for diabetic foot care</a>.<br />Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">patient guidelines for treatment of diabetic peripheral neuropathy</a>.</p> <p> </p> <p>References</p> <ol> <li>McAra Sylvia Patient awareness of loss of protective sensation in the diabetic foot: an opportunity for risk reduction?  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103013/">J Foot Ankle Res</a>. 2011; 4(Suppl 1): P37.  Published online 2011 May 20. doi: <a href="https://dx.doi.org/10.1186%2F1757-1146-4-S1-P37">10.1186/1757-1146-4-S1-P37<br /></a></li> <li>Gabbay KH, Merola LO, Field RA: Sorbitol pathway: presence in nerve and cord with substrate accumulation in diabetes. <em>Science</em> <strong>151</strong>: 209–210, 1966  <a href="https://diabetes.diabetesjournals.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEyOiIxNTEvMzcwNy8yMDkiO3M6NDoiYXRvbSI7czoyNDoiL2RpYWJldGVzLzU0LzYvMTYxNS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=">Abstract/FREE Full Text</a></li> <li>Smeriglio A, Giofrè SV, Galati EM, Monforte MT, Cicero N, D'Angelo V, Grassi G, Circosta C (June 2018). 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Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:318https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitionersDiabetic Peripheral Neuropathy - patient examination guidelines for practitioners (part 2)<h2>Part 2 - Examination guidelines for physicians and midlevel providers<img style="float: right;" src="/images/uploaded/Blog images/single_shoes(7).jpg" alt="" width="150" /></h2> <h3>Objectives</h3> <p>In <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitioners">part 1 of this three-part blog</a> on the treatment of patients with diabetic peripheral neuropathy (DPN) we discussed the economic impact of diabetic peripheral neuropathy, the pathophysiology of DPN and staging of DPN.  In part 2, let's take a closer look at the history and physical exam of the DPN patient. This post is intended to act as a treatment guideline for lower extremity health practitioners including podiatrists, primary care physicians, NP’s and PA’s.  The objective of this post is to create a framework for a meaningful patient exam of patients with diabetic peripheral neuropathy.</p> <p>Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">patient guidelines for diabetic foot care</a>.<br />Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">patient guidelines for treatment of diabetic peripheral neuropathy</a>.</p> <h3>Examination of the patient referred for treatment of diabetic peripheral neuropathy</h3> <p>Treatment of diabetes is a team effort.  Primary care providers treat blood sugar levels, teaching their diabetic patients methods of optimizing their blood sugar levels with diet and medications.  The effective primary care doc also builds a team of providers to manage diabetic issues that are outside the realm of primary care.  This team includes;</p> <ul> <li>Dietary counseling</li> <li>Ophthalmology – management of diabetic retinopathy</li> <li>Nephrology – management of renal failure</li> <li>Podiatry – wound care, Charcot joint management, and treatment of peripheral neuropathy</li> </ul> <p>As a hospital-based podiatrist, I see a lot of patients specifically for the prevention and treatment of symptoms of diabetic peripheral neuropathy (DPN).  Clinic visits with diabetic patients suffering from DPN are an opportunity to assess lower extremity health in the patient and also provide important education to the patient.  In this post, I’d like to create a format for the history and physical exam of a patient with DPN.  This history and physical exam format is specific only for patients referred for treatment of DPN.</p> <h3>The history and physical exam of a patient with diabetic peripheral neuropathy</h3> <p>Let me first list the questions I use when taking a history of a patient with DPN.  Second, we'll discuss the testing I use in the exam of a patient with DPN.  Lastly, we’ll go into each history question and physical exam in detail.</p> <ul style="list-style-type: disc;"> <li>When were you first diagnosed with diabetes?</li> <li>How well would you say you managed your diabetes once diagnosed?</li> <li>Have you ever used insulin?  If so, how long have you used insulin?</li> <li>Do you know your most recent HbA1c number?</li> <li>Do you know how the HbA1c test works and why it is so important?</li> <li>Do your legs and feet hurt?  Please describe your symptoms.</li> <li>How long have you experienced pain in your feet and legs?</li> <li>On a scale of 1-10, how severe would you rate your pain?</li> <li>Do your symptoms of DPN keep you awake at night?</li> <li>Do you feel that you’ve lost sensation in your feet?</li> <li>Do you wobble when you walk?  Do you need to hold on to furniture when you walk?</li> <li>How many times have you fallen in the past month?</li> <li>Do you have any history of lumbo-sacral disc disease, chronic back pain or back surgery?</li> <li>Do you use an insulin pump or continuous glucose monitoring device?</li> <li>What was your average blood sugar when you first started treatment?  What is it now and how quickly has it changed?</li> </ul> <p> </p> <h3>Physical exam of the patient with diabetic peripheral neuropathy</h3> <ul style="list-style-type: disc;"> <li>Vascular</li> </ul> <p style="padding-left: 60px;">Pedal pulses</p> <p style="padding-left: 60px;">Capillary refill time</p> <ul style="list-style-type: disc;"> <li>Neurological</li> </ul> <p style="padding-left: 60px;">Tinel’s sign of the tarsal canal, deep peroneal nerve and common peroneal nerves</p> <p style="padding-left: 60px;">Deep tendon reflexes</p> <p style="padding-left: 60px;">Light touch with a <a href="https://www.myfootshop.com/weinstein-monofilament">Weinstein monofilament</a></p> <ul style="list-style-type: disc;"> <li>Dermatological</li> </ul> <p style="padding-left: 60px;">Dry skin of the foot</p> <p style="padding-left: 60px;">Erythematous moccasin distribution of t. rubrum</p> <p style="padding-left: 60px;">Heavy areas of callus of the heel, forefoot or toes</p> <p style="padding-left: 60px;">General hygiene</p> <ul style="list-style-type: disc;"> <li>Orthopedics</li> </ul> <p style="padding-left: 60px;">Ability to rock back on heels and rise up on toes</p> <p style="padding-left: 60px;">Calor to touch</p> <p style="padding-left: 60px;">Muscle strength testing</p> <p style="padding-left: 60px;">Indurated edema of the forefoot, midfoot, subtalar joint or ankle</p> <p style="padding-left: 60px;">Gait exam</p> <h3>Discussion</h3> <p>First, let’s take a closer look at each of these history questions in more detail to understand the significance of their meaning and how they may affect the treatment of diabetic peripheral neuropathy.  Second, let’s take a close look at the significance of each exam and why they may help to diagnose and treat peripheral neuropathy.</p> <h3>History</h3> <ul style="list-style-type: disc;"> <li>When were you first diagnosed with diabetes?</li> </ul> <p style="padding-left: 60px;">At the heart of the patient’s diabetes journey is the duration of the patient’s diabetes, not just treatment of the diabetes but also the period of time prior to treatment.  The period of time prior to treatment is often a lost opportunity.  Perhaps the patient didn’t realize that they had diabetes or perhaps they didn’t act upon recommendations by a health care provider.  It’s therefore important to document both the onset of the disease and the onset of treatment.</p> <ul style="list-style-type: disc;"> <li>How well would you say you managed your diabetes initially?</li> </ul> <p style="padding-left: 60px;">This goes back to the onset of diabetes and the onset of treatment.  I find this part of the history to be an opening to further discussion.  It’s a point where the patient will get real with the conversation and usually admit that their initial response was denial of the disease and lack of initial treatment.  This is a great opportunity for the patient and provider to bond over the ‘honesty’ of treatment.</p> <ul style="list-style-type: disc;"> <li>Have you ever used insulin?  If so, how long have you used insulin?</li> </ul> <p style="padding-left: 60px;">Past history of insulin use can be a topic that can help the provider understand two things.  First, if a patient has a history of insulin use it typically means that they have a more extensive history of treatment.  For instance, a prior hospital admission might have included the use of insulin while in the hospital.  Secondly, prior insulin use might indicate another related change in the patient’s course of treatment such as weight loss.  With significant weight loss or bariatric surgery, the patient might have been able to transition from insulin dependency back to using oral hypoglycemic medication exclusively.</p> <p style="padding-left: 60px;">Optimization of blood sugar levels using insulin can be tricky but also can be very reliable.  This topic provides an opportunity for the provider to understand any challenges that the patient might be having related to insulin use.</p> <ul style="list-style-type: disc;"> <li>Do you know your most recent HbA1c number?</li> </ul> <p style="padding-left: 60px;">How tuned in to their diabetes care is a patient?  How much time and counseling does a patient get from their primary care doctor or diabetes educator?  Understanding the importance of their HbA1c number tells a lot about past history of care.  When a patient can clearly state that their most recent HbA1c was on December 5<sup>th</sup> and was 5.6%, you’ve got an informed and conscientious patient.  Unfortunately, this is not very often the case.</p> <ul style="list-style-type: disc;"> <li>Do you know how the HbA1c test works and why it is so important?</li> </ul> <p style="padding-left: 60px;">I tell my diabetic patients that the HbA1c test is the best thing ever.  And I explain exactly how it works, tagging RBC’s at birth at the A1c molecule.  Most patients nod their heads and agree that the science behind the HbA1c test is really interesting and want to understand more.  My goal is to get the patient to focus less on daily blood sugar levels and more on their HbA1c numbers.</p> <ul style="list-style-type: disc;"> <li>Do your legs and feet hurt?  Please describe your symptoms.</li> </ul> <p style="padding-left: 60px;">Why do the legs of diabetic patients hurt?  The differential diagnosis for lower leg pain in diabetics can include a host of different conditions.  Knowing that our diabetic population is going to have multiple co-morbidities, you need to drill down on this topic to evaluate vascular status and past hx of chronic lumbo-sacral pain.</p> <ul style="list-style-type: disc;"> <li>How long have you experienced pain in your feet and legs?  Can you describe the onset?</li> </ul> <p style="padding-left: 60px;">The correlation between onset and duration of diabetes and the onset and duration of diabetic peripheral neuropathy is poorly correlated.  One would assume that diabetic patients with a longer duration of treatment would be more prone to DPN but this is not necessarily the case.  In some cases, DPN can actually precede the diagnosis of diabetes. </p> <ul style="list-style-type: disc;"> <li>On a scale of 1-10, how severe would you rate your pain?</li> </ul> <p style="padding-left: 60px;">I’ve always struggled with pain scales, but I do feel this is a pertinent question due to the need to identify the possibility of treatment-induced neuropathy n diabetics (TIND - see a brief discussion below)</p> <ul style="list-style-type: disc;"> <li>Do your symptoms of DPN keep you awake at night?</li> </ul> <p style="padding-left: 60px;">One of the classic symptoms of DPN is that the symptoms aren’t too bad by day while the patient is distracted by activities of daily living (ADL), but when getting into bed and trying to get the mind to relax, the symptoms of DPN rise to the surface, limiting the ability to fall asleep and stay asleep.</p> <ul style="list-style-type: disc;"> <li>Do you feel that you’ve lost sensation in your feet?</li> </ul> <p style="padding-left: 60px;">This question is purposely subjective.  As we move into the physical exam and perform a <a href="https://www.myfootshop.com/weinstein-monofilament">Weinstein monofilament</a> test, I’ll fall back on this question.  When you’re performing the Weinstein monofilament testing, if the patient cannot feel, have them open their eyes and visually see that they do indeed have loss of protective sensation.</p> <ul style="list-style-type: disc;"> <li>Do you wobble when you walk?  Do you need to hold on to furniture?</li> </ul> <p style="padding-left: 60px;">Instability of gait is often a symptom of loss of sensation in the feet.  If you can’t feel your feet, you start to lose the ability to balance.  Therefore, instability of gait is often seen with loss of protective sensation (LOPS) and DPN.</p> <ul style="list-style-type: disc;"> <li>How many times have you fallen in the past month?</li> </ul> <p style="padding-left: 60px;">Simply a way to quantify instability of gait and LOPS.</p> <ul style="list-style-type: disc;"> <li>Do you have any history of lumbo-sacral disc disease, chronic back pain or back surgery?</li> </ul> <p style="padding-left: 60px;">When considering the differential diagnosis of DPN, lumbo-sacral disc disease will be often be considered a complimentary condition that can either complicate lower extremity pain or even be the primary source of lower leg pain.  Lumbo-sacral pain will often be worse proximal to distal while DPN will be worse distal to proximal.  Lumbo-sacral pain may also be uni-laterally worse while DPN is always bilaterally symmetrical in its pain.  Lumbo-sacral pain is aggravated by activities such as standing while DPN is static and not influenced by activity.  Lumbo-sacral pain can vary where one day it is a bit better while DPN is always consistent and often worse at night.</p> <ul style="list-style-type: disc;"> <li>Do you use an insulin pump or continuous glucose monitoring device?</li> </ul> <p style="padding-left: 60px;">Type 1 diabetics who are lucky enough to have an insulin pump will always be the folks who treat their diabetes like a trip to the grocery store.  They'll bring a written list and can tell you accurate histories and detail their treatment history.  I ask this question of all T1DM patients also as a motivator to see if we can move care in the direction of using a pump and continuous glucose monitoring.  For many patients, this will be the first time that they have ever thought about treating their diabetes with more than just testing strips.</p> <ul style="list-style-type: disc;"> <li>What was your average blood sugar when you first started treatment?  What is now and how quickly has it changed?</li> </ul> <p style="padding-left: 60px;">Think of the treatment of blood sugar levels to be much like the treatment of hypertension.  When you lower a patient’s blood pressure, you’re often going to see secondary changes to include somnolence, impotence and personality changes.  The same can hold true in the regulation of blood glucose levels, particularly if those levels are decreased rapidly.  Treatment-induced neuropathy in diabetes (TIND) also called insulin neuritis, was first described in 1933.  Recent studies indicate that more than 10% of diabetic may be affected by TIND at the onset of treatment.  Rapid decrease of HbA1c levels, greater than 2% point over the course of 3 months will result in a greater than 20% chance of TIND.  DPN due to TIND results in more severe symptoms of DPN that are more refractory to treatment.  More on TIND in <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners-part-3">part 3</a> of these blog posts.</p> <h3>Physical exam of the patient with diabetic peripheral neuropathy</h3> <p>Let’s take a little bit closer look at the physical exam of the patient with diabetic peripheral neuropathy, why each of these tests are important and what they can tell you about DPN.</p> <ul style="list-style-type: disc;"> <li>Vascular</li> </ul> <p style="padding-left: 60px;">Pedal pulses</p> <p style="padding-left: 60px;">Capillary refill time</p> <p style="padding-left: 60px;">Diabetes and vascular disease go hand-in-hand.  My personal belief is that the primary effect on the lower extremity vascular complex in diabetic patients isn’t directly related to elevated blood glucose levels, but is actually secondary to renal disease caused by diabetes.  This secondary effect results in decreased permeability of the artery (atherosclerosis) and hardening of the <a href="/images/uploaded/medical/x-ray/xray_ankle_Monckebergs_arteriosclerosis_mod.jpg" target="_blank"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Medical/X-ray/xray_ankle_Monckebergs_arteriosclerosis_mod-Copy-1.jpg" alt="Monckeberg sclerosis x-ray ankle" width="150" /></a>artery (arteriosclerosis).  As we see in renal disease, the distribution of problems of the lower leg arterial system is worse distal to proximal.  When problems do arise in diabetic patients, this makes revascularization very difficult.  The classic radiographic finding in both renal patients and diabetic patients is Monckeberg sclerosis, as seen in this image. Diabetic patients progressively lose circulation that we can call a de-vascularization process.  The way I describe the de-vascularization process to our residents is to compare the diabetic foot and cell structure to a healthy cell in a young, healthy patient.  In the young, healthy foot, no one cell is more than three cells away from an artery.  In this healthy scenario, cells have easy access to nutrients, oxygen and waste disposal.  In the diabetic foot, individual cells need to survive sometimes 10, 20 or even 30 cells away from the artery.  This ‘cell survival distance’ isn’t measurable but becomes apparent in wound care.  In cases of DPN, the greater the cell survival distance, the greater the challenge for the nerve to function, subsequently, vascular compromise and renal disease is a contributing factor to DPN.</p> <ul style="list-style-type: disc;"> <li>Neurological</li> </ul> <p style="padding-left: 60px;">Tinel’s sign of the tarsal canal, deep peroneal nerve and common peroneal nerves</p> <p style="padding-left: 60px;">Deep tendon reflexes</p> <p style="padding-left: 60px;">Light touch with a Weinstein monofilament</p> <p style="padding-left: 60px;">There are a number of competing and perhaps complimentary theories that describe the onset and cause of DPN.  These theories were briefly discussed in <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitioners">part one</a> of this three-part blog.  It’s important to recognize the neurological symptoms of DPN and how they can be tested in the lower extremity. </p> <p style="padding-left: 60px;">Learn the locations of the deep peroneal nerve, posterior tibial nerve, and common peroneal nerves.  Percuss with two fingers and when you elicit a tingle (paresthesia) distal to the percussion site, that’s called a Tinel’s sign.  A single, isolated Tinel’s sign likely means that that one nerve is affected, perhaps a local entrapment, specific to that site.  But multiple, symmetrical positive Tinel’s signs, at all three sites, are pathoneumonic for DPN.</p> <p style="padding-left: 60px;"><img src="/images/uploaded/Medical/Diagnostic testing/Tinels_sign_deep_peroneal_nerve.jpg" alt="Tinel's sign of the deep peroneal nerve" width="150" />      <img src="/images/uploaded/Medical/Diagnostic testing/Tinels_sign.jpg" alt="Tinel's sign of the posterior tibial nerve" width="150" />    <img src="/images/uploaded/Medical/Diagnostic testing/surgery_external_neurolysis_common_peroneal_nerve_mod1.jpg" alt="Common peroneal nerve" width="150" /></p> <p style="padding-left: 60px;">Deep tendon reflexes (DTR) should be measured during the exam of the patient with diabetic peripheral neuropathy but DTR's can vary with each patient.  The physiological changes noted with DPN may certainly influence DTR testing, particularly in patients with stage 3 DPN.  The reliability of DTR as a measure of DPN in patients with DPN is low.</p> <p style="padding-left: 60px;">Light touch is often diminished in diabetic peripheral neuropathy.  <a href="https://www.myfootshop.com/weinstein-monofilament">Weinstein monofilament</a> testing has become the gold standard of testing for DPN.  Documentation of diminished light touch and changes in the patient's ability to sense light touch is an important part of the examination of the patient with diabetic peripheral neuropathy.</p> <ul style="list-style-type: disc;"> <li>Muscle strength testing</li> </ul> <p style="padding-left: 60px;">DPN is often thought of as merely a sensory deficit affecting the patient in a stocking and glove distribution.  But DPN in advanced stages can also affect the motor distribution of the peripheral nervous system.  In the hands, you’ll see muscular atrophy of the interosseus muscles.  In the foot, the most common symptom is a drop foot and steppage gait due to the motor loss of the <a href="https://www.myfootshop.com/tibialis-anterior">tibialis anterior muscle</a>.  Muscle strength testing can help identify motor deficits secondary to DPN.</p> <ul style="list-style-type: disc;"> <li>Dermatological</li> </ul> <p style="padding-left: 60px;">Dry skin of the foot</p> <p style="padding-left: 60px;">Erythematous moccasin distribution of t. rubrum</p> <p style="padding-left: 60px;">Heavy areas of callus of the heel, forefoot or toes</p> <p style="padding-left: 60px;">General hygiene</p> <p style="padding-left: 60px;">DPN is also found in conjunction with an autonomic deficit in the peripheral nervous system.  The most common symptom of diabetic autonomic dysfunction is dyshydrosis, or lack of perspiration.  Dyshydration often presents with diffuse dryness of the foot and lower extremity.</p> <p style="padding-left: 60px;">Calluses can be ticking time bombs in diabetic patients.  Calluses, or what we call grade 0 ulcerations, cannot be felt in patients who have loss of protective sensation (LOPS).  As a callus thickens, it places significant pressure on the underlying skin.  What was once a protective layer of hard skin now becomes a chronic pressure point that will progressively and painlessly liquefy the skin under the callus.  </p> <ul style="list-style-type: disc;"> <li>Orthopedics</li> </ul> <p style="padding-left: 60px;">Ability to rock back on heels and rise up on toes</p> <p style="padding-left: 60px;">Calor to touch</p> <p style="padding-left: 60px;">Muscle strength testing</p> <p style="padding-left: 60px;">Indurated edema of the forefoot, midfoot, subtalar joint or ankle</p> <p style="padding-left: 60px;">Gait exam</p> <p style="padding-left: 60px;">Neuromuscular exercises like toe raises and heel rocks are active measures of muscle strength and are used to assess motor loss in the lower extremity of the diabetic patient.</p> <p style="padding-left: 60px;">When your exam finds calor to touch (hot foot) think <a href="https://www.myfootshop.com/charcot-joint">Charcot arthropathy</a>.  Charcot foot, also known as diabetic osteoarthropathy, is a progressive neurological disease that results in the collapse of the midfoot or ankle.  In the early stages of Charcot arthropathy plain films will be normal.  The foot will be mildly swollen and hot to touch.  Consider a prompt referral to podiatry in these cases.  Expeditious treatment can save the foot and leg from amputation.  Gait exam helps to assess instability of gait, a common symptom of DPN.  This is also an opportunity to discussed fall prevention.</p> <p style="padding-left: 60px;">In your gait exam, watch the patient for an inability to rise to their feet and balance.  Do they reach for an adjacent chair or wall for support?</p> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line break bare foot.jpg" alt="" width="500" /></p> <p>Summary</p> <p>The history and physical exam of the patient who is referred to you for assessment and treatment of diabetic peripheral neuropathy is a great opportunity to both treat and educate.  An understanding of the important aspects of a thorough history can help build a lasting relationship with the patient.  The physical exam is important in assessing the severity of DPN and LOPS.  By doing so, an ongoing and effective treatment plan for DPN can be implemented and used to coordinate with primary care as they manage blood sugars.  Your role in treating DPN and LOPS will be an effective part of amputation prevention. </p> <p>In <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners-part-3">part 3</a> of this three-part blog, we'll discuss treatment of peripheral neuropathy.</p> <p>Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">patient guidelines for diabetic foot care</a>.<br />Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">patient guidelines for treatment of diabetic peripheral neuropathy</a>.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com<br /><br />Updated 12/24/2019</p>urn:store:1:blog:post:317https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitionersDiabetic Peripheral Neuropathy - patient examination guidelines for practitioners (part 1)<p><img style="float: right;" src="/images/uploaded/Blog images/single_shoes(4).jpg" alt="" width="175" /></p> <h2>Part 1 – Background of diabetic peripheral neuropathy</h2> <h3>Objectives</h3> <p>Diabetic peripheral neuropathy is the most common complication of both type 1 (T1DM) and type 2 (T2DM) diabetes.  Diabetes causes a number of different neuropathic complications to include sympathetic and parasympathetic autonomic dysfunction.  Part 1 of this three-part blog post focuses on the causes of diabetic peripheral neuropathy (DPN), the economic impact of DPN and proposes a staging classification for clinicians who treat patients with DPN. This post is intended to act as a guideline for lower extremity health practitioners including podiatrists, primary care physicians, NPs and PAs.  The objective of this post is to create a framework for a meaningful patient exam of patients with diabetic peripheral neuropathy.</p> <p>Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">patient guidelines for diabetic foot care</a>.<br />Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">patient guidelines for treatment of diabetic peripheral neuropathy</a>.</p> <h3>Background of diabetic peripheral neuropathy</h3> <p>Introduction</p> <p>The incidence of diabetes makes it one of the most significant health issues of the 21st century.  Current estimates note that 10% of the general population has diabetes with a global incidence to reach 366 million people by 2020. (1)  Diabetic peripheral neuropathy (also called distal symmetrical polyneuropathy) is the most common complication of diabetes and is found in 90% of type 1 and type 2 diabetics. (2-6) </p> <p>The term neuropathy is a paradox in that it describes both loss of sensation and increased sensation (hyperalgesia).  Loss of protective sensation (LOPS) leads to significant foot wounds that may result in loss of limb.  Loss of sensation also leads to gait instability and falls.  30% of all cases of DPN will have painful neuropathy. (5-8)  The annual cost of treating diabetes increases with DPN, LOPS and even more significantly with the onset of painful neuropathic neuropathy.  It has been estimated that 27% of the cost of treating diabetes is associated with the treatment of DPN. (9-11)                                              </p> <table style="height: 61px;" width="596"> <tbody> <tr> <td>Annual cost per diabetic patient</td> <td>$6,632</td> </tr> <tr> <td>Annual cost per diabetic patient with DPN </td> <td>$12,492</td> </tr> <tr> <td>Annual cost per diabetic patient with painful neuropathy </td> <td>$30,755</td> </tr> </tbody> </table> <h3>The pathophysiology of diabetic neuropathy</h3> <p>Although the precise cause of diabetic peripheral neuropathy is not fully understood, there are several key factors that are attributed to the onset of peripheral nerve pain in patients with sustained diabetes.(12)  Those theories include –</p> <ul> <li>Polyal pathway hyperactivity</li> <li>Oxidative and nitrosative stress</li> <li>Microvascular changes</li> <li>Channels sprouting</li> <li>Microglial activation</li> <li>Central sensitization</li> <li>Brain plasticity</li> </ul> <p>Is DPN exclusively due to sustained hyperglycemia?  Recent research has begun to look at metabolic syndrome as a complimentary condition that may influence the onset and severity of DPN.  Conditions considered a part of metabolic syndrome that may affect the onset and treatment of DPN include obesity, hypertriglyceridemia, hypercholesterolemia, hypertension and cigarette smoking.(13,14)  The concept that these commorbidities are in part a cause for DPN is support by the fact that the DPN symptoms of T1DM are more responsive to treatment than the DPN symptoms of T2DM.(15-20)</p> <table> <tbody> <tr> <td width="213"> <p> </p> </td> <td width="213"> <p>T1DM</p> </td> <td width="213"> <p>T2DM</p> </td> </tr> <tr> <td width="213"> <p>Lifetime incidence of DPN</p> </td> <td width="213"> <p>59%</p> </td> <td width="213"> <p>45%</p> </td> </tr> <tr> <td width="213"> <p>Potential change of DPN with treatment</p> </td> <td width="213"> <p>60-70%</p> </td> <td width="213"> <p>5-7%</p> </td> </tr> </tbody> </table> <p> </p> <p>Therefore, in addition to hyperglycemia, a host of other factors need to be considered when assessing the root cause of damage to the peripheral nerve.  Additional influencing factors include toxic adiposity, oxidative stress, mitochondrial dysfunction, activation of the polyal pathway, accumulation of advanced glycation end products (AGE’s) and elevated inflammatory markers. (2,21)</p> <h3>Treatment-induced neuropathy in diabetes (TIND)</h3> <p>TIND is described as “acute onset of neuropathic pain and/or autonomic dysfunction within 8 weeks of a large improvement in glycemic control specified as a decrease in glycosylated HbA1c of more than 2% points over 3 months”. (22)  TIND was first described by Caravati in 1933 and originally called insulin neuritis. (22)  The underlying pathophysiology of TIND is poorly understood, but TIND is thought to be secondary to rapid change in Hbg A1c that results in arterio-venous changes within the nerve fiber resulting in hypoxemia of the nerve.(23,24)  Compared to non-TIND DPN, symptoms of TIND are found to be more severe and less responsive to opioids.  TIND is self-limiting and resolves over a period of 6-12 months as HbA1c levels normalize.  At the onset of treatment of diabetes, the risk of developing TIND is greater than 10%.(25)</p> <p> </p> <h3>Staging of diabetic peripheral neuropathy symptoms<img style="float: right;" src="/images/uploaded/Blog images/single_shoes(5).jpg" alt="" width="175" /></h3> <p>The following is a staging schema that I use in my clinic to define the symptoms of diabetic peripheral neuropathy and the indications for treatment.</p> <p><strong>Stage 1</strong></p> <p style="padding-left: 30px;">Symmetrical loss of sensation in the toes and forefoot as measured by Weinstein monofilament but not known to the patient at the time of exam.</p> <p style="padding-left: 30px;">No symptoms of pins and needles.</p> <p style="padding-left: 30px;">Tinel’s sign of posterior tibial nerve, deep peroneal nerve and common peroneal nerve negative.</p> <p><strong>Stage 2</strong></p> <p style="padding-left: 30px;">Symmetrical loss of sensation in the toes and forefoot as measured by Weinstein monofilament known to the patient at the time of exam.</p> <p style="padding-left: 30px;">Symptoms of pins and needles that do not affect the patient's sleep cycle.</p> <p style="padding-left: 30px;">Tinel’s sign of posterior tibial nerve, deep peroneal nerve and common peroneal nerve positive or negative.</p> <p><strong>Stage 3</strong></p> <p style="padding-left: 30px;">Symmetrical loss of sensation in the toes and forefoot as measured by Weinstein monofilament known to the patient at the time of exam.</p> <p style="padding-left: 30px;">Symptoms of pins and needles that negatively affect the patient’s sleep cycle.</p> <p style="padding-left: 30px;">Tinel’s sign of posterior tibial nerve, deep peroneal nerve and common peroneal nerve positive.</p> <p><strong>Stage 3 – late-stage</strong></p> <p style="padding-left: 30px;">Additional symptoms may include –</p> <p style="padding-left: 30px;">Loss of sensation that progresses to both hands and feet in a stocking and glove distribution.</p> <p style="padding-left: 30px;">Instability of gait secondary to loss of proprioception and the inability to feel the floor.</p> <p style="padding-left: 30px;">Motor changes to include foot drop, steppage gait, and interosseous muscle wasting. </p> <p style="text-align: left;"> </p> <p><img style="display: block; margin-left: auto; margin-right: auto;" src="/images/uploaded/Blog images/line break bare foot.jpg" alt="" width="500" /></p> <p>Summary</p> <p>Diabetic peripheral neuropathy is the most common complication of type 1 and type 2 diabetes.  The social and economic impact of diabetic peripheral neuropathy is significant.  An understanding of the underlying pathophysiology and staging of the neuropathy can help to treat these challenging patients. </p> <p>In <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners">part 2</a> of this three-part blog post, we'll take a close look at the history and physical exam of the patient with diabetic peripheral neuropathy.  In <a href="https://www.myfootshop.com/diabetic-peripheral-neuropathy-patient-examination-guidelines-for-practitioners-part-3">part 3</a>, we'll drill down into treatment options of the patient with diabetic peripheral neuropathy.</p> <p>Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-foot-care">patient guidelines for diabetic foot care</a>.<br />Click this link to print <a href="https://www.myfootshop.com/treatment-guide-diabetic-peripheral-neuropathy">patient guidelines for treatment of diabetic peripheral neuropathy</a>.</p> <p> </p> <ol> <li>Hossain P, Kawar B, El Nahas M: Obesity and diabetes in the developing world--a growing challenge. <em>N Engl J Med.</em> 2007;356(3):213–5. 10.1056/NEJMp068177 [<a href="https://dx.doi.org/10.1056%2FNEJMp068177">CrossRef</a>]</li> <li>Singh R, Kishore L, Kaur N: Diabetic peripheral neuropathy: current perspective and future directions.<em>Pharmacol Res.</em> 2014;80:21–35. 10.1016/j.phrs.2013.12.005 [<a href="https://dx.doi.org/10.1016%2Fj.phrs.2013.12.005">CrossRef</a>] </li> <li>Boulton AJ: Management of Diabetic Peripheral Neuropathy. <em>Clin Diabetes.</em> 2005;23(1):9–15. 10.2337/diaclin.23.1.9 [<a href="https://dx.doi.org/10.2337%2Fdiaclin.23.1.9">CrossRef</a>]</li> <li>Tesfaye S, Selvarajah D: Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. <em>Diabetes Metab Res Rev.</em> 2012;28(Suppl 1):8–14. 10.1002/dmrr.2239 [<a href="https://dx.doi.org/10.1002%2Fdmrr.2239">CrossRef</a>]</li> <li>Tesfaye S, Vileikyte L, Rayman G, et al. : Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. <em>Diabetes Metab Res Rev.</em> 2011;27(7):629–38. 10.1002/dmrr.1225[<a href="https://dx.doi.org/10.1002%2Fdmrr.1225">CrossRef</a>]</li> <li>Tesfaye S, Boulton AJ, Dyck PJ, et al. : Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. <em>Diabetes Care.</em> 2010;33(10):2285–93. 10.2337/dc10-1303[<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945176/">PMC free article</a>] [<a href="https://dx.doi.org/10.2337%2Fdc10-1303">CrossRef</a>]</li> <li>Quattrini C, Tesfaye S: Understanding the impact of painful diabetic neuropathy. <em>Diabetes Metab Res Rev.</em> 2003;19(Suppl 1):S2–8. 10.1002/dmrr.360 [<a href="https://dx.doi.org/10.1002%2Fdmrr.360">CrossRef</a>]</li> <li>Callaghan BC, Cheng HT, Stables CL, et al. : Diabetic neuropathy: clinical manifestations and current treatments. <em>Lancet Neurol.</em> 2012;11(6):521–34. 10.1016/S1474-4422(12)70065-0 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254767/">PMC free article</a>][<a href="https://dx.doi.org/10.1016%2FS1474-4422(12)70065-0">CrossRef</a>]</li> <li>Sadosky A, Mardekian J, Parsons B, et al. : Healthcare utilization and costs in diabetes relative to the clinical spectrum of painful diabetic peripheral neuropathy. <em>J Diabetes Complications.</em> 2015;29(2):212–7. 10.1016/j.jdiacomp.2014.10.013[<a href="https://dx.doi.org/10.1016%2Fj.jdiacomp.2014.10.013">CrossRef</a>] </li> <li> American Diabetes Association: Economic costs of diabetes in the U.S. in 2012. <em>Diabetes Care.</em>2013;36(4):1033–46. 10.2337/dc12-2625 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609540/">PMC free article</a>] [<a href="https://dx.doi.org/10.2337%2Fdc12-2625">CrossRef</a>] </li> <li>Gordois A, Scuffham P, Shearer A, et al. : The health care costs of diabetic peripheral neuropathy in the US. <em>Diabetes Care.</em> 2003;26(6):1790–5. 10.2337/diacare.26.6.1790[<a href="https://dx.doi.org/10.2337%2Fdiacare.26.6.1790">CrossRef</a>]</li> <li>Schreiber AK, Nones C, Reis RC, Chichorro JG, Cunha JM: Diabetic neuropathic pain: Physiopathology and treatment. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398900/">World J Diabetes</a>. 2015 Apr 15; 6(3): 432–444.</li> <li>Callaghan B, Feldman E: The metabolic syndrome and neuropathy: therapeutic challenges and opportunities. <em>Ann Neurol.</em> 2013;74(3):397–403. 10.1002/ana.23986 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881591/">PMC free article</a>] [<a href="https://dx.doi.org/10.1002%2Fana.23986">CrossRef</a>] </li> <li>Zilliox L, Russell JW: Treatment of diabetic sensory polyneuropathy. <em>Curr Treat Options Neurol.</em>2011;13(2):143–59. 10.1007/s11940-011-0113-1 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099261/">PMC free article</a>] [<a href="https://dx.doi.org/10.1007%2Fs11940-011-0113-1">CrossRef</a>]</li> <li>The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. <em>N Engl J Med.</em> 1993;329(14):977–86. 10.1056/NEJM199309303291401[<a href="https://dx.doi.org/10.1056%2FNEJM199309303291401">CrossRef</a>]</li> <li>Linn T, Ortac K, Laube H, et al. : Intensive therapy in adult insulin-dependent diabetes mellitus is associated with improved insulin sensitivity and reserve: a randomized, controlled, prospective study over 5 years in newly diagnosed patients. <em>Metabolism.</em> 1996;45(12):1508–13. 10.1016/S0026-0495(96)90180-8] [<a href="https://dx.doi.org/10.1016%2FS0026-0495(96)90180-8">CrossRef</a>]</li> <li>Duckworth W, Abraira C, Moritz T, et al. : Glucose control and vascular complications in veterans with type 2 diabetes. <em>N Engl J Med.</em> 2009;360(2):129–39. 10.1056/NEJMoa0808431[<a href="https://dx.doi.org/10.1056%2FNEJMoa0808431">CrossRef</a>]</li> <li>Ismail-Beigi F, Craven T, Banerji MA, et al. : Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. <em>Lancet.</em>2010;376(9739):419–30. 10.1016/S0140-6736(10)60576-4 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123233/">PMC free article</a>] [<a href="https://dx.doi.org/10.1016%2FS0140-6736(10)60576-4">CrossRef</a>] </li> <li>Gibbons CH, Freeman R: Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy. <em>Ann Neurol.</em> 2010;67(4):534–41. 10.1002/ana.21952 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057039/">PMC free article</a>] [<a href="https://dx.doi.org/10.1002%2Fana.21952">CrossRef</a>]</li> <li>Tesfaye S, Malik R, Harris N, et al. : Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). <em>Diabetologia.</em> 1996;39(3):329–35. 10.1007/s001250050449[<a href="https://dx.doi.org/10.1007%2Fs001250050449">CrossRef</a>]</li> <li>Tesfaye S, Chaturvedi N, Eaton SE, et al. : Vascular risk factors and diabetic neuropathy. <em>N Engl J Med.</em>2005;352(4):341–50. 10.1056/NEJMoa032782[<a href="https://dx.doi.org/10.1056%2FNEJMoa032782">CrossRef</a>]</li> <li>Caravati CM.  Insulin Neuritis: a case report. VA. Med.Monthly. 1933;59:745-746.</li> <li>Tran C, Philippe J, Ochsner F, et al. : Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy. <em>Swiss Med Wkly.</em> 2015;145:w14131. 10.4414/smw.2015.14131[<a href="https://dx.doi.org/10.4414%2Fsmw.2015.14131">CrossRef</a>] </li> <li>Callaghan BC: The Impact of the Metabolic Syndrome on Neuropathy. <a href="https://grantome.com/grant/NIH/K23-NS079417-02">Reference Source</a></li> <li>Callaghan B, Feldman E: The metabolic syndrome and neuropathy: therapeutic challenges and opportunities. <em>Ann Neurol.</em> 2013;74(3):397–403. 10.1002/ana.23986 [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881591/">PMC free article</a>]  [<a href="https://dx.doi.org/10.1002%2Fana.23986">CrossRef</a>]</li> </ol> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com<br /><br />Updated 12/24/2019</p>urn:store:1:blog:post:316https://www.myfootshop.com/why-doesnt-my-daughter-have-an-archWhy doesn’t my daughter have an arch?<h2>Procedure choices and outcomes of PTTD surgery</h2> <p>I saw an 18 y/o young woman today in my practice who was 12 weeks out on her surgical procedure to correct posterior tibial<img style="float: right;" src="/images/uploaded/Blog images/feet-349687_1280.jpg" alt="" width="200" /> tendon dysfunction (PTTD).  Following her surgery, the patient had spent 8 weeks in a hard cast and 4 weeks in a walking cast.  She was now ready to return to shoes when her mom said, “Why doesn’t she have an arch?”  Good question.  What are the procedures used to treat PTTD and will they create an arch for every patient? </p> <h3>Posterior tibial tendon dysfunction defined</h3> <p>Posterior tibial tendon dysfunction was first described in the literature in 1936 but was defined by Johnson and Strom in their classic 1989 Clinical Orthopedics article. (1)  The Johnson Strom article classified PTTD in three stages.  For more information on this classification be sure to check our <a href="https://www.myfootshop.com/posterior-tibial-tendon-dysfunction#Tab3">knowledge base article on PTTD</a>.</p> <h3>What is posterior tibial tendon dysfunction?</h3> <p>In my surgical consult with patients regarding surgical correction of PTTD, I often describe the foot as a ball under the leg.  The primary goal in treating PTTD is to realign that ball under the leg.  In symptomatic cases of PTTD, you’ll see the heel collapse resulting in load-bearing on the foot that is significantly more on the medial arch.  Viewed from behind, the heels would appear as /  \ .  The poorly-aligned heel then placed undue stress on the posterior tibial tendon, the primary tendon that supports the arch.</p> <p>Another contributing factor to PTTD is equines.  Equines describes tightness of the calf and Achilles tendon.  Equines limits range of motion of the ankle.  In cases of equines, to acquire the needed range of motion at the ankle that is required for walking, the arch flattens adding additional strain to the PT tendon.</p> <p>Abduction of the forefoot is a secondary finding in cases of PTTD.  The classic ‘too many toes sign’ is the test to evaluate forefoot abduction.  When viewed from behind, the normal foot will not show the 5<sup>th</sup> toe.  But in cases of PTTD that include forefoot abduction, the 4<sup>th</sup> and 5<sup>th</sup> toes become obvious when viewed from behind.</p> <p>What procedures are used to treat PTTD?</p> <p>The procedures used to treat PTTD include the following –</p> <ul> <li>Achilles tendon lengthening</li> <li>Calcaneal displacement osteotomy (calcaneal slide)</li> <li>Flexor hallucis longus tendon transfer to the posterior tibial tendon</li> <li>Medial column fusion</li> <li>Evans procedure</li> </ul> <p>Let’s take a look at each of these procedures in relationship to their ability to create an arch.  We’ll use the three cardinal planes of the body to describe how each of these procedures is used to treat PTTD.</p> <h4>Procedures that have no effect on arch height in surgical repair of PTTD</h4> <ol> <li>Although an Achilles tendon lengthening is an integral procedure used in almost all cases of PTTD repair, the Achilles tendon lengthening affects the foot in the sagital plane and does not increase the height of the arch.<br /><br /></li> <li>Calcaneal displacement osteotomy – this procedure is also a mainstay of surgical repair of PTTD.  The heel bone is surgically broken and moved medially (towards the inside of the ankle).  The broken heel is then fixated with screws.  This transposition of the heel is performed in the transverse plane and does not change the height of the arch.<br /><br /></li> <li>Flexor hallucis longus tendon transfer to the PT tendon – this classic tendon transfer is used to double the strength of the posterior tibial tendon.  The long flexor tendon to the great toe is sacrificed and grafted to the PT tendon.  These two tendons work in phase, meaning that the work at the same time and are a good choice for grafting.  This increase in support to the PT tendon is a change that occurs in the sagital plane and does not increase the height of the arch.</li> </ol> <p>These three procedures (the trifecta) make up the core of procedures used to treat PTTD.  These three procedures stabilize the medial arch but do not change the height of the arch.</p> <h4>Procedures that have a slight effect on the height of the arch in surgical repair of PTTD</h4> <ol> <li>       Evans procedure – the Evans procedure is used to treat forefoot abduction.  The Evan procedure lengthens the lateral column of the foot by making a surgical break in the calcaneus and placing a bone graft in the osteotomy to lengthen the lateral column.  By lengthening the lateral column you have, in turn, a relative shortening of the medial column of the foot.  This shortening of the medial column may (not always) result in an increase in arch height.  The Evans procedure is a correction performed in the transverse plane.</li> </ol> <p>In my experience, the Evans procedure may be used in less than 30% of PTTD correction</p> <h4>Procedures that have a significant effect on the height of the arch in surgical repair of PTTD</h4> <ol> <li>       Medial column fusion – a medial column fusion is a procedure where a saw is used to remove (resect) a joint in the medial column.  By removing a specific joint, the medial column is shortened resulting in a significant increase in arch height.  The medial column fusion is a procedure used to correct PTTD in the frontal plane.</li> </ol> <p>Medial column fusion is the least used procedure in correction of PTTD.</p> <h4>Why isn’t there an arch created by most of the procedures used to correct PTTD?</h4> <p>As you can see, each of the surgical procedures used to correct PTTD work in a different body plane.  Remember the example I described earlier about the foot as a ball that we’re trying to center under the leg?  Planning a PTTD surgery requires that the surgeon choose a procedure(s) that will center the foot under the leg.  Some of the procedures may create correction in the sagital plane while others may create correction in transverse or frontal plane.  But as you can see, very few of these procedures, with the exception of the medial column fusion, create a new and noticeable arch.</p> <p>Surgical correction of PTTD does not, in most cases, create an arch.  PTTD surgery does realign the foot and a number of unique ways (changes in bone structure, tendon transfers) that do place the primary load-bearing of the body, directly over the foot.  By doing so, this decreases the biomechanical loads applied to the posterior tibial tendon.</p> <p>Good question, Mom!</p> <p> </p> <p>1. Johnson KA, Strom DE. Tibial posterior tendon dysfunction. Clin Orthop 1989;239:196-206.</p> <p style="text-align: center;"><img src="/images/uploaded/Blog images/line_break_shoe_8.jpg" alt="" width="500" /></p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p>urn:store:1:blog:post:315https://www.myfootshop.com/metatarsalgia-what-is-it-and-how-is-it-treatedMetatarsalgia – what is it and how is it treated?<h2>Fifth metatarsal metatarsalgia – “Why does the outside of my foot hurt?”</h2> <p><a href="https://www.myfootshop.com/dp-foot-mod-lateral-column"><img style="float: left;" src="/images/uploaded/Medical/Graphics/dp_foot_mod_lat_column.jpg" alt="Metatarsalgia fifth metatarsal" width="150" /></a>Pain specific to the outside, or lateral, aspect of the foot is a common condition called <strong><a href="https://www.myfootshop.com/metatarsalgia#Tab3">metatarsalgia</a>.  </strong>The term metatarsalgia is used to describe vague, aching pain specific to the metatarsal bones.  Metatarsalgia can describe midfoot pain, lateral foot pain, and forefoot pain.  Let’s take a closer look at lateral foot pain caused by 5<sup>th</sup> metatarsal metatarsalgia.</p> <p>The foot and all of its 27 bones and 115 ligaments are designed to work as a team with each of the bones and ligaments pulling their own weight. Metatarsalgia is caused by excessive load being carried disproportionally by one bone of the foot. Simply put, metatarsalgia happens when one metatarsal bone does more work than it can manage long-term.</p> <p>Fifth metatarsal metatarsalgia can be caused by a unique structural position of the foot known<a href="https://www.myfootshop.com/images/anatomy/anatomy_foot_drawing_calcaneal_varus_mod.jpg"><img style="float: right;" src="/images/uploaded/Medical/Graphics/anatomy_foot_drawing_calcaneal_varus_mod.jpg" alt="Calcaneal varus" width="150" /></a> as rearfoot varus. The following image shows a normal heel or rectus heel (left) and an inverted or varus heel (right.) From this image, you can see how rearfoot varus will result in excessive load being applied to the lateral, or outer, border of the foot. </p> <p>Rearfoot varus is a contributing factor to fifth metatarsal metatarsalgia, <a href="https://www.myfootshop.com/peroneal-tendon-rupture#Tab3"><strong>peroneal tendon injuries</strong></a>, <a href="https://www.myfootshop.com/peroneal-tendon-subluxation#Tab3"><strong>peroneal tendon subluxation</strong></a>, and <a href="https://www.myfootshop.com/ankle-sprain#Tab3"><strong>chronic ankle sprains</strong></a>.</p> <p>Treatment of rearfoot varus, fifth metatarsal metatarsalgia, peroneal tendon injuries, and even chronic ankle instability can usually be accomplished with the use of simple in-shoe wedges:</p> <p> </p> <p><a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><img style="float: left; padding-right: 10px;" src="/images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts.jpg" alt="Lateral sole Wedge Inserts" width="150" /><strong>Lateral Sole Wedge Inserts</strong></a> are inexpensive, easy to use, and can be trimmed with scissors to fit most shoes. Lateral Sole Wedge Inserts provide a 5-degree lift to the outer foot, helping to limit both rearfoot and forefoot varus.</p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/heel-wedges-rubber-1"><strong><img style="float: left;" src="/images/uploaded/Products/711_Heel_Wedges_Rubber.jpg" alt="Rubber Heel Wedges" width="150" />Rubber Heel Wedges</strong></a> also help to control rearfoot varus. Simple and effective, Rubber Heel Wedges fit easily into all shoes.</p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/premium-heel-wedges"><strong><img style="float: left;" src="/images/uploaded/Products/950_Premium_Heel_Wedges.jpg" alt="Premium Heel Wedges" width="150" />Premium Heel Wedges</strong></a> are the same as our Rubber Heel Wedges but come with a finished leather top cover.</p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/heel-wedges-ppt"><strong><img style="float: left;" src="/images/uploaded/Products/945_Heel_Wedges_PPT_ALT1.jpg" alt="Heel Wedges PPT" width="150" />PPT Heel Wedges</strong></a> offer a softer and more subtle bit of control with similar wedge technology.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p>Additional teatment recommendations - Lateral foot pain due to metatarsalgia can be treated with any of these shoe inserts. Additional treatment recommendations include:</p> <ul> <li>Avoid high-heeled shoes</li> <li>Wear shoes with a rigid shank</li> </ul> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com<br /><br />Updated 12/24/2019</p>urn:store:1:blog:post:314https://www.myfootshop.com/chronic-lower-extremity-cellulitis-treatment-optionsChronic Lower Extremity Cellulitis - Treatment Options<h2>Long term oral antibiotic treatment for patients with recurrent lower leg cellulitis</h2> <p>Edema of the lower leg frequently contributes to a superficial infection of the skin called cellulitis.  Cellulitis can often be treated, but if swelling persists, cellulitis will become chronic.   It’s important to recognize that the root cause of cellulitis is not infectious but rather due to poor management of chronic swelling and the effect that the swelling has on the skin of the lower extremity.  Many of the factors that contribute to lower extremity edema are difficult to modify.  These contributing factors may include <a href="https://www.myfootshop.com/venous-stasis-dermatitis-and-venous-ulcerations#Tab3">venous insufficiency</a>, lymphedema, obesity, and <a href="https://www.myfootshop.com/may-thurner-syndrome">May-Thurner Syndrome</a>.</p> <p>Chronic cellulitis that has failed treatment with compression therapy alone, may be treated with long term low dose oral antibiotics. Although a number of oral agents have been tried, most studies find success with the use of oral Penicillin.  The most common dose is 250m of PCN VK twice daily. (1,2,3,4,5)</p> <h2>Lower extremity cellulitis – case study</h2> <p><img style="float: left; padding-right: 8px;" src="/images/uploaded/Medical/Derm/cellulitis_leg_2.jpg" alt="Cellulitis lower leg" width="400" />This case study describes a 68 y/o obese female (BMI 48) who presented with chronic lower extremity edema and concurrent cellulitis.  Initial treatment included use of four-layer compression wraps from the knee to the toes along with concurrent use of diuretics.  Wounds of the lower leg showed significant weeping and serous drainage.  Wound cultures show coag-negative staph aureus.  There were no open or deep ulcerations but localized areas of maceration and drainage were found in multiple locations.  Global erythema was found from the knee, distal to the toes.  No lymphangitis or regional lymphadenopathy was found.  The sides of the heel and plantar aspect of the foot showed no erythema.  CBC was normal and sed rate and CRP mildly elevated.  PCN 250mg, four times daily, was initiated.</p> <p>Several weeks of four-layer compression, antibiotics and diuretics allowed for transition to Tubi-Grip compression.  Although swelling subsided by 50%, each attempt to withdraw oral antibiotics resulted in recurrence of erythema due to cellulitis.  After 4 months of treatment, the patient was placed on long term PCN 500mg twice daily. </p> <p>Although not completely resolved, the patient’s symptoms are much more manageable.  Our goal is to increase activity and focus on weight loss. </p> <p>In cases of chronic lower extremity edema with cellulitis, additional treatment recommendations include –</p> <ul> <li>Management of albumin and pre-albumin</li> <li>Compression therapy 24 x 7</li> <li>Elevation of legs when possible</li> <li>Dietary consult for weight loss, increased protein consumption and decrease in sodium use</li> <li>Medicine consult for fluid management</li> </ul> <p>Long term oral antibiotic use for chronic cellulitis can have a significant impact on long term care.  Our goal is always to focus on using oral antibiotics as a bridge to enable an opportunity for patients to work to improve co-morbidities such as obesity and smoking.</p> <p>References</p> <p>1. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. <span class="ref-journal"><em>Clin Infect Dis</em>. </span>2005;<span class="ref-vol">41</span>:1373–1406.</p> <p>2. Babb RR, Spittel JA Jr, Martin WJ, et al. Prophylaxis of recurrent lymphangitis complicating lymphedema. <span class="ref-journal"><em>JAMA</em>. </span>1966;<span class="ref-vol">195</span>:871–873.</p> <p>3. Sjoblom AC, Eriksson B, Jorup-Ronstrom C, et al. Antibiotic prophylaxis in recurrent erysipelas. <span class="ref-journal"><em>Infection</em>. </span>1993;<span class="ref-vol">21</span>:390–393. </p> <p>4. Wang HJ, Liu YC, Cheng DL, et al. Role of benzathine penicillin G in prophylaxis for recurrent streptococcal cellulitis of the the lower legs. <span class="ref-journal"><em>Clin Infect Dis</em>. </span>1997;<span class="ref-vol">25</span>:685–689.</p> <p>5. Kremer M, Zuckerman R, Avraham Z, et al. Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections. <span class="ref-journal"><em>J Infect</em>. </span>1991;<span class="ref-vol">22</span>:37–40.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com<br /><br />Updated 12/24/2019</p> <p> </p>urn:store:1:blog:post:313https://www.myfootshop.com/what-is-accessory-navicular-pain-and-how-is-it-treatedWhat is accessory navicular pain and how is it treated?<h3>What products are used to treat accessory navicular pain?</h3> <p><a href="/images/uploaded//Medical/X-ray/xray_foot_os_tibiale_externum-Copy-1.jpg" target="_blank"><img style="float: right; padding-left: 5px;" src="/images/uploaded//Medical/X-ray/xray_foot_os_tibiale_externum-Copy-1.jpg" alt="Accessory navicular" width="250" /></a></p> <p>The <a href="https://www.myfootshop.com/bone-medial-mod-labeled">navicular</a> is often called the keystone of the arch.  The navicular articulates with the talus (art of the ankle) and the cuneiform bones.  The posterior tibial tendon inserts in the medial and plantar aspect of the navicular.  The <a href="https://www.myfootshop.com/tibialis-posterior">posterior tibial tendon</a> acts to plantarflex the foot (toes away from the arch) and lift the arch.  In less than 20% of the general population, an accessory bone called the accessory navicular (also called the os tibiale externum) acts to facilitate motion around the navicular. </p> <p>What’s the purpose of the accessory navicular?  Think of the accessory navicular as acting much like the knee cap.  Tendons are an extension of a muscle.  When the muscle fires, the tendon pulls and creates action.  In the case of the knee cap (patella), the knee cap helps to facilitate the transfer of that muscle energy from the calf to extend the knee and lift the leg.  Without the knee cap, the tendon would wear and fail.  Therefore, the purpose of an accessory bone like the knee cap or accessory navicular is to facilitate the transfer of muscle and tendon force around a corner, creating action in a direction other than direct pull by the muscle and tendon.</p> <h3>Types of accessory navicular pain</h3> <p>The accessory navicular can present with two types of pain.  In cases of a flat foot, the accessory navicular presses against the wall of the shoe causing pain.  Think square peg and round hole where the square peg is the foot and accessory navicular and the shoe is the round hole. It’s just a poor fit.  Let’s call this type of accessory navicular pain type one pain.  Type one pain is usually more pronounced when wearing shoes.</p> <p>The second type of pain we’ll see with an accessory navicular is pain due to inflammation between the accessory navicular and the navicular itself.  Many of us are familiar with knee pain due to rough cartilage on the back of the knee cap.  This condition is called chondromalacia patella.  I’ve never heard the term used before, but type two accessory navicular pain, caused by inflammation of the interface between the accessory navicular and navicular, could also be called chondromalacia navicular.  But for sake of this article, let’s just call it type two accessory navicular pain.</p> <h3>Treatment of accessory navicular pain</h3> <p>Type one accessory navicular pain is treated by off-loading direct pressure to the accessory navicular.  This can be done with adhesive-backed felt padding in the shoe.  Depending upon the needed thickness, use a split 1/8 inch thick <a href="https://www.myfootshop.com/tongue-pads-felt">Tongue Pad</a> or a 1/4 inch thick <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">Felt Metatarsal Pad</a>, using scissors to craft the pad in a way that allows for off-loading of the accessory navicular.</p> <p><a href="https://www.myfootshop.com/comfo-arch"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/985_Comfo_Arch_Insole.jpg" alt="Comfo Arch" width="75" /></a>Type two accessory navicular pain may be isolated or found in conjunction with type one accessory navicular pain.  In type two, strain on the tendon and motion between the navicular and accessory navicular are the primary causes of pain.  This pain can be treated with arch support.  For flat to moderate arch height, I use the <a href="https://www.myfootshop.com/comfo-arch">Comfo Arch Support</a>. <a href="https://www.myfootshop.com/comfo-high-arch-insole"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Products/986_Comfo-High Arch Insole_alt_1.jpg" alt="Comfo-High Arch Insole" width="75" /></a>For a higher arch, I default to the <a href="https://www.myfootshop.com/comfo-high-arch-insole">Comfo-High Arch Insole</a>.  Both the Comfo arch and the Comfo-High Arch Insole will conform to the shape of the navicular.  In cases of combined type one and type two accessory navicular pain, a combination of arch support and padding may be required.</p> <p>Some cases of accessory navicular pain fail to respond to the conservative care measure described above.  In those cases, surgical excision of the accessory navicular may be required.  The steps used to excise the accessory navicular are described in our article of <a href="https://www.myfootshop.com/posterior-tibial-tendon-dysfunction">posterior tibial tendon dysfunction</a>.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:312https://www.myfootshop.com/fungal-toe-nail-treatment-the-natural-non-surgical-wayFungal Toe Nail Treatment – The Two-Step Method<h2>The two-step process for non-surgical treatment of <a href="/images/uploaded/Medical/Derm/onychomycosis_toe_1.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Medical/Derm/onychomycosis_toe_1.jpg" alt="Onychomycosis" width="150" /></a>onychomycosis</h2> <p> </p> <p>Fungal toe nail infection, also called <a href="https://www.myfootshop.com/onychomycosis#Tab3">onychomycosis</a>, is a progressive disorder of the nail that is due to the environment inside our shoes.  Fungus is a plant, and to survive fungus needs an environment that is dark, warm and moist.  There’s no better place for a fungus to thrive than inside your shoe.  Smart little plant, that fungus.</p> <p> </p> <h2>But I shower every day - how did I get a fungal toe nail infection?</h2> <p>As a species, we humans are shed machines.  I’ve heard estimates that in the course of our lifetimes, each of us will shed an amount of skin, hair and nail cells close to three times our body weight.   That means that a 100lbs person will shed 300lbs of skin cells in their lifetime.  Where does all this detritus go?  We can vacuum and sweep, but inevitably we’re bound to come in contact with this shed, especially in areas of high people traffic like the grocery store, post office, etc.  And in many cases, this shed is going to have little surprises in it like fungus cells.  That’s where the fungal toe nail story begins.</p> <p>Many fungal nail infections are preceded by an <a href="https://www.myfootshop.com/toe-nail-injuries#Tab3">injury to the nail</a>.  The protective barrier provided by the nail is disrupted with an injury to the nail and that's when our little fungal friends take advantage of an opportunity to infect the nail.  The process of infection is slow, typically beginning at the distal margin of the nail and progressing over a period of months to years to the base of the nail.  Changes include;</p> <ul> <li>Thickening of the nail</li> <li>White/yellow discoloration of the nail</li> <li>Separation of the nail from the underlying nail bed</li> </ul> <h3> </h3> <h3>Treatment options for onychomycosis</h3> <p>What’s the best treatment for fungal nail infections?  It’s important to recognize that there’s no silver bullet treatment for fungal nail infections.  Most importantly, you need to realize that treatment needs to be daily and ongoing.  Treatment of fungal nail infections should be considered foot hygiene, just as brushing your teeth is a daily dental hygiene project.</p> <p>Traditional approaches to the treatment of onychomycosis include;</p> <ul> <li>Topical over-the-counter (OTC) medications (<a href="https://funginail.com/">FungiNail</a>, <a href="https://www.myfootshop.com/terpenicol-antifungal-cream">Terpenicol</a>)</li> <li>Topical prescription medications (<a href="https://www.jubliarx.com/">Jublia</a>, <a href="https://www.rxlist.com/penlac-drug.htm">Penlac</a>)</li> <li>Oral antifungal medications (<a href="https://en.wikipedia.org/wiki/Terbinafine">Lamisil</a>, <a href="https://en.wikipedia.org/wiki/Itraconazole">Sporonox</a>)</li> <li>Surgical excision of the nail (temporary or permanent)</li> </ul> <p>As a practicing podiatrist, I have this ‘toe nail’ conversation with patients each and every day.  And invariably, every patient asks, “Isn’t there a better way?”  Yes, there is a better way to treat toe nail fungus that’s safe, affordable and natural.  Let’s walk through the steps you should take to treat your toe nail fungus with <a href="https://www.myfootshop.com/natural-antifungal-nail-solution">Natural Antifungal Nail Solution</a> and <a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Antifungal Nail Butter</a>.</p> <h4> </h4> <h4>Steps to treat toe nail fungus</h4> <p>The first step is to determine the severity of your toe nail infection.  How severe is your nail infection?  Image 1 shows an early, superficial fungal infection of the nail.  Image 2 shows a deep fungal infection of the nail.  Let’s take a look at the best treatment methods for both a superficial and deep fungal infection of the nail.</p> <p> </p> <h4>Treatment of superficial fungal infections of the toe nail</h4> <p>Superficial fungal infections of the nail can be treated with daily applications of <a href="https://www.myfootshop.com/natural-antifungal-nail-solution">Natural Antifungal Nail Solution</a>.  Clean the nail<a href="/images/uploaded/Medical/Derm/onychomycosis_foot_1_labeled.jpg" target="&quot;_blank:"><img style="float: right;" src="/images/uploaded/Medical/Derm/onychomycosis_foot_1_labeled.jpg" alt="Superficial onychomycosis" width="150" /></a> with soap and water or alternatively with an alcohol swab.  Apply Natural Antifungal Nail Solution twice daily to the nail.  Be sure to continue application of Natural Antifungal Nail Solution until the entire fungal infection has grown out.  Depending upon the severity of the fungal toe nail infection, this may take months. </p> <p> </p> <p><strong>Treatment tips! </strong></p> <ul style="list-style-type: disc;"> <li>Be patient and be compliant. </li> <li>Every treatment you miss is a win for the fungus. </li> <li>Twice a day, every day is the way you win this battle.</li> <li>Keep your feet cool, dry and open to UV light.  Use a drying agent like <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> on a daily basis.</li> <li>Rotate shoes allowing 24 hours between use to allow them to dry thoroughly.</li> </ul> <p> </p> <h4>Treatment of deep fungal infections of the toe nail</h4> <p>Treatment of deep fungal nail infections is a two-stage project that requires physical and chemical debridement (removal) of the <a href="/images/uploaded/Medical/Derm/onychomycosis_toe_3_labeled.jpg" target="_blank"><img style="float: right;" src="/images/uploaded/Medical/Derm/onychomycosis_toe_3_labeled.jpg" alt="Deep onychomycosis" width="150" /></a>nail and follow-up daily treatment of the toe nail fungus.  To treat deep fungal infections of the toe nail, begin with mechanical debridement (removal) of the nail using a <a href="https://www.myfootshop.com/nail-cutter-large">nail cutter</a>.  Remove as much nail as possible.  Next, begin chemical debridement of the nail by applying <a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Antifungal Nail Butter</a>.  Natural Antifungal Nail Butter works to gently remove diseased portions of the nail while preserving healthy nail.  It also actively treats toe nail fungus.  Once you feel that the Natural Antifungal Nail Butter has removed the entire fungal nail, discontinue Natural Antifungal Nail butter and begin using Natural Antifungal Nail Solution.</p> <p> </p> <p><strong>Treatment tips!</strong></p> <ul style="list-style-type: disc;"> <li>Mechanical and chemical removal of the diseased (fungal) nail is required for optimal antifungal treatment</li> <li>Natural Antifungal Nail Butter will make your nail fall off – you got that right!  But that’s exactly what we want.</li> <li>Use Natural Antifungal Nail Butter to remove the fungal toe nail but transition to a less aggressive method of treatment (Natural Antifungal Nail Solution) for long term treatment of the fungus.</li> <li>Keep your feet cool, dry and open to UV light.  Use a drying agent like <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> on a daily basis.</li> <li>Rotate shoes allowing 24 hours between use to allow them to dry thoroughly.</li> </ul> <p> </p> <p>There is a fungus among us.  But treatment of toe nail fungus is possible with safe, affordable and effective natural tools from Myfootshop.com.  You’ll never cure toe nail fungus, but you can have clear, beautiful nails with ongoing treatment.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:311https://www.myfootshop.com/brodsky-stage-5-have-we-overlooked-the-forefootBrodsky type 5 - have we overlooked the forefoot?<h3>Is Brodsky type 5 neuropathic arthropathy often overlooked?</h3> <p>In his 1986 Foot and Ankle article, <em>Patterns of Breakdown in the Charcot Tarsus of Diabetics and Relation to Treatment</em>, Dallas based orthopedist James Brodsky defined patterns of breakdown seen in <a href="https://www.myfootshop.com/charcot-joint">Charcot arthropathy</a> (also called diabetic neuropathic arthropathy or Charcot joint).  He defined three primary, yet separate zones that included the midfoot or what is called Lisfranc’s joint (Type 1), Chopart’s joint and the subtalar joint (Type 2) and the ankle (Type 3A).  Type 3B follows a fracture of the Calcaneal tuberosity.  Brodsky describes types 4 and 5 (forefoot) as far less common.  Frequencies of each type of Charcot arthropathy are seen in the chart below adapted from <a href="https://www.orthobullets.com/foot-and-ankle/7047/diabetic-charcot-neuropathy">Ortho Bullets</a>.</p> <p>Brodsky Classification</p> <p> </p> <p><a href="/images/uploaded/Medical/Graphics/Type_0_brodsky.png" target="_blank"><img src="/images/uploaded/Medical/Graphics/Type_0_brodsky.png" alt="Brodsky classification of neuropathic arthropathy" width="200" /></a></p> <table> <tbody> <tr> <td width="638"> <p>Type 1   • Involves tarsometatarsal and naviculocuneiform joints</p> <p style="padding-left: 30px;"> • Collapse leads to fixed rocker-bottom foot with valgus angulation</p> <p style="padding-left: 30px;">60%</p> <p>Type 2   • Involves subtalar, talonavicular or calcaneocuboid joints</p> <p style="padding-left: 30px;"> • Unstable, requires long periods of immobilization (up to 2 years)</p> <p style="padding-left: 30px;">10%</p> <p> Type 3A               • Involves tibiotalar joint</p> <p style="padding-left: 30px;"> • Late varus or valgus deformity produces ulceration and osteomyelitis of malleoli          20%       </p> <p>Type 3B                • Follows fracture of calcaneal tuberosity</p> <p style="padding-left: 30px;"> • Late deformity results in distal foot changes or proximal migration of the tuberosity   &lt; 10%   </p> <p>Type 4  </p> <p style="padding-left: 30px;">• Involves a combination of areas           &lt; 10%   </p> <p>Type 5  </p> <p style="padding-left: 30px;">• Occurs solely within forefoot&lt; 10%</p> <p> </p> </td> </tr> </tbody> </table> <p> </p> <p>In my practice, I see that neuropathic arthropathy, particularly when secondary to diabetic peripheral neuropathy, often affects the forefoot.  Is the prevalence of Brodsky type 5 perhaps and overlooked aspect of diabetic foot care?  The two following cases show progressive neuropathy changes specific to the metatarsal phalangeal joints and digits (Brodsky type 5).  </p> <p>Case number one is a 57y/o female who presented to my office from our emergency department for swelling of the forefoot.  She described a 23-year hx of poorly controlled type 1 diabetes.  She recalled no hx of injury to the foot but states that she felt obligated to prepare food for a family reunion.  The onset of symptoms occurred two months prior to her visit with us.  She states that the foot became progressively worse over the week-long family reunion.  The foot was warm to touch with minimal pain described with range of motion of the forefoot.  Surface temperature of the forefoot was elevated by 3 degrees compared to the shin as measured by infrared temperature testing.  Plain films showed the following.</p> <p><a href="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy_4.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy_4.jpg" alt="Brodsky stage 5 Charcot arthropathy" width="200" /></a></p> <p>Case number two shows the progressive changes within the interphalangeal joint of a 34 y/o female.  She describes a 12-year hx of poorly controlled T2DM.  The patient also describes a hx of opioid addiction and chronic pain management.  In this case, the patient does describe a hx of trauma in that she fell down her stairs at home.  Early x-rays show a marginally displaced intra-articular fracture of the distal phalanx.  X-rays taken 4 weeks later show displacement of the fracture fragment, osteolysis of the fracture site with a new, longitudinal fracture of the central proximal phalanx. </p> <p><a href="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy_3.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy_3.jpg" alt="Brodsky type 5 neuropathic arthropathy" width="200" /></a>   <a href="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy_2.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy_2.jpg" alt="Brodsky type 5 neuropathic arthropathy" width="200" /></a>   <a href="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/diabetic neuropathic arthropathy.jpg" alt="Brodsky type 5 neuropathic arthropathy" width="200" /></a></p> <p>These two case show progressive changes of the metatarsal phalangeal jonts and phalanges, but are they truly type 5 Charcot by the classical definition?  The citation to Ortho Bullets above cites three contributing factors to Charcot arthropathy.</p> <table> <tbody> <tr> <td width="638"> <p>Mechanism and pathophysiology of Charcot arthropathy</p> <p>o    theories</p> <ul> <li>neurotraumatic</li> </ul> <ul> <li>  insensate joints subjected to repetitive microtrauma</li> <li>  body unable to adopt protective mechanisms to compensate for microtrauma due to abnormal sensation</li> </ul> <ul> <li>neurovascular</li> <ul> <li>autonomic dysfunction increases blood flow through AV shunting</li> <li>leads to bone resorption and weakening</li> </ul> </ul> <p>o    molecular biology</p> <ul> <li>inflammatory cytokines may cause destruction</li> <ul> <li>IL-1 and TNF-alpha lead to increased production of</li> <ul> <li>transcription factor-kB</li> <li>RANK/RANKL/OPG triad pathway </li> </ul> </ul> </ul> <p> </p> </td> </tr> </tbody> </table> <p>The above theories that describe the onset of neuropathic arthropathy suggest that trauma, whether repetitive micro-trauma (case 1) or abrupt trauma (case 2) contribute to the onset of Charcot arthropathy while neuropathy both aggravates and delays healing.  Knowing these facts, the two cases briefly discussed above represent Brodsky type 5 neuropathic arthropathy.  As foot and ankle specialists, we know to keep a high degree of suspicion for midfoot Charcot arthropathy.  I think we need to have the same high degree of suspicion in our diabetic population when we see forefoot swelling suggestive of Brodsky type 5 diabetic neuropathic arthropathy.</p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:310https://www.myfootshop.com/medically-guided-shopping-Medically Guided Shopping ™<h3>Using Medically Guided Shopping™ to select the right products for plantar fasciitis<a href="https://www.myfootshop.com/article/plantar-fasciitis#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Blog images/plantar fasciitis screen shot - Copy 1.jpg" alt="medically guided shopping - plantar fasciitis" width="300" /></a></h3> <p>I was working with a patient this morning, discussing one of the more common problems that a foot doc sees in practice – <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a>.  At the conclusion of the discussion, I printed the plantar fasciitis knowledge base article in Myfootshop.com’s foot and ankle knowledge base and gave it to the patient.  This accomplished two goals of the patient visit.  First, printing the article helps confirm the points discussed in the patient visit.  The patient can take the article home and read it in the leisure of their home.  Second, printing the article <a href="https://qpp.cms.gov/mips/overview">satisfies MIPS requirements for physician Meaningful Use</a>.</p> <p>But then the patient said, “So, do I just go to WalMart for those heel lifts?”  That’s when I explained to her how <a href="https://www.myfootshop.com/medicallyguidedshopping">Medically Guided Shopping™</a> works.  How do you find the right diagnosis and the right product?</p> <ul> <li>Step 1 – Navigate to <a href="https://www.myfootshop.com/articles">www.myfootshop.com/articles</a> and click on the location where it hurts</li> <li>Step 2 – Research the conditions specific to that region of the foot and make your diagnosis.</li> <li>Step 3 – Evaluate the products selected by our medical staff (always located at the bottom of the condition article) specific to that condition.</li> <li>Step 4 – Make your purchase.</li> </ul> <p>Finding the right product for foot and ankle conditions is easy when you use Medically Guided Shopping™.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:309https://www.myfootshop.com/may-thurner-syndromeMay-Thurner Syndrome<h2>Differential diagnosis for unilateral, left leg edema<img style="float: right;" src="/Content/Images/uploaded/Medical/Vascular/May-Thurner_syndrome.jpg" alt="May-Thurner Syndrome" width="200" /></h2> <p>I saw a 53-year-old female today for left ankle pain and chronic left leg swelling.  The swelling was pitting, meaning that with digital pressure to the skin, when you pull away, your finger leaves a divot, or pit in the skin.  Pitting edema classically describes fluid retention in the legs, commonly called <a href="https://www.myfootshop.com/article/venous-stasis-dermatitis-and-venous-ulcerations#Tab3">venous stasis</a>.  But this case was unusual.  The swelling was only in the left leg. </p> <p>What is the significance of unilateral vs. bilateral edema?  Bilateral edema is by far more common and signifies a fluid overload of the body.  With standing or dependency of the legs, the legs will swell with fluid edema.  An important characteristic of fluid retention and lower extremity swelling is the fact that the edema is found in both legs.</p> <p>What could cause unilateral swelling of the left leg?  Fortunately, this patient was familiar with her diagnosis and has been thoroughly evaluated by vascular medicine specialists.  This patient presented with May-Thurner Syndrome which is a compression syndrome of the iliac vein.  The iliac <img style="float: left;" src="/Content/Images/uploaded/Medical/Vascular/Compression site for May-Thurner.jpg" alt="May-Thurner venous compression" width="150" />vein is found in the lower pelvis and is the final vein of the lower extremity that feeds into the vena cava, the primary vein that returns blood to the heart.  In cases of May-Thurner Syndrome, swelling of the legs is exclusive to the left leg due to the unique anatomical, arterial-venous complex found in the lower abdomen.  May-Thurner Syndrome is caused by compression of the left iliac vein by the right common iliac artery. </p> <p>It’s interesting to note that May-Thurner Syndrome is due to the alignment of the vena cava (venous return to the heart) and aorta (arterial supply to the legs).  You can see from the attached picture how the anatomical arrangement of the arterial tree is superficial to the venous return.</p> <p>Treatment of May-Thurner syndrome is primarily fluid management with diuretics, compression hose and venous ablation of the superficial veins of the left leg. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:308https://www.myfootshop.com/foot-and-ankle-resources-for-providersFoot and Ankle Resources for Providers<h2>Foot and ankle educational resources for patients<img style="float: right;" src="/Content/Images/uploaded/MISC/Dr_Oster_headshot.jpg" alt="" width="200" /></h2> <h3>A how-to guide for providers – using the Myfootshop.com foot and ankle knowledge base</h3> <p>As a health care provider, how can you use Myfootshop.com’s foot and ankle knowledge base to benefit your patients?  There are two ways that are really quick and easy.</p> <ol> <li>      <strong>During patient visits.</strong></li> </ol> <p style="padding-left: 60px;">Ever get stuck trying to educate a patient about anatomy, body planes or the bone structure of the foot?  A picture can be worth a thousand words.  Here are some fast references you might want to use on your laptop to help patients.</p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/articles/List/27">X-rays of the foot and ankle</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/articles/List/21">Spatial orientation</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/articles/List/26">Muscles of the lower extremity</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/articles/List/25">Nerves of the lower extremity</a></p> <ol> <li>       <strong>Conclusion of the patient’s  visit</strong></li> </ol> <p style="padding-left: 60px;">It’s easy to satisfy Meaningful Use requirements with foot and ankle knowledge base pages.  Here’s a few quick links to some of our more popular foot and ankle knowledge base page.</p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/article/plantar-fasciitis#Tab3">Plantar fasciitis</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/article/achilles-tendonitis#Tab3">Achilles tendinitis</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/article/saddle-bone-deformity#Tab3">Saddle bone deformities</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/article/hallux-limitus#Tab3">Hallux limitus</a></p> <p style="padding-left: 90px;"><a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3">PTTD</a></p> <p> </p> <p>All articles are open source meaning that you are free to share articles with your patients.  Simply print the article at the conclusion of your patient’s visit and you’ve not only helped your patient understand your recommendations, but you’ve also checked just one more box off the MIPS list.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:306https://www.myfootshop.com/foot-drop-injury-to-the-common-peroneal-nerveFoot Drop - injury to the common peroneal nerve<h2>Foot drop – trauma and treatment<a href="https://www.myfootshop.com/article/peroneal-palsy#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/surgery_external_neurolysis_common_peroneal_nerve_mod1.jpg" alt="Common peroneal nerve" width="250" /></a></h2> <h3>Contusion of the common peroneal nerve resulting in foot drop</h3> <p>I saw an interesting case of post-trauma foot drop (<a href="https://www.myfootshop.com/article/peroneal-palsy#Tab3">peroneal palsy</a>) this week.  The patient was a 24 y/o female who described falling against her car and hitting her right leg on the license plate.  She presented to the emergency department for a small laceration of the lateral knee.  She also described the inability to lift her foot while walking.  The laceration was dressed in the ED and the patient referred to me for follow-up.</p> <p>The patient is of healthy BMI, good health and an everyday smoker.  Upon examination, she showed a well-healed laceration of the lateral right knee.  Muscle strength testing was strong on the left leg noting dorsiflexion, plantarflexion, inversion, and eversion all 4/4 with resistance.  The injured right leg though showed 4/4 plantar flexion with 2/4 inversion and eversion.  Dorsiflexion was present but limited at 1/4.  Findings were suggestive of an injury to the common peroneal nerve.  Sensation of the top of the foot (distribution of the common peroneal nerve) was intact.  Gait exam noted adequate but weak dorsiflexion of the right foot in the swing phase of gait.  The patient did relate two falls since the injury due to instability of the ankle.  Percussion of the injury site noted a positive Tinel’s sign to the dorsal right foot.</p> <h3>Anatomy of the common peroneal nerve</h3> <p><img style="float: left;" src="/Content/Images/uploaded/Anatomy/Neurology/Nerves_lower_extremities.jpg" alt="Nerves of the lower extremity" width="100" />The <a href="https://www.myfootshop.com/article/nerves-lower-extremities">common peroneal nerve</a> is a branch of the sciatic nerve that wraps around the lateral aspect of the knee just below the head of the fibula.  The common peroneal nerve branches into the superficial and deep branches.  The deep branch supplies the innervations to the two dorsiflexors of the ankle, the <a href="https://www.myfootshop.com/article/extensor-digitorum-longus">extensor digitorum longus</a> and the <a href="https://www.myfootshop.com/article/tibialis-anterior">tibialis anterior muscles</a>.</p> <p>Innervation of the extensor digitorum longus and tibialis anterior by the deep branch of the common peroneal nerve enables dorsiflexion of the foot at the ankle.  Dorsiflexion at the ankle is an important part of the biomechanics of walking.  In the swing phase of gait, when the foot is not touching the ground but swinging forward at the hip, the innervations of these muscles lifts the foot so that it doesn’t drag on the ground.  Injury to the common peroneal nerve results in foot drop or ‘palsy’.  Inability to lift the foot at the ankle necessitates lifting of the leg at the hip and low back to complete a cycle of gait.</p> <h4>Neuropraxia of the common peroneal nerve</h4> <p>Injuries of peripheral nerves are broken down into three primary types by the <a href="https://en.wikipedia.org/wiki/Nerve_injury">Seddon classification</a> of peripheral nerve injuries.  My patient sustained the mildest of injury called neuropraxia.  Neuropraxia should respond in weeks to months as the nerve regains its ability to send both motor and sensory signals.</p> <h4>Treatment of peroneal palsy</h4> <p>What was interesting in this particular case was the fact that the laceration was several centimeters proximal to the common peroneal nerve.  This knowledge was comforting in that we could assume that there was not a direct laceration of the common peroneal nerve.  Palpation of the nerve at the head of the fibula produced a tingling sensation in the top of the foot called a Tinel’s sign.  A positive Tinel's sign meant that the common peroneal nerve was intact.</p> <p>The initial injury was treated with ice, elevation, and compression.  Since the common peroneal nerve was found clinically to be intact, there was no need for surgical exploration or reapposition of a lacerated nerve.  Physical therapy has been helping with muscle strengthening, preserving existing muscle strength while the nerve regenerates.</p> <p>How quickly will the nerve regenerate?  There are a number of variables in this case that include;</p> <ul> <li>Age of the patient</li> <li>Smoking status</li> <li>Severity of the injury to the nerve</li> </ul> <p>Based on our clinical findings this week, I think the patient will go on to a full recovery. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:307https://www.myfootshop.com/adjacent-segment-disease-secondary-to-correction-of-charcot-deformitiesAdjacent segment disease secondary to correction of Charcot deformities<h2>Charcot joint treatment pearls...<img style="float: right;" src="/Content/Images/uploaded/Blog images/doctor-79579_640.jpg" alt="" width="250" /></h2> <p>In my blog post last week, I discussed how fusion of one joint increases load to adjacent joints resulting in early onset of pain and arthritis.  This accelerated deformation of the joint is called adjacent segment disease.  Speaking of adjacent segment disease…</p> <p>I was at a limb salvage seminar today and had a number of great conversations related to reconstructive surgery and limb salvage.  A big topic of conversation was Charcot joint surgery.  The thread that connected these conversations was that there is no clearly defined ‘correct’ way to treat Charcot arthropathy.  Is surgery best?  Is conservative care better?  There really are no guidelines for care, but it seems that these conversations with my peers are the guideposts that best sum up care.</p> <p>Here’s a couple of important topics that bubbled up during the day.</p> <ol> <li>If you surgically fuse a Charcot joint, expect adjacent segment disease at the next proximal joint.  This stands to reason in that the load that was once distributed across two joints is now distributed across one.  That increase load in a fragile foot will certainly lead to a greater incidence of Charcot arthropathy.</li> <li>Don’t treat stage 1 Charcot joints with fusion.  Eichenholtz defined the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317422/">four stages of Charcot arthropathy</a>.(1)  In stage 1 where the foot is hot, active and weak, primary fusion is a poor choice.  An external frame to support the foot is the best way to protect the foot from deformation.  Total contact casting is the next best alternative.</li> <li>When you’re using an ex-fix frame to treat Charcot joints, expect three problems.  What will those problems be?  It’s hard to say.  Just expect three.</li> </ol> <p>Great to be able to join with peers today to discuss these complex foot and ankle challenges. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <ol> <li>       <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317422/">Clin Orthop Relat Res</a>. 2015 Mar; 473(3): 1168–1171.</li> </ol> <p>Updated 12/24/2019</p>urn:store:1:blog:post:305https://www.myfootshop.com/adjacent-segment-disease-post-bunionectomyAdjacent segment disease post bunionectomy<h1>To fuse or not to fuse – that is the bunionectomy<a href="https://www.myfootshop.com/article/bunion#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Medical/Surgery/surgery_austin_bunionectomy_mod4.jpg" alt="Austin bunionectomy" width="250" /></a></h1> <h2>Adjacent segment pathology following bunionectomy procedures</h2> <p>Foot and ankle surgeons use a number of fusion techniques to treat forefoot pathology.  Fusion of the great toe joint is commonly used to treat acquired hallux valgus (bunion).  The Lapidus procedure (fusion of the metatarsal cuneiform joint) has also become popular as a method of <a href="https://www.myfootshop.com/article/bunion#Tab3">bunionectomy</a> over the past decade.  Surgeons who use these fusion procedures would argue that they feel more comfortable with structural surgical procedures in that they have more control over the outcome of the surgery and a more lasting result. </p> <p>Bunionectomy procedures that use balancing (non-fusion) rather than structural techniques are more common procedures.   Balancing procedures would include the Austin bunionectomy or Mitchell bunionectomy.  Balancing procedures, like the Austin or Mitchell, rely on ‘on the table’ results that appear good at the conclusion of the procedure.  But what you see on the operating table changes dramatically when the patient begins to walk.  Every surgeon who performs bunionectomy procedures has seen a beautiful outcome at the time of surgery change dramatically for the worse within months post-op.  That’s why many surgeons rely on the permanence of structural bunionectomy procedures.</p> <h3>Complications of fusion procedures of the forefoot</h3> <p>Fusion procedures, regardless of the location in the body, may result in a post-operative problem called adjacent segment pathology.  Adjacent segment pathology is the term used to describe the stress effects on joints adjacent to fusion sites.   The definition of adjacent segment pathology, to a great degree, focuses on spine surgery and the effects on cervical and lumbar joints adjacent to fusion sites.  Fusion of a joint limits the range of motion of the joint, altering normal range of motion and increasing load to adjacent joints.   The incidence of adjacent segment pathology post lumbar fusion ranges from 5% to 100%.(1)</p> <p>Adjacent segment pathology can be broken down into two subcategories; adjacent segment degeneration and adjacent segment disease.  Hilibrand and Robbins described these two subcategories referring to adjacent segment degeneration as merely a radiographic finding with no clinical symptoms while adjacent segment disease represents a symptomatic adjacent joint with radiographic findings. (2)</p> <p>Lee and Choi in their article <em>Adjacent Segment Pathology After Lumbar Fusion</em>, describe a number of factors that they consider to be contributing factors to adjacent segment pathology in spine sugary. (3)  Those factors include;</p> <p><strong>Pre-existing variables</strong></p> <ul> <li>Age</li> <li>Adjacent segment disc degeneration</li> <li>Tropism of adjacent segments</li> <li>Gender</li> <li>Osteoporosis</li> <li>Physical activity</li> </ul> <p><strong>Surgery related variables</strong></p> <ul> <li>Number of segments fused</li> <li>Adjacent segment damage during surgery</li> <li>Fusion methods</li> <li>Alignment</li> </ul> <p>If we fuse a portion of the forefoot, what is the effect on adjacent segments?  In the case of the great toe joint fusion, I think the effects are minimal.  Surgeons intentionally fuse the great toe in a position that is dorsiflexed, or elevated.  By fusing the great toe in a dorsiflexed position, the forefoot will rock over the joint with no significant limitation in range of motion.  Granted, the foot may be a bit less propulsive in running, but in walking, there is minimal adjacent segment loading post great to fusion.</p> <p>The Lapidus procedure may be a different story.  As mentioned earlier, the Lapidus procedure is a bunionectomy that corrects the bunion deformity by means of fusing the metatarsal cuneiform joint.  Load applied to the forefoot, post-Lapidus procedure, is no longer accommodated by the metatarsal-cuneiform joint but in now carried by the cuneiform-navicular joint.  I’ve yet to see studies in the literature that discuss the impact of medial column fusion on the remaining midtarsal joints. </p> <p>It stands to reason that the criteria defined by Lee and Choi would hold constant with the Lapidus procedure.  The result adjacent segment disease post-Lapidus procedure would be an increase in the onset and severity of midfoot osteoarthritis.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p> </p> <ol> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/15541666">Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 2004;29:1938–1944. </a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pubmed/15541666">Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4(6 Suppl):190S–194S.</a></li> <li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591457/#B8">Lee JC, Choi S. Adjacent segment pathology after lumbar fusion.  Asian Spine J. 2015 Oct; 9(5): 807–817.</a></li> </ol> <p> </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:304https://www.myfootshop.com/lisfrancs-fracture-and-fixation-questionsLisfranc’s fracture and fixation questions<h2>Lisfranc fractures - when is the most appropriate time to <img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/xray_foot_lisfranc's_fracture_intra-op.jpg" alt="Closed reduction Lisfranc fracture" width="300" />remove the fixation?</h2> <p>Most foot and ankle surgeons will agree that there’s a need to remove fixation, particularly screw fixation, prior to failure of the fixation by weight-bearing. Once broken, internal fixation is almost impossible to remove without significant dissection.</p> <p>So that begs the question; when is the best time to remove fixation? When a doctor has a question like this, there’s only one place to turn – to the literature.</p> <p>A great 2010 International Orthopedics article, entitled ‘The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature’,  does a good drill down on the topic by using a meta-analysis of the literature. (1) Here’s a summary of the article and aggregated recommendations from the articles reviewed.</p> <ul> <li>Routine hardware removal at 8, 10 or 12 weeks. (2,3,4,5)</li> <li>Routine hardware only after radiographic confirmation of healing. (6,7)</li> <li>Removal of hardware only if there’s hardware failure. (8,9)</li> <li>No recommendations for hardware removal (10,11,12)</li> </ul> <p>What about removal by type of fixation (screw vs k-wire)? Screw removal was performed at 8 weeks in 14% of patients (4,5), 12 weeks in 11.6% of patients (2,3) and at 16 weeks in 17% of patients.(3,7) Clearly, no defined time limit here on removal of screw fixation for Lisfranc fractures. K-wires were typically removed at 6-8 weeks. (5,8)</p> <p>Why the discrepancies in these numbers? Why doesn’t all fixation come out at the same time? First, you need to assess the patient in terms of the capacity to heal. Issues that may influence bone healing may include;</p> <ul> <li>Patient age</li> <li>History of smoking</li> <li>BMI</li> <li>Ability to remain non-weight bearing</li> <li>Co-morbidities such as diabetes, renal disease</li> <li>Peripheral arterial disease</li> </ul> <p>Specific to the injury itself, variation in fixation removal times may be due to;</p> <ul> <li>The fracture/dislocation pattern (<a href="https://www.google.com/search?q=myerson+classification+of+lisfranc&amp;rlz=1C1LDJZ_en&amp;tbm=isch&amp;tbo=u&amp;source=univ&amp;sa=X&amp;ved=0ahUKEwikyLyJlobbAhUC74MKHTM3CcUQsAQIRQ&amp;biw=1280&amp;bih=892#imgrc=lSmWMaDTIMOCCM:">Myerson</a>, <a href="https://www.google.com/search?q=hardcastle+classification+lisfranc&amp;rlz=1C1LDJZ_en&amp;tbm=isch&amp;tbo=u&amp;source=univ&amp;sa=X&amp;ved=0ahUKEwjp34LClobbAhWk4IMKHb3iBKAQsAQIMg&amp;biw=1280&amp;bih=892#imgrc=jWeSnfGfvSlSTM:">Hardcastle</a> or <a href="https://www.google.com/search?q=myerson+classification+of+lisfranc&amp;rlz=1C1LDJZ_en&amp;tbm=isch&amp;tbo=u&amp;source=univ&amp;sa=X&amp;ved=0ahUKEwikyLyJlobbAhUC74MKHTM3CcUQsAQIRQ&amp;biw=1280&amp;bih=892#imgrc=t0ljrhy3CMvBmM:">Quénu and Küss </a>classifications)</li> <li>True dislocation, fracture or combined fracture/dislocation</li> </ul> <p>Yet, even after considering the make-up of the patient, co-morbidities and fracture/dislocation patterns, there’s still a significant range of answers to the simple question; when do you remove fixation in cases of Lisfranc’s fracture.</p> <p>So if medicine is a science, why isn't there one answer to this question?  Another case of ‘the art of medicine’ giving me job security.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <ol> <li>Stavlas, P, Roberts, C, et al. The role of reduction and fixation in Lisfrac fracture-dislocations: a systematic review of the literature. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989076/">Int Orthop</a>. 2010 Dec; 34(8): 1083–1091.</li> <li>Henning JA, Jones CB, Sietsema DL, et al. Open reduction internal fixation versus primary arthrodesis for Lisfranc injuries: a prospective randomized study. Foot Ankle Int. 2009;30:913–922. doi: 10.3113/FAI.2009.0913.</li> <li>Mulier T, Reynders P, Dereymaeker G, et al. Severe Lisfrancs injuries: primary arthrodesis or ORIF? Foot Ankle Int. 2002;23:902–905.</li> <li>Rajapakse B, Edwards A, Hong T. A single surgeon's experience of treatment of Lisfranc joint injuries. Injury.2006;37:914–921. doi: 10.1016/j.injury.2005.12.003.</li> <li>Rammelt S, Schneiders W, Schikore H, et al. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg Br.2008;90:1499–1506. doi: 10.1302/0301-620X.90B11.20695.</li> <li>Arntz CT, Veith RG, Hansen ST., Jr Fractures and fracture-dislocations of the tarsometatarsal joint. J Bone Joint Surg Am. 1988;70:173–181.</li> <li>Teng AL, Pinzur MS, Lomasney L, et al. Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation. Foot Ankle Int. 2002;23:922–926.</li> <li>Kuo RS, Tejwani NC, Digiovanni CW, et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg Am. 2000;82-A:1609–1618.</li> <li>Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am. 2006;88:514–520. doi: 10.2106/JBJS.E.00228.</li> <li>Perez Blanco R, Rodriguez Merchan C, Canosa Sevillano R, et al. Tarsometatarsal fractures and dislocations.J Orthop Trauma. 1988;2:188–194. doi: 10.1097/00005131-198802030-00003.</li> <li>Perugia D, Basile A, Battaglia A, et al. Fracture dislocations of Lisfranc's joint treated with closed reduction and percutaneous fixation. Int Orthop. 2003;27:30–35.</li> <li>Tan YH, Chin TW, Mitra AK, et al. Tarsometatarsal (Lisfranc's) injuries—results of open reduction and internal fixation. Ann Acad Med Singapore. 1995;24:816–819.</li> </ol> <p> </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:303https://www.myfootshop.com/anticoagulation-therapy-and-foot-surgery-how-do-you-safely-discontinue-anticoagulation-treatmentAnticoagulation therapy and foot surgery – how do you safely discontinue anticoagulation treatment?<h2>How risky is it to stop Coumadin prior to elective foot surgery?<img style="float: right;" src="/Content/Images/uploaded/Blog images/blood_vessel_cells.jpg" alt="erythrocytes" width="300" /></h2> <p>Anticoagulation therapy is used for a number of conditions including atrial fibrillation, history of deep vein thrombosis, cardiac and vascular implants and in cases of clotting disorders that result in thrombocytosis (elevated platelets that lead to clotting).  Invariably, some of these patients who are on anticoagulation therapy will need to undergo elective surgery.  As a podiatrist, how do I manage the transition away from Coumadin (warfarin) so that I can perform a surgery without excessive blood loss?</p> <h3>Is bridging with heparin necessary in elective foot surgery?</h3> <p>Salynn Boyles wrote a great article in MedPageToday on June 22, 2015 that drills down into the topic of anticoagulation therapy, elective surgery and bridging with heparin.  Coumadin and heparin both work to delay clotting.  Coumadin has a long half-life while heparin is short-acting.  Classically, Coumadin is stopped five days prior to a surgery and heparin is used as a bridge to inhibit clotting.  According to James Douketis, MD of McMaster University, Hamilton Ontario, bridging is no longer necessary.  Dr. Douketis states,</p> <p style="padding-left: 30px;"><em>“The rationale for the use of bridging anticoagulation therapy has been anchored on the premise that the associated higher bleeding risk was clinically acceptable because it would be off-set by a lower risk of peri-operative arterial thromboembolism.  The findings from our trial as well as from randomized studies suggest that the peri-operative risk of arterial thromboembolism in patients with atrial fibrillation during interruption of warfarin treatment may have been overstated and may not be mitigated by bridging anticoagulation.”</em></p> <p>The McMaster study was a double-blind, randomized trial that included 950 patients who received no bridging and 934 who did bridge with a low molecular weight heparin (dalteparin).  Patients were followed for 30 days post-surgery.  Thromboembolism was found in 0.4% of the no bridge and 0.3% of the bridged patients.</p> <p>In the article, hematologist Stephan Moll, MD of the University of North Carolina commented;</p> <p style="padding-left: 30px;"><em>“It has increasingly become clear that the patients at low or moderate risk for thromboembolism, either atrial fibrillation or DVT or PE patients on warfarin do not need low molecular weight heparin bridging when warfarin if temporarily interrupted for surgical interventions.   It leads to more bleeding yet no benefit.”</em></p> <h3>What is the new protocol for cessation of anticoagulation therapy for foot and ankle surgery patients?</h3> <p>Although the study suggests a low risk to patients undergoing foot and ankle surgery who are on Coumadin who undergo elective surgery without bridging, I still have concerns about three issues.</p> <ol> <li>Co-morbidities – patients who have co-morbidities that increase the chance of VTE (venous thromboembolism) would not be considered low risk.  Co-morbidities would include;</li> </ol> <ul> <li style="padding-left: 30px;">BMI greater than 40</li> <li style="padding-left: 30px;">Hx of past or present smoking</li> <li style="padding-left: 30px;">Current use of birth control pills</li> <li style="padding-left: 30px;">Patients currently using hormone replacement therapy</li> </ul> <p style="padding-left: 30px;">2. Tourniquet use in surgery – tourniquets are frequently used in lower extremity surgery.  Compression of the vein by a tourniquet during surgery may contribute to a VTE.</p> <p style="padding-left: 30px;">3. Ambulatory or non-ambulatory post-op – the make-up of the patient and the surgery that the patient undergoes results in either early ambulation, delayed ambulation or complete non-weight bearing post-op.  I would consider a patient who is actively anticoagulated to be high risk if the outcome of the surgery resulted in delayed weight-bearing or complete weight-bearing.</p> <p>But the bottom line for foot and ankle surgeons is the fact that we can feel a bit more comfortable with our choice to temporarily discontinue anticoagulation therapy without bridging with LMWH.  Our primary job is to ensure the safety of the patient.  And without bridging, surgery can often be performed more safely and easily without excessive bleeding.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:302https://www.myfootshop.com/what-is-a-stress-riserWhat is a stress riser?<h2><strong>How do stress risers affect bone healing and fractures?<img style="float: right;" src="/Content/Images/uploaded/Blog images/stress risers.jpg" alt="Stress risers" width="250" /></strong></h2> <p>The image to the right is one of those moments where my wife just shakes her head.  We were driving through northern New Mexico when I pulled over to the side of the road and got out of the car - in the middle of nowhere.  And I took a picture of the guardrail on the side of the road.  Getting back into the car my wife said to me, "Honey, what are we doing?"  My response was to say, "It's all about stress risers, honey."</p> <h3>What is the mechanical definition of a stress riser?</h3> <p>Take a close look at this image and what you'll see is that the highway department intentionally drilled holes (<a href="https://en.wikipedia.org/wiki/Stress_concentration">stress risers</a>)  in the base of each of the first five or six wooden posts holding up the guardrail.  The idea behind the holes is to decrease the impact that a car and driver would sustain upon hitting the guardrail.  The posts are intentionally drilled to snap at the hole.  The holes purposely make the post snap, resulting in a slower, more gradual impact.  In this case, stress risers can have a very positive effect and may actually save lives.</p> <p>Historically though, stress risers have been studied in engineering due to their negative impact on structures.  Two of the saddest examples of negative stress risers (or stress concentrations) was the design of the <a href="https://en.wikipedia.org/wiki/Liberty_ship">Liberty Ships of WWII </a>and of the <a href="https://en.wikipedia.org/wiki/De_Havilland_Comet">De Havallin Comet </a>Airplanes of the late 1950s and early 1960s.</p> <h3><strong>Bone - how it responds to stress</strong></h3> <p>Bone is remarkably designed to provide internal support and act as a reservoir for vitamins, minerals and bone marrow.  Bone is only one of the two tissues in the body (also the liver) that has the capacity to generate more bone in response to stress.  Bone also is remarkable in its ability to configure itself in a way that provides the best design for support and yet still allow motion in all three body planes.</p> <h4><strong>Stress risers in bone</strong></h4> <p>Stress risers in bone develop in areas of weakness that concentrate stress.  Stress risers in bone may include the following:</p> <ul> <li>Previous site of fracture</li> <li>Site of bone tumor or bone infection</li> <li>Current or previous implant site</li> </ul> <p>These examples of stress risers in bone are the sites that will first undergo deformity, leading to fracture.  Just like the posts on the highway, stress risers in bone will be a focal area for fracture.  That's why your doctor will often remove your hardware after internal fixation is used to treat a fracture.  Stress risers are probably the only downside of the science of fixation as described by the <a href="https://www.aofoundation.org/Structure/Pages/default.aspx">AO Foundation </a>in Davos, Switzerland.</p> <p>Thanks, honey for stopping on the side of the road in New Mexico.  I don't think I disturbed her knitting one bit.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:301https://www.myfootshop.com/talar-neck-fracturesTalar neck fractures<h2>Why are talar neck fractures so prone to avascular necrosis?<img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/Nutrient artery of the talus_mod.jpg" alt="Talar fracture patterns" width="325" /></h2> <p>Sometimes a simple x-ray can say it all.  With all of the advanced testing that we have today, a simple x-ray can speak volumes.  You aren’t always able to capture the subtleties of bones and joints with each and every x-ray.  But every so often, you see a film that speaks to you.</p> <p>The lateral foot x-ray in this post shows what is called the nutrient artery of the talus.  That small bullet-shaped hole is the primary in-flow point for blood flow to the talus.  Why is that important?  Talar fractures typically happen through what is called the neck of the talus (the black line).  And that’s exactly where this image shows the nutrient artery.</p> <p><img style="float: left;" src="/Content/Images/uploaded/Medical/Vascular/talus_arteriography1.jpg" alt="Arterial in-flow of the talus" width="300" />Most bones have a redundant blood supply so that when a fracture occurs at one end of the bone, the opposite end of the bone is called into action to participate in healing.  But the talus is different.  Although it has a small amount of redundancy, such as arteries coming in from both the medial and lateral sides of the talar neck, the fault in that redundancy is that the in-flow into the talus is all within the neck of the talus.  Unfortunately, the neck of the talus is where the majority of fractures take place.  Therefore, even simple talar neck fractures are prone to loss of blood flow resulting in avascular necrosis.  The image to the left shows some of that vascular in-flow pattern.</p> <h3>The Hawkin’s classification of talar neck fractures</h3> <p>Talar fractures are described by the Hawkins classification.  In the Hawkins classification, all stages, 1-4, have the primary fracture line within the neck of the talus.  With increased force applied to the fracture, dislocation of the talus from adjacent bones becomes more complex, therefore increasing the risk of avascular necrosis. (1)</p> <p> </p> <p>Hawkin’s classification and rates of avascular necrosis</p> <p style="padding-left: 30px;">Hawkins 1:   0- 13%<br /> Hawkins 2:  20- 50%<br /> Hawkins 3:  20-100%<br /> Hawkins 4:  75-100%</p> <h3>What is avascular necrosis of the talus?</h3> <p>That little bullet hole in the first image says it all.  That one image captures the location of the nutrient, or most significant artery that supplies blood flow to the talus.  Avascular necrosis is the term used to describe loss of blood flow to bone.  If the bone, and in the case, the talus, loses blood supply, the bone dies and collapses.  The only solution is a pantalar fusion, fusing the heel bone (calcaneus) to the leg bone (the tibia). </p> <p>In my book, that’s a bad day.</p> <p>References</p> <p><a href="https://www.wheelessonline.com/ortho/fractures_of_the_talar_neck">https://www.wheelessonline.com/ortho/fractures_of_the_talar_neck</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:300https://www.myfootshop.com/the-cure-for-plantar-faciitisThe cure for plantar faciitis!<h2>How do you cure plantar fasciitis? <img style="float: right;" src="/Content/Images/uploaded/Blog images/Plantar fasciitis banding_mod.jpg" alt="Plantar fasciitis banding" width="250" /></h2> <p>How six little hairbands can fix your feet.  We call it banding.</p> <p>I’ve seen thousands of patients who suffer from <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a>, and there's one thing for sure, they all suffer from the same problem; equines.  <a href="https://www.myfootshop.com/article/equinus">Equinus</a> is a medical condition that describes tightness in the calf.  What does tightness in the calf have to do with plantar fasciitis?  Let’s do a little drill down into the basics of plantar fasciitis and see what you can do to stop this common form of heel pain.</p> <p>When you were young and active, activities were all about strength and speed.  But as you age, the key to keeping active transitions away from strength and speed and becomes more of an issue about flexibility.  Flexibility is the key to preventing injuries in 30-60 y/o athletes. </p> <p>What does flexibility have to do with plantar fasciitis?  Think of plantar fasciitis as an overuse syndrome.  The primary contributing factor to plantar fasciitis is tightness in the calf that increases the mechanical load applied to the plantar fascia from the calf with each and every step you take.  And if those tissue structures (muscle, tendon, and fascia) are tight, that’s what contributes to overuse injuries like plantar fasciitis.</p> <h3>How to stretch your way out of painful plantar fasciitis.</h3> <p>The problem with stretching is simply remembering to get them done.  Stretches are like exercise; you need to stop and take the time out to just do them.  And most patients, even those in pain, simply forget to get six stretches done each day.  How do you remember to stretch?  Here’s the coolest idea that a patient has ever given me.  We call it banding – get six hairbands and put them on one wrist.  With each calf stretch, move one hairband to the opposite wrist.  And when they’ve all moved to the opposite wrist, you’re done for the day.</p> <h3>What's the best stretch to treat plantar fasciitis?</h3> <p>Stretches are best done for sixty seconds, six times a day.  Simply put the ball of your foot on the edge of a step and hang the heel off to make the calf burn a bit.  Hold that for 60 seconds and switch out a hairband from one wrist to the other.</p> <p>Thanks, Melanie.  Crowdsourcing medical care – a brilliant suggestion to help with getting all six stretches in each day.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:299https://www.myfootshop.com/5th-metatarsal-fractures-conservative-vs-surgical-care5th Metatarsal Fractures – Conservative vs. Surgical Care<h2>When is surgery indicated in 5<sup>th</sup> metatarsal fractures?</h2> <p>It's been a busy week for <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal fractures</a>.  I’ve seen three 5<sup>th</sup> metatarsal fractures this week.  One was a fracture that required open reduction with internal fixation (surgery).  One was treated with conservative care.  The third case was referred to me as a fracture for treatment - but is it really a fracture?  What determines how to treat a metatarsal fracture?  To understand how 5<sup>th</sup> metatarsal fractures heal, it’s important to understand a bit of bone anatomy. </p> <h3>Metatarsal bone anatomy</h3> <p><a href="https://www.myfootshop.com/article/x-ray-of-the-foot-anterior-posterior-view">Metatarsal bones</a> are a subset of bones classically called long bones.  Long bones, like metatarsal bones, consist of three types of bone.  These types of bone include <a href="https://en.wikipedia.org/wiki/Epiphysis">epiphyseal bone, metaphyseal bone and diaphyseal bone</a>.  </p> <ul> <li>Epiphysis – the end of the bone.</li> </ul> <p style="padding-left: 60px;">If the epiphysis articulates with another bone forming a joint, this is known as a pressure epiphysis.</p> <p style="padding-left: 60px;">If the epiphysis is the site of a tendon attachment, this is known as a traction epiphysis</p> <ul> <li>Metaphysis – the primary region of bone growth located adjacent to the epiphysis.</li> <li>Diaphysis-- - The long, hard central portion of the bone. </li> </ul> <p>To better explain long bone anatomy, let’s use a real-life example.  Think of a chicken drumstick.  The bone inside the drumstick is a long bone.  The drumstick has an epiphysis, metaphysis, and a diaphysis.  The epiphysis is the soft bone at either end, just under the cartilage.  The metaphysis is also the soft bone that transitions into the harder, central bone called the diaphysis.  Think of the diaphysis as a structural support, holding up the chicken and the epiphyseal and metaphyseal bone as a shock absorber that functions when the chicken jumps down of the roost in the morning. </p> <h3>Treatment options for 5th metatarsal fractures</h3> <p>So what does this silly example of long bone anatomy have to do with 5<sup>th</sup> metatarsal fractures?  The location of the 5<sup>th</sup> metatarsal fracture, in the epiphysis, metaphysis or diaphysis, helps us understand the potential for the fracture to heal.  Epiphyseal and metaphyseal fractures have a good chance of healing with conservative care, while diaphyseal fractures have a more difficult time healing and often require internal fixation.  We also need to consider the physical make-up of the patient.  Are they sedentary or active?  Smoker or non-smoker?  Normal BMI or obese?  The more active the patient, particularly in athletes, we’ll be erring to the side of internal fixation. </p> <p>Let’s take a closer look at the three cases I treated this week. </p> <p>Case #1 is a 6’ 7” police officer.  At 42 years old, he’s active, non-smoker and fit.  The location of the fracture (as seen in image 1) is at the demarcation of the metaphyseal bone and diaphyseal bone.  As you can see in the image, I took him to surgery for a percutaneous closed reduction using a 6.5 mm cannulated bone screw.  Even with internal fixation, the patient will be 8 weeks non-weight bearing and follow with 4 weeks in a walking cast.  </p> <p><img src="/Content/Images/uploaded/Medical/X-ray/Dancer's fracture - modified.jpg" alt="Dancer's fracture" width="250" />   <img src="/Content/Images/uploaded/Medical/X-ray/ORIF Dancer's fracture.jpg" alt="ORIF dancer's fracture" width="250" /></p> <p>In case #2, the patient is a 64 y/o female who sustained an inversion sprain 8 months ago while at work.  The patient is sedentary, a non-smoker and overweight.  The initial plain films showed what appeared to be an avulsion fracture at the base of the 5th metatarsal.  An avulsion fracture is where a small chip of bone is pulled from the epiphysis (hence the name traction epiphysis).  Interestingly though, as time passed, a true dancer’s fracture of the metaphyseal-diaphyseal junction appeared.  At 8 months out with continued pain, an MRI was obtained that showed no inflammatory reaction at the site of the dancer’s fracture.  The MRI was primarily ordered to rule out tendon pathology to include peroneal tendon tear or tendinitis.  The differential diagnosis includes non-union of the 5<sup>th</sup> metatarsal dancer’s fracture.  This patient will likely go on to have internal fixation.</p> <p><img src="/Content/Images/uploaded/Medical/X-ray/Avulsion fracture and dancer's fracture - modified.jpg" alt="5th metatarsal avulsion and dancer's fracture" width="250" /></p> <p>The third case was a 12 y/o male with no history of injury.  He was referred to me for evaluation and treatment of a 5<sup>th</sup> metatarsal fracture.  Symptoms included +1 swelling that was site-specific and pain with initial onset of activities along with pain with increased duration of activities.  In this case, the primary problem was not actually a fracture but a growth plate issue called apophysitis.  More specifically, apophysitis of the 5<sup>th</sup> metatarsal base is known as Iselin’s disease.  Iselin’s disease is self-limiting in that the symptoms will resolve at boney maturity.  Short term treatment includes limitation of activity and use of a lateral sole wedge to limit supination of the foot.  Iselin’s disease is a good example of 5<sup>th</sup> metatarsal pathology specific to the epiphysis. </p> <p><img src="/Content/Images/uploaded/Medical/X-ray/xray_foot_Iselins_disease_mod.jpg" alt="Iselin's disease, 5th metatarsal" width="250" /></p> <p>As you can see from these case examples, much of the treatment decisions in 5<sup>th</sup> metatarsal fractures depends upon the location of the fracture.  Epiphyseal and metaphyseal bone – good to heal with conservative care.  Diaphyseal – hard to heal and likely requires internal fixation.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:298https://www.myfootshop.com/a-dose-of-my-own-medicineA Dose of My Own Medicine<h2>Lessons learned from a foot surgeon undergoing foot surgery - <img style="float: right;" src="/Content/Images/uploaded/Blog images/Megan and me.jpg" alt="Dr. Oster" width="200" /></h2> <p> One of the factors that motivated me to go into podiatry as a young man was, in fact, a bit personal.  Being born with bilateral club feet, I felt I might have a little more empathy for folks who suffered from foot and ankle pain.  It’s been a long 34-year journey, but one heck of a lot of fun.  And those clubfeet?  Every once in a while, they need a little tune-up.</p> <p>Treatment of pediatric clubfoot and adult clubfoot is dramatically different.  Pediatric clubfoot is very malleable and flexible, allowing for serial manipulation of the foot and casting.  Adult clubfoot, on the other hand, is much more rigid.  The rigidity of the adult clubfoot means that many of the procedures used to correct adult clubfoot are going to be fusions or bone resection.</p> <p>My most recent clubfoot surgery was performed to correct subluxation of my toes.  A partial met head resection was performed and the toes pinned in a corrected position.</p> <p> So what does a foot surgeon learn from the perspective of being a patient?  Here are some thoughts:</p> <ol> <li>Surgery doesn’t really hurt that much.  In this day and age of using fewer opioids post-op, if coached well pre-operatively, you really don’t need a lot of pain medication.  In my case, that would be none.</li> <li>Strangers can be quite kind.  Most of us go out into the world with a degree of cynicism.  When you have a disability, it’s often surprising to see how kind some strangers can be.</li> <li>Crutches are really noisy.  I’m certainly not sneaking up on anyone.</li> <li>Time slows down when you’re non-weight bearing.  Is it time to pull the pins yet?  Albert Einstein discovered the theory of relativity after foot surgery (just kidding).</li> <li>Surgical teams are awesome.  Undergoing general anesthesia, particularly when the doctors and nurses are your peers, you wonder; did I say anything stupid?  My team is tight.  They smiled and just said, “you were fine.”  Nice to know both the personal and professional sides of my co-workers.</li> <li>Life goes on.  Like the old song says – <em>you got to get behind the mule in the morning and plow</em>.</li> </ol> <p>Thanks to everyone who helped me this month.  And a special thanks to my bride.  She’s a good’n.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:297https://www.myfootshop.com/os-trigonum-vs-gouty-arthritisOs Trigonum vs Gouty Arthritis<h2>Gout as a differential diagnosis for os trigonum syndrome in adolescent patients<img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/os_trigonum.jpg" alt="MRI - Os trigonum" width="300" /></h2> <p>Posterior ankle pain in the adolescent patient population is a relatively uncommon complaint.  What is the differential diagnosis for posterior ankle pain in the adolescent population?  Most clinicians would not consider <a href="https://www.myfootshop.com/article/gout">gout</a> in the differential diagnosis for posterior heel pain in the adolescent population. </p> <p>The differential diagnosis specific to adolescent patients may include;</p> <ul> <li>Os trigonum syndrome</li> <li><a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendonitis</a></li> <li>Flexor tendinitis</li> <li><a href="https://www.myfootshop.com/article/calcaneal-fractures">Calcaneal stress fracture</a></li> <li><a href="https://www.myfootshop.com/article/talar-dome-fracture">Transchondral talar dome fracture</a></li> </ul> <p>Gout is caused by the accumulation of purines consumed in our daily diet.  Purines are a chemical found in many foods that are typically eliminated through the kidneys as the end product known as uric acid.  In some cases, and for reasons that are unknown, uric acid is deposited in joints causing acute pain and disability.  This painful syndrome is called gout.  High levels of uric acid, called hyperuricemia, is a contributing factor to gout.  Hyperuricemia may be caused by a diet concentrated in the foods described below, use of medications that limit the excretion of uric acid in the kidney and dehydration. </p> <h3>Foods that contribute to hyperuricemia include;</h3> <ul> <li>Peanuts</li> <li>Red meat, particularly heart, liver, and kidney</li> <li>Dairy products including milk, ice cream, and cottage cheese</li> <li>Fish and shellfish, particularly herring, anchovies, sardines, mussels and scallops</li> <li>Alcohol</li> </ul> <p> </p> <h3>Drugs that contribute to hyperuricemia include:</h3> <ul> <li>Diuretics</li> <li>Salicylates</li> <li>Pyrazinamide</li> <li> Ethambutol</li> <li> nicotinic acid</li> <li> ciclosporin</li> <li> 2-ethylamino-1,3,4-thiadiazole</li> <li>cytotoxic agents.</li> </ul> <p> </p> <p><strong>Case report</strong></p> <p>A 16 y/o active male presented to my office with pain in the posterior right ankle.  The patient described daily pain in the posterior ankle that intensified when load was applied to the leg in weight lifting and gym class. </p> <p>History noted a 16 y/o male with no history of developmental problems.  He took no medications, had no allergies to medications and no remarkable past medical history.  Physical exam noted palpable pain in the posterior ankle.  No edema or erythema was found.  No crepitus or pain was found with range of motion of the ankle.</p> <p>Plain x-rays of the ankle showed separation of the os trigonum with no overt sign of fracture of the posterior process of the talus.  MRI (shown above) noted inflammatory changes of the interface of the os trigonum and talus.</p> <p>In the course of conversation with the patient and his mom, his mom noted an injury to the right little finger two months ago that swelled upon injury and persisted as swollen and painful.  No treatment had been sought for the finger injury.</p> <p>Labs noted CBC normal.  Uric acid was elevated at 8.2 mg/dl suggestive of gout.</p> <p>Treatment was initiated with allopurinal 100mg/day to lower uric acid levels with pending re-evaluation of uric acid planned in 3 weeks.</p> <p>Comments;</p> <p>This is the second case that I have seen in the past two years of adolescent posterior ankle pain that was initially diagnosed as os trigonum syndrome only to be determined to be gout.  What is causing hyperuricemia in these cases?  Well, like every doc that has a question I turn to the literature for answers.  I found a whopping two citations for os trigonum syndrome that was actually secondary to hyperuricemia.  (1,2)  My hope is that this blog post is the start of a research project that helps to understand why this disease called gout, often viewed as the disease of kings, is now found in children.  I don’t have any answers but I’m determined to find a common link in my two patients.</p> <ol> <li> <a href="https://pdfs.semanticscholar.org/d47f/68b9995994ff4224813fa9645c26192af900.pdf">Rosemol Xaviour , Girijamony V K. Os trigonum – a case report.  International Journal of Science and Research, India Edition. Volume 2 Issue 3, March 2013.</a></li> <li> Ersin, E Mehmet, G Serdar A, Intraosseus Tophi Deposit in the O Trigonum.  <a href="https://www.researchgate.net/journal/1938-2367_Orthopedics">Orthopedics</a> 35(1):e120-3 · January 2012</li> </ol> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:296https://www.myfootshop.com/bone-contusion-confusionBone Contusion Confusion<h2>What's the confusion about the contusion?<img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/Ankle MRI.jpg" alt="Ankle MRI" width="200" /></h2> <p>It was December 2008 when I posted a blog entitled, <a href="https://myfootshop.wordpress.com/2008/12/02/bone-contusions-are-they-really-fractures/">Bone contusions – are they really fractures?</a>  The conversation from readers was absolutely intriguing.  But the irony of the post is that in the past nine years, there doesn’t seem to be any more clarity regarding the treatment of bone contusions.  So again I ask, are bone contusions really fractures?</p> <p>The confusion regarding bone contusions lies in a simple treatment paradigm used in medicine.  Here’s how medical consensus works;</p> <ol> <li><strong>Define the problem and publish your findings in the literature.</strong></li> <li><strong>Allow the community of providers (readers of the literature) to define consensus regarding the problem.</strong></li> <li><strong>Consensus then leads to an optimal treatment plan for the problem.</strong></li> <li><strong>Optimal treatment become the community standard of care.</strong></li> </ol> <p>Ironically, this process, or paradigm has yet to develop in the medical/surgical community regarding bone contusions.</p> <p>What is a bone contusion?  Bone contusions (also called a bone bruise) are injuries that result in swelling, or bone edema.  Bone contusions are most common following an injury such as a common sprain.  Bone contusions are often found adjacent to joints but can also be found secondary to direct trauma to the bone.</p> <h3>Contusion confusion</h3> <p>I’ve been seeing a worker’s comp patient since his original injury in October of 2017.  The patient was working outdoors and sprained his ankle on the edge of the road pavement.  When his ankle failed to heal, an MRI found bone edema in the calcaneus (heel bone) specific to the posterior facet of the subtalar joint.  Physical therapy and rest failed to decrease the pain in the subtalar joint, therefore subchondroplasty was recommended.  Subchondroplasty is a percutaneous technique that is used to inject calcium phosphate, a bone substitute, into the fracture site.  The patient sought a second opinion.  Unfortunately, the second opinion came back as a ‘high acuity attenuation of the ankle ligament’.  The second opinion was inconsistent with the MRI which clearly defined a bone contusion.  This places the patient in a position of ‘bone contusion confusion’.</p> <h3>How can we do better in the treatment of bone contusions?</h3> <p>How do we raise the bar of understanding related to bone contusions?  You have to think of the medical community as a very large boat that is hard to steer and even harder to turn around.  In a recent surgical seminar that I attended, bone contusions and subchondroplasty were a hot topic.  But in the general community, there’s far less understanding of this condition.</p> <p>So again I ask - are bone contusions really fractures?   They certainly are.  There, it’s officially published.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:295https://www.myfootshop.com/treatment-of-onychomycosis-with-lamisil-how-can-i-optimize-treatmentTreatment of onychomycosis with Lamisil – how can I optimize treatment?<h2>Lamisil and onychomycosis - getting the most out of oral terbinifine<a href="https://www.myfootshop.com/article/onychomycosis"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_toe_3.jpg" alt="onychomycosis" width="100" /></a></h2> <p>I had an interesting conversation this morning with a carpenter who came to see me regarding a <a href="https://www.myfootshop.com/article/onychomycosis">fungal infection of the toe nails</a>.  My first thought was, ‘smart man’ in that it’s early spring and he’s getting a jump on treatment prior to sandal season.  He proceeded to tell me that he had already done one 90 day round of oral Lamisil, one year ago, that seemed to work well on the lesser nails, but he still had an infection of the great toe nails.  He posed an interesting question to me; how often can or should he use Lamisil and what really is the most effective way to go about using Lamisil.</p> <h3>History of Lamisil clinical trials</h3> <p>Oral Lamisil, also known as terbinafine, is used to treat fungal infections of the finger nail and toe nail (onychomycosis).  The origin of Lamisil use for nail infections is interesting.  McNeil Pharmacueticals was the lab that originally developed Lamisl to treat aspergillosis, a fungal infection of the lung that commonly affects immune compromised patients such as AIDS patients or those folks undergoing chemo-therapy for cancer.  What McNeil found was that terbinafine treated the aspergillosis but remarkably terbinafine also treated each and every patient’s fungal toe nail infection.  McNeil had created a new and unique marketing opportunity.  Could McNeil bypass doctors and market directly to consumers?  Most of us know the answer to that question.  McNeil had one of the most successful television and print marketing campaigns in the history of prescription drugs.  As a provider, in the early 1990s, I had a McNeil rep in my office virtually every day.</p> <h4>Is Lamisil effective in resolving nail fungus?</h4> <p>Is Lamisil effective in resolving nail fungus?  Well, yes and no.  In the short term, yes, it can be very effective.  The <a href="https://www.rxlist.com/lamisil-drug.htm">summary of terbinafine dosing from Rxlist.com</a> sums up what most clinicians consider to be the community consensus for oral dosing of terbinafine for finger nail and toe nail treatment of onychomycoisis;</p> <p style="padding-left: 30px;"><em>Fingernail onychomycosis: One <strong>250 mg</strong> tablet once daily for 6 weeks. Toenail onychomycosis: One <strong>250 mg</strong> tablet once daily for 12 weeks. The optimal clinical effect is seen some months after mycological cure and cessation of treatment.</em></p> <p>At this dosing, the majority of fungal nail infections do clear.  But unfortunately, the recurrence rate of fungal nail infections is quite high with recurrence rates as high as 90% in 3-5 years. </p> <h4>If Lamisil is an effective but non-lasting solution, how can we make that solution better? </h4> <p>Take more Lamisil?  Take Lamisil more frequently?</p> <p>The goal of any pharmaceutical treatment is to use the least amount of medication to affect a cure.  But there’s more to this specific fungal problem than what initially meets the eye.  There’s a number of contributing factors to recurring fungal infections of the nail, the most important of which is moisture.  Fungus is a plant.  Water the plant with perspiration and you’re bound to see fungus recur. An easy win in finding a long term cure for onychomycosis is to dry the foot.  Easy wins include:</p> <ul> <li>Frequent changes of socks</li> <li>Rotate shoes, leaving 24 hours between use</li> <li>Use a drying agent like <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> to inhibit perspiration</li> <li>Topical over-the-counter agents used to treat onychomycosis</li> </ul> <p>I always feel like a success when I can divorce my patients from being dependent upon pharmaceuticals.  When it comes to the treatment of dermatophytosis (fungal infections of the skin) and onychomycosis (fungal infections of the nail) I’m a big fan of <a href="https://www.myfootshop.com/all-natural">tea tree oil-based products</a>.  I get it, I know the chemistry.  Pharmaceutical-grade agents are more effective as a short term solution but create a dependency on prescriptions.  That’s the beauty of tea tree oil products.</p> <h4>How do I use tea tree oil products to treat fungal infections of the skin and nail?</h4> <p>I told my carpenter patient to think of the treatment of dermatophytosis and onychomycosis as daily hygiene, just like brushing your teeth.  Start using tea tree oil products when you start using Lamisil.  When your Lamisil script is complete, continue using the tea tree oil products.  The benefits can be significant and prolong the clear time of the nails, decreasing the need for repeat dosing of Lamisil.</p> <p>And lastly, here's a <a href="https://www.myfootshop.com/toe-nail-fungus-treatment-recommendations">treatment guide</a> for the treatment of onychomycosis.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:294https://www.myfootshop.com/overlapping-toes-causes-and-treatmentOverlapping toes - causes and treatment<h2>Overlapping toes - causes and treatment</h2> <p>Ronnie on our sales team asked me to talk a bit about overlapping toes.  Overlapping toes are a problem that increases with age, although overlapping toes can be found even in infants. </p> <p>What causes overlapping toes?  First, let’s define what an overlapping toe actually is. </p> <p><img style="float: left;" src="/Content/Images/uploaded/Anatomy/Spacial_Orientation/Cardinal_planes.jpg" alt="Body planes" width="75" /></p> <p> </p> <p>When anatomists discuss the body, they speak in reference to <a href="https://www.myfootshop.com/article/cardinal-planes-of-the-human-anatomy">body planes</a>.  In the image to the left, the sagital, <img style="float: right;" src="/Content/Images/uploaded/Anatomy/Misc_Drawings/varus rotation 5th toe.jpg" alt="Varus rotation of toes" width="100" />frontal and transverse planes are defined.  Toe deformities can be found in all three planes.  For instance, <a href="https://www.myfootshop.com/article/hammer-toes">hammer toes</a> are a deformity of the sagital plane.  One of the more common toe deformities in children is a frontal plane rotational deformity where the toe rotates in a position called <a href="https://www.myfootshop.com/article/varus-rotation-of-the-5th-toe-lister-corns">varus rotation</a> (see image to the right).  But overlapping toes are in the remaining plane, the transverse plane.</p> <p> </p> <p> </p> <h3>What is the cause of overlapping toes? </h3> <p>Overlapping toes are caused by four factors;</p> <ul> <li>Mal-alignment of the long flexor and long extensor tendons.</li> <li>Translation of the plantar plate and attached structures</li> <li>Rupture of the plantar plate</li> <li>Trauma and arthritis</li> </ul> <p><strong>Mal-alignment of the long flexor and long extensor tendons</strong> is an interesting phenomenon that can occur due to a number of structural conditions in the foot.  To understand this concept of mal-aligned tendons, let’s take a second to think like a tendon.  The <a href="https://www.myfootshop.com/article/flexor-digitorium-longus">long flexor (bottom of the toe)</a> and the <a href="https://www.myfootshop.com/article/extensor-digitorum-longus">long extensor (top of the toe)</a> originate in the calf as moderately strong muscles and terminate in the most terminal aspect of the toe (the distal phalanx).  The primary function of the long flexor and extensor tendons is to stabilize the foot as your body passes over it.  Although we’d tend to think that these tendons are used to control the function of the toe, these tendons use the toes to make the foot rigid and increase the lever arm of the foot.  Essentially the toes are anchor points for these tendons and the actual function of the toes is somewhat of an afterthought. </p> <p>What causes the long flexor and extensor tendons to become mal-aligned?  As these tendons descend the leg and round the front and the back of the ankle, the tendons then pull in a straight direction against the toes.  Any change in the shape of the foot between the ankle and the toes can result in an eccentric pull on the toes.  Structural changes n the foot that can result in mal-alignment of the long and short flexor tendons include:</p> <ul> <li>Skew foot</li> <li><a href="https://www.myfootshop.com/article/pronation">Pronation</a></li> <li>Metatarsus adductus</li> <li><a href="https://www.myfootshop.com/article/supination">Supination</a></li> <li>Fractures resulting in poor alignment</li> </ul> <p>With each step, eccentric pull on the toe progressively results in deviation in the toe that results in the transverse plane deformity we call an overlapping toe.</p> <p><strong>Translation of the plantar plate and associated structures</strong> is what causes the most common instance of overlapping toes, the second toe overlapping the great toe, particularly in cases of <a href="https://www.myfootshop.com/article/bunion">bunions</a>.  As the first metatarsal ‘adducts’ (moves to the center line of the body), it places eccentric load on the great toe resulting in the characteristic ‘abduction’ of the great toe towards the second toe.  This widening of the first intermetatarsal space (the space between the first and second metatarsals) places tension on the intermetatarsal ligament.  This tension results in the medial displacement of the base of the second toe.  This characteristic ‘abduction’ of the great toe and ‘adduction’ of the second toe results in the characteristic overlapping we see in this video.</p> <p><iframe width="560" height="315" src="https://www.youtube.com/embed/We9CCtxWKWg?rel=0" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p><strong>Rupture of the plantar plate</strong> is an often discussed and often over-diagnosed condition that results in instability of the toe.  In all cases of plantar plate rupture that I see, the translation of the toe is greatest in the sagital plane and to a lesser degree in the transverse plane.</p> <p><strong>Trauma and arthritis</strong> are the two least common reasons for overlapping toes.  Mal-alignment post-fracture can result in a poorly aligned toe that results in overlapping.  <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Arthritis, particularly rheumatoid arthritis</a>, displaces the toe in unpredictable directions resulting in overlapping and mal-alignment.</p> <h3>Treatment of overlapping toes</h3> <p>Treatment of overlapping toes can be accomplished with conservative and surgical methods of care.  <a href="https://www.myfootshop.com/toe-straightener-single-toe">Toe Straighteners</a> (also called Budin Splints) can be used to ‘lasso’ toes into position.  <a href="https://www.myfootshop.com/3pp-toe-loops">Toe Loops</a> and <a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1">Crest Pads</a> are used to align rotational deformities of the toes.  Surgical solutions often focus on metatarsal head wedge resections to align the toe.  In some cases, partial metatarsal head resections are used to align the toes.  In severe cases of overlapping second toes with asymptomatic bunions, amputation of the toe is indicated.</p> <p>As you can see, overlapping and mal-aligned toes can result from a number of causes and treatment varies on a case by case basis.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p> </p>urn:store:1:blog:post:293https://www.myfootshop.com/what-is-passive-suicideWhat is passive suicide?<h2>Is passive, personal neglect a form of suicide? <img style="float: right;" src="/Content/Images/uploaded/Blog images/depression-2912404_640.jpg" alt="Passive suicide" width="200" /></h2> <p>One of my jobs in lower extremity health is limb salvage.  I had completed a forefoot amputation on a patient several weeks ago for osteomyelitis (bone infection).  In the course of recovery, I got to know a wonderful man who was full of laughter and stories about rural life in western Colorado.  He was most proud of his work in the bauxite industry, something that was unfamiliar to me.  He described for me the uses of bauxite in the agricultural industry.</p> <p>But interestingly, as I learned more about my patient’s personal life, I learned that he had a long history of self-neglect.  He had been in and out of wound care clinics due to diabetic wounds of both feet.  I spoke with his wound care nurse who told me about how he had grown increasingly despondent, had not cared about his rapid increase in weight and refused to participate in his personal care.  His weight was now close to 300 lbs.</p> <p>I also had the pleasure to get to know his wife and daughter.  You could tell that the family had been very close over the years, but the patient’s refusal to care for himself was tearing the family apart.  His wife was unable to personally care for him.  The only solution to save the family was to institutionalize the patient.</p> <p>In speaking to our hospitalist team who also cared for the patient, they used a term that I was unfamiliar with: passive suicide. </p> <p>What are the factors that contribute to passive suicide?  In an article entitled, ‘What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community-dwelling Israelis’ by Ayalon and Witman, they look at the cognitive domains associated with passive suicide ideation. (1) Interestingly, they relate time orientation as a factor in an aging population that is most closely associated with passive suicide ideation.</p> <p>I’ll be sure to lose track of this patient over the next few months as his need for lower extremity care starts to wane.  But I won’t forget how he and so many other patients I have seen over the years neglected themselves. I used to call this a death spiral – increased weight gain from inactivity leads to increased weight loss resulting in hypertension, diabetes, and osteoarthritis of the knees.  Now I know better.  It’s actually more than a passive death spiral, it’s better described as passive suicide.</p> <ol> <li>       Ayalon L, Litwin H. What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community-dwelling Israelis. Int J Geriatr Psychiatry. 2009 May; 24(5): 472–478.</li> </ol> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:292https://www.myfootshop.com/is-pttd-still-pttdIs PTTD still PTTD?<h2>What happened to the dysfunctional aspect of posterior tibial tendon dysfunction? <a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/PTTD_1.jpg" alt="Posterior tibial tendon dysfunction" width="250" /></a></h2> <h2> </h2> <h3>A proposal for modification of the Johnson and Storm classification of PTTD.</h3> <p>I met with a patient this week who came to my office upon the referral of his physical therapist who told him that he had posterior tibial tendon dysfunction (PTTD).   The patient had no pain and was able to walk quite well but did have a long history of flat feet.  Is this really PTTD? </p> <p>PTTD is classically defined as an important cause of adult-acquired flatfoot. (1)  The literature states the earliest description of PTTD was by Kulkowski in 1936. (2)  Johnson and Strom, in 1989, described the staging system used today to describe progressive change in the PT tendon. (3)  A review of other early papers describing posterior tibial dysfunction all describe a symptomatic, progressive change in the posterior tibial tendon.(1,2,3,4,4,5,6)  Their papers discuss degenerative changes of the posterior tibial tendon and treatment options.</p> <p>But again, my patient, who was referred to me for PTTD, was asymptomatic.  Is this just semantics, or is there a slow progressive cooptation taking place here? </p> <p>As a podiatrist, I’ve struggled for years with the insurance coverage issue related to flat feet.  Many insurance companies deny coverage for flat feet as an exclusion to their coverage.  But in the 1990s, orthopedics realized that lower extremity health was a neglected aspect of care, and as a result, they developed a focus of care with fellowship-trained orthopedic specialists. But these new specialists didn’t fight with insurers over flat foot coverage.  They simply called this condition PTTD.  This was a very smart way to leapfrog over the issue of non-covered services.</p> <p>Fast forward to today – what is PTTD?  Has the definition of PTTD changed?  What used to be a staged definition of degenerative change of the posterior tibial tendon, as defined by Johnson and Storm, now seems to be a definition for loss of the medial arch by both acquired and congenital reasons.</p> <p>This new definition of PTTD now begs the question; do we need a new classification?  In my practice, I’ve begun to use a modified version of the Johnson and Storm classification that includes stage 0.  Stage 0 is asymptomatic, congential dysfunction of the posterior tibial tendon that shows no progression.</p> <ol> <li>       Geideman WM, Johnson JE.  Posterior tibial tendon dysfunction. <a href="https://www.ncbi.nlm.nih.gov/pubmed/10693084">J Orthop Sports Phys Ther.</a> 2000 Feb;30(2):68-77.</li> <li>       <a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3">https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3</a></li> <li>       Johson KA, Storm DE. Tibialis posterior dysfunction. Clin Orthop Relat Res 1989;239:196-206.[<a href="https://www.ncbi.nlm.nih.gov/pubmed/2912622">PubMed</a>]</li> <li>       Myerson MS. Treatment of dysfunction of posterior tibial tendon. J Bone Joint Surg Am 1996;78:780-92.</li> <li>       Sheldon SL, Berkman AR. Tendon problems of foot. Mizel MS, Miller RA, Scioli MW, editors. , Orthopedic knowledge update. Rosemont, IL: American Academy of Orthopedic Surgeons; 1998. pp 253-278.</li> <li>       Supple KM, Hanft JR, Murphy JR, et al. Posterior tibial tendon dysfunction. Semin Athritis Rheum1992;22:106-13. [<a href="https://www.ncbi.nlm.nih.gov/pubmed/1439842">PubMed</a>]</li> </ol> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:291https://www.myfootshop.com/fall-preventionFall Prevention<h2>When it comes to falls – “I’m the winner!”<img style="float: right;" src="/Content/Images/uploaded/Blog images/mom-1462556_640.jpg" alt="fall prevention" width="200" /></h2> <p>I was speaking with an older patient and his wife and touched on the topic of home safety and falls.  The patient has Parkinson’s disease and is particularly at risk for falls.  When I asked how he was doing with falls, he didn’t miss a beat by stating, “I’m the winner!”</p> <p>On one hand, I have to respect him for his light-hearted approach to a serious subject.  But on the other hand, when you look at the statistics from the American Council on Aging, you really see how fall prevention is so important.</p> <h3>Fall statistics</h3> <ul> <li>         Once every 11 seconds, an older American is treated in an emergency room for a fall. </li> <li>         Once every 19 seconds, an older American dies from a fall.</li> <li>         Falls are the leading cause of non-trauma related injuries in older populations and the leading cause of fatalities in older Americans.</li> <li>         In 2017, the cost of fall injuries was $31 billion dollars and expected to reach $60 billion as America ages into 2020</li> </ul> <p>There’s the old joke is about the guy who found out that most accidents happen within 25 miles of home – so he moved.  Life just doesn’t work that way.  How do we improve fall statistics and protect older Americans from falls?  The first step is to perform a home assessment. </p> <h3>Fall Prevention</h3> <p> </p> <ul> <li>        Check for hand holds, not just in the bathroom but in areas of frequent travel like the kitchen and bedroom.</li> <li>        Remove throw rugs.</li> <li>        Check for loose edges of carpet or door thresholds.</li> <li>        Wear supportive, laced shoes.</li> <li>        Learn how to focus on the task at hand.</li> </ul> <p>In my practice, the most common location that patients describe falling is the front porch.  As you leave the house, you’re typically preoccupied with the task at hand; going to the store, finding car keys, etc.  And the change in light from darker inside to lighter outside affects the ability to focus on exiting the home and descending the steps.  That’s why focus is so important – focus on the task at hand.</p> <p>The National Council on Aging and the National Falls Prevention Resource Center leads the Falls Free Initiative, a national program for fall prevention.  The Falls Free initiative involves more than 70 national organizations acting to fund fall prevention and bring to attention the significance of falls in the aging. </p> <p>For more information on the Falls Free Initiative, go to <a href="ncoa.org/fallsprevention">ncoa.org/fallsprevention</a>.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:290https://www.myfootshop.com/tineacide-becomes-terpenicolTineacide Becomes Terpenicol<h2>The same great powerful antifungal foot care product – now with a new name.</h2> <p>Tineacide Antifungal Cream has changed. The manufacturer, Blaine Labs, states that they intend to market the Tineacide line of products in a retail environment and wanted to have an extra strength product that would be exclusively dispensed by a physician. <a href="https://www.myfootshop.com/terpenicol-antifungal-cream">Terpenicol Antifungal Cream</a> is still the same great product, only better. Terpenicol Antifungal Cream is available at Myfootshop.com.</p> <p style="text-align: center;"><br /><a href="https://www.myfootshop.com/terpenicol-antifungal-cream"><img src="/Content/Images/uploaded/Products/683_Terpenicol_Antifungal_Cream.jpg" alt="Terpenicol Antifungal Cream" width="200" /></a></p> <h3>Indications for Terpenicol Antifungal Cream</h3> <ul> <li>treats fungal infections that cause onychomycosis (fungal nail infections)</li> <li>treats fungal infections that cause athlete’s foot and chronic fungal infections of the skin (t. rubrum and t.mentagrophytes)</li> </ul> <p>If you have any questions regarding this product, please contact us for additional information.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:289https://www.myfootshop.com/its-not-just-dry-feet-its-a-fungal-infectionIt’s not just dry feet – it’s a fungal infection!<h2>Low-grade, chronic fungal infections of the feet are often mistaken for just dry skin.</h2> <p>You've tried Avon products, Eucerin, Vasoline Intensive Care and Aveno. Why isn't the dry skin on your feet clearing up? Here's a recent product review from one of our customers for <a href="https://www.myfootshop.com/antifungal-healing-foot-cream">Antifungal Healing Foot Cream</a>:</p> <p style="padding-left: 30px;"><strong><em>I was so skeptical. I didn't have foot fungus, I just have really dry feet from yoga. But all the Avon products and pedicure sandings and Korean foot treatments hadn't really been helping. But this stuff ACTUALLY WORKS! I'm telling all my yoga friends about it. It smells good, too. I glob it on and then put on a pair of thick socks for the evening. By bedtime, my feet are nice and supple. And they stay that way! I try to use it every few days. Thank you!</em></strong></p> <p>Most cases of dry skin on the bottom of the adult foot aren’t simply dry skin.  The dry skin is actually caused by a fungal organism known as <a href="https://www.myfootshop.com/article/athletes-foot">tinea rubrum</a>.  But doesn’t <a href="https://www.myfootshop.com/article/athletes-foot">athlete’s foot</a> itch and have bubbles and blisters on the skin?  Yes, that is true.  But acute athlete’s foot is caused by another fungal organism called tinea mentagrophytes.  Although closely related, t. rubrum and t. mentagrophytes present differently. </p> <p>Both t. rubrum and t. mentagrophytes are members of the fungus family.  They have a particular fondness for the foot simply due to<img style="float: right;" src="/Content/Images/uploaded/Products/794_Myfootshop_Healing_Foot_Cream_ALT.jpg" alt="Antifungal Healing Foot Cream" width="150" /> the fact that inside the shoe, the environment is hot and wet.  Water the fungus and keep it warm, and it’s sure to thrive.  With cases of t. rubrum, the symptoms include prolific dry skin that just won’t respond to topical OTC skin lotions.  Although t. rubrum infections cannot be healed, they certainly can be managed with daily application of a skin softener that includes a topical antifungal medication.</p> <p>To get on top of that ‘dry skin’ on your feet be sure to;</p> <ul> <li>Rotate your shoes allowing them to dry over the course of 24 hours</li> <li>Leave your feet open to the air and UV light to inhibit fungal growth</li> <li>Use a drying agent like <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> to inhibit perspiration</li> <li>Apply a combined dry skin and antifungal cream, like <a href="https://www.myfootshop.com/antifungal-healing-foot-cream">Antifungal Healing Foot Cream</a> each and every day.</li> </ul> <p>Our team is constantly trying to help customers understand that it’s not just dry feet, it’s a fungal infection.  It’s always great when we see a customer find success with <a href="https://www.myfootshop.com/antifungal-healing-foot-cream">Antifungal Healing Foot Cream</a> and they too say, “it’s not dry feet, it’s a fungal infection.”</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-12-21</p>urn:store:1:blog:post:288https://www.myfootshop.com/cast-disease-is-it-still-an-issueCast Disease – is it still an issue?<p>How has internal fixation changed our thinking about cast disease?<img style="float: right;" src="/Content/Images/uploaded/Blog images/Hans_Willeneger.jpeg" alt="Hans_Wilennegger" width="250" /></p> <p>Immobilization is one of the primary tenants of injury management.  But prolonged immobilization can result in problems.  Cast disease describes the problems associated with immobilization of an injury with rigid casting or prolonged non-weight bearing.  Cast disease can be described as a syndrome of symptoms that occur and become increasingly worse with prolonged immobilization.  These symptoms include osteoporosis, muscle atrophy, lymphedema and the potential for deep vein thrombosis. </p> <p>As a resident in 1983, I had the honor to meet one of the founders of the science of internal fixation, Hans Willenegger (image right).  Dr. Willenengger, along with several other doctors had formed a study group in Davos, Switzerland called the <a href="https://www.aofoundation.org/Structure/Pages/default.aspx">AO Foundation</a> (Arbeitsgemeinschaft für Osteosynthesefragen).  The AO Foundation established the founding principles for internal bone fixation. </p> <p>I was a young, naive foot and ankle surgeon and Dr. Wilennegger was a seasoned surgeon who trained in wartime as a surgeon for the German army in WWII.  He kindly and passionately described to me something that I’ll never forget.</p> <p>“As the Allied forces advanced, our field hospital and our patients were forced to evacuate.  Fortunately, I had the opportunity to watch these men heal over weeks to months.  What struck me was the fact that for those soldiers with orthopedic injuries, when forced to ambulate, they healed much faster than if they were allowed to rest.  There was something important in early weight-bearing and early return to activity.”</p> <p>What Dr. Wilennegger described was cast disease – the problems that arise as a result of inactivity and non-weight bearing.  Internal fixation, and now external fixation techniques, allowed patients to return to early ambulation.  The core principles of the AO group stressed early return to weight-bearing.</p> <p>So have we put to rest the problems of cast disease?  Is cast disease a thing of the past?  Unfortunately not.  The point of this post is to honor that fundamental principal of the AO group – early return to weight-bearing.  I see all too often treatment that is based on just the opposite; place the patient in a cast and see them in 8 weeks.   I think that defeats some of the best medical science of the 20<sup>th</sup> century.  Early weight bearing requires a well-defined treatment plan.  Early weight bearing requires coordination with ancillary services like physical therapy and occupational therapy.  And it requires a carefully defined treatment plan with frequent monitoring of patient status.  In these days of rapid room turn over, I can’t help but honor the legacy of Dr. Wilennegger and his push to individualize care and push for early ambulation.</p> <p>Is cast disease a thing of the past?  Unfortunately not.  But keeping the spirit of Hans Wilennegger alive and well may help.  Internal fixation, early ambulation, and individualized care – that’s the cure for cast disease.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-21</p>urn:store:1:blog:post:287https://www.myfootshop.com/what-is-micro-fractureWhat is micro fracture?<h2>How is micro-fracture used in foot and ankle surgery?<img style="float: right;" src="/Content/Images/uploaded/Blog images/Chondromalacia stage 4 labeled.jpg" alt="Hallux limitus chondromalacia" width="300" /></h2> <p>The surface of every joint is covered with a smooth, glistening material called cartilage.  Cartilage is an avascular structure that is supplied with oxygen and essential nutrients by the synovial fluid within the joint.  Synovial fluid is capable of keeping healthy cartilage viable but lacks the capability to effectively repair damaged cartilage.  Large defects in cartilage, whether due to injury, arthritis, or a combination of both, often requires repair by surgical fusion or joint replacement.  In cases of focal injury, where only a small percentage of cartilage is damaged, a technique called microfracture can be used to restore cartilage.</p> <p>Cartilage is supported by a layer of hard, dense bone called the subchondral plate.  Deep to the subchondral plate lies the bone marrow, rich in pleuri-potential cells (stem cells) that have the capability to become bone cells, cartilage or other musculoskeletal components.  In cases of focal cartilage defects, breaking through the subchondral plate and releasing these stem cells provides a way to resurface the joint with new cartilage.</p> <h3>Which foot and ankle joints are treated with microfracture?</h3> <p>Microfracture is used in foot and ankle surgery to restore focal cartilaginous defects of the talar dome and great toe joint.  The images in this post show a focal defect of the first metatarsal head due to a condition called hallux limitus.  <img style="float: left;" src="/Content/Images/uploaded/Blog images/microfracture mod.jpg" alt="Microfracture for hallux limitus" width="300" />Microfracture was used in this case in an attempt to resurface the first metatarsal head.  Should microfracture fail to restore cartilage in this joint, joint replacement or joint fusion would be indicated.</p> <h3> </h3> <h3>How is microfracture performed in foot and ankle surgery?</h3> <p>Microfracture is performed by using a Kirschner wire or small drill.  The technique is to drill through the subchondral plate.  During the first few moments following completion of the surgery, blood rich in stem cells will flow from the marrow into the joint.  These unique marrow based cells will act to form fibrocartilage within the joint defect.</p> <h4>Is microfracture universally successful in foot and ankle surgery?</h4> <p>The success or failure of microfracture in foot and ankle surgery depends upon a number of variables including the viability of the host's marrow cells and the extent of the injury to the cartilage.  Although microfracture does not replace the original hyaline cartilage, the fibrocartilage created by the stems cells is often adequate to restore joint mobility and decrease pain.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-12-2021</p>urn:store:1:blog:post:286https://www.myfootshop.com/reliability-of-abi-testingReliability of ABI testing<h2>More questions for an old vascular test<img style="float: right;" src="/Content/Images/uploaded/Blog images/blood-pressure-1006791_640.jpg" alt="ABI testing" width="300" /></h2> <p>I was at a wound care conference several weeks ago and got into a conversation with a colleague regarding ABI testing.  ABI stands for ankle brachial index, sometimes also called an ankle brachial pressure index or ABPI.  An ABI is used to ascertain and quantify blood flow to the foot.  For years, ABI testing was the gold standard to determine flow to the foot.  But as newer, more sophisticated testing becomes available, some doctors are questioning the validity of the ABI.</p> <h3>What is ABI testing?</h3> <p>The ABI test is relatively simple and cost-effective to perform.  Using a blood pressure cuff and handheld Doppler device, the systolic blood pressure of the arm (brachial artery) is divided by the systolic blood pressure in the foot (posterior tibial or anterior tibial artery).  The resulting ratio in a healthy patient would be 120/120 or 1.0.  As occlusion due to peripheral arterial disease (PAD) occurs in the lower extremity, the ratio starts to drop.  For instance, a brachial BP of 120 mm/hg and posterior tibial pressure of 140 mm/hg results in a ratio of 0.85.  This ratio would indicate lower extremity peripheral arterial disease.</p> <h3>Which arteries to use in ABI testing?</h3> <p>My question to my colleague was this:  which of the two primary arteries in the foot do we measure?  There's only one brachial artery in the arm but there are two arteries in the foot.  Which artery is the right one to measure?</p> <p>I spoke with the vascular techs in both of the hospitals where I work and both said they didn't know.  The first said she does not do the calculations and leaves that up to the doc.  The second said that she had a machine that figured that out.  That left me with one bigger question.  Thirty years of practice and why don't I have an answer to this simple question.  If we look at medicine as a mature science, how come we don't have this simple answer.</p> <p>A search on the internet pulled a peer-reviewed article that stated the proper artery to use was the artery with the highest pressure. (1)  That didn't make sense in the least.  What if the other artery is totally occluded.</p> <p>A little more searching found that there are others with this same question about ABI testing.  McDermott et al had an interesting article that recommended averaging the two arteries of the foot. (2)  Al-Qaisi et al agreed that although we still rely on the ABI as a workhorse in the vascular lab, there needs to be standardization of the test. (3)</p> <p>I'll still rely on the ABI to help determine a general sense of PAD, whether or not to use compression therapy for wounds and to determine the appropriate level of amputation.  But now I'll combine those tests more with trans-cutaneous oxygen testing and when possible, arteriograms. </p> <p>1. Vowden P, Vowden K (March 2001). <a href="https://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html"><em>"Doppler assessment and ABPI: Interpretation in the management of leg ulceration"</em></a>. Worldwide Wounds.</p> <p>2. McDermott M, Criqui M, Kiang L, Guralnik J, Greenland P, Martine G, Pearce W (2000) <a href="https://www.jvascsurg.org/article/S0741-5214(00)65301-6/fulltext">"Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial arteries, associated with leg functioning in peripheral arterial disease"</a> Journal of Vascular Surgery 32:6 1164-1171</p> <p>3. Al-Qaisi, M; Nott, DM; King, DH; Kaddoura, S (2009). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762432"><em>"Ankle brachial pressure index (ABPI): An update for practitioners"</em></a> Vascular Health and Risk Management. <strong>5</strong>: 833–41.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-12-2021</p>urn:store:1:blog:post:285https://www.myfootshop.com/whats-the-best-hands-free-speaker-for-the-operating-roomWhat’s the best hands-free speaker for the operating room?<p>Music in the OR?<img style="float: right;" src="/Content/Images/uploaded/Blog images/surgical-instruments-81489_640.jpg" alt="Music in the OR" width="250" /></p> <p>What’s the mood in an OR?  A lot of times, the mood in an operating room is set by the choice of music played during a surgical case.   Some surgeons are classical buffs.  Others show tunes.  I’m a jam band kind of guy.  So as the surgeon, I usually get to choose the music.  When we’re in the OR, we’re usually listening to Phish, M.O.E. or The Dead.   </p> <p>What’s the best way to listen to music in the OR?  I wanted to purchase a new hands-free speaker for our hospital this year so I ended up doing a bit of homework and working to understand which speaker might work best in the OR.</p> <p>There are a number of choices to make when selecting a hands-free speaker for the OR, but the first is fidelity.  Operating rooms aren’t designed for acoustics.  Therefore, you can forget about the high-end hands-free speakers like <a href="https://www.sonos.com/en-us/home">Sonos Play1</a> or <a href="https://store.google.com/us/product/google_home_max?hl=en-US">Google Home Max</a>.  You’ll never be able to enjoy the sound of these speakers.</p> <p>Another consideration is your source of music.  Music on most hands-free devices can be streamed from your phone.  So if you use <a href="https://www.spotify.com/us/">Spotify</a> or <a href="https://www.pandora.com/">Pandora</a>, you can use your phone as the music source and simply use a Bluetooth connection to the speaker.  Alternatively, you can use a music streaming service via the web like <a href="https://www.amazon.com/gp/dmusic/promotions/PrimeMusic">Amazon Prime Music</a>.</p> <p>What about cost?  On the low end of hands-free speakers, <a href="https://express.google.com/product/6126314284824667080_7310516196836374342_6136318">Escape</a> makes a nice portable, hands-free speaker, starting at $29.95.    </p> <p>In the end, I chose an <a href="https://www.amazon.com/dp/B07456BG8N?tag=googhydr-20&amp;hvadid=237282226208&amp;hvpos=1t1&amp;hvnetw=g&amp;hvrand=5883430004810816174&amp;hvpone=&amp;hvptwo=&amp;hvqmt=e&amp;hvdev=c&amp;hvdvcmdl=&amp;hvlocint=&amp;hvlocphy=9029132&amp;hvtargid=kwd-295921611050&amp;ref=pd_sl_2g7cb1h5ze_e">Amazon Echo</a>.  I know the product and have used it in the OR before.  Reasonably priced at $79.95 and good fidelity.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:284https://www.myfootshop.com/durable-medical-goods-dme-what-should-they-costDurable Medical Goods (DME) - what should they cost?<h2>DMEs – a $300 dollar hammer?<a href="https://www.myfootshop.com/plantar-fasciitis-night-splint"><img style="float: right;" src="/Content/Images/uploaded/Products/906_Plantar_Fasciitis_Night_Splint.jpg" alt="plantar fasciitis night splint" width="200" /></a></h2> <p>Durable medical goods are items that your doctor would often dispense from his or her office.  In other cases, durable medical goods might be purchased from a home health supply company.  Examples of durable medical goods include a walking cast, a night splint, a bedside commode or a hospital bed.  What’s the true value of these durable medical goods?  How much should they cost?  That’s often a very hard question to answer. </p> <p>This question came to my attention recently while reading my hometown newspaper.  One of my neighbors had written to the editor of the paper to complain that she felt she had been overcharged by a doctor in town.  The doctor had dispensed a lower extremity night splint to her.  She was upset that she and Medicare were charged $122 for the night splint.  The reason she was upset was that a quick search on the Internet had found that you could buy the exact same night splint from Amazon for $29.95.</p> <h3>So what’s a plantar fasciitis night splint really worth? </h3> <p>The answer actually creates more questions.  All DME goods are billed to Medicare via numerical codes called HCPCS (Health Care Procedure Coding System Codes).  A search on Medicare’s 2017 DME supply reimbursement for 2017 shows that in Colorado (my home state), for a night splint (HCPCS code L4360), the allowed amount by Medicare is $159.94.  That means that Medicare would approve to pay a doctor $159.94, 80% of which would be paid for by Medicare and 20% billed to the patient’s secondary insurance or the patient.  These billed amounts are also subject to co-pays and deductibles. </p> <p>A quick search on Amazon for ‘plantar fasciitis night splint’, finds night splints sold as low as $21.95.</p> <p>How could these two charges be so disparate?  Where does the true value of this DME lie?  The doctor, I’m sure, would argue that he or she was providing personalized instructions for use of the splint.  But again, we’re assuming that this is exactly the same device found on Amazon – apples to apples.  So how could you find this same device for $138 less on Amazon?</p> <h3>Health care delivery and health care economics is a lumbering juggernaut that desperately needs to be improved. </h3> <p>Traditionally controlled by government agencies and insurance providers, the delivery of health care is now facing competitive pressures from many sides.  Patients have opportunities to step out of traditionally funded health solutions to find more cost-effective solutions on the Internet, within community support groups or from alternative health care providers.  Is this good health care?  In many instances, yes, it can be.  But just as the US Military famously bought hammers for $300, we don’t need to be approving Medicare payments 7-8 times the market price.</p> <p>So what is the real value of DME?  We like to think that Medically Guided Shopping™ helps to determine DME value.  Myfootshop.com uses Medically Guided Shopping™ to help our customers understand their health problems and find affordable solutions with products specifically intended to treat their conditions.  No guessing, no upsell.  We simply combine consumer-focused health information and cost-effective products. </p> <p>My personal interest in this story is two-fold.   I dispense night splints from my office and bill at accepted Medicare rates.  I also sell night splints here on Myfootshop.com - $49.95.  Can we compete with Amazon?  No, but depending on your preference and your interpretation of value, I think we fit right into that sweet spot of true DME value.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:283https://www.myfootshop.com/posterior-ankle-pain-differential-diagnosisPosterior Ankle Pain – Differential Diagnosis<h2>What are the causes of posterior ankle pain?<a href="https://www.myfootshop.com/article/nerves-lower-extremities"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/Nerves_lower_extremities.jpg" alt="Nerves of the lower extremity" width="200" /></a></h2> <p>One of my peers came to me the other day at the hospital and asked me about a pain she was having in the back of the ankle.  She stated that she had had plain films taken that were unremarkable.  She also had an MRI that failed to show any bone edema, arthritis or stress fracture.  She had the site injected with cortisone with no change in symptoms.  She asked, “With no signs on testing, what’s causing the pain in the back of my ankle?”</p> <p>Her question has really stumped me.  First I had to run through the differential diagnosis in my head that may be present with posterior ankle pain prior to the MRI.  Possibilities included:</p> <ul> <li>Posterior facet arthritis of the subtalar joint</li> <li>Fracture of the posterior process of the talus (Steida’s process)</li> <li>Tendonitis of flexor hallucis tendon or flexor digitorum tendon</li> <li>Stress fracture of the posterior talus or calcaneus</li> <li>Retrocalcaneal bursitis</li> <li>Gout</li> </ul> <p>And then she had her MRI which would have identified inflammatory presence in all of the above conditions.  So what was left?  One of two things –</p> <ul> <li>Focal nerve pain</li> <li>Referred nerve pain</li> </ul> <p>Why nerve pain?  First, neuropathy (nerve pain) doesn’t show up on an MRI.  Secondly, she described her pain as transient but consistent.  She said that it didn’t hurt when she first stood but increased in pain after a period of time on her feet.</p> <p>The <a href="https://www.myfootshop.com/article/nerves-lower-extremities">innervation of the ankle</a> is described in the literature as all nerves passing the ankle.  These nerves include the tibial, sural, deep peroneal and saphenous.  But which of these nerves supplies the posterior ankle?  Although this isn't clearly defined in the literature, the tibial is likely the primary source of innervations with the sural as secondary. </p> <p>What other nerve entrapments do we see associated with the tibial nerve?  First and foremost is <a href="https://www.myfootshop.com/article/tarsal-tunnel-syndrome#Tab3">tarsal tunnel syndrome</a>.  The symptoms of tarsal tunnel syndrome include a vice-like sensation in the midfoot and forefoot.  And then there’s <a href="https://www.myfootshop.com/article/baxters-nerve-entrapment">Baxter’s nerve entrapment</a>.  Baxter’s nerve entrapment is specific to the first branch of the tibial nerve that supplies sensation to the plantar heel.  Each of the conditions describe problems distal to the trifurcation of the tibial nerve in the tarsal canal.  But what about deep to the trifurcation of the tibial nerve?  Is there another branch that supplies Kajer’s triangle and the posterior ankle?  And could this ‘fourth branch’ be the source of posterior ankle pain?</p> <p>Usually, in my blog posts, I try to shed light on a condition that has a definitive cause and effect relationship.  But in this case, I can’t say that I can explain this problem. </p> <p>Stayed tuned, I’ll let you know how it progresses. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:281https://www.myfootshop.com/total-contact-casting-for-charcot-arthropathyTotal Contact Casting for Charcot Arthropathy<h2>Ambulatory treatment of Charcot arthropathy – total contact casting.<img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/xray_foot_Charcot_joint_repair_mod.jpg" alt="x-ray Charcot joint" width="300" /></h2> <p>I work in a rural, hospital-based practice that is a regional referral center.  Much of the care I provide is related to diabetes.  Subsequently, I see and treat a lot of <a href="https://www.myfootshop.com/article/charcot-joint#Tab3">Charcot joints</a>.  Charcot arthropathy occurs in patients who have lost sensation in their feet.  Charcot arthropathy often results in collapse of the arch and chronic wounds of the plantar foot secondary to a problem called a rocker bottom flat foot. </p> <h3>Stages of Charcot arthropathy</h3> <p>Charcot arthropathy is typically classified into four stages (Eichenholzt Classification) (1).   </p> <p> </p> <p> </p> <table> <tbody> <tr> <td width="319"> <p>Stage 0</p> </td> <td width="319"> <p>Warmth to touch, no deformation of arch</p> </td> </tr> <tr> <td width="319"> <p>Stage 1</p> </td> <td width="319"> <p>Warmth to touch, early signs of change on x-ray, edema</p> </td> </tr> <tr> <td width="319"> <p>Stage 2</p> </td> <td width="319"> <p>Collapse of the arch, increased edema</p> </td> </tr> <tr> <td width="319"> <p>Stage 3</p> </td> <td width="319"> <p>Consolidation of collapse and remodeling</p> </td> </tr> </tbody> </table> <p> <br /> Diagnosis of Charcot arthropathy in stage 0 requires a high degree of clinical suspicion due to lack of overt signs on x-ray. </p> <p>I saw a patient this month with a Brodsky type 2 (subtalar joint) Charcot joint (1).  She lives alone and has been treated successfully for a Brodsky type 1 Charcot joint.  With this new onset, aggressive treatment is required to arrest the process of the Charcot joint.  So I placed her in a non-weight bearing cast.  And just by chance, I watched her walk out of clinic on the ‘non-weight bearing’ cast.  She ended up in our emergency department in the next week with wounds on the shin.</p> <p>I had to come up with a compromise, something that would allow light weight-bearing but in a protected environment.  I chose total contact casting (TCC).  We use total contact cast as a method of off-loading until we can get our patient into a TORCH boot.  A TORCH boot is an off-loading boot used to treat deformities such as Charcot arthropathy.</p> <h3>What is a total contact cast? </h3> <p>The images below show the stages used to apply a TCC.  You’ll notice plenty of padding to protect the shin and ankle bones.  Once padded, the final application (with the green and red stripe) is a semi-hard cast.  This cast is then placed in a walker. </p> <p><img src="/Content/Images/uploaded/Medical/Ortho/TCC_1.jpg" alt="Total contact casting" width="150" />  <img src="/Content/Images/uploaded/Medical/Ortho/TCC_2.jpg" alt="Total contact casting" width="150" />  <img src="/Content/Images/uploaded/Medical/Ortho/TCC_3.jpg" alt="Total contact casting" width="150" />  <img src="/Content/Images/uploaded/Medical/Ortho/TCC_4.jpg" alt="Totat contact casting" width="150" />  <img src="/Content/Images/uploaded/Medical/Ortho/TCC_5.jpg" alt="Total contact casting" width="150" /></p> <h4>Why use a total contact cast?</h4> <p>Total contact casting is typically used for <a href="https://www.myfootshop.com/article/diabetic-wound-care#Tab3">diabetic foot ulcerations</a> of the plantar foot.  In this case, we were trying to create a compromise.  We were trying to allow for limited ambulation for a patient who lives alone and needs to complete a certain degree of activities of daily living.  Luckily we were right in our choice.  This patient has done well with good resolution of her Charcot joint.</p> <p>(1)    <a href="https://www.podiatrytoday.com/current-insights-on-classifying-charcot-arthropathy">https://www.podiatrytoday.com/current-insights-on-classifying-charcot-arthropathy</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:280https://www.myfootshop.com/warts-green-breakfast-smoothieVerrucae treatments – the green smoothie solution<h2>Warts – it’s all about the vitamin A<img style="float: right;" src="/Content/Images/uploaded/Blog images/green_smoothie.jpg" alt="Green smoothies for treating warts" width="300" /></h2> <p>I’ve seen a wonderful patient over the past year who is in her late sixties and has been coming in for treatment of a wart.  Although we typically think of a <a href="https://www.myfootshop.com/article/warts#Tab3">wart (verrucae plantaris)</a> as a disease of adolescence, every so often I’ll see someone in their sixth or seventh decade of life with a wart.  Most commonly the wart will be associated with a callus in the forefoot.   And over the years, I’ve found that these particular warts, in folks over the age of 60, are tough to eradicate.</p> <p>Treatment to date with this patient has included periodic paring of the wart and topical application of 60% salicylic acid.  We had also recommended daily supplemental Vitamin A. </p> <p>In my most recent visit with this patient, the wart, and to a great degree, the callus, had disappeared.  We talked about lifestyle and possible contributing factors that may have helped to eliminate the wart.  The one change that rose to the top was a new green smoothie for breakfast diet kick that this patient and her husband were on.  Why is a green smoothie important?   Green leafy vegetables are a very high source of Vitamin A.  Vitamin A is a fat-soluble vitamin that is stored in body fat.  Unlike Vitamins B and C, which are water-soluble, Vitamins A, D, E and K are stored in your body for future use.  Vitamin A is stored primarily in body fat.  And the cushion in the palm of the hand and the sole of the foot?  That’s fat.  Knowing that most warts are found on the palm of the hand and the sole of the foot, the intent of using elevated levels of Vitamin A is to drive excess vitamin A to the palm and the sole.  Every 28 days, we get a whole new layer of skin.  Therefore, over the course of a month, you’ll see elevated levels of Vitamin A in the skin. </p> <h2>What’s in a green breakfast smoothie? </h2> <ul> <li>Kale, 1 cup cooked – 354% of daily recommended amount of vitamin A. (1)</li> <li>Spinach, 1 cup cooked – 377% of daily recommended amount of vitamin A. (1)</li> </ul> <p>There are so many theories in the lay literature that suggest how to treat a wart.  Knowing that most warts are found in adolescence, the vitamin A theory comes from a simple fact – what self-respecting adolescent is going to eat green leafy vegetables? </p> <p>Is the green smoothie a new medication?  Likely not, but I do believe that the dietary changes made by my patient significantly contributed to the elimination of the wart.  Maybe not a new medication, but I’d certainly call it good medicine.  </p> <p><a href="https://www.onegreenplanet.org/vegan-health/food-face-off-health-benefits-of-kale-vs-spinach/">https://www.onegreenplanet.org/vegan-health/food-face-off-health-benefits-of-kale-vs-spinach/</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:279https://www.myfootshop.com/venous-stasis-dermatitisVenous Stasis Dermatitis<h2>What is venous hypertension and how does it cause venous stasis dermatitis?<img style="float: right;" src="/Content/Images/uploaded/Medical/Vascular/venous_stasis_dermatitis.jpg" alt="Venous stasis dermatitis" width="150" /></h2> <p>Hypertension most commonly refers to the overall pressure of the circulatory system, or what would be called high blood pressure.   The term hypertension can also be used to describe elevated pressures in specific regions of the body.</p> <p>Circulation is obviously derived from the word circle.  Blood circulates, or moves from the heart to the toes and back up to the heart.  The front side of this circle, where blood moves from the heart to the toes is called the arterial circulation.  Arterial blood is well oxygenated and supplies oxygen to the tissues of the lower extremity.  As the blood returns to the heart, or what we’ll call the back side or venous return, <img style="float: left;" src="/Content/Images/uploaded/Medical/Derm/venous_stasis_ulcer2.jpg" alt="Venous stasis ulcer" width="150" />pressure can develop if the blood is not effectively carried up the legs.  When pressure develops, we call this <a href="https://www.myfootshop.com/article/venous-stasis-dermatitis-and-venous-ulcerations#Tab3">venous hypertension</a>.  Venous hypertension is typically the result of defective valves in the veins (valvular insufficiency). </p> <p>Venous hypertension can result in swelling of the legs that is characteristically better in the am and worse in the pm.  Swelling is called pitting edema because the swelling leaves a pit or indentation when you press a finger into it. </p> <p>Venous stasis (lack of motion of the blood) is the result of venous hypertension.  Venous stasis results in pressure on the skin.  The changes in the skin as the result of venous stasis are called venous stasis dermatitis.  Venous stasis dermatitis can be mild, showing redness of the skin along with scaling and pain.  Venous stasis dermatitis can also result in deep medial ankle ulcers that require skilled wound care to resolve. </p> <p>The primary treatment of venous stasis is compress therapy with <a href="https://www.myfootshop.com/therafirm-compression-knee-high-socks">compression hose</a>.  Elevation is helpful but difficult in daily practice.  Serious venous wounds need to be treated with wound care and multi-layer compression wraps.</p> <p>If you suspect discoloration of your ankle is due to venous stasis dermatitis, be sure to contact your podiatrist for treatment recommendations. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:278https://www.myfootshop.com/calcaneal-fracture-plantar-medial-tubercleCalcaneal Fracture – Plantar Medial Tubercle<h2>A unique fracture of the calcaneus not found within any fracture classification.<img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/calcaneal fracture.jpg" alt="Unique fracture of the calcaneus" width="200" /></h2> <p>I saw a unique fracture of the heel bone (calcaneus) this week that in 32 years of practice, I don’t believe I have ever seen before.  This fracture is not described in the most common fracture classifications, including the Rowe and Sanders classifications.</p> <p>The patient described the onset as the result of trying to make a point in conversation.  She stomped her foot several times and felt an acute onset of pain.  X-rays show a non-displaced fracture of the plantar medial tubercle.  The plantar medial tubercle of the calcaneus is the primary insertion of the plantar fascia.</p> <p>Fracture healing requires good apposition and good alignment of the fracture site.  In this case, there is a very strong surrounding envelope of soft tissue that will be able to hold the fracture in place and enable uneventful healing.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:277https://www.myfootshop.com/tarsal-tunnel-syndrome-and-the-tinels-signTarsal Tunnel Syndrome and the Tinel’s Sign<h2>Is the Tinel’s sign a reliable diagnostic test?<img style="float: right;" src="/Content/Images/uploaded/Medical/Diagnostic testing/Tinels_sign.jpg" alt="Testing for Tinel's sign of the posterior tibial nerve" width="200" /></h2> <p><a href="https://www.myfootshop.com/article/tarsal-tunnel-syndrome#Tab3">Tarsal tunnel syndrome</a> describes an entrapment of the posterior tibial nerve at the medial aspect of the ankle.  The posterior tibial nerve descends the leg and splits into three branches.</p> <ul> <li>First branch – supplies sensation to the plantar heel.  Also called Baxter’s nerve.</li> <li>Second branch – supplies sensation to the plantar medial aspect of the foot.</li> <li>Third branch – supplies sensation to the plantar lateral aspect of the foot.</li> </ul> <p>When diagnosing tarsal tunnel syndrome, the level of the entrapment and the branches affected by the entrapment can be diagnosed with a test called a Tinel’s sign (French neurologist Jules Tinel 1879-1952).  Knowing the anatomical path of the posterior tibial nerve, use two fingers to percuss along the course of the nerve.  When you identify a tingling sensation (paresthesia), this is likely the location of the entrapment.</p> <p>Is a positive Tinel’s sign of the medial ankle a definitive diagnosis of tarsal tunnel syndrome?  The answer is in many cases – maybe.   First, there is no better test to diagnose tarsal tunnel syndrome.  Therefore, a positive Tinel’s sign of the medial ankle and symptoms that are consistent with tarsal tunnel syndrome is the best we’ve got with today’s technology.</p> <p><img style="float: left;" src="/Content/Images/uploaded/Medical/Diagnostic testing/Tinels_sign_deep_peroneal_nerve.jpg" alt="Testing for Tinel's sign of the deep peroneal nerve" width="200" />But let’s expand the use of the Tinel’s sign and test the deep peroneal nerve on the top of the foot.  If you get a positive Tinel’s sign of the deep peroneal nerve, I start to think that I need to reconsider the validity of my posterior tibial nerve Tinel’s sign. </p> <p>Now let’s go one step further.  If you percuss the common peroneal nerve at the head of the fibula and get a positive Tinel’s sign, now I think you have a diagnostic dilemma.  Let’s look a bit more closely at this diagnostic challenge.</p> <p>When we map out the neuroanatomy of the lower leg, knowledge of the location of each of the branches helps you to isolate the most common areas of focal entrapment.  So if you percuss at all three of the above described known areas of entrapment and only one results in a positive Tinel’s sign, odds are that’s the location of your problems.  But when all three locations result in a positive Tinel’s sign, my thinking takes me more proximal (head north up the leg) and likely you’re dealing with a lumbo-sacral problem to include:</p> <ul> <li>Lumbar disc disease</li> <li>Lumbar stenosis</li> <li>Arthritis of the lumbar and sacral spine</li> <li>Metabolic issue including diabetes, thyroid disease</li> <li>Neurological diseases such as multiple sclerosis</li> <li>Neurotoxicity from chemical exposure or alcohol abuse</li> </ul> <p>In the history that you take from your patient, it’s important to ask about a history of lumbar pain, recurrent injuries and lumbar surgery, general medical conditions, chemical exposures, and alcohol use.</p> <p>In summary, is the Tinel’s sign a good test to diagnose tarsal tunnel syndrome?  Certainly, it is.  But you also need to be sure to rule out other more proximal entrapment issues that may mimic the symptoms of tarsal tunnel syndrome.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-12-2021</p>urn:store:1:blog:post:276https://www.myfootshop.com/pemphigus-vulgaris-of-the-footPemphigus Vulgaris of the Foot<h2>How does the skin blister and why does it happen?</h2> <p>The formation of a blister is a localized deposition of fluid, most commonly deep to the epidermis, the most superficial layer of skin.  Blistering can occur due to a direct insult to the skin such as friction, an acute temperature injury to the skin or due to direct chemical exposure.  Indirect influences can also cause localized blistering including allergic reactions to antigens such as a bee sting, allergic reaction or illness.</p> <h3>What causes blistering?</h3> <p>Blistering is an acute release of interstitial fluid that is part of an inflammatory cascade that:</p> <ul> <li>Stops bleeding</li> <li>Attracts mast cells and platelets that release histamine </li> <li>Clears injured cells from the wound site</li> <li>Generates new skin to resurface the injury</li> </ul> <h3>Pemphigus Vulgaris</h3> <p>One unique and sometimes serious cause of blistering that occurs secondary to an immune reaction is called pemphigus vulgaris.  Pemphigus vulgaris forms a fluid-filled blister that often has an erosive base, blistering deep into the deeper layers of skin, called the dermis.  Pemphigus vulgaris is due to an autoimmune reaction mediated by autoantibodies that are specific to keratin cells.  Pemphigus vulgaris affects skin, mucous membranes of the nose, and perianal tissues.  Erosions can range from quite small to large and<img style="float: right;" src="/Content/Images/uploaded/Blog images/pemphigus_vulgaris.jpg" alt="Pemphigus vulgaris of the foot" width="300" /> life-threatening with a mortality rate of 5-15%. (1)</p> <h4>Case presentation of pemphigus vulgaris of the foot</h4> <p>I saw a unique case presentation this week of pemphigus vulgaris in the foot.  The patient’s history was negative for new drugs, use of new socks or detergents.  She described a painful, deep blister that presented within 24 hours.  I monitored the blister over the course of two weeks while it spontaneously resolved without treatment.</p> <h5>Treatment of pemphigus vulgaris</h5> <p>In cases that do require treatment, corticosteroids or other immune suppressants at required to control the progress of the blistering and skin erosion.</p> <p>(1)    Ahmed AR, Moy R.  Death in Pemphigus.  J AmAcad Dermatol. 1982 Aug. 7(2)6221-8.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:275https://www.myfootshop.com/external-fixation-for-charcot-joint-reconstructionExternal Fixation for Charcot Joint Reconstruction<h2>Patient choice – are there weight limits when using ex-fix?<img style="float: right;" src="/Content/Images/uploaded/Blog images/charcot_fluro_2.jpg" alt="Charcot reconstruction" width="200" /></h2> <p>External fixation (ex-fix) is often used as an adjunct to internal fixation when correcting rocker bottom flat foot due to Charcot arthropathy.  The reason that ex-fix is used is that the frame, or ex-fix device, can be used to carry weight thereby offloading the internal fixation.  With the use of an ex-fix device, patients are able to ambulate earlier which reduces many of the post-op complications in this high-risk population of patients.  The ex-fix device is also used to protect the internal fixation from excessive load-bearing and potential failure.</p> <p>Lower extremity reconstruction with ex-fix enables off-loading of the foot by applying body weight to the various types of pins anchored directly in the tibia, talus (ankle bone) and calcaneus (heel bone).  When these pins are loaded with weight-bearing, they apply sheer force to the bone.  When using ex-fix in patients with higher BMI, how much sheer force can the bone tolerate?</p> <p><img style="float: left;" src="/Content/Images/uploaded/Blog images/2017-10-09 17.15.13.jpg" alt="Charcot reconstruction" width="200" />I performed a Charcot reconstruction 3 weeks ago on a patient with a body mass index of 79 (450 lbs/5’3” tall).  In my initial interview with this patient, I recommended below the knee amputation.  A second opinion concurred with my recommendation but the patient wanted to attempt limb salvage.  Due to her size, she was a poor candidate for reconstruction with internal fixation alone.   I opted for combined internal fixation and ex-fix with primary load applied by the frame to half-pins in the tibia.</p> <p>To date, the patient has done well with weight-bearing limited to 25-50% of full weight.  Wounds appear healthy with no issues.  This patient will be in her ex-fix for four months. </p> <h2>What are the weight limitations of lower extremity ex-fix? </h2> <p>When considering ex-fix in Charcot reconstruction, BMI needs to be considered.  A review of the literature shows no papers that discuss BMI in use of lower extremity ex-fix.  With a BMI of 79, we certainly are testing the limits.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:274https://www.myfootshop.com/whats-in-your-toe-boxWhat’s in your toe box?<h2>The shape of the toe box – add that to length and width next time you go shoe shopping.</h2> <h2><img style="float: right;" src="/Content/Images/uploaded/Blog images/toe box shape.jpg" alt="toe box" width="200" /></h2> <p>I saw a young man who came into the clinic this week with a sore ingrown toenail. His family doctor had placed him on antibiotics and referred him to us for correction of the nail.  But there was a problem.  The primary issue was the fact that the patient’s great toe was exceedingly long.  What this meant was that I could fix the nail issue that he had today, but he was destined to have the same problems again due to the incompatibility between the shape of the toe box of his shoe and the length of his great toe.  Shorten the big toe?  It’s an option, but maybe, just maybe, the better choice would be to find a shoe that has a toe box that is compatible with the shape of his foot, right?</p> <p><img style="float: left;" src="/Content/Images/uploaded/Blog images/toe_box_poor_fit.jpg" alt="toe box" width="150" />The image to the left is a good example of incompatibility of the shape of the forefoot and the shape of the shoe.  It’s obvious that this foot is prone to problems with the great toe, including recurrent ingrown nail.  The image to the right shows a more compatible shape of the foot in relationship to the shape of the shoe.</p> <p>Which shoe is right for you?  That’s a question that every foot doc gets asked every week.  And there’s really<img style="float: right;" src="/Content/Images/uploaded/Blog images/toe_box_good_fit.jpg" alt="toe box" width="150" /> no good answer to that question since every foot is just a little bit different.  But remember, length and width are just the start of finding the right shoe. </p> <p> </p> <p> </p> <p> </p> <h2>Here are some additional considerations when shoe shopping;</h2> <ul> <li>Shape of the toe box</li> <li>Rigidity of the shank</li> <li>Height of the heel</li> <li>Breathability of the materials (leather and mesh vs. plastic)</li> <li>Matching the right shoe to the right activity (no tennis shoes for chopping wood)</li> </ul> <p>Interestingly, there’s a lot that goes into selecting the right shoes for each activity in your life.  One resource that can help is to find a shoe shop in your town that employs a certified pedorthist.  A pedorthist is trained and certified by the state to select and fit shoes for all ‘walks of life’.  For more information on finding a pedorthist in your area, go to the <a href="https://www.pedorthics.org/?page=WHATISACREDPED">Pedorthic Footcare Association</a>.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:273https://www.myfootshop.com/turf-toe-of-the-ip-jointTurf Toe of the IP Joint<h2>Great toe injuries post 1<sup>st</sup> mpj fusion<img style="float: right;" src="/Content/Images/uploaded/Blog images/1st mpj fusion.jpg" alt="x-ray 1st mpj fusion " width="150" /></h2> <p>I saw an interesting case of <a href="https://www.myfootshop.com/article/turf-toe#Tab3">turf toe</a> this week.  The patient was a 63 y/o female who underwent 1<sup>st</sup> mpj fusion for stage 4 hallux limitus in 2007.  The fusion was a success and the patient went on to be quite active in sports.</p> <p>The patient presented to my office this week stating that 2 weeks ago she had caught her great toe in the pants cuff of a friend while walking.    The resulting fall caused an injury to the interphalangeal joint (IP joint) of the great toe.  The IP joint is the joint in the toe, close to the nail.  X-rays of the foot showed a stable fusion site with no indication of injury to the 1<sup>st</sup> mpj.  But <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat"><img style="float: left;" src="/Content/Images/uploaded/Products/972_Turf_Toe_Plate_Carbon_Graphite_Flat.jpg" alt="turf toe plate" width="75" /></a>ironically, the primary injury was a hyperextension injury of the IP joint.  When this injury occurs at the 1<sup>st</sup> mpj, it is classically called turf toe.  Could we call this injury of the IP joint turf toe?  I think we can.  This is the first case of IP joint turf toe that I’ve seen.  This is an unusual case that is directly due to the great toe fusion.</p> <p>Treatment includes rest, ice, NSAID’s and use of a <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">turf toe plate</a>.  She should heal unremarkably.</p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:272https://www.myfootshop.com/foot-care-101-metatarsal-stress-fracturesFoot Care 101: Metatarsal Stress Fractures<h2>How did I get a fracture?  I didn’t do anything to hurt my foot?         </h2> <h2><img style="float: right;" src="/Content/Images/uploaded/Blog images/people-2557534_1280.jpg" alt="Metatarsal Stress Fracture" width="300" /></h2> <p>“I was late for the plane, so I grabbed my carry-on bag and ran like heck to make the flight.  I was the last passenger on.  But when I got on the plane, I realized that my foot hurt.  It’s been hurting now for about 2 weeks.”  This is a familiar conversation in my office.  A benign event, like running for a plane, often is enough stress to result in a <a href="https://www.myfootshop.com/article/metatarsal-fracture#Tab3">metatarsal stress fracture</a>.</p> <h3>What is a metatarsal stress fracture? </h3> <p><a href="https://www.myfootshop.com/article/bone-ap-forefoot-mod-labeled">The metatarsal bones</a> are the bones that extend from the arch to the toes.  The metatarsal bone is soft on the ends (metaphyseal bone) with a long tubular center (diaphyseal bone).  When load is applied to a bone, particularly the hard diaphyseal bone, that load is called strain.  When strain becomes so great that the bone fails, we call that stress.  Therefore, a stress fracture occurs when load applied to a bone results in a small break in the diaphyseal bone.</p> <h3>Symptoms of metatarsal stress fractures</h3> <ul> <li>Pain with initial weight bearing</li> <li>Pain that increases with the duration of time on your feet</li> <li>Pain most commonly found in the 2<sup>nd</sup> and 3<sup>rd</sup> metatarsals</li> <li>Focal, palpable pain on the dorsal (top) of the foot</li> <li>Localized swelling specific to the dorsal foot</li> <li>Swelling and redness, but no bruising found</li> </ul> <p>Confirmation of a stress fracture with plain x-ray can be difficult in the first 3-4 weeks following the onset of pain.  The stress applied to the bone results in a fracture that is initially indistinguishable on x-ray.  The confirmation of a stress fracture is often made with x-ray 4-6 weeks following the onset of symptoms.  At 4 weeks, the initial bone callus (healing tissue at the fracture site) will begin to calcify at the site of fracture.</p> <h3>Treatment of metatarsal stress fractures</h3> <p>Most metatarsal stress fractures will heal in a matter of 4-6 weeks.  But you can help expedite that healing process by using a stiff sole.  Many physicians will treat metatarsal stress fractures with a walking cast, but a still sole will often suffice.  The key is to avoid the use of a soft, flexible sole.  Additional treatment recommendations include;</p> <ul> <li>Stiff sole like a clog or men’s wingtip</li> <li><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Fiber Spring Plate</a></li> <li><a href="https://www.myfootshop.com/forefoot-compression-sleeve">Forefoot Compression Sleeve</a></li> </ul> <p>I find the Carbon Fiber Spring Plate to be the most effective tool for metatarsal stress fracture management.  Carbon fiber Spring Plates are very thin and very light.  They fit easily into shoes and provide the rigidity needed to expedite healing.</p> <p>For more information on metatarsal stress fractures, be sure to visit our knowledge base pages on metatarsal stress fractures.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:271https://www.myfootshop.com/medical-micro-momentsMedical Micro Moments<h2>Google calls them Micro Moments - <img style="float: right;" src="/Content/Images/uploaded/Blog images/cell-phone-791365_640.jpg" alt="medical micro moment" width="300" /></h2> <h2> </h2> <h3>We call them Medical Micro Moments – great opportunities for medical education.</h3> <p>You know the scenario – you go to the doctor and you get your diagnosis.  It all made sense while you were in the office speaking with the doctor.  You walk out to your car and your head is spinning.  What did the doctor say?  I have a what?</p> <p>Next thing you know, you’re on Google or YouTube checking out your new condition.  When it comes to foot care, we want to be a part of your medical micro moments.  Our <a href="https://www.myfootshop.com/Articles/">foot and ankle knowledge base</a> offers more than 120 consumer-oriented, in-depth articles specifically targeted for foot and ankle pathology.</p> <p><img style="float: left;" src="/Content/Images/uploaded/foot_finder-expanded.jpg" alt="INGRID" width="200" />Where do you start?  Are you a left-brain or right-brain person?  Many people enter our site and land directly on pages that describe specific conditions.  Other users of our site prefer to search for their condition using <a href="https://www.myfootshop.com/Articles/">INGRID, our Interactive Graphical Interface for Diagnoses</a>.  INGRID is a great way to search for foot and ankle conditions specific to the geographic region of the foot or ankle.  The graphical overlay allows our staff to work with customers to better define the exact location of their foot or ankle problem.</p> <p><a href="https://www.myfootshop.com/articles/List/21">Foot and ankle anatomy</a>?  We’ve definitely got you covered.  I’m particularly proud of our graphical presentation of the <a href="https://www.myfootshop.com/articles/List/26">muscles of the leg, ankle and foot (myology). </a> The images show the origin and insertion of the lower leg muscles along with their primary vascular inflow and innervation.</p> <p>Our <a href="https://www.myfootshop.com/articles/List/27">foot and ankle X-ray images</a> with graphical overlay is another way that we can help you drill into the problems that you’re trying to<img style="float: right;" src="/Content/Images/uploaded/Anatomy/Radiology/x-ray_lat_foot_mod.jpg" alt="x-ray foot" width="200" /> treat.</p> <p><a href="https://www.myfootshop.com/about">Medically Guides Shopping™</a> is a perfect partner for medical micro moments.  We use Medically Guided Shopping™ to pair medical conditions of the foot and ankle with the most appropriate product to treat the condition.  Medically Guided Shopping™ and medical micro moments are the perfect partners.</p> <p>How do you find your solutions to foot and ankle problems?  We’ve discussed a number of options, but most importantly, we’re always here to help.  Jump on chat or give us a call.  We look forward to helping you use medical micro moments and Medically Guided Shopping™  to make your journey through this world a good one.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:270https://www.myfootshop.com/anatomy-101-the-lower-extremityAnatomy 101 – the lower extremity<h2>Foot anatomy – them bones them bones<a href="https://www.myfootshop.com/articles/List/27"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Radiology/x-ray_lat_foot_mod.jpg" alt="foot x-ray" width="300" /></a></h2> <p>One of the more popular tools on Myfootshop.com is our vast foot and ankle knowledge base.  In addition to articles on common foot and ankle conditions, we also have an entire section on lower extremity anatomy.  The most useful set of images in our foot and ankle anatomy section are the x-rays of the feet.  The x-rays are marked with a colorful overlay.  The overlay helps our sales staff when working with customers – does it hurt more over the #5 or the #7?</p> <h3>Training the professionals of tomorrow</h3> <p>We also get feedback from students and health care professionals who use our anatomy images in presentations.  It’s great to know that our information is being used to train future health care professionals.  Additional resources in the foot and ankle anatomy section include;</p> <ul> <li><a href="https://www.myfootshop.com/articles/List/21">Spacial orientation of the foot and ankle</a> (body planes)</li> <li><a href="https://www.myfootshop.com/articles/List/22">Topography</a> (medial/lateral)</li> <li><a href="https://www.myfootshop.com/articles/List/23">Osteology</a> (them bones, them bones, them crazy foot bones)</li> <li><a href="https://www.myfootshop.com/articles/List/24">Angiology</a> (arteries and veins of the foot)</li> <li><a href="https://www.myfootshop.com/articles/List/25">Neurology</a> (nerves of the foot and lower leg)</li> <li><a href="https://www.myfootshop.com/articles/List/26">Myology</a> (muscles of the leg, ankle, and foot)</li> <li><a href="https://www.myfootshop.com/articles/List/27">Radiology</a> (x-rays of the foot and ankle)</li> </ul> <p>Our foot and ankle anatomy images are just a small part of what we call <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a>.  We’re not your doctor and we can’t make a diagnosis for you, but we help to guide you into a better understanding of your foot or ankle problem.  With a better understanding comes focused care, fewer costs, and improved outcomes.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:269https://www.myfootshop.com/opiod-addictionOpioid Addiction<h2>Opioid Addiction Stories – being on the front line of managing patients with opioid addiction<img style="float: right;" src="/Content/Images/uploaded/Blog images/drug addiction.jpg" alt="Opioid addiction" width="200" /></h2> <p>Opioid and heroin addiction is unfortunately all too common, and this addiction is mean.   It changes people in a way that is almost incomprehensible.  In my practice, I’m confronted every day with decision making that is influenced by addiction.  That’s right – every day.</p> <p>I was speaking with a colleague this week who treated a patient in the emergency department (ED) for vague symptoms of nausea and vomiting.  One of the most basic fundamentals of treatment, in this case, is hydration.  Hydration is typically accomplished through an IV.  So the IV was started and the patient walked out of the ED.  She just up and left.  And then she came back.</p> <p>In this case, the patient had run out of veins to shoot-up and came to the ED specifically to use their expertise to identify a vein.  Who better than a trained phlebotomist to help you access your vein, right?</p> <p>I know this conversation deviates a bit from our focus on foot and ankle care, but it’s an important conversation that needs to be shared.  I’ll keep sharing stories in an effort to help readers understand the power of addiction.  People are dying – good people.  Let’s put this topic out in the light to help bring this epidemic of drug use to a close.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:268https://www.myfootshop.com/lateral-sole-wedge-inserts-for-osteoarthritis-of-the-medial-compartment-of-the-kneeLateral Sole Wedge Inserts for Osteoarthritis of the Medial Compartment of the Knee<h2>Can a Lateral Sole Wedge Insert be worn with a Prescription Orthotic?<a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><img style="float: right;" src="/Content/Images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts_ALT2.jpg" alt="Lateral Sole Wedge Insoles" width="200" /></a></h2> <p>Lateral Sole Wedge Inserts are used and recommended to limit <a href="/article/supination">supination of the foot</a>. Excessive supination leads to biomechanical overload of the medial knee making patients prone to early-onset osteoarthritis of the knee.  By limiting supination, Lateral Sole Wedge Inserts not only prevent early-onset osteoarthritis but they also help to treat active osteoarthritis of the medial compartment of the knee. </p> <p>Can a prescription orthotic be worn in conjunction with a Lateral Sole Wedge Insert?  Researchers from the University of British Columbia recently studied this issue.  In a study entitled <a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0201-x">'<em>Lateral wedges with and without custom arch supports for people with medial knee arthritis and pronated feet'</em></a>, his study followed 25 patients with medial compartment osteoarthritis of the knee who have worn prescription foot orthotics.  The researchers added a 5-degree lateral sole wedge under the prescription orthotic.  Results were as follows;</p> <table style="width: 100%;" width="664"> <tbody> <tr> <td style="padding-left: 30px;"><span style="background-color: #c0c0c0; color: #ffffff; font-size: 10pt;">Using a minimal clinically important improvement of 17% for WOMAC pain and 12% for WOMAC function [<a href="https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0201-x#CR29"><span style="background-color: #c0c0c0; color: #ffffff;">29</span></a>], use of lateral wedges alone resulted in improved pain in 13 (54%) participants and improved function in 14 (58%) participants. When using the lateral wedges plus arch support, 14 (64%) participants had improved pain while 17 (77%) participants had improved physical function.</span></td> </tr> </tbody> </table> <p>Although the total number of participants in the study does limit the objectivity of the study, the outcome is inequitable in the support for use of both Rx inserts and lateral wedges.</p> <p><a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">Lateral Sole Wedge Inserts</a> are simple to use, easily trimmed and fit in all shoes.  It’s great to offer an easy to use, affordable solution for medial compartment osteoarthritis of the knee.</p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:267https://www.myfootshop.com/carbon-graphite-insoles-and-gaitCarbon graphite insoles and gait<h2>Levers, rockers and carbon graphite insoles</h2> <h3>Part 3 – Putting it all together</h3> <p>In <a href="https://www.myfootshop.com/carbon-graphite-shoe-inserts-can-i-use-a-single-insert-or-are-they-better-as-a-pair">part 1</a> of this conversation I presented a common customer question:  can I wear just one carbon fiber insole?  I briefly discussed gait and how a carbon fiber insole may affect gait.  In <a href="https://www.myfootshop.com/rocker-mechanics-of-the-lower-extremity">part 2</a> of this conversation, I addressed rockers and how rockers work in the gait cycle.  Let’s close this conversation by discussing how each of our carbon fiber insoles affects gait, including similarities and differences.</p> <h3>Lever arms and rockers – what’s the deal?</h3> <p>The leg, ankle, and foot are a lever.  The primary function of this lever is to deliver the mechanical force generated by the calf muscle to where the action takes place in the forefoot.  So let’s put a carbon fiber insert under the foot.  What happens to the leg, ankle and foot lever?  First, think of the carbon fiber insert as something that splints the foot, strengthening the lever arm.  Is this a good thing?  Can you wear just one or should you wear a pair?</p> <p>Normal gait requires a forefoot rocker.  To mimic normal gait, I’ll always lean on the Spring Plate as the best choice of carbon fiber insert due to the forefoot rocker in the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a>.  But much of the success that we see with carbon fiber insoles comes with personal preference.  Some of our customers who have tried both the Spring Plate and <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Turf Toe Plates</a> prefer the Turf Toe Plate for sports.  Other customers prefer the thinner <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">Flat Turf Toe Plate</a> due to the ease of fit in dress shoes.  Therefore, it’s safe to say that the choice of carbon fiber insert can be somewhat personal based on not only the foot problem but also on intended use of the insert.</p> <p>Can you wear just one carbon fiber insole?  Absolutely.  In fact, we purposely sell the majority of our carbon fiber insoles as a single insert and not a pair.  Less expensive and just as effective – try one at a time.  If you find you need another to make a pair, we’ll be here.</p> <p>Carbon fiber inserts are durable and versatile.  If you need help with selecting the correct carbon fiber insole, be sure to contact us for further assistance.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:266https://www.myfootshop.com/rocker-mechanics-of-the-lower-extremityRocker mechanics of the lower extremity<h2>How do carbon fiber insoles affect gait?</h2> <h3>Part 2 - rocker mechanics of the lower extremity</h3> <p>Rockers are a very important part of lower extremity biomechanics.  Rockers describe pivot points in the gait cycle that decrease the range of motion of the ankle and knee.  Rockers are also employed by the body to conserve energy during gait.  In the lower extremity, the three rockers are the heel rocker (also called a rearfoot rocker), the ankle and the forefoot rocker.  What’s the importance of each of these rockers?  Let’s take a closer look.</p> <h3>Rearfoot, ankle and forefoot rockers</h3> <p>The first image (below left) shows the function of the foot without the ankle rocker.  This image shows the excursion of the tibia using only the rearfoot and forefoot rocker.  The total excursion of the tibia with just the rearfoot and forefoot rocker is significant resulting in what would be impractical range of motion of the knee.  The second image (below right) adds a third rocker, the ankle rocker.  Adding the ankle rocker significantly decreases the total excursion of the tibia which in turn decreases energy expended by the body during gait.  In the second image, you can see that walking is a kinetic chain of events that relies on the interplay of multiple rockers. (Images from Human Walking by Inman, et al.)</p> <p> </p> <p><img src="/Content/Images/uploaded/Blog images/rearfoot-forefoot rockers.jpg" alt="lower extremity rocker mechanics" width="345" height="374" />    <img src="/Content/Images/uploaded/Blog images/rearfoot-ankle-forefoot rockers.jpg" alt="" width="338" height="374" /></p> <p> </p> <h3>How do carbon fiber inserts affect gait?</h3> <p>How do carbon fiber insoles affect rocker mechanics of the lower extremity?  Rearfoot rocker mechanics aren’t affected in the least by rigid, carbon fiber insoles.  Knowing from the images in this post that the forefoot rocker and ankle rocker work together, we can assume that any impact on the forefoot rocker will affect the ankle rocker.  Use of most carbon fiber inserts is going to delay the toe-off phase of gait.  This means that the <a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat">Flat Shoe Plate</a>, <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Molded Turf Toe Plate</a>, and <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">Flat Turf Toe Plates</a> are all going to delay toe-off.  To a degree, delay in toe-off will increase load to the lower back due to lifting of the foot instead of active toe-off.  The <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a>, on the other hand, is just a bit different.  Due to the built-in toe spring in the Spring Plate, the Spring Plate will allow for timely toe-off during gait.</p> <p>If a carbon fiber insert affects the forefoot rocker, is that necessarily a bad thing?  In most cases, no.  Most users of carbon fiber plates really don’t notice the difference in their gait.  For those with a history of lumbar pain though, the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> may be the better choice.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:265https://www.myfootshop.com/carbon-graphite-shoe-inserts-can-i-use-a-single-insert-or-are-they-better-as-a-pairCarbon Graphite Shoe Inserts – can I use a single insert or are they better as a pair?<h2>How do carbon graphite insoles affect gait?<img style="float: right;" src="/Content/Images/uploaded/Blog images/beach-2090091_1280.jpg" alt="Gait analysis" width="300" /></h2> <h3>Part 1 – Legs and levers</h3> <p>A common question that we hear from customers is whether a <a href="https://www.myfootshop.com/carbon-graphite-foot-orthotic">carbon graphite shoe insole</a> can be used as a single shoe solution or should they purchase as a pair to balance gait.  Does a single carbon graphite insert effect gait in a detrimental way?  Let’s take a closer look at carbon graphite shoe inserts and their effect on gait.</p> <h3>How do carbon graphite shoe insoles affect the lever mechanics of the lower extremity?</h3> <p>Walking can be described as a controlled forward fall, regulated by a lever arm we know as the leg, ankle, and foot.  Levers typically include three parts; the effort arm, the resistance arm, and the fulcrum.  In this example, the leg is the effort arm, primarily dominated by the function of <a href="https://www.myfootshop.com/article/soleus">the soleus muscle</a>.  The foot becomes the resistance arm of the lever where the biomechanical force generated by the effort arm is manifested.  The ankle is the fulcrum, the hinge that translates the force generated by the effort arm to the resistance arm to create work.  We call this work walking.</p> <p>In the leg, the soleus muscle is the slow twitch muscle that dominates the effort arm and acts to decelerate the forward motion of the tibia as it moves forward over the foot during the stance phase of gait.  During stance phase, the soleus muscle is undergoing eccentric muscle contraction – providing force while lengthening.   </p> <h4>How does a carbon graphite shoe insert effect the lever mechanic of the lower extremity? </h4> <p>Think of carbon graphite inserts as a brace for the foot much akin to a rigid shank in the shoe – the shank being the portion of the shoe extending from the heel to the ball of the foot.  A carbon graphite shoe insert is intentionally used to stiffen the shank.  Referring back to lever mechanics, use of a carbon graphite insert effectively lengthens the resistance arm of this lever.  Lengthening the resistance arm increases the power of the entire lever.  The result becomes:</p> <ul> <li>Increased duration of the stance phase of gait</li> <li>Increased force to the forefoot at the toe-off phase of gait</li> <li>Empowerment of the soleus muscle (increased duration and amount of eccentric contraction)</li> <li>Increased mechanical load applied to the lower leg, knee and upper leg</li> <li>Increased mechanical load applied to the hip and lumbar spine</li> </ul> <p>Lengthening of the resistance arm can indeed result in increased load applied to the leg, hip, and back.  Lengthening the resistance arm can also result in prolonging the stance phase of gait, decrease propulsion at toe-off and result in steppage gait.  Steppage gait describes lifting of the foot rather than actively pushing off with the ball of the foot. </p> <p>Are these mechanical changes caused by a carbon graphite shoe insert necessarily a bad thing?  Are they detrimental to gait?  In some respects, yes.  But these changes in gait are often off-set by use of what's called a forefoot rocker.</p> <p>Let’s jump to <a href="https://www.myfootshop.com/rocker-mechanics-of-the-lower-extremity">part 2</a> of this conversation – <a href="https://www.myfootshop.com/rocker-mechanics-of-the-lower-extremity">rocker mechanics</a>.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:264https://www.myfootshop.com/just-for-toenails-antifungal-nail-polishJust For Toenails - Enhanced Nail Polish<h2>Enhanced Nail Polish In Multiple Colors<a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish"><img style="float: right;" src="/Content/Images/uploaded/Products/905_Just_For_Toenails_Medicated_Nail_Polish_ALT2.jpg" alt="Just For Toenails Nail Polish" width="150" /></a></h2> <h3>Who'd've thought you could treat nail fungus with fun colors?</h3> <p>Spring has sprung, the grass has riz’, my how good my toenail is! It’s sandal season, y'all, and <a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish">Just For Toenails</a> is here just in time to help you get ready for summer and sandal season. Choose from fun colors like ’Loose Lips Pink Ships’, ‘Fiery Coral’ or ‘Mountain View Blue’.  All contain the top antifungal product, tea tree oil, to fight that fungus.</p> <p>Toe nail fungus, also called <a href="https://www.myfootshop.com/article/onychomycosis">onychomycosis</a>, typically occurs following an injury to the nail. Once the protective barrier of the nail is disrupted by injury, fungus, which is everywhere around us in nature, will slowly invade the nail. Fungus initially appears as a yellow discoloration at the tip of the nail, progressing slowly to the base of the nail over the course of months to years.</p> <p>You can have fun with nail polish colors while you fight toe nail fungus – how cool is that?</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:263https://www.myfootshop.com/natural-urea-callus-creamPodiatrists'® Choice Callus Control Cream<h1>What is urea and how is it used in skin care?<a href="https://www.myfootshop.com/ureacin-20-cream-1"><img style="float: right;" src="/Content/Images/uploaded/Products/1102_Urea_Cream.jpg" alt="Urea Cream" width="150" /></a></h1> <p>Urea is a naturally occurring nitrogen crystal.  Urea is the product of protein degradation in the human body, produced by the liver and excreted through the kidneys.  Urea is the primary means through which your body eliminates nitrogen.  Urea is non-toxic to the human body.</p> <h2>Commercial uses of urea</h2> <p>Urea can be commercially manufactured and is used in many different applications.  In medicine, urea is prized for its’ hydrating and exfoliating properties.  Additional applications include:</p> <ul> <li>         Agricultural feed additives</li> <li>         Flavor enhancer for tobacco products</li> <li>         Explosives</li> <li>         Diesel exhaust systems</li> <li>         Hair removal products</li> <li>         De-icing applications</li> </ul> <h3>Urea in skin care - Podiatrists Choice Callus Control Cream</h3> <p>After many late nights in the Myfootshop.com lab, we’re proud to announce the launch of our new urea skin cream, <a href="https://www.myfootshop.com/podiatrists-choice-callus-control-cream">Podiatrists Choice Callus Control Cream</a>.  Podiatrists Choice Callus Control Cream is safe enough to use every day and tough enough to soften even the hardest of calluses.  With the addition of tea tree oil and lavender extracts in our formula,  Podiatrists Choice Callus Control Cream also acts as a potent antifungal.</p> <p>Myfootshop.com’s line of natural skin care products is developed with sustainability in mind. Our goal is to save our customers money by buying a single product to treat multiple conditions.  Our secondary goal is to decrease packaging and transportations costs.</p> <p></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3-11-2021</p>urn:store:1:blog:post:262https://www.myfootshop.com/treat-hallux-limitus-with-a-mortons-extensionTreat Hallux Limitus with a Morton's Extension<h2>What is a Morton's Extension?</h2> <p>Thomas George Morton (1835-1903) was a clinical professor and surgeon at The Pennsylvania Hospital.  He was an active surgeon during The Civil War and founding director of several hospitals in the Philadelphia area.  As a pioneer of surgical techniques, he is accredited with diagnosing and performing one of the first appendectomies in which the patient survived.</p> <p>Although the history is obscure, Dr. Morton's name remains in foot care and describes a number of different conditions including <a href="https://www.myfootshop.com/article/metatarsalgia">Morton's metatarsalgia</a> and <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>.  A modification to shoes also carries his name, specifically, the Morton's extension.</p> <h3> </h3> <h3>What foot conditions can be treated with a Morton's extension?</h3> <p>A Morton's extension is an extension of the shoe or arch support, that changes the function of the foot by limiting the range of motion of the great toe joint.  Morton's extensions are used in the treatment of:</p> <p><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux limitus (and hallux rigidus)</a></p> <p><a href="https://www.myfootshop.com/article/turf-toe">Turf toe</a></p> <p><a href="https://www.myfootshop.com/article/sesamoiditis">Sesamoiditis</a></p> <p><a href="https://www.myfootshop.com/article/sesamoid-fracture">Sesamoid fractures</a></p> <p><a href="https://www.myfootshop.com/article/diabetic-foot-care">Ulcerations of the great toe (diabetic)</a></p> <p>Use of a Morton's extension has a profound effect on the function of the forefoot.  In addition to limiting the range of motion of the great toe joint, a Morton's extension increases the lever arm length of the foot. </p> <h3> </h3> <h3>Myfootshop.com orthotics with a Morton's extension</h3> <p>Myfootshop.com carries a number of products that utilize a Morton's extension in varying degrees of stiffness.  Choosing the most appropriate device for your needs depends upon your level of activity and shoe type.</p> <p> </p> <table style="height: 86px;" width="598"> <tbody> <tr> <td><img src="/Content/Images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="Turf toe plates" width="150" /></td> <td><a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Molded Turf Toe Plates</a> are most commonly used for pedestrian and sports activities.  In addition to arch support, Molded Turf Toe Plates provide a very rigid Morton's extension.</td> </tr> </tbody> </table> <table style="height: 162px;" width="600"> <tbody> <tr> <td> <p><a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Carbon Graphite Turf Toe Plates</a> are a simple semi-rigid, flat orthotic that fits well into pedestrian shoes.  Carbon Graphite Turf Toe Plates are a particularly good option for dress shoes. </p> <p> </p> </td> <td><img src="/Content/Images/uploaded/Products/972_Turf_Toe_Plate_Carbon_Graphite_Flat.jpg" alt="Turf toe plate" width="150" /></td> </tr> </tbody> </table> <table style="height: 21px;" width="600"> <tbody> <tr> <td><img src="/Content/Images/uploaded/Products/962_Hallux_Trainer_Working_ALT.jpg" alt="Hallux Trainer Insoles" width="150" /></td> <td> <p><a href="https://www.myfootshop.com/hallux-trainer-insoles">Hallux Trainer Insoles</a> are a finished insert with a semi-rigid polypropylene Morton's Extension.  Hallux Trainer Insoles are a great product for tennis shoe or boot insole replacement.</p> <p> </p> </td> </tr> </tbody> </table> <table style="height: 21px;" width="599"> <tbody> <tr> <td> <p><a href="https://www.myfootshop.com/vasyli-dananberg-orthotic">VHD - Vasyli Howard Dananberg Insoles</a> are a unique form of modifiable Morton's extension.  The proximal and distal plugs (included) are used to either increase or decrease the range of motion of the great toe joint depending on the stage of hallux limitus (increased motion for early-stage with decreased motion for late-stage HL).</p> <p> </p> </td> <td><img src="/Content/Images/uploaded/Products/963_Dananberg_Insole.jpg" alt="VHD - Vasyli Howard Danaberg Orthotics" width="200" /></td> </tr> </tbody> </table> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/15/2021</p>urn:store:1:blog:post:261https://www.myfootshop.com/piezogenic-papules-what-are-they-and-how-do-they-formPiezogenic papules – what are they and how do they form?<p style="text-align: left;"> </p> <h2>Bumps on my heel – what are they?  </h2> <p>Adipose tissue (fat) performs a number of functions in our body.  Adipose tissue can act as a fuel for energy and can act as a reservoir for vitamins, electrolytes, and chemicals needed for future use.  Adipose tissue also has a structural function that shapes our bodies and helps to protect us from injury.  Adipose tissue is what makes the palm of the hand and sole of the foot soft and able to accommodate weight-bearing.  Adipose tissue is found throughout the body and is often contained within other more rigid tissues such as fascia and the dermis of the skin.</p> <p>When adipose tissue herniates out of these stiffer supporting tissues and becomes obvious to the eye, the term for this condition is called a piezogenic papule.  The term piezo comes from the Latin term piezein, meaning to compress.   In the heel, adipose tissue acts to pad the bottom of the foot.  With weight-bearing, pressure from the floor is applied to the adipose tissue of the bottom of the foot.  As body weight is applied to the foot, adipose tissue is forced out against the skin forming piezogenic papules.</p> <p> </p> <p style="text-align: center; margin-top: 30px;"><a class="helpful-products" href="#helpfulproducts">Shop For Helpful Products</a></p> <p> </p> <h3>Are piezogenic papules common?</h3> <p>Piezogenic papules are quite common and are found in 10-20% of the general population.  Piezogenic papules have no predilection for male/female or race.  Piezogenic papules are more common in adults but can be found in children.</p> <p> </p> <h3>How are piezogenic papules treated?</h3> <p>Most cases of piezogenic papules do not require treatment.  When treatment is required due to a piezogenic papule rubbing against a shoe, surgery can be used to excise the piezogenic papule.  Surgical success is often limited by the inability to rebuild the fibrous network that holds the fat.  </p> <p><a name="helpfulproducts"></a></p> <p> </p> <h3>Which products are helpful for treating piezogenic papules?</h3> <p>From a conservative standpoint, <a href="/heel-lifts">heel lifts</a> can be used to raise the heel in the shoe, often lifting the heel away from shoe irritation. <a href="/moleskin-pads">Moleskin Pads</a> and <a href="/forefoot-callus-protector">Forefoot Callus Protectors</a> can be used in the heel area to effectively limit friction with footwear, and are a popular choice because of their neutral skin tone.</p>urn:store:1:blog:post:260https://www.myfootshop.com/what-is-metatarsalgia-and-how-is-it-treated-with-cantingWhat is metatarsalgia and how is it treated with canting?<h2>Metatarsalgia | Can you or can’t you cant?<a href="https://www.myfootshop.com/article/bone-lateral-mod-labeled"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Osteology/bone_lateral_mod2.jpg" alt="Metatarsal bones" width="225" /></a></h2> <p><a href="https://www.myfootshop.com/article/metatarsalgia">Metatarsalgia</a> describes pain in the metatarsal bone.  Metatarsalgia can be caused by a number of contributing factors and can affect any of the 5 metatarsal bones of the foot.  Metatarsalgia is most commonly caused by eccentric loading of the forefoot resulting in mechanical load applied to one metatarsal.  In the early stages of this eccentric loading, the metatarsal reacts by becoming painful.  If the load continues, the outcome may be a <a href="https://www.myfootshop.com/article/metatarsal-fracture">stress fracture of the metatarsal</a>.</p> <h3>Metatarsalgia caused by ski boots</h3> <p><a href="https://www.myfootshop.com/article/cardinal-planes-of-the-human-anatomy"><img style="float: left;" src="/Content/Images/uploaded/Anatomy/Spacial_Orientation/Cardinal_planes.jpg" alt="Cardinal planes of the body" width="100" /></a>I saw a case of 5<sup>th</sup> metatarsal metatarsalgia in the office this week in a patient who is an avid snowboarder.  He told me that his feet were fine whenever he was off the slopes but every time he used his board, the outside of his foot would start to hurt.  The clinical exam showed no swelling but the entire 5<sup>th</sup> metatarsal was achy and sore to palpation.  X-rays were negative for a fracture.  Our working diagnosis was 5<sup>th</sup> metatarsal metatarsalgia.</p> <p>The eccentric loading previously described that caused this patient’s metatarsalgia was due to the canting in his board set up.  To describe canting we need to refer to body planes.  Use this mental image – you’re standing facing out of a glass sliding door.  The door represents what’s called the frontal plane.  For a skier, a board adjustment in the frontal plane is an adjustment to canting.  Raise the outside of the boot (<a href="https://www.myfootshop.com/article/pronation">pronate</a> the foot) or raise the inside of the boot (<a href="https://www.myfootshop.com/article/supination">supinate</a> the foot).  An adjustment in canting that pronates the foot will decrease load to the 5<sup>th</sup> metatarsal.  Patriot Footbeds has a great <a href="https://www.youtube.com/watch?v=yf1-tK-_Bho">video</a> that describes the concept of canting and modification of<a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><img style="float: right;" src="/Content/Images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts.jpg" alt="Lateral Sole Wedges" width="150" /></a> ski boot.</p> <h3>Lateral Sole Wedge - treatment of metatarsalgia</h3> <p>How can you cant your boot or shoe at home?  The simple way is to use a <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">Lateral Sole Wedge</a>.  A Lateral Sole Wedge is a thin insert that fits into the shoe or boot and limits the supination of the foot (rolling to the outside of the foot).  The use of a Lateral Sole Wedge will decrease load to the 5<sup>th</sup> metatarsal and heal cases of 5<sup>th</sup> metatarsal metatarsalgia.</p> <p>This example of a ski boot adjustment is just one small example of how metatarsalgia is treated.  Metatarsalgia is by no means exclusive to skiers and is found in all walks of life including sports, work or daily activities.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/15/2021</p>urn:store:1:blog:post:259https://www.myfootshop.com/toe-spring-what-is-it-and-why-is-it-helpfulToe Spring | What is it and why is it helpful?<h2>What is Toe Spring?<img style="float: right;" src="/Content/Images/uploaded/Blog images/toe_spring.jpg" alt="Toe Spring" width="300" /></h2> <p>Toe spring is the term used to describe a shoe or foot insert that enables rolling off the forefoot. Let me create the visual – think clog, men’s wingtip shoes or MBT Shoes. Each of these are examples of what is also called a forefoot rocker (aka toe spring.)</p> <h3>Toe Spring – is there a spring hidden in there?</h3> <p>The origin of the term toe spring is obscure, but if you consider the different types of gait, toe spring makes sense. Walking can actually be described as a controlled forward fall. The calf muscle is used to decelerate the forward motion of the body (your center of gravity) over the foot. Bear in mind that walking isn’t really propulsive. Running, on the other hand, is propulsive. Propulsion comes from the force generated by the calf which is delivered to the forefoot. In both cases, walking (non-propulsive) and running (propulsive) force is concentrated at the forefoot just prior to the heel-off stage of gait. Toe spring helps to decrease that force.  Toe spring decreases force to the forefoot by enabling a rocking motion as force loads at the forefoot. </p> <p>So is there a spring? Not really, but a toe spring does put a bit of spring in your step.</p> <h3>What are the advantages of toe spring?</h3> <p>Toe spring, whether created by a specific shoe design or by and insert affects gait by:</p> <ul> <li>Decreasing force at the ball-of-the-foot</li> <li>Weakening the mechanical force generated by the calf and Achilles tendon</li> <li>Decreasing the energy necessary to walk or run</li> </ul> <h4>What foot conditions can be improved by toe spring?</h4> <p>Foot conditions that respond to the use of toe spring include:</p> <ul> <li><a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a></li> <li><a href="https://www.myfootshop.com/article/achilles-tendon-rupture">Partial Achilles tendon ruptures</a></li> <li><a href="https://www.myfootshop.com/article/plantar-fasciitis">Plantar fasciitis</a></li> <li><a href="https://www.myfootshop.com/article/plantar-fibromatosis">Plantar fibromatosis</a></li> <li><a href="https://www.myfootshop.com/article/cuboid-syndrome">Cuboid syndrome</a></li> <li><a href="https://www.myfootshop.com/article/peroneal-tendonitis">Peroneal tendinitis</a></li> <li><a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Midfoot and forefoot arthritis</a></li> <li><a href="https://www.myfootshop.com/article/freibergs-infraction">Freiberg's infraction</a></li> <li><a href="https://www.myfootshop.com/article/metatarsal-fracture">Metatarsal stress fractures</a></li> <li><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Metatarsalgia<img style="float: right;" src="/Content/Images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Spring Plate" width="175" /></a></li> <li><a href="https://www.myfootshop.com/article/capsulitis">Forefoot capsulitis</a></li> <li><a href="https://www.myfootshop.com/article/mortons-neuroma">Morton’s neuroma</a></li> <li><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux limitus</a></li> </ul> <p>As you can see, the list of conditions affected by the use of toe spring is extensive. One of the easiest ways to start using toe spring is with the use of a Carbon Graphite Spring Plate. Why is it called a spring plate?  You got it – due to the toe spring. Carbon Graphite Spring Plates are extremely light and thin. They fit into most shoes and are easy to use for both day-to-day use and sports.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/15/2021</p>urn:store:1:blog:post:258https://www.myfootshop.com/tarsal-coalition-treatment-optionsTarsal Coalition | Treatment options<h2>Tarsal Coaliton - diagnosis</h2> <p>I met with a mom and her daughter yesterday to discuss chronic flat foot issues.  The patient was an 18 y/o female who described<a href="https://www.myfootshop.com/article/tarsal-coalition#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/xray_foot_calcaneal-navicular_coalition_mod.jpg" alt="x-ray tarsal coalition" width="200" /></a> a progressive increase in pain over the past several years.  She was now limited from activities that she loved including running and skiing.  The mom was concerned about the progression of symptoms and was interested in using orthotics to help her daughter’s pain.</p> <p>Examination of the feet showed a rigid flatfoot both while sitting and with weight-bearing.  Range of motion of the foot was very limited and stiff.  Ankle range of motion was also limited by a tight calf and Achilles tendon.  X-rays were inconclusive for findings.  Based on the onset, location of pain and x-rays, all findings seemed to suggest the presence of a fibrous tarsal coalition.</p> <h3>Tarsal Coalition - treatment options</h3> <p>A tarsal coalition is a progressive limitation of bone in the rear portion of the foot.  Symptoms of a tarsal coalition increase with age as the coalition (a bridge of bone) changes from soft, flexible tissue to rigid bone.  Be sure to read our knowledge base article on <a href="https://www.myfootshop.com/article/tarsal-coalition#Tab3">tarsal coalitions</a> for more information on this condition.</p> <h3>Tarsal Coalition - stretching and orthotics</h3> <p>How could I answer the question about prescription orthotics or arch supports?  In a tarsal coalition, the tight calf muscle is actively acting to flatten the arch.  Putting an arch support under the arch of a tarsal coalition can in some cases actually increase the symptoms of pain and stiffness of the foot.  In the early stages of tarsal coalition, the foot may accommodate the arch support, but as it grows to be more rigid, an arch support can cause increased pain.</p> <p>We also discussed physical therapy and stretches as a method of treatment.  Just as I mentioned earlier with the use of the inserts, stretches may only help in early stages of tarsal coalition.  As the coalition ossifies, the use of both orthotics and stretches become less and less useful.</p> <p>In this particular case, we are waiting for an MRI to identify the coalition.  Once we have that information, a definitive treatment plan can then be mapped.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/15/2021</p>urn:store:1:blog:post:257https://www.myfootshop.com/chronic-achilles-tendinitis-treatment-with-a-carbon-graphite-spring-plateChronic Achilles tendinitis – treatment with a Carbon Graphite Spring Plate<h2>Chronic Achilles tendonitis – treatment with Spring Plates<a href="https://www.myfootshop.com/article/gastrocnemius"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Myology/Gastrocnemius.jpg" alt="Achilles tendon" width="200" /></a></h2> <p>What’s a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> got to do with <a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a>?  Quite a bit, actually.  A Spring Plate changes the gait cycle enough to ‘unload’ the Achilles tendon during gait.  Let’s take a little closer look.</p> <p>The leg, the ankle and the foot act as a lever to deliver the force of the calf, distal through the ankle to the forefoot.  During walking, the calf and Achilles tendon act to slow the forward progression of the body over the foot.  As the lower leg and central body mass move forward, the calf resists that forward motion until the load applied to the forefoot becomes too great.  At this stage of gait, called toe-off, the mass of the body applied against this lever becomes so great that the heel lifts off the ground and the body begins to fall forward.  To arrest this forward fall we instinctually put out our other foot to break the fall and the process starts all over again with the opposite leg, ankle, and foot.  In cases of chronic Achilles tendinitis, the longer the heel is on the ground, the greater the load applied to the tendon.  More load to the tendon means chronic inflammation and delayed healing.</p> <h3><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left;" src="/Content/Images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon fiber spring plate" width="150" /></a>What is a carbon graphite spring plate?</h3> <p>Spring Plates derive their names from the toe spring in the plate.  When viewed from the side, the Spring Plate rises at the toes (toe spring).  Toe spring contributes to ‘earlier’ heel-off in the gait cycle.  Using a Spring Plate will decrease the time that the Achilles tendon is under load – hence the ability to heal chronic Achilles tendinitis.</p> <h3><br />How does a carbon graphite spring plate heal chronic Achilles tendinitis?</h3> <p>The forefoot rocker provided by the carbon graphite spring plates is a subtle change but in many cases sufficient enough to cure chronic Achilles tendinitis.  Are there other ways to acquire toe spring?  You can accomplish the same effect with Dansko clogs or shoes with a forefoot rocker like MBT’s or Hoka’s.  The key is to have a forefoot rocker that will enable early heel rise during gait.  If you aren’t interested in new shoes and want to use your existing shoes, the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> is the tool of choice.  Or combine both a shoe with a forefoot rocker and a Spring Plate, and you’ll have an even more effective forefoot rocker.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:256https://www.myfootshop.com/toe-walkers-treatment-optionsToe Walkers - treatment options<h2>Toe Walking<img style="float: right;" src="/Content/Images/uploaded/Blog images/toe_walker.jpg" alt="toe walker" width="250" /></h2> <p> Toe walking describes gait in which the heel may only partially touch the ground.  Toe walking is most common in young, early walkers between the ages of 1 and 5 years of age.  Let’s take a look at the causes of toe walking and treatment options. </p> <h3>What causes toe walking?</h3> <p>Toe walking can be due to structural limitations of the lower leg and ankle or due to neurological stimulation of the lower leg.  Structural limitations may include a block at the ankle which limits normal ankle range of motion or may be due to a short triceps surae (calf muscles).  With structural limitations, the extent of toe walking will remain constant over the course of time and as the child ages.</p> <p>Toe walkers who are affected by neurological stimulation may show variations in the degree of toe walking.  For instance, when tired or distracted, toe walking may decrease allowing the heel to contact the ground.  Physical stimulation of the foot may also contribute to toe walking.  Physical stimulation may include cold or pain.</p> <h3>Treatment of toe walking</h3> <p>Successful treatment of toe walking often requires physical therapy and bracing.  Physical therapy can be used to train and motivate families to perform daily stretching of the calf muscles.  Bracing can be used by day, by night or a combination of both.  Nationwide Children’s Hospital has a good overview of bracing techniques (<a href="https://www.aacpdm.org/UserFiles/file/IC362.pdf">idiopathic toe walking orthoses</a>), including the <a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat"><img style="float: right;" src="/Content/Images/uploaded/Products/893_Carbon_Graphite_Shoe_Plate_Flat_ALT.jpg" alt="Flat carbon plates" width="150" /></a>advantages and disadvantages of both.</p> <h4>Shoe inserts for toe walkers</h4> <p><a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat">Flat rigid carbon plates</a> are often used in children’s shoes to limit the flexibility in the shoe.  Using the carbon graphite plate to lengthen the shank of the shoe, essentially making it stiffer, delays heel rise in normal gait.  By doing so, toe walking is often decreased.  The combination of PT and a carbon foot plate is one of the most commonly used methods of treatment for toe walkers. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:255https://www.myfootshop.com/treating-leg-length-discrepancy-2Treating Leg Length Discrepancy<h2>What Causes Leg Length Discrepancy<img style="float: right;" src="/Content/Images/uploaded/Blog images/leg length.jpg" alt="Leg length discrepancy" width="300" /></h2> <p>Leg length discrepancy describes a variation in the length of one leg compared to the other.  Leg length discrepancy can be functional or structural.  Let’s take a closer look at each of these definitions of leg length differences.</p> <p>Functional leg length discrepancy is often secondary to another neuromuscular condition.  The neuromuscular conditions may be congenital, such as spina bifida or cerebral palsy, or may be acquired such as a lumbar injury that causes muscle splinting.</p> <p>Structural problems that result in leg length discrepancies are also categorized as congenital or acquired.  Congenital problems that may contribute to a leg length discrepancy include scoliosis, injuries to growth plates of the legs or injury to bone such as a fracture or infection.</p> <h3>Treating Leg Length Discrepancy</h3> <p>Regardless of the cause of leg length discrepancy, the body will work hard to accommodate the discrepancy and ensure an upright position of the spine.  As an example, think of a candle on a table.  The candle represents the spine and the table represents the pelvis.  Any change to the level of the table will significantly affect the position of the candle.  The same holds true with the pelvis and spine.  A leg length difference can have a significant effect on the level of the pelvis and subsequently on the opposition of the spine.</p> <p>Treating leg length discrepancies can be accomplished with the use of lifts in the shoe or additions to the sole of the shoe.  As a rule of thumb, it will be difficult to achieve greater than ½” lift inside the shoe.  Any additional lift will need to be applied to the shoe.</p> <p>How do you determine which heel lift is best for your needs?  The first step is to have help in understanding the testing for leg<a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork"><img style="float: right;" src="/Content/Images/uploaded/Products/677_Heel_Lifts.jpg" alt="Heel lifts for leg length discrepancy" width="150" /></a> length differences.  And easy way to begin is to use books in varying thicknesses.  Stand in front of a mirror and add ½” under the suspected short limb.  As a rule of thumb, the short leg will have a high shoulder.   Add ½” book to the short side and the shoulder should begin to appear level with the other shoulder.  Continue to add books at ½” per stage and reassess shoulder height.</p> <h3>Products for Leg Length Discrepancy - Heel Lifts</h3> <p>Which heel is best for you?  First, be sure to realize that heel lifts and heel cushions are two distinctly different tools.  Heel lifts are firm and will not compress.  The <a href="https://www.myfootshop.com/medi-heel-lift">Medi-Heel Lift</a>, <a href="https://www.myfootshop.com/adjust-a-heel-lift">Adjust-a-Lift</a>, and <a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork">Cork Heel Lifts</a> are going to be the best choices for treating leg length discrepancy.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/2019</p>urn:store:1:blog:post:254https://www.myfootshop.com/thanks-to-the-staffThanks guys!<h2>Big thanks to the Myfootshop team.</h2> <p>'Tis the season to be thankful. I just wanted to take a second to thank all of our team at Myfootshop.com.<img style="float: right; padding-left: 10px;" src="/Content/Images/uploaded/clips/christmas party.jpg" alt="" width="200" /></p> <p>Our customer service and fulfillment team is made up of folks who get there early and don't leave until the work is done.  Big thanks to Marianne, Sue, Gina, Lynn and Kelly.  You guys rock it.</p> <p>On the tech side Steve, Jonathon and Mark.  Many thanks for spending the time to figure out the details in life.</p> <p>Our operations director, Thalia- thanks for riding shotgun through the mountains with your cowboy.</p> <p>I'm very fortunate to work with such dedicated, wonderful people.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:253https://www.myfootshop.com/foot-and-ankle-anatomyFoot and ankle anatomy<h2>Understanding the anatomy of the foot and ankle</h2> <p>Many of our customers who follow this blog and <a href="https://www.myfootshop.com/newsletter">subscribe to our newsletter</a> are in the medical profession.  We hear from home <img style="float: right;" src="/Content/Images/uploaded/Anatomy/Myology/Flexor_digiti_minimi_brevis.jpg" alt="Foot and ankle anatomy" width="200" />health nurses, wound care professionals, students, and physicians.  One of our best resources for these health care professionals is our foot and ankle anatomy page.  This page includes:</p> <ul> <li> <h3><a href="https://www.myfootshop.com/articles/List/22">topical foot and ankle anatomy</a></h3> </li> <li> <h3><a href="https://www.myfootshop.com/articles/List/27">radiographic foot and ankle anatomy</a></h3> </li> <li> <h3><a href="https://www.myfootshop.com/articles/List/21">spacial orientation</a></h3> </li> <li> <h3><a href="https://www.myfootshop.com/articles/List/25">neuroanatomy of the lower extremity</a></h3> </li> <li> <h3><a href="https://www.myfootshop.com/articles/List/24">angiology</a></h3> </li> <li> <h3><a href="https://www.myfootshop.com/articles/List/23">osteology</a></h3> </li> <li> <h3><a href="https://www.myfootshop.com/articles/List/28">graphics</a></h3> </li> </ul> <p>I'm particularly proud of our <a href="https://www.myfootshop.com/articles/List/26">myology section</a>.  In our myology section (muscle) we've developed an entire catalog of the muscles of the lower extremity.  Each muscle is carefully detailed showing the origin, insertion, vascular source and nerve innervation.</p> <p>All of the images in our anatomy section are open source.  We want you to use them for educational purposes.  If you do intend to use any of our images for commercial use, please refer to our <a href="https://creativecommons.org/licenses/by-nc/3.0/deed.en_US">Creative Commons Attribution-Noncommercial License</a>.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Director<br />Myfootshop.com</p> <p>Updated 12/24/19</p>urn:store:1:blog:post:252https://www.myfootshop.com/chronic-dry-skin-of-the-foot-consider-t-rubrumChronic dry skin of the foot? Consider t. rubrum.<h2>Dry Skin on the foot?  Likely a fungal infection.</h2> <p>If you're over 35 years of age, it's likely that you've come in contact with a low-grade fungal infection called tinea rubrum (t. <a href="https://www.myfootshop.com/article/athletes-foot"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/chronic_tinea_1_labeled.jpg" alt="t. rubrum infection of the foo" width="200" /></a>rubrum).  t. rubrum looks just like dry skin.  Classically described in the dermatology literature, t.rubrum infections appear in a moccasin distribution, meaning to say that the appearance of dry skin, (t. rubrum infection) is distributed on the sides and bottom of the foot.  In my private office, I hear at least once a day, "that's not just dry skin?  No wonder it never responded to skin lotions."</p> <p>t. rubrum is one of the two types of fungal foot infections we often refer to as <a href="https://www.myfootshop.com/article/athletes-foot">athlete's foot</a>.  The classic description of athlete's foot - bubble, blisters, and itching, is caused by another member of the tinea family tinea mentagrophytes.  But the more common infection, t. rubrum, is found in most people over 35 years of age. </p> <h3>What causes t. rubrum infections?</h3> <ul> <li>The dark, damp environment inside the shoe</li> <li>Wearing shoes that haven't sufficiently dried out</li> <li>Exposure to other people with t. rubrum infection</li> </ul> <h3>Treatment of t. rubrum infections</h3> <p>There are several points to consider when treating t. rubrum infections.  First, treating fungal infections requires an ongoing plan and<a href="https://www.myfootshop.com/antifungal-bar-soap"><img style="float: right;" src="/Content/Images/uploaded/Products/809_Myfootshop_Antifungal_Soap_ALT2.jpg" alt="Natural Antifungal Lavender Tea Tree Bar Soap" width="100" /></a> ongoing treatment.  You're not going to cure a t. rubrum infection.  And second, create your treatment plan by picking the low hanging fruit.  Start by doing the following;</p> <ul> <li>Rotate your shoes allowing them to dry for 24 hour between use</li> <li>Wear only shoes that are made with materials that can absorb moisture i.e. leather</li> <li>Frequent changes of socks</li> <li>Use an antifungal soap on a daily basis</li> </ul> <p><a href="https://www.myfootshop.com/antifungal-foaming-soap"><img style="float: left;" src="/Content/Images/uploaded/Products/932_Myfootshop_Antifungal_Foaming_Soap_ALT.jpg" alt="Natural Antifungal Lavender Tea Tree Foaming Soap" width="100" /></a>We carry two products that I recommend that you keep in your shower and use to wash your feet on a daily basis.  Natural Antifungal Lavender Tea Tree Bar Soap and Natural Antifungal Lavender Tea Tree Foaming Soap are both antibacterial and antifungal. </p> <p>Granted, you cannot cure t. rubrum infections with any medication, over-the-counter or prescription.  But you can easily manage these infections with daily use of either of these two products.  Take the two-week test and you'll see an obvious difference in the appearance of your feet.</p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Director<br />Myfootshop.com</p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:251https://www.myfootshop.com/treating-leg-length-discrepancyTreating Leg length Discrepancy<p> </p> <h2>What's the best heel lift to treat a leg length discrepancy?</h2> <p>Leg length discrepancy can be caused by a number of reasons including;</p> <ul> <li>Disruption of femoral or tibial growth plate</li> <li>Fracture with resultant shortening</li> <li>Joint replacement surgery</li> <li>Hip injury or dysplasia</li> <li><a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction">Posterior tibial tendon dysfunction</a></li> </ul> <p>I'd say that the majority of cases that I see clinically are cases where we see asymmetrical growth.  This is simply normal lower leg growth with no injury, no surgery - just a short leg.</p> <p>Clinical testing for leg length discrepancy includes non-weight bearing observation of the leg length while both sitting and while lying down.  Weight-bearing exam should include assessment of the anterior superior iliac crest (part of the pelvis), curvature of the spine and shoulder height.  A simple test that you can do at home to check leg length is to assess your own shoulder height in a mirror.  Shake your shoulders out and stand erect.  Ironically, the short leg typically has the higher shoulder.  The high shoulder results as compensation in the spine.  Leg length can also be measured with x-rays and a metallic ruler.</p> <p><a href="https://www.myfootshop.com/adjust-a-heel-lift"><img style="float: left;" src="/Content/Images/uploaded/Products/973_Adjust-a-heel_Lift_ALT.jpg" alt="Adjust-a-Heel Lift" width="100" /></a>How do you treat a leg length discrepancy?  One rule of thumb is that you'll be limited with how much you can place inside a shoe.  My experience is that I can typically get up to 3/4" in a shoe (depending on shoe type).  When I need to add more than 3/4", I add <a href="https://www.myfootshop.com/medi-heel-lift"><img style="float: right;" src="/Content/Images/uploaded/Products/832_Medi-Heel_Lift.jpg" alt="Medi Heel Lift" width="100" /></a>the lift to the outside of the shoe.</p> <p>Two products that I recommend for leg length discrepancy treatment include the <a href="https://www.myfootshop.com/adjust-a-heel-lift">Adjust-a-Heel Lift</a> and the <a href="https://www.myfootshop.com/medi-heel-lift">Medi Heel Lift</a>.  The Adjust-a-Heel Lift comes as a 3/8" heel lift and can be adjusted by removing layers, 1/8" at a time.  The Medi Heel Lift comes in fixed sizes including 3, 5, 7, 9 and 12 mm.  We also carry a lightweight <a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork">Cork Heel Lift</a> that is 3/8" in thickness. </p> <h2>Which heel lift is best for me?</h2> <p>Which heel lift is right for your needs?  From customer feedback, we sell equal numbers of each of the lifts.  I tend to see that customers use the cork lifts for short term use, such as treating plantar fasciitis or Achilles tendinitis while customers who are focused on treating leg length discrepancy tend to use the Adjust-a-Lift and the Medi Heel Lift.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:250https://www.myfootshop.com/fungal-toe-nails-chemically-debride-naturally-treat-themFungal toe nails – chemically debride, naturally treat<p> </p> <h2>Treatment of onychomycosis requires elimination of the diseased portion of the nail – that’s what’s so special about Natural Antifungal Nail Butter</h2> <p>Fungal nail infections, also known as <a href="https://www.myfootshop.com/article/onychomycosis">onychomycosis or mycotic nails</a>, come in varying degrees of infection.  Fungal infections of the nail classically start at the distal tip of the nail and slowly progress under the nail, moving proximally.  As the fungal infection spreads, the nail becomes thick and discolored.  Filaments of the skin and nail become evident at the distal tip of the nail and then progressively separates from the underlying nail bed.</p> <h3>Early-stage treatment of onychomycosis with topical antifungals</h3> <p><a href="https://www.myfootshop.com/article/onychomycosis"><img style="float: left;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_foot_1.jpg" alt="Early onychomycosis" width="100" /></a>In the early stages of onychomycosis, use of a topical antifungal medication can help to improve the infection.  Notice that I say improve.  Antifungal medications, whether topical or oral, will improve the appearance of the nail but will never eliminate the infection.  So you must consider treatment as an ongoing task.  A good analogy would be brushing your teeth to remove plaque.  You can’t brush your teeth for 2 months and assume the tartar and plaque will be cured for good.  You need to continue to brush on an ongoing basis.  The same holds true for treatment of onychomycosis.  In the early stages of treating onychomycosis, topical antifungal medications like <a href="https://www.myfootshop.com/clearzal-fungal-nail-care-system">ClearZal</a> and <a href="https://www.myfootshop.com/terpenicol-antifungal-cream">Terpenicol Antifungal Cream</a> work well to decrease the rate of fungal growth.  Decreasing the rate of fungal growth allows the healthy nail to grow out at a faster rate, slowly eliminating the fungal infection.</p> <h3>Late stage treatment of onychomycosis with topical antifungals</h3> <p><a href="https://www.myfootshop.com/article/onychomycosis"><img style="float: left;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_toe_3.jpg" alt="Late stage onychomycosis" width="100" /></a>In later stages of onychomycosis, the nail thickens and becomes yellow.  As the nail thickens, it becomes difficult for a topical medication to penetrate the nail.  At this stage, mechanical or chemical debridement of the nail is required to enable effective use of the topical antifungal medication.  <a href="https://www.myfootshop.com/nail-cutter-large">Nail cutters</a> can be used to mechanically debride the nail.  Use of a nail cutter can leave the nail rough and irregularly shaped.  Chemical debridement is often preferable due to the fact that chemical debridement is a slow and gradual method that preserves the shape<a href="https://www.myfootshop.com/natural-antifungal-nail-butter"><img style="float: right;" src="/Content/Images/uploaded/Products/1107_Nail_Butter_ALT3.jpg" alt="Natural Antifungal Nail butter" width="125" /></a> of the nail.  The optimal method of debriding the nail is to use both chemical and mechanical debridement.  Chemical debridement softens the nail while use of a nail cutter will help remove the softened nail.</p> <p>In the Myfootshop.com lab, we developed a unique topical antifungal that chemically debrides the nail and treats the fungal infection at the same time.  The properties of <a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Antifungal Nail Butter</a> include:</p> <ul> <li>Use of 40% urea to chemically debride thick mycotic nails.</li> <li>Treats onychomycosis with tea tree oil and lavender.</li> </ul> <p>Natural Antifungal Nail Butter is the only product on the market today that manages the thickness of fungal nails and treats the fungus simultaneously. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:248https://www.myfootshop.com/vasyli-dananberg-turf-toe-plateHallux limitus – what can be done with conservative care and inserts?<p> </p> <h2>The Turf Toe Plate vs. The Vasyli-Danaberg Orthotic – what’s the difference?</h2> <p><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux limitus (HL)</a> describes the four stages of degenerative change that the great toe undergoes as the result of jamming or limited motion.  Stage 1 HL has mild pain with no degenerative signs of change found on x-ray.  Stage 4 on the other hand, also known as <a href="https://www.myfootshop.com/article/hallux-limitus">hallux rigidus</a>, shows complete flattening and limited range of motion of the joint due to arthritis and bone spurs surrounding the joint.  Stage 1 and stage 4 HL are two very different problems that need to be treated with different conservative approaches.</p> <h3>Can hallux limitus be treated without surgery? </h3> <p>In most cases, yes it can.  Inserts can help to slow the progression of HL but won’t actually correct the existing problem.  In most cases, arresting the progress of HL will significantly decrease pain in the joint.</p> <p>There are two fundamental ways to treat hallux limitus with inserts depending upon the stage of the condition.</p> <h3> </h3> <h3>Hallux Limitus Stages 1 &amp; 2</h3> <p><a href="https://www.myfootshop.com/vasyli-dananberg-orthotic"><img style="float: left;" src="/Content/Images/uploaded/Products/963_Dananberg_Insole.jpg" alt="Vasylit-Dananberg Orthotic" width="150" /></a>Prior to the onset of degenerative change seen in the joint on x-ray in stages 1 &amp; 2 HL, increasing the range of motion can markedly decrease pain.  A <a href="https://www.myfootshop.com/vasyli-dananberg-orthotic">Vasyli-Dananberg Orthotic</a> uses wedges to change the range of motion of the great toe joint.  In the early stages of HL the wedges in the Vasyli-Dananberg Orthotic are used to increase the range of motion.  As the joint progresses to stage 3, the position of the wedges can be changed to decrease the range of motion of the great toe joint.  The Vasyli-Dananberg Orthotic is a well designed, innovative device specifically used to treat HL.</p> <p> </p> <p> </p> <p> </p> <h3> </h3> <h3>Hallux Limitus Stages 3 &amp; 4<a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded"><img style="float: right;" src="/Content/Images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="Turf Toe Plate" width="150" /></a></h3> <p>In HL stages 3 &amp; 4, most folks are going to default to a rigid extension under the great toe joint called a Morton’s extension.  The <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Turf Toe Plate</a> is a classic design example of a Morton’s extension used to treat turf toe and hallux limitus.  Most customers with stages 3 &amp; 4 HL are quite surprised with the efficacy of the Turf Toe Plate.  Funny looking insert but the perfect solution for end stage HL.</p> <p>Which insert is the best choice for you?  That depends on your stage of HL.  Touch base with your doctor and get a set of plain x-rays taken.  The discussion you have with your doc will help you to understand the best choice for your needs.</p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:247https://www.myfootshop.com/which-dancers-pad-is-right-for-meWhich dancer’s pad is right for me?<p> </p> <h2>How to choose the correct dancer’s pad for your needs.</h2> <p><a href="https://www.myfootshop.com/dancers-pads">Dancer’s pads</a> are a type of forefoot pad that have a cut-out used to off-load the ball of the foot.  A dancer’s pad increases weight-bearing to the lesser metatarsal heads while decreasing load bearing to the sesamoids and big toe joint.  Dancer’s pads are used to treat <a href="https://www.myfootshop.com/article/sesamoiditis">sesamoiditis</a>, <a href="https://www.myfootshop.com/article/sesamoid-fracture">sesamoid fractures</a>, and early <a href="https://www.myfootshop.com/article/hallux-limitus">hallux limitus</a>.</p> <p><a href="https://www.myfootshop.com/dancers-pads-premium-felt"><img style="float: left;" src="/Content/Images/uploaded/Products/810_Dancers_Pad_Premium_Felt.jpg" alt="Felt dancer's pad" width="150" /></a>Dancer’s pads can also be reversed and used to treat pain beneath the little toe and 5<sup>th</sup> metatarsal head.  By doing so, podiatrists often call this a ‘reversed’ dancer’s pad.   Reversed dancer’s pads are used to treat callus beneath the <a href="https://www.myfootshop.com/article/x-ray-of-the-foot-anterior-posterior-view">5<sup>th</sup> metatarsal head</a>.</p> <p>At Myfootshop.com, we offer foam, felt and reusable gel dancer’s pads.  How to they differ?  Foam and<a href="https://www.myfootshop.com/dancers-pads-premium-foam"><img style="float: right;" src="/Content/Images/uploaded/Products/980_Dancers_Pads_Premium_Foam_ALT.jpg" alt="Foam dancer's pad" width="150" /></a> felt dancer’s pads are adhesive-backed and are typically going to be used directly in the shoe.  When the shoe’s insole is not removable, foam and felt dancer’s pads can be placed directly in the shoe on top of the insole.  But if the insole is removable, it’s advised to apply the foam or felt dancer’s pad to the underside of the insole.  By placing the foam or felt dancer’s pad on the underside of the insole, the dancer’s pad is less apt to move and will stay in place much longer.  Be sure to watch each of our product videos to understand how to order and where to place the dancer’s pad.</p> <p><a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/680_reusable_dancers_pad.jpg" alt="Reuseable gel dancer's pads" width="150" /></a>Gel dancer’s pads are intended to be worn directly on the skin.  Gel Dancer’s pads are a great all-around purchase in that they can be worn at all times, even just with socks around the house.</p> <p>What’s the best choice for you?  If you’re a runner who uses running shoes in mostly dry climates, I’d select felt dancer’s pads and wear them on the underside of your insole.  If you’re a runner and you run a lot in wet climates or frequently in the rain, select the foam dancer’s pads.</p> <p>If you lead a more pedestrian lifestyle, you may also use the foam or felt dancer’s pads in your shoes, but you might also want to go with the gel dancer’s pads.</p> <p>Much of the choice of dancer’s pads requires a bit of trial and error.  You might have a felt dancer’s pad in your tennis shoe but use the gel in all of your dress shoes.  And remember, you don’t have to be a dancer to use dancer’s pads.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/16/2021</p>urn:store:1:blog:post:246https://www.myfootshop.com/lateral-sole-wedges-how-symptoms-of-medial-knee-osteoarthritis-are-improvedLateral Sole Wedges - how symptoms of medial knee osteoarthritis are improved<h2>Lateral Sole Wedges - how symptoms of medial knee osteoarthritis are improved with a simple shoe insert<a href="/lateral-sole-wedge-inserts"><img style="float: right;" src="/Content/Images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts_ALT2.jpg" alt="Lateral sole wedge used to treat knee arthritis" width="200" /></a></h2> <p> </p> <h3>Medial knee osteoarthritis - treatment with a Lateral Sole Wedge</h3> <p>The International Journal of Preventative Medicine calls the use of a <a href="/lateral-sole-wedge-inserts">Lateral Sole Wedge</a> for the treatment of medial knee arthritis 'simple, inexpensive therapy for decreasing pain and improving life.' In their 2012 article entitled, '<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482996/">The Effects of Various Kinds of lateral sole Wedge Insoles on Performance of Individuals with Knee Joint Osteoarthritis</a>', the authors studied 36 patients with medial knee arthritis. The results showed a marked decrease in overall knee pain.</p> <p>It is important to recognize that Lateral Sole Wedges are useful for only those patients with medial knee osteoarthritis.  Other types of knee pain, such as lateral knee pain or knee cap pain (patella pain) will not be affected by the use of a Lateral Sole Wedge.</p> <p>Lateral Sole Wedges are a lightweight shoe insert that subtly changes the position of the foot to off-load the medial knee.  Lateral Sole Wedges can be trimmed with scissors to fit any shoe.</p> <p>Jeff  </p> <p><a href="/jeffrey_a_oster_dpm_cv"><img src="/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:245https://www.myfootshop.com/lateral-sole-wedges-treatment-of-lateral-ankle-instabilityLateral Sole Wedges - treatment of lateral ankle instability<h1>Lateral Sole Wedges - treatment of lateral ankle instability<a href="/lateral-sole-wedge-inserts"><img style="float: right;" src="/Content/Images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts.jpg" alt="Lateral sole wedges" width="200" /></a></h1> <p> </p> <h2>How mild ankle instability and ankle sprains can be treated with Lateral Sole Wedges</h2> <p>Ankle instability can be due to a number of different factors that include:</p> <ul> <li><span style="color: #008080;">Congenital ligamentous laxity</span></li> <li><span style="color: #008080;">Injury to the lateral ankle ligaments</span></li> <li><span style="color: #008080;">Congenital heel inversion (calcaneal varus)</span></li> </ul> <p>Treating <a href="/article/ankle-sprain">lateral ankle instability</a> depends upon a number of factors including age, weight and activity level.  For very active patients, the use of an <a href="/ankle-supports-for-instability">ankle brace</a> or stabilization surgery is a matter of necessity.  But the majority of patients that I see with ankle instability are not extreme sports enthusiasts or professional athletes.  The majority of patients with ankle instability are simply looking for ways to control instability in everyday situations like going to school or to the store.  In these cases, the use of a <a href="/lateral-sole-wedge-inserts">Lateral Sole Wedge</a> is a perfect solution.</p> <p>The Lateral Sole Wedge is a shoe insert that fits into all shoes.  The Lateral Sole Wedge is thicker laterally than it is medially.  By being thicker on the outside of the foot, the wedge inhibits rolling of the foot to the lateral side of the foot, thereby inhibiting lateral ankle sprains.</p> <h3>The Lateral Sole Wedge is a great tool for a number of different lateral ankle conditions including:</h3> <ul> <li><a href="/article/peroneal-tendonitis">Peroneal tendinitis</a></li> <li><a href="/article/peroneal-tendon-subluxation">Peroneal tendon subluxation</a></li> <li><a href="/article/peroneal-tendon-rupture">Partial ruptures of the peroneal tendons</a></li> <li><a href="/article/cuboid-syndrome">Cuboid syndrome</a></li> <li><a href="/article/peroneal-tendonitis">Peroneus brevis tendinitis</a></li> <li><a href="/article/peroneal-tendonitis">Painful os peroneum</a></li> </ul> <p>Lateral Sole Wedges are thin, light, and easy to use.  They can be trimmed with scissors to fit any shoe.</p> <p>Jeff  </p> <p><a href="/jeffrey_a_oster_dpm_cv"><img src="/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:244https://www.myfootshop.com/five-steps-to-prevent-fallsFall Prevention - 5 simple steps to prevent falls<h2>Fall Prevention - 5 simple steps to prevent falls<img style="float: right;" src="/Content/Images/uploaded/Blog images/human-874979_640.jpg" alt="Fall prevention" width="300" /></h2> <p> </p> <h3>Why fall prevention is so important for geriatric patients</h3> <p>Every doctor who works with a geriatric population knows that when the falls begin, the geriatric patient is entering the final stages of his or her life.  Falls in the geriatric population are difficult to heal for a number of reasons.  First, healing in the geriatric population is slowed due to a delayed inflammatory and immune response.  Circulation may be decreased and upper body strength is often limited.  Therefore, a fall can have catastrophic outcomes including the inability to walk again, pneumonia due to prolonged bed rest and increased potential for deep venous thrombosis (DVT/blood clot).</p> <p>The older we become, the greater the fear of falling to the ground.  Many of my patients tell me that if they were to fall, they would not be able to get up by themselves. </p> <h3>Simple steps can be taken around the home to prevent falls.  These steps include:</h3> <p>Remove loose items on the floor such as throw rugs, piles of magazines or newspaper and loose edges of carpet or tile.</p> <ol> <li><strong><span style="color: #008080;">Hand rails</span></strong> - watch the owner of the house in their normal routines.  They will teeter from countertop to door frame.  Observe where they have no supports and add hand rails. </li> <li><strong><span style="color: #008080;">Supportive shoes</span></strong> - many geriatric patients default to slip-on shoes.  Slip-ons are far easier to get on but provide very poor support.  Wear a lace-up shoe when possible.</li> <li><strong><span style="color: #008080;">Strength training</span></strong> - I know it sounds funny getting your mom or grandma into a yoga or tai chi class, but it works.  Yoga renews that relationship with the floor and tai chi is all about balance.</li> <li><strong><span style="color: #008080;">Avoid unfamiliar surroundings</span></strong> - stepping out into unfamiliar surroundings, like a dark restaurant or movie house requires increased vigilance on the part of the family.</li> </ol> <p>It just takes a second to fall.  And it just takes a couple of minutes to prevent falls.  It matters - take that couple of minutes and prevent a fall.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:243https://www.myfootshop.com/posterior-heel-pain-how-to-differentiate-the-symptoms-of-heel-painPosterior Heel Pain - how to differentiate the symptoms of heel pain<h2>Achilles tendinitis, Haglund's deformity and insertional Achilles tendinitis - what's the difference?<a href="https://www.myfootshop.com/article/x-ray-of-the-foot-lateral-view"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Radiology/x-ray_lat_foot_mod.jpg" alt="x-ray foot, lateral view" width="200" /></a></h2> <p> </p> <h3>Achilles pain - the location of pain makes a difference.</h3> <p>The Achilles tendon is the single largest, strongest tendon in the human body.   There are a number of different problems specific to the tendon, particularly at the insertion of the tendon into the heel bone (calcaneus).   Those problems include <a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a>, <a href="https://www.myfootshop.com/article/achilles-tendonitis">insertional  Achilles tendinitis</a> and <a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's deformity</a>.  Let's take a look at each of these problems in a bit of detail so that you can differentiate one from another.</p> <p>Achilles tendinitis typically occurs 2-4 cm proximal to the insertion of the tendon into the heel bone.  This area is called the tidal zone of the tendon.  The tidal zone is an area where there is a decrease in the vascular in-flow to the tendon.  This area of hypo-vascularity makes the tendon more susceptible to injury.  Findings associated with Achilles tendinitis include:</p> <ul> <li><span style="color: #008080;">Pain at the onset of an activity such as rising from bed in the morning or at the start of a run.</span></li> <li><span style="color: #008080;">Stiffness of the tendon that decreases with activity.</span></li> <li><span style="color: #008080;">Pain is 2-4cm above the heel in the body of the tendon.</span></li> <li><span style="color: #008080;">Pain increased by going barefoot or in low heeled shoes.</span></li> <li><span style="color: #008080;">Swelling of the tendon is rare and if present represents a partial tear of the tendon.</span></li> <li><span style="color: #008080;">No swelling at the back of the heel.</span></li> </ul> <p>Insertional Achilles tendinitis occurs at the level of the insertion of the Achilles tendon into the heel bone.  Symptoms include:</p> <ul> <li><span style="color: #008080;">Pain at the onset of activity.</span></li> <li><span style="color: #008080;">Pain increased by going barefoot or wearing low heeled shoes.</span></li> <li><span style="color: #008080;">Stiffness that decreased with activity only to get worse at the conclusion of activity.</span></li> <li><span style="color: #008080;">Pain at the back of the heel.</span></li> <li><span style="color: #008080;">Firm swelling of the back of the heel that is circumferential, encompassing all sides of the back of the heel.</span></li> </ul> <p>Haglund's deformity, also called a pump bump, is found on the lateral side (outside) of the heel.  Symptoms of Haglund's deformity include:</p> <ul> <li><span style="color: #008080;">No pain at the onset of activity.</span></li> <li><span style="color: #008080;">Pain not influenced by heel height.</span></li> <li><span style="color: #008080;">Pain is increased by wearing enclosed shoes.</span></li> <li><span style="color: #008080;">Swelling of the heel specific to the posterior lateral heel only.</span></li> </ul> <p> </p> <h3>Treatment of posterior heel pain</h3> <p>A <a href="https://www.myfootshop.com/heel-lifts">heel lift</a> can have a significant impact on all three conditions, but for different reasons.  A heel lift will decrease the pull of the Achilles tendon which will have a positive impact on both Achilles tendinitis and insertional Achilles tendinitis.  With a Haglund's deformity, the heel lift is used to raise the bump higher.  In many cases, this is enough of a solution to decrease direct pressure to the bump.</p> <p><a href="https://www.myfootshop.com/night-splints">Night splints</a> will have a positive impact on both Achilles tendinitis and on insertional Achilles tendonitis, but will have no effect at all<a href="https://www.myfootshop.com/night-splints"><img style="float: right;" src="/Content/Images/uploaded/Products/906_Plantar_Fasciitis_Night_Splint.jpg" alt="night splint" width="150" /></a> on Haglund's deformity.  A <a href="https://www.myfootshop.com/calf-wedge-stretching-block">stretching block</a> will provide the same effect - great for Achilles tendinitis and insertional Achilles tendinitis while providing no change for Haglund's disease.</p> <p style="text-align: left;">An <a href="https://www.myfootshop.com/achilles-heel-pad">Achilles Heel Pad</a> provides gel cushion and can be used in conjunction with a heel lift.  The Achilles Heel Pad can have a positive effect on all three types of heel pain described.</p> <p><a href="https://www.myfootshop.com/achilles-tendon-support-by-pro-tec">The Achilles Tendon Support</a> and <a href="https://www.myfootshop.com/airheel-by-aircast-2">The AirHeel</a> are unique products that provide compression.  both can be used in conjunction with a heel lift.</p> <p>Which product is right for you?  We call it <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a> - you need to find the right diagnosis before you can purchase the right product.  Be sure to consult our <a href="https://www.myfootshop.com/Articles/">knowledge base articles</a> on the conditions before making a purchase.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:242https://www.myfootshop.com/five-foot-and-ankle-conditions-treated-with-heel-liftsFive Foot and Ankle Conditions Treated with Heel Lifts<h2>Five foot and ankle conditions that are treated with a heel lift<a href="https://www.myfootshop.com/heel-lifts"><img style="float: right;" src="/Content/Images/uploaded/Products/677_Heel_Lifts.jpg" alt="heel lift" width="200" /></a></h2> <h3> </h3> <h3>How a heel lift works to change the function of the foot</h3> <p>The leg, ankle, and foot function as a lever.  Granted, it's a complicated lever that is comprised of bone, muscle, tendon, and ligaments and is constantly changing with each phase of gait.  The primary function of this unique lever is to deliver force from the muscles of the leg distally to the forefoot.  Walking and running are quite different from a biomechanical standpoint.  The differences between walking and running include:</p> <p><span style="text-decoration: underline;"><strong>Walking</strong></span></p> <ul> <li><span style="color: #008080;">Considered a controlled forward fall with the center of mass slightly forward of center</span></li> <li><span style="color: #008080;">Forward motion is slowed and controlled by the <a href="https://www.myfootshop.com/article/soleus">soleus muscle</a> as it decelerates the motion of the tibia over the foot</span></li> </ul> <p><span style="text-decoration: underline;"><strong>Running</strong></span></p> <ul> <li><span style="color: #008080;">A forward fall with the center of mass far ahead of the foot</span></li> <li><span style="color: #008080;">The triceps surae (<a href="https://www.myfootshop.com/article/gastrocnemius">gastrocnemius</a> and <a href="https://www.myfootshop.com/article/soleus">soleus muscles</a>) act as a spring and accelerator. </span></li> </ul> <p> </p> <h3>How does a heel lift affect walking and running?</h3> <p>Walking is significantly affected by a <a href="https://www.myfootshop.com/heel-lifts">heel lift</a>.  Running, on the other hand, is much less affected by a heel lift and only in cases where the running is a heel strike runner.  The use of a heel lift weakens the lever action of the leg, ankle, and foot.  The five foot and ankle conditions that can be treated with a heel lift include (from proximal to distal);</p> <ol> <li><a href="https://www.myfootshop.com/article/achilles-tendonitis">Chronic Achilles tendinitis</a> - a heel lift will weaken the pull of the Achilles tendon enabling healing.</li> <li><a href="https://www.myfootshop.com/article/severs-disease">Sever's Disease</a> - Sever's disease is referred to as a form of traction apophysitis.  Traction, or pulling on the growth plate by both the Achilles tendon and plantar fascia, irritates the growth plate within the calcaneus (heel bone)</li> <li><a href="https://www.myfootshop.com/article/plantar-fasciitis">Plantar fasciitis</a> - plantar fasciitis is an overuse injury due to traction or pulling of the plantar fasciitis against the heel bone.</li> <li><a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction">Posterior tibial tendon dysfunction (PTTD)</a> - posterior tibial tendon dysfunction describes chronic loading with partial to complete failure of the posterior tibial tendon.</li> <li><a href="https://www.myfootshop.com/article/ankle-pain">Anterior ankle impingement</a> - anterior impingement of the ankle, whether by bone or soft tissue, can be influenced by the use of a heel lift.</li> </ol> <p>Heel lifts are often a part of a more comprehensive treatment plan for these five conditions.  Be sure to read each of our <a href="https://www.myfootshop.com/Articles/">knowledge base articles</a> for more detailed information on these conditions.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:241https://www.myfootshop.com/tongue-padsTongue Pads - the shoe fitter's secret weapon<h1 style="text-align: justify;">Treating heel slip by optimizing the fit of the shoe<a href="https://www.myfootshop.com/tongue-pads-felt"><img style="float: right;" src="/Content/Images/uploaded/Products/813_Tongue_Pads_Felt_ALT2.jpg" alt="Tongue pads - felt" width="150" /></a></h1> <h2>Tongue pads – the shoe fitter's secret weapon</h2> <p>You've invested in a great pair of shoes.  The left shoe fits like a glove but the right seems a bit loose and the heel slips.  What can you do to make the shoe fit just right?  The tool used by custom shoe stores is called a <a href="https://www.myfootshop.com/tongue-pads-felt">tongue pad</a>.</p> <p>Tongue pads are named after the location where the pad is usually placed.  The tongue pad is placed under the tongue of the shoe (that portion under the laces).  Tongue pads are adhesive-backed.  Depending on the fit, you may use one or more tongue pads to optimize shoe fit.</p> <p>Heel slipping is a common problem with shoes.  Heel slippage can easily be resolved with a tongue pad.  Placing a single tongue pad under the tongue of the shoe pushes the foot back into the heel, reducing slippage.</p> <p>Width differences may also be treated with tongue pads.  Tongue pads may be placed adjacent to the tongue of the shoe to take up space in the shoe.</p> <p><a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund’s disease</a> and <a href="https://www.myfootshop.com/article/saddle-bone-deformity">saddle bone deformities</a> may be treated with tongue pads.  Simply split the tongue pad lengthwise and place in the shoe in a manner that will off-load the pressure points found in Haglund’s disease or with saddle bone deformities (as seen above).  Tongue pads are really quite easy to use in these cases and very effective at reducing pain.</p> <p>Tongue pads are inexpensive and easy to place.  Now you know the shoe fitter's secret weapon – tongue pads.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:240https://www.myfootshop.com/just-for-toenails-the-medicated-nail-polishJust For Toenails - the enhanced nail polish<h2>Enhanced Antifungal Nail Polish<a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish"><img style="float: right;" src="/Content/Images/uploaded/Products/905_Just_For_Toenails_Medicated_Nail_Polish_ALT.jpg" alt="Just For Toenails" width="150" /></a></h2> <h3>Treat fungal infections of the toes with Just For Toenails</h3> <p>Fungal infections of the toe nails are common and are the result of two contributing factors.</p> <ul> <li><span style="color: #008080;">The moist, warm environment inside the shoe</span></li> <li><span style="color: #008080;">Trauma to the toe nail</span></li> </ul> <p>The healthy nail plate (toe nail and finger nail) is quite resistant to <a href="https://www.myfootshop.com/article/onychomycosis">fungal infections</a> (also called onychomycosis).  But when the nail is injured and disrupted from the underlying nail bed, fungal infections are able to infiltrate the undersurface of the nail and begin the slow process of infecting the nail.  The fungal infection is promoted by the unique environment found inside the shoe.  The hot, wet, warm environment is wonderfully conducive to the growth of fungus and bacteria.</p> <p>Knowing these facts, you’d think that treatment of fungal nail infections was next to impossible.  The key to successful treatment is easier than you might think.  The key is being compliant and treating the nail each and every day.  Treating fungal infections got a little easier (and a little more fun) with the use of a new topical colored antifungal nail polishes call <a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish">Just For Toenails.</a>  Just For Toenails uses the strength of tea tree oil to fight fungal infections.  Just For Toenails comes in multiple colors.</p> <p>Treating toe nail fungus just got a little more fun with Just For Toenails.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:239https://www.myfootshop.com/what-is-a-hammer-toeWhat is a hammer toe?<h2>What is a hammer toe?</h2> <h3>What’s the best treatment for my hammer toe?</h3> <p>The term <a href="https://www.myfootshop.com/article/hammer-toes">hammer toe</a> comes from the distinctive way in which the tip of the toe ‘hammers’ or hits the ground.  Our knowledge base article on hammer toes describes the differences in the three types of hammer toes.</p> <p>There are a number of different styles of hammer toes pads available on Myfootshop.com.  Which one works the best?  That depends on the location of your problem.  Hammer toes that develop callus on the tips of the toes are best treated with products that limit the hammering.  Here are a few examples of a specific type of hammer toe pad called a crest pad (also known as a buttress pad).</p> <h3><a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1">Hammer Toe Crest Pad  - Foam</a></h3> <p><a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1"><img src="/Content/Images/uploaded/Products/701_Hammer_Toe_Crest_Pad.jpg" alt="Hammer Toe Crest Pad" width="150" /></a></p> <h3><a href="https://www.myfootshop.com/hammer-toe-crest-pad-gel">Hammer Toe Crest Pad – Gel</a></h3> <p><a href="https://www.myfootshop.com/hammer-toe-crest-pad-gel"><img src="/Content/Images/uploaded/Products/853_Hammer_Toe_Crest_Pad_Gel.jpg" alt="Hammer Toe Crest pad - Gel" width="150" /></a></p> <h3><a href="https://www.myfootshop.com/hammer-toe-crest-pad-gel-adjustable">Hammer Toe Crest Pad – Adjustable</a></h3> <p><a href="https://www.myfootshop.com/hammer-toe-crest-pad-gel-adjustable"><img src="/Content/Images/uploaded/Products/971_Adjustable_Gel_Hammer_Toe_Crest_Pad.jpg" alt="Hammer Toe Crest Pad - Adjustable" width="150" /></a></p> <p>These three types of crest pads are used to buttress the toe, decreasing the tendency to hammer and make the tip of the toe sore.  Each of these pads are right/left specific, so be sure to select the correct foot (right or left) when checking out. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:238https://www.myfootshop.com/foot-perspiration-and-foot-odorFoot perspiration and foot odor - treat them with six easy steps<h2>Six step checklist to manage foot odor and foot perspiration</h2> <h3>Follow these steps each day to manage foot odor and foot perspiration</h3> <p>The summer solstice ushered in the long, hot days of summer.  The heat is bound to increase perspiration and contribute to foot odor.  Perspiration is the root cause of foot odor.  Perspiration and foot odor are ongoing problems that can easily be managed if you follow these six simple steps.</p> <ol> <li>       Start your day with <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a>, the antiperspirant made just for feet.<a href="https://www.myfootshop.com/onox-foot-drying-solution-1"><img style="float: right;" src="/Content/Images/uploaded/Products/685_Onox_Foot_Drying_Solution.jpg" alt="Onox" width="150" /></a></li> <li>       Wear socks whenever possible.  Socks will wick away moisture.</li> <li>       Rotate your shoes allowing 24hrs between use for drying.</li> <li>       Wear shoes that are made of natural substances that will absorb perspiration.</li> <li>       Wash your feet daily to remove bacteria and salts that may contribute to odor.</li> <li>       Finish your day with a <a href="https://www.myfootshop.com/antifungal-healing-foot-cream">topical antibacterial and antifungal lotion</a>. </li> </ol> <p>Foot odor is a fact of life that is simple to manage and control with just a few steps every day.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:237https://www.myfootshop.com/bone-contusions-are-they-really-fracturesBone Contusions | Are they really fractures?<h2>Bone Contusions - are they really fractures?<a href="https://www.myfootshop.com/article/talar-dome-fracture"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/ct_scan_ankle_osteochondral_fracture.jpg" alt="Bone contusion of the talar dome (ankle)" width="200" /></a></h2> <h3>How are bone contusions and bone bruises classified?</h3> <p>A brief search through the literature for the terms 'bone contusion' and 'bone bruise' will leave you confused due to the lack of clarity and consensus on this topic.  Attempts to classify bone contusions have been met with little acceptance by practicing clinicians.(1,2,3)  To date, there is no classification of these conditions that allows clinicians to objectively predict the extent to which a bone contusion may or may not heal.</p> <p>A survey of the literature on bone contusions and bone bruises brought up a number of articles, but the best I found came out of Meath, Ireland.  Published in The International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine, Drs. Niall and Bobic summarize the topic in a paper entitled, 'Bone Bruising and Bone Marrow Edema Syndromes: Incidental Radiological Findings or Harbingers of Future Joint Degeneration? (4)  The authors describe bone edema and bone contusions as an area of swelling within the bone with or without microtrabecular fracture, without disruption of the bone cortex or adjacent cartilage. Their article focuses primarily on the knee and bone contusions associated with ACL tears.  They summarize that bone contusions are unique and poorly classified injuries that do qualify as fractures.</p> <p>Magnetic resonance imaging (MRI) has helped to identify several characteristics of these injuries that were previously poorly seen with plain x-ray images.  As such, MRI has helped to identify breaches in the cortical bone, and when the injury is associated with overlying cartilage, MRI has been able to clearly identify disruption of the cartilage from the subchondral bone. </p> <p>Are bone contusions really fractures?  In many cases yes.  When the outer cortical bone is violated, or when the subcortical or subchondral bone is compressed, these injuries really do represent fractures.</p> <p>Granted, the mechanism of injury will vary, and the affected joint may be different (hip/knee/ankle).  These variations will make classification much more difficult.  For instance, the mechanism of injury in the ankle will be vastly different from that of the hip.  Although MRI cannot differentiate the mechanism of injury, it can quantitate many characteristics of these injuries such as dept of bone edema, pattern of bone edema and disruption of cortical bone.  Although the interpretation of this information by the clinician remains subjective, it does act as a guide for prognostic interpretation of the injury.  This knowledge can help clinicians discuss long term sequelae with their patients and predict future viability of the joint.</p> <ol> <li>     Lynch TCP, Crues JV, Morgan FW et al. Bone Abnormalities of the knee: prevalence and significance at MR imaging. Radiology 1989; 171:761-6.</li> <li>     Mink JH, Deutsch AL. Occult cartilage and bone injuries of the knee: Detection, classification and assessment with MR imaging. Radiology 1989; 170:823-9.</li> <li>     Vellet AD, Marks PH, Fowler PJ et al. Occult post-traumatic osteochondral lesions: Prevalence, classification and short-term sequelae evaluated with MR imaging. Radiology 1991; 178:271-6.</li> <li>     <a href="https://www.isakos.com/innovations/niall">Niall D, Bobic V. Bone Bruising and Bone Marrow Edema Syndromes: Incidental Findings or Harbingers of Future Joint Degeneration? </a>(undated publication) </li> </ol> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:235https://www.myfootshop.com/calcaneal-stress-fracture-differential-diagnosis-of-heel-painCalcaneal Stress Fracture | Differential diagnosis of heel pain<h2>Do I have a stress fracture of my heel bone?<a href="https://www.myfootshop.com/article/calcaneal-fractures#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/calcaneal_fracture_lat.jpg" alt="Calcaneal stress fracture" width="200" /></a></h2> <h3>Differential diagnosis for calcaneal stress fractures</h3> <p>A stress fracture is a nondisplaced defect in a bone that occurs due to repetitive load or trauma.  A calcaneal stress fracture (fracture of the heel bone) is most often the result of a sudden abrupt injury but can occur without a history of trauma. </p> <p>Confirming the diagnosis of calcaneal stress fractures can be difficult with just clinical testing. The appearance of a stress fracture on x-ray is not always evident. Quite often, the only x-ray findings seen are those signs that show up towards the end of the healing process, sometimes as long as several months after the onset of the stress fracture. The initial fracture may not be visualized but the healing bone will show evidence of a fracture 4-6 weeks after the onset of the injury. If the initial clinical findings of heel pain seem suggestive of a stress fracture, there are several tests that can be used to help determine the diagnosis. These tools include plain x-ray, bone scans, CT scanning, and MRI.</p> <p>How do you differentiate a calcaneal stress fracture from other heel problems?  Let's take a look at a short list of common reasons for heel pain and their symptoms.</p> <h3><a href="https://www.myfootshop.com/article/calcaneal-fractures#Tab3">Calcaneal stress fracture</a></h3> <ul> <li><span style="color: #008080;">Onset varies - may or may not result from an injury such as a fall</span></li> <li><span style="color: #008080;">Swelling is not common</span></li> <li><span style="color: #008080;">Location of pain - pain found with side to side compression of the medial and lateral walls of the heel bone</span></li> <li><span style="color: #008080;">Weight bearing with pain in the mid-body of the heel and is not relieved by rest</span></li> </ul> <h3><a href="https://www.myfootshop.com/article/plantar-fasciitis">Plantar fasciitis</a> </h3> <ul> <li><span style="color: #008080;">Onset varies and may be abrupt and associated with a specific event like a period of long standing (i.e. convention, seminar or sporting event)</span></li> <li><span style="color: #008080;">Swelling is not common</span></li> <li><span style="color: #008080;">Location of pain is specific to the bottom of the heel</span></li> <li><span style="color: #008080;">Pain found with initial weight bearing and is relieved by rest</span></li> </ul> <h3><a href="https://www.myfootshop.com/article/baxters-nerve-entrapment">Baxter's nerve entrapment</a></h3> <ul> <li><span style="color: #008080;">Onset is usually insidious and not abrupt</span></li> <li><span style="color: #008080;">Swelling is uncommon</span></li> <li><span style="color: #008080;">Location of pain specific to the medial heel</span></li> <li><span style="color: #008080;">Pain increases with the duration of time spent on the feet and is not relieved by rest</span></li> </ul> <h3><a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a></h3> <ul> <li><span style="color: #008080;">Onset is insidious or abrupt</span></li> <li><span style="color: #008080;">Swelling is common and specific to the posterior heel</span></li> <li><span style="color: #008080;">Pain occurs with the onset of activity - getting out of bed or at the onset of a run.  Pain is partially relieved with rest</span></li> </ul> <p>The clinical symptoms of heel pain, particularly in cases of calcaneal stress fractures, can often be difficult to differentiate.  In my experience, calcaneal stress fractures are relatively rare injuries but need to be considered as a differential diagnosis for the more common heel pain problems like plantar fasciitis. </p> <p>If your heel pain symptoms seem suspicious for a calcaneal stress fracture please be sure to check with your podiatrists or orthopedist.  Prompt diagnosis of a calcaneal fracture can significantly expedite healing.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:234https://www.myfootshop.com/chronic-achilles-tendon-pain-what-is-the-role-of-mri-and-ultrasoundChronic Achilles Tendon Pain | What is the role of MRI and ultrasound?<h2>What is the role of MRI in chronic Achilles tendinitis and partial tears of the Achilles tendon?<a href="https://www.researchgate.net/publication/233967706_Achilles_tendon_classification"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/Doppler image - grade III vasculariztion.jpg" alt="Doppler image of Achilles tendon - grade III vascularization" width="250" /></a></h2> <h3>When is MRI or ultrasound indicated for chronic Achilles pain?</h3> <p>The causes of <a href="https://www.myfootshop.com/article/achilles-tendonitis">chronic Achilles tendon pain</a> can vary from simple inflammation of the tendon to partial rupture.  Prior to the advent of soft tissue scanning techniques, including magnetic resonance imaging (MRI) and ultrasound (US), the classification of injury to the Achilles tendon was poorly defined in the literature.  With these new scanning techniques, new classifications for Achilles tendon injuries are being proposed, but these classifications are yet to be accepted by practicing clinicians.  Without accepted classification for Achilles injuries, is there value in these imaging techniques?  Does the cost of these tests justify their use?  And do these tests actually improve patient outcomes?</p> <p>Buono et al in a 2013 paper entitled Achilles tendon function: functional anatomy and novel emerging models of imaging classification, were among the first to propose an image-based classification of Achilles tendon injuries. (1)  The goal of their paper was to create a degree of prognostic value with a classification based on US and MRI.  Their paper proposes a classification of Achilles tendon injuries based on anatomy of the tendon, symptoms, clinical findings and histopathology.  The authors used MRI to define structural changes in the tendon with 96% sensitivity and color Doppler with reported 86% sensitivity. (2)  Their classification was twofold.  First, they used MRI to define structural alterations of the tendon.  Secondly, they used color Doppler to define the degree of reactive revascularization surrounding the tendon.  Increased revascularization suggested not only a response to injury but also provided an opportunity to prognosticate regarding the success of the response to injury - increase vascularization suggested a potentially successful outcome, whereas lack of revascularization suggested a poor outcome.</p> <p>Imaging studies are always correlated with clinical findings.  But what determinative value do these imaging studies add to the course of treatment of chronic Achilles tendinitis or partial tears of the Achilles tendon?  Clinical findings appear to still be the primary determinant of outcome.  Pain, swelling, and fusiform swelling of the tendon all suggest different stages of injury.  It does not appear to date that a classification based on imaging techniques, whether MRI or US, has been clearly defined or may provide prognostic value to the clinician.  </p> <ol> <li><a href="https://www.researchgate.net/publication/233967706_Achilles_tendon_classification">Buono A, Chan O, Maffulli N, Achilles tendon: functional anatomy and novel emerging models of imaging classification.  Int Orthop 2013 Apr;37(4) 715-721.</a></li> <li>Khan KM, Forster BB, Robinson J et al (2003) Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders?  A two years prospective study.  Br J Sports Med 37:149-153.</li> </ol> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:236https://www.myfootshop.com/gel-heel-pads-indications-for-useGel Heel Pads | Indications for use<h2>Gel heel pads - what works for what?</h2> <h3>What are the indications for each of the gel heel pads we sell?</h3> <p>We carry a number of different gel heel pads on Myfootshop.com.  Let's take a look at each of the gel heel pads that we carry and review the indications for each.</p> <h3><a href="https://www.myfootshop.com/plantar-fasciitis-reliever">Plantar Fasciitis Reliever</a></h3> <p><a href="https://www.myfootshop.com/plantar-fasciitis-reliever"><img style="float: left;" src="/Content/Images/uploaded/Products/949_Plantar_Fasciitis_Reliever.jpg" alt="Plantar fasciitis reliever" width="75" /></a>The Plantar Fasciitis Reliever, in my opinion, is one of the most unique ways of treating <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a> that is really quite underutilized.  Many cases of plantar fasciitis transition to a condition that lack acute inflammation.  Most doctors will call this plantar fasciosis.  Plantar fasciosis is just as painful as plantar fasciitis, but simply lacks the cellular and chemical components for healing.  The Bars that come with the Plantar Fasciitis Reliever vary in firmness.  Using a firm bar will massage the plantar fascia and tend to re-stimulate the healing properties of plantar fasciitis. </p> <p>___________</p> <h3><a href="https://www.myfootshop.com/heel-cups-pq-gel">PQ Gel Heel Cups</a></h3> <p><a href="https://www.myfootshop.com/heel-cups-pq-gel"><img style="float: left;" src="/Content/Images/uploaded/Products/975_Heel_Cups_PQ_Gel.jpg" alt="PQ Gel Heel Cups" width="75" /></a>PQ Gel Heel Cups are my go-to for patients with fat pad atrophy of the heel.  The gel in the PQ heel pads is unique in that it's soft yet supportive.  PQ Gel Heel Cups are a very unique and special product, particularly for older customers who have lost padding.  Also great for customers with bruised heels.</p> <p><br /><br />___________</p> <h3><a href="https://www.myfootshop.com/gel-heel-spur-pads">Gel Heel Spur Pads</a></h3> <p><a href="https://www.myfootshop.com/gel-heel-spur-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/910_Gel_Heel_Pads_with_Removable_Pads.jpg" alt="Gel Heel Spur Pad" width="75" /></a>Gel Heel Spur Pads are a wee bit firmer than most of our other gel heel pads.  The gel in the Gel Heel Spur Pad will act as a heel lift of sorts.  Lifting the heel (different than a cushion) will help to weaken the calf, decreasing symptoms of plantar fasciitis.  And some customers feel much better with the cut-out in the Gel Heel Spur Pad.</p> <p><br /><br />___________</p> <h3><a href="https://www.myfootshop.com/reusable-gel-heel-cushions">Reusable Gel Heel Cushion</a></h3> <p><a href="https://www.myfootshop.com/reusable-gel-heel-cushions"><img style="float: left;" src="/Content/Images/uploaded/Products/855_Heel_Cushion_Gel_ALT.jpg" alt="Reusable Gel Heel Cushion" width="75" /></a>Reusable Gel Heel Cushions are a great everyday heel pad that I recommend most often for dress shoes.  Reusable Gel Heel Pads are thin enough to fit into all shoes.  Easily trimmed with scissors.  We do have customers who have told us that Reusable Gel Heel Pads have helped with plantar fasciitis.</p> <p><br /><br />___________</p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:233https://www.myfootshop.com/haglunds-deformity-treatment-optionsHaglund's Deformity | Treatment options<h2>What is a Haglund's deformity and how is it treated?<a href="https://www.myfootshop.com/article/haglunds-deformity"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/haglunds_deformity_mod.jpg" alt="Haglund's deformity" width="150" /></a></h2> <h3>Conservative treatment options for Haglund's deformity</h3> <p>The term <a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's deformity</a> (also called Haglund's disease) describes a bump of bone (exostosis) found on the posterior, lateral aspect of the heel.  Haglund's deformity is usually found bilaterally and varies in size.  The origin of a Haglund's deformity is debated in the literature.  Most authors believe that a Haglund's deformity forms as a reaction from external pressure.  External pressure may include stiff shoes, such as the heel counter on a hockey skate or stiff shoe.</p> <p>It's important to differentiate Haglund's deformity from <a href="https://www.myfootshop.com/article/achilles-tendonitis">insertional Achilles tendonitis.</a>  Haglund's is found at the lateral margin of the Achilles tendon and only hurts with direct shoe pressure.  Insertional Achilles tendinitis, on the other hand, shows hypertrophy (bone growth and swelling) encompassing the entire body of the Achilles tendon where it inserts into the heel bone.  Achilles tendinitis hurts at the onset of activity such as getting out of bed with your first steps in the morning, or at the onset of a run.</p> <p>Once you've determined that the problem is Haglund's disease and not insertional Achilles tendinitis, there are several opportunities for conservative treatment.  Treatment options include;</p> <ul> <li>Open heel shoes</li> <li><a href="https://www.myfootshop.com/heel-lifts">Heel lift</a></li> <li><a href="https://www.myfootshop.com/tongue-pads-felt">Split tongue pad</a></li> <li><a href="https://www.myfootshop.com/achilles-heel-pad">Achilles Heel Pad</a></li> </ul> <p>By the time I see a patient in the office with a Haglund's deformity, most have already tried an open heel shoe like a sandal or <a href="https://www.myfootshop.com/tongue-pads-felt"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/split_tongue_pad_for_haglunds.jpg" alt="Split tongue pad for Haglund's deformity" width="150" /></a>clog.  Although open shoes are not a very good wintertime solution, open heel shoes are definitely a starting point for all patients with Haglund's deformity.</p> <p>A simple heel lift can be an effective tool if the primary force applied to the Haglund's bump is at the level of the shoe counter.  By using a heel lift, you can raise the bump above the level of the heel counter.  It's a simple solution and sometimes very effective.</p> <p>A split tongue pad is another simple solution used to off-load direct pressure from the Haglund's bump.  A split tongue pad is shaped using scissors and placed within the heel counter of the shoe adjacent to the pressure point of the Haglund's bump.</p> <p>The Achilles Heel Pad is a simple gel lined sock that helps to off-load pressure on the posterior heel.</p> <p>Be sure to read our knowledge base article on <a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's disease</a> for complete information on both conservative and surgical methods of care.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:232https://www.myfootshop.com/hallux-limitus-what-you-need-to-know-about-conservative-treatmentHallux Limitus | What you need to know about conservative treatment<h2>Treating Hallux Limitus with Orthotics<a href="https://www.myfootshop.com/content/images/medical/ortho/HL_diagram_mod2.jpg"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Misc_Drawings/HL_diagram_mod.jpg" alt="Causes of hallux limitus" width="150" /></a></h2> <h3>When to choose a turf toe plate vs. Vasyli-Howard Dananberg Insole</h3> <p><a href="https://www.myfootshop.com/article/hallux-limitus#Tab3">Hallux limitus</a> is a painful condition of the great toe joint that is the result limited range of motion of the joint.  The limitation of range of motion has several contributing factors, the most common of which is an elevated <a href="https://www.myfootshop.com/article/bone-ap-forefoot-mod-labeled">1st metatarsal</a> (metatarsus primus elevatus).  Normal range of motion of the great toe joint requires a hinge motion of the first metatarsal and the bone of the toe (the proximal phalanx).  The associated diagram shows how the first metatarsal plantarflexes, allowing the proximal phalanx to dorsiflex.</p> <p>Hallux limitus has four stages.  With each progressive stage, from 1 through stage 4, the joint undergoes progressive degenerative changes consistent with what we could call localized osteoarthritis.  Conservative care of hallux limitus includes the use of inserts to either increase the range of motion of the great toe joint or limit range of motion.  The choice of increasing or decreasing the range of motion depends upon the stage of hallux limitus.</p> <p>In stages 1 and 2, use of an orthotic to increase the range of motion of the joint can enable plantarflexion of the first metatarsal <a href="https://www.myfootshop.com/vasyli-dananberg-orthotic"><img style="float: right;" src="/Content/Images/uploaded/Products/963_Dananberg_Insole.jpg" alt="Dananberg Insole" width="150" /></a>and decrease pain.  By increasing the range of motion of the joint, the joint no longer jams.  The result is less pain and a decrease in the rate of onset of stages 3 and 4 (stage 4 also called <a href="https://www.myfootshop.com/article/hallux-rigidus">hallux rigidus</a>).  The best tool to use in stages 1 and 2 is the <a href="https://www.myfootshop.com/vasyli-dananberg-orthotic">Vasyli-Howard Dananberg Insole</a>.  The Vasyli-Dananberg Insole has a pair of wedges that can be moved and placed in a way that plantar flexes the first metatarsal and increases range of motion.</p> <p>In hallux limitus stages 3 and 4, the joint has already undergone significant degenerative arthritic change.  Trying to increase the range of motion in stages 3 and 4 would create increased pain in the joint.  In stages 3 and 4, we change our conservative approach from increasing the range of motion to decreasing the range of motion.  In stages 3 and 4 we use insets with a stiff extension known as a <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded"><img style="float: left;" src="/Content/Images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="Turf toe plate" width="150" /></a>Morton's extension beneath the great toe.    Products with a Morton's extension include the <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">molded turf toe plate</a> and the <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">flat turf toe plate</a>.  <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring plates</a> may also be used to treat stages 1-4 by stiffening  the entire forefoot.</p> <p>Which insert is the best for your needs?  First, it's important to know the stage of hallux limitus.  Early stages benefit from increased range of motion while late stages benefit from splinting.  The type of shoe that you intend to wear and the activity that you intend to participate in are also points to be included in choosing the right product.</p> <p>Be sure to read our knowledge base page on <a href="https://www.myfootshop.com/article/hallux-limitus">hallux limitus</a> to better understand staging and selection of the right products.  If you have additional questions, contact our sales staff by chat, phone or <a href="mailto:help@myfootshop.com">support ticket</a>.</p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/18/2021</p>urn:store:1:blog:post:231https://www.myfootshop.com/relative-hardness-of-heel-lifts-and-heel-cushionsRelative Hardness of Heel Lifts and Heel Cushions<h2>Which heel pad is right for me?<a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork"><img style="float: right;" src="/Content/Images/uploaded/Products/677_Heel_Lifts.jpg" alt="Cork heel lifts" width="150" /></a></h2> <h3>Relative firmness of heel cushions and heel lifts</h3> <p>We had a customer contact us this week to ask about the relative hardness of each of our heel lifts and heel cushions.  I thought I'd convey the conversation to you through a blog post.</p> <p>What is the difference between a <a href="https://www.myfootshop.com/heel-lifts">heel lift </a>and a <a href="https://www.myfootshop.com/heel-cushions">heel cushion</a>?  Heel lifts are intentionally firm and are used to raise the heel.  Heel lifts are not intended to compress and are used to raise the heel.  Raising the heel is indicated in:</p> <ul> <li><a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a></li> <li><a href="https://www.myfootshop.com/article/achilles-tendon-rupture">Achilles tendon rupture - partial</a></li> <li><a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's deformity</a></li> <li>Leg length discrepancies</li> <li><a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction">Posterior tibial tendon dysfunction</a></li> <li><a href="https://www.myfootshop.com/article/shin-splints">Posterior shin splints</a></li> <li><a href="https://www.myfootshop.com/article/plantar-fasciitis">Plantar fasciitis</a></li> </ul> <p>Heel cushions, on the other hand, are intended to compress.  Heel cushions are used to treat;</p> <ul> <li><a href="https://www.myfootshop.com/article/heel-pain">Chronic heel pain</a></li> <li>Loss of plantar fat pad (fat pad atrophy)</li> </ul> <p>Let me list the different heel lifts and heel cushions that we sell in order of hardness.  The harder lift or cushion will be first with the softest heel lift or cushion last.</p> <h3>Heel lifts</h3> <ul> <li><a href="https://www.myfootshop.com/medi-heel-lift">Medi-Heel  Lift</a> (hardest)</li> <li><a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork">Heel Lift for Plantar Fasciitis - Cork</a></li> <li><a href="https://www.myfootshop.com/adjust-a-heel-lift">Adjust-a-heel-lift</a></li> <li><a href="https://www.myfootshop.com/gel-heel-spur-pads">Gel Heel Spur Pad</a></li> <li><a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-felt">Heel Lift for Plantar Fasciitis - Felt</a></li> <li><a href="https://www.myfootshop.com/feltastic-flat-heel-pads">FELTastic® Flat Heel Pads</a></li> <li><a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-foam">Heel lifts for Plantar Fasciitis - Foam</a></li> <li><a href="https://www.myfootshop.com/reusable-gel-heel-cushions">Reusable Gel Heel Cushions</a></li> </ul> <h3>Heel Cushions</h3> <ul> <li><a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-felt">Heel Lifts For Plantar Fasciitis - Felt</a> (hardest)</li> <li><a href="https://www.myfootshop.com/gel-heel-spur-pads">Gel Heel Spur Pads</a></li> <li><a href="https://www.myfootshop.com/heel-cushion-ppt">Heel Cushions - PPT</a></li> <li><a href="https://www.myfootshop.com/heel-wedges-ppt">Heel Wedges PPT</a></li> <li><a href="https://www.myfootshop.com/heel-cups-pq-gel">Heel Cups PQ Gel</a></li> <li><a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-foam">Heel Lifts for Plantar Fasciitis - Foam</a></li> <li><a href="https://www.myfootshop.com/reusable-gel-heel-cushions">Reusable Gel Heel Cushions</a></li> </ul> <p>Why are some lifts in the cushion section and some cushions in the lift section?  Some of our lifts and cushions cross over.  Either a lift has to be soft enough to be considered a cushion and a cushion firm enough to be a lift.</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:230https://www.myfootshop.com/achilles-tendinitis-using-a-heel-lift-and-spring-plate-for-treatmentAchilles Tendinitis | Using a heel lift and spring plate for treatment<h2>Treating Chronic Achilles Tendinitis<a href="https://www.myfootshop.com/article/achilles-tendonitis#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Myology/Gastrocnemius.jpg" alt="Calf and achilles tendon" width="150" /></a></h2> <h3>Using a spring plate and heel lift to treat chronic Achilles tendinitis</h3> <p>Tendon is notoriously slow to heal.  The primary challenge with healing tendon is the limited blood flow to tendons.  Tendons receive nutrition and cellular support through a very small network of capillaries.  In addition to this very limited vascular flow, tendons receive a bit of support from the lubrication produced by the peritenon,  or outer lining of the tendon.  Tendons have such a limited supply of blood and extracellular fluid that tendon injuries are often very difficult to heal.</p> <p>The Achilles tendon is the single largest and strongest tendon in the human body.  Anatomists argue that the Achilles tendon lacks a true peritenon.  In my experience, surgical dissection of the Achilles does show a peritenon but it is very thin and often difficult to suture on wound closure.  Knowing that the Achilles tendon has poor vascularization and that the peritenon is virtually nonexistent, we can assume that healing Achilles tendon injuries are going to be particularly difficult.</p> <p>What other steps can be used to heal tendon injuries?  The single most important key to treating <a href="https://www.myfootshop.com/article/achilles-tendonitis#Tab3">chronic Achilles tendinitis</a> is decreasing load applied to the tendon.  The literature that reviews treatment of chronic Achilles tendinitis stresses rest and ice.  Rest can take on many forms of care including:</p> <ul> <li><span style="color: #008080;">Walking cast - ambulatory</span></li> <li><span style="color: #008080;">Hard Cast - non-ambulatory</span></li> <li><span style="color: #008080;">Heel lift</span></li> <li><span style="color: #008080;">Avoidance of going barefoot or use of low heeled shoes</span></li> <li><span style="color: #008080;">Anterior rocker sole</span></li> </ul> <p>An anterior rocker sole is used to decrease load (off-load) to the tendon at the heel-rise stage of gait.  The gait pattern of the foot in a traditional shoe is as follows:</p> <p style="padding-left: 30px;"><span style="color: #800000;">Heel strike &gt;&gt; stance phase  &gt;&gt;  heel lift &gt;&gt; toe-off</span></p> <p>As your body weight passes over the foot in stance phase, just prior to heel lift, the force that the Achilles tendon is applying to the<img style="float: right;" src="/Content/Images/uploaded/rocker1.jpg" alt="Rocker sole shoe" width="100" /> heel becomes concentrated.  When you modify the shoe with an anterior rocker, the anterior rocker helps to <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left;" src="/Content/Images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="carbon spring plate" width="150" /></a>makes that transition from mid stance to heel lift more gradual with less force applied to the Achilles tendon.  Unfortunately, anterior rocker soles are a shoe modification that will permanently change the shoe.</p> <p>You can accomplish the same effect of an anterior rocker with the use of a clog or you can modify your own shoe with a <a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork">heel lift</a> and <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">spring plate</a>.  The heel lift will decrease the load to the Achilles tendon from heel strike to heel lift.  And the toe spring in the spring plate will function just like an anterior rocker sole.  Toe spring is the curvature of the spring plate that resembles the sole of a clog.  The best part of using a heel lift and spring plate is that you don't need to have a shoemaker make a permanent change to your shoes.</p> <p>A heel lift and a spring plate can be an effective tool for patients with chronic Achilles tendonitis.  Remember that treatment of chronic Achilles tendonitis is a comprehensive plan of rest and modifications of activities.  Although each case may vary, use of a heel lift and spring plate is one of the ways you can treat chronic Achilles tendinitis and still remain active. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:229https://www.myfootshop.com/fungal-nail-infections-how-to-optomize-treatmentFungal Nail Infections | How to optimize treatment<h2>Is medicated nail polish enough to treat fungal infections of toe nails?<a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish"><img style="float: right;" src="/Content/Images/uploaded/Products/905_Just_For_Toenails_Medicated_Nail_Polish_ALT.jpg" alt="Just For Toenails medicated nail polish" width="150" /></a></h2> <h3>How can I optimize treatment of fungal nail infections?</h3> <p>We sell a lot of our medicated nail polish, <a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish">Just For Toenails</a>.  Although Just For Toenails is active against fungal nail infections (also called <a href="https://www.myfootshop.com/article/onychomycosis">onychomycosis</a>), treating fungal nail infections with a topical agent like Just For Toenails is just the starting point of treatment.  What else can be done to treat nail fungus?  Let’s take a closer look at what I consider to be a comprehensive approach to fungal infections of the toe nails.</p> <p>First and foremost, be sure to change the environment that promotes growth of fungal infections.  Keep the feet cool and dry by exercising the following steps:</p> <ul> <li><span style="color: #008080;">Rotate shoes to allow them to dry over the course of 24 hours between use.</span></li> <li><span style="color: #008080;">Use a <a href="https://www.myfootshop.com/lavender-tea-tree-body-powder">drying powder</a> with antifungal properties to dry the shoe.</span></li> <li><span style="color: #008080;">Change your socks at the end of work or wear open shoes.</span></li> <li><span style="color: #008080;">Use a topical antiperspirant like <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> to dry the foot.</span></li> </ul> <p>Most cases of nail fungus begin with <a href="https://www.myfootshop.com/article/athletes-foot">fungal infections of the skin</a>.  Controlling fungal infections of the skin requires daily use of topical antifungal products.  Daily use of an antifungal soap or lotion will significantly reduce the transfer of fungal infections from the skin to the nail.  These products include:</p> <ul> <li><span style="color: #008080;"><a href="https://www.myfootshop.com/antifungal-healing-foot-cream">Antifungal Healing Cream</a><br /></span></li> <li><a href="https://www.myfootshop.com/antifungal-bar-soap">Natural Antifungal Bar Soap</a></li> <li><a href="https://www.myfootshop.com/antifungal-foaming-soap">Natural Antifungal Foaming Soap</a></li> <li><span style="color: #008080;"><a href="https://www.myfootshop.com/lavender-tea-tree-body-powder">Natural Antifungal Body Powder</a><br /></span></li> </ul> <p>Fungal infections of the skin cannot be healed and require daily, routine care.  Following these simple guidelines will significantly reduce fungal infections and result in healthy skin and nails.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:227https://www.myfootshop.com/posterior-shin-splints-causes-and-treatment-optionsPosterior Shin Splints | Causes and treatment options<h2>What are shin splints?<a href="https://www.myfootshop.com/article/tibialis-posterior"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Myology/Tibialis_posterior.jpg" alt="tibialis posterior muscle and tendon" width="125" /></a></h2> <h3> </h3> <h3>How do I treat posterior shin splints?</h3> <p>In my previous blog post, I discussed the more common form of shin splints, anterior shin splints.  Posterior shin splints is the term used to describe tendonitis of the medial ankle.  Although not truly shin pain, posterior shin splints have found their way into our medical vernacular.  Posterior shin splints are actually a form of tendinitis of the medial ankle.</p> <p><a href="https://www.myfootshop.com/article/shin-splints#Tab3">Posterior shin splints</a> describe tendinitis of the posterior tibial muscle and tendon.  The posterior tibial muscle and tendon originate in the lower leg, deep to the calf muscle.  The tendon of the posterior tibial muscle descends to the medial ankle and rounds the ankle extending to the medial arch.  The primary function of the posterior tibial tendon is to support the arch through the weight-bearing phase of gait.  The most common location of pain seen in posterior shin splints is at the medial ankle bone (medial malleolus) and 6-10 centimeters proximal to the ankle.</p> <p>Posterior shin splints is an athletic term used to describe tendinitis of the medial ankle.  The same problem, when described in a less active and older population, is called <a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3">stage 1 posterior tibial tendon dysfunction (PTTD)</a>.  Although the terms posterior shin splints and PTTD describe the same condition, they are used to describe two distinctly different populations of people. </p> <p>The symptoms of posterior shin splints include:</p> <ul> <li><span style="color: #008080;">Medial ankle pain upon the onset of activity</span></li> <li><span style="color: #008080;">Increased medial ankle pain with toe raise</span></li> <li><span style="color: #008080;">Palpable pain along the course of the posterior tibial tendon</span></li> </ul> <p>The differential diagnosis for posterior shin splints includes:</p> <ul> <li><span style="color: #008080;"><a href="https://www.myfootshop.com/article/tarsal-tunnel-syndrome#Tab3">Tarsal tunnel syndrome</a><br /></span></li> <li><a href="https://www.myfootshop.com/article/baxters-nerve-entrapment#Tab3">Baxter's nerve entrapment</a></li> <li><span style="color: #008080;">Os trigonum syndrome</span></li> <li><span style="color: #008080;">Flexor hallucis tendinitis</span></li> </ul> <p>Treatment of posterior shin splints includes:</p> <ul> <li><span style="color: #008080;">Rest</span></li> <li><span style="color: #008080;">Ice before and after activities</span></li> <li><span style="color: #008080;">Support of the arch with a rigid arch support</span></li> <li><span style="color: #008080;">Shoes with a stiff shank</span></li> </ul> <p>Posterior shin splints are a type of overuse syndrome that typically respond to rest and support of the arch.  If you suspect symptoms of posterior shin splints and you've tried these initial methods of treatment but you still have pain, please consult your podiatrist, orthopedist or family doctor for evaluation.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:226https://www.myfootshop.com/shin-splints-causes-and-treatment-optionsAnterior Shin Splints | Causes and treatment options<h2>What are shin splints?</h2> <h3>How do I treat anterior shin splints?</h3> <p>Shin splints describe two distinctly different lower extremity problems; anterior shin splints and posterior shin splints.  In this post, let's focus on anterior shin splints.  I'll follow with a second post on posterior shin splints.</p> <p><a href="https://www.myfootshop.com/article/tibialis-anterior"><img style="float: left;" src="/Content/Images/uploaded/Anatomy/Myology/Tibialis-anterior.jpg" alt="Tibialis anterior muscle - graphic" width="125" /></a><a href="https://www.myfootshop.com/article/shin-splints#Tab3">Anterior shin splints</a> are the most common form of shin splints.  Pain is specific to the middle to distal 1/3 of the lower leg and found on the anterior, medial aspect of the tibia (shin bone).  This location on the shin corresponds to the origin of the tibialis anterior muscle.   The origin of a muscle is where the muscle begins (proximally).  This is different than the insertion of the muscle.  The insertion is where the muscle (or tendon attached to the muscle) inserts or ends. </p> <p>The tibialis anterior muscle can easily be seen in your own legs.  To visualize the tibialis anterior muscle, sit with your shoe and socks off.  Turn your feet slightly until the soles face each other and pull your toes towards your shin.  The muscle that pops up on the anterior medial ankle is the tibialis anterior muscle.<a href="https://www.myfootshop.com/article/shin-splints#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Anatomy/Myology/Tibialis anterior tendon.jpg" alt="Tibialis anterior tendon" width="150" /></a></p> <p>The most common cause of anterior shin splints is overuse of the tibialis anterior muscle.  Overuse results in stretching or tearing of the origin of the tibialis anterior on the anterior shin.  Although anterior shin splints are the most common cause of shin pain, the differential diagnosis of anterior shin pain includes:</p> <ul> <li><span style="color: #008080;">Compartment syndrome</span></li> <li><span style="color: #008080;">Tibial stress fracture</span></li> </ul> <h3>How do you treat anterior shin splints?</h3> <p>First, be sure to read our <a href="https://www.myfootshop.com/article/shin-splints#Tab3">knowledge base page on anterior shin splints</a>.  The article will help you to understand the causes of anterior shin splints.  Begin treatment with some very simple steps:</p> <ul> <li><span style="color: #008080;">Do not over stride - take shorter steps</span></li> <li><span style="color: #008080;">Do not run downhill</span></li> <li><span style="color: #008080;">Stretch the lower leg 4-6 times a day.</span></li> <li><span style="color: #008080;">Ice the anterior, medial shin before and after exercise.</span></li> </ul> <p>Shin splints are usually caused by overuse and are often seen at the onset of an activity (beginning of track season for example).   Try these simple steps to begin treatment.  If your symptoms do not begin to subside after two weeks of treatment, consult your doctor to rule out a tibial stress fracture.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:224https://www.myfootshop.com/metatarsal-transfer-lesions-causes-and-treatment-optionsMetatarsal Transfer Lesions | Causes and treatment options<h2>What is a metatarsal transfer lesion?<a href="https://www.myfootshop.com/article/capsulitis"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/bursitis_capsulitis_with_text.jpg" alt="Capsulitis forefoot" width="150" /></a></h2> <h3>How do I treat a metatarsal transfer lesion?</h3> <p>The forefoot is designed to work as a unit.  With each step, the multiple bones of the forefoot are intended to distribute load bearing in an equal distribution.  In theory, each metatarsal head should carry an equal amount of load.  A metatarsal transfer lesion occurs when one metatarsal head carries more than its fair share of load.  As a result of this increase in focal load bearing, a number of conditions can occur:</p> <ul> <li><span style="color: #008080;"><a href="https://www.myfootshop.com/article/capsulitis#Tab3">Capsulitis</a> beneath the metatarsal head</span></li> <li><a href="https://www.myfootshop.com/article/callus#Tab3">Callus formation</a></li> <li><span style="color: #008080;"><a href="https://www.myfootshop.com/article/metatarsal-fracture#Tab3">Metatarsal stress fracture</a><br /></span></li> </ul> <p>There are a number of reasons that metatarsal transfer lesions occur, but the most common reason is foot surgery.  Surgery on the first metatarsal, such as bunion surgery, hallux limitus or hallux rigidus surgery, can result in disproportionate load bearing of the forefoot.  If the outcome of these surgeries results in elevation or shortening of the first metatarsal, a transfer lesion beneath the second metatarsal head is a common outcome.</p> <p>In cases of a transfer lesion sub 2, what I find interesting is how the second metatarsal responds.  The increased load to the second metatarsal can result in two outcomes. </p> <ul> <li><span style="color: #008080;">Metatarsal stress fracture</span></li> <li><span style="color: #008080;">Increased girth (as seen on x-ray) of the second metatarsal</span><a href="https://www.myfootshop.com/article/capsulitis#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/metatarsal_deformity_mod (1).jpg" alt="X-ray of the foot with metatarsal deformity" width="147" height="184" /></a></li> </ul> <p>In cases where the transfer lesion results in an abrupt, increased load to the second metatarsal, we'll often see the body self-correct this eccentric load by creating a stress fracture of the second metatarsal.  This secondary stress fracture often results in resolution of the transfer lesion.  In other cases, the second metatarsal will 'step up to the plate' and increase in size to accommodate this new load.  Unfortunately, this often results in a chronic problem with load bearing in the forefoot.  The most common problem is chronic capsulitis beneath the second metatarsal head.</p> <p>How can a transfer lesion be treated?  First and foremost, the surgeon who performs the 1st metatarsal surgery should be keenly aware of the potential for transfer lesions and perform a surgery that does not result in shortening or elevation of the first metatarsal.  But even in cases with the best surgeons, transfer lesions still happen.  Treatment options for transfer lesions include:</p> <ul> <li><span style="color: #008080;"><a href="https://www.myfootshop.com/metatarsal-pads">Metatarsal pads</a><br /></span></li> <li><span style="color: #008080;">Rx orthotics with metatarsal pads, metatarsal bars or a pocket sub 2</span></li> <li><span style="color: #008080;">Metatarsal osteotomy</span></li> </ul> <p>If you experience pain beneath the second metatarsal head following bunion or hallux limitus surgery, be sure to speak with your surgeon about treatment options.  Although an unfortunate outcome of some forefoot surgeries, transfer lesions are usually a problem that can be treated and corrected.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:223https://www.myfootshop.com/metatarsal-pads-which-one-is-right-for-meMetatarsal Pads | Which one is right for me?<h2>Differences in metatarsal pads at Myfootshop.com</h2> <h3>Which metatarsal pad is right for me?</h3> <p>Why is one metatarsal pad better than another?  There's a number of differences in our metatarsal pads and I address each of those differences below, but first, let's talk about the similarities of metatarsal pads.</p> <h3>What are metatarsal pads used for?</h3> <p>Metatarsal pads are used to off-load the forefoot.  By taking load off of the ball of the foot, metatarsal pads help to redistribute load bearing.  In essence, metatarsal pads work to increase the surface area of load bearing.  By doing so, metatarsal pads will help to treat <a href="https://www.myfootshop.com/article/forefoot-pain">forefoot pain</a> including <a href="https://www.myfootshop.com/article/capsulitis">capsulitis</a>, <a href="https://www.myfootshop.com/article/bursitis-of-the-foot-and-ankle">bursitis</a>, <a href="https://www.myfootshop.com/article/callus">forefoot callus</a> and <a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a>.</p> <p>The second thing that a met pad can do is to lift and separate the metatarsal heads.  This becomes very important in treating <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>.  In the case of Morton's neuroma, the primary task of the met pad is to stabilize the metatarsal heads and decrease the entrapment of the interdigital nerve.  Same placement of the met pad as used to off-load the forefoot, but in this second use, just a little bit different method of action.</p> <p>Let's take a look now at the differences between each of our adhesive-backed metatarsal pads.  I'll list the metatarsal pads in density or firmness.  So the first metatarsal pad (felt) is the most firm).</p> <p><a href="https://www.myfootshop.com/reusable-metatarsal-pad"><img style="float: left;" src="/Content/Images/uploaded/Products/929_Reusable_Gel_metatarsal_pad.jpg" alt="Reusable gel metatarsal pad" width="100" /></a><a href="https://www.myfootshop.com/reusable-metatarsal-pad">Reusable Gel Metatarsal Pad</a> - Although not adhesive-backed, the Reusable Gel Metatarsal Pad has a unique property in that the sticky side of the pad is reactivated by washing in soap and water.  Adhesive?  Sort of, but different than all of the other metatarsal pads that we've discussed in this article.  The Reusable Gel Metatarsal Pad is one of our top sellers.  It's the firmest of all of our metatarsal pads and comes in two thicknesses.  The reason the Reusable Gel Metatarsal Pad is so popular is that first, it's reusable.  And second, you can use it in different activities and conditions.  Get it wet and it'll perk up to be used again.  Use it under a sock around the house.<br /><br />____________________</p> <p><a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img style="float: left;" src="/Content/Images/uploaded/Products/729_Metatarsal_Pads_Felt.jpg" alt="Metatarsal pad - felt" width="100" /></a></p> <p><a href="https://www.myfootshop.com/metatarsal-pad-felt-1">Metatarsal Pad - Felt</a> is by far our best seller.  The durability of the felt metatarsal pads is their best attribute.  Felt is boiled, compressed wool and one of the oldest, most reliable forms of padding that has been used for centuries.  Prior to the invention of rubber, felt was used for under padding on horse saddles, mattresses - you name it.  Felt is still a durable and user-friendly substance in that it absorbs moisture and dries to its original size and shape.  Felt metatarsal pads are skived, meaning the edges are rounded to feel more comfortable to the user.  felt metatarsal pads can be used directly on the foot or in the shoe.</p> <p><br />____________________</p> <p><a href="https://www.myfootshop.com/neuroma-pads-mini-felt"><img style="float: left;" src="/Content/Images/uploaded/Products/977_Neuroma_Pads_Mini_Felt.jpg" alt="Felt neuroma pad" width="100" />Neuroma Pads - Mini Felt</a> are also a popular metatarsal pad.  Neuroma Pads - Mini Felt are made of the same durable felt in our felt met pads, just a hitch smaller.  neuroma pads - Mini Felt can be used directly on the bottom of the foot or in the shoe.</p> <p> </p> <p><br /><br />____________________</p> <p><a href="https://www.myfootshop.com/metatarsal-pads-ppt"><img style="float: left;" src="/Content/Images/uploaded/Products/868_Metatarsal_Pads_PPT.jpg" alt="Metatarsal Pad - PPT" width="100" />Metatarsal Pad - PPT</a>.  PPT is a proprietary medical-grade foam produced by Langer Biomechanics.   PPT is designed to absorb rapid repetitious shock.  PPT retains 95% of its pressure absorbing capacity under extreme conditions such as long-distance running.  We recommend use of PPT metatarsal pads in the shoe and not directly on the foot.</p> <p> </p> <p><br />____________________</p> <p><a href="https://www.myfootshop.com/metatarsal-bars"><img style="float: left;" src="/Content/Images/uploaded/Products/908_Metatarsal_bar_PPT.jpg" alt="PPT metatarsal bar" width="100" />Metatarsal Bar PPT Cushions</a> are the same material used in our PPT metatarsal pads just shaped in a more broad shape.  Metatarsal bars are a common addition to Rx orthotics when support is needed across the entire 1-5 set of metatarsal heads.  Metatarsal Bar Cushions PPT shoe be used directly in the shoe.</p> <p> </p> <p><br /><br />____________________</p> <p><a href="https://www.myfootshop.com/metatarsal-pad-foam"><img style="float: left;" src="/Content/Images/uploaded/Products/815_Metatarsal_Pad_Foam.jpg" alt="Foam metatarsal pad" width="100" /></a><a href="https://www.myfootshop.com/metatarsal-pad-foam">Metatarsal Pads - Foam</a> are the same shape and size as our felt metatarsal pads, just a bit softer.  Foam metatarsal pads are recommended to be used in the shoe.  Foam metatarsal pads are a better choice when customers anticipate wet conditions such as inside a fireman's boot or muck boots.</p> <p> </p> <p><br /><br />____________________</p> <p><a href="https://www.myfootshop.com/gel-metatarsal-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/925_Gel_Metatarsal_Pads.jpg" alt="Gel metatarsal pad" width="100" /></a><a href="https://www.myfootshop.com/gel-metatarsal-pads">Gel Metatarsal Pads</a> are specialty pads that are intended to be used in sandals.  The clear Gel Metatarsal Pad is much less obvious in sandals.  We recommend that you use the Gel Metatarsal Pad directly in the shoe and not on the foot.</p> <p> </p> <p><br /><br />____________________</p> <p><a href="https://www.myfootshop.com/pedag-t-form-metatarsal-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/943_Pedag_TForm_Metatarsal_Pads_ALT1.jpg" alt="Pedag T-Form Metatarsal Pad" width="100" /></a><a href="https://www.myfootshop.com/pedag-t-form-metatarsal-pads">Pedag T-Form Metatarsal Pads</a> are a softer metatarsal pad in a leather cover.  The smooth profile of the Pedag T-Form metatarsal pad makes it an excellent choice for use in dress shoes.  The shape of the Pedag T-Form Metatarsal Pad is much like a metatarsal bar and contours the more of the forefoot.  We do not recommend use of the Pedag T-Form Metatarsal Pd directly on the foot.</p> <p> </p> <p><br />____________________</p> <p><a href="https://www.myfootshop.com/pedag-drop-metatarsal-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/961_Pedag_DROP_Metatarsal_Pads_ALT.jpg" alt="Pedag Drop Metatarsal Pad" width="100" /></a><a href="https://www.myfootshop.com/pedag-drop-metatarsal-pads">Pedag Drop Metatarsal Pads</a> are very similar to the Pedag T-Form pads in density but vary in shape.  Where the Pedag T-Form pad is bar-shaped, the Drop Metatarsal Pad is teardrop-shaped, much like the felt metatarsal pad.  The choice between the Pedag T-Form and Pedag Drop pad is one of personal choice.</p> <p> </p> <p><br /><br />____________________</p> <p>Which metatarsal pad is best for your needs?  It's sometimes a tough decision that is based upon your individual needs.  Be sure to contact us by live chat if you have any questions prior to purchase. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:220https://www.myfootshop.com/carbon-shoe-plate-flat-indication-for-useGlass Fiber Shoe Plate Flat | Indications for use<h2>When would I choose to use a Glass Fiber Shoe Plate?<a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat"><img style="float: right;" src="/Content/Images/uploaded/Products/893_Carbon_Graphite_Shoe_Plate_Flat_ALT.jpg" alt="Carbon Shoe Plate - Flat" width="150" /></a></h2> <h3>How do I use a Glass Fiber Shoe Plate?</h3> <p><a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat">Glass Fiber Shoe Plates</a> are one of our more popular shoe insert products.  Used to stiffen the shoe, Glass Fiber Shoe Plates are great inserts that have a number of unique applications.  How do they stack up compared to our <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Molded Turf Toe Plates</a> or our <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plates</a>?  Let's take a look at what I consider to be the indications for a Glass Fiber Shoe Plate.</p> <p>First, I look at the Glass Fiber Shoe Plate as a fundamental part of the shoe.  What I mean by that is that the Glass Fiber Shoe plate ought to be placed deep within the shoe, under any existing insert.  Basically, the Glass Fiber Shoe Plate ought to act to supplement the shank of the shoe.  The shank is that stiff portion of the shoe that reinforces the arch and limits flex of the arch.  The Flat Glass Fiber Plate really does need to have a cover of some sort, preferably an arch support or orthotic.</p> <p>What are the indications for the Flat Glass Fiber Shoe Plate?  Indications include:</p> <ul> <li><a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Midfoot arthritis</a></li> <li>Midfoot injury (Lisfranc's fracture or dislocation)</li> <li><a href="https://www.myfootshop.com/article/arch-pain">Arch strain or arch pain</a></li> <li><a href="https://www.myfootshop.com/article/stress-fractures-of-the-foot">Midfoot fractures</a></li> <li><a href="https://www.myfootshop.com/article/cuboid-syndrome">Cuboid Syndrome</a></li> <li><a href="https://www.myfootshop.com/article/stress-fractures-of-the-foot">Metatarsal stress fractures</a></li> </ul> <p>To manage forefoot pain including <a href="https://www.myfootshop.com/article/capsulitis">capsulitis</a>, plantar plate tears, <a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a>, <a href="https://www.myfootshop.com/article/freibergs-infraction">Freiberg's infraction</a>, and <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>, I tend to prescribe more <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plates</a>.  The rocker sole on the Spring Plate works much better to accommodate forefoot pain.  And for <a href="https://www.myfootshop.com/article/turf-toe">turf toe</a> and <a href="https://www.myfootshop.com/article/hallux-limitus">hallux limitus</a> or hallux rigidus?  That's when I defer to the <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Molded Turf Toe Plate</a> or the <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">Flat Turf Toe Plate</a>.</p> <p>One last note on Flat Glass Fiber Plates - we have a number of customers who have told us that the Flat Glass Fiber Plate has really saved the day on construction sites.  Nail and screw punctures are a common injury on construction sites.  The Flat Carbon Plate is a lightweight measure of protection from puncture injuries.</p> <p>Remember, the Flat Glass Fiber Plate is part and parcel of the shoe.  It needs to go under an insert like a <a href="https://www.myfootshop.com/pedag-sport-insert">Pedag Sport</a> or a <a href="https://www.myfootshop.com/pedag-viva-full-length-arch-supports">Pedag Viva Full Length Arch Support</a>.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Director<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:219https://www.myfootshop.com/natural-wart-salve-ingredientsNatural Wart Remover | Ingredients<h2>Natural Wart Remover - How does it work?<a href="https://www.myfootshop.com/wart-salve"><img style="float: right;" src="/Content/Images/uploaded/Products/790_Wart_Salve_ALT.jpg" alt="Natural Wart Salve" width="150" /></a></h2> <h3>How do the ingredients in Natural Wart Remover work against a wart?</h3> <p><a href="https://www.myfootshop.com/wart-salve">Natural Wart Remover</a> is the only natural product available today on the market that is used to treat superficial warts of the skin (hands and feet.)  What are the ingredients of Natural Wart Remover and how do they work in treating warts?  Let's take a peek at each active ingredient in Natural Wart Remover.</p> <ul> <li><span style="color: #008080;"><span style="color: #993300;">Willowbark oil (Salix amygdaloides)</span>  - Salicin is the primary ingredient in willow bark.  Salicin is the precursor to salicylic acid.  Although primarily used as a pain reliever, sal acid is also an effective chemical debriding agent.  We use sal acid to debride the wart and to decrease the pH of the wart.</span></li> <li><span style="color: #008080;"><span style="color: #993300;">Chapparal oil (Larrea tridentate)</span> - Chapparal oil is derived from Larrea tridentata, a plant found in the American southwest.  Chapparal oil has a long history of topical and internal uses.  Our intended use of chapparal oil is due to it's success in treating herpes 1 virus and HPV.  The common wart is a papilloma virus that is affected by chapparal oil.</span></li> <li><span style="color: #008080;"><span style="color: #993300;">Castor oil (Ricinus communis)</span> -  Castor oil is the source of undecylenic acid, a natural antifungal.  In addition to its antifungal properties, undecylinic acid has been shown to possess anitiviral properties including the papilloma virus that causes the common wart.</span></li> <li><span style="color: #008080;"><span style="color: #993300;">Sage oil (Salvia officinalis)</span> -  Sage oil can contain up to 50% thujone.  Thujone is a ketone and best known as the active ingredient in absinthe.  Thujone exerts a mild cytotoxic effect on skin cells and significantly affects the rapid cell growth of a virus including papilloma virus.</span></li> <li><span style="color: #008080;"><span style="color: #993300;">Lavender oil</span> - Lavender oil is not a pure essential oil but rather a complex of phytochemicals including linalool and linayl acetate.  Lavender oil has shown antibacterial and antifungal properties.  Its antiviral properties are not fully proven.</span></li> <li><span style="color: #008080;"><span style="color: #993300;">Tea tree oil</span> - Tea tree oil is derived from a number of different plants including Melaleuca.  Tea tree oil has a long history of use as an antibacterial and antifungal.  Use against viruses is still unproven.</span></li> </ul> <p>You can see that the formulation of Natural Wart Remover is actually quite complex and targeted to wart treatment.  It's important to note that each of the active ingredients we use are focused to our intended use and efficacy.  Our goal is to use only natural, proven ingredients, and no extra fillers or unneeded ingredients.</p> <p>We've had a lot of positive feedback from customers who have tried Natural Wart Remover.  We hope you are also able to enjoy the benefits of this unique natural wart solution.</p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:218https://www.myfootshop.com/natural-remedies-for-wartsPlantar Warts | Treatment options<h2>Plantar warts - what are my treatment options?<a href="https://www.myfootshop.com/article/warts"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/wart3.jpg" alt="Subungual wart (verrucae)" width="100" /></a></h2> <h3>Is there a natural treatment option for plantar warts?</h3> <p><a href="https://www.myfootshop.com/article/warts">Warts</a> are the bane of all adolescents, right?   It may seem like that to a teenager who's ever had a wart, but interestingly, as a virus, I find warts to be an interesting little laboratory of sorts.  The scientist in me thinks that if I can manipulate a wart virus, then I might understand a bit more about other types of viruses.  Maybe?</p> <p>Be sure to read our <a href="https://www.myfootshop.com/article/warts">knowledge base article on warts</a> for a complete rundown on how to treat warts.  For this blog, let's take a look at what we can do from a natural standpoint to treat warts.  Here are some of the tricks that I've used and found to be successful in my practice.  Most of these techniques involve changing the host.  Here are just a few:</p> <ul> <li><span style="color: #008080;">Dry the foot - use <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> or a comparable drying agent to dry the foot.</span></li> <li><span style="color: #008080;">Rotation of shoes and socks - frequent rotation makes a drier environment.</span></li> <li><span style="color: #008080;">Vitamin A - increase your dietary intake of vitamin A or start taking a vitamin A supplement</span></li> <li><span style="color: #008080;">Debridement of the wart - get a little mean.  Use a <a href="https://www.myfootshop.com/pumice-stone">pumice stone</a> or <a href="https://www.myfootshop.com/safety-corn-and-callus-trimmer">callus shaver</a>.</span></li> <li><span style="color: #008080;">Topical natural medications - <a href="https://www.myfootshop.com/wart-salve">Natural Wart Remover</a> - willow bark oil, chapparal oil, and castor oil (among other ingredients) are not what a wart calls a friend.</span></li> </ul> <p>The wart virus simply is at home on the bottom of the foot.  The goal is to change that relationship and make the host (you or your children) less hospitable.  And it works. </p> <p>And what's the role of your body's immune system in treating warts?  It's almost as if the active treatment of the wart creates focus within the immune system.  Is that a scientific approach?  Not today.  But in years to come, I believe we'll find effective ways to target our own immune response to treat problems like warts.</p> <p>See what I mean about a little laboratory?  That humble little wart becomes a very visible way in which we can study the response of treatment of a virus.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:217https://www.myfootshop.com/treatment-options-for-plantar-fibromatosisPlantar Fibromatosis | Treatment Options<h2>An orthotic for plantar fibromatosis?<a href="https://www.myfootshop.com/article/plantar-fibromatosis"><img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/plantar_fibromatosis_mod.jpg" alt="Plantar fibromatosis" width="150" /></a></h2> <h3>Is there a brace or insert that can be used for painful plantar fibromatosis nodules?</h3> <p>I had an interesting question from a customer regarding the treatment of plantar fibromatosis.  <a href="https://www.myfootshop.com/article/plantar-fibromatosis">Plantar fibromatosis</a> is a condition in which benign nodules form in the plantar fascia.  Plantar fibromatosis has no predictable course.  Some cases result in small, asymptomatic nodules while others proliferate rapidly, resulting in large nodules on the bottom of the foot that are painful to walk on.</p> <p>There is no definitive conclusion in the literature regarding the reason why people develop plantar fibromatosis.  Most authors in the literature feel that the origin is a small micro tear in the fascia that over proliferates into a fibrous nodule within the plantar fascia.  The origin of these tears in the plantar fascia seem to be the result of tension on the fascia.  Each time you apply body weight to the foot, the arch decreases in height placing tension on the fascia.  Be sure to read our knowledge base article on <a href="https://www.myfootshop.com/article/plantar-fibromatosis">plantar fibromatosis</a> and treatment options.  </p> <p>So, if the origin of plantar fibromatosis is tension on the fascia, can an orthotic, shoe or brace help to decrease the pain?  In most cases, the pain associated with plantar fibromatosis is due to the size of the nodule and how it is compressed by the floor with each step. </p> <p>The conservative options for treating plantar fibromatosis are fairly limited.  Treatment options include:</p> <ul> <li><span style="color: #008080;">Taping the foot to inhibit depression of the arch and tension on the plantar fascia.</span></li> <li><span style="color: #008080;">Soft orthotics with cut-outs specific to the plantar fibromatosis nodules.</span></li> <li><span style="color: #008080;">Shoe brace options that decrease load to the plantar surface of the foot (patellar tendon off-loading brace).</span></li> </ul> <p>My reply to our customer was that most of the conservative methods of care for plantar fibromatosis are limited in their success.  In cases of plantar fibromatosis where pain limits activities, the only long term solution is surgical excision of the nodules.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:216https://www.myfootshop.com/thickness-of-gel-foot-padsWhich Thickness of Reusable Gel Foot Pad is Right For Me?<h2>Reusable Gel Dancer's Pads come in two thicknesses - 1/4" and 1/8".<a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: right;" src="/Content/Images/uploaded/Products/reusable-gel-dancers-pads_70.jpeg.jpg" alt="Reusable Gel Dancer's Pad" width="150" /></a></h2> <p> </p> <h3>Which thickness of dancer's pad is right for me?</h3> <p>We carry a number of different reusable gel products.  <a href="https://www.myfootshop.com/reusable-gel-dancers-pads">Reusable Gel Dancer's Pads</a> and <a href="https://www.myfootshop.com/reusable-metatarsal-pad">Reusable Gel Metatarsal Pads</a> are by far our two best sellers.  I took a couple of minutes to look at our sales data to see if I could determine which of the thicknesses were most popular.  Here's what I found:</p> <p>I was surprised to see that with each of the thicknesses, 1/4" and 1/8", our sales data showed that total sales for each product were almost equal. </p> <p>So how do you decide which thickness of Reusable Gel Metatarsal Pad or Reusable Gel Dancer's Pad is right for you? When I work with customers, I'll recommend that the thinner 1/8" pad is going to be most appropriate for thinner dress shoes while the thicker pad I'll recommend for hiking shoes, boots, and tennis shoes. </p> <p>Fortunately, the cost of these pads is so affordable that you can try both!  As always, if you have questions about these or any other products, just jump onto our chat line to speak with one of our customer service representatives.</p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:215https://www.myfootshop.com/five-ways-to-treat-sesamoiditisThe Five Ways To Treat Sesamoiditis<h2>The five ways to treat sesamoiditis.<a href="https://www.myfootshop.com/article/x-ray-of-the-foot-anterior-posterior-view"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/xray_foot_Sesamoid_bones.jpg" alt="sesamoid bones of the foot" width="150" /></a></h2> <p> </p> <h3>What is sesamoiditis and how is it treated?</h3> <p><a href="https://www.myfootshop.com/article/sesamoiditis#Tab3">Sesamoditis</a> is the term used to describe inflammation of a small bone in the foot known as the sesamoid bone.  Each foot has a pair of sesamoid bones called the tibial (medial) or fibular sesamoid (lateral).  The sesamoid bones act to facilitate the transfer of force around the bottom or plantar surface of the great toe joint.  The sesamoid bones are incorporated within the tendon of the flexor hallucis brevis muscle.  Sesamoid bones function much like the knee cap (patella), gliding over the surface of the joint, transferring mechanical load generated by a muscle. </p> <p>Sesamoiditis is an inflammatory condition of the sesamoid bone.  The inflammation of the sesamoid can be between the articulation of the sesamoid and the first metatarsal.  Sesamoiditis can also be caused by thinning (atrophy) of the fat pad beneath the sesamoid bone.</p> <p>Treatment of sesamoiditis consists of the following 5 basic categories of care:</p> <ol> <li><span style="color: #008080;">Padding or off-loading with temporary pads such as <a href="https://www.myfootshop.com/dancers-pads">dancer's pads</a>.</span></li> <li><span style="color: #008080;">Prescription orthotics used to off-load the sesamoids.</span></li> <li><span style="color: #008080;">Anti-inflammatory medication including cortisone.</span></li> <li><span style="color: #008080;">Partial resection of the sesamoid.</span></li> <li><span style="color: #008080;">Complete excision of the sesamoid.</span></li> </ol> <p><a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/reusable-gel-dancers-pads_70.jpeg.jpg" alt="Reusable gel dancer's pad" width="100" /></a>Be sure to check our <a href="https://www.myfootshop.com/article/sesamoiditis#Tab3">foot and ankle knowledge base article on sesamoiditis</a> for more information on the pros and cons of each of these methods of treatment.</p> <p>Our most popular product used to treat sesamoiditis is our <a href="https://www.myfootshop.com/reusable-gel-dancers-pads">Reusable Dancer's Pad.</a>  The Reusable Dancer's Pad is used to off-load weight bearing on the sesamoid bone.  As the name describes, the pad is reusable, refreshed simply by washing in soap and water.</p> <p> </p> <p> </p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:214https://www.myfootshop.com/toe-nail-fungus-causes-and-contributing-factorsToe Nail Fungus | Causes and contributing factors<h2>What causes toe nail fungus?<a href="https://www.myfootshop.com/article/onychomycosis#Tab1"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_toe_3.jpg" alt="toe nail fungus" width="150" /></a></h2> <p> </p> <h3>Contributing factors to onychomycosis</h3> <p><a href="https://www.myfootshop.com/article/onychomycosis#Tab1">Toe nail fungus</a>, also called tinea unguim or onychomycosis, is a common problem found in adults throughout the world.  The prevalence of toe nail fungus increases with age.  Toe nail fungus is estimated to affect over 50% of people over the age of 50 years, including over 50 million Americans.  What is toe nail fungus?  Why is it more common in the toes and not the fingers?  And what are the contributing factors to toe nail fungus?  Let's answer each of these questions.</p> <p>Fungus is a saprophyte or saprobe.  Saprobes are plants that have no chlorophyll and subsequently make their living by using the cells to which they attach.  In the case of toe nail fungus, the fungus is actually using the nail cell for nutrition.</p> <h3>Toe nail fungus is much more common than finger nail fungus for the following reasons:</h3> <ul> <li><span style="color: #000000;">Toes reside in a shoe and are not open to the air and UV light.</span></li> <li><span style="color: #000000;">Moisture inside the shoe is required for growth of the fungus.</span></li> <li><span style="color: #000000;">Toe nails sustain repetitive damage from the shoe or bumping into the leg of the couch.</span></li> <li><span style="color: #000000;">We wash our hands often and not our feet.</span></li> </ul> <h3>There are a number of contributing factors to toe nail fungus.  Many of the contributing factors have to do with our lifestyle and habits imposed by society.</h3> <ul> <li><span style="color: #000000;">No shirt, no shoes, no service.  We've all seen the signs.  But by wearing shoes we create a unique and somewhat hostile environment.  The environment inside the shoe is dark, warm, and damp.  This is a perfect environment for the growth of fungus.</span></li> </ul> <h3>What changes can you make to prevent toe nail fungus infections?  Follow these simple tips:</h3> <ol> <li><span style="color: #000000;">Wear the right shoes for the activity.  Splitting firewood in a pair of tennis shoes isn't smart.  Nail injuries always precede fungal toe nail infections.</span></li> <li><span style="color: #000000;">Rotate your shoes - if you wear a pair of shoes on Monday, let them dry on Tuesday.  Damp shoes are a significant contributing factor to onychomycosis.</span></li> <li><span style="color: #000000;">Know the signs of toe nail fungus.  When you see discoloration or thickening of the nail, get started on a <a href="https://www.myfootshop.com/antifungal-nail-products"><span style="color: #000000;">topical antifungal</span></a>.</span></li> <li><span style="color: #000000;">Wash your feet regularly and be sure to dry between the toes.</span></li> <li><span style="color: #000000;">Socks help to wick moisture away from the skin and nail of the foot.  Be sure to change socks at least once a day if not more.</span></li> <li><span style="color: #000000;">Wear open shoes that allow UV light and open air.</span></li> </ol> <p><span style="color: #000000;">Jeff  </span></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 3/23/2021</p>urn:store:1:blog:post:213https://www.myfootshop.com/runners-nail-treatmentRunner's Nail | How do I treat it?<h2>I bruised my toe nail - how do I treat it?<img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/runners_nail_labeled.jpg" alt="Runner's nail" width="200" /></h2> <p> </p> <h3>How to treat runner's nail.</h3> <p><a href="https://www.myfootshop.com/article/runners-nail">Runner's nail</a> is a common diagnosis that occurs following an injury to the toe nail.  Runner's nail is often the result of running downhill in a loose shoe.  I also see runner's nail occur when a runner is focused on completing an activity, such as the end of a race.  As the foot pistons forward in a loose shoe, the nail repetitively hits against the toe box causing a bruise beneath the nail.  This bruise is called a subungual hematoma, or what we commonly call runner's nail. </p> <p>Do you need to be a runner to have runner's nail?  Absolutely not.  I see runner's nail in walkers and hikers, and in active sports like soccer and football.</p> <p><a href="https://www.myfootshop.com/naileezer-nail-drill"><img style="float: left;" src="/Content/Images/uploaded/Products/848_NAILeezer_Nail_Drill_ALT.jpg" alt="Naileezer Nail Drill" width="150" /></a>The black discoloration of runner's nail is no more than a localized bruise.  But that bruise can do some serious damage to the nail.  The bruise tends to float the nail off of the underlying nail bed.  This separation of the nail leads to eventual loss of the nail.</p> <p>Draining the bruise under the nail is really quite easy with the Naileezer Nail Drill.  The Naileezer drill is a very sharp tool that easily cuts a small hole in the nail, allowing for drainage of the bruise.  But what's so special about the Naileezer Drill is the adjustable stop that is on the drill.  With the adjustable stop, you have complete control over the depth of the drill (and that's important).</p> <p>To use the Naileezer Nail Drill simply set the adjustable depth guide and slowly drill in a clockwise direction. </p> <p>Once the bruise has been drained, try to keep the nail in place as long as possible.  The potential loss of the nail is dependent upon the size of the bruise beneath the nail and the duration of the bruise.  The earlier you drain the bruise, the better your chances of keeping the nail.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:212https://www.myfootshop.com/hallux-trainer-insoles-3Hallux Trainer Insoles<h2>Hallux Trainer Insoles<a href="https://www.myfootshop.com/hallux-trainer-insoles"><img style="float: right;" src="/Content/Images/uploaded/Blog images/962_Hallux_Trainer.jpg" alt="Hallux Trainer Insoles" width="150" /></a></h2> <p> </p> <h3>Treating hallux limitus with Hallux Trainer Insoles</h3> <p><a href="https://www.myfootshop.com/hallux-trainer-insoles">Hallux Trainer Insoles</a> are used to treat hallux limitus (also often called turf toe).  Hallux Trainer Insoles are a finished product with a Vitatex antifungal top cover, Memopur soft foam insert and metatarsal pad.  Hallux Trainer Insoles are soft and comfortable, but offer the rigidity of a Morton's extension to treat hallux limitus.</p> <p><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux limitus</a> is a progressive form of localized arthritis specific to the great toe joint.  <a href="https://www.myfootshop.com/article/turf-toe">Turf toe</a> is an acute injury of the great toe joint.  Both conditions cause great toe joint pain and can be treated by splinting, or limiting the range of motion of the great toe joint.</p> <p><a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="Turf Toe Plates" width="150" /></a>A Morton's extension, sometimes also referred to as a turf toe plate or turf toe insert, is an extension of the shell of the insert that is intended to limit the range of motion of the great toe joint.  Limiting the motion of the great toe joint is very helpful when hallux limitus has created bone spurs on the top of the great toe joint.  These bone spurs, called an exostosis or dorsal bump, painfully limit the normal range of motion of the joint.  Use of Hallux Trainer Insoles will limit that bone on bone contact, decreasing the pain associated<a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat"><img style="float: right;" src="/Content/Images/uploaded/Products/972_Turf_Toe_Plate_Carbon_Graphite_Flat.jpg" alt="Turf Toe Plate - Flat" width="150" /></a> with hallux limitus.</p> <p>Earlier I called the Hallux Trainer Insoles a finished product.  We also offer an unfinished version of the <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">Turf Toe Plate- Molded</a> and the <a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat">Turf Toe Plate - Flat</a>.  Both of these products offer the same limitation of range of motion at the great toe joint, but do not have a finished top cover or metatarsal pad.</p> <p>Which is a better product for your needs?  Personal selection depends upon your intended use and type of shoes that you may be wearing.  Be sure to contact us if you need more help selecting the right product for your needs.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/19</p>urn:store:1:blog:post:207https://www.myfootshop.com/mallet-toe-padsMallet Toe Pads<h2>What foot pad is best to treat mallet toes?</h2> <p> </p> <h3>Mallet toe pads - which one is best for my needs?</h3> <p>This is the last post in a series of three blog posts that I've written to discuss hammer toe pads and which pads are best suited to treat hammer toes, claw toes and mallet toes.  Let's talk a little bit about mallet toes.</p> <p>A mallet toe is a flexion deformity of the distal joint in the toe.  The proximal two joints of the toe remain straight while the distal joint<a href="https://www.myfootshop.com/gel-toe-protector-1"><img style="float: right;" src="/Content/Images/uploaded/Blog images/697_Gel_Toe_Protector_ALT.jpg" alt="Gel toe protector" width="100" /></a> contracts.  The result is usually a sore spot on the top of the distal toe knuckle or a build-up of callus on the tip of the toe.  For a visual <a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1"><img style="float: left;" src="/Content/Images/uploaded/Blog images/701_Hammer_Toe_Crest_Pad_ALT2.jpg" alt="Hammer toe crest pad" width="100" /></a>reference of a mallet toe, be sure to check out <a href="https://www.myfootshop.com/hammer-toe-pad-choices">my previous blog post</a> on hammer toes that includes a graphic of the three types of hammer toes.</p> <p>In terms of product sales for customers who contact us regarding mallet toes,  I'd have to say that the use of a Crest Pad and use of Gel Toe Protector are about neck and neck.  Both the <a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1">Crest Pad</a> and the <a href="https://www.myfootshop.com/gel-toe-protector-1">Gel Toe Protector</a> are going to pad the tip of the toe.  When I spoke to our medical director about these two padding choices, he seemed to lean to the Crest Pad for flexible mallet toes and the Gel Toe Protector for more rigid mallet toes.</p> <p>Questions about hammer toe pads?  Be sure to contact us by chat, email or phone.  We're happy to help you make the right choice for your needs. </p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:211https://www.myfootshop.com/reusable-foot-padsReusable Foot Pads<h2>Reusable foot pads - how do they work?<a href="https://www.myfootshop.com/reusable-gel-callus-cushions"><img style="float: right;" src="/Content/Images/uploaded/Blog images/931_Gel_Callus_Cushions.jpg" alt="Gel Callus Cushion" width="150" /></a></h2> <p> </p> <h3>Long-lasting and effective - reusable metatarsal pads and reusable dancer's pads.</h3> <p>Reusable foot pads fill a niche that is important to a lot of our customers.  The indications for reusable foot pads include:</p> <ul> <li><span style="color: #008080;">Quick on-off application.</span></li> <li><span style="color: #008080;">Easy to use around the house, under a pair of socks or without shoes</span></li> <li><span style="color: #008080;">Use in dress shoes where a traditional shoe pad cannot fit.</span></li> <li><span style="color: #008080;">Use in wet environments such as water aerobics in water shoes.</span></li> </ul> <p>When possible, I'll always recommend that you try to place a metatarsal pad or dancer's pad in the shoe on the bottom of the<a href="https://www.myfootshop.com/reusable-gel-u-shaped-pads"><img style="float: right;" src="/Content/Images/uploaded/Products/970_Reusable_Gel_U-shaped_Callus_Pads.jpg" alt="Reusable Gel Callus Cushion" width="150" /></a> insole.  In this way, the pad is in-place whenever you're ready to go.  And when placed on the bottom of the insole, the pad is less likely to move as you put your foot in and out of the shoe.  But not all shoes have a removable insole.  That's where the reusable pads have a place.</p> <p><a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: left;" src="/Content/Images/uploaded/Products/680_reusable_dancers_pad.jpg" alt="Reusable Gel Dancer's Pads" width="150" /></a>The remarkable thing about the reusable line of pads is that when the sticky side of the pad starts to fail, wash it with a little soap and water.  Soap and water will revive the sticky side so that it's ready to use again.</p> <p>The indications for each of the reusable pads depends upon the location of the problem.  The most common use of reusable pads is for <a href="https://www.myfootshop.com/article/forefoot-pain">forefoot conditions</a> including <a href="https://www.myfootshop.com/article/capsulitis">capsulitis</a>, <a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a> and <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>.  The indications for reusable gel foot pads are only limited by your imagination.  They can be used for <a href="https://www.myfootshop.com/article/saddle-bone-deformity">saddle bone deformities</a>, <a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's Deformity</a> or other lumps, bumps or areas of callus.</p> <p>We carry a number of different sizes and shapes of reusable pads.  The thickness and shape vary due to your need.  Easy to use, long-lasting and comfortable - that's the line of reusable foot pads from Myfootshop.com.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:210https://www.myfootshop.com/bunion-pads-which-one-is-right-for-meBunion Pads - Which one is right for me?<h2>Which bunion pad is best for me?<img style="float: right;" src="/Content/Images/uploaded/Blog images/bunion.jpg" alt="Bunion" width="175" /></h2> <p> </p> <h3>Do I need a toe spacer or bunion pad to treat my bunion?</h3> <p>Bunion pain is caused by two problems.  The two types of bunion pain include:</p> <ul> <li><span style="color: #008080;">Medial bump pain</span> – the bump (bunion) is difficult to fit into a shoe and creates pressure and soreness at the great toe joint.</li> <li>J<span style="color: #008080;">oint pain</span> – joint pain associated with a bunion is actually a form of arthritis caused by misalignment of the great toe.  As the joint moves, it moves outside of its normal range of motion, resulting in pain.</li> </ul> <p>There are a number of different pads used to treat bunion pain.  Some pads are specific to medial bump pain while others are intended to be used to treat the misalignment of the great toe.  And there’s one pad used to treat both bump pain and joint pain.</p> <p>Pads used to treat medial bump pain include <a href="https://www.myfootshop.com/bunion-shield-gel">Gel Bunion Shield</a>, <a href="https://www.myfootshop.com/toe-spacer-bunion-guard-combo">Toe Spacer-Bunion Guard Combo</a>, <a href="https://www.myfootshop.com/foam-bunion-cushion">Foam Bunion Cushion</a> and <a href="https://www.myfootshop.com/bunion-shield-felt">The Felt Bunion Shield</a>.</p> <p><a href="https://www.myfootshop.com/bunion-shield-gel"><img src="/Content/Images/uploaded/Blog images/851_gel_bunion_shield.jpg" alt="Gel bunion shield" width="100" /></a>    <a href="https://www.myfootshop.com/toe-spacer-bunion-guard-combo"><img src="/Content/Images/uploaded/Blog images/846_Toe_Spacer_Bunion_Guard_Combo_ALT.jpg" alt="Toe Spacer Bunion Guard Combo" width="100" /></a>    <a href="https://www.myfootshop.com/foam-bunion-cushion"><img src="/Content/Images/uploaded/Blog images/828_Bunion_Cushion_Foam.jpg" alt="Foam Bunion Cushion" width="100" /></a>    <a href="https://www.myfootshop.com/bunion-shield-felt"><img src="/Content/Images/uploaded/Blog images/823_Bunion_Shield_Felt.jpg" alt="Felt Bunion Shield" width="100" /></a></p> <p>Pads used to treat joint pain due to bunions include the <a href="https://www.myfootshop.com/gel-bunion-spacer-1-1">Gel Bunion Spacer</a>, <a href="https://www.myfootshop.com/gel-bunion-spacer-1-1">Toe Separator Large/Firm</a>, <a href="https://www.myfootshop.com/toe-spacer-bunion-guard-combo">Toe Spacer-Bunion Guard Combo</a> and the <a href="https://www.myfootshop.com/gel-bunion-spacer-with-stay-put-loop">Gel Bunion Spacer with Stay-Put Loop</a>.</p> <p><a href="https://www.myfootshop.com/gel-bunion-spacer-1-1"><img src="/Content/Images/uploaded/Blog images/710_Gel_Bunion_Spacer_ALT.jpg" alt="Gel Bunion Spacer" width="100" /></a>    <a href="https://www.myfootshop.com/gel-bunion-spacer-1-1"><img src="/Content/Images/uploaded/Blog images/693_Toe_Separator_LargeFirm.jpg" alt="Toe Spacer - Large/Firm" width="100" /></a>    <a href="https://www.myfootshop.com/toe-spacer-bunion-guard-combo"><img src="/Content/Images/uploaded/Blog images/846_Toe_Spacer_Bunion_Guard_Combo_ALT.jpg" alt="Toe Spacer Bunion Guard Combo" width="100" /></a>    <a href="https://www.myfootshop.com/gel-bunion-spacer-with-stay-put-loop"><img src="/Content/Images/uploaded/Blog images/959_Gel_Bunion_Spacer_w_StayPutLoop_Front.jpg" alt="Gel Bunion Spacer with Stay-Put Loop" width="100" /></a></p> <p>The one pad that treats both?  <a href="https://www.myfootshop.com/toe-spacer-bunion-guard-combo">The Toe Spacer-Bunion Guard Combo</a>.</p> <p>What’s the best pad for you?  That depends on a number of variables.  Are you having bump or joint pain?  What kind of shoes are you planning on wearing?  How active are you going to be?  The easy solution?   The Toe Spacer – Bunion Guard Combo.  It’s like hitting two bunions with one pad.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:209https://www.myfootshop.com/bunion-regulator-indications-and-usesBunion Regulators - What are they and how do they work?<h2><a href="https://www.myfootshop.com/bunion-regulator-night-splint"><img style="float: right;" src="/Content/Images/uploaded/Blog images/719_Bunion_Regulator_ALT3.jpg" alt="Bunion Regulator" width="200" /></a></h2> <h2>What’s a Bunion Regulator and how does it work?</h2> <h3> </h3> <h3>Will a Bunion Regulator correct my bunion?</h3> <p>Our staff is often asked by customers whether a <a href="https://www.myfootshop.com/bunion-regulator-night-splint">Bunion Regulator</a> can actually correct a bunion.  Unfortunately, no, a Bunion Regulator cannot correct a bunion.  And if it can’t correct a bunion, then what is it used for? </p> <p>Bunion regulators have two primary purposes:</p> <ul> <li><span style="color: #008080;">Use as a splint to maintain the position of the great toe following bunion surgery.</span></li> <li><span style="color: #008080;">Helps to decrease pain in non-surgical candidates who have painful bunions.</span></li> </ul> <p>Bunion Regulators are non-ambulatory splints, meaning that while you are wearing a Bunion Regulator, you cannot walk on the foot.  As such, many customers will refer to a Bunion Regulator as a bunion night splint.  A Bunion Regulator is adjustable so that varying degrees of tightness will result in more alignment of the great toe.</p> <p>There are a number of padding and splint options that can be used on an ambulatory basis.  I’ll address the different types of bunion pads in my next post.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:206https://www.myfootshop.com/claw-toe-padsClaw Toe Pads - Which one is best for my needs?<h2><a href="https://www.myfootshop.com/article/hammer-toes#Tab3"><img style="float: right;" src="/Content/Images/uploaded/Blog images/hammer_toes_mod.jpg" alt="Claw toes" width="250" /></a></h2> <h2>Which hammer toe pad is best for claw toes?</h2> <p> </p> <h3>Crest pads, Budin splint or toe straighteners – which one is best for my needs?</h3> <p>Last week I discussed my go-to pads for <a href="https://www.myfootshop.com/article/hammer-toes#Tab3">hammer toes</a>.  This week, let’s talk a bit about claw toes and the pads that are used to treat claw toes.  Claw toes are usually a flexible deformity that affects all three joints of the toe.  This means that potentially you may have a problem on the top of the toe or on the tips of the toes. </p> <p><a href="https://www.myfootshop.com/toe-straightener-single-toe"><img style="float: left;" src="/Content/Images/uploaded/Blog images/706_Toe_Straightener_Single_Toe.jpg" alt="Toe Straightener" width="100" /></a>My first choice for claw toes is to use a <a href="https://www.myfootshop.com/toe-straightener-single-toe">Single</a> or <a href="https://www.myfootshop.com/toe-straightener-double-toe-2">Double Toe Straightener</a> to help pull the toes down away from the shoe and to get the toes to lay flat.  Toe Straighteners are also called Budin splints.  There's plenty of padding in the pad of the toe (opposite side from the nails) but there's hardly any padding in the tip of the toe.  So using the Toe Straightener actually accomplishes two things; straightens the toes and gets pressure off of the tips of the toes.</p> <p>The other way to approach the treatment of claw toes is to use a <a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1">crest pad</a>.  A crest pad helps to lift the toes a bit,<a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1"><img style="float: right;" src="/Content/Images/uploaded/Blog images/701_Hammer_Toe_Crest_Pad_ALT2.jpg" alt="Hammer toe crest pad" width="100" /></a> relieving pressure on the tips of the toes.  If you're having problems on the tops of the toes, a crest pad really isn't the right choice for you.  But if the claw toes are having problems on the tips of the toes, a crest pad is the tool to use.  We offer a <a href="https://www.myfootshop.com/hammer-toe-crest-pad-foam-1">foam</a>, <a href="https://www.myfootshop.com/hammer-toe-crest-pad-gel">gel</a> or adjustable <a href="https://www.myfootshop.com/hammer-toe-crest-pad-gel-adjustable">red rubber crest pad</a>.  I prefer the foam due to the leather cover and comfort.</p> <p>Next week we'll talk a bit about the correct pads to choose for mallet toes.</p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.naturalfootcareproducts.com/about-us">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:208https://www.myfootshop.com/how-do-i-treat-a-metatarsal-stress-fractureHow do I treat a metatarsal stress fracture?<h2>What's the best way to treat metatarsal<img style="float: right;" src="/Content/Images/uploaded/Blog images/xray_foot_metatarsal_fracture_with_bone_callus_mod.jpg" alt="mt\etatarsal stress fracture" width="167" height="176" /></h2> <h2>stress fractures?</h2> <p> </p> <h3>What product do I need to treat my metatarsal stress fracture?</h3> <p>Years ago I saw a Columbus, Ohio police officer as a patient in early July.  Although his x-rays were inconclusive, he had classic symptoms of a <a href="https://www.myfootshop.com/article/metatarsal-fracture#Tab3">metatarsal stress fracture</a>.  Symptoms included point specific pain over one metatarsal, no bruising, pain with range of motion of the metatarsal and pain when first standing.</p> <p><a href="https://www.myfootshop.com/forefoot-compression-sleeve"><img style="float: left;" src="/Content/Images/uploaded/Blog images/862_Forefoot_Compression_Sleeve.jpg" alt="Forefoot compression sleeve" width="100" /></a>The officer was a great patient but had an issue.  He was days away from the big fourth of July celebration in Columbus called Red, White, and Boom.  He said, "Doc, I hear everything that you're saying, but I get triple time for Red, White, and Boom.  I've got to work."</p> <p>So we came up with a compromise.  He agreed to rest whenever possible and to wear his policeman's service shoes.  The service shoe really proved to be a great part of his treatment.  When laced, they compressed any swelling.  They also have toe spring, or a rocker sole that will decrease load to the metatarsals.</p> <p>We're not all policemen, so what's the best way to treat a metatarsal stress fracture?  Simply put, the answer is rest.  My go-to is a <a href="https://www.myfootshop.com/forefoot-compression-sleeve">forefoot compression sleeve </a>and a <a href="https://www.myfootshop.com/walking-cast-low-top-pneumatic">walking cast.</a></p> <p>Interested in learning more about metatarsal stress fractures?  Be sure to read our knowledge base article on stress fractures.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:205https://www.myfootshop.com/hammer-toe-pad-choicesHammer Toe Pads - Which hammer toe pad is right for me?<h2>Which hammer toe pad is right for me?<img style="float: right;" src="/Content/Images/uploaded/Blog images/hammer_toe_differences_mod.jpg" alt="Three types of hammer toes" width="168" height="259" /></h2> <h2> </h2> <h3>Crest pads, budin splints, gel pads – what’s the best way to treat my hammer toe?</h3> <p>Our sales team gets a lot of questions about <a href="https://www.myfootshop.com/article/hammer-toes">hammer toes</a> and which pad is best for this or that toe problem.  The answer is – well, <br />that depends.  Let’s use <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a> to learn how to go about making the right choices for your needs.  Using Medically Guided Shopping, we need to find the right diagnosis and then the right product.  So first, let’s talk a little bit about hammer toes.</p> <p>The term hammer toe is the generic term for three types of toe deformities.  The type of hammer toe is defined by the location of the deformity or bend in the toe.  The three types of hammer toes include:</p> <ul> <li><span style="color: #008080;">Hammer toe – bend at the proximal interphalangeal joint.  May be flexible or rigid.<br /></span></li> <li><span style="color: #008080;">Claw toe – bend at all three joints of the toe.  Usually flexible.</span></li> <li><span style="color: #008080;">Mallet toes -  the result of a deformity of the distal interphalangeal joint.  Mallet toes are typically a rigid deformity.</span></li> </ul> <p>Let’s talk about hammer toes today and in two upcoming blog posts, we’ll talk about which products are best for treating claw toes and mallet toes.</p> <p>Flexible hammer toes are easy to treat because they always respond to care.  Flexible hammer toes can be treated with Toe Straighteners.  <a href="https://www.myfootshop.com/toe-straightener-single-toe">Single</a> or <a href="https://www.myfootshop.com/toe-straightener-double-toe-2">Double Toe Straighteners</a> are a great tool to pull flexible hammer toes down away from the toe box of the shoe.</p> <p>Rigid hammer toes are a different problem and not always so easy to treat.   The primary problem we’re treating in a rigid hammer toe is the shoe irritation found on the top of the toe.  Personal preference varies with these pads, but my go to pads for rigid hammer toes include:</p> <p><a href="https://www.myfootshop.com/tubular-foam-toe-bandages">Tube Foam</a></p> <p><a href="https://www.myfootshop.com/gel-corn-protectors-1">Gel Corn Protectors</a></p> <p><a href="https://www.myfootshop.com/toe-sleeves-gel">Gel Toe Sleeves</a></p> <p><a href="https://www.myfootshop.com/lambs-wool-padding">Lambs Wool</a></p> <p>Lambs Wool, you say?  Although Lambs Wool is kind of an ‘old school’ approach to foot care, we still find a lot of our customers use Lambs Wool.  It’s easy to use, absorbent and inexpensive.</p> <p>In my next post, we’ll talk about hammer toe products for claw toes.</p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:204https://www.myfootshop.com/beta-blockers-and-raynauds-diseaseRaynaud's Disease and beta blockers - How beta blockers contribute to Raynaud's Disease<h2 style="text-align: left;"><img style="float: right;" src="/Content/Images/uploaded/Blog images/gloves-1156291_1280.jpg" alt="Should Raynaud's patients use beta blockers?" width="346" height="264" /></h2> <h1 style="text-align: left;">Raynaud's Disease and beta blockers - perhaps a bad combination?</h1> <h2> </h2> <h3>Does taking a beta blocker affect my Raynaud's Disease?</h3> <p>In a <a href="https://www.myfootshop.com/raynauds-disease-l-symptoms-and-treatment-options">previous post</a>, I discussed how some medications typically used to treat high blood pressure are also used to treat Raynaud's Disease.  I'd be remiss if I didn't address one class of medications that are used to treat heart disease that can actually contribute to Raynaud's Disease.  That class of medication is called beta blockers.</p> <p>Beta blockers are a class of medications that are used to regulate the rhythm of the heart (cardiac arrhythmias).  First discovered in 1964, beta blockers were initially used to treat hypertension.  The primary use of beta blockers has shifted away from hypertension and is now primarily focused in the treatment of arrhythmias.  Beta blockers work to block the effect of endogenous catecholamines, also known as epinephrine (adrenaline) and norepinephrine (noradreanaline).   Catecholamines are the chemicals that increase tension in the flight or fight response we have to stress.  Beta blockers block this response by decreasing the rate and stroke volume of the heart. </p> <p>The mechanism of action of beta blockers significantly affects patients with Raynaud's Disease.  Beta blockers decrease the rate at which blood is delivered to the fingers and toes, but more importantly, a decrease in the volume of blood results in cold hands.  Cold hands are a common complaint of patients on beta blockers.  Remember, beta blockers are doing nothing to change the diameter or normal pressure of the small blood vessels of the fingers and toes.  So as stroke volume of the heart and heart rate decrease, so does volume of blood to the fingers and toes.</p> <p>For patients with Raynaud's Disease who are on beta blockers, here are a few recommendations that should be discussed with your doctor:</p> <ul> <li><span style="color: #008080;">Discontinuation or decrease dosage of beta blocker</span></li> <li><span style="color: #008080;">Change medication to a calcium channel blocker</span></li> <li><span style="color: #008080;">Change medication to an alph1 blocker</span></li> </ul> <p>Calcium channel blockers and alpha adrenergic blockers tend to decrease peripheral vascular tone and increase blood flow to digits and toes.  Be sure to consult your doctor before making medication changes.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:203https://www.myfootshop.com/raynauds-disease-symptoms-and-treatment-optionsRaynaud's Disease - Symptoms and treatment options<h2>Do I have Raynaud's Syndrome?<a href="https://www.myfootshop.com/article/raynauds-disease"><img style="float: right;" src="/Content/Images/uploaded/Blog images/Raynaud's_disease_mod3.jpg" alt="Raynaud's disease" width="300" /></a></h2> <h2> </h2> <h3>What is Raynaud's Syndrome and how is it treated?</h3> <p>There's an old saying in the backpacking world, 'ultra-light means cold at night'.  My hiking buddy and I are pretty serious about what we'll carry because every pound of weight in your pack means a tougher day on the trail.  My hiking buddy has had Raynaud's Syndrome for years.   It's amazing to watch his hands blanch white upon cold exposure.  Last May on the Appalachian Trail, my buddy even brought a pair of foam ice fishing gloves in an attempt to battle his Raynaud's.  The gloves didn't prove to be much of a success in the wet and cold conditions of the trail.</p> <p><a href="https://www.myfootshop.com/article/raynauds-disease#Tab3">Raynaud's</a> is known as phenomenon, a syndrome, and a disease.  The syndrome is often described as the symptoms of Raynaud's while referring to the disease describes having the condition.  The symptoms of Raynaud's include:</p> <ul> <li><span style="color: #008080;">Acute vasoconstriction in the fingers and toes with cold exposure.</span></li> <li><span style="color: #008080;">Pain with re-warming of the extremities.</span></li> </ul> <p><span style="color: #000000;">The classic description of a Raynaud's patient is often described as:</span></p> <ul> <li><span style="color: #008080;">Menopausal or post-menopausal female.</span></li> <li><span style="color: #008080;">History of anxiety or depression.</span></li> <li><span style="color: #008080;">Tobacco use.</span></li> </ul> <p>What can be done to prevent Raynaud's Disease?  Here's a short list of ways to help prevent Raynaud's syndrome:</p> <ul> <li><span style="color: #008080;">Avoid cold exposure.</span></li> <li><span style="color: #008080;">Keep your hands and feet dry.</span></li> <li><span style="color: #008080;">Wear adequate cold-weather clothes including a hat.</span></li> <li><span style="color: #008080;">Avoid tobacco.</span></li> <li><span style="color: #008080;">Consider use of a calcium channel blocker during cold weather.</span></li> <li><span style="color: #008080;">Use an L-arginine cream prior to cold exposure.</span></li> </ul> <p>I live and work in a very cold environment in the mountains of Colorado.  I have a number of patients who are on an extended-release calcium channel blocker called <a href="https://www.drugs.com/dosage/nifedipine.html">Nifedipine</a>.  The literature describes use of calcium channel blockers as very successful for treatment of Raynaud's. (1)  Nifedipine has been quite successful in my practice with only minimal side effects and drug complications.</p> <p>What about my hiking buddy?  He's reluctant to take medications and even more reluctant to carry that extra weight in his pack.  He's so focused on ultra-light, I think I'm going to have to wish for warm days.  </p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/3536108">Aldoori  M, Campbell WB, Dieppe PA.  Nifedipine in the treatment of Raynaud's Syndrome.  Cardiovasc Res. 1986 Jun;20(6): 466-70</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:202https://www.myfootshop.com/metatarsal-pad-placementMetatarsal Pads - Proper placement<h2>Metatarsal Pad - where do I put it in my shoe?<a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img style="float: right;" src="/Content/Images/uploaded/Blog images/729_Metatarsal_Pads_Felt.jpg" alt="felt metatarsal pad" width="185" height="185" /></a></h2> <p> </p> <h3>What's the best way to use a metatarsal pad?</h3> <p>We get a lot of questions from our customers regarding proper placement of <a href="https://www.myfootshop.com/metatarsal-pads">metatarsal pads</a>.  Regardless of the type of metatarsal pad (foam, felt, gel), the concept of placing the metatarsal pad is the same.  We prefer our customers to place the pad on the underside of the insole of the shoe.  But if you cannot take the innersole out of the shoe, placement can also be made on top of the innersole or even directly on the foot.  The main point though is the location of the placement.  The location is always just proximal to the weight-bearing surface of the ball-of-the-foot.  Be sure to watch this video for a quick lesson in proper placement of metatarsal pads.</p> <p><iframe width="560" height="315" src="https://www.youtube.com/embed/m4f7wT70K_M" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>Updated 4/15/2021</p> <p> </p>urn:store:1:blog:post:201https://www.myfootshop.com/metatarsal-transfer-lesionMetatarsal Transfer Lesions<h2>What is a metatarsal transfer lesion?<img style="float: right;" src="/Content/Images/uploaded/Blog images/xray_foot_metatarsal_parabola.jpg" alt="x-ray image of the metatarsal parabola" width="169" height="198" /></h2> <p> </p> <h3>Why are metatarsal transfer lesions common after bunion surgery?</h3> <p>There are five metatarsal bones in each foot.  The metatarsal bones descend from the midfoot to the ball-of-the-foot.  The relative length of each metatarsal is important in creating the weight-bearing surface of the ball-of-the-foot.  The image to the right shows the relative length of the metatarsals, often referred to as the metatarsal parabola.  The importance of the metatarsal parabola is that it enables the foot to work as a unit, with no one metatarsal bearing more weight than any of the other metatarsals.  When one metatarsal functions outside of the unit (outside of the function of the metatarsal parabola), that's when metatarsal transfer lesions may occur.</p> <p>Eccentric load of the metatarsal heads contributes to:</p> <ul> <li style="padding-left: 30px;"><a href="https://www.myfootshop.com/article/forefoot-pain">Forefoot pain</a></li> <li style="padding-left: 30px;"><a href="https://www.myfootshop.com/article/callus">Forefoot callus</a></li> <li style="padding-left: 30px;"><a href="https://www.myfootshop.com/article/capsulitis">Forefoot capsulitis</a></li> <li style="padding-left: 30px;"><a href="https://www.myfootshop.com/article/metatarsal-fracture">Metatarsal stress fracture</a></li> </ul> <p>When the weight-bearing pattern of the metatarsal parabola is altered by surgery or trauma, the area where load b<a href="https://www.myfootshop.com/article/capsulitis"><img style="float: right;" src="/Content/Images/uploaded/Blog images/foot_surgery_jacoby_metatarsal_osteotomy_mod5.jpg" alt="surgery image - metatarsal osteotomy" width="239" height="182" /></a>ecomes focused is called a transfer lesion.  Transfer lesions may occur following <a href="https://www.myfootshop.com/article/bunion">bunion surgery</a>.  In this case, the transfer lesion is found beneath the second metatarsal head.  The cause of the transfer lesion is due to a decrease in the load-bearing capacity of the first metatarsal.  Bunion surgery often requires a metatarsal osteotomy, or break in the metatarsal.  If the first metatarsal heals in an elevated position, that elevated position will alter the load-bearing of the metatarsal parabola and cause a transfer lesion beneath the second metatarsal head.</p> <p>Metatarsal transfer lesions may also occur beneath the lesser metatarsal heads following metatarsal surgery or fractures.  Although the correction of the metatarsal looks perfect while on the surgery table, the 6 weeks that it takes for healing may contribute to elevation of the correction.  Fixation with pins, plates, and screws is often used to try to prevent elevation of the metatarsal head. (1)</p> <p>Herzog J, Goforth WD, Stone P, Paden M. A modified fixation technique for a decompressional shortening osteotomy: a retrospective analysis.  J Foot and Ankle Surg 53:131-136, 2014.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:200https://www.myfootshop.com/sales-bias-in-medical-web-sitesSales bias in medical web sites<h2>Walking the line - How can a medical web site provide<a href="https://www.myfootshop.com/jeffrey_A_oster_dpm_cv"><img style="float: right;" src="/Content/Images/uploaded/dr_oster_sm.jpg" alt="Jeffrey A. Oster, DPM" width="227" height="240" /></a> objective medical information yet still generate income? </h2> <h3>Sales bias - advertising v.s. product sales  - which is the lesser of the two evils?</h3> <p>Myfootshop.com is an educationally-driven medical web site.  Our focus is on providing consumer-oriented health information specific to the treatment of the foot and ankle.  As medical advisor, it's my job to curate the medical information we provide and aggregate it into what we call our <a href="https://www.myfootshop.com/Articles/">foot and ankle knowledge base</a>.  It's also my job to select and pair the products we sell with each knowledge base article.  This pairing of medical information and products is a business model we call <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a>.  With Medically Guided Shopping, we help you find the right diagnosis and the right product, the right way.   We feel that Medically Guided Shopping helps users of Myfootshop.com to focus their efforts in a way that saves time and money.</p> <p>We're a health care business.  As such, we need to earn income to pay our employees, our web development staff and a host of other business expenses.  But how can a health care web site earn income without sales bias?  How do we avoid bias and present objective and reliable information that consumers can trust?  As medical advisor, this is a concept that I struggle with every day.  Here are a few of the points that I feel make Myfootshop.com a reliable medical source:</p> <ol> <li><span style="color: #999999;">We do not mention any of our products in our knowledge base articles.  All knowledge base articles are free of sales or advertising references.  Optional products that have been vetted for each condition are offered at the conclusion of each knowledge base article.<br /><br /></span></li> <li><span style="color: #999999;">We keep consumers informed of new concepts and trends in medicine.  This is simply what scientific journals do.  It's our job to report timely advances and new methods of treatment.<br /><br /></span></li> <li><span style="color: #999999;">All knowledge base articles are written by a board-certified physician.  Authorship is transparent with no use of ghostwriters or articles solicited by advertisers.<br /><br /></span></li> <li><span style="color: #999999;">We do not accept ads in any way shape or form on any page of Myfootshop.com.<br /><br /></span></li> <li><span style="color: #999999;">Our distribution is open source.  We do not target specific populations or demographics with advertising or sales pitches.</span></li> </ol> <p>Although there is no way to completely eliminate sales bias, we feel that Medically Guided Shopping is the more effective method of blunting sales bias  Take this simple test and compare Myfootshop.com to <a href="https://www.webmd.com/">WebMD</a>.  Advertising is the engine that drives sites like WebMD.  The objectivity of all of our information is always at the forefront of our minds.  Yes, we do need to make a living, and we hope that in the act of doing so, we have a positive effect on our customers.  We don't feel that advertising is in your best interest.  As a user of this site, please give us feedback.  If at any time you sense sales bias, please contact me directly at jeff@myfootshop.com.  Your feedback is not only appreciated, it's what helps us to provide you with the most meaningful way to access reliable healthcare solutions.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/15/2021</p>urn:store:1:blog:post:199https://www.myfootshop.com/how-is-40-urea-used-to-treat-fungal-infections-of-the-toe-nailHow is 40% urea used to treat fungal infections of the toe nail?<h2>What is urea and why does it help to treat fungal nail infections?</h2> <p> </p> <h3>Urea debridement of mycotic nails - safe, easy and effective.</h3> <p>Urea, also known as carbamide, is an organic chemical compound that was first synthesized in 1828.  Urea is often referred to as one of the most basic and important chemicals used in healthcare today.   In addition to medical uses, urea is used as a resin in making plywood, as an adjunct in animal feed and is actually used as the main ingredient that makes pretzels their distinctive brown color. (<a href="https://en.wikipedia.org/wiki/Urea" target="_blank">https://en.wikipedia.org/wiki/Urea</a> )</p> <p></p> <p style="text-align: center; margin-top: 30px; margin-bottom: 30px;"><a class="helpful-products" href="#helpfulproducts">Shop For Helpful Products</a></p> <p> </p> <p>Urea's primary uses though are in medicine.  Urea is used in skin preparation to soften keratin, treating psoriasis, eczema, and <a href="/corn-and-callus">corns and calluses</a>.  Urea is particularly helpful in treating thick, dystrophic fungal (<a href="/onychomycosis">onychomycosis</a>) nails.  40% urea effectively debrides the diseased nail while leaving healthy nail intact and unaffected.   </p> <p><img src="/Content/Images/uploaded/Blog images/early fungal nail infection - labeled.jpg" alt="early stage fungal infection of a toe nail" width="327" height="311" />        <img src="/Content/Images/uploaded/Blog images/late stage onychomycosis - labeled.jpg" alt="late stage fungal infection of a toe nail" width="244" height="309" /></p> <p></p> <p>In the early years of my podiatry practice, I would follow a chemical recipe from the Russian literature to make a 40% urea preparation for my patients to use to treat thick, mycotic nails.  With the help of our in-house skin care team (Myfootshop.com's <a href="https://www.myfootshop.com/all-natural">Natural's line</a> of products), we've formulated a 40% urea paste we call <a href="/natural-antifungal-nail-butter">Natural Antifungal Nail Butter</a>.  To treat the fungal infection of the nail, we've also added tea tree oil and lavender to naturally treat fungal nail infections.</p> <p></p> <p><a name="helpfulproducts"></a></p> <p>I want to stress that Natural Antifungal Nail Butter with 40% urea is intended to treat fungal nail infection, but more importantly, the 40% urea is intended to debride diseased nail.  The images below show two stages of a fungal nail infection.  On the left, the image shows an early infection.  This nail is easily treated with a topical antifungal like <a href="/terpenicol-antifungal-cream">Terpenicol</a> or <a href="/clearzal-fungal-nail-care-system">Clearzal</a>.  The nail on the right will require both mechanical and chemical debridement.  In this case, the use of a <a href="/nail-cutter-large">nail cutter</a> and Nail Butter with 40% urea is indicated. </p>urn:store:1:blog:post:197https://www.myfootshop.com/keeping-your-feet-warmHow should you keep your feet warm this winter?<h2><img style="float: right;" src="/Content/Images/uploaded/Blog images/winter scene.jpg" alt="Winter scene" width="299" height="200" />How to keep your feet warm in the winter</h2> <p> </p> <h3>Winter sports mean cold feet - how can you fight back?</h3> <p>Fortunately, I live in a place where winter is something we embrace.  Ski season is in full swing.  Snowshoeing, ice fishing, and snowmobiling are also very popular here.  After practicing in Ohio for 30 years, it's interesting to see how Coloradoans embrace and enjoy the cold.  In Ohio, I would see all kinds of cold weather injuries including Raynaud's disease, chilblains, frostnip, and frostbite.  But in Colorado, I've only seen one case of Raynaud's.  Why?  It makes me think of snow tires.  In Ohio, no one was ever prepared for winter.  Everyone was willing to take a chance with their tires and see if they could get through the winter.  This obviously wreaked havoc with the roads.  And in that same line of thinking, no one was prepared to be in the cold for any length time.</p> <p>This past weekend I drove through several mountain towns that were over 10,000 ft in elevation.  Lots of snow and cold.  You know, you just don't mess with it.  You read the weather and anticipate pass closures.  Your tires are snow tires and you carry chains, a flashlight, and blankets.</p> <p>What's this have to do with staying warm?  I think staying warm starts with a Colorado mindset.  You're prepared.  Here are some simple tricks to keep your feet warm this winter.</p> <ul> <li><span style="color: #008080;">Wet feet are cold feet.  Use a drying solution like <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a> to keep the feet dry.  Perspiration is one of the best ways to <a href="https://www.myfootshop.com/onox-foot-drying-solution-1"><img style="float: right;" src="/Content/Images/uploaded/Products/685_Onox_Foot_Drying_Solution.jpg" alt="Onox" width="100" /></a>conduct cold.  Use of Onox decreased perspiration leading to warmer feet.</span></li> <li><span style="color: #008080;">Allow your boots or shoes to dry.  Rotate shoes to allow them to dry for at least 48 hours.</span></li> <li><span style="color: #008080;">Frequent changes of socks.  Socks are a simple tool that'll wick away moisture.</span></li> <li><span style="color: #008080;">Wear shoes with ample room.  Tight shoes lead to cold feet.</span> <span style="color: #008080;">Y</span></li> <li><span style="color: #008080;">Your mom was right - wear a hat.  She knew that 50% of heat loss is from the head.</span> </li> </ul> <p>Button up, it's cold outside.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/21/2021</p>urn:store:1:blog:post:196https://www.myfootshop.com/curvecorrect-ingrown-nail-treatment-kit-2CurveCorrect Ingrown Nail Treatment Kit<h2><img style="float: right;" src="/Content/Images/uploaded/Blog images/814_NailEase_Ingrown_Nail_Treatment_ALT1.jpg" alt="NailEase Ingrown Nail Treatment" width="247" height="247" />What people are saying about CurveCorrect Ingrown Nail Treatment Kit</h2> <p> </p> <h3>CurveCorrect is a non-surgical way to treat ingrown nails without surgery</h3> <p>Product reviews are powerful.  When we watch how customers are using our pages, it's striking to see how many customers go directly to the product reviews to see whether other customers were satisfied with their purchase.  We learn a lot from those reviews - so keep 'em coming, OK? </p> <p>I wanted to share some of the reviews from the <a href="https://www.myfootshop.com/curvecorrect-ingrown-toenail-treatment-kit">CurveCorrect Ingrown Nail Treatment Kit</a>.  The CurveCorrect Ingrown Nail Treatment Kit includes multiple carbon fiber nail braces, super glue and the tools necessary to apply the brace.  What I learned from scanning the reviews was that some customers have difficulty with the kit in applying the nail brace.  The nail brace is adhered to the nail with super glue, so you have to have a degree of manual dexterity to apply the brace.  But first, let's take a look at the reviews.</p> <p>Here are some of the most recent positive reviews for CurveCorrect Ingrown Nail Treatment Kit -</p> <ul> <li><span style="color: #008080;">"Best money I've spent in a long time."</span></li> <li><span style="color: #008080;">"Love it - would absolutely order again if needed."</span></li> <li><span style="color: #008080;">"The CurveCorrect worked exactly as advertised. In a world of useless gimmicks, it is wonderful to find a product that really works!"</span></li> <li><span style="color: #008080;">"I ordered two more to have on hand for future problems. Awesome invention."</span></li> </ul> <p>But not all reviews are positive -</p> <ul> <li><span style="color: #008080;">"Despite clear instructions, I still glued my thumb and finger together on the first attempt. I then read it was super glue so was a little more careful, it was a bit messy, I have super glue all over my toes but I have not had it on long enough to see any results but you did ask for my opinion so there it is."</span></li> <li><span style="color: #008080;">"Well, I was very disappointed with the nail treatment kit. After gluing my finger and thumb together, the black strip came off in bed that night. And it wasn't easy to use. The black strip is way too narrow and hard to hold. which is how I glued my finger and thumb together! I will find another venue to deal with my ingrown toe nail!"</span></li> </ul> <p>Even though the product reviews for CurveCorrect Ingrown Nail Treatment Kit are overall very positive, the reviews do indicate that some users are finding it hard to apply the nail brace.  Here are some pointers;</p> <ol> <li>It doesn't take a lot of glue - use a minimal amount of glue.</li> <li>Hold the brace in-place while being glued for a reasonable amount of time.  I suggest 2 minutes.</li> <li>Trim the brace to fit - the width of toe nails vary, therefore, be sure to trim the brace prior to actually adhering the brace to the nail.</li> </ol> <p style="display: inline !important;">Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/21/2021</p>urn:store:1:blog:post:195https://www.myfootshop.com/forefoot-compression-sleeve-indications-for-useForefoot Compression Sleeve | Indications for use<h2>What is a Forefoot Compression Sleeve?<a href="https://www.myfootshop.com/forefoot-compression-sleeve"><img style="float: right;" src="/Content/Images/uploaded/Products/862_Forefoot_Compression_Sleeve_ALT2.jpg" alt="Forefoot compression sleeve" width="238" height="238" /></a></h2> <h3> </h3> <h3>How does a Forefoot Compression Sleeve help to treat forefoot injuries?</h3> <p>Every doctor, nurse, and medic knows the acronym used to treat acute orthopedic injuries: RICE.  RICE stands for rest, ice, compression and elevation.  Used individually, each of these methods of treatment can help, but when used together, RICE is a powerful tool.  Whether it’s a sports injury, a sprain or even care following orthopedic surgery, RICE is the go-to method of care.</p> <p>A few years back I started to see that there really wasn’t a good product available for forefoot compression.  Traditional compression hose stopped at the mid-arch.  ACE wraps were bulky and really didn’t stay in place well.  I could apply a compression wrap in the office, but with the first shower, the bandage would need to be removed.  So I decided to invent a better tool that could be used by consumers to compress the forefoot.</p> <p>I measured several hundred feet to determine sizing for the device, coming up with three sizes.  With the help of Pedifix, we now market The Forefoot Compression Sleeve world-wide.</p> <p>Indications for The Forefoot Compression sleeve include;</p> <ul> <li><a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Forefoot arthritis</a></li> <li><a href="https://www.myfootshop.com/article/freibergs-infraction">Freiberg’s Infraction</a></li> <li><a href="https://www.myfootshop.com/article/stress-fractures-of-the-foot">Metatarsal stress fractures</a></li> <li><a href="https://www.myfootshop.com/article/metatarsalgia">Metatarsalgia</a></li> <li>Peripheral edema</li> <li>Swelling following forefoot surgery</li> <li>Swelling following bunion surgery</li> </ul> <p>The Forefoot Compression Sleeve is safe and easy to use.  Extra care should be considered with patients with diabetes or peripheral vascular disease.  In these cases, compression may cause skin irritations, rashes or wounds that may not be initially felt.  Be sure to use The Forefoot Compression Sleeve with caution, checking every hour or so for sites of irritation.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/21/2021</p>urn:store:1:blog:post:194https://www.myfootshop.com/what-we-do-and-why-we-do-itWhat we do, why we do it and how you can help<h2>Why we do what we do – and how you can help.<a href="https://www.myfootshop.com/Articles/"><img style="float: right;" src="/Content/Images/uploaded/Blog images/foot_finder.jpg" alt="INGRID - Interactive Graphical Interface for Diagnoses" width="356" height="248" /></a></h2> <h3> </h3> <h3>What’s Medically Guided Shopping™ and how does it benefit you?</h3> <p>At first glance, you might think that Myfootshop.com is just another niche web site that’s here to sell things to you.  Well, in part that's true.  But I think it’s important to understand what we do, how we do it and why we do it. </p> <p>As a young doctor, I was eager to dive into treating patients with the best skill set that I could provide.  But what I started to see over time were the inefficiencies of the way medical care is delivered.  For instance, I can have a conversation with a patient regarding a common condition, say <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a>.  The vast majority of that conversation is education – helping a person understand their condition, what treatment options are available and how to proceed with a plan we design together.  Seems spot on for medical care, right?  But then you enter the next treatment room and have the same conversation.  This conversation can be repeated any number of times over the course of a day.  The inefficiency was that the treatment didn’t scale.  How could I scale medical care?</p> <ul> <li><span style="color: #008080;">Find a communication model that was ubiquitous</span></li> <li><span style="color: #008080;">Focus on consumer-oriented care</span></li> <li><span style="color: #008080;">Make learning easy</span></li> <li><span style="color: #008080;">Provide value that can enhance lives</span></li> </ul> <p>Think 1999.  That’s when Myfootshop.com first set foot on the Internet.  What an awesome opportunity.  If I could reach every person on the planet who had access to the Internet, I could change lives.  I slowly met friends who helped me refine the concept of <a href="https://www.myfootshop.com/about">Medically Guided Shopping™</a>.  In a nutshell, Medically Guided Shopping is intended to help customers find the right diagnosis and the right products, the right way.  It’s our firm belief that you can’t treat a condition until you understand it (diagnosis first, product second). </p> <p>At the heart of Medially Guided Shopping is <a href="https://www.myfootshop.com/Articles/">INGRID</a>, our <strong>In</strong>teractive <strong>Gr</strong>aphical <strong>I</strong>nterface for <strong>D</strong>iagnoses.  INGRID makes finding your diagnosis easy.  Just hover over the graphical image of the foot and click on a zone where you hurt.</p> <p>Our mission is the democratization of healthcare.  Healthcare should not be behind a wall created by health care insurance, money or privilege.  Healthcare should be available to anyone with a curiosity and access to a computer.  It’s that easy.</p> <p>If you agree that Medically Guided Shopping™ is a cost-effective way that we can change lives, please help us with our mission.  Here’s what you can do;</p> <ul> <li>Share our knowledge base articles with your friends and family.</li> <li>Share our knowledge base articles with your doctor</li> <li>Join in the conversation about Myfootshop.com by sharing our mission on <a href="https://www.facebook.com/myfootshop">Facebook</a>, Twitter</li> <li>When you buy a product, please share a product review.</li> <li>Review Myfootshop.com on <a href="https://www.yelp.com/search?find_desc=myfootshop.com&amp;find_loc=Columbus%2C+OH&amp;ns=1">Yelp</a>, <a href="https://www.bbb.org/centralohio/business-reviews/internet-shopping/my-footshop-com-llc-in-newark-oh-3005703">BBB</a> and <a href="https://www.google.com/maps/place/MyFootShop.com/@40.0533071,-82.4817957,17z/data=!4m2!3m1!1s0x883815e36a3e6095:0xa47688a22905a3c1">Google</a>. </li> </ul> <p>I know I speak for our whole team here at Myfootshop.com in saying that we delighted to help you solve problems.  We look forward to speaking with you.  And most of all, thank you for your support.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/21/2021</p>urn:store:1:blog:post:193https://www.myfootshop.com/thalia-oster-chief-of-everythingThalia Oster | Chief of everything at Myfootshop.com and more...<h2>Something you might not know about Thalia Oster<img style="float: right;" src="/Content/Images/uploaded/Blog images/Thalia Oster podiatry office manager.jpg" alt="Thalia Oster, COE of Myfootshop.com" width="250" /></h2> <h2> </h2> <h3>The title of COE (chief of everything) includes hands-on patient care.</h3> <p><a href="https://www.myfootshop.com/foundersbio">Thalia</a> acquired the title chief of everything (COE) by wearing so many different hats in the business.  In addition to being CFO, legal counsel, and operations chief at Myfootshop.com, Thalia’s often the one under the desks fixing computers or figuring out why the network is down. </p> <p>But there’s another job that makes Thalia so well suited for her role at Myfootshop.com.  Most Myfootshop.com customers don’t know that Thalia acts as office manager for my podiatry practice in Gunnison, Colorado.  By being in active practice, Thalia sees patients with problems that are often solved with Myfootshop.com solutions.  “We founded Myfootshop.com to help patients solve problems.  It’s fun to be on the front lines of practice to see how the resource we created is so helpful to patients” said Thalia.  “We use Myfootshop.com’s knowledge base articles to help patients understand their problems.  And it really helps that the knowledge base articles help fulfill requirements for <a href="https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives">Meaningful Use</a>” (the federal government's incentive program for integration of health records.)</p> <p>Sometimes you just have to tip your hat to your business partner.  For me, I’m lucky that this talented, hard-working gal is my partner, my best friend, and my wife.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/21/2021</p>urn:store:1:blog:post:192https://www.myfootshop.com/supination-and-pronation-how-are-these-terms-used-to-describe-hands-and-feetSupination and Pronation | How are these terms used to describe hands and feet?<h2>Supination and Pronation</h2> <p> </p> <h3>What’s the difference between supination and pronation?</h3> <p>Pronation and supination are the two terms used to describe the position of the hands or feet.  The terms at first can be a bit</p> <p><img style="float: right;" src="/Content/Images/uploaded/Blog images/peach-698592_1280.jpg" alt="Supinated hands" width="400" />confusing in that they can be used as a noun, a verb, and an adjective.  Let’s take a closer look at these two terms and see how they are used in the language of biomechanics.</p> <h3>Supination</h3> <p>As a young doc, I was taught to think of supination as the position of the hands as they hold ‘soup’.  The hands shown in the image are in a supinated position.  And as they come together, the hands are supinating. </p> <p>When we refer to feet, the terms supination, supinated and supinating all refer to a high arched foot. </p> <ul> <li>Supination is the act of creating a high arched foot.</li> <li>A supinated foot is a foot with a high arch.</li> <li>Supinating is the movement towards a high arched foot.</li> </ul> <h3>Pronation</h3> <p>To describe pronated hands, think of the position of the hands as you do push-ups – hands away from each other.</p> <p>Pronated feet are flat feet.  And the act of pronation occurs with each step, as our body weight is applied to the foot, the arch flattens, or shall I say, pronates.</p> <ul> <li>Pronation describes a flat foot.</li> <li>A pronated foot is a flat foot.</li> <li>Pronating is the movement towards a flat foot.</li> </ul> <p>What’s best, a supinated foot or a pronated foot?  Actually neither.  Each of us has our own ‘normal’ foot that varies with each step that we take.  Although supinated feet are usually rigid and flatfeet are more flexible, both perform comfortably. </p> <p>For more information on <a href="https://www.myfootshop.com/article/supination">supination</a> and <a href="https://www.myfootshop.com/article/pronation#Tab1">pronation</a>, be sure to follow these links to our knowledge base pages on supination and pronation.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:191https://www.myfootshop.com/how-to-avoid-treadmill-injuriesHow to avoid treadmill injuries<h2>Treadmill Injuries</h2> <p> </p> <h3>A simple 5 point guide to help you avoid treadmill injuries</h3> <p><br /><img style="float: left;" src="/Content/Images/uploaded/Blog images/treadmill - Copy 1.jpg" alt="" width="400" /></p> <p>It’s that time of year when the weather is going to force us to move indoors to exercise.  Treadmills are a great way to exercise, but unknown to most people, treadmills may actually contribute to lower extremity injuries.  To understand how a treadmill may contribute to lower extremity injuries, let’s take a look at how walking or running on a treadmill differs from walking or running on a flat, fixed surface.</p> <p>Walking on a fixed, flat surface, like a road or sidewalk, can be described as a controlled forward fall.  During walking, the calf and Achilles tendon creates resistance to forward motion and functions to decelerate the forward motion of the leg and our body mass as it moves forward over the foot.  As the forward motion becomes too great for the calf and Achilles tendon to manage, we put our opposite foot forward to begin the gait cycle again.</p> <p> </p> <p>The gait cycle in running is just a little different.  With running, the function of the calf and Achilles tendon changes to include spring motion and propulsion.  As the center of body mass leans forward in running, the calf and Achilles take on all three properties:</p> <ul> <li><span style="color: #008080;">Resisting forward motion</span></li> <li><span style="color: #008080;">Spring accommodation of weight bearing</span></li> <li><span style="color: #008080;">Forward propulsion</span></li> </ul> <p>Now let’s switch from a flat, fixed outdoor surface and jump inside onto a treadmill.  Walking and running on a treadmill changes the way in which the calf and Achilles tendon work.  The difference between a fixed surface and a moving surface is that the functions of resistance, spring and propulsion change.  On a treadmill, we tend to over stride, stretching tissue structures beyond their normal end length.  Doing so for a short period of time is fine, but when stressed by repetitive exercise, soft tissue injuries on treadmills become common.  Injuries include:</p> <ul> <li><a href="https://www.myfootshop.com/article/plantar-fasciitis">Plantar fasciitis</a></li> <li><a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendinitis</a></li> <li><a href="https://www.myfootshop.com/article/achilles-tendon-rupture">Partial Achilles tendon ruptures</a></li> <li><a href="https://www.myfootshop.com/article/shin-splints">Posterior shin splints</a></li> </ul> <p>What can you do to prevent treadmill injuries?  Here’s a simple 5 point guide to avoid treadmill injuries.</p> <ol> <li><span style="color: #008080;">       Stretch prior to using a treadmill. </span></li> <li><span style="color: #008080;">       Use moderation, especially when beginning treadmill use.</span></li> <li><span style="color: #008080;">       Wear shoes with an adequate arch support.</span></li> <li><span style="color: #008080;">       Wear a shoe with a slight heel lift or add a heel lift.</span></li> <li><span style="color: #008080;">       Add incline to the treadmill slowly.  Start flat and only add incline after at least 1 – 2 weeks of continuous treadmill use.</span></li> </ol> <p>Although the switch from outdoor exercise to indoor treadmill work seems fairly benign, there’s actually a number of lower extremity injuries we see each winter that are specific to treadmill use.  To ensure a healthy and injury-free winter, go slow, use moderation, and follow my 5 point plan. </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/24/19</p>urn:store:1:blog:post:190https://www.myfootshop.com/foot-pain-caused-by-lumbar-radiculitisChronic low back pain may cause foot pain<h2>My back pain can make my feet hurt?</h2> <p> </p> <h3>How chronic lumbar disc disease is a frequent cause of leg and foot pain</h3> <p><img style="float: left;" src="/Content/Images/uploaded/Blog images/person(2).jpg" alt="Chronic lumbar pain may cause foot pain" width="442" height="298" />In a previous post, I listed lumbar disc disease as a differential diagnosis for Morton’s neuroma.  The lumbar region of the spine is the lower back, just above the pelvis.  The nerves that supply sensation and motor function to the leg and foot exit the spin at the level of the lumbar spine.  Any injury or deformity of the lumbar spine may affect the nerves that innervate the leg and foot.  Conditions of the lumbar spine that may contribute to foot pain include:</p> <ul> <li>Lumbar disc disease</li> <li>Herniated lumbar disc</li> <li>Arthritis of the lower back</li> <li>Age-related narrowing of the spine due to disc atrophy</li> </ul> <p>In a healthy back, the nerves of the leg and foot exit the spine through a small opening called a foramen.  Any factor that contributes to narrowing of the foramen will place compression on the lumbar nerves creating pain in the leg and foot.  In advanced cases of lumbar nerve compression, patients will lose strength and motor function of the leg.</p> <p>Symptoms of leg and foot pain due to disc disease include pain on the side and front of the thigh, pain down the side of the leg and dull aching pain of the foot.  When leg and foot pain is caused by compression of the nerve roots of the lumbar spine, this condition is called lumbar radiculitis.  The distribution of the nerves of the leg and foot are seen in this image.</p> <p><a href="https://www.myfootshop.com/article/nerves-lower-extremities"><img src="https://www.myfootshop.com/Content/Images/Anatomy/To_Add/Nerves_lower_extremities.jpg" alt="image of the nerves of the lower extremities" width="614" height="614" /></a></p> <p>Lumbar radiculitis should be a differential diagnosis for leg and foot pain.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/19</p>urn:store:1:blog:post:189https://www.myfootshop.com/differential-diagnosis-mortons-neuromaDifferential diagnosis for Morton's neuroma<h2>If it’s not Morton’s neuroma, then what could it be?</h2> <p> </p> <h3>Differential diagnosis for Morton’s neuroma</h3> <p><br /><img style="float: left;" src="/Content/Images/uploaded/forefoot(2).jpg" alt="Differential for forefoot pain" width="300" /></p> <p>The vast majority of referrals that I get from primary care for evaluation of forefoot pain are referred for a suspected <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton’s neuroma</a>.  Interestingly, not many of these referrals actually have Morton’s neuroma.  So if it’s not Morton’s neuroma, what could the source of the pain be?  Let’s take a look at the differential diagnosis for Morton’s neuroma.</p> <p>First, we have to qualify this patient and rule out a history of lumbar pain or peripheral vascular disease.  Referred pain from lumbar disc disease and critical limb ischemia (poor circulation) can also contribute to forefoot pain.  But in this case, we’re referring to a young and otherwise healthy individual.  And the pain that we’re referring to does not involve the great toe joint.  We’re talking pain behind the 2-5<sup>th</sup> toes.</p> <h3> </h3> <h3>Other than Morton’s neuroma, what foot conditions can be the source of forefoot pain?  Here’s a list of possible problems.</h3> <ul> <li><a href="https://www.myfootshop.com/article/capsulitis">Capsulitis</a></li> <li>Fat pad atrophy</li> <li><a href="https://www.myfootshop.com/article/puncture-wounds-of-the-foot">Foreign body injury</a></li> <li><a href="https://www.myfootshop.com/article/corn-and-callus">Forefoot callus</a></li> <li><a href="https://www.myfootshop.com/article/tarsal-tunnel-syndrome">Tarsal tunnel syndrome</a></li> <li>Plantar plate tear</li> <li><a href="https://www.myfootshop.com/article/freibergs-infraction">Freiberg’s infraction</a></li> <li><a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Arthritis</a></li> <li><a href="https://www.myfootshop.com/article/gout">Gout</a></li> <li><a href="https://www.myfootshop.com/article/warts">Wart</a></li> </ul> <p>By far, the most common problem that I see in the office that causes forefoot pain is capsulitis.  Capsulitis will usually be found in the ball of the foot under the second toe.  The symptoms of capsulitis increase when going barefoot and are relieved with the use of a shoe. </p> <p>The other conditions listed should be ruled out when evaluating forefoot pain.  Be sure to follow the link for more information on each condition.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/24/19</p>urn:store:1:blog:post:188https://www.myfootshop.com/which-antifungal-is-right-for-my-toe-nail-fungusWhich antifungal is right for my toe nail fungus?<h2>How do I treat toe nail fungus?</h2> <p> </p> <h3>Which antifungal is the best antifungal for me?</h3> <p>Fungal infections of the nail (<a href="https://www.myfootshop.com/article/onychomycosis#Tab3">onychomycosis</a>) cause yellow discoloration of the nail, thickening of the nail and separation of the nail from the underlying nail plate.  Infections typically begin after an incident of trauma to the nail.  A healthy nail offers a degree of protection to the nail from bacteria and fungus.  But with an injury to the nail, the nail becomes much more susceptible to infection.  Fungal infections of the nail usually begin at the distal margin of the nail and progress proximally into the body of the nail.</p> <h3>How do you choose the right medication to treat nail fungus?</h3> <p>Let's take a look at three stages of nail fungus and treatment recommendations for each stage of infection.</p> <p>Early-stage - In this case, there is just a small percentage of the nail that is infected.  In early cases of onychomycosis, treatment<a href="https://www.myfootshop.com/content/images/medical/derm/onychomycosis_foot_1.jpg"><img style="float: left;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_foot_1.jpg" alt="Early onychomycosis" width="104" height="79" /></a> with a topical medication like <a href="https://www.myfootshop.com/clearzal-fungal-nail-care-system">ClearZal</a> or <a href="https://www.myfootshop.com/terpenicol-antifungal-cream">Terpenicol</a> works to clear the nail.  Compliance is the most important aspect of care.  Fungus doesn't take a day off and neither should you.  Apply your topical medication twice a day.  Apply just enough to cover the nail.  Allow it to dry and you're good to go.  Be sure to continue application of a topical antifungal until the nail is 100% clear.  <a href="https://www.myfootshop.com/just-for-toenails-medicated-nail-polish">Topical antifungal nail polish</a> is also OK to use in early-stage onychomycosis.</p> <p> </p> <p>Intermediate stage - In the nail seen at right, we see a much greater percentage of the nail being infected.  The nail has become dystrophic and<a href="https://www.myfootshop.com/content/images/medical/derm/onychomycosis_toe_3.jpg"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_toe_3.jpg" alt="Intermediate stage onychomycosis" width="91" height="76" /></a> fragmented.  The diseased nail needs to be mechanically debrided or chemically debrided with a urea-based medication.  The same medications can be used that were described in early-stage treatment, but the diseased nail should be removed either mechanically or chemically.  <a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Healthy Nail Butter</a>, with a 40% urea base, is well suited to chemically debride the diseased nail and treat the nail fungus simultaneously. </p> <p>Late-stage - In late-stage treatment of onychomycosis, debridement of the nail is essential by both mechanical and <a href="https://www.myfootshop.com/content/images/medical/derm/onychomycosis_toe_4.jpg"><img style="float: left;" src="/Content/Images/uploaded/Medical/Derm/onychomycosis_toe_4.jpg" alt="Late stage onychomycosis" width="110" height="90" /></a>chemical means.  It's important to recognize in late-stage onychomycosis that the nail has physically separated from the nail bed.  Although topical medications can treat the fungal component of the nail, antifungal medications will not enable the nail to re-adhere to the nail bed.  Mechanical debridement of the nail with <a href="https://www.myfootshop.com/nail-cutter-small">nail cutters</a> needs to be performed and followed with chemical debridement with Natural Antifungal Nail Butter.</p> <p> </p> <p>Be sure to remember that nail fungus is not a condition that can be treated for a finite period (a few months) and be cured.  Effective treatment of onychomycosis requires ongoing treatment to manage the infection.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:187https://www.myfootshop.com/malignant-melanoma-check-those-little-brown-spotsMalignant Melanoma | Check those little brown spots<h2>Money can't buy life, said Bob Marley.</h2> <p> </p> <h3>Check those little brown spots - it might just save your life.</h3> <p>Bob Marley was one of the greats. An innovator and artist, Bob died in 1981 from malignant melanoma.  The diagnosis of acral<img style="float: right;" src="/Content/Images/uploaded/Blog images/Dr_Oster-check_those_brown_spots.jpg" alt="Dr. Oster - check those brown spots" width="200" /> lentiginous melanoma came in 1977 from a biopsy of Bob's great toe nail. Recommended treatment was amputation of the toe, which he refused. While on tour in the spring of '81, Bob's condition became much worse, forcing him to stop his tour and be hospitalized in Miami. He died on May 11, 1981 in Miami as a result of metastasis of malignant melanoma to his brain and lungs.</p> <p>There are four basic types of malignant melanoma. The type that effected Bob is called acral lentiginous melanoma, a type of melanoma found on the palms, soles of the foot, finger nails and toe nails. The symptoms of acral lentiginous melanoma include:</p> <ul> <li><span style="color: #008080;">Variable pigmentation with red, blue-grey and black as the predominant colors.</span></li> <li><span style="color: #008080;">Ulceration or bleeding of the skin.</span></li> <li><span style="color: #008080;">Smooth surface at first that becomes rough or warty over time.</span></li> <li><span style="color: #008080;">Asymptomatic at first but progresses to a chronic burning or itching.</span></li> </ul> <p>Had Bob treated his cancer from the start, we'd still be hearing new Marley songs today, but he didn't. Bob's life ended at 36 years of age. His last words to his son Ziggy were "money can't buy life." </p> <p>Brown spots on the feet? Dark stripes in the nails? Have those brown spots screened by your podiatrist or dermatologist. Money really can buy life if you act prudently and take charge of your health.</p> <p>- Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:186https://www.myfootshop.com/do-i-have-a-metatarsal-stress-fractureDo I have a metatarsal stress fracture?<h2>Metatarsal Stress Fractures - Symptoms and Treatment Options</h2> <p> </p> <h3>How can I tell if I have a metatarsal stress fracture?</h3> <p>Patients are always surprised when I tell them that they have a <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal stress fracture</a>.  When we hear the word fracture, we're<a href="https://www.myfootshop.com/article/metatarsal-fracture"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/xray_foot_metatarsal_fracture_with_bone_callus_mod.jpg" alt="Metatarsal stress fracture" width="150" /></a> naturally programmed to go back into our last few days or weeks and do a rundown on our activities.  Patients ask themselves "when did I injure my foot?"  I don't remember twisting it or turning it in any way.  But the reality of a metatarsal stress fracture is that the onset of a metatarsal stress fracture is not from acute trauma but rather from increased and unsustainable load applied to the metatarsal bone.  Here are a few examples of how my patients have recently described the onset of their metatarsal stress fracture:</p> <p style="padding-left: 30px;"><span style="color: #008080;"><em>"I've been training for a triathlon and have been doing really well keeping to my training schedule.  I order a new pair of shoes and started using them last week.  I used them for two days and my left forefoot got a little sore.  When I tried to get up out of bed last Thursday, I could hardly put weight on my left foot."</em></span></p> <p style="padding-left: 30px;"><span style="color: #008080;"><em>"I wanted to try a pair of minimalist shoes, so I tried a pair on my treadmill.  I liked the feel and increased my time on the treadmill but started to feel a little burning in my right forefoot.  Now I can't even walk."</em></span></p> <p style="padding-left: 30px;"><span style="color: #008080;"><em>"I was late for a flight at O'Hare.  I grabbed my bag and had to run for my flight.  I made the flight but once I got on the plane I noticed a sore spot in the ball of my foot."</em></span></p> <p>Metatarsal bones are the long bones that extend from the midfoot to the ball-of-the-foot, descending at about a 35-degree angle.  In an ideal world, each of the metatarsal bones would support the foot, carrying a proportionate amount of load.  But in cases of metatarsal stress fractures, load-bearing by the metatarsal bones is eccentric and results in loading of one metatarsal bone with loads that it cannot sustain.  The result is unsustainable bone fatigue and a stress fracture. </p> <h3>Symptoms of a metatarsal stress fracture include:</h3> <ul> <li>Mild firm swelling specific to the fracture site</li> <li>Limited erythema (redness) and bruising</li> <li>Site-specific pain with initial weight bearing.  Pain increases with duration of time on the feet.</li> </ul> <p>The diagnosis of a stress fracture is confirmed only by symptoms and cannot be seen by x-ray in the first 3-4 weeks of healing.  At 4 weeks, a cloud of bone called bone callus forms.  Bone callus is the internal cast used by your body to stabilize the metatarsal stress fracture.  Visualization of bone callus at 4 weeks following the onset of the fracture is the earliest time that metatarsal stress fractures can be confirmed on x-ray.  Us of an x-ray is helpful to determine the alignment and apposition of a fracture.  Good alignment and apposition is essential for successful healing.</p> <p>Treatment of metatarsal stress fractures requires rest and a decrease in activities.  Remember the acronym RICE-</p> <ul> <li>rest</li> <li>ice</li> <li>compression</li> <li>elevation</li> </ul> <p>Treatment of metatarsal stress fractures requires immobilization and limited activity.  In addition to ice and elevation, the following products can help-</p> <ul> <li><a href="https://www.myfootshop.com/forefoot-compression-sleeve">forefoot compression sleeve<img style="float: right;" src="/Content/Images/uploaded/Blog images/862_Forefoot_Compression_Sleeve_with_border.jpg" alt="Forefoot compression sleeve" width="150" /></a></li> <li><a href="https://www.myfootshop.com/arch-binder-1">arch binder</a></li> <li><a href="https://www.myfootshop.com/post-op-shoe-1">fracture shoe</a> (aka post-op shoe/surgery shoe)</li> <li><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">spring plate</a></li> </ul> <p>Be sure to check our complete knowledge base article on <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal fractures</a> for more information on these unique fractures of the foot.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p> <p> </p>urn:store:1:blog:post:185https://www.myfootshop.com/have-you-met-ingridHave you met my friend Ingrid?<h2>Ingrid - Interactive graphical interface for diagnoses.</h2> <p> </p> <h3>How can Ingrid help you make the right diagnosis of a foot or ankle problem?</h3> <h3> </h3> <p><a href="https://www.myfootshop.com/Articles/"><img style="float: right;" src="/Content/Images/uploaded/Blog images/foot_finder.jpg" alt="Ingrid - interactive graphical interface for diagnoses" width="339" height="236" /></a></p> <p>I'd like to introduce you to <a href="https://www.myfootshop.com/Articles/">Ingrid</a>.  Ingrid is a hard worker.  She's there working 24 hours a day, 7 days a week.  Ingrid helps customers like you find diagnoses by grouping conditions into zones.  To use Ingrid, simply hover over the graphical image of the foot and click into a highlighted zone.  Each zone contains a collection of articles specific to that region of the foot.  </p> <p>Granted, we're not your doctor and we can't make your diagnosis for you, but we can guide you into some of the web's best information on foot and ankle problems.</p> <p>Ingrid is a part of a unique way in which we do business called <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a>.  With Medically Guided Shopping, we help you find the right diagnosis (using Ingrid) and the right product, the right way.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:184https://www.myfootshop.com/natural-moisturizing-callus-butter-for-dry-heelsNatural Moisturizing Callus Butter<h2> Cold weather means cracked, fissured heels.</h2> <p> </p> <h3>Natural Moisturizing Callus Butter - the solution for cracked, fissured heels.</h3> <p> </p> <p><a href="https://www.myfootshop.com/article/cracked-heels">Heel fissures</a> occur around the rim of the heel.  Heel fissures start out as a simple callus that thickens over time.  Heel fissures are<a href="https://www.myfootshop.com/article/cracked-heels#Tab1"><img style="float: right;" src="/Content/Images/uploaded/Blog images/heel_fissure.jpg" alt="Heel fissures" width="150" /></a> a unique form of foot callus that can progress to a point where they split, bleed and occasionally become infected. The formation of heel callus is aggravated by cold, dry weather making heel fissures a seasonal form of callus.</p> <p>In my podiatry practice, I reserve the use of <a href="https://www.myfootshop.com/moisturizing-callus-butter">Natural Moisturizing Callus Butter</a> for the toughest of calluses like heel fissures.  Natural Moisturizing Callus Butter works to soften rough calluses by using a combination of:</p> <ul> <li><span style="color: #008080; background-color: #ffffff;">cocoa butter</span></li> <li><span style="color: #008080; background-color: #ffffff;">beeswax</span></li> <li><span style="color: #008080; background-color: #ffffff;">organic sunflower oil</span></li> <li><span style="color: #008080; background-color: #ffffff;">coconut oil</span></li> </ul> <p>Naturally scented with spearmint and peppermint, Natural Moisturizing Callus Butter also uses Vitamin E to replenish dry, damaged skin of the heel.</p> <p>Tough calluses like heel fissures will need periodic debridement to remove superficial skin.  Don't forget to combine the use of Natural Moisturizing Callus Butter with one of the following;</p> <p><a href="https://www.myfootshop.com/safety-corn-and-callus-trimmer">Safety Corn and Callus Trimmer</a></p> <p><a href="https://www.myfootshop.com/callus-file">Callus File</a></p> <p><a href="https://www.myfootshop.com/pumice-stone">Pumice Stone</a><br /><br /></p> <p>Natural Moisturizing Callus Butter contains no artificial fragrances, colors or chemical.  All-natural, all the time.  That's the <a href="https://www.myfootshop.com/all-natural">Natural's Line</a> of skin care products from Myfootshop.com.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:183https://www.myfootshop.com/curvecorrect-and-antifungal-medicationsCurveCorrect and Antifungal Medications<h2>Can I use CurveCorrect and Antifungal Nail Butter at the same time?</h2> <p>Recently, our Medically Guided Shopping Team received a question from a family practice doctor who contacted us regarding her patient who had an ingrown nail and a fungal nail infection (onychomycosis.)  Wanting to 'kill two birds with one stone', she asked our staff whether her patient could safely and effectively use both the <a href="https://www.myfootshop.com/curvecorrect-ingrown-toenail-treatment-kit">CurveCorrect Ingrown nail Treatment Kit</a> to treat the ingrown nail, and <a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Healthy Nail Butter</a> to treat the fungal infection of the toe nail at the same time.  Our answer was no, and here's why.</p> <p><span style="color: #ffffff;">space</span></p> <h3 style="text-align: left;">CurveCorrect is a small, matchstick-size piece of carbon graphite that is glued to the <a href="https://www.myfootshop.com/nailease-ingrown-nail-treatment"><img style="float: right;" src="/Content/Images/uploaded/Blog images/814_NailEase_Ingrown_Nail_Treatment_ALT1.jpg" alt="NailEase ingrown nail treatment" width="90" /></a>base of the nail.  </h3> <ul> <li style="padding-left: 30px;">As the nail grows out, the carbon graphite stick exerts a lifting effect on the nail, lifting the edges of the nail up and away from the skin.  CurveCorrect is often effective in treating ingrown nails.</li> </ul> <h3>Antifungal Nail Butter is an all-natural topical antifungal used to treat fungal nail infections.</h3> <h3><a href="https://www.myfootshop.com/natural-antifungal-nail-butter"><img style="float: right;" src="/Content/Images/uploaded/Products/1107_Nail_Butter_ALT3.jpg" alt="Natural Antifungal Nail Butter" width="100" /></a><br /> </h3> <ul> <li style="padding-left: 30px;">Healthy Natural Nail Butter is unique in that it uses 40% urea to debride away the diseased (fungal) portion of the nail.  </li> </ul> <h4> </h4> <h4> </h4> <h4>Our recommendation to the doctor was that CurveCorrect and Natural Antifungal Nail Butter should not be used together for the following reasons;</h4> <ul> <li>The CurveCorrect requires a smooth surface to which it can be glued.</li> <li>Natural Healthy Nail Butter chemically debrides nail and may debride the nail from beneath the CurveCorrect, weakening the brace and rendering it ineffective.</li> </ul> <p>We recommended to the doctor to use the CurveCorrect Ingrown Nail Kit with a different topical antifungal.  <a href="https://www.myfootshop.com/clearzal-fungal-nail-care-system">ClearZal</a> or <a href="https://www.myfootshop.com/terpenicol-antifungal-cream">Terpenicol</a> would be appropriate alternatives.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:182https://www.myfootshop.com/natural-antifungal-nail-butter-treatment-recommendationsNatural Healthy Nail Butter | Treatment Recommendations<p>  </p> <h2>How to use Natural Healthy Nail Butter</h2> <p><a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Healthy Nail Butter</a> is the first all-natural product specifically designed to treat nail fungus.  The most effective way to use Natural Antifungal Nail butter is as follows:</p> <ul> <li>Begin by debriding the nail with a <a href="https://www.myfootshop.com/pumice-stone">pumice stone</a> or <a href="https://www.myfootshop.com/nail-cutter-large">nail cutter</a>.  Remove any loose nail tissue.<a href="https://www.myfootshop.com/natural-antifungal-nail-butter"><img style="float: right;" src="/Content/Images/uploaded/Products/1107_Nail_Butter_ALT.jpg" alt="Natural Antifungal Nail Butter" width="100" /></a></li> <li>Wash the site to be treated with soap, water, and a washcloth.</li> <li>Apply a light coat of Natural Healthy Nail Butter to the nail.  Do not cover the nail.</li> <li>Repeat this procedure so that the nail is treated twice each day.</li> </ul> <h3> </h3> <h3>What is nail fungus (onychomycosis)?</h3> <p>Fungus is a form of yeast that thrives in the environment found inside the shoe.  The warm, dark, damp environment found inside the shoe is perfect for fungus to thrive.  For more information on fungal nail infections, visit our knowledge base page on <a href="https://www.myfootshop.com/article/onychomycosis">onychomycosis</a>.</p> <h3> </h3> <h3>Best practices for treating nail fungus.</h3> <ul> <li>Fungus does not take a day off and neither should you.  The success of using natural Antifungal Nail Butter depends upon your compliance.  Be sure to follow the above and treat the nail twice daily.</li> <li>Rotate shoes to create an environment inside the shoe that does not promote growth of fungus.</li> <li>Dry the feet following a shower or bath.  Use a <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">topical antiperspirant</a> specifically made for feet.</li> </ul> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:181https://www.myfootshop.com/natural-antifungal-nail-butter-2Natural Healthy Nail Butter<h2>Treatment of  Fungal Nails - Safe, Sustainable and Effective</h2> <p>Oral medications used to treat <a href="https://www.myfootshop.com/article/onychomycosis">fungal nail infections (onychomycosis)</a> have been around for a number of years.  But the safety profile and side effects of the oral medications (Lamisil, Sporanox, and Diflucan), particularly for long term use are significant.  Although popular at one time, long term use of these medications has fallen out of favor due to side effects.  <a href="https://www.myfootshop.com/natural-antifungal-nail-butter"><img style="float: right;" src="/Content/Images/uploaded/Products/1107_Nail_Butter_ALT3.jpg" alt="Natural Antifungal Nail Butter" width="150" /></a></p> <h3> </h3> <h3>A better way to treat fungal nail infections.</h3> <p>We're proud to announce that we have a better, safer way to treat fungal nail infections.  We recently released <a href="https://www.myfootshop.com/natural-antifungal-nail-butter">Natural Healthy Nail Butter</a>.  Natural Healthy Nail Butter uses a two-step process to treat fungal nail infections.  </p> <ol> <li>Natural Healthy Nail Butter used 40% urea to act as a keratolytic.  Skin and nail are made of keratin.  A keratolytic is a chemical that breaks down nail, particularly diseased nail affected by fungal infection.  </li> <li>Natural Healthy Nail Butter uses tea tree oil and lavender as active antifungal agents, treating the fungus on contact.</li> </ol> <h3> </h3> <h3>A natural remedy for fungal nail infections.</h3> <p>Natural Healthy Nail Butter is a part of our <a href="https://www.myfootshop.com/all-natural">Naturals Collection</a> of skin and nail care products.  All of our Naturals Collection is made from 100% natural ingredients.  We use no animal testing and do not rely on artificial stabilizers, perfumes or preservatives.  All-natural, all the time.  That's the Naturals Collection from Myfootshop.com.</p> <p>Used daily, Natural Healthy Nail Butter can heal thick, discolored nails due to onychomycosis and nail trauma.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:180https://www.myfootshop.com/mitten-pad-dancers-padThe Mitten Pad | Why it's just a dancer's pad<h2><em>A dancer's pad looks like a mitten.</em></h2> <p> </p> <p>One of the gals that works in my office asked me the other day, "Dr. Oster, where are those pads that look like mittens?"  It took me a second to think about what she meant.  But once it made sense for me, I think her example was spot on.  What she was referring to was a <strong><a href="https://www.myfootshop.com/dancers-pads">dancer's pad</a></strong>.  Dancer's pads are shaped much like a mitten.<a href="https://www.myfootshop.com/dancers-pads"><img style="float: right;" src="/Content/Images/uploaded/Blog images/dancers_pad.jpg" alt="Dancer's pad" width="300" /></a></p> <h3>Dancer's pads are used to treat forefoot problems including:</h3> <ul> <li><strong><a href="https://www.myfootshop.com/article/sesamoiditis">Sesamoiditis</a></strong></li> <li><strong><a href="https://www.myfootshop.com/article/sesamoid-fracture">Sesamoid fractures</a><br /></strong></li> <li><strong><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux Limitus, stage 1</a><br /></strong></li> <li><strong><a href="https://www.myfootshop.com/article/turf-toe">Turf toe</a><br /></strong></li> <li><strong>Fat pad atrophy</strong></li> </ul> <p>Proper use of the dancer's pad would put the callus or sore spot in the nook just above the thumb, between the thumb and forefinger.</p> <p>Dancer's pads can also be used to treat problems beneath the 5th toe.  And this is where the left/right-specific nature of the dancer's pads are important to understand. </p> <h3><span style="color: #666699;">Dancer's pads are cut to treat problems beneath the big toe joint.</span> </h3> <p>So if you're treating a sesamoid problem of the left foot, you'd order a left dancer's pad.  But the left dancer's pad can also be used to treat a problem beneath the right little toe.  Same pad, just a different spot on the foot.  Be sure to check the video on each of the product pages for more information on fitting dancer's pads.</p> <p>The mitten pad - I like that.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/22/2021</p>urn:store:1:blog:post:179https://www.myfootshop.com/treating-forefoot-arthritis-with-a-carbon-fiber-spring-plateTreating Forefoot Arthritis with a Carbon Fiber Spring Plate<h2><span style="font-size: 9pt;"> </span>How do carbon fiber spring plates treat forefoot pain?</h2> <p><span style="font-size: 9pt;">Our Medically Guided Shopping team gets a lot of great questions from our customers.  And that's the fun of our jobs - we help our customers find value and comfort.  Common questions that the Medically Guided Shopping team receives include:</span></p> <ul style="list-style-type: disc;"> <li>The right foot and ankle diagnosis - which problem do I have?</li> <li>The right product - which product is best to treat my particular foot problem?</li> <li>How to use this product?</li> </ul> <p>A customer contacted us this week to ask what they might do to remain active in spite of <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">forefoot arthritis</a> pain.  Our customer described herself as a 65 y/o female who was active playing golf and tennis.  She described mild forefoot arthritis that would get a bit worse with increased activity.  She wanted to know the best way to improve her forefoot pain.  Our Medically Guided Shopping Team forwarded this question up to me to get my opinion as medical advisor.</p> <p>I recommended a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> for this customer to treat her forefoot arthritis.  The beauty of the Spring Plate is two-fold:</p> <ul> <li>The Spring Plate is very thin and will fit into virtually any shoe.</li> <li>The Spring Plate has a bend in the plate that creates a rocker effect at the toe-off phase of gait. </li> </ul> <p>The use of a forefoot rocker is exactly what this customer needed to stay active; splint the forefoot arthritis and keep in the game.</p> <p>A forefoot rocker is a very simple yet eloquent shoe modification.  A forefoot rocker can be placed on the outside of a shoe, ca<a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right;" src="/Content/Images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon fiber spring plate" width="100" /></a>n be built as the sole of the shoe or placed on the inside of the shoe (like a Spring Plate).  To describe a forefoot rocker, think of a pair of clogs.  As the maximal load is applied to the forefoot at the toe-off phase of gait, the forefoot rocker decreases the load to the ball of the foot.  The forefoot rocker is very simple yet very effective in decreasing forefoot load.</p> <p>Our customer wrote us back and thanked us for helping her find a solution.  She said, </p> <p style="padding-left: 30px; text-align: center;"><em>"I'm much more comfortable playing tennis.  The Spring Plate easily fit into my shoe </em></p> <p style="padding-left: 30px; text-align: center;"><em>and actually helped improve my golf score."</em></p> <p>That's the beauty of <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a> - helping our customers find the right diagnosis and the right product, the right way.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:178https://www.myfootshop.com/new-insights-on-an-old-problem-pttdNew insights on an old problem - PTTD<h2>New treatment recommendations for treatment of PTTD</h2> <p>I read an interesting article in <a href="https://lermagazine.com/">Lower Extremity Review (LER)</a> entitled <a href="https://lermagazine.com/article/researchers-inch-toward-understanding-of-pttd">Researcher Inch Towards Understanding of PTTD</a> by Cary Groner. As a clinician and surgeon, you sometimes get set in your ways. When you read about a new approach to an old problem, it's great to get the wheels turning in your head, thinking about new ways to solve old problems.  What I thought was interesting about this article were two new concepts that were introduced in the article; PTTD as the dysfunction of the system, not just the tendon.  And the second concept, the foot core system.</p> <p><a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3"><img style="float: right;" src="https://www.myfootshop.com/content/images/medical/ortho/PTTD_1_thumb.jpg" alt="PTTD" /></a>Traditionally we've looked at <a href="https://www.myfootshop.com/article/posterior-tibial-tendon-dysfunction#Tab3">PTTD</a> as a problem specific to the posterior tibial tendon.  One of the specialists interviewed in the article was Patrick McKeon, PhD, ATC who suggested maybe we need to focus less on the PT tendon and look more at the sum total of contributing factors that may precipitate the onset of PTTD.  McKeon recommends mechanical support of the tendon but advocates rehabilitation to strengthen the foot, to wean the foot off of orthotics.  This global kind of approach to PTTD is a new way of thinking about an old problem.  Wean folks off of their orthotics?  That's a beautiful goal and should have been our primary treatment objective all along.</p> <p>Bahram Jam, a physical therapist at York University in Toronto was also interviewed in the article. Jam's idea is to focus on the core or support from the intrinsic musculature in the foot.  We're all familiar with core training for chronic lumbar pain (pilates).  Why not think in those same terms when we begin rehab for PTTD?</p> <p>The ideas put forth by Mckeon and Jam are interesting and worth an honest effort.  It'll be interesting how these ideas play out in the literature over time.  For these concepts to become an intrinsic part of our treatment of PTTD, it's going to require open-minded clinicians and motivated patients.  It'll be interesting to watch these ideas become a reality in the medical literature.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:177https://www.myfootshop.com/stress-fracture-treatment-with-spring-plateMetatarsal Stress Fractures | Treatment with a Spring Plate.<p><a href="https://www.myfootshop.com/article/metatarsal-fracture#Tab3"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/xray_foot_metatarsal_fracture_mod1.jpg" alt="metatarsal stress fracture" width="214" height="330" /></a></p> <h2>Metatarsal stress fractures can be treated with a spring plate</h2> <p>Our Medically Guided Shopping team contacted me this week with a customer question regarding <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal stress fractures</a>.  The customer had been to their doctor and had received a diagnosis of a non-displaced metatarsal stress fracture of the 3rd and 4th metatarsals.  The customer wanted to know what the best product would be - flat carbon graphite plate or Spring Plate.</p> <p>Metatarsal stress fractures are fractures that are not displaced.  The bone at the fracture site is well-apposed and well-aligned.  The bone will heal in time, but the use of a splint is necessary to allow the bone to rest as it heals.  The challenge for a foot specialist is to design a treatment plan that splints the bone while enabling the patient to be ambulatory.  A walking cast or a fracture shoe could be used.  But what works best in many cases is simply stiffening the patient's shoe. </p> <p>Several years ago I saw a police officer in late June for what turned out to be a metatarsal stress fracture.  My recommendation was to use a walking cast.  The officer was a nice fellow and said to me, "Doc, we can do that but I'll need to work the big fourth of July celebration.  I get triple pay to work it and I just can't miss it."  We talked for a bit and came together to the conclusion that the use of a police work shoe with a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> was as good if not better than the walking cast.  My patient was instructed to listen to his symptoms.  Ice when possible and elevate his foot when he could.  Don't push through the pain.  He went on to heal uneventfully and was able to work his 4th of July shift.</p> <p>I used the same recommendation for our customer suggesting that they use a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> to treat the fractures.  I stressed with our team that the customer read our article on <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal stress fractures</a>.  The Carbon Graphite Flat Plate would also work, but for the ambulatory patient, the Spring Plate is just a bit more comfortable.</p> <p>It'll be a matter of weeks before those fractures will be healed, but the use of the Spring Plate ought to help the fractures heal just a bit faster.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:176https://www.myfootshop.com/treating-achilles-tendon-ruptures-spring-plateAchilles Tendon Rupture | Treatment with a carbon graphite spring plate<h2>Treatment of partial Achilles tendon ruptures with a Spring Plate</h2> <p>Our Medically Guided Shopping Team forwarded me a question this week from a customer who had <a href="https://www.myfootshop.com/article/achilles-tendon-rupture">ruptured their Achilles tendon</a>. <a href="https://www.myfootshop.com/article/gastrocnemius"><img style="float: right;" src="/Content/Images/uploaded/Blog images/Gastrocnemius.jpg" alt="Gastrocnemius" width="120" /></a> The customer described undergoing surgery to repair the tendon.  He stated that his surgeon had used a graft from the tendon to the great toe.  His outcome was good and he was back to playing basketball.  His complaint was that he had no spring in his step.  He could play but wasn't satisfied with being less than 100%. </p> <p>A normal, healthy calf and Achilles tendon will have a spongy, soft end range of motion.  When you examine a healthy calf and Achilles with the patient sitting and knees extended, pushing against the ball of the foot, the end range of motion at the ankle will bounce or feel spongy.  What had happened to our customer was that the scar tissue from his injury and surgery had taken away that spongy, bouncy end range of motion.  The end range of motion was now stiff.  That stiffness of the end range of motion is what took the spring out of our customer's step.  What could we do to help this?</p> <p><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left;" src="/Content/Images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon graphite spring plate" width="120" /></a>My recommendation was to use a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a>.  The forefoot rocker in the Spring Plate affects that end range of motion of the Achilles tendon by changing the way that the ball of the foot pushes off at the toe-off phase of gait.  In a traditional shoe, the toe-off phase of gait results in a focus of load that can be used to push off aggressively, resulting in an abrupt transfer of load.  With a healthy Achilles tendon and calf, that's the optimal biomechanical response for the lower leg.  The rocker on the Spring Plate changes that forceful, abrupt push-off.  Rather than an abrupt forceful push-off, the rocker on the Spring Plate creates a smoother push-off and a sense of spring in gait.  This was the perfect solution for this customer's Achilles tendon injury.</p> <p>The scar tissue that forms following repair of an Achilles tendon rupture is a normal part of the healing process.  Unfortunately, that scar tissue also results in stiffness of the injured tendon.  Fortunately, use of a Spring Plate is a simple solution to this problem that can be used in everyday activities including sports.</p> <p>This is how we solve individual foot and ankle problems for our customers.  We call it <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a> - only at Myfootshop.com.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:175https://www.myfootshop.com/spring-plate-sizingSizing a Spring Plate<h2>How do you select the right size carbon fiber spring plate?</h2> <p> </p> <p>It's true that no good company gets ahead without honest criticism.  One of the tools we use to listen to our customers and to learn what our customers like and dislike is our Google reviews.  As a Google Trusted Store, Myfootshop.com receives customer feedback on each and every order.  Google reviews are an objective and honest review of our site.  We learn a lot from Google Trusted Store reviews, and if you want to read a bit about us, <a href="https://www.google.com/maps/place/MyFootShop.com/@41.358261,-73.6367797,17z/data=!4m8!1m2!2m1!1smyfootshop!3m4!1s0x883815e36a3e6095:0xa47688a22905a3c1!8m2!3d41.358261!4d-73.634591">follow this link</a>.</p> <p>One of the negative reviews that we got was from a customer who had difficulty determining which size <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a> to order.  She<a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right;" src="/Content/Images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Spring Plate" width="100" /></a> said that it was difficult to determine which size Spring Plate to purchase because the sizes were only 1/4" different.  The instructions for ordering a Spring Plate from Myfootshop.com say to remove the inner sole from your shoe and measure the length of your inner sole.  If you're unable to determine which Spring Plate to purchase, choose the size smaller.</p> <p>Why just a 1/4" difference between sizes?  Well, it all goes back to King Edward in the 14th century.  King Edward II decreed in 1352 that shoe sizing was to be standardized by the size of a barleycorn - 1 barleycorn would equal one shoe size.  I may be one of the few folks with barley in my basement since I brew beer.  But I think for most of us we're not in the habit of taking a few barleycorns with us when we go shoe shopping.  But measure a barleycorn and you'll see it's about 1/4".</p> <p>Fast forward to the 1880s. A shoe salesman by the name of Edwin B. Simpson of New York developed our current measuring system for shoe sizing.  Use of The Brannock device and standardized sizing has simplified shoe fitting.  For adult male and female shoe sizing, each increase in shoe size is 1/3" in length and 1/4" in diameter of the foot. </p> <p>In response to our customer, I wish we could make sizing easier when ordering Spring Plates, but is important to optimize the size.  As King Edward and Edwin Simpson stressed, every 1/4" does matter when it comes to proper sizing.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:174https://www.myfootshop.com/what-causes-heel-fissuresWhat causes heel fissures?<h2>What are heel fissures?</h2> <p> </p> <p>Heel fissures are a unique and often misunderstood type of callus.  Most areas of callus are formed by a physical irritation to the skin.  Think of when you work in the yard with a shovel or rake.  The first response of the skin is a simple blister.  But if you continue the shoveling or raking, callus will form over the boney prominences of the palm.  To slow this formation of callus, we might use hand lotion or a pair of gloves.  This particular type of callus is caused by friction or direct pressure to a boney prominence.  The skin reacts by increasing the thickness of the skin, and forms a callus.</p> <p><a href="https://www.myfootshop.com/content/images/medical/derm/heel_fissure_composite_mod.jpg"><img style="float: left;" src="/Content/Images/uploaded/Blog images/heel_fissure.jpg" alt="Heel fissures" width="120" /></a>Heel fissures are also a form of callus but they form a bit differently.  Heel fissures form as the result of tension on the skin and not pressure or friction.  Let me use a simple example to describe how heel fissures form.  Let's imagine that you're in your kitchen at the sink.  You fill a balloon with water and tie the balloon.  Holding the balloon at the knot you gently set the balloon down on the kitchen counter.  Then lift it and set it down again.  Each time you repeat this action, the walls of the balloon expand and stretch.  Lift the balloon and the tension on the wall of the balloon is decreased.</p> <p>The pad of the human heel works in much the same manner.  The pad of the heel is made of fat.  The fat is encased in a fibrous network of fascia much like the honeycomb of a beehive.  When we stand and apply pressure to the heel, the pad is compressed and tension placed on the walls of the heel.  Release weight from the heel and the tension on the walls of the heel is released.  Each time we<a href="https://www.myfootshop.com/moisturizing-callus-butter"><img style="float: right;" src="/Content/Images/uploaded/Blog images/818_Myfootshop_Moisturizing_Foot_Butter_ALT2.jpg" alt="Callus butter" width="100" /></a> repeat weight-bearing, tension is applied to the walls of the heel that stimulate an irritation in the skin causing the skin to thicken.  In time, as the callus surrounding the pad of the heel thickens, the callus will crack resulting in heel fissures.</p> <h2>How do you treat heel fissures?  </h2> <p>There is no long term solution.  That means that treating heel fissures becomes an ongoing maintenance challenge.  The best approach is to lotion the heel each day with a callus cream that is fortified with a keratolytic agent.  A keratolytic agent is a chemical that breaks down keratin.  Examples of keratolytic agents include <a href="https://www.myfootshop.com/ureacin-20-cream-1">urea</a>, <a href="https://www.myfootshop.com/clearzal-callus-cream">sal acid, and chlortriacetic acid</a>.  Even with the use of a 'callus buster', you'll still need to debride the callus with a pumice stone or callus file.  <a href="https://www.myfootshop.com/moisturizing-callus-butter">Callus Butter</a> is also a go-to for heel fissures,  Callus butter is made from beeswax and cocoa butter and will treat even the toughest of calluses.  </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:173https://www.myfootshop.com/is-it-a-wart-or-a-callusHow can you tell the difference between a wart and a callus?<h2>How do you differenciate a wart from a callus?</h2> <p> </p> <p>What's the difference between a <a href="https://www.myfootshop.com/article/warts">wart </a>and a <a href="https://www.myfootshop.com/article/corn-and-callus#Tab1">callus</a>?  How do you tell the two apart?  It's a common question in my podiatry office.  Ironically, I think the common wart is an interesting virus to study.  It's benign, self-limiting with age and responds to many different treatment options.   Callus, on the other hand, is different.  Callus increases with age.  Let's see if we can't help you figure out the difference between a wart and a callus. </p> <p><a href="https://www.myfootshop.com/article/warts"><img style="float: left;" src="/Content/Images/uploaded/Medical/Derm/wart3.jpg" alt="common wart of he skin" width="100" /></a>The most common scenario I see in the office is a middle-aged patient whose chief complaint is a wart on the bottom of the foot.  Possible, sure.  But not likely.  Warts are a disease of adolescence.  We'll usually find warts in a population of patients aged 8-30 years of age.  As we mature beyond our fourth decade of life, we seem to acquire a resistance to the papovavirus that causes the common wart.  So, the first consideration in differentiating a wart from a callus is age. </p> <p>The second consideration is location of the lesion.  Warts are most commonly found on the bottom of the foot.  Occasionally I'll see <a href="https://www.myfootshop.com/article/callus"><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/callus_foot_labeled.jpg" alt="Deep callus of the foot" width="100" /></a>a wart on the top of the foot or between the toes, but by far, the most common location is the bottom of the foot.  And callus?  You'll find callus on both the top and the bottom of the foot.</p> <p>Another tip is the appearance of the wart or callus.  Callus, when trimmed, is smooth and clear, made of hard keratin.  Warts, on the other hand, have little black dots.  Wart tissue is living tissue that is highly vascularized.  The blood vessels that feed the wart are bumps and clot making the wart have little black dots, or clots.  Trim a wart and you'll see pinpoint bleeding.  Calluses, on the other hand, never have these little black dots.  Trim a callus and you'll have no bleeding.</p> <p>So how do you tell the difference between a wart and callus?  First is age - warts in the younger population and callus in the older population.  The appearance is the other differentiating fact.  Black stipples and it's a wart.  No black stipples, likely a callus.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor</p> <p>Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:172https://www.myfootshop.com/when-should-you-replace-your-running-shoesWhen is it time for new running shoes?<h2>When is it time to replace running shoes?</h2> <p> </p> <p>How do you know when it's time to retire your running shoes?  When is it time to say, enough, I need some new shoes (or I want some new shoes)?  Without sounding like I'm beating around the bush, it really all depends.  Let's take a look at the three basic attributes of a shoe and see how they change over the course of the life of the shoe.  And maybe based on this knowledge we can come up with some logical reasons why you may or may not need to change your running shoes out.</p> <p>Think back to the days when you ran in your Chuck Taylors and how things have improved.  The difference today is that good running shoes are really a knock-off of a traditional Oxford shoe.  Sure, they're lighter and more able to adapt to a recreational activity than a heavy leather Oxford.  But to make a good running shoe, we need to incorporate some of the attributes that make an Oxford a supportive shoe.  The three attributes of an Oxford include a slight heel, a rigid shank and a laced upper.  Combined, all three attributes of the Oxford shoe create what is a very eloquent brace, that we call a shoe.  Let's take a quick look at each attribute and how they may wear out and create a need for replacement. </p> <p>The heel of the shoe is used to weaken the calf.  Running and walking is really a controlled forward fall regulated by the calf and Achilles tendon slowing the forward excursion of the leg over the foot.  As your body moves forward over the foot, the <img style="float: left;" src="/Content/Images/uploaded/Blog images/shoes-592770_1280.jpg" alt="running shoes" width="261" height="195" />calf can no longer limit that forward motion of the lower leg and you enter the 'heel off' phase of gait.  By placing a heel on the shoe, you elevate the heel just a wee bit.  This results in early heel off which decreases the effort required to walk or run.</p> <p>The shank of the shoe is used as a brace to carry the mechanical force (eccentric muscle contraction) from the heel to the ball of the foot.  Really simply put, place a doctor's wooden tongue depressor on the bottom of your foot, secure with some duct tape and you have a shank (don't try this at home).  But for sake of example, I think you get the point.  The shank is a brace.  It decreases the amount of effort needed to walk or run by splinting the bottom of the foot.</p> <p>And lastly, the laced upper.  By definition, the upper of the shoe includes the walls of the shoe and the mechanism that holds the walls together.  The upper could be bound by laces (most common), slip tie or perhaps Velcro.  The upper (hopefully laced) is what really holds the whole shoe together.  The laced upper is what binds the foot and forces it to utilize the shank and heel raise.</p> <p>So when do you swap out your running shoes?  The first consideration is foot health and foot comfort.  Some people are lucky to have good feet.  They could run 10 miles barefoot or in a pair of loafers and it really wouldn't faze them either way.  But for most of us, we use our shoes to protect the feet and to make the foot more efficient.  And this is where the three attributes of the traditional Oxford start to come into play.  When the heel wears, running becomes a bit harder.  As the shank breaks down, the foot becomes less efficient and tires more easily.  And lastly, the laced upper - as the walls of the shoe stretch, the support provided by the laced upper becomes increasingly less supportive.</p> <p>I've never been a fan of swapping shoes every 400 miles or every 4 months (or whatever formula you may read about).  You may have a formula that works for you but I'll bet that formula came from a history of wearing out multiple pairs of running shoes.  Try this as an alternative; wear a pair of running shoes for a dedicated period of time (say 3 months), and then pick up another pair of the same shoes.  Start to rotate them and see if you can tell the difference.  Run with the new shoes only once a week.  As you get into the 4th - 6th months, you'll start to see the difference.  The old shoes, although comfortable around town just don't have the support anymore.  Why?  The heel is wearing down, the shank is becoming weak and the laced upper is no longer able to support your foot in running.</p> <p>Swapping out running shoes in this manner is a way I've helped runners over the years determine the right time to swap out their running shoes.  Give it a try and let me know - how long until you need to swap out your shoes?</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p> <p> </p> <p> </p>urn:store:1:blog:post:171https://www.myfootshop.com/whats-a-tongue-pad-and-how-do-i-use-itWhat's a tongue pad and how do I use it?<h2>What is a tongue pad and how is it used?</h2> <p> </p> <p>The secret weapon hidden under the counter of every good shoe store is an ample supply of <a href="https://www.myfootshop.com/tongue-pads-felt">tongue pads</a>.  What's a tongue pad and why are they important?  Let's focus on one solution that tongue pads offer and that's protecting runners against nail injuries.</p> <p>The tongue of the shoe is that little loose portion of the shoe immediately beneath the laces.  I think we all pull on our running shoes, pull up the tongue of the shoe and lace up, right?  OK, now you know what the tongue of the shoe is, a tongue pad is a felt or foam pad that is self-adherent and is placed on the undersurface of the tongue of the shoe.  Most tongue pads are relatively<a href="https://www.myfootshop.com/tongue-pads-felt"><img style="float: right;" src="/Content/Images/uploaded/Products/813_Tongue_Pads_Felt_ALT2.jpg" alt="Tongue pad" width="150" /></a> thin, ranging from 1/8" to 3/16" in thickness.  So the first tip - don't be shy about wearing one, two or even more tongue pads to solve your problems.  They can easily be doubled in most shoes for a better fit.</p> <p>So how does a tongue pad prevent toe nail injuries?  The secret is that the tongue pads will push the foot back into the heel of the shoe.  As your run progresses and your shoes might get a little loose, the tongue pad will hold the foot back preventing the nails from hitting the toe box.  Do you frequently bruise your nails on a run (<a href="https://www.myfootshop.com/article/runners-nail">runner's nail</a>), a tongue pad is the solution.  Running trails?  As you descend a hill, the foot will piston forward in the shoe.  During mid-stance of gait while descending a hill, your body weight will force the foot to piston forward in the shoe.  The result is typically a nail injury and possible loss of the nail.  I think you understand the solution to the problem - the humble tongue pad will prevent those nail injuries. </p> <p>Tongue pads are a simple tool - cheap and easy to use.  Use them to optimize shoe fit, prevent nail injuries, and even off-load a bump on the top of the foot (<a href="https://www.myfootshop.com/article/saddle-bone-deformity">saddle bone deformity</a>).  Tongue pads are an essential in every shoe store and runner's toolbox.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:170https://www.myfootshop.com/mortons-neuroma-surgical-careMorton's Neuroma | Surgical Care<h2>Surgical treatment of Morton's neuroma</h2> <p>Surgical treatment of Morton's neuroma is considered following a reasonable course of conservative care and when pain due to Morton's neuroma makes day to day activities difficult.  What's a reasonable course of conservative care?  The definition of conservative care will vary with each and every doctor, but a minimum of 2 months is a reasonable period of time.  As you and your doctor team-up to treat your neuroma, you'll be trying different methods of care, but you'll also be building a bit of rapport.  Honestly, I think a lot of the conservative care period is a period for building trust.  Should you choose to have surgery performed on your neuroma, hopefully, the procedure will be performed by a doctor who you have learned to know and trust.</p> <p>I mentioned in my first blog post on this topic that the treatment for Morton's neuroma has essentially remained unchanged since the condition was first described.  Morton, an orthopedic surgeon, described a simple neurectomy from the dorsal (top of the foot) approach.  The interdigital nerve was simply excised (cut out).  One alternative to this procedure is to perform the neurectomy from the plantar (bottom of the foot) approach.  There are pros and cons to both approaches.  The dorsal approach preserves the sole of the foot.  By doing so, a patient can walk on the foot immediately following surgery.  But bear in mind that the interdigital nerve resides on the bottom of the foot.  So to access the neuroma from a dorsal approach necessitates crossing a lot of anatomy that can be damaged in the course of surgery.  With a plantar approach, the neuroma is very close to the bottom surface of the foot.  One additional advantage of the plantar approach is the ability to transpose the nerve once excised.  With a high potential for regrowth of the resected nerve, it's helpful to try to decrease this problem.  With the plantar approach, you can transpose (move) the proximal stump of the nerve into an adjacent muscle belly.  This transposition of the nerve does help to cut down on the formation of a stump neuroma. </p> <p>It's a rare day that I do a neurectomy for Morton's neuroma, but in my hands, I've found the plantar approach to be superior.  Granted, the plantar approach does force the patient to be non-weight bearing for 3 weeks following surgery.  Weight-bearing on the incision would potentially result in formation of a scar on the bottom of the foot.  But from a surgeon's perspective, what I'm looking to do is to get in and get out with the least amount of tissue damage.  I just find the dorsal approach to be awkward in my hands.  And outcomes of the plantar approach just seem to be better for me.</p> <p>The reason that I no longer perform a traditional neurectomy, as originally described by Morton, is that there is a surgical option.  Think about Morton's neuroma surgery from this perspective; Morton's neuroma and carpal tunnel are both nerve entrapments.  In both conditions, the nerve is entrapped and irritated making the function of the nerve faulty.  I will grant you the fact that the median nerve of the wrist is both a sensory and motor nerve while the interdigital nerve is purely sensory.  But still, although each is caused by a nerve entrapment, the treatments are so radically different.  In the case of carpal tunnel, the nerve is preserved through a procedure to release the entrapment either with an open procedure or with an endoscopic procedure.  But in the case of Morton's neuroma, we just chop out the nerve?  Wait a minute.  We can do better than that. </p> <h3>EDIN - endoscopic decompression of intermetatarsal neuroma</h3> <p>There's a very underutilized procedure for the surgical treatment of Morton's neuroma that goes by the acronym of the EDIN<iframe width="560" height="315" style="float: right;" src="https://www.youtube.com/embed/O_CsXqQyVDU?rel=0" frameborder="0" allowfullscreen="allowfullscreen"></iframe> procedure.  EDIN stands for endoscopic decompression of the interdigital nerve.  The procedure is a nerve-sparing procedure that releases the intermetatarsal ligament.  The EDIN procedure is performed with three 1cm incisions and patients can walk on the foot the same day of surgery.  In my experience, I've found the success of the EDIN procedure to be very good.  I think the reason that the EDIN procedure has not gained favor in the orthopedic and podiatric communities is simply due to surgical dogma.  Once you've been trained in the EDIN procedure, it's relatively easy to perform in under ten minutes.  I have to think that the dogma surrounding the treatment of Moton's neuroma is so steadfast and ingrained in our residency training models, that the EDIN procedure has failed to yet see the light.</p> <p>In addition to traditional neurectomy and the EDIN procedure, there are a few other options that are available to patients who have<br /> failed to respond to conservative care of Morton's neuroma.  We've already mentioned chemical ablation (also called neuroablation) of the nerve with absolute alcohol.  Neuroablation can be performed in a number of ways including radiofrequency ablation and thermal ablation.  Radiofrequency ablation is performed using an ultrasound-guided probe that emits radiofrequency.  The radiofrequency results in a thermal burn (hot) that destroys tissue adjacent to the probe.  Cold neuroablation is also used to treat Morton's neuroma.  Under ultrasound guidance, the cold probe is placed adjacent to the Morton's neuroma and activated.  The cold probe freezes the contents of the nerve, sparing the nerve sheath and destroying the contents.  We've spoken earlier about why this is important and how sparing the sheath of the nerve results in fewer stump neuromas.</p> <p>As a surgeon, I find the treatment of Morton's neuroma to be one of the more interesting areas of foot care.  You have to ask yourself, why isn't there more progress in the treatment of Morton's neuroma?  Why isn't there consensus in terms of what is the best method of treatment?  I think implicit in this conversation is the fact that there's really no consensus as to what actually caused Morton's neuroma.  Why does one person develop Morton's neuroma and another does not.  Is Morton's neuroma purely a structural problem due to the conjoined nerve of the medial and lateral plantar nerves?  Is Morton's neuroma a functional problem due to the motion of the metatarsal bones and structure of the forefoot?  Maybe both structural and functional?  Or is it something else that has yet to be defined in the literature.  When it comes to the treatment of Morton's neuroma, I think as a professional we need to think outside the box and come up with some new and better treatment methods.  And for starters, more use of the EDIN procedure would be a good place to begin.</p> <p>See related posts - </p> <p><a href="https://www.myfootshop.com/mortons-neuroma-history">Morton's neuroma history</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-diagnosis">Morton's neuroma diagnosis<br /></a><a href="https://www.myfootshop.com/mortons-neuroma-conservative-care">Morton's neuroma conservative care</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:169https://www.myfootshop.com/mortons-neuroma-conservative-careMorton's Neuroma | Conservative Care<h2>Conservative care of Morton's neuroma</h2> <p>Conservative care of <a href="https://www.myfootshop.com/article/mortons-neuroma#Tab3">Morton's neuroma</a> begins with understanding how weight-bearing, walking, and shoes contribute to the symptoms of Morton's neuroma.  Wider shoes with a lower heel will help to decrease the symptoms of Morton's neuroma.  Narrow shoes have a tendency to compress the forefoot which in turn compresses the interdigital nerve, contributing to the onset of a neuroma.  The higher the heel, the greater force the forefoot will carry and subsequently increase the symptoms of Morton's neuroma.  It's interesting how some shoes seem perfectly designed to bring about the onset of Morton's neuroma.  When you look at the function of a high heel pump, there's really only one part of the shoe that grabs onto the foot and that's at the forefoot.  By doing so, a pump will compress the forefoot and initiate a new neuroma or irritate an existing Morton's neuroma.  Add a bit of a heel to that and you've got a great potential for problems.  I've treated many patients who have found that by simply changing the style of their shoes they correct all problems with a Morton's neuroma.  They just keep their pumps for special occasions.</p> <p>But it's not only high heels that are the trouble makers.  There are a lot of specialty sports shoes that contribute to the onset of Morton's neuroma.  Biking shoes are a big one as are bowling shoes.  In both cases, you wear a shoe designed for the activity and then once you're actually in the activity you focus load bearing on the forefoot.  In biking, you focus load on the peddle and in bowling, load is focused with the delivery of the ball. </p> <h3>What is the Jane Russell effect?</h3> <p>Once you've determined that your shoes are wide enough, it's time to start working with different types of pads to treat Morton's neuroma.  My favorite pad is the <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">felt metatarsal pad</a>.  In practice, I tell my patients that the felt metatarsal pad offers the Jane Russell effect.  Jane Russell was the spokesperson for Playtex Cross Your Heart Bras.  Jane was a big girl and needed the support offered by the Cross Your Heart Bra.  Their motto was that the Cross Your Heart Bra 'lifts and separates'.  Well, that's exactly what the felt metatarsal pad does when used to treat Morton's neuroma.  When properly placed, the felt metatarsal pad will lift and separate the metatarsal heads.  By doing so, the felt met pad will off-load the Morton's neuroma and decrease pain.  I really think the use of a felt met pad is underutilized in foot care.  In my practice, I tend to find that up to 7 out of ten folks who use a felt met pad to treat Morton's neuroma respond favorably if not completely to this simple treatment.  Metatarsal pads come in a variety of sizes, shapes, and materials.  Sizes and material often become a personal preference.  But in terms of durability and success of treatment, my go-to is the felt met pad.</p> <p>Orthotics with a metatarsal pad are one further step that can be used to treat Morton's neuroma.  Orthotics will tend to offer a bit more mechanical stability for the foot.  When combined with a met pad, orthotics can be an awesome tool in the toolbox for treating Morton's neuroma.  I think the issue with orthotics though is fit.  From an academic standpoint, orthotics make good sense.  But sometimes, from a practical standpoint, orthotics just won't work.  Orthotics are great for work boots and running shoes but will never work in dress loafers.  It's important to speak with your doctor prior to being cast for orthotics to have a thorough discussion regarding your intended use of the inserts. If you are an office worker wearing dress shoes, you may be better off with a met pad in the shoe or with the use of an <a href="https://www.myfootshop.com/arch-binder-with-metatarsal-pad">Arch Binder with Met Pad</a>.  But if your daily activities allow for an orthotic, that might be the better way to go.</p> <p>One additional shoe modification that's often overlooked in the treatment of Morton's neuroma is the anterior rocker sole.  To describe an anterior rocker sole, think clog.  Clogs will rocker off the forefoot with each step.  The forefoot rocker will decrease<a href="https://www.myfootshop.com/content/images/medical/ortho/rocker1.jpg"><img style="float: right;" src="/Content/Images/uploaded/Blog images/rocker1.jpg" alt="Anterior rocker sole" width="90" /></a> ground reactive force to the forefoot and decrease load bearing to the Morton's neuroma.  Clogs are in fact a great tool used in treating Morton's neuroma due to their wide, open forefoot and anterior rocker sole.  Anterior rocker soles can also be added to your shoe by a shoe repair shop.</p> <h3>When should you use cortisone to treat Morton's neuroma?</h3> <p>So if shoe modifications, met pads and orthotics don't do the trick, how then do we treat Morton's neuroma?  At this stage, we'd consider using one of several choices of injectable medications.  The mainstay of injectable medications for years has been cortisone.  Cortisone is used to decrease inflammation of the nerve and nerve sheath.  Other injectables include dilute absolute alcohol.  Injection of alcohol adjacent to the neuroma is used to intentionally destroy (ablate) the contents of the nerve.  Bear in mind though that you really shouldn't use both at the same time.  Cortisone will decrease the ability of alcohol to ablate the nerve.  Think cortisone for nerve healing and alcohol for nerve destruction.  Let's talk about each in a little more detail.</p> <p>Cortisone for injection is a man-made chemical analog of a hormone that is secreted by your body each and every day.  The cortisone secreted from your adrenal gland is used to regulate both emotional and physical stress.  When your doctor recommends the use of injectable cortisone to treat your Morton's neuroma, he or she is recommending a concentrated does of cortisone to be placed immediately adjacent to the neuroma.  An injection of cortisone can be very successful in reducing the inflammation in the neuroma which subsequently reduces pain.  How many cortisone injections is too many?  There's no definitive answer for this question due to the fact that each patient and each injection may vary.  Some patients will respond to cortisone injections very favorably and tolerate several injections with no ill effects.  Also, the type of cortisone and the dosage of cortisone used by your doctor may vary.  As a rule of thumb, I don't use more than two injections of cortisone for the treatment of Morton's neuroma.  These two injections are usually going to be spaced at 3-4 weeks apart.  My fear with multiple injections of cortisone is fat pad atrophy of the ball of the foot.  When used judiciously, cortisone is a great drug.  But when overused, cortisone can weaken tendons and destroy the plantar fat pad of the forefoot.  Cortisone also needs to be used sparingly in diabetic patients.  An injection of cortisone can make a Type 1 or Type 2 diabetic's blood sugars go on a roller coaster ride.  Easy does it with the cortisone.</p> <p>Injectable alcohol is one of those medications that comes into vogue every 30 years or so.  This technique goes by a number of different names including chemical ablation, chemical neuro-ablation, and chemical neuroma injection. Injectable absolute (pure) alcohol has been used for years to treat trigeminal neuralgia (facial pain).  In the past 6 years or so, alcohol injections for the treatment of Morton's neuroma have become very popular.  The advantage of alcohol injections is that the injection spares the nerve sheath.  The intent of the alcohol injection is to destroy the contents of the nerve (like surgery) but spare the sheath of the nerve (unlike surgery).  Peripheral nerves have a tendency to try to grow back.  In surgery where the nerve is removed (neurectomy) there are many instances of an attempt to regenerate the nerve which results in a regrowth of poorly differentiated nerve tissue often called a stump neuroma.  The beauty of the alcohol injections is that you're essentially performing a neurectomy without the surgery.  Alcohol injections for ablation are performed on a serial basis and repeated each week for 5-7 weeks.  That means if you're interested in this method of care you need to be ready for up to 7 injections.  The success rate of alcohol injections is quite good.  Occasionally we do see regrowth of the nerve following ablation that requires additional injection one to two years following the initial series of injections.</p> <p>What else might be tried to treat Morton's neuroma?  Additional physical therapy measures such as ultrasound or electric stimulation have not really proven to help in cases of Morton's neuroma.  I'm not familiar with chiropractic methods of care, but I have heard from patients that their chiropractor has helped with manipulation of the foot.  Massage, acupuncture, and orthobiometrics may also be tried.  Personally, I don't have experience with these methods of treatment and cannot cite success rates with their use.</p> <p>Related blog posts -</p> <p><a href="https://www.myfootshop.com/mortons-neuroma-history">Morton's neuroma - history</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-diagnosis">Morton's neuroma - diagnosis</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-surgical-care">Morton's neuroma - surgical care</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:168https://www.myfootshop.com/mortons-neuroma-diagnosisMorton's Neuroma | Diagnosis<h2>How is Morton's neuroma diagnosed?</h2> <p>Diagnosing <a href="https://www.myfootshop.com/article/mortons-neuroma#Tab3">Morton's neuroma</a> begins with a thorough patient history.  The questions asked by your health care provider will likely include where the problem is located, the duration of the symptoms, the character of the symptoms, the onset of the symptoms and what methods of treatment you may have tried to date.  The history taken by your doctor may seem like a simple way to first evaluate the problem, but the history is actually the single best tool your doctor has to determine whether or not you are suffering from Morton's neuroma.  Let's take a look at each of the history questions that we just asked and see how they may provide your doctor with information about a Morton's neuroma.</p> <h3>Where is Morton's neuroma located in the foot?</h3> <p>The location of a Morton's neuroma is most commonly going to be found on the plantar (bottom) aspect of the forefoot.  Morton's neuroma is usually found between the third and fourth toes (third intermetatarsal space or third IMS) and to a lesser degree <a href="https://www.myfootshop.com/content/images/anatomy/anatomy_foot_drawing_mortons_neuroma.jpg"><img style="float: right;" src="/Content/Images/uploaded/anatomy_foot_drawing_mortons_neuroma.jpg" alt="anatomy of Morton's neuroma" width="90" /></a>between the second and third toes (second inter-metatarsal space).  In my practice, I've found it rare, if ever at all, that I've diagnosed a Morton's neuroma in the first or fourth inter-metatarsal spaces.  The reason that Morton's neuroma is so common in the 3rd IMS is due to a unique anatomical adaptation of the digital nerves of the forefoot.  In the accompanying image, the branches of the medial plantar nerve and the lateral plantar nerve join into a common digital nerve in the 3rd IMS.  This finding is unique to the 3rd IMS.  Clinicians believe that this confluence of the two nerves results an the common digital nerve of the 3rd IMS being bound and not able to move and adapt to the motion of the forefoot.  As the nerve passes distally to the toes, it passes below the intermetatarsal ligament.  It's at this location, adjacent and plantar (below) the ligament that the irritation of the nerve occurs.  Therefore, location of the symptoms is very critical in the diagnosis of Morton's neuroma.</p> <p>The duration of the symptoms of Morton's neuroma vary.  Many patients find that the symptoms are situational meaning that if they don't wear shoes that irritate the nerve, they have limited symptoms.  Due to the situational nature of the symptoms, many patients will describe symptoms that have come and gone for years.</p> <h3>What are the symptoms of Morton's neuroma?</h3> <p>The character of the symptoms of Morton's neuroma is also an important aspect of the history and helps to define the presence of a Morton's neuroma.  Patients describe a sensation of walking on a bunched up sock or as if something is in their shoe.  Some describe a clicking or popping sensation and other electrical shocks out to the toes.  The symptoms increase with the duration of time on the feet and increase with tightness of the shoe on the forefoot.  Wider shoes and lower heels result in less severe symptoms.  Tighter shoes and higher heels increase symptoms.  Symptoms of Morton's neuroma are relieved by rest.</p> <p>The onset of the symptoms of Morton's neuroma vary.  And again, this may be situational.  The onset might be abrupt when wearing a pair of heels to a wedding but subside once returning to more casual shoes.  In other cases, the symptoms may progressively increase over weeks to months.</p> <h4>How is Morton's neuroma treated?</h4> <p>Treatment methods that you may have tried also matter to your doctor and are an important part of your history.  Wider shoes, arch support, and shoe pads can all help your doctor determine whether Morton's neuroma is present or not. </p> <p>Once your doctor has completed your history, he or she will examine your foot.  The clinical symptoms of Morton's neuroma may vary based upon the amount of swelling and size of the nerve.  A small Morton's neuroma may come and go based upon the shoes that you wear and the activities that you are involved in.  In the case of a smaller Morton's neuroma, the clinical symptoms may be <a href="https://www.myfootshop.com/article/mortons-neuroma#Tab3"><img style="float: left;" src="/Content/Images/uploaded/muldiers_sign2.jpg" alt="Muldier's sign for Morton's neuroma" width="90" /></a>difficult to elicit upon examination.  Your doctor will first feel the bottom of the foot for any sense of a mass between the toes.  He or she will then wrap their hand around the forefoot and squeeze while pushing up on the bottom of the foot at the site of the neuroma.  In a more advanced case and with a larger neuroma, the patient will feel a snapping or popping sensation in the forefoot.  This test is called a Muldier's sign.  A positive Muldier's sign results in pain and electrical shock sensations to the toes.  Although a positive Muldier's sign (with pain) is pathoneumonic for Morton's neuroma, a Muldier's sign without pain does not necessarily mean that a neuroma requires treatment. </p> <p>Additional parts of the clinical exam may include having you stand, applying weight to the bare foot.  In some cases, weight-bearing with a mass such as a neuroma between the toes will result in spreading of the third and fourth toes.  This is what some doctors call a victory sign.</p> <p>Imaging studies are often used to help diagnose Morton's neuroma.  X-rays are commonly used to rule out specific conditions that may contribute to forefoot symptoms that may be similar to Morton's neuroma.  These conditions include <a href="https://www.myfootshop.com/article/metatarsalgia#Tab3">metatarsalgia</a>, <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">arthritis</a>, <a href="https://www.myfootshop.com/article/freibergs-infraction#Tab3">Freiberg's infraction</a>, <a href="https://www.myfootshop.com/article/puncture-wounds-of-the-foot#Tab3">foreign body</a>, and previous forefoot trauma.  Ultrasound is particularly helpful in imaging Morton's neuroma.  Hand held ultrasound may be used to determine the size of the interdigital nerve.  If the size of the interdigital nerve is increased, these findings suggest the diagnosis of Morton's neuroma.  MRI is used in some cases to diagnose Morton's neuroma but based upon the cost of an MRI, this imaging study is not favored by insurance companies (or patients for that matter, right?)</p> <p>Another less frequently used diagnostic method used to assess Morton's neuroma is a digital nerve block.  Local anesthesia is used to block the nerve in the 3rd IMS.  Although this isn't a common diagnostic tool, I'll use this technique if I suspect that the pain may either be in part or completely due to <a href="https://www.myfootshop.com/article/tarsal-tunnel-syndrome#Tab3">tarsal tunnel syndrome</a>.  I won't speak here about tarsal tunnel syndrome, but you may follow the link for more information.  Suffice it to say, tarsal tunnel syndrome should be considered within the differential diagnosis of Morton's neuroma.</p> <h5>What is the differential diagnosis of Morton's neuroma?</h5> <p>And lastly, what is the differential diagnosis for Morton's neuroma?  A differential diagnosis is a list of conditions that may mimic a Morton's neuroma.  We've mentions metatarsalgia, arthritis, Freiberg's infraction, foreign body, prior forefoot trauma, and tarsal tunnel syndrome.  Additional considerations in the differential diagnosis for Morton's neuroma include <a href="https://www.myfootshop.com/article/capsulitis">capsulitis</a> and <a href="https://www.myfootshop.com/article/metatarsal-fracture#Tab3">metatarsal stress fractures</a>. </p> <p>Related blog posts:</p> <p><a href="https://www.myfootshop.com/mortons-neuroma-history">Morton's neuroma - history</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-conservative-care">Morton's neuroma - conservative care</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-surgical-care">Morton's neuroma - surgical care</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:167https://www.myfootshop.com/mortons-neuroma-historyMorton's neuroma | History<h2>The history behind the diagnosis of Morton's neuroma</h2> <p>This is the first of a four-part series of blog posts dedicated to a better understanding of <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>.  I'd like to take a conversational approach with the topic and share some of my experiences as a podiatrist with 30 years of practice.  Although the medical literature is helpful in understanding Morton's neuroma from a scholarly standpoint, I think the medical literature sometimes leaves out some of the subtleties that need to be shared regarding the diagnosis and treatment of Morton's neuroma.  This first of four posts will focus on the history of Morton's neuroma.  The second blog post will explore the diagnosis of Morton's neuroma.  The third post will discuss conservative treatment of Morton's neuroma.  And the fourth and final blog post will discuss surgical correction of Morton's neuroma.</p> <h3>Background of Morton's neuroma</h3> <p>Morton's neuroma goes by many names including Morton neuroma, Morton's metatarsalgia, Morton's toe, Morton's neuralgia, plantar neuroma, intermetatarsal neuroma, interdigital neuroma, and perineural fibroma.  Despite the suffix, 'oma' which usually refers in Latin to a tumor, Morton's neuroma is a focal swelling of the interdigital nerve caused by an entrapment of the nerve against the transverse intermetatarsal ligament.  Morton's neuroma is most commonly found in the forefoot with symptoms between the third and fourth toes.  Pain is limited to the plantar (bottom) forefoot. </p> <h3>History of Morton's neuroma</h3> <p>The term neuroma was originally coined by Queen Victoria's surgical chiropodist Lewis Durlacher, in his 1845 book, <em>A treatise on corns, bunions, diseases of nails and the general management of feet</em>. (1) Durlacher described the condition as "a form of neuralgic affection".  Morton's neuroma was first documented in the medical literature in 1876 by Philadelphia physician and surgeon Thomas G. Morton, professor of orthopedics surgery at the Philadelphia Polyclinic.(2)  Dr. Morton is described as faculty of the Clinic and surgeon to the Pennsylvania Hospital and to the Orthopedic Hospital and Infirmary for Nervous Diseases. (3)  Although Morton accurately described the symptoms of this condition, he concluded incorrectly that the condition was due to capsulitis of the 4th metatarsal phalangeal joint.  Interestingly, T. G. Morton was also a pioneer in the diagnosis and surgical care of acute appendicitis.  Although their relationship is unknown but presumed to be the son of T.G Morton, Thomas K. Morton also described the condition in 1890. T.K. Morton was professor of clinical surgery, surgeon to the out-patient department of the Pennsylvania Hospital, assistant surgeon to the orthopedic hospital and consulting surgeon to the Philadelphia dispensary. (3)  In 1883 Hoadley was the first surgeon to intentionally excise a Morton's neuroma of the foot. (4)  And in 1940, L.O. Betts confirmed in the literature that the symptoms of Morton's neuroma were indeed nerve pain and not capsular pain. (5)</p> <p>It's interesting to note that most medical conditions will evolve over time, based upon new methods of treatment or new understanding of the condition.  In the case of Morton's neuroma, once the condition was described and basic treatment methods applied, the ways in which we treated Morton's neuroma didn't change appreciably between 1845 and 1990.  The chiropody literature is incomplete and doesn't describe a history of treating Morton's neuroma with conservative measures such as padding or shoe modification.  The orthopedic literature leans upon Betts's description of surgical excision.  Like the old surgeons used to say, "when in doubt, cut it out."  As such, the treatment of Morton's neuroma remained unchanged for a century before newer, more recent methods of care evolved.  More on that in my upcoming blog on the surgical treatment of Morton's neuroma.</p> <p>Related blog posts:</p> <p><a href="https://www.myfootshop.com/mortons-neuroma-diagnosis">Morton's neuroma - diagnosis</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-conservative-care">Morton's neuroma  - conservative care</a><br /><a href="https://www.myfootshop.com/mortons-neuroma-surgical-care">Morton's neuroma - surgical care</a></p> <p>References</p> <p>1. Durlacher, L. A treatise on corns, bunions, the diseases of nails and the general management of feet:  Marshal and Co., 1845.<br /> 2. Morton TG.  The Classic.  A peculiar and painful affection of the fourth metatarsal-phalangeal articulation.  Thomas G. Morton, MD.  Clinical orthopedics and related research 1979:4-9.<br /> 3. The Philadelphia Polyclinic Vol. 4. 1895<br /> 4. Hoadley AE.  Six cases of metatarsalgiaChicago Med Rec 1893;5:32.<br /> 5. Betts L O. Morton's metatarsalgia.  Med J August 1940;514-5.</p> <p> </p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:163https://www.myfootshop.com/plantar-fasciitis-surgical-complicationsPlantar Fasciitis | Surgical complications<h2>Surgical complications of endoscopic plantar fasciotomy</h2> <p><img style="float: right;" src="/Content/Images/uploaded/Medical/Surgery/drO.JPG" alt="plantar fasciitis surgery" width="400" />OK, I thought I was all out of breath when it came to talking about <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a>.  But you know, I really ought to talk a little bit about a unique complication of plantar fasciitis surgery called lateral column syndrome.  Lateral column syndrome is one of the reasons why some surgeons shy away from performing plantar fasciotomies.  But like everything else in life, when you have a good understanding of something it becomes easier to manage.  So let's talk a little bit about lateral column syndrome or what we'll call LCS.</p> <p>Back in the early 1980s when I was a new doc in practice, I was puzzled by the post-op course of traditional 'old school' heel spur surgeries (open with resection of the spur.)  Some patients did really quite well.  Once their wound healed they went on to get back to full activities within a matter of two months.  But then there were a few patients who went on to have pain that lasted upwards of a year.  The pain that the later group of patients experienced was unique in that the pain was not specific to the heel and the site of surgery.  The pain was in the top of the arch and the outside of the foot.  These patients experienced minimal swelling but had pain when they first tried to stand.  This pain increased with the duration of time spent on the feet.  All of these patients went on to eventually heal but it was a long course of healing.  Knowing this, recommending a heel spur surgery was not something that you'd recommend very often.  But you had to wonder why some people did so well while others took so long to heal.</p> <p>In the mid-1980s, I was fortunate to train in a new technique called endoscopic plantar fasciotomy (EPF.)  The EPF procedure was really quite an amazing advance compared to what I had learned in residency training.  The old heel spur resection was an open and very traumatic procedure.  The EPF, on the other hand, was performed through a 1cm incision.  Patients were able to walk on the surgery the same day and were usually back in a regular street shoe and just a Band-Aid within 3 days of surgery.  Amazing stuff.  And patients just came out of the woodwork to have this new procedure done.  The volume of patients that I saw enabled me to be witness to trends.  The most striking trend was in about 10% of patients who had post-op arch and foot pain.  These patients did very well with their surgery.  They followed the normal post-op course and were back in regular shoes, very pleased with their choice to have the surgery done.  As the incisions healed, patients would assume that the change affected by the surgery was also healed.  So at 4-6 weeks following their surgery they would resume their normal activities only to develop pain in the top and outside of the foot. </p> <p>When a patient consents to a surgery, they assume their doctor is fully aware of the possible risks and complications of the surgery.  And to a great extent, that's true in that the doctor has done a number of these surgeries and been able to witness the post-op course of the patients.  Although the EPF was a simple improvement of what had been performed for years, I now had a new problem that I couldn't explain to my patients.  I remember treating a male nurse who underwent his first EPF and was so pleased that he wanted to complete the surgery on his other foot.  So six weeks out on the first procedure I performed an EPF on his other foot.  And then things went bad.  As he returned to work and his normal activity level he developed pain in the arch and outside column of the foot (the foot can be split into a medial and lateral column).  He was obviously upset that this complication wasn't explained prior to surgery.  He ultimately ended up seeing another doctor for a second opinion.  The second opinion doctor obtained a bone scan that lit up in the midfoot.  Although a bone scan is nonspecific and cannot determine the reason for inflammation, it is a great test to find areas of inflammation.  What the bone scan suggested was that this patient had acute inflammation suggestive of a stress fracture.</p> <p>Why had he developed a stress fracture?  That got all of us early adopters of EPF surgery on the phone to share cases and discuss what was happening and why 10% of all of our cases were experiencing this same complication.  What we found was a similar pattern in every practice.  What we were seeing in EPF surgery was a complication that had been present all along.  Remember the subset of patients who underwent traditional heel spur surgery and took a year to heal?  That same complication was still present with the new advanced EPF procedure but now much more apparent due to the minimally invasive nature of the EPF procedure. </p> <h3>What is lateral column syndrome?</h3> <p>What we were seeing wasn't really a problem specifically due to the surgery.  Interestingly, what we were seeing was a complication that was indirectly related to the surgery.  This complication, what we now call lateral column syndrome (LCS), was a complication due to the biomechanical change that the surgery had caused.  The surgery, whether performed with the older open method or with the new EPF method changed the biomechanical function of the foot.  So as a patient started to use the foot the structural interface of the joints was different.  And that change created vague pain in the bones and the joints of the foot.</p> <p>Bones and joints can accommodate change but it takes time, usually in the range of weeks to months.  What we were seeing was a response of the bones and joints of the midfoot and lateral column of the foot to change.  And change it did not like.  Some patients described stiffness in the arch of the foot following EPF surgery.  But for this subset of 10% of our patients, the pain went way beyond stiffness.  It was pain that mimicked a fracture.  The pain improved with rest but hurt with weight-bearing and increased with the duration of time spent on the foot.  These symptoms are exactly what a person experiences with a stress fracture.  So we began to treat these cases as stress fractures using a walking cast and rest.  And most importantly, we reassured our patients that this was a new trend that we had identified with the use of our new, less traumatic approach.</p> <p>There's an important lesson to be learned here.  As patients, we tend to think in a linear manner.  We expect this symptom or limitation in the first-week post-op, this or that the second week and so on.  But when you're doing well and a new symptom occurs it'll throw that linear thinking for a loop.  That's why it's so important to prep your EPF patients pre-op and through the immediate post-op period to understand the symptoms of lateral column syndrome.  Although I have performed a lot of EPF surgeries my patients are by no means immune to LCS.  But when those patients fully understand the symptoms of LCS they're back in the office saying, "are the symptoms that you had told me about.  I'm glad you warned me about this."  These patients don't get upset.  They understand what lateral column syndrome is and why it may have occurred.  And we work together to get them better.</p> <p>Additional topics in the blog series include:</p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-history">Plantar fasciitis | History</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">Plantar fasciitis | Causes and contributing factors</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-pain">Plantar fasciitis | Differential diagnosis of heel pain</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatment">Plantar fasciitis | Conservative methods of care</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-treatment">Plantar fasciitis | Surgical treatment</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methods">Plantar fasciitis | Additional treatment methods</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:162https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methodsPlantar Fasciitis | Additional treatment methods<h1>Additional treatment methods for plantar fasciitis</h1> <p><img style="float: right;" src="/Content/Images/uploaded/Blog images/shoes-1031591_1280.jpg" alt="plantar fasciitis" width="300" /></p> <p>Let's say that you've had painful <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a> for at least 4 months that has failed to respond to traditional conservative care.  You've tried stretching, you've used heel lifts and you've had in-office physical therapy to include ultrasound and electric stimulation.  You've tried a night splint and have used your Rx orthotics religiously.  You've tried two cortisone shots and have been on an oral anti-inflammatory medication for several months. You've read a lot on the Internet and have a good understanding regarding the causes of plantar fasciitis.  But you're not a fan of surgery.  What can you do?  How can you treat plantar fasciitis without surgery?  There are actually a lot of options that are used as alternatives to surgery.  The problem with the alternatives though is that they are not consistently reliable.  Sure, surgery has its risks, but an endoscopic plantar fasciotomy has a successful and reliable outcome.  What about the 'other' treatments.  What are some of the alternatives?</p> <p>First, let's talk a little bit about why these alternative methods are used.  Some providers believe that the fascia simply shouldn't be cut.  Their belief is that once the fascia is cut it causes irreparable harm to the biomechanical function of the foot.  I can understand this logic.  From my perspective as a surgeon, I've seen my fair share of complications following endoscopic plantar fasciotomy (EPF).  Lateral column syndrome is what I consider to be the most unpredictable complication of EPF surgery.  Lateral column syndrome is pain the occurs as the patient begins to get active again following fasciotomy.  The pain of lateral column syndrome is much like a stress fracture.  In fact, that is how I describe this complication to my surgery patients. So in part, the 'save the fascia' approach to chronic plantar fasciitis is understandable.  Lateral column syndrome is not a common complication and occurs in up to 10% of endoscopic plantar fasciotomy patients.  Lateral column syndrome resolves with several months of care.</p> <p>Another consideration is the difference between plantar fasciitis and plantar fasciosis.  The suffice 'itis' denotes an acute, inflamed condition.  The suffice 'osis' denotes a 'condition of' where pain is still present but without the inflammatory component.  An interesting study was performed that sampled the tissue of the plantar fascia where the tissue was evaluated under a microscope to determine the number of inflammatory cells that were present.  What these researchers found was that over several months, the cell structure of tissue in the plantar fascia changed from acutely inflamed to showing fewer and fewer inflammatory cells.  The theory then is that in time (over months), plantar fasciitis changes from an inflamed condition to a non-inflammatory condition.  What these researchers recommended was to use treatment methods that re-initiated inflammation in the fascia.  By doing so, the body could then heal the condition as an acute condition.  I think it's an interesting theory, quite honestly.  And there's a number of ways to go about 'jumpstarting' the inflammation.  My impression is that the 'other methods' are primary used to spare the fascia and to restart the inflammatory component of plantar fasciitis. </p> <p>ESWT - Extracorporeal shock wave therapy is a sound wave that is used to treat plantar fasciitis.  Although there is no consensus as to how shock wave therapy works, I believe it to work by restarting the inflammatory component of fasciitis.  Shock wave therapy employs a pulsed ultrasound wave.  The shock wave therapy is performed under sedation at a surgery center or hospital.  Think of the shock wave as a punch, just like you took your fist and punched the heel, except that the ultrasound has the capacity to penetrate deep into tissue.  I trained some time ago in pulsed shock wave therapy and have used it on just a handful of patients.  The literature cites a success rate of about 60%. </p> <p>Platelet Rich Plasma (PRP) - Platelet-rich plasma is interesting in that it uses your own plasma to heal plantar fasciosis.  Serum is the liquid portion of your blood.  To use PRP, 50cc of your blood is drawn and placed in a centrifuge to spin off the cellular component of your blood.  The plasma is rich in platelets that contain human growth factor.  The plasma is then injected into the heel in the area of the plantar fasciosis.  PRP has been around for years but has failed to gain traction with providers.  PRP is not covered by insurance so it is typically a cash out of pocket procedure.  PRP has many applications including wound care and surgical closure.  Success rates vary and to date, the use of PRP is not consistently accepted as a reliable procedure in the treatment of plantar fasciitis and plantar fasciosis.</p> <p>Rolfing - Rolfing is deep tissue massage that is used to restart the inflammatory phase of plantar fasciosis.  Rolfing is a common practice in massage therapy and chiropractic offices.  I've not tried it in my practice - it sounded painful.  Rolfing is a manual massage method often performed with a knuckle of the finger. </p> <p>Topaz surgery - Topaz surgery was popular for a few years but I've not seen it used very often as of late.  Topaz employs a method called radiofrequency ablation.  The Topaz technique uses a wand about the size of a piece of spaghetti.  The wand is inserted percutaneously and when activated creates a small thermal burn at the site of treatment.  Again, this is a method of reinitiating the inflammatory component of plantar fasciitis.  And by doing so, you're calling on the chemical and cellular components of the body to heal plantar fasciitis.</p> <p>Needling or stippling - needling is used to jump-start inflammation.  The plantar heel is anesthetized with local anesthetic and a hypodermic needle is used to pierce the fascia.  This pierced fascia reinitiates the inflammatory process, changing the condition from plantar fasciosis to the acute form, plantar fasciitis. </p> <p>Tenex FAST - Tenex is a relatively new technique that uses ultrasound-guided, ultrasonic debridement of the fascia.  FAST stands for focused aspiration of scar tissue.  Tenex FAST is used to treat tennis elbow, shoulder pain, osteoarthritis of the knee and ankle, along with plantar fasciitis.  When we specifically speak of treating plantar fasciitis with the Tenex method, I think it's debatable whether the true action of the Tenex procedure is actually removal of scar tissue or re-initiation of the acute (fasciitis) stage of the condition from the dormant condition of fasciosis.  To date, the success rate of the Tenex FAST procedure has not been published in the literature.</p> <p>Heel pads with bars of varying density - one of the products that we sell on the site has gained very little attention but I think it's<a href="https://www.myfootshop.com/plantar-fasciitis-reliever"><img style="float: right;" src="/Content/Images/uploaded/949_Plantar_Fasciitis_Reliever.jpg" alt="Plantar Fasciitis Reliever" width="90" /></a> one of those sleeper products used to treat plantar fasciitis and plantar fasciosis.  It's called <a href="https://www.myfootshop.com/plantar-fasciitis-reliever">The Plantar Fasciitis Reliever</a>.  The Plantar Fasciitis Reliever uses three interchangeable bars of varying densities to 'massage' the plantar heel.  Honestly, I think the bars work to re-stimulate inflammation just like Rolfing.  Although it's not a particularly popular product, I think it's an innovative approach to the treatment of plantar fasciitis.  </p> <p>I'm sure that there are more methods that are being used to treat plantar fasciitis and plantar fasciosis that I'm not aware of.  I think the interesting thing about this though is that any time you see multiple treatment methods what you're actually seeing is a lack of consensus among providers.  If one method of treatment was universally reliable, we would all be doing the same thing.  But in the treatment of plantar fasciitis, that's not the case.  As I've mentioned in previous posts, it's important to speak with your doctor and see what their opinion is about these different methods.  Each has its pros and cons and it's important to see what your doctor feels is best for your case. </p> <p>Additional topics in the blog series include - </p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-history">Plantar fasciitis | History</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">Plantar fasciitis | Causes and contributing factors</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-pain">Plantar fasciitis | Differential diagnosis of heel pain</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatment">Plantar fasciitis | Conservative methods of care</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-treatment">Plantar fasciitis | Surgical treatment</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-complications">Plantar fasciitis | Surgical complications</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:161https://www.myfootshop.com/plantar-fasciitis-surgical-treatmentPlantar Fasciitis | Surgical treatment<h1>Surgical treatment of plantar fasciitis</h1> <p>Any discussion of surgery should begin with a careful review of the indications for the surgery.  Why are we doing the surgery? <iframe width="420" height="315" style="float: right; padding-left: 5px;" src="https://www.youtube.com/embed/oTLBoxeZoRs" frameborder="0" allowfullscreen="allowfullscreen"></iframe>What do we stand to gain?  What are the risks of the surgery?  As a podiatrist, I'll occasionally perform a surgery for cosmetic reasons, but those procedures are few and far between.  The primary indication for foot surgery is pain that has not responded to conservative care or restoration of function (broken bone).  How do we define pain and how long do we provide conservative care prior to suggesting surgery?  As a community, doctors often speak about the decision making in medicine and surgery being based on what is called the community standard.   Think of the community standard as what might be the average of decision making.  Where one surgeon might be quick to go to surgery with a plantar fasciitis patient following two months of conservative care, there will be others who would wait longer and go to surgery at 6 months.  In the literature, I think you'll find the community standard for moving from conservative care of plantar fasciitis to surgical care will be about four months of conservative care.  Simply put, you need to complete about four months of conservative care prior to initiating a discussion on surgical care of plantar fasciitis.  I think you can see that there's a lot of leeway here for give and take.  As an example, I've been in practice long enough to see patients who come back to have a second case of plantar fasciitis treated.  In their first case, they completed four months of conservative care and then had to have surgery.  Most of these patients say, "Doc, do I really have to go through all that stretching and shots?  It didn't work last time.  Can't we just do the surgery?"  I need to stress with these patients that conservative care really does work.  They still need to go through at least a trial period of three months.  And if I start to see a lack of response to conservative care, will I lower the threshold to 3 months before going to surgery?  Probably.</p> <h2>Indications for plantar fasciotomy</h2> <p>When you fail to respond to the conservative treatment of plantar fasciitis and you're considering your remaining options for care there's actually a lot of options to choose from.  In my next blog post I'll discuss what I call the 'other choices', but for this blog post, I'd like to focus on a surgical procedure called a fasciotomy.  The term fasciotomy describes a cut made in the fascia.  And in this case, since we are discussing the plantar fascia, this procedure is called a plantar fasciotomy.  This cut or release of the plantar fascia is made at the insertion of the fascia on the bottom of the heel.  The choice of this location for the fasciotomy is logical in two respects.  First, the plantar heel is the primary location of pain found in most cases of plantar fasciitis.  But another reason that the fasciotomy is performed here is that there is a lot of tissue to work with.  The plantar fat pad of the heel is thick enough to accommodate the surgical equipment used to complete the fasciotomy. </p> <p>I trained in the early eighties and during those years I can honestly say that I did some terrible things to patients with plantar fasciitis.  When you read my prior post on the history of the treatment of plantar fasciitis, you'll see that the thinking among docs in the '80s was still that the spur was the primary surgical objective.  Heel spur surgery was all about hammers and chisels.  It was pretty rough.  An in those days, you really didn't recommend surgery until you had 6-12 months of conservative care knowing that the surgery was so tough on patients.  But I was fortunate to be one of the early adopters of endoscopic plantar fasciotomy surgery.  I honestly think that this transition from open to the endoscopic technique was the single biggest advance in foot care during my career. </p> <h3>Endoscopic plantar fasciotomy - surgical technique</h3> <p>A plantar fasciotomy can be performed in a number of ways.  My preferred technique is a two-incision approach.  A 1cm incision is made on the medial aspect of the heel.  The location of the incision is away from the weight-bearing portion of the foot and adjacent to the location where the fascia attaches to the medial tubercle of the heel bone.  I'll always measure 2cm up from the plantar aspect of the foot and 5cm from the posterior heel.  Another rule of thumb is 2 fingers up and 5 fingers in from the posterior heel.  The incision is bluntly dissected with a hemostat and an obturator and cannula inserted.  The cannula is about the size of a large drinking stray (5mm).  The cannula is a large tube that is used to create a space for the camera.  But to get the cannula in the correct space, a tool called an obturator is inserted in the cannula.  The obturator is a blunt rod that fits within the cannula.  Both the obturator and cannula are inserted into the incision and used to bluntly dissect a path on the plantar heel superficial to the fascia.  When the obturator reaches the lateral wall of the heel, a second 1cm incision is placed on the lateral wall of the heel, 2cm up from the plantar surface.  The obturator is removed and suction used to remove any residual fat from within the cannula.  The cannula has an open slot running along one side so that when the obturator is removed and the 4mm endoscope (camera) is inserted, you can visualize the fascia through the slot in the cannula.  And to make viewing even easier, the tip of the camera is angled by 30 degrees.  Face the 30-degree angle towards the slot and you are able to see the fascia.  The fascia is made of three segments, a medial, central and lateral segment.  Although you cannot really differentiate these segments, the inside of the cannula is marked and helps to guide the portion of fascia on which you are going to perform your fasciotomy.  Another trick that I use is to place my thumb on the edge of the blade handle and measure the depth of the blade on the outside of the heel.  I'll hold my thumb in that place and then re-insert the blade into the cannula.  My objective is to perform a fasciotomy on only the medial 50% of the fascia.  So by measuring the depth of the blade on the outside of the heel and then re-inserting the blade into the cannula, I'm somewhat guaranteed to know how much of the fascia that I'm releasing. </p> <p>As you complete the fasciotomy you'll see the muscle belly of the flexor hallucis brevis (FHB) muscle.  The fascia is very white and the muscle a deep red.  It is very obvious when the cut is compete.  Once you see the FHB and you've released 50% of the fascia, your job is done.  The endoscope is removed and sterile saline solution is used to flush the site, removing any loose tissue or debris from the surgery.  The obturator is re-inserted and the obturator and cannula are removed.  A single suture of 4-0 nylon is used to reappose skin edges at the incision site.  A dry dressing is applied.</p> <h4>Endoscopic plantar fasciotomy - post-op care</h4> <p>My post-op course of treatment is to keep the original bandage in place for 3 days.  At three days I see the patient in the office for follow-up at which time the patient can wear a normal, loose-fitting shoe.  Simple Band-Aids are used to cover the incisions.  Showers are OK but no swimming or hot tubs until the sutures come out.</p> <p>There are a number of variations of this procedure.  Some doctors use a 1 incision approach.  Others use a direct plantar approach with a plantar incision.  Some use a larger medial incision and use scissors to cut the fascia.  And other doctors refuse to perform the procedure saying that it is unnecessary.  Like so many other aspects of medicine, you need to have an honest discussion with your doctor about what works best in his or her hands.  For me, endoscopic plantar fasciotomy is a very useful part of my toolbox for treating cases of plantar fasciitis that fail to respond to conservative care.  In your case, talk to your doctor and see what he or she thinks may work best for you. </p> <p>Additional topics in the blog series include - </p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-history">Plantar fasciitis | History</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">Plantar fasciitis | Causes and contributing factors</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-pain">Plantar fasciitis | Differential diagnosis of heel pain</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatment">Plantar fasciitis | Conservative methods of care</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methods">Plantar fasciitis | Additional treatment methods</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-complications">Plantar fasciitis | Surgical complications</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:159https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatmentPlantar Fasciitis | Conservative methods of treatment<h2>Plantar fasciitis - conservative care</h2> <p>When we start to develop a treatment plan for <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a> it's important to go back and re-read my prior post on the <a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">causes and contributing factors for plantar fasciitis</a>.  In that post you'll see that plantar fasciitis is an overuse syndrome caused by the calf.  Our goal in treatment is to break into that re-injury cycle and make a subtle change in how the leg, ankle and foot work with each step.</p> <p>In a case of plantar fasciitis that is only 4-6 weeks old, I always start my patients on a program of calf stretches.  From experience<a href="https://www.myfootshop.com/calf-wedge-stretching-block"><img style="float: right;" src="/Content/Images/uploaded/857_Calf_Wedge_Stretching_Block.jpg" alt="Calf stretching block" width="90" /></a> over the years I've learned that many patients don't expect to be given a physical therapy assignment.  That's work and who wants to do that, right?  So I stress the importance of stretching with my patients.  Is stretching your calf in bed before you get up adequate?  Not at all.   I like to get my patients using a <a href="https://www.myfootshop.com/calf-wedge-stretching-block">stretching block</a>.  The stretching block makes a patient feel committed to the stretches.  The stretches are simple, you just stand with the ball of the foot up on the block for a minute.  With the first stretch of the day the calf will contract and tighten.  With the second stretch it'll loosen a bit.  And by the 6th stretch of the day the calf will actually start to lengthen.  Frugal guy that I am I used to have patients stretch on a step or book.  But I found without the commitment of the stretching block they would invariably come back saying that they forgot to stretch.  Another common response I hear from patients is, "I remember how you told me to stretch but what I've been doing is..."  No.  You need to really do the 6 stretches per day for a minute each time.</p> <h3>Plantar fasciitis -stretching and heel lifts</h3> <p><a href="https://www.myfootshop.com/plantar-fasciitis-night-splint"><img style="float: left;" src="/Content/Images/uploaded/906_Plantar_Fasciitis_Night_Splint.jpg" alt="Plantar fasciitis night splint" width="90" /></a>So what if the patient won't stretch?  That's when I move into a <a href="https://www.myfootshop.com/plantar-fasciitis-night-splint">stretching splint</a> or <a href="https://www.myfootshop.com/dorsal-night-splint-for-plantar-fasciiitis">night splint</a>.  Stretching by day is easy and cheap.  Stretching with a night splint is the same thing except you need to buy a splint.  Another option is physical therapy.  I think PT is a great way to motivate and educate patients. </p> <p>The other important component of care for treating patients newly diagnosed with plantar fasciitis is understanding that low heels are bad and higher heels are good.  Remember the old folk remedy of the cowboy boot that I spoke of in an earlier post?  The cowboy boot simply elevated the heel which weakens the calf.  When you weaken the calf<br /> you decrease the amount of force delivered by the calf to the heel and fascia.  Do you need a cowboy boot - no, not at all.  But the example is used to stress the importance of not going barefoot and wearing a heel lift.  <a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork">Cork heel lifts</a> can be<a href="https://www.myfootshop.com/heel-lifts-for-plantar-fasciitis-cork"><img style="float: right;" src="/Content/Images/uploaded/Products/677_Heel_Lifts.jpg" alt="Heel lifts for plantar fasciitis" width="100" /></a> trimmed with scissors to fit in about any shoe.  Another important distinction to make is the difference between a heel lift and a <a href="https://www.myfootshop.com/reusable-gel-heel-cushions">heel cushion</a>.  Lifts are firm and cushions are soft.  A lift is used to weaken the calf by elevating the heel.  A cushion can't do that.  Although many products are marketed as 'used to treat plantar fasciitis' they are cushions and just don't hit the mark in how plantar fasciitis should be treated.  The most popular cushion I see is grey and blue 'plantar fasciitis cushion made by Dr. Scholl's.  If you're reading this article, I'll bet you're either wearing one or have looked at them in the foot care section of your drug store or at Wal-Mart.  Right?  Remember, cushions may feel good but you need a lift to break the re-injury cycle.</p> <p>In my experience, if you have a motivated patient who wears the lifts, avoids going barefoot and does their stretches 6/day, you'll see 7/10 patient will have a significant improvement with their <a href="https://www.myfootshop.com/article/heel-pain">heel pain</a>.  But what if there's no improvement?  The next step I use is injectable cortisone.  The cortisone that your doctor will use is a synthetic analog of what your body actually produce on a daily basis.  There's a number of different types of cortisone.  Some are long acting, some short acting.  With experience, your doctor has found what mixture of cortisone works best.  Doctors are a bit like bartenders in this regard, mixing what we call the perfect 'cocktail' of steroids.  I tell my patients that I'm mixing up and injecting into one spot about the same amount of cortisone that you would produce on a normal day.  It's just that I concentrate that dose in one location.  Cortisone acts as an anti-inflammatory agent.  There may be some soreness following the injection, just like a flu shot or immunization.  But what we're looking for is the response over the next 3-5 days.  Cortisone has the potential to decrease the inflammation associated with plantar fasciitis and relieve pain. </p> <h3>Plantar faciitis - cortisonwe injections</h3> <p>Does cortisone work in every case of plantar fasciitis?  No.  But is works consistently well.  It's important to remember that a cortisone shot is not a substitute for the stretches and heel lifts.  Cortisone is used to supplement that mainstay of care - stretching and heel lifts.  Although the number of cortisone injections given by any doctor may vary, in my practice I'll try two separated by about 3-4 weeks.  Excessive use of cortisone in the treatment of heel pain may result in fat pad atrophy of the plantar heel.  There's no rule book for the use of cortisone and even more ironic is the fact that there's not literal guide for how much cortisone to use.  Doctors just rely on their training and prior experience to judge the frequency and dosing of cortisone injections.</p> <p><a href="https://www.myfootshop.com/carbon-fiber-foot-orthotics-full-length"><img style="float: left;" src="/Content/Images/uploaded/sport-carbon-fiber-orthotics-full-length.jpeg" alt="Carbon fiber orthotics" width="90" /></a>So we've helped 7/10 patients with stretches and heel lifts.  I'd say another 1 or 2 patients will respond to cortisone.  So that leaves another 1 or 2 patients who still hurt.  This is where it gets harder to see progress.  These patient who fail to respond to care are often the patients who have had plantar fasciitis for a long time, greater than 6 months.  What do we do next?  First and foremost is to stress the need for a heel lift and continued stretching (don't give that up yet).  I'll often prescribe an <a href="https://www.myfootshop.com/insole-arch-supports-casual">orthotic</a> at this stage.  I'll incorporate a heel lift in the orthotic to be sure we get the lift under the heel that we need.  Orthotics will act to support and rest the fascia. </p> <p>The final consideration in treating plantar fasciitis is time.  Most cases of plantar fasciitis will respond in time.  It's not easy to remember this when every step hurts.  To explain this a little more, let me tell you a story about a patient I saw several years ago.  The patient was a woman in her mid fifties.  She had failed all conservative care and we had begun talking surgery to fix her plantar fasciitis.  And then she disappeared from my practice.  She came back in several years later with a problem unrelated to heel pain, a nail problem as I recall.  Going back through her chart I noticed we had been talking about surgery for her plantar fasciitis.  She said, "Oh that.  That's gone.  When you started talking about surgery I wasn't interested in doing that so I got options from 4 other doctors.  The first three all had different opinions.  The fourth doctor asked me to tell him more about the stretches that Dr. Oster had recommended.  I answered honestly that I hadn't really done them.  He recommended that I do 8 stretches a day.  I did that and the pain went away."  Imagine that.</p> <p>Additional topics in the blog series include - </p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-history">Plantar fasciitis | History</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">Plantar fasciitis | Causes and contributing factors</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-pain">Plantar fasciitis | Differential diagnosis of heel pain</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-treatment">Plantar fasciitis | Surgical treatment</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methods">Plantar fasciitis | Additional treatment methods</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-complications">Plantar fasciitis | Surgical complications</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Director<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:158https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-painPlantar Fasciitis | Differential diagnosis of heel pain<h2>Plantar fasciitis - differential diagnosis</h2> <h2> </h2> <p>As a clinician who treats <a href="https://www.myfootshop.com/article/heel-pain">heel pain</a>, one of the things you really need to be careful about is the fact that not all heel pain is <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar <img style="float: right;" src="/Content/Images/uploaded/Medical/Ortho/plantar_fasciitis.jpg" alt="plantar fasciitis" width="250" />fasciitis</a>.  I'll grant you the fact that the vast majority of plantar heel pain is indeed plantar fasciitis.  But heel pain can be so many things.  Let's talk a bit about the differential diagnosis for plantar fasciitis.</p> <p>We talked a bit in a previous blog post about the onset and symptoms of plantar fasciitis.  The symptoms are classic and rarely vary.  Patients who suffer from plantar fasciitis are usually between the ages of 35-65 years of age and may be just a bit overweight.  Patients describe plantar (bottom of the heel) pain with initial weight-bearing.  After a few steps, the heel pain subsides and gets a bit better, sometimes even going away for a while.  But sit again and try to stand and the plantar heel pain is right back.  The pain is often described as stepping on broken glass.  Getting out of bed in the morning is one of the worst times of the day.  As the duration of plantar fasciitis increases most patients will find the symptoms also become bad in the afternoon and evening after standing for a period of time.  This pain is a bit different.  Patients describe this pain not as sharp but more dull, like being hit in the heel with a hammer. </p> <p>Patients suffering from plantar fasciitis also described good days and bad days.  In the prior blog post, I discussed why this would happen.  I've described plantar fasciitis as an overuse syndrome.  So if you overuse it on a Monday you can expect Tuesday morning is going to be a tough day getting out of bed.  Rest on Tuesday and Wednesday is going to seem like a better day. That's just the nature of an overuse syndrome.  As an overuse syndrome, that's the roller coaster of plantar fasciitis.</p> <h3>Plantar fasciitis - what else could it be?</h3> <p>So if the pain isn't plantar fasciitis, then what else could it be?  What other plantar heel pain problems do we need to rule out?  Fat pad atrophy is a common complaint, particularly in older patients.  With fat pad atrophy you can actually palpate (feel) the plantar tubercles of the calcaneus (heel bone).  The pain of fat pad atrophy isn't so focused on initial weight bearing but seems to become a bit worse on hard floors while barefoot.  Cushion under the heel will help to cushion the heel bone.  When that cushion is gone, there's no cushion to protect the calcaneus.  Like plantar fasciitis, the pain of fat pad atrophy will respond to rest. </p> <h3>Baxter's nerve entrapment</h3> <p>Another problem that can cause plantar heel pain is a nerve entrapment called <a href="https://www.myfootshop.com/article/baxters-nerve-entrapment">Baxter's nerve entrapment</a>.  Baxter's nerve is the first branch of the posterior tibial nerve as it triforcates (splits into three branches) at the level of the medial ankle.  Baxter's nerve supplies sensation to the plantar heel.  The symptoms of Baxter's nerve entrapment are a bit different than those of plantar fasciitis.  Where plantar fasciitis causes heel pain with initial weight bearing, Baxter's nerve entrapment has no pain with initial weight-bearing.  But with Baxter's nerve entrapment pain will increase with the duration of weight-bearing.  Simply put, the longer you stand the more it hurts.  Another symptom of Baxter's entrapment that differentiates it from plantar fasciitis is the fact that Baxter's nerve entrapment continues to hurt once you're off your feet.  Plantar fasciitis, on the other hand, will respond very quickly to rest.  Baxter's nerve entrapment may also cause numbness of the plantar heel.</p> <h4>Calcaneal stress fracture</h4> <p><a href="https://www.myfootshop.com/article/calcaneal-fractures">Stress fractures of the calcaneus</a> (heel bone) are another problem to be ruled out in the differential diagnoses of heel pain.  Calcaneal stress fractures may be due to a traumatic injury like a fall from a height or an auto accident, but the more common onset of calcaneal fractures is due to the onset of a new activity.  The onset of basketball season or the patient who decides to start a new running program are the more common examples of what may cause a calcaneal stress fracture.  Calcaneal stress fractures often have pain with initial weight bearing but not necessarily focused on the plantar heel.  Pain can be elicited by compressing the body of the heel (side to side pressure).  Swelling may be present but is not always the case.  Pain with calcaneal stress fractures doesn't respond to rest.  Often x-rays will fail to show changes in the heel bone to indicate a stress fracture.  An MRI is often needed to visualize bone edema (swelling) in the bone that defines the fracture.</p> <p>There's a number of other less common problems that cause heel pain.  <a href="https://www.myfootshop.com/article/achilles-tendonitis">Achilles tendonitis</a> and <a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's disease</a> are posterior heel problems and difficult to confuse with the classic symptoms of plantar fasciitis (plantar heel pain).  Heel pain in an adolescent patient is often <a href="https://www.myfootshop.com/article/severs-disease">Sever's disease</a>.  And again, it's rare to see cases of plantar fasciitis in teens.</p> <p>Although x-rays are not regularly used in making the diagnosis of plantar fasciitis (remember, plantar fasciitis is a soft tissue problem), x-rays are indicated when there is a suspicion of stress fractures or bone tumors.  Bone scans are able to define areas of inflammation but cannot specifically define a fracture from say arthritis or osteomyelitis (bone infection) of the heel.  Bone scans are used to determine if there is indeed an inflammatory component to a problem.  MRI is often used to be the tie-breaker when compared to a bone scan in that the MRI is able to be more specific in terms of fracture or swelling.  CT scans are also often used in differentiating the diagnosis of heel pain when fracture of the heel is suspected.</p> <h5>Reiter's syndrome and rheumatoid arthritis</h5> <p>A complete review of the differential diagnosis of heel pain wouldn't be complete without mentioning types of heel pain that are arthritic in nature.  <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">Reiter's syndrome</a> is an uncommon diagnosis in my practice.  I have seen several cases of <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">rheumatoid arthritis</a> that initially presented with plantar heel pain.</p> <p>So is it plantar fasciitis or something else?  If the symptoms that you're experiencing don't seem to follow any of these typical patterns, it might be wise to have a conversation with your podiatrist or orthopedist regarding the differential diagnosis of heel pain.</p> <p>Additional topics in this blog series include-</p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-history">Plantar fasciitis | History</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">Plantar fasciitis | Causes and contributing factors</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatment">Plantar fasciitis | Conservative methods of care</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-treatment">Plantar fasciitis | Surgical treatment</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methods">Plantar fasciitis | Additional treatment methods</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-complications">Plantar fasciitis | Surgical complications</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:157https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factorsPlantar Fasciitis | Causes and contributing factors<p><a href="https://www.myfootshop.com/article/plantar-fasciitis"><img style="float: right;" src="/Content/Images/uploaded/Blog images/foot_finder.jpg" alt="Foot diagnosis tool" width="262" height="183" /></a></p> <h2>Plantar fasciitis - causes</h2> <p>One of the most interesting findings about <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a> is that the condition is an overuse syndrome specific to an aging yet active patient population.  I can't recall ever seeing a case of plantar fasciitis in a child under the age of 20.  And nor do you see plantar fasciitis in the elderly.  The vast majority of cases of plantar fasciitis that I treat are in patients who are between the ages of 35 and 65 years of age.  These folks are typically active, not necessarily runners or athletes (although some are).  Usually, these are patients who enjoy working in the yard on weekends, they go for walks and haven't slowed down in their lives at all.  They really share no common denominator in terms of their chosen employment or level of physical activity.  I see plantar fasciitis in patients who are office workers, factory workers, lawyers, and pizza shop owners.</p> <h3>Plantar fasciitis - tissue elasticity</h3> <p>What these patients do have in common is a loss of tissue elasticity.  Tissue elasticity is that ability of tissue to accept a load, perform a task and heal within a 24hr period so that you're ready to repeat the same activity the next day.  To illustrate this point, let's use a really simple example.  When you're in your 20's you're able to be active and participate in so many things.  You may be on the local softball team.  You play soccer with your kids and you can go out and work all day in the yard.  But as you get into your 40's and 50's things start to change.  Last year you got injured playing softball so you bailed out on the team knowing that you just don't have the stamina and ability to heal like you used to.  Your kids are in high school and now you go watch their games instead of actually playing with them.  And yard work?  It's not getting any easier.  After a big Sunday in the yard, you're stiff until Tuesday or Wednesday.  All of this is due to a loss of tissue elasticity.  You just cannot rebound as quickly as you used to be able to.  And that's part of the key to understanding plantar fasciitis.  The injury that causes plantar fasciitis is simple enough - walking.  With each step, the calf muscle delivers a force through the Achilles tendon into the heel, and the plantar fascia carries the force to the ball of the foot where the 'action of walking' takes place.  The injury to the plantar fascia that caused plantar fasciitis is actually due to the inherent mechanical stress placed on the fascia with simple walking.  The tissue elasticity of the fascia has decreased to a degree that it is susceptible to injury from a benign activity like simple walking.  Not recognizing the fact that we are recreating the injury each day, we continue with our normal activities and wonder why we ever got plantar fasciitis in the first place and why it won't go away.  An important part of treating plantar fasciitis is breaking into that cycle of re-injury.  That cycle of re-injury is what we call an overuse syndrome.</p> <p>I became very interested in this topic about 20 years ago and did a fair amount of original research on lower extremity biomechanics.  My goal was to quantify the amount of force that was generated by the calf and delivered to the foot during gait.  I called the project <a href="https://www.myfootshop.com/article/ct-band-syndrome">CT band syndrome</a>, CT referring to calf-to-toes.  The topic proved to be somewhat challenging from the standpoint that the leg ankle and foot are in a constant state of change during gait.   The leg, ankle, and foot are a lever that functions in the sagital plane.  Think of other examples of levers that you may use in your daily life.  A pry bar is a good example.  If you want to move a rock in your yard, you find a small rock that you place adjacent to the large rock to use a fulcrum.  So the long arm of the pry bar is the effort arm and the short arm is the resistance arm.  The small rock is the fulcrum.  If we translate this lever knowledge to the CT band, the calf is the effort arm, the ankle is the fulcrum and the foot is the resistance arm.  Levers need to function in one plane.  Think of how that pry bar works.  The pry bar cannot be curved or in an S shape.  It needs to be straight and move in one direction (a single plane.)  The same holds true for the CT band.  Although I think the CT band concept is interesting and I did <a href="https://faoj.org/2009/05/01/the-ct-band-ct-band-biomechanics-and-ct-band-syndrome/">publish in a peer-reviewed journal</a>, the topic never really gained much traction in the literature.  For those of you who are bio-engineers, you might want to take a peek at these links to better understand the mechanical aspects of CT band syndrome and how it relates to plantar fasciitis.</p> <p>Simply put, plantar fasciitis is due to mechanical load applied through the CT band that results in an injury to the insertion of the plantar fascia on the plantar aspect of the heel.  When we talk about treatment, you'll see how weakening the force of the calf is key to breaking into the overuse syndrome of plantar fasciitis.</p> <h3>Plantar fasciitis - contributing factors</h3> <p>What are some of the contributing factors to plantar fasciitis?  Put your bio-engineer hat back on for a second and think about the concept of work.  Work is the amount of action that a structure performs.  And when something contributes to or increases the amount of work or the duration of work performed, it has the potential to contribute to the problem.  The work that the CT band performs is to deliver force from the calf to the ball of the foot.  Think of walking as a controlled forward fall.  The CT band slows that forward fall.  And in running the CT band actually pushes off, rapidly pushing your center of mass forward.  The more bodyweight that the CT band has to manage, the more work it has to perform.  As such, obesity is a contributing factor to plantar fasciitis.  Other contributing factors include age, increased duration of time spent on the feet and any condition that would result in loss of tissue elasticity.  The primary contributing factor that causes loss of tissue elasticity is age.</p> <p>Most importantly, remember that plantar fasciitis is an overuse syndrome caused primarily by the calf muscle.  Contributing factors include age and obesity.</p> <p>Additional topics in this blog series include - </p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-history">Plantar fasciitis | History</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-pain">Plantar fasciitis | Differential diagnosis of heel pain</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatment">Plantar fasciitis | Conservative methods of care</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-treatment">Plantar fasciitis | Surgical treatment</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methods">Plantar fasciitis | Additional treatment methods</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-complications">Plantar fasciitis | Surgical complications</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:156https://www.myfootshop.com/plantar-fasciitis-historyPlantar Fasciitis | History<h2>Plantar fasciitis - history</h2> <p>Let's talk a little bit about <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a>.  I'd like to get away from the traditional educational format and have a conversation <a href="https://www.myfootshop.com/article/plantar-fasciitis"><img style="float: right;" src="/Content/Images/uploaded/Medical/X-ray/xray_heel_spur_mod.jpg" alt="Heel spur" width="300" /></a>about plantar fasciitis, touching on some of the subtleties of the condition.  Let's break this conversation into four parts; the history of plantar fasciitis, what causes plantar fasciitis (etiology), the differential diagnosis of heel pain and treatment options for plantar fasciitis.  I'll relay some of my experiences in treating plantar fasciitis over the past 30 odd years.</p> <p>As a point of reference, there are two things I'd like to mention before getting into the details of plantar fasciitis.  First, plantar fasciitis is one of the most common foot conditions that I see as a foot care specialist.  Heel pain will be the single most common complaint in a podiatrist's office.  Granted, not all heel pain is plantar fasciitis.  And that's where the art of medicine comes into play.  And we'll address the differential diagnosis for heel pain in a following blog.  And second, there's a lot of misunderstanding and misconceptions regarding the causes and subsequently the treatment of plantar fasciitis.  We'll address these misconceptions in the blog to follow on treatment of plantar fasciitis.  But first, let's talk about the history of plantar fasciits.</p> <p>When I'm working with a patient and trying to help them understand a condition, I like to tell stories.  Stories convey information in an informative way that people can remember.  Stories have been used for thousands of years to illustrate life. The story I tell my patients to illustrate the history of plantar fasciitis goes back to more than 100 years ago.  There were a number of patients who went to the local family doctor to ask why their heels hurt.  The patients described a classic set of symptoms that went something like this, 'When I try to stand, particularly in the mornings getting out of bed or after I've been sitting for a bit, I get a sharp tearing pain in the bottom of my heel.  Some days it seems as if it's getting better but then the next day it seems to get worse again.  It's always relieved by rest.'  The doctor proudly said, "Fortunately you've come to the right place.  I keep up on the latest developments in medical science and invest in the latest technology.  Did you know that we are the only practice in town that offers a new test that can actually see your bones?  This new test is called an x-ray machine."</p> <p>X-rays were taken that day and the doctor was surprised to see that many (not all) of the patients with this unique collection of symptoms showed evidence on the bottom of the heel of a projection or what appeared to be a spur on the bottom of the heel.  Assuming that the primary problem was due to this spur on the bottom of the heel, the doctor called the patient back into the office to proudly tell them that his new x-ray machine had made the diagnosis.  They had a heel spur.</p> <p>Well, not so fast.  This doctor actually did some bad science.  Bad science is when you jump to a conclusion.  Good science, on the other hand, is when you compare two populations of patients, one group who has the symptoms and another group who do not.  Had this doctor done good science and studied similar populations of people in terms of age and weight, he would have been surprised to find that many patients who have heel pain have no heel spur.  And even more surprising, just as many of the group that had no heel pain actually had heel spurs.  Are you following me here?  It's not an x-ray that makes the diagnosis.  The presence or the lack of a spur on x-ray means very little.  And that's because the primary problem is not bone, it's soft tissue.  Fast forward to today - many insurance companies will not pay for x-rays when the accompanying diagnosis is plantar fasciitis.</p> <p>So now let's go back to maybe 30-40 years ago.  We have two camps of providers.  Some doctors still are holding fast to the diagnosis of a heel spur.  In doing so, they treat patients with horseshoe pads, donut pads, and cushions.  When the pain fails to respond to conservative care, their surgical treatment is to resect the heel spur with a hammer and chisel.</p> <p>But there was also a growing camp of providers who suspected that the primary problem was not bone at all but actually soft tissue.  A band of tissue called the fascia attaches to the exact location of the spur on the bottom, or what is referred to as the plantar surface of the heel.  From an anatomical standpoint, since this band of fascia is located on the plantar surface of the foot it is called the plantar fascia.  This group of doctors suspected that the plantar fascia was inflamed.  In medical jargon, when a tissue structure is inflamed we use the suffix 'itis'.  Think appendicitis, bronchitis, arthritis - follow?  So in this case, the soft tissue etiology of these unique heel pain symptoms was called plantar fasciitis.</p> <p>Medical dogma is slow to change.  Doctors look first to their peers for trends and second to the literature for confirmation of these trends.  I was fortunate to be a part of this bone vs soft tisse trend in the late 1980s and early '90s.  I was invited by Steve Barrett, DPM to use his new, patented procedure called the endoscopic plantar fasciotomy.  Steve's idea was to treat plantar<iframe width="420" height="315" style="float: right;" src="https://www.youtube.com/embed/oTLBoxeZoRs" frameborder="0" allowfullscreen="allowfullscreen"></iframe> fasciitis with a minimally invasive procedure that simply cut the fascia at it's insertion to the bottom of the heel.  Steve's idea was revolutionary, both philosophically and technically.  It required doctors to have a new way of thinking and a new technical skill.  As <br />Steve tells the story, he was waiting for a friend to go play tennis.  His buddy was a hand surgeon who was finishing an endoscopic carpal tunnel surgery.  While Steve watched the procedure, he thought - why couldn't I apply the same technology to performing an endoscopic plantar fasciotomy?  Fortunately, Steve was an innovator and risk-taker. Steve works out the kinks in the procedure and began to teach others.  He published in peer-reviewed journals and still medical dogma was slow to change.  Today endoscopic plantar fasciotomy is commonly used and even has it's own CPT code for billing purposed.  Steve was the driving force behind legitimizing the concept of fasciotomy vs spur resection.  He proved that the primary problem is not a bone spur but instead a soft tissue problem we now call plantar fasciitis. </p> <p>Additional blog topics in this series include -</p> <p><a href="https://www.myfootshop.com/plantar-fasciitis-causes-and-contributing-factors">Plantar fasciitis | Causes and contributing factors</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-differential-diagnosis-of-heel-pain">Plantar fasciitis | Differential diagnosis of heel pain</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-conservative-methods-of-treatment">Plantar fasciitis | Conservative methods of care</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-treatment">Plantar fasciitis | Surgical treatment</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-additional-treatment-methods">Plantar fasciitis | Additional treatment methods</a><br /><a href="https://www.myfootshop.com/plantar-fasciitis-surgical-complications">Plantar fasciitis | Surgical complications</a></p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:153https://www.myfootshop.com/why-business-partners-matter-the-us-post-officeWhy business partners matter – the US Post Office<p><img style="float: right;" src="/Content/Images/uploaded/Blog images/packages to ship1.jpg" alt="" width="210" height="296" /></p> <p>We had a meeting with our rep from one of our most important business partners today: the US Post Office. Cynthia has been a great resource for us over the years. Even though she is retiring in 3 days, she drove out to see us and to have one last meeting to introduce us to our new rep, Carl. So helpful!</p> <p>The USPS is one of our most important business partners because it serves our needs on several levels.</p> <ul> <li> <p>First, they provide very economical rates for our customers. Since most of our products are small and don’t weigh very much, USPS is a far better economic choice than UPS or FedEx.</p> </li> <li> <p>Second, the speed with which packages get delivered, whether with First Class Parcel, Priority or Express mail, is consistently faster than the other options.</p> </li> </ul> <ul> <li> <p>Third, they provide some of our shipping boxes and envelopes free of charge, which helps to keep our prices down.</p> </li> <li> <p>Every package we ship through USPS is trackable, even the 1<sup>st</sup> class boxes. This helps keep our shipping process transparent and allows our customers to see exactly where their package is once it leaves our hands.</p> </li> </ul> <p>Every year we review rates and compare them to UPS and FedEx, and every year we stick with the Post Office. Even when rates go up on occasion, the price of shipping through the Post Office is still well below the other options.</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)</p> <p>4/23/2021 Update</p> <p>We all know that USPS has been challenged as of late with delayed deliveries and lost packages.  We continue to compare  delivery options and remain with USPS for most methods of shipping.  We are optimistic that USPS will improve services here in the near future.</p> <p>9/9/2021</p> <p>There have been improvements in delivery times at the U.S. Post Office ~ our postal workers have been working hard during the covid-19 pandemic and associated supply chain and staffing issues. We are so very thankful!</p>urn:store:1:blog:post:148https://www.myfootshop.com/bunions-and-hammer-toe-productsHammer Toe and Bunion Products<h2>Hammer toes - products for treatment</h2> <p>In the previous blog post we talked a bit about the pathomechanics of a <a href="https://www.myfootshop.com/article/bunion">bunion</a> and overlapping second <a href="https://www.myfootshop.com/article/hammer-toes">hammer toe</a>, but we didn't talk about any ways that we might be able to treat the overlapping second toe.  Here are a few suggestions.</p> <p><a href="https://www.myfootshop.com/toe-straightener-single-toe"><img style="float: left;" src="/Content/Images/uploaded/Blog images/706_Toe_Straightener_Single_Toe.jpg" alt="Toe Straightener" width="90" /></a>First and foremost my choice to control the second toe would be to use a <a href="https://www.myfootshop.com/toe-straightener-single-toe">Toe Straightener</a>.  In this particular case, the single Toe Straightener would suffice.  Although the Toe Straightener will not actually correct the toe, it will keep the toe in place.  The single Toe Straightener works particularly well since it's anchored to the plantar pad.  Anchoring the toe in this way limits the ability of the toe to overlap the great toe.  Alternatively, <a href="https://www.myfootshop.com/3pp-toe-loops">Toe Loops</a> could be used or even <a href="https://www.myfootshop.com/double-stall-tubular-foam-toe-bandage">Double Stall Tube Foam</a>.  I tend to find that your personal favorite might vary.  Fortunately, each of these items are fairly inexpensive so it's easy to take each for a test drive to see which hammer toe product works best for your needs.</p> <h3>Bunions - products for treatment</h3> <p>And the bunion, well that's a tougher problem to solve.  In many cases, I'd recommend the use of a <a href="https://www.myfootshop.com/gel-bunion-spacer-1-1">Bunion Spacer</a> or <a href="https://www.myfootshop.com/toe-separator-large-firm">Large Firm Toe Separator</a>.  But with an unstable second toe, the pads used between the 1st and 2nd toes just won't stay in place.  And <a href="https://www.myfootshop.com/bunion-regulator-night-splint">The Bunion Regulator</a> is intended for non-ambulatory use (mostly while sleeping).  So, in this case, The Bunion Regulator would really be our only choice to treat the bunion.</p> <p>When I see patients who have reached this stage of bunion and overlapping toes, surgery is something most folks seriously consider.  But for the short term, while preparing for surgery, these few products can be of help.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:147https://www.myfootshop.com/overlapping-toesBunion and Overlapping Second Toe<h2>Bunion and overlapping second toe</h2> <p><iframe width="560" height="315" src="https://www.youtube.com/embed/d3S1CllOA5k" frameborder="0" allowfullscreen="allowfullscreen"></iframe> </p> <p> </p> <p>Great video, right?  But why would this ever happen?  Why would the second toe ride up and over the great toe?  It all starts with a person's genetic predisposition to form a <a href="https://www.myfootshop.com/article/bunion">bunion</a>.</p> <p>Bunions aren't inherited per se, but people do inherit the same biomechanical set of bones and joints that their parents and grandparents have.  And if there's a tendency for a family to have bunions, we tend to see that biomechanical trait passed down through the family.</p> <h3>Bunion - what causes a bunion?</h3> <p>A bunion is normal bone, it's just that the bone is in a poor position.  The bump of bone we call a bunion is located on the head of the <a href="https://www.myfootshop.com/article/x-ray-of-the-foot-anterior-posterior-view">first metatarsal bone</a>.  The reason that a bunion forms is due to the fact that the first metatarsal is no longer straight, but over time changes in position becoming poorly aligned.  The position of the first metatarsal makes the foot wider.  In the process of creating a bunion, the first metatarsal moves away from the second metatarsal, essentially making the forefoot much wider.  As the first metatarsal moves medially (away from the second metatarsal) the tendons attached to the toe continue to pull up and down on the toe.  As the first metatarsal changes position, the tendons that move the great toe start to pull in a deviated position, tugging the great toe towards the second toe.</p> <p>These same mechanical properties also make the second toe move towards the great toe.  The tendons that pull the second toe up and down become poorly aligned and rather than simply pulling the second toe up and down, they now pull the toe in a medial direction, towards the great toe.  The outcome is an overlapping toe that is difficult to fit into a shoe.</p> <p>This video shows the early stages of the progressive deviation of the toes.  In this case, the changes of the great toe and the second toe are flexible and return to their normal positions when done moving.  Progressively though, over time these flexible deformities will become rigid and fixed with the great toe permanently residing under the second toe.</p> <p>For more information, be sure to check out our knowledge base page on <a href="https://www.myfootshop.com/article/bunion">bunions</a> and <a href="https://www.myfootshop.com/article/hammer-toes">hammer toes</a>.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 12/26/19</p>urn:store:1:blog:post:129https://www.myfootshop.com/metatarsal-stress-fractures-treatment-optionsMetatarsal Stress Fractures<h1>Metatarsal Stress Fractures</h1> <p>Another springtime injury that I'm sure we'll start to see a lot of are metatarsal stress fractures.  The metatarsal bones are the long bones that extend from the mid-arch to the ball of the foot.  Ideally, the five metatarsal bones share load applied to the forefoot.  In cases where one metatarsal bone carries increased load, the bone fails to successfully carry that load and undergoes a stress reaction.  This stress reaction results in a small crack in the metatarsal bone.  Read our knowledge base article on <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal stress fractures</a> for a detailed description of the condition.</p> <h2>Metatarsal Stress Fractures - treatment</h2> <p>Treatment of metatarsal stress fractures includes rest, splinting and compression.  Rest can be many things and should be dictated by how your foot feels.  For instance, rest doesn't have to be completely non-weight bearing or in a non-weight bearing hard cast.  Rest could simply be a decrease in your normal daily activities.  Simply put, if it hurts, you should back away from that activity.  And if it feels ok, go for it.</p> <h3>Metatarsal Stress Fractures - products for treatment</h3> <p>Splinting of the fracture can be accomplished in a number of ways.  <a href="https://www.myfootshop.com/cast-and-bandage-care">Walking casts</a> and <a href="https://www.myfootshop.com/cast-and-bandage-care">fracture shoes</a> are commonly prescribed by doctors but in many instances, you can avoid their use by wearing a stiff-soled shoe.  Any shoe with a rigid shank and rocker sole will help to off-load a metatarsal stress fracture.  Clogs and men's wingtip shoes are just two examples of shoes that have a very rigid <a href="https://www.myfootshop.com/forefoot-compression-sleeve"><img style="float: left;" src="/Content/Images/uploaded/Blog images/862_Forefoot_Compression_Sleeve.jpg" alt="Forefoot Compression Sleeve" width="90" /></a>shank and forefoot rocker.  For softer shoes, you can stiffen the shank with a <a href="https://www.myfootshop.com/glass-fiber-shoe-plates-flat">glass fiber shoe plate</a> or <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">spring plate</a>. </p> <p>Compression of the forefoot can help control swelling and stabilize any movement of the metatarsal stress fracture.  Compression helps to decrease pain by stabilizing the metatarsal stress fracture.  <a href="https://www.myfootshop.com/forefoot-compression-sleeve">The Forefoot Compression Sleeve</a><a href="https://www.myfootshop.com/arch-binder-1"><img style="float: right;" src="/Content/Images/uploaded/Blog images/730_Arch_Binder.jpg" alt="Arch Binder" width="90" /></a> and the <a href="https://www.myfootshop.com/arch-binder-1">Arch Binder</a> are two examples of ways the forefoot can be compressed and stabilized.</p> <p>As you get active this spring, start with a dose of common sense and a little prevention.  Metatarsal stress fractures are often seen in the onset of new activities like running or biking.  Be sure to start slowly, building up your endurance and strength over time.  And be sure to wear the right shoes for the right activity.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:128https://www.myfootshop.com/runners-nail-causes-and-treatment-optionsTreatment of Runner's Nail<h1>Runner's Nail - diagnosis and treatment</h1> <p>Spring is in the air and many of the patients that I've seen this week are getting out and getting active.  Many times new activities mean new shoes and new shoes can mean problems.  One of the more common foot problems I'm seeing with this increase in activity is <a href="https://www.myfootshop.com/article/runners-nail">runner's nail</a>.  Runner's nail is a bruise that forms beneath the nail.  This bruise is called a subungual hematoma.  The most common contributing reason for runner's nail is shoes that are too short, but even more often, loose shoes that allow the foot to piston within the shoe.  With a loose shoe, the nail repeatedly slams into the toe box of the shoe resulting in runner's nail.  And in the vast majority of cases, patients don't realize that there is a problem until they notice darkening of the nail long after the injury.</p> <h2>Runner's Nail - prevention</h2> <p>Treatment of runner's nail includes prevention, acute management of the subungual hematoma and long term management as the <a href="https://www.myfootshop.com/tongue-pads-felt"><img style="float: left;" src="/Content/Images/uploaded/Blog images/813_Tongue_Pads_Felt.jpg" alt="Tongue Pad" width="90" /></a>old nail is lost and the new nail begins to grow in. </p> <p>The best method used to prevent runner's nail is the use of a <a href="https://www.myfootshop.com/tongue-pads-felt">tongue pad</a>.  A tongue pad is an adhesive-backed felt pad that is placed under the tongue of the shoe.  You can apply one or more tongue pads depending on your individual case.  The purpose of a tongue pad is to push the foot into the heel of the shoe, limiting the pistoning of the foot and keeping the nail from hitting against the toe box of the shoe.</p> <p> </p> <h3>Runner's Nail - treatment</h3> <p>If you do sustain a bruise under the nail,  the bruise should be drained within 24 hours of the injury.  Draining the subungual hematoma<a href="https://www.myfootshop.com/naileezer-nail-drill"><img style="float: right;" src="/Content/Images/uploaded/Blog images/848_naileezer-nail-drill.jpeg" alt="Naileezer nail Dril" width="90" /></a> (bruise beneath the nail) will decrease pain and improve the chances of salvaging the injured nail.  The bruise can be drained using a Dremel Drill or heated, sterile paper clip.  heat the tip of the paper clip with a lighter and gently pass through the nail to release the subungual hematoma.</p> <p>And last is management of fungal infections of the nail.  Any injured nail is susceptible to a fungal infection.  Fungal infections of the nail (<a href="https://www.myfootshop.com/article/onychomycosis">onychomycosis</a>) cause the nail to become thick, yellow and permanently separate the nail from the underlying nail bed.  Use of a <a href="https://www.myfootshop.com/antifungal-skin-products">topical antifungal</a> is an important part of care following the onset of runner's nail.  Be sure to continue to use the topical antifungal until any evidence of the injury has completely grown out.</p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a> </p> <p>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:123https://www.myfootshop.com/hammer-toe-pads-used-to-treat-soft-cornsHammer Toes - Pads for soft corns caused by hammer toes.<p><a href="https://www.myfootshop.com/article/hammer-toes#Tab3"><img style="float: right;" src="https://www.myfootshop.com/content/images/medical/ortho/hammer_toe_differences_mod_thumb.jpg" alt="Mallet_toe/hammer_toe/claw_toe" width="100" /></a></p> <h1>Hammer toes - splints and pads</h1> <p> </p> <p>We've spoken in the previous two blog posts about <a href="https://www.myfootshop.com/article/hammer-toes#Tab3">hammer toes</a> and specific splints or pads to be used for problems on the top of the toe (hammer toe) and for sores on the tips of the toes (mallet toes and claw toes).  Hammer toes may also result in sores between the toes.  These specific corns are called a soft corn or helloma molle.  Soft corns are the result of a mal-alignment of the toes.  In a healthy toe, the bones of the toe are aligned in a way that the boney prominences are offset - a prominence of one toe is offset and against a concavity on the adjacent toe.  In a hammer toe with a soft corn, the hammer toe has caused this mal-alignment and subsequent sore we know as a soft corn.  Treatment of a soft corn is accomplished by splinting the toe or separating the toes to separate each of the boney prominences.  </p> <h2>Hammer toe pads - splints</h2> <p><a href="/3pp-toe-loops"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/864_3pp_Toe_Loops.jpg" alt="3pp Toe Loops" width="75" /></a> <a href="/co-flex-bandage-1-inch"> <img style="float: left; padding-right: 5px;" src="/images/uploaded/Products/829_Co_Flex_Bandage_1_Inch.jpg" alt="Coflex 1 Inch Bandage" width="75" /></a> <a href="/toe-corrector-foam"> <img style="float: left;" src="/images/uploaded/Products/695_Toe_Corrector.jpg" alt="Toe Corrector - Foam" width="75" /></a></p> <h3> </h3> <h3> </h3> <h3> </h3> <h3><span style="font-family: Verdana, Arial, Helvetica, sans-serif;">Hammer toe pads</span></h3> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;">Pads that are used to treat soft corns can be broken down into three categories; wool, gel or foam.  The choice of wool, gel or foam depends upon personal preference.</span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"> Examples of wool pads that are used for hammer toes and soft corns include -</span></p> <p><a href="/lambs-wool-padding"><img src="/images/uploaded/Blog images/940_Lambs_Wool_Padding.jpg" alt="Lambs Wool" width="75" /></a></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"> Examples of gel pads that are used to treat soft corns caused by hammer toes include -</span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"><a href="/gel-corn-protectors-1"> <img src="/images/uploaded/Products/704_Gel_Corn_Protector_ALT.jpg" alt="Gel Corn Protector" width="75" /></a> <a href="/toe-separators-gel"><img src="/images/uploaded/Products/696_Gel_Toe_Separator.jpg" alt="Toe Separators - Gel" width="75" /></a><a href="/toe-sleeves-gel"><img src="/images/uploaded/Products/854_Toe_Sleeves_Gel_ALT.jpg" alt="Toe Sleeve - Gel" width="75" /></a><a href="/gel-bunion-spacer-1-1"><img src="/images/uploaded/Products/710_Gel_Bunion_Spacer.jpg" alt="Gel Bunion Spacer" width="75" /></a></span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"> Examples of foam pads that are used to treat soft corns caused by hammer toes include - </span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"><a href="/double-stall-tubular-foam-toe-bandage"> <img src="/images/uploaded/Products/694_DoubleStall_foam_Toe_Bandage.jpg" alt="Double Stall Tubular Toe Bandage" width="75" /></a> <a href="/soft-corn-pads"><img src="/images/uploaded/Products/686_Soft_Corn_Pads_ALT2.jpg" alt="Soft Corn Pads" width="75" /></a><a href="/corn-protectors"><img src="/images/uploaded/Products/816_Corn_Protectors_ALT.jpg" alt="Corn Protectors" width="75" /></a><a href="/toe-cushions"><img src="/images/uploaded/Products/821_Toe_Cushions.jpg" alt="Toe Cushions" width="75" /><img src="/images/uploaded/Products/693_Toe_Separator_LargeFirm.jpg" alt="Toe Separator - Large - Firm" width="75" /></a></span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"><a href="/toe-separators-3-layered"><img src="/images/uploaded/Products/827_Toe_Separators_3Layered_ALT2.jpg" alt="Toe Separator - 3 Layered" width="75" /></a><a href="/tubular-foam-toe-bandages"><img src="/images/uploaded/Products/700_Tubular_Foam_Toe_Bandages.jpg" alt="Tubular Foam bandages" width="75" /></a></span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;">Soft corns are very common between the 1st and 2nd toes.  There are also a number of pads that are specifically used for treatment of soft corns between the 1st and 2nd toes.  These pads are often combined with a method used to treat a bunion.  Examples of these pads that are used to treat both a bunion and a hammer toe with soft corn include - </span></p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"><a href="/toe-corrector-gel"><img src="/images/uploaded/Products/967_Toe_Corrector_Gel.jpg" alt="Toe Corrector - Gel" width="75" /></a> <a href="/gel-bunion-spacer-with-stay-put-loop"><img src="/images/uploaded/Products/959_Gel_Bunion_Spacer_w_StayPutLoop_ALT.jpg" alt="Gel Bunion Spacer with Stay-Put Loop" width="75" /></a>  <a href="/toe-spacer-bunion-guard-combo"><img src="/images/uploaded/Products/846_Toe_Spacer_Bunion_Guard_Combo_ALT.jpg" alt="Toe Spacer - Bunion Guard Combo" width="75" /></a></span></p> <p> </p> <p> </p> <p>Jeff  </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM<br /></a>Medical Advisor<br />Myfootshop.com  </p> <p>Updated 4/23/2021</p> <p><span style="font-family: Verdana, Arial, Helvetica, sans-serif;"> </span></p>urn:store:1:blog:post:122https://www.myfootshop.com/hammer-toe-pads-for-tip-of-toe-painHammer Toes - Which pad is best for tip of the toe pain?<h1><a href="https://www.myfootshop.com/article/hammer-toes#Tab3"><img style="float: right;" src="https://www.myfootshop.com/content/images/medical/ortho/hammer_toe_differences_mod_thumb.jpg" alt="Mallet_toe/hammer_toe/claw_toe" /></a>Hammer Toe Pain- claw toes and mallet toes</h1> <h1> </h1> <p>Claw toes and mallet toes (see image at right) are a specific type of <a href="https://www.myfootshop.com/article/hammer-toes">hammer toe</a>.  Claw toes and mallet toes result in sores on the tips of the toes.  When you treat these specific types of hammer toes you need to use either a splint or cushion.  Splints are effective for use on flexible and semi-flexible hammer toes.  Splints can be broken into two types of splints, Budin splints, and crest pads.  Budin splints are available in a single toe or double toe variety. </p> <h2>Hammer toes - splints</h2> <p>Examples of Budin Splints include -</p> <p><a href="/toe-straightener-single-toe"> <img src="/images/uploaded/Products/706_Toe_Straightener_Single_Toe_ALT.jpg" alt="Toe Straightener - Single Toe" width="75" /></a> <a href="/toe-straightener-double-toe-2"> <img src="/images/uploaded/Products/707_Toe_Straightener_Double_Toe_ALT.jpg" alt="Toe Straightener - Double Toe" width="75" /></a></p> <h3>Hammer toes - crest pads</h3> <p>Crest pads come in foam, firm red rubber or gel.  Each of our crest pads is equally effective.  Choosing a crest pad depends upon your personal preference of material.  Examples of crest pads include - </p> <p><a href="/hammer-toe-crest-pad-foam-1"> <img src="/images/uploaded/Products/701_Hammer_Toe_Crest_Pad.jpg" alt="Hammer Toe Crest Pad - Foam" width="75" /></a> <a href="/hammer-toe-crest-pad-gel-adjustable"> <img src="/images/uploaded/Products/971_Adjustable_Gel_Hammer_Toe_Crest_Pad.jpg" alt="Hammer Toe Crest Pad - Adjustable Gel" width="75" /></a> <a href="/hammer-toe-crest-pad-gel"> <img src="/images/uploaded/Products/853_Hammer_Toe_Crest_Pad_Gel.jpg" alt="Hammer Toe Crest Pad Gel" width="75" /></a></p> <p> </p> <h4>Hammer toes - toe caps</h4> <p>And lastly, cushion that slip over the tip of the toe also help to pad the tips of sore claw toes and mallet toes.  Examples of these pads include -</p> <p><a href="/gel-toe-protector-1"> <img src="/images/uploaded/Products/697_Gel_Toe_Protector_ALT.jpg" alt="Gel Toe Protector" width="75" /></a> <a href="/toe-caps-foam"><img src="/images/uploaded/Products/699_Foam_Toe_Cap.jpg" alt="Toe Cap - Foam" width="75" /></a> <a href="/gel-toe-caps"> <img src="/images/uploaded/Products/871_Gel_Toe_Caps_by_ProTec_ALT.jpg" alt="Gel Toe Cap" width="75" /></a></p> <p>Up next, hammer toe pads used for sores between the toes.</p> <p>Jeff </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:121https://www.myfootshop.com/hammer-toes-which-pad-is-right-for-meHammer Toes - What's the best pad for my toe?<p><a href="https://www.myfootshop.com/article/hammer-toes#Tab3"><img style="float: right;" src="https://www.myfootshop.com/content/images/medical/ortho/hammer_toe_differences_mod_thumb.jpg" alt="Mallet_toe/hammer_toe/claw_toe" /></a></p> <h1>Hammer toe pads</h1> <p>What's the best pad for your sore <a href="https://www.myfootshop.com/article/hammer-toes">hammer toes</a>?  That depends to a great degree on the location of the problem that you are trying to treat.  Is the toe sore on the top of the toe, the tip of the toe or between the toes?  Let's take a closer look at hammer toe products based upon how they treat the top, the tip or between the toes.  I'll break this topic into three blog posts.  First, products for the top of the toe. </p> <p>The classic hammer toe is a semi-rigid to rigid deformity of the interphalangeal joint (top image to left).  The rigidity of the toe creates an irritation on the top of the toe that we typically call a corn.  A corn is simply a specific type of callus that forms as the result of shoe pressure on the top of the toe.  The first step in treating top of the toe irritations is to try to eliminate the shoe that is causing the problem.  A wider, softer shoe can make a big difference in treating top of the toe corns.   </p> <h2>Hammer toe pads - toe splints</h2> <p>There's a host of products that are sold on Myfootshop.com that are used to treat top of the toe corns.  I break these products down into splints and pads.  Splints can be used with semi-rigid hammer toes to splint them away from the shoe.  Examples of hammer toe splints include the following -</p> <p><a href="/3pp-toe-loops"><img src="/images/uploaded/Products/864_3pp_Toe_Loops.jpg" alt="3pp Toe Loops" width="75" /></a><a href="/co-flex-bandage-1-inch"><img src="/images/uploaded/Products/829_Co_Flex_Bandage_1_Inch.jpg" alt="Co-Flex Bandage 1 Inch" width="75" /></a><a href="/double-stall-tubular-foam-toe-bandage"><img src="/images/uploaded/Products/694_DoubleStall_foam_Toe_Bandage.jpg" alt="Double-Stall Tubular Foam Bandage" width="75" /></a><a href="/toe-corrector-foam"><img src="/images/uploaded/Products/695_Toe_Corrector.jpg" alt="Toe Corrector - Foam" width="75" /></a><a href="/toe-corrector-gel"><img src="/images/uploaded/Products/967_Toe_Corrector_Gel.jpg" alt="Toe Corrector - Gel" width="75" /></a><a href="/toe-straightener-double-toe-2"><img src="/images/uploaded/Products/707_Toe_Straightener_Double_Toe_ALT.jpg" alt="Toe Straightener - Double Toe" width="75" /></a><a href="/toe-straightener-single-toe"><img src="/images/uploaded/Products/706_Toe_Straightener_Single_Toe_ALT.jpg" alt="Toe Straightener - Single Toe" width="75" /></a></p> <h3>Hammer toes - gel pads</h3> <p>When hammer toes are rigid, splints become less effective.  A hammer toe splint simply cannot move a rigid hammer toe away from the shoe.  In the case of rigid hammer toes, we recommend the use of pads to protect the hammer toe and corn from the shoe.  I break pads down into the categories of gel, foam, and wool.  Examples of gel hammer toe pads that are used to treat corns on the top of a rigid hammer toe include -</p> <p><a href="/toe-sleeves-gel"><img src="/images/uploaded/Products/854_Toe_Sleeves_Gel_ALT.jpg" alt="Toe Sleeve - Gel" width="75" /></a><a href="/gel-corn-protectors-1"><img src="/images/uploaded/Products/704_Gel_Corn_Protector_ALT.jpg" alt="Gel Corn Protectors" width="75" /> </a></p> <p> </p> <h4>Hammer toe - foam pads</h4> <p>Examples of foam pads that are used to treat the corn on the top of a rigid hammer toe include -</p> <p><a href="/double-stall-tubular-foam-toe-bandage"><img src="/images/uploaded/Products/694_DoubleStall_foam_Toe_Bandage.jpg" alt="Double-Stall Tubular Foam Toe Bandage" width="75" /></a><a href="/corn-protectors"><img src="/images/uploaded/Products/816_Corn_Protectors_ALT.jpg" alt="Corn Protectors" width="75" /></a><a href="/triple-stall-tubular-foam-toe-bandage"><img src="/images/uploaded/Products/889_Triple_Stall_foam_Toe_Bandage_ALT2.jpg" alt="Triple Stall Tubular Foam Toe Bandages" width="75" /></a><a href="/tubular-foam-toe-bandages"><img src="/images/uploaded/Products/700_Tubular_Foam_Toe_Bandages.jpg" alt="Tubular Foam Toe Bandages" width="75" /></a></p> <p> </p> <p>Lambs wool is an old world tool that is still used quite frequently to wrap rigid hammer toes. </p> <p><a href="/lambs-wool-padding"><img src="/images/uploaded/Products/940_Lambs_Wool_Padding.jpg" alt="Lambs Wool Padding" width="75" /></a></p> <p>You can see that for rigid hammer toes that have a corn on the top of the toe, there's a number of different solutions.  The success of these products will depend upon the shoes that you wear and how effectively and frequently these pads are applied.</p> <p>Next up, how to treat corns that appear on the tip of a hammer toe.</p> <p>Jeff </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com </p> <p>Updated 4/23/2021</p>urn:store:1:blog:post:120https://www.myfootshop.com/forefoot-compression-devicesForefoot Compression Devices - indications for treatment<h1>Forefoot swelling - products for treatment</h1> <p>Compression of the midfoot and forefoot is an integral part of treating both acute and chronic problems of the foot.  Indications for midfoot and forefoot compression include <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">midfoot arthritis</a>, non-displaced <a href="https://www.myfootshop.com/article/stress-fractures-of-the-foot">midfoot fractures</a> or resolved <a href="https://www.myfootshop.com/article/charcot-joint">Charcot joints</a>.  Indications for compression of the forefoot include management of swelling or <a href="https://www.myfootshop.com/article/stress-fractures-of-the-foot">metatarsal fractures</a>.  Which device is best for your needs?  Let's take a look at each of the compression devices we provide on Myfootshop.com.</p> <p><a href="https://www.myfootshop.com/arch-binder-1"><img style="float: left;" src="/Content/Images/uploaded/Blog images/730_Arch_Binder_with_border.jpg" alt="Arch binder" width="90" /></a>The <a href="https://www.myfootshop.com/arch-binder-1">arch binder</a> is a simple 3" elastic band that slips over the forefoot to compress the arch.  The arch binder can be worn directly on the skin or over a sock.  The arch binder fits into all shoes.  I'd recommend the arch binder to anyone with midfoot pain that would respond to compression.  It's easy to use and inexpensive.  I really feel that the arch binder is one of those unsung heros when it comes to treating midfoot pain.</p> <p>The <a href="https://www.myfootshop.com/arch-binder-with-metatarsal-pad">arch binder with metatarsal pad</a> is just a little twist on the concept of midfoot compression.  The arch binder<a href="https://www.myfootshop.com/arch-binder-with-metatarsal-pad"><img style="float: right;" src="/Content/Images/uploaded/Blog images/900_Arch_Binder_with_Metatarsal_Pad.jpg" alt="Arch binder with Metatarsal Pad" width="90" /></a> with metatarsal pad adds a firm metatarsal pad that can be used to treat a number of forefoot conditions including metatarsalgia, forefoot capsulitis, plantar plate tears, and Freiberg's infraction.  The arch binder with metatarsal pad is a very popular product on our site.  The use of the arch binder with metatarsal pad is just the same as the traditional arch binder.  It slips over the forefoot and is worn either directly on the skin or over a sock.  The arch binder with metatarsal pad also fits easily into all shoes.</p> <p><a href="https://www.myfootshop.com/forefoot-compression-sleeve"><img style="float: left;" src="/Content/Images/uploaded/Blog images/862_Forefoot_Compression_Sleeve_with_border.jpg" alt="Forefoot compression sleeve" width="90" /></a>The <a href="https://www.myfootshop.com/forefoot-compression-sleeve">forefoot compression sleeve</a> is a little bit different take on forefoot compression.  This is a product that I personally invented.  I saw a need for compression that went beyond what compression hose could offer.  What I created is a forefoot compression device that works very well for management of forefoot swelling following surgery such as metatarsal surgery or bunion surgery.  The forefoot compression sleeve is also a great product to manage metatarsal stress fractures.  The forefoot compression sleeve fits over the forefoot and has a loop that slips over the great toe.</p> <p>Which forefoot compression device is best for your needs?  The best choice depends upon your individual needs.  Metatarsalgia and metatarsal stress fractures are best treated by the forefoot compression sleeve.  Midfoot pain is best treated by the arch binder or arch binder with metatarsal pad.</p> <p>Jeff </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com </p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:118https://www.myfootshop.com/osteoarthritis-of-the-footMidfoot osteoarthritis - Treatment options<h1>Arthritis of the midfoot - treatment options</h1> <p>One of the toughest problems that I manage in practice is midfoot arthritis. Osteoarthritis is the most common cause of midfoot arthritis. Osteoarthritis is often due to a previous injury but for many patients, they may simply be genetically predisposed to osteoarthritis. For more information on osteoarthritis, be sure to visit our knowledge base page that describes the onset and treatment options for <a href="/article/arthritis-of-the-foot-and-ankle">osteoarthritis of the foot and ankle</a>.</p> <p>Osteoarthritis is treated in much the same way regardless of body location.  That means that osteoarthritis of the knee, the hand or the foot are treated by three primary categories of care: bracing, medications or surgery.  As an example, think of a friend that has had osteoarthritis of the knee.  First, they'll take a little Tylenol.  Next, they'll get a slip-on knee brace.  As the pain increases, a visit to the doctor will result in the use of oral anti-inflammatory medications.  More pain necessitates a trip to the orthopedist.  A shot of cortisone will be used.  With more cartilage loss Synvisc will be used.  Arthroscopic surgery can debride some of the loose cartilage.  And lastly, the knee is replaced with a prosthetic joint.</p> <h2>Osteoarthritis of the midfoot</h2> <p>With midfoot arthritis, surgery is a poor choice.  We have no implant that can be reliably used.  That leaves us with midfoot fusions - not one of my favorite procedures due to significant patient disability and lower than expected surgical outcomes.  Medications can be helpful in the active 'inflammatory' stages of osteoarthritis but have some degree of limitations.</p> <p>That leaves bracing as the primary category that we use for treatment of midfoot arthritis.  The primary goal with bracing is to create a splint that will limit the amount of mechanical load that is applied to the midfoot.  When I say mechanical load, I'm referring to the <a href="https://www.myfootshop.com/article/ct-band-syndrome">load generated by the calf and delivered to the ball-of-the-foot</a> with each step that we take.  For sake of a visual image, think of a large wooden tongue depressor duct-taped to the bottom of the foot.  Not a recommended treatment, but I think you get the picture.</p> <h3>Treating osteoarthritis of the foot with carbon graphite orthotics</h3> <p>To provide rigidity in the shoe but allow a patient to use their existing insert, I often use a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Graphite Spring Plate</a> or <a href="https://www.myfootshop.com/glass-fiber-shoe-plates-flat">Glass Fiber Shoe Plate Flat</a>.  In each case, the support is accompanied by an <a href="https://www.myfootshop.com/arch-binder-1">Arch Binder</a>.  The Arch Binder<a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat"><img style="float: right;" src="/Content/Images/uploaded/Blog images/893_Carbon_Graphite_Shoe_Plate_Flat_ALT_border.jpg" alt="Carbon Graphite Shoe Plate Flat" width="90" /></a> can be worn with or without a shoe. </p> <p>And lastly, each of these products needs to be paired with an appropriate shoe.  When treating midfoot osteoarthritis, the three characteristics of a traditional Oxford shoe really become important.  Those characteristics include a rigid shank, a slight heel and a laced upper.  the shank helps to compliment the insert, reinforcing the rigidity under the midfoot.  The raised heel helps to decrease the amount of force generated by the calf and actually tips you a bit forward.  And lastly, the laced upper is what really ties things together making this insert/shoe combination into what is actually a brace.</p> <p>Midfoot osteoarthritis can be tough to manage, but with the correct inserts and shoes, bracing is simple and functional.</p> <p>Jeff </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:116https://www.myfootshop.com/sustainable-health-care-the-commonsSustainable Health Care - Tragedy of the Commons<h1>Health Care Sustainability</h1> <p>When we talk about sustainability, we're often talking about responsible stewardship of a resource.  In the case of sustainable <img style="float: right;" src="/Content/Images/uploaded/Blog images/brown-cow.jpg" alt="Sustainability in health care" width="200" />health care, that resource is the ability to provide quality care to all Americans in a timely manner and at a reasonable cost.  How does this resource we know as health care become stressed and perhaps unsustainable?  To describe health care as a resource, let's look at <a href="https://en.wikipedia.org/wiki/Tragedy_of_the_commons">Wikipedia's definition of the tragedy of the commons</a>:</p> <blockquote> <p><span style="font-size: small;">The <strong>tragedy of the commons</strong> is an economic theory by <a href="https://en.wikipedia.org/wiki/Garrett_Hardin">Garrett Hardin</a>, which states that individuals acting independently and rationally according to each's self-interest behave contrary to the best interests of the whole group by depleting some common <a href="https://en.wikipedia.org/wiki/Resource">resource</a>. The term is taken from the title of an article written by Hardin in 1968, which is in turn based upon an essay by a Victorian economist on the effects of unregulated grazing on <a href="https://en.wikipedia.org/wiki/Common_land">common land</a>.</span></p> <p><span style="font-size: small;">"<a href="https://en.wikipedia.org/wiki/Common_good_(economics)">Commons</a>" in this sense has come to mean such as <a href="https://en.wikipedia.org/wiki/Carbon_dioxide#In_the_Earth.27s_atmosphere">atmosphere</a>, <a href="https://en.wikipedia.org/wiki/Great_Pacific_garbage_patch">oceans</a>, rivers, <a href="https://en.wikipedia.org/wiki/Fish_stocks">fish stocks</a>, the office refrigerator, energy or any other shared resource which is not formally regulated; not common land in its agricultural sense.</span></p> </blockquote> <p><span style="font-size: small;">Now think of the commons as health care.</span></p> <p><span style="font-size: small;">Think about your own personal experiences in health care.  Do you have a relative who uses an inordinate amount of health care?  Do you know anyone who's had a medical test or surgical procedure and prior to that event you asked yourself, is this test (or surgery) really necessary?  What about the surgeon who will fix anything?  We all have examples in our individual lives where we question the necessity or validity of a proposed test or procedure in health care.  </span></p> <p><span style="font-size: small;">This resource we know as health care simply can't live on forever.  It's a drain on our economy, expensive to the individual and unsustainable. </span></p> <p><span style="font-size: small;">Let's talk.</span></p> <p>Jeff </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /><br /></a><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com </p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:112https://www.myfootshop.com/sustainable-health-care-who-bears-the-real-cost-of-careSustainable Health Care - who bears the real cost of care?<h1>Sustainability in health care</h1> <p>We've talked about choice and transparency as being fundamental principles of sustainable health.   But what about the cost of <img style="float: right;" src="/Content/Images/uploaded/Blog images/business-man-1385050_1280.jpg" alt="sustainability in health care" width="200" />providing health care?  Is the cost of providing health care sustainable?  For instance, is it possible for a patient to receive health care services without a residual bill?  What if a patient has multiple health problems and sees multiple doctors.  Are they able to receive these services and use their insurance coverage to pay for those services?  Unfortunately, this is rarely the case.</p> <p>As an example, let's take a look at my friend Danny (name changed.)  I diagnosed Danny 25 years ago with vasculitis.  Since that time he has been unable to work and has subsequently gone on social security disability.  Late last year Danny didn't feel well.  He was pale and short of breath.  He went to our local emergency room with symptoms of what appeared to be a heart attack.  Upon evaluation in the ER, they determined that Danny had severe coronary artery blockage and was life-flighted to our regional medical center where he underwent coronary artery bypass surgery.  Prior to surgery Danny asked his caregivers about the costs of his care and was reassured that he would be covered. </p> <p>Danny's better now with one exception.  He almost had another heart attack when he received the bill for his care.  He now owes $12,000 to the hospital.  When he spoke to the billing department at the hospital and told them that his only income was social security disability they advised him that they intended to garnish his income.</p> <p>Contemporary health care has developed a new economic model.  The model is to proceed with business as usual knowing that the burden of cost can be shifted onto the shoulders of the consumer.  But think for a moment of what this does to the economy as a whole.  In Danny's case, sure, he's alive as a direct result of his care.  But now he is a financial cripple.  Just like Danny, literally thousands of people are being crippled by health care costs every day.  The outcome is that the cost of paying for health care is now the number one reason that consumers file for personal bankruptcy.  The price we pay for health care as consumers creates a huge drag on the overall economy. </p> <p>There were many players in Danny's care, some who added to his care and others who took away from that care, and they should be justly compensated for their hard work.  There were doctors, nurses, hospitals, and most importantly, Danny himself.  But in Danny's case, the balance sheet doesn't lie.  There's simply nothing left of health care for Danny.  Now the health care system wants more from him that what he is able to give.  As such, the cost of health care is simply not sustainable.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:111https://www.myfootshop.com/sustainable-health-care-transparencySustainable Health Care - the meaning of transparency in health care<h1>Transparency in health care</h1> <p>I had mentioned in a previous post that two of the fundamental principles of sustainable health care are intentional choice and <img style="float: right;" src="/Content/Images/uploaded/Blog images/heart-665187_1280.jpg" alt="transparency in health care" width="200" />transparency.  I discussed intentional choice in a previous post.  What is the importance of transparency in health care and how is transparency an important part of sustainable health care?</p> <p>Transparency in health care is the ability to easily and clearly understand all of the transactions that take place with your health care.  One of the most complicating aspects of receiving and providing health care is the intersection of health care coverage and the care itself.  To understand what I mean, think about what it takes for you to personally access your primary care doctor.  Are you part of a provider panel that your doctor accepts?  Has your coverage changed as of the first of the year?  Does your coverage comply with the minimal standards of the Affordable Care Act?  What's your co-pay?  What labs are covered?  What hospitals?  This is just the shortlist of challenges that each of us faces when trying to access health care.  Each of these challenges that we face when trying to access health care detracts from the transparency of the interaction and ultimately detracts from the quality and affordability of your health care.</p> <p>My family was recently faced with a good example of the inherent lack of transparency in health care.  My mom is in her late 80's.  She fell at home and was hospitalized, sent to rehab, back into the hospital and back to rehab.  While she was in the hospital her Medicare supplemental insurance switched.  Her insurer said that she was notified three times by mail and was required to respond but had failed to do so.  Interestingly, my family had been collecting her mail and received no such notification.  As of January 3rd when she was discharged from the hospital and was to go back to the rehab center for the third time, the rehab center refused to accept her 'new insurance' and told our family to come and pick up her belongings.  Social services at the hospital searched for a rehab center that would accept her new insurance and could find none within 60 miles of the hospital.  My mom had no recourse other than a discharge to the home of a family member.</p> <p>This lack of transparency in health care requires families to advocate for their loved ones.  To do so takes hours to speak with customer service representatives at the insurance company, customer service reps at <a href="https://www.healthcare.gov/">www.healthcare.gov</a>, letters back and forth.  The drain on time and resources is huge.  I think I'm telling a story that is all too familiar to many Americans.  Ultimately in my mom's case, the insurance company could not produce a single record that would indicate that my mom was notified of a change.  Her Medicare supplemental insurance is now reinstated as of 3/1/2015.  To do so required the help of the state insurance commission and a threat of legal action.</p> <p>Why is the system so complex with so much lack of transparency?  The system is obviously unsustainable.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:110https://www.myfootshop.com/plantar-plate-tear-conservative-treatmentTreatment of plantar plate tears<h1>Treatment of plantar plate tears</h1> <p>OK, so you talk about plantar plate tears and in walks a plantar plate tear to my office today.  This fellow was a 70 y/o male who is retired but very active.  His primary concern wasn't today but what is going to happen in 5-10 years if left untreated. He currently runs 3 miles a day and is planning a major hiking trip this summer.</p> <p><a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img style="float: left;" src="/Content/Images/uploaded/Blog images/met_pad_video.jpg" alt="Metatarsal pad video" width="373" height="248" /></a>Clinically my patient showed a rigid hammer toe 3 left and a very prominent ball of the foot.  He described no pain with the onset of this change but noted that the change in the position of his toe happened fairly abruptly some 2.5 to 3 years ago.  The 3rd toe was deviated in the sagital plane (toe moving toward the shin) and the transverse plane (3rd toe deviated towards the 5th toe).  X-rays showed complete dislocation of the <a href="https://www.myfootshop.com/article/x-ray-of-the-foot-anterior-posterior-view">metatarsal phalangeal joint</a>.</p> <p>So what to do?  With a plantar plate tear and complete subluxation that had been present for over two years, I gave my patient a 75% success rate with surgery.  Combine that with the fact that he's relatively pain-free, I think you can see what needs to be done.  At this stage, nothing.  The patient's primary location of pain was on the bottom of the foot.  He had tried Rx orthotics with little change in his symptoms. </p> <p>We watched the video on placement of metatarsal pads and I sent him on his way.  For the short term, he's doing ok.  Let's just keep it that way.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:108https://www.myfootshop.com/sustainable-health-care-what-is-intentional-choiceSustainable Health Care - What is an intentional choice?<p>Sustainability in health care - intentional choice</p> <p>In my previous blog post on sustainable health care, I mentioned two fundamental aspects of sustainable health - intentional choice and transparency in health care.  Let's talk about intentional choice.</p> <p><img style="float: left;" src="/Content/Images/uploaded/Blog images/new-cases-diabetes-adults-chart.gif" alt="New cases of diabetes" width="322" height="230" />When you think of health care, what kinds of choices come to mind?  You can choose your doctor.  You can choose the hospital that you may prefer.  But beyond that, what else can you choose?  Can you choose the type of insulin that you'll need for your diabetes?  That seems a little absurd right?  You wouldn't choose your insulin, that's your doctor's choice based on his or her training.  Most of us would delegate that choice to someone who is more trained in the field. </p> <p>But wait a minute, let's stop and take a closer look at why most people are diabetics.  As we transitioned from a pre-WWII agrarian society to the consumer-based society we know today, we've seen a staggering growth in Type 2 diabetes.  According to the American Diabetes Association, in 2012, 9.3 % of the US population had diabetes.  The total cost of caring for diabetes in the US in 2012 was $245 billion dollars. (1)</p> <p>Many peer-reviewed medical articles confirm that weight gain is a predisposing factor in Type 2 diabetes.  And interestingly, many articles confirm this fact is a somewhat oblique way - diabetes, diabetic nephropathy, and hyperlipidemia can be reversed with surgery - bariatric surgery. (2)  When you lose the weight, you no longer<img style="float: right;" src="/Content/Images/uploaded/Blog images/350px-USObesityRate1960-2004.svg.png" alt="New cases of obesity in the US" width="400" /> have diabetes.</p> <p>Let's go back to talking about choice.  For a great many Americans, obesity and the onset of Type 2 diabetes is a matter of choice.  The choice comes down to the food that you eat and the physical activities that you participate in.  You can even choose to defer the cost and responsibility of caring for your diabetes to a health care system that is simply - unsustainable.</p> <p>So what are the deliberate choices, the intentional choices that can be made to create a sustainable health care system?  In the case of type 2 diabetes, the choices are obvious.  But for most of us, if a choice has no immediate benefit, why should we opt for the more difficult choice?  Why choose to exercise when you could be watching television?  Why choose to grow your own vegetables when you can pick-up prepared food that's quick and easy? </p> <p>So what is an intentional choice?  Intentional choices aren't always the easy choices.  Deliberately choosing the more difficult pathway in your life may actually be more expensive or result in more work.  But in the end, it's just about feeling good about yourself - your life, your health, and how you impact the world.</p> <p><a href="https://www.diabetes.org/diabetes-basics/statistics/">https://www.diabetes.org/diabetes-basics/statistics/</a> </p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/24018646">https://www.ncbi.nlm.nih.gov/pubmed/24018646</a></p> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p> <p> </p>urn:store:1:blog:post:107https://www.myfootshop.com/plantar-plate-tear-differential-diagnosisPlantar plate tears vs. capsulitis<h1>Plantar plate tear vs capsulitis</h1> <p>Every so often I thumb back through old journals and pick up a few pearls that'll be pertinent to either patients who I am currently treating or cases that I've seen over the years.  I was reading an article in The Journal of Foot and Ankle Surgery dated Sept/Oct 2012.  The article by Sung, et. al was called Diagnosis of Plantar Plate Tears by Magnetic Resonance Imaging with Reference to Intraoperative Findings.  What the article was attempting to do was to correlate MRI findings of plantar plate tears with surgical findings.  Their outcomes in the article definitively stated that the accuracy and specificity of MRI findings and how they related to surgical findings were greater than 95%.  Based on this knowledge, the authors advocated surgical correction for MRI confirmed plantar plate tears.</p> <p>Every practice is going to be a bit different in their approach to specific clinical conditions.  And in many cases, decision making in part is driven by the literature.  Decision making in surgery is driven by a) where you trained, b) with experience, what you find works best in your hands and c) current findings in peer-reviewed literature.  As a patient, you need to understand that for a specific condition, like a plantar plate tear, you may get a number of different opinions based upon training, experience, and literature.  Knowing this, how does a patient decide what they should do to treat a problem?</p> <p>As a clinician and surgeon who's been active for the past 30 years, I have a little bit different take on plantar plate tears.  I'm much less aggressive with surgical treatment of plantar plate tears knowing that the symptoms of many will subside over time with conservative care.  The question I often ask myself is whether the forefoot problem that I'm seeing is a case of <a href="https://www.myfootshop.com/article/capsulitis#Tab3">forefoot capsulitis</a> or is it actually a plantar plate tear.  Granted, I do believe the authors are correct in using an MRI to reach their conclusion, but does every patient with forefoot pain need an MRI?  Or is there a simpler and less costly way in which to proceed when treating plantar forefoot pain?</p> <p><a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img style="float: left;" src="/Content/Images/uploaded/Blog images/metatarsal-pad-felt.jpeg" alt="Metatarsal pad" width="90" /></a>In cases where the toe is deviated and pain does not resolve with conservative care, an MRI is indeed indicated to rule out a plantar plate tear.  But in cases of plantar forefoot pain with no deviation of the digit (hammer toe or transverse plane deviation), I'll initiate care with the use of a <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">metatarsal pad</a>.  Metatarsal pads can also be combined with a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">spring plate</a>.  The vast majority of these cases of plantar forefoot pain resolve with the use of these off-loading methods. </p> <p>The authors of this article did an excellent job in correlating clinical testing and surgical results, but a follow-up article describing the percentage of plantar plate tears as a differential in forefoot pain would be helpful to clinicians and their patients.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:106https://www.myfootshop.com/pediatric-flat-feet-treatment-optionBirkoBalance Children's Orthotics<h1>Pediatric flatfoot - treatment options</h1> <p>They say things come in 3's and this week it was <a href="https://www.myfootshop.com/article/flatfeet">pediatric flatfeet</a>.  I usually don't see that many children in my office but this week was an exception.</p> <p>What can be done for children with flatfeet?  The literature isn't very clear when it comes to the treatment of pediatric flatfeet.  In my practice, I do very little flatfoot surgery.  By far, the most common pediatric flatfoot case is one in which there is a symptomatic os trigonum.  The os trigonum is an accessory bone that forms within the body of the posterior tibial tendon, at the medial aspect of the <a href="https://www.myfootshop.com/article/x-ray-of-the-foot-lateral-view">navicular bone</a>.  and in each of these cases, the children are limited by pain from participating in sports or other activities in which they need to be on their feet for extended periods of time.</p> <h2>Pediatric flatfoot - arch cookies</h2> <p>Conservative care for pediatric flatfeet includes the use of <a href="https://www.myfootshop.com/arch-cookies">arch cookies</a> or <a href="https://www.myfootshop.com/shoe-insoles-and-arch-supports">arch supports</a>.  I tend to lean to arch cookies for early walkers (age 2-4 y/o) and use arch supports in older children.  If I need more correction and want to err to the side of more support, I'll typically use a <a href="https://www.myfootshop.com/ucbl-preform-childrens-orthotic">UCBL</a>.  The UCBL orthotic has a firm polypropylene arch and lateral flange.  The lateral flange will block the lateral heel, inhibiting pronation.</p> <h3>Pediatric flatfoot - Birkobalance pediatric arch supports</h3> <p style="text-align: justify;"><a href="https://www.myfootshop.com/birkobalance-arch-supports-for-children"><img style="float: left;" src="/Content/Images/uploaded/Blog images/837_BirkoBalance_Arch_Supports_for_Children.jpg" alt="BirkoBalance Pediatric Orthotic" width="90" /></a></p> <p style="text-align: justify;">  </p> <p style="text-align: justify;">But this week we had a run on 5-8 y/o children with mildly symptomatic flatfeet.  In this case, I fall back on the use of the <a href="https://www.myfootshop.com/birkobalance-arch-supports-for-children">BirkoBalance Pediatric support</a>.  The BirkoBalance is semi-firm and much better tolerated by children.  And I think they like the colors too.  Anything you can do to get the kids to wear these, right?</p> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 4/30/2021</p>urn:store:1:blog:post:104https://www.myfootshop.com/sustainable-health-care-intentional-choiceIntentional Choices in Health Care<h1>Intentional choices in health care</h1> <p>In my previous blog post, I introduced the concept of sustainability in health care.  By definition, sustainability refers to taking only<img style="float: right;" src="/Content/Images/uploaded/Blog images/burger.jpg" alt="Intentional choices in health care" width="250" /> what you need and leaving something for others.  In fact, a sustainable lifestyle may even result in giving back more than you take. Let's talk a little bit about the fundamental principles of sustainability and how they may relate to health care.</p> <p>The first element of living a sustainable lifestyle is making intentional choices.  The sustainable agriculture movement is a good example of an opportunity to make intentional choices.  There's been a recent change of mind for many folks with the quality and source of their foods.  Many people are choosing to purchase foods from a known source.  They're choosing to shop local and buy organically grown fruits, grains, and vegetables.  Look at the success of Whole Foods, Sprouts and Kroger's 'Simple Truth' line of organics.  In a September 2014 <a href="https://www.bloomberg.com/bw/articles/2014-09-12/krogers-organic-food-sales-are-about-to-hit-1-billion"> article in Bloomberg Business</a>, Justin Bachman writes that the Simple Truth line has hit $1billion dollars in annual sales.  That's a lot of intentional choices.  Although the Simple Truth line represents only 1% of Kroger's annual revenue, Kroger realizes that the market is there.  The simple fact is that people are making intentional choices with their food.</p> <p>Is the intentional choice of organic food for everyone?  Not at all.  As of February 2015, <a href="https://fortune.com/2015/02/17/burger-king-earnings-mcdonalds/">Burger King sales posted a 3% increase</a> in the previous sales quarter.  An intentional choice with food is a difficult one for low-income families.  Good food often equals expensive food, but eating a fresh, healthy diet can be affordable when you grow your own.  Who's got time for that, right?   To me, personally, not having a vegetable garden would be a sad loss of a growing season.  But I also know other people who wouldn't know how to grow a tomato if their life depended upon it.</p> <p>Fifty years ago, health care in this country was just plain different.  The delivery model was quite simple.  You went to the doctor when you were bruised or broken.  There was no management of chronic illness and subsequently, you died from a disease.  Not so today.  But the point is this; the way that primary care manages our health makes us feel as if we have no choices.  Our health is managed for us by others taking the choices out of our hands.  I disagree.  It's time to reinstitute intentional choice in health care.  Intentional choices in health care are personal choices.  You're simply assuming responsibility for the most precious thing that you have been given - the gift of life.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:103https://www.myfootshop.com/what-is-the-meaning-of-naturalWhat is the meaning of 'Natural'?<h2>What is the meaning of natural?</h2> <p>What is the meaning of 'natural' when you see it on a product label? When I buy a product - especially food - I look for the word natural, along with the word organic. These terms are important to me because I try to avoid chemicals and processed things as much as possible. This is an intentional choice to protect my health and the health of my loved ones.  However, the term 'natural' isn't regulated much. According to the USDA website, the term natural as applied to food means:</p> <p><em>"<a href="https://www.fda.gov/aboutfda/transparency/basics/ucm214868.htm">From a food science perspective, it is difficult to define a food product that is 'natural' because the food has probably been processed and is no longer the product of the earth. That said, FDA has not developed a definition for use of the term natural or its derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances.</a>"</em></p> <p>When it comes to skin care or cosmetics, the USDA is even more vague:</p> <p><em><a href="https://www.fda.gov/Cosmetics/ResourcesForYou/Industry/ucm388736.htm#7">FDA has not defined the term “natural” and has not established a regulatory definition for this term in cosmetic labeling. FDA also does not have regulations for the term "organic" for cosmetics.</a> </em></p> <p>Fundamentally, 'natural' means something that occurs in nature and is not made or caused by humankind. The simpler and more natural a product is, the more you can understand it and decide on whether it is safe to use or eat. To honor the belief that natural is safer than man-altered, we have created a line of foot care/skin care products created with all-natural and mostly organic ingredients. Applying creams and lotions to your skin affects your health just as ingesting food does, so it is important to know what you are rubbing into your skin. To this end, our definition of natural is:</p> <p><em>"<a href="https://www.myfootshop.com/all-natural">Ingredients used to make our products occur naturally in nature and are acquired from organic sources whenever possible. Our natural products are made from ingredients that do not cause cancer, allergies or hormone disorders in humans. Product ingredients are clearly labeled and may be researched in our product glossary.</a>"</em></p> <p>This is our promise.</p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p><!--==== BEGIN Mainlist_Folio ====--></p>urn:store:1:blog:post:102https://www.myfootshop.com/treating-sesamoiditis-with-dancers-padsSesamoiditis<p>I saw an 83 y/o patient yesterday with a very angry tibial sesamoid.  Although he's not on his feet too much these days he still was able to develop a very painful, inflamed bursa beneath the tibial sesamoid.  Two contributing factors included fat pad atrophy (thinning of the fat pad) and improper shoes.  A week ago I had applied a dancer's pad in the office that made a big difference in how he felt, improving his <a href="https://www.myfootshop.com/article/sesamoiditis">sesamoiditis</a>.  Now the question was how we were going to keep him comfortable while at home and perhaps modify his shoes.</p> <p><a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/products/680_reusable_dancers_pad.jpg" alt="Reusable dancer's pad" width="90" /></a>The first consideration we discussed was his activities.  He said he spent a fair amount of time in his slippers while at home.  Slippers are usually just that - they slip on and are flimsy.  Not a great foundation in which we can place a supportive pad.  In this case, the best solution was to teach him how to use a <a href="https://www.myfootshop.com/reusable-gel-dancers-pads">Reusable Dancer's Pad</a>.  The Reusable Dancer's Pad is applied directly to the skin and a sock and slipper could be used over it while at home.  The neat thing about the Reusable Dancer's Pad is that you wash it with a little soap and water and it becomes sticky again.  Brilliant, right?</p> <p> </p> <p style="text-align: justify;"><a href="https://www.myfootshop.com/dancers-pads-premium-felt"><img style="padding-right: 5px; float: left;" src="/Content/Images/uploaded/Blog images/810_Dancers_Pad_Premium_Felt.jpg" alt="Felt dancer's pad" width="90" /></a>But stepping out in a pair of dress shoes is a bit different.  Although he could continue to use the Reusable Dancer's Pad, it's always easier if you can place the dancer's pad in the shoe.  In that way, the pad is there when you're ready to go.  I showed him the video on our <a href="https://www.myfootshop.com/dancers-pads-premium-felt">Premium Dancer's Pad</a> product page and placed it in the shoe for him.  Teach a man to fish, right?</p> <p>So what's the best dancer's pad?  It all depends.  If you need help with the best choice for your needs, be sure to connect with us on <a href="https://www.facebook.com/myfootshop">Facebook</a> or in chat.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:100https://www.myfootshop.com/sustainable-health-lessons-from-permacultureSustainability in Health Care - Lessons Learned From Permaculture<h1>Sustainability in health care</h1> <p>Sustainability is a bit of a buzz word these days.  To be sustainable means that you only use what you need, leaving the rest to be <img style="float: right;" src="/Content/Images/uploaded/Blog images/or_nurse.jpg" alt="sustainability in healthcare" width="250" />used by you or others in the future.  For example, sustainability is a popular topic in environmental sciences and refers to renewable agriculture, good stewardship of natural resources and recycling of waste.  What about sustainability in health care?</p> <p>How do we grapple with the concept of sustainability in health care?  In health care, we often describe The United States health care system as unsustainable.  The skyrocketing costs of US health care simply cannot continue on their current trajectory.  The World Bank describes total US health expenditures in 2012 as 17.9% of GDP, higher than any other single country. (1)  If the reality is that the rate of spending in the US health care system is indeed unsustainable, how then do we implement changes that will bring about sustainability?</p> <h2>Lesson learned from permaculture</h2> <p>I've been a student of permaculture for several years.  Permaculture is the science of growing food in ways that give back to the earth.  In permaculture, natural resources are conserved and food production is possible without artificial pesticides and fertilizers.  My personal garden is a very important source of food in my diet.  To me, it's important to know where my food comes from and how it has been cared for.  Through permaculture, my goal is to live a sustainable lifestyle.</p> <p>There are a lot of bright minds in health care, but sometimes bright minds evaluate problems exclusively from the standpoint of macroeconomics.  Through the use of meta-analysis, surveys and white papers, bright minds look for trends that will address the problems in health care.  But successful, sustainable health care isn't about trends, it's about people.  Individual people and the choices they can voluntarily make.  Unfortunately, in many cases, it's also about people and the involuntary choices that they are forced to make. </p> <h3>Practicing sustainability in healthcare</h3> <p>In permaculture, there are two fundamental principles.  First, we each need to make a personal, lifestyle choice.  To live a permaculture lifestyle we need to choose a permaculture lifestyle.    Rainwater?  Save it in a barrel.  Kitchen scraps?  Compost or feed them to your chickens.  Waste?  Recycle it.  It's a choice - a personal choice.</p> <p>The second principle is transparency.  Transparency is the ability to see and understand all that goes into your personal choice.  Transparency of methods, tools that are used and the outcomes of your actions all need to be transparent.  For instance, in permaculture, many people will choose to eat locally grown foods.  Locally grown foods have not been shipped from afar, using fossil fuels.  Locally grown foods will also be known to the consumer.  The local rancher who raised that cow for which you now have a hamburger can tell you what went into raising that cow.  The local farmer who raised those turnips can tell you about the chemicals (or lack of) that went into raising your food.</p> <p>In health care, personal choice and transparency are the two building blocks of sustainable health.  I'll address each in upcoming blog posts.</p> <p>1. <a href="https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS">data.worldbank.org/indicator/SH.XPD.TOTL.ZS</a> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:99https://www.myfootshop.com/medicallyguidedshopping-empowering-patientsMedically Guided Shopping<h1>Medically Guided Shopping</h1> <p>Every successful business has a unique method of pleasing their customers.  Great companies consistently provide excellent customer service and provide value to their customers that is far superior to their competitors.  As customers, we tend to think of these attributes as a company's brand, a brand being a promise of a benefit.  At the core of many brands is a unique method of doing business, often called a unique product offering.  With a unique product offering, a company can differentiate itself from its' competitors.</p> <p>In the crowded field of health care, it's unusual to find unique products that are patient-centered.  By patient-centered, I'm referring to tools that enable and empower consumers as patients to self direct their care.  One such patient-centered tool is <a href="https://www.myfootshop.com/about">Medically Guided Shopping</a>.  Medically guided Shopping is the unique product offering from Myfootshop.com that uses the power of the Internet to help consumers self direct their health care.  Medically Guided Shopping helps consumers find their right diagnosis and the right product, the right way.  What's the right way?  Medically Guided Shopping.</p> <p>Here's a short video that describes how Medically Guided Shopping works.</p> <p><a href="https://www.youtube.com/watch?v=WfPZ5NbrUj4"><img src="/Content/Images/uploaded/Blog images/medically_guided_shopping.jpg" alt="medically guided shopping" width="554" height="340" /></a></p> <p>I'm going to spend this week describing Medically Guided Shopping and how consumers can take advantage of this unique product offering. As medical director of Myfootshop.com, it's my job to help consumers learn about Medically Guided Shopping and how they can self manage their care.  But what's most interesting is to see the transformation that occurs with customers when they realize that they actually can self direct their care.  It's great to see our customers find our unique product and engage our brand.  </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:97https://www.myfootshop.com/reusable-metatarsal-padsA reusable metatarsal pad? How smart is that!<h1>Reusable metatarsal pads</h1> <p>OK, so how smart is this?  A metatarsal pad that's reusable.  Just wash it and the surface becomes sticky again.  This pad is easy to use while barefoot, in socks around the house or all day while in shoes.  </p> <p>We just launched a new series of videos that feature the proper placement of metatarsal pads.  <a href="https://www.myfootshop.com/reusable-metatarsal-pad">The Reusable Gel Metatarsal Pad</a> is one of our most popular met pads.   Used to treat <a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a>, <a href="https://www.myfootshop.com/article/capsulitis">capsulitis</a>, <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>, and <a href="https://www.myfootshop.com/article/forefoot-pain">forefoot pain</a>, the Reusable Met Pad is latex-free and easy to place.  This link to the video explains proper use.</p> <p><a href="https://www.myfootshop.com/reusable-metatarsal-pad"><img src="/Content/Images/uploaded/Blog images/929_video.jpg" alt="Reusable metatarsal pad" width="466" height="293" /></a></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:96https://www.myfootshop.com/cold-weather-woes-for-your-dry-skinCold weather woes for your dry skin<h2 style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;"><img style="margin-right: 5px; float: left;" src="/Content/Images/uploaded/933_natural-lavender-tea-tree-lotion-8-oz - Copy 1.jpg" alt="Natural Tea Tree and Lavender Lotion" width="150" />Cold weather means dry skin</h2> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;"> </p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;">When it's cold outside, my skin gets so dry. There is less moisture in the air outside, and even less moisture inside with furnaces running nonstop. Every winter I battle dry skin, especially on my hands. Since I am always washing my hands and doing dishes, I wind up with jaggedy nails, raw cuticles, and dry skin.</p> <p style="margin: 0in; font-family: Calibri; font-size: 11pt;"> </p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;">In years passed, I have spent oodles of money trying out different hand creams and moisturizers, until I understood what to look for. I now know that natural hydrating creams and lotions based on plant oils such as sesame oil, and avocado oil absorb into the skin and hydrate longer. We developed our line of natural foot care products primarily as antibacterials and antifungals, but their properties are the perfect elixir for dry skin too.</p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;"> </p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;">So, I keep a jar of our <a href="https://www.myfootshop.com/antifungal-lavender-tea-tree-lotion-8oz">Natural Lavender and Tea Tree Lotion </a>next to every sink, along with our <a href="https://www.myfootshop.com/antifungal-foaming-soap">Natural Antifungal Lavender Tea Tree Foaming Soap</a>. Whenever I wash my hands, at least I can do it with a gentle moisturizing foaming soap that doesn't dry out my skin, and then add extra moisture with our lotion.</p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;"> </p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;">Thalia</p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;"> </p> <p style="margin: 0in; color: #222222; font-family: inherit; font-size: 10pt;"><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)<br />Myfootshop.com<br /><br />Updated 12/27/19</p>urn:store:1:blog:post:95https://www.myfootshop.com/metatarsal-pad-instructional-videosMetatarsal Pad Instructional Videos<h1>Metatarsal pad- instructional videos</h1> <p>How do I use it?  That's a question we answer many times a day at Myfootshop.com.  And what's important to us is not that you just use it, but rather you use it in the best way possible.  That's why our instructional videos are so important.  We can tell you how to use it but there's nothing better than actually seeing a pad placed in the correct position.</p> <p>That's why we're excited to roll out our 9 new videos that describe our entire line of metatarsal pads and how to correctly place the pads.  Met pads can be placed directly on the foot, they can be placed in the shoe or they can be used to modify orthotics.  How do you use a met pad?  Check it out.</p> <p><a href="https://youtu.be/m4f7wT70K_M"><img src="/Content/Images/uploaded/Blog images/729_video.jpg" alt="Metatarsal pad video" width="390" height="258" /></a> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:92https://www.myfootshop.com/mortons-neuroma-jane-russell-effectTreating Morton's Neuroma - The Jane Russell Effect<h1>Treating Morton's Neuroma</h1> <p>What does Jane Russell have to do with a Morton's neuroma?  Actually a lot.  Jane Russell was the spokesperson for Playtex and represented the Cross Your Heart line of bras.  The Playtex motto for the Cross Your Heart Bra was that 'it lifts and separates'. Remember?  And what was that about neuromas?</p> <p><a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a> is a common forefoot condition, so common in fact that in many cases, if a patient has forefoot pain, Morton's <a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img style="float: right;" src="/Content/Images/uploaded/Products/729_Metatarsal_Pads_Felt.jpg" alt="felt metatarsal pad" width="200" /></a>neuroma is cited as a differential diagnosis.  Although there's a host of different conditions that may cause forefoot pain, Morton's neuroma often tops the list of problems.  A review of the literature finds that there is very little consensus regarding why Morton's neuroma develops.  And even Morton himself was confused.  Morton, a Viennese physician from the late 19th century coined the term neuroma.  The suffix 'oma' refers to a primary tumor.  But a Morton's neuroma isn't a tumor, it is actually a nerve entrapment much like carpal tunnel.  Although there is no consensus on the etiology of Morton's neuroma, most podiatrists will agree that Morton's neuroma is due to an impingement of the interdigital nerve by the adjacent metatarsal bones.  Hypermobility of the forefoot results in increased movement of the metatarsal bones and in subsequent impingement.</p> <p>So what about Jane Russell?  If you're old enough, you'll remember the Playtex Cross Your Heart slogan; it lifts and separates.  And that's what a simple <a href="https://www.myfootshop.com/metatarsal-pad-felt-1">metatarsal pad</a> does for Morton's neuroma.  Use of a metatarsal pad in the treatment of Morton's neuroma is used to lift and separate the metatarsal bones, stabilizing the bones, and decreasing the tendency towards compression of the intermetatarsal nerve.</p> <p>The Jane Russell effect?  Call it what you may, but the use of a metatarsal pad in the treatment of Morton's neuroma is one of the most successful methods of treatment.  Felt, foam, PPT or gel met pads are the first line to lift and separate those metatarsals.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:94https://www.myfootshop.com/the-wonders-of-capsaicinThe Wonders of Capsaicin<p><img style="float: right; padding-left: 5px;" src="/Content/Images/uploaded/hot_pepper_harvest_small.jpg" alt="hot pepper harvest" width="170" height="150" /></p> <h2>Hot peppers for diabetics?</h2> <p>In the summer and fall, you can find me in my garden, nurturing and harvesting many vegetables, fruits and herbs. We usually dedicate a large portion of our garden to hot pepper plants, planting many varieties. We love the heat and spice they add to our meals so we grill, dehydrate and freeze lots of them. It's also an annual tradition to make several gallons of hot sauce to give to friends and family at Christmastime.</p> <p style="text-align: left;">You know what it's like when you handle, chop and cook a bunch of hot peppers without wearing rubber gloves, don't you? It seems like at least once every harvest season, I forget to don my rubber gloves and then for days afterward, my hands tingle and burn from the capsaicin in the peppers. I didn't realize until recently that this property can actually be a benefit to folks with diabetes and peripheral neuropathy. Regular use of an ointment or cream desensitizes peripheral pain fibers, which decreases the painful symptoms of diabetic peripheral neuropathy.</p> <p>We developed our own <a href="https://www.myfootshop.com/diabetic-foot-cream">Natural Diabetic Foot Cream</a> and have added it to our line of natural foot care products. We're excited about its unique natural properties and hope that it helps a lot of folks manage their symptoms. It's wonderful how science can take a common irritant and make good use of it! </p> <p> Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)<br />Myfootshop.com<br /><br />Updated 12/27/19</p>urn:store:1:blog:post:91https://www.myfootshop.com/raynauds-disease-and-treatmentRaynaud's Disease and Treatment Options<h1>Raynaud's Disease and Phenomenon</h1> <p>In my previous blog post, I described why fingers and toes hurt so badly after cold exposure and upon warming.  Let's talk a little bit about some of the conditions that contribute to this unique kind of cold weather pain and treatment options.</p> <p>The symptoms and the treatment of cold exposure vary dramatically from person to person.  For many of us, cold weather exposure means just that; we're going to get cold and shiver.  But for many people, cold exposure results in significant pain.  The most common diagnosis used to describe this condition is <a href="https://www.myfootshop.com/article/raynauds-disease">Raynaud's disease</a>.  When discussing Raynaud's disease, the terms disease and phenomenon are often used interchangeably.  Raynaud's disease described a person who has been diagnosed with the condition while Raynaud's phenomenon describes a single instance of Raynaud's disease.</p> <p>My hiking buddy has Raynaud's disease.  When we go on a multi-day trip in the spring or fall, he always brings gloves to help.  It's not necessarily severe cold that affects his hands, but in backcountry conditions, it's often hard to get out of the elements.  It's remarkable to see his fingers blanch white with temperatures that don't even get below 50F.  And they hurt.  Other than his Raynaud's disease, he's essentially healthy.  He is a previous smoker but has not smoked in years.</p> <h2>Raynaud's disease - causes</h2> <p>What causes Raynaud's phenomenon and Raynaud's disease?  A review of the literature may result in more confusion than can be of help.  Many authors associate Raynaud's disease with connective tissue disorders such as lupus, rheumatoid arthritis, and scleroderma.  Medications, including birth control and beta-blockers, are often cited.  Anxiety and mood disorders are also cited as contributing causes.  Tobacco use, whether traditional cigarettes, vape pens or snuff, becomes a potent vasoconstrictor.  A single cigarette can reduce blood flow to the toes by 30% for up to 1 hour.</p> <h3>Treatment of Raynaud's disease</h3> <p>The most common pharmaceutical approach to treating Raynaud's disease is the use of a blood pressure medication called a calcium channel blocker that works by dilating the peripheral arteries, in many cases preventing peripheral vasospasm and easing the symptoms of Raynaud's Disease.  Mood stabilizers such as Prozac are also used.  Patients are also instructed to avoid smoking and use of beta-blockers.</p> <p>For many patients with Raynaud's disease, the single best solution is to move to a warm climate.  Even in these cases, exposure to the freezer chest at the grocer or air conditioning at a restaurant may trigger an episode of Raynaud's phenomenon.  </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:93https://www.myfootshop.com/recycling-is-a-big-part-of-our-every-dayRecycling is a big part of our every day.<h2 style="text-align: left;"><span class="_Tgc">Recycling Matters!<br /></span></h2> <p> </p> <p style="text-align: center;"><span class="_Tgc"><img style="float: right; padding-left: 5px;" src="/Content/Images/uploaded/recycling - Copy 1.jpg" alt="thalia oster" width="150" /></span></p> <p style="text-align: left;">We don't let snow or frigid temperatures deter us from hauling all of our recyclables to the local recycling center. As a fulfillment center, we go through quite a bit of cardboard, paper, and plastic each and every day. We also unpack an unseemly amount of plastic film bags, as you can see in the photo. We are very pleased to be able to take as much plastic film as we generate to our local Walmart, which has a big recycling bin by their entrance for plastic grocery bags and plastic film.</p> <p style="text-align: left;"><span class="_Tgc">Since we make and sell foot care products with all-natural, organic and recyclable ingredients, recycling the byproducts of what we do is just as important. We all feel so much better knowing all of this plastic doesn't go in the trash! </span></p> <p>Thalia</p> <p><img src="/images/uploaded/Blog images/thalia_cc4.jpg" alt="Thalia Oster, JD" width="100" /></p> <p><a href="https://www.myfootshop.com/foundersbio">Thalia Oster, JD</a><br />Founder and COE (Chief of Everything)<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:90https://www.myfootshop.com/why-does-cold-exposure-make-toes-and-fingers-hurtWhy do my hands hurt so badly after they've been cold?<h1>Raynaud's disease - prevention and treatment</h1> <p>Cold exposure, particularly to the distal extremities (fingers and toes) results in profound vasospasm, limiting blood flow.  As the fingers and toes are re-warmed, many people experience significant pain that is described as severe as grasping broken glass.  Why does this happen?  Let's take a look and see if we can describe why fingers and toes can hurt so much upon re-warming.</p> <p>From a physiological standpoint, your body is a smart manager of cold weather.  Your body views every experience of cold exposure as a potentially life-threatening situation.  When exposed to cold weather, your body's sole responsibility is to maintain it's core temperature.  Deviations in core body temperature to 35 C (95 F) will result in symptoms of fatigue, lethargy, drowsiness and a confused state.  If blood was to be circulated through cold hands, the blood would be chilled and returned to the body core, lowering core body temperature.  Your body's natural defense mechanism is to shut off blood flow to the coldest (most distal) parts of the body.  In medical terms, this loss of blood flow is called peripheral vasospasm.</p> <p>The hypothalamus is the portion of your brain that regulates your body temperature.  When your hypothalamus recognizes that you've returned to a warmer environment, it responds by increasing the blood flow back to the hands.  This response in increased blood flow is called reactive hyperemia.  In cases where people experience pain in the fingers and toes, the pain is due to the peripheral vasospasm and reactive hyperemia clashing.  Pain results from the stimulus of the nerves found in the small arteries (arterioles) of the fingers and toes.  It's as if the arterioles didn't get the message from the hypothalamus that the threat is over.  Peripheral vasospasm persists while reactive hyperemia tries to push new, warm blood into the fingers and toes.  There's one warning signal that we all recognize when our body is threatened and that's pain.  And in the case of pain upon warming, your body is simply saying there's a critical issue here.  In a way, your body is warning you to just not do this again.</p> <h2>Treatment of Raynaud's with L-Arginine Cream</h2> <p style="text-align: left;">Prevention is key to preventing cold exposure and post-cold exposure pain.  Keeping the hands and feet dry with a drying agent is important.  <a href="https://www.myfootshop.com/lavender-tea-tree-body-powder">Body powder</a> and <a href="https://www.myfootshop.com/onox-foot-drying-solution-1">drying agents</a> are essential, particularly in cases of generalized hyperhydrosis.  One amazing tool that can be used to keep that hands and feet warm is warming creams made of L-Arginine.  </p> <p>And don't forget to wear your hat.  Why?  Because your mom said so.  And she was right.  The majority of heat loss in cold exposure is heat loss from the head.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:89https://www.myfootshop.com/corss_country_skiingThe biomechanics of cross-country skiing<h1>The biomechanics of cross country skiing</h1> <p>I've been working a bit lately on my cross-country skiing and started thinking about the biomechanics of skiing.  The biomechanics <img style="float: right;" src="/Content/Images/uploaded/Blog images/xc_toe_clip.jpg" alt="Cross country toe clips" width="200" />of cross-country skiing are markedly different than that of downhill (Alpine) and even Rondenee (also called Alpine touring.)  Cross-country skiing requires form that is centered over the ski with virtually no reliance on your bindings.  Alpine and Rondonee bindings differ in that they are rigidly fixed to the ski (Alpine) or semi-rigidly/rigidly tethered as found in Rondonee bindings.  The beauty of a cross country set-up is the simplicity of a toe clip.  But that simplicity also means that the act of cross-country skiing requires a very calculated, centered load-bearing and swing phase to keep the skis in alignment.</p> <p>To enable walking and running, the leg, ankle, and foot work as a lever delivering force from the calf to the ball of the foot.  This kinetic chain of events enables forward propulsion.  Your body strives for efficiency to reduce energy consumption.  The single best way it achieves this is to keep your body moving forward in the <a href="https://www.myfootshop.com/article/cardinal-planes-of-the-human-anatomy">sagital plane</a>, not deviating in other directions.  For instance, moving up and down or side to side are deviations that require additional energy input by your body.</p> <p>As a foot doc, my thinking is about what happens to the foot during cross-country skiing.  If we think of the leg ankle and foot as <a href="https://www.myfootshop.com/article/ct-band-syndrome">a lever</a>, what can make this lever more effective and what can make it less effective.  There are three things that come to mind.  First, alignment of the feet out of the normal base of gait.  Second, control of hip rotation during gait.  And third, rotation of the foot in the frontal plane.  Let me explain.</p> <p>If you're standing barefoot or in street shoe, your normal base of gait (medical definition) is approximately 30 degrees of abduction form the center line.  What's that mean?  If you looked down at your feet and had a center line for reference, they'd look like this  \  |  /.  Follow?    Now with cross country skiing, you need to align like this |  |  |.  And without the additional support of a fixed binding, this takes some practice.</p> <p>When I was in school playing football, I played defensive end and linebacker.  My coach taught me that the most reliable way to track a running back was to watch their belt buckle.  And he was right.  You can be fooled by the feet and fooled by the shoulders, but the belt buckle doesn't lie in terms of what direction the runner is headed.  This is because in gait (both running and walking) your body will maximize efficiency by preventing the center of gravity from deviating from the direction in which you are headed.  But there's always going to be a certain degree of deviation in normal gait.  Arm swing will result in rotation of the torso.  Flexion of the hip in swing phase and extension of the hip in weight bearing to toe off phases of gait certainly will contribute to deviation of your center of gravity.  With Alpine and Rondonee skis, you can use these motions to manuever your skis.  But in cross country skiing you don't have the advantage of fixed bindings.  In cross-country skiing, it becomes a constant focus to keep your center of gravity centered.  Just like coach taught me.</p> <p>Rotation of the foot in the frontal plane is the final consideration in cross-country skiing.  To define the frontal plane, pretend you are standing at a sliding glass door facing out.  The glass door represents the frontal plane.  In normal gait, the foot will roll out (supinate) and roll in (pronate).  Supination and pronation in cross country skiing can contribute to significant deviation from forward motion in the sagital plane. </p> <p>Limiting each of these three ways your body deviates from the sagital plane maximizes the efficiency of your cross-country ski experience.  Keeping your feet in alignment and minimizing rotation of the shoulders and hips will keep you in the sagital plane and on-track.</p> <p>When treating cross country skiers for foot issues, I use a lot of in-shoe devices to limit supination and pronation (motion in the frontal plane).  In every case, a barefoot gait exam is used to determine the degree of supination and pronation in gait.  Depending on the foot type, different in-shoe products may be recommended.  First and foremost is management of pronation with a <a href="https://www.myfootshop.com/sole-active-insole">semi-rigid carbon graphite orthotic</a>.  Carbon graphite has the strength to limit pronation but enough flex to promote sagital plane gait.  To limit supination, I use <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">lateral sole wedges</a> and <a href="https://www.myfootshop.com/heel-wedges-rubber-1">heel wedges</a> to control motion. </p> <p>Keeping it centered.  That's the key to a good ski.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:86https://www.myfootshop.com/spring-plates-used-to-treat-metatarsal-stress-fracturesTreating metatarsal stress fractures with Carbon Graphite Spring Plates<h1><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right;" src="/Content/Images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon Graphite Spring Plate" width="90" /></a>Treating metatarsal fractures with Spring Plates</h1> <p>When you purchase a <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Carbon Graphite Fiber Spring Plate</a> we'll send you a follow-up survey asking why you purchased it.  The feedback that we get from customers on Myfootshop.com regarding the use of Spring Plates is really quite interesting.  I not only enjoy reviewing the feedback but I actually learn from the uses.  Many of our customers are referred to us by their podiatrist or orthopedist while many customers are self-referred, particularly the sports customers.  Seems carbon graphite spring plates are talked about in a number of runners forums and Facebook running groups. </p> <p>I saw two of my own patients this week for follow-up on <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal stress fractures </a>that were diagnosed over a month ago.  In each case, we recommended the use of a Spring Plate as an alternative to a walking cast or post-op shoe.  In both cases, the patients confirmed that the use of the Spring Plate made a significant difference in how they felt.  With the Spring Plate, they could be on their feet for longer periods of time.  Without the Spring Plate, they were limited in their activities. </p> <p>Any other uses that you might have used your Spring Plate for?  We'd love to hear from you.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:85https://www.myfootshop.com/treating-plantar-fibromatosis-with-orthoticsTreating plantar fibromatosis with orthotics<h1>Treating plantar fibromatosis</h1> <p>It's always great when a patient makes a comment that makes you re-think everything that you've learned about a condition.  I was meeting with a patient today who wanted to schedule a surgery and said, "hey doc, can you take a look at this little bump on the bottom of my arch?  Is that something that I should have fixed too?"  What the patient was describing was a nodule in the mid arch commonly known as <a href="https://www.myfootshop.com/article/plantar-fibromatosis">plantar fibromatosis</a>.  There isn't a consensus in the literature as to the origin of plantar fibromatosis but I think most foot surgeons will agree that plantar fibromatosis is due to a micro tear in the fascia that heals with an over-proliferation of scar tissue.  That over-proliferation of scar tissue in the plantar fascia forms the nodule we call plantar fibromatosis.  Clinically plantar fibromatosis is easy to differentiate from other conditions that may exhibit swelling in the mid arch.  Plantar fasciitis is focal, subdermal, and specific to the medial or central slips of the plantar fascia.</p> <p>The second thing that most foot surgeons are going to agree upon is that you steer clear of asymptomatic cases of plantar fibromatosis.  The re-growth rate of plantar fibromatosis is greater than 25%.  It's not uncommon to take a patient back to the OR for an additional resection of the lesion due to re-growth post-surgery.</p> <p>And that's where my patient had a good point.  She said, "isn't surgery just pre-meditated trauma?  I mean, isn't what you do to take plantar fibromatosis out just an incentive for the fascia to over proliferate with more nodules?"  She has a very valid point.  Does trauma fix trauma?  I think collectively, we still have a lot to learn about plantar fibromatosis.</p> <p>So what non-surgical alternatives do we have?  The most common non-surgical method used to treat plantar fibromatosis is the use of a supportive insert called an orthotic.  Soft inserts like a gel or foam insert don't support the arch enough to unload the fascia.  We've had good success in managing the symptoms of plantar fibromatosis with our <a href="https://www.myfootshop.com/sole-active-insole">SOLE Active Insoles</a> and <a href="https://www.myfootshop.com/sole-active-insole-with-metatarsal-pad">SOLE Active Insoles with Metatarsal Pads</a>.  As an option, some prescription orthotic labs create a cut-out in the inserts to accommodate the nodule.  I find the primary treatment though is mechanical off-loading of the fascia.  This can be accomplished with a semi-rigid carbon graphite orthotic.</p> <p>So is the trauma of surgery actually a traumatic contributing factor to the proliferation of plantar fibromatosis?  Interesting thought.  I think that idea is something we'll need to watch in the literature.  And maybe in time, just maybe, we'll find a better, non-surgical way to treat plantar fibromatosis.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:83https://www.myfootshop.com/lateral-ankle-instability-in-charcot-marie-tooth-diseaseUsing the Malleoloc Brace for treatment of CMT<h1>Charcot-Marie Tooth Disease - ankle bracing</h1> <p>Ankle braces are used for a number of reasons including instability and swelling.  Instability can be due to a number of reasons including lateral ankle ligament injury, mal-alignment of the heel and forefoot and trauma to the lateral ankle ligaments.  <a href="https://www.myfootshop.com/article/charcot-marie-tooth-disease">Charcot-Marie Tooth Disease</a> (CMT) is an inherited neuromuscular disorder that causes foot drop and lateral ankle instability.  It's a rare case when I see someone with an inherited neuromuscular condition respond to over-the-counter (OTC) bracing.  Inherited neuromuscular conditions like CMT usually require the use of custom made prescription braces like an ankle foot orthotic (AFO).  </p> <p>I saw a patient today who I've seen for years who inherited CMT.  His development as a child was normal but as he reached his late teens he developed atrophy of the muscles of the lower leg, characteristic of CMT.  He's fought against using an AFO and has marginally controlled his drop foot with high top tennis shoes.  But the high top tennis shoes weren't enough to control his lateral ankle instability.  He was suffering from recurrent ankle sprains that would eventually result in a fracture or other permanent disability. </p> <p><a href="https://www.myfootshop.com/malleoloc-ankle-brace"><img style="float: right;" src="/Content/Images/uploaded/Products/860_MalleoLoc_Ankle_Brace.jpg" alt="Malleoloc Ankle Brace" width="90" /></a>To prevent long term injury, we tried thinking out of the box.  I placed the patient in a <a href="https://www.myfootshop.com/malleoloc-ankle-brace">Malleoloc Ankle Brace</a>.  The Malleoloc Brace is typically used as a sports brace controlling inherited lateral ankle instability or used as a brace following injury or surgery.  The Malleoloc Brace is lightweight so it wouldn't tax already weak lower leg muscles as seen in CMT.  The patient presented back to the office today after wearing the brace for 6 weeks and was happy as could be.  Most importantly, he was happy that we had respected his wishes to not wear a large AFO.  We found a way to keep him as the person he wanted to be.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:82https://www.myfootshop.com/bunion-products-following-bunion-surgeryDoing the second bunion<h1>Bunion surgery</h1> <p>I had a unique opportunity this morning to perform a bunionectomy on two different patients.  What was unique was that both of these patients had previously undergone correction of their bunion on their other foot.  So both were back for a second go 'round to take care of the other foot.  It's an honor when I can earn the opportunity to perform a patient's second surgery. </p> <p>One of the things that's important in a second case is that you duplicate the success of the first case.  Bunion surgery is somewhat of a step-wise procedure; you do this step first and then the next.  But each case is always a little bit different from the previous case.  I sometimes marvel at the variables and the fact that the outcomes are so similar despite the variables.</p> <p>In both of these cases, I found the second surgery seemed more challenging than the first.  The anatomy is the same but it's all the little things like alignment of the toe and positioning of the fixation.  Unbeknownst to the patient, I do ask a lot of questions pre-op in an attempt to duplicate the success of the first surgery.  For instance, "Did you have sutures to remove or did they dissolve on their own?" or "what kind of pain medicine seemed to work for you?"  The more I can duplicate the first procedure, the better the overall success of the second procedure.</p> <p><a href="https://www.myfootshop.com/toe-separator-large-firm"><img src="/Content/Images/uploaded/Blog images/693_Toe_Separator_LargeFirm.jpg" alt="Large, firm toe separator used following bunion surgery" width="90" /></a>  <a href="https://www.myfootshop.com/bunion-regulator-night-splint"><img src="/Content/Images/uploaded/Blog images/719_Bunion_Regulator.jpg" alt="Bunion regulator use following bunion surgery" width="90" /></a> Invariably, there are going to be some differences with the outcome, and that's where I use some of the products we carry on <a href="https://www.myfootshop.com/"> www.myfootshop.com</a>.  My go-to items are the <a href="https://www.myfootshop.com/bunion-regulator-night-splint">bunion regulator</a> and the <a href="https://www.myfootshop.com/toe-separator-large-firm">large, firm toe separator</a>.  Both are used to optimize the position of the great toe once the bandages come off.  I'll also use a <a href="https://www.myfootshop.com/forefoot-compression-sleeve">forefoot compression sleeve</a> to compress the surgery site.  The sooner you can eliminate the post-op swelling, the sooner you'll be back in a shoe.</p> <p>Although things went well in surgery this morning, it's always great to have these bunion products to fine-tune the final result.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:79https://www.myfootshop.com/treating-superficial-staph-infectionsTreating superficial cellulitis with a natural remedy<h1>Superficial cellulitis - treatment options</h1> <p>Each day we put on our shoes and socks and head out into the world.  What happens inside the shoes has little bearing on our day until something goes wrong with our feet.  What happens though is that inside the shoe we create a terrarium of sorts.  The inside of the shoe is hot, wet and dark.  Perspiration is locked inside the shoe creating a moist and hot environment.  This unique environment has a powerful effect on the skin of the foot making it prone to fungal infections and bacterial infections of the foot.  Many of these foot problems become chronic, perpetuated by the harsh environment inside our shoes.</p> <p><img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/cellulitis_foot_1.jpg" alt="superficial cellulitis of the foot" width="100" height="100" />I saw an 83 y/o male patient this morning for follow-up on superficial cellulitis of both feet.  I had seen him several weeks ago when he presented with well-demarcated lesions of the top of the foot and anterior ankle.  The lesions showed well-defined borders and an erythematous (red) base.  Small blisters (vesicles) were found within the lesions.  These lesions were consistent with a superficial staph infection.  The generic term used to define a superficial staph infection is called superficial cellulitis.</p> <p>Octogenarians are fragile folk.  As a doctor, when you treat octogenarians you need to use a gentle touch.  It's not an unusual occurrence to start an eighty-some year old on an antibiotic only to find them to come down with super colonization or overgrowth of a new and different bacteria.  The fear of c. difficile infections of the bowel are real and unfortunately all too common in octogenarians.</p> <p>In this case, we chose to treat the patient's cellulitis with a more natural solution called <a href="https://www.myfootshop.com/antifungal-healing-foot-cream">Antifungal Healing Foot Cream</a>.  Antifungal HealingFoot Cream is an antifungal and antibacterial cream that uses tea tree and lavender oils as its active ingredients.  My patient was very compliant with his treatment, applying Antifungal Healing Foot Cream twice daily.</p> <p>We've grown accustomed in our society to go to the doctor and get a pill - a fast fix for a problem.  But in the case of my patient, that fast fix comes with some serious side effects.  And in his case, he looks forward to the task of applying his cream every day.</p> <p>Most importantly, the choice of treatment worked.  Antifungal Healing Foot Cream was the right antibacterial for this case.  I also coached my patient to change his socks daily, rotate shoes to allow them to dry and to periodically use an Epsom Salt soak to dry the vesicles.</p> <p>My paycheck?  When my patient said to me, "Thanks, doc.  This really works."</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:78https://www.myfootshop.com/treating-metatarsalgia-with-lateral-sole-wedgesTreating metatarsalgia with lateral sole wedges<h1>Treating 5th metatarsalgia with lateral sole wedges</h1> <p>I saw a 14 y/o young lady today with symptoms of pain specific to the right 5th metatarsal.  She said that the pain had begun several weeks into training for basketball season.  She described no injury but stated that whenever she 'pushed it' the pain in the outside of the foot increased.  She said that basketball was her life and that I really needed to find a solution.</p> <p>The patient had palpable pain specific to the 5th metatarsal.  Pain was focused at the base of the metatarsal but also found in the mid-shaft.  She described no increase in pain with weight-bearing or with toe raises.  X-rays were negative for a stress fracture or for spurring of the base of the metatarsal (styloid process).  Primary diagnosis was <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a></span> of the 5th metatarsal with a differential diagnosis of <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/peroneal-tendonitis">peroneus brevis tendonitis</a></span>. </p> <p><a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><img style="float: right;" src="/Content/Images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts.jpg" alt="lateral sole wedges" width="90" height="90" /></a>We talked about treatment options and initiated care with the use of a <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><span style="text-decoration: underline;">lateral sole wedge</span>.</a>  The lateral sole wedge is intended to inhibit rolling to the outside of the sole.  By doing so, many cases of 5th metatarsalgia will resolve.  We also looked at this athlete's shoes.  At the onset of this pain, she had switched to a pair of shoes that had a curved last.  A curved last differs from a straight last in that the curvature of the shoe is intended to match the curvature of the foot.  In this patient's case, I think the curved last was actually throwing weight-bearing to the lateral aspect of the foot, thereby increasing load to the 5th metatarsal resulting in metatarsalgia.  We also suggested a new pair of shoes with a straight last.</p> <p>I don't think we'll see any change in this young athlete's play patterns with the use of a lateral sole wedge.  She'll keep playing due to her love of the game.  But I have my fingers crossed that the lateral sole wedges are going to be enough of a mechanical change to decrease the symptoms of metatarsalgia.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:77https://www.myfootshop.com/pulling-out-of-tail-spinPulling out of the tailspin<h1>Pulling out of the tailspin - part 3</h1> <p>I still see both Janet and Sharon as patients.  The two have had dramatically different outcomes, one pulling out of the tailspin and the other crashing.</p> <p>Janet is now on disability.  She truly is in pain and unable to stand for any length of time.  She lost her job when she started having problems with her car and was unable to get a ride to work.  Due to her poor educational background, Janet has been unable to find another job.  Her breathing is short due to cardiomyopathy and COPD.  Her husband and son remain unemployed.  Janet was unable to pull out of the tailspin and is now living a life in poverty.  Her obesity complicates her diabetes and her hypertension.  We've managed recurrent ulcerations of her feet and know that a lower extremity amputation is likely.</p> <p>Sharon, on the other hand, pulled out in time to recover her life.  She really embraces life.  She exercises daily and has recognized a weight loss that brings her BMI to 36.  She's completely off of both her hypertension medications and diabetes medications.  She's dating and planning a trip to Cancun in the spring.</p> <p>Health care choices matter.  The choices often require taking responsibility for your health and your life.  As you reach your 50's and 60's, health care choices matter even more.  From the examples of Janet and Sharon, you can see how their choices throughout their lives have an impact on the closure of their lives.  Janet entered a health care tailspin from which she couldn't pull out.  Sharon did pull out of the tailspin.  She worked hard to improve both her health and her personal life. </p> <p>Live well and make good choices.  It matters.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:75https://www.myfootshop.com/tails-spin-similarities-differencesWhat causes the tailspin?<h1><span style="font-family: Verdana; font-size: small;">The tailspin - part 2</span></h1> <p><span style="font-family: Verdana; font-size: small;">We're talking about our two patients, Janet and Sharon, who are at a turning point in their lives.  That turning point is called the tailspin.  The tailspin happens when they make poor health care choices that result in a loss of their vitality and health.  Let's take a look at the similarities and differences between their cases.</span></p> <p><span style="font-family: Verdana; font-size: small;"> Similarities - </span></p> <p><span style="font-family: Verdana; font-size: small;">1. Occupation - Both of these patients work hard.  They stand for long periods of time and have done so for many years.  Their incomes are meager compared to the amount of time that they work.  Why?  They may have been poor students or come from a less than supportive household.  In most cases, they're perpetuating a socio-economic status we'd call poverty.</span></p> <p><span style="font-family: Verdana; font-size: small;">2. Obesity - It's expensive to eat fresh fruits and vegetables.  The availability of inexpensive, highly processed foods makes obesity so common.  Simply put, when you're trying to stretch a dollar, you'll be eating cereal and pasta.  Obesity is contributing to loading on their joints, especially their hips and knees, resulting in early-onset osteoarthritis.</span></p> <p><span style="font-family: Verdana; font-size: small;">3. Hypertension - Although not all hypertension is caused by obesity, it's a known fact that if you lose your weight you'll go off of your blood pressure medication.  Over time, hypertension will result in damage to the heart and kidneys. </span></p> <p><span style="font-family: Verdana; font-size: small;">4. Diabetes - It's also a well-known fact that obesity contributes to diabetes.  Although not all cases of diabetes are due to obesity, the relationship is indisputable.  In a study that tracked obese diabetic patients who underwent bariatric surgery, 83% of all obese, diabetic patients went off of all of the diabetes medication follow successful weight loss with bariatric surgery.</span></p> <p><span style="font-family: Verdana; font-size: small;">5. Socio-economic status - What was it like for these two patients growing up?  Did they have supportive families or were their parents too busy trying to survive hard economic times?  In Janet's case, she's got her work cut out for her.  Her husband is unemployed and her son is sponging off of her with no contribution to the family overhead.  To make tough choices like the choices you need to make in a health care tailspin, how does a person do so without a supportive family?  How do they have the capacity to improve themselves when they are unfamiliar with the concept of self-improvement?  </span></p> <p><span style="font-family: Verdana; font-size: small;"> Differences - </span></p> <p><span style="font-family: Verdana; font-size: small;">1. Social - Where Janet has no support at home, Sharon is embarking on a new life and may very well be open to new ideas.  Sharon's recent mastectomy has given her a chance to take a good look at her mortality and her divorce has freed her from previous ties that may have kept her life 'as-is.'  Janet's support system is virtually non-existent.  Her husband and son have come to depend on her and that's all she knows.</span></p> <p><span style="font-family: Verdana; font-size: small;">2. Income - As the sole provider for her family, Janet cannot take time for herself.  And when she does, she's just plain tired.  There's no room in her life for exercise.  Sharon, on the other hand, may be open to exercise but also trying new things that she's never before considered like yoga, hiking or dancing.  She's going to be open to an active lifestyle.</span></p> <p><span style="font-family: Verdana; font-size: small;">In my next blog post, let's see how the conversations with Janet and Sharon went.  Were they able to pull out of the tailspin?</span></p> <p> </p> <p>Jeff</p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:74https://www.myfootshop.com/health-care-tail-spinThe tailspin<h1><span style="font-family: Verdana; font-size: small;">The tailspin - part 1</span></h1> <p><span style="font-family: Verdana; font-size: small;">After being in practice for thirty years you start to pick up on trends in your practice.  You start to realize <img style="float: right;" src="/Content/Images/uploaded/Blog images/women-85203_1280.jpg" alt="tail spin" width="200" />subsets of patients who have similar problems or challenges and share similar outcomes.  Any good doctor is going to try to help these patients do better, be more and live long and productive lives.  One of the most challenging subsets of patients that I see is a group of folks who come to me for foot pain, but the foot pain is just the tip of the iceberg.  These are patients who are going into what I describe as a tailspin.  These patients are fifty years of age or older, need to work for a living and spend long hours in manual labor jobs.  They are morbidly obese and are developing arthritis as a result of their long years of obesity.  Common co-morbidities, often weight-related, include type 2 diabetes and hypertension.  They're finding it difficult to work due to pain.  And they can't exercise due to their weight.  The tailspin is a defining moment in their lives where they need to make some difficult choices.  They still have an opportunity to pull out of the tailspin.  Let me give you two examples.</span></p> <p><span style="font-family: Verdana; font-size: small;">Janet is a 58 y/o female.  She presented to see me upon referral of her primary care doctor for foot pain and diabetic foot care education.  She had a 4-year history of poorly controlled diabetes and a 15-year history of poorly managed high blood pressure.  She is employed as a cafeteria worker at our local college.  She is married with a husband and 38 y/o son who never left home.  She is the sole income earner in the family.  Janet stood 5 foot 2 inches tall, weighed 265 lbs and had a body mass index (BMI) of 48.5. (greater than 30 = obese)</span></p> <p><span style="font-family: Verdana; font-size: small;">Sharon is a 62 y/o female employed as a forklift operator in a local factory.  She stands all day.  Sharon's chief complaint was chronic foot pain that was consistent with <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a>.  She stood 5 foot 4 inches tall, weighed 220 lbs with a BMI of 37.8.  She is single and appears financially stable following a divorce several years ago.  She lives alone.  Additional health issues included a ten-year history of hypertension, previous breast cancer with mastectomy, hypothyroidism and a 30 pack-year history of cigarette smoking (1 pack a day for thirty years).</span></p> <p><span style="font-family: Verdana; font-size: small;">Over the next several blog posts, let's take a look at these two patients and see if we can tease out similarities, differences and defining issues that contribute to their tailspin.</span></p> <p> </p> <p>Jeff</p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></p> <p>Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:73https://www.myfootshop.com/chilblains-and-frostnipChilblains - it's that time of year again<p> </p> <h2><span style="font-family: Verdana;"><span style="font-size: small;">Chilblain's and Frostnip- chronic cold weather injury</span></span></h2> <p><span style="font-family: Verdana;"><span style="font-size: small;">It's winter in the northern hemisphere and time again for</span><span style="font-size: small;"> </span><a href="https://www.myfootshop.com/article/frostbite#Tab1"><span style="font-size: small;">cold weather injuries of the feet</span></a><span style="font-size: small;">.  I'm starting to see<img style="float: right;" src="/Content/Images/uploaded/Medical/Vascular/frostnip_mod.jpg" alt="cold weather injuries of the ftt" width="200" /> the two most common cold-weather injuries: chilblains and frostnip.  The difference between chilblains and frostnip is the presence or absence of moisture.  </span></span></p> <p><span style="font-family: Verdana;"><span style="font-size: small;">Chilblains occur with chronic cold temperatures and in the presence of moisture (think damp, cold British castle).  Chilblains do not require that tissue freezes but occurs in temperatures above freezing (35-45 degrees F).  </span></span></p> <p><span style="font-family: Verdana;"><span style="font-size: small;">Frostnip, on the other hand, occurs in a dry environment where the superficial tissue actually freezes.  Freezing of the superficial skin cells results in dehydration of the cell and cell death.</span></span></p> <p><span style="font-family: Verdana; font-size: small;">The origin of the word chilblain is derived from old English.  Chil refers to a lower temperature and blain is the name of a superficial area of redness and swelling.  Frostnip differs from frostbite in that frostnip is a very superficial skin injury.</span></p> <p><span style="font-family: Verdana;"> <span style="font-size: small;"> The symptoms of chilblains and frostnip are actually quite different.  Chilblains present with slight swelling of the toes and redness.  The toes and forefoot have a dull ache</span><span style="font-size: small;"> that is not relieved by rest.  With frostnip the affected skin blisters and has a red, brown or wheat-colored crust.  Pain is described as a burning type of pain.</span></span></p> <p><span style="font-family: Verdana;"><span style="font-size: small;">To learn about the difference between frostnip,frostbite, and other cold weather conditions please read our article on <a href="https://www.myfootshop.com/frostbite#Tab3">Frostbite</a>.</span></span></p> <p><span style="font-family: Verdana; font-size: small;">So be careful out there.  No snow shoveling in your tennis shoes.  Be sure to stay warm in your little castle. </span></p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 01/18/2022</p> <p> </p>urn:store:1:blog:post:68https://www.myfootshop.com/problem-with-tarsal-coalitionThe problem with tarsal coalition surgery<h1>Tarsal coalition surgery</h1> <p>I had a long conversation today with a patient regarding surgery for a bilateral <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/tarsal-coalition#Tab3">tarsal coalition</a></span>.  The patient is a 21-year-old female who presented with deep achy pain in the rearfoot bilat.  We had sent her for a CT scan that confirmed the presence of a calcaneal-navicular coalition bilaterally.</p> <p>As described in the link above to our knowledge base page for tarsal coalitions, the evolution of a coalition follows a similar pattern.  As a child, the patient has a rigid flatfoot that becomes increasingly more rigid over time.  This change from semi-rigid to rigid occurs as the coalition ossifies.  As a child, the coalition is a fibrous bridge (syndesmosis).  This fibrous coalition is somewhat flexible and moves to accommodate motion.  But as the patient reaches skeletal maturity, the fibrous union ossifies and the foot becomes rigid.  This rigidity occurs in the late teens and early twenties.</p> <p>The pain created by the ossification of the tarsal coalition is caused by a number of factors.  The primary reason for pain is due to the stress that is placed on adjacent bone and soft tissue structures of the rearfoot.  The subtalar joint is particularly affected by this alteration in loading. </p> <p>My primary reason for obtaining the CT scan was not so much to rule in the CN bar, you could easily see it on plain films taken in the office.  The CT scan was ordered to identify the degree of collateral damage that the subtalar joint has already sustained.  And in this case, cystic erosion adjacent to the subtalar joint has already occurred.  The importance of this finding is that the subtalar joint damage will continue to be painful even following resection of the CN bar.  In most cases, this pain is only resolved with a subtalar joint fusion.</p> <p>In the conversation today with my patient I think she was disappointed with my discussion of the problems associated with these surgeries.  I detailed the fact that 50% of my patients will require a subtalar joint fusion due to continued pain.  The patient was interested in doing both feet at the same time but I told her that was impossible.  We also discussed the possibility of a primary fusion of the subtalar joint rather than doing a two-stage surgery.  We focused on what the community standard would be and I assured her that all surgeons would begin with just the resection of the tarsal coalition. </p> <p>But that does bring up a good point.  If most patients require a subtalar joint fusion, why aren't we performing that fusion at the time we resect the coalition?  I think most surgeons will agree that the earlier the fusion the greater the chance of destruction of adjacent joint.  By putting off the subtalar joint fusion you'll be sparing increased load to the ankle and midfoot that will result in early osteoarthritis of the ankle and midfoot.</p> <p>Treatment of CN bars is just one of those problems that ultimately deserves a better solution.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:65https://www.myfootshop.com/tailors-bunion-and-soft-cornHow does a tailor's bunion cause a soft corn?<h1>How does a tailor's bunion cause a soft corn?</h1> <p>One of the greatest things about medicine is that you're always learning.  This week I saw four different cases of <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/corn-and-callus#Tab3">interdigital soft corns called helloma molle</a></span>.  These little areas of callus are often found in the space between the 4th and 5th toes and are often confused with a case of interdigital <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/athletes-foot#Tab3">athlete's foot</a></span>.  But prior to this week, I hadn't realized the relationship between soft corns and a condition of the 5th metatarsal called a tailor's bunion.</p> <p>Take a peek at our <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/athletes-foot#Tab3">knowledge base article on tailor's bunions</a></span> and you'll see that the primary contributing cause of a tailor's bunion is the deviation of the 5th metatarsal away from the foot.  This bowing of the 5th metatarsal creates the bump we know as a tailor's bunion.</p> <p>So what's this have to do with soft corns?  In each of the four soft corn cases that I saw this week, each had a significant tailor's<a href="https://www.myfootshop.com/tailors-bunion-toe-spreader-combo-pad"><img style="float: right;" src="/Content/Images/uploaded/Products/981_Tailors_Bunion_Combo_Pad.jpg" alt="Tailor's bunion combo" width="200" /></a> bunion.  As the 5th metatarsal bows away from the foot, the long flexor tendon will begin to pull the toe in an eccentric manner.  In fact, in each of these cases, the long flexor tendon was actively pulling the 5th toe against the 4th toe resulting in the recurrent pressure that causes a soft corn.</p> <p>OK, I realize that this information isn't going to change the world, but honestly, it is a biomechanical characteristic of the foot that contributes to soft corns that I had never considered.  30 years of practice to understand this?  I'm still learning.</p> <p>As a boy I overheard a couple of fellows talking about motorcycles.  One said that the day you think you've mastered riding a motorcycle, that's the days you ought to quit riding.  And the same holds true for the practice of medicine.  I learned something new this week.  I guess I'll stick with this for a while.</p> <div class="post-body"> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> Updated 12/27/19</div> <div class="tags"> </div>urn:store:1:blog:post:64https://www.myfootshop.com/can-yoga-prevent-falls-in-seniorsCan yoga prevent falls in seniors?<h1>Can Yoga prevent falls in seniors?</h1> <p>A large percentage of my practice is an older population that is prone to falls.  A history of falls defines the aging person.  A single <img style="float: right;" src="/Content/Images/uploaded/Blog images/old_man.jpg" alt="Can Yoga prevent falls" width="200" />fall or series of falls is the hallmark of the final stages of aging.  In many cases, seniors don't have the physical ability to recover from the secondary effects of falls and succumb to pneumonia or stroke.</p> <p>From a physiological perspective, the changes that contribute to a fall are many.  First, the peripheral nerve impulse that is present in a younger population just isn't able to respond quickly enough to respond to the onset of a fall.  And brain chemistry is also a factor.  Neurotransmitters in the brain significantly decrease in the aging population.  Can't remember that person's name?  It's simply a fact of aging that we lose the capacity to react in a timely manner.  These are just two of the factors that make the aging population prone to falls.</p> <p>So what can be done to help the aging population prevent falls?  A careful review of the home is the first step.  Hand holds are important not only in the bathroom but also in strategic places throughout the home.  Remove the throw rugs and look for loose carpet and other obvious sources that might contribute to tripping.</p> <p>Exercise also has a place in preventing falls.  Strength training is important but balance training is also a must.  Tai chi has been used and now yoga has been proven to enhance seniors' ability to balance and prevent falls.  In a September article in The Archives of Physical Medicine and Rehabilitation, researchers found that yoga enhanced postural stability in seniors. (1)</p> <p>The problem I have in practice is selling the concept of yoga to my seniors.  Yoga is a very foreign concept to most octogenarians.  I've found that a referral to a yoga studio just flat out never works.  And without a thorough explanation of why exercise (sshhh - I mean yoga) works, most seniors just aren't going to get with balance training, let alone formal yoga.</p> <p>The way I start is with balance training in the doorway at home.  I have patients start by standing in a doorway with their hands on the door.  I have them lift one foot and balance using the doorway to prevent falls.  And then I have them switch feet and balance on the other foot.  5 minutes in the morning and 5 minutes of training at night.  Easy as that.</p> <p>It may not be tai chi or yoga, but if I can get a little balance training in, maybe just a fall or two can be prevented.</p> <p>1. Ni M, Mooney K, Richards L et al.  Comparative impacts of tai chi, balance training and specially designed yoga program of balance in older fallers.  Arch Phys Med Rehabil 2014;95(9):1620-1628.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:63https://www.myfootshop.com/medically-guided-shoppingMedically Guided Shopping - the Myfootshop.com business model<h1>Medically Guided Shopping ™</h1> <p>We had a great question from one of our customers this week that related to how we do business.  The customer wanted clarification on how medical questions are answered and how products are selected for specific conditions.  She asked, "does the doctor review every live chat session?  Does he review every recommendation for a product?"  These are very valid questions that go to the heart of our business model, a method that we call <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/about">Medically Guided Shopping™</a></span>.  As medical director of Myfootshop.com, it's my job to ensure that our customers understand how we go about doing business.</p> <p>What's Medically Guided Shopping™?  With Medically Guided Shopping, we 'help our customers find the right diagnosis and the right products the right way'.  First, it's important to recognize that none of the staff at Myfootshop.com, including me as medical director, are able to make your diagnosis for you.  Only your doctor can make your diagnosis.  But we can help answer questions you may have about a condition or diagnosis.  As an example, many of our customers have already been to see their doctor and have a diagnosis.  The reason that they contact Myfootshop.com is to learn more about their condition.  In many cases, our customers reach us through one of our <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/Articles/">foot and ankle knowledge base</a></span> articles.  The foot and ankle knowledge base contains articles on over 120 different foot and ankle conditions.  Although written in layman's terms, the knowledge base articles are detailed enough to be used by medical students and health care providers.  Our foot and ankle knowledge base articles are often used to satisfy the requirements for electronic health record meaningful use.  But again, let me be clear, although we cannot make your diagnosis, we can help you to understand your diagnosis a bit better.</p> <p><iframe src="https://www.youtube.com/embed/WfPZ5NbrUj4" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p>One of my roles as medical advisor is to curate the foot and ankle knowledge base.  Each week I scan journals for updated articles and collect images from my practice.  Updates of the knowledge base are performed daily. </p> <p>Another one of my roles as medical advisor is to select and vet products for sale by Myfootshop.com.  Our foot care products are paired with specific conditions in the foot and ankle knowledge base.  By doing this we not only offer to our customers the best foot care products but we also help to cut down on unnecessary purchases.  Our goal is to help our customers save money by selecting the best product for their particular condition.</p> <p>Communication with our customers whether by live chat, email or on the phone is accomplished by our sales staff.  As medical advisor, do I review each and every live chat or phone call? No, I can't possibly do so.  But each of those customer touchpoints is reviewed on a weekly basis.  As a company, we have an all-hands-on-deck meeting once a week to discuss medical conditions, product selection and specific questions related to foot care product use.  Questions about specific foot care products go into our product FAQs while customer service questions are placed in our customer service portal knowledge base.  I'm proud of my staff and the way they manage customer questions.</p> <p>We work hard to build your confidence and your trust.  And we thank you for the opportunity to serve you.  For additional information about our business model, please visit our <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/privacyinfo">privacy and security policy page</a></span>. </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:62https://www.myfootshop.com/treating-heel-slippageMy heel slips - what can I do?<h1>My heel slips - tongue pads</h1> <p>We had a question from a customer this week who asked what they could do to manage side to side slipping of the heel in their shoe.  They said that they had unsuccessfully used heel grips and were looking for another alternative.</p> <p>One of the oldest shoe fitting tricks is the use of a <a href="https://www.myfootshop.com/tongue-pads-felt">tongue pad</a>.  Tongue pads are used to snug the shoe.  Tongue pads are placed <img style="float: right;" src="/Content/Images/uploaded/Products/813_Tongue_Pads_Felt_ALT2.jpg" alt="Tongue pads" width="200" />under the 'throat' of the shoe.  The throat is the area of a non-laced shoe that would meet the top of the arch.  In laced shoes, there's often an adjustable tongue that protects the top of the foot from the laces of the shoe.  Placing one or more tongue pads on the underside of the tongue of the shoe (or the throat in non-tied shoes) will effectively push the foot back into the heel of the shoe.  The use of tongue pads can make a significant change in the fit of the shoes.</p> <p>But side to side motion in the heel?  In this case, we recommended the use of a tongue pad trimmed to fit the heel.  One tongue pad is applied to the medial side (inside) of the heel while another is applied to the lateral aspect of the heel.  And a third tongue pad is applied where?  You guessed it, under the tongue of the shoe to push the foot back into the heel.</p> <p>Another alternative for this customer would be to just go with the sloppy fit.  What I mean by this is that some shoes are specifically designed to have a sloppy fit in the heel.  Clogs, whether open or closed are specifically designed to have the heel slip.  So with the use of a clog, you don't need to worry about snug fit or the use of a tongue pad. </p> <p>Like they say, "if the shoe fits..."</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:61https://www.myfootshop.com/best-orthotic-for-hallux-limitusWhat's the best orthotic for hallux limitus?<h1>What's the best orthotic for hallus limitus?</h1> <p>We had a question from one of our customers this week that was discussed this morning at our all-hands-on staff meeting.  The question was this; what's the best orthotic for hallux limitus?</p> <p>Most of the time when we're asked a question like this, we fall back on our business credo - the right diagnosis and the right product, the right way.  So first, what's the right diagnosis?  If you read our knowledge base article on <a href="https://www.myfootshop.com/article/hallux-limitus">hallux limitus</a> you'll find that there are four different stages of hallux limitus and in each stage, treatment may vary.</p> <p>In stage 1, the only orthotic I'd recommend would be the <a href="https://www.myfootshop.com/sole-active-insole">SOLE Active Insole</a> that is modified with a <a href="https://www.myfootshop.com/dancers-pads-premium-felt">Dancer's Pad</a>.  Stage 1 hallux limitus is a bit unique.  In stage 1 there is no dorsal exostosis (dorsal bunion) and x-rays show no radiographic changes.  Stage 1 is characterized by a dull ache in the great toe joint.  In the vast majority of cases, hallux limitus is going to be caused by metatarsus primus elevatus (refer to the knowledge base article).  When hallux limitus is due to metatarsus primus elevatus, the orthotic is used as a foundation to hold the dancer's pad.  Use of the dancer's pad will plantarflex the 1st metatarsal correcting metatarsus elevatus and in many cases eliminate pain and slow the progression of hallux limitus.  <a href="https://www.myfootshop.com/turf-toe-t-strap">Turf Toe T Straps</a> may be a temporary relief for many.</p> <p>Stage 2 hallux limitus is a bit different.  Clinically, stage 2 will begin to show a wee bit of a dorsal bump on the head of the <a href="https://www.myfootshop.com/hallux-trainer-insoles"><img style="float: right;" src="/Content/Images/uploaded/Products/962_Hallux_Trainer_Working_ALT.jpg" alt="Hallus trainer inserts" width="200" /></a>metatarsal and subtle spurring on x-ray around the periphery of the joint.  In stage 2 I'm inclined to go with either the <a href="https://www.myfootshop.com/hallux-trainer-insoles">Hallux Trainers</a> or the <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plates</a>.  Hallux Trainers and Spring Plates are going to enable normal function of the foot but give just a bit of limitation to the range of motion of the great toe joint.  The more normal the function of the foot, the more normal gait will be with less load applied to the hip and lumbar spine.  <a href="https://www.myfootshop.com/turf-toe-t-strap">Turf Toe T Straps</a> will also be a temporary help in a pinch.</p> <p>Stage 3 and 4 are treated by splinting the great toe with either a <a href="https://www.myfootshop.com/glass-fiber-shoe-plates-flat">Glass Fiber Shoe Plate</a> or <a href="https://www.myfootshop.com/turf-toe-plates-molded-glass-fiber">Turf Toe Plate</a>.  Our goal with stages 3 &amp; 4 is to simply limit motion.</p> <p>So what's the best orthotic for hallux limitus?  First, be sure to have the right diagnosis before you consider the right product.  We just think that's the right way to do things.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:59https://www.myfootshop.com/chronic-pain-following-peroneal-tendon-rupturesPeroneus brevis tear - the reason for chronic pain.<h1>Peroneal tendon tear</h1> <p>I had an interesting conversation the other day with a chiropractic student who came in to see me as a patient.  He's a 26 y/o male who's very focused on physical fitness.  He's in great shape and loves soccer and running.  Six months ago he was tackled in a soccer game.  The play resulted in what at first seemed like a sprained ankle, except this sprain didn't heal.  Interestingly, the patient had no symptoms with pedestrian activities.  When he did attempt to return to sports he was limited by <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/peronius-brevis">peroneal tendon</a></span> pain.  He said that if he went for a recreational run he couldn't play soccer the same day.  Or if he played soccer, he wouldn't be able to run for several days.</p> <p>Clinical exam noted swelling specific to the posterior aspect of the left lateral malleolus.  Swelling was specific to the peroneal tendon sheath.  There was no crepitus or subluxation of the tendons on range of motion.  Plain x-ray revealed no fracture of the fibula or chip fracture associated with a rupture of the peroneal retinaculum.  MRI confirmed a <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/peroneal-tendon-rupture">longitudinal tear of the peroneus brevis tendon</a></span>.</p> <p><a href="https://www.myfootshop.com/article/peroneal-tendon-injuries"><img style="float: left; margin-right: 5px;" src="https://www.myfootshop.com/Content/Images/uploaded/Anatomy/Misc_Drawings/peroneal_tendon_injuries.jpg" alt="Peroneus brevis tendon rupture" width="100" height="79" /></a>The patient had an interesting question.  He asked whether the pain that he had now with activity was due to the original injury or whether it was due to a repetitive injury that occurred when he pushed the ankle (like soccer and recreational running in the same day).  The original injury occurred when the peroneus longus tendon created a split or longitudinal rupture of the brevis tendon.  To understand the mechanism of injury, think of the fibula carrying the patient's body weight like a spear towards the ground and the two peroneal tendons abruptly trying to pull up against this force.  I can see how the mechanism of injury actually happened, but was it the original injury that was causing his daily pain?  Or does the longitudinal tear contribute to increased degenerative changes in the tendon and subsequent pain?</p> <p>I'd have to go with the latter.  It's not the original injury that hurts but rather the repetitive re-injury that causes chronic pain with peroneal tendon tears.  Smart kid.  He'll go places with that kind of intellectual curiosity.  </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:58https://www.myfootshop.com/treating-bunions-with-spring-platesCan a Spring Plate be used to treat a bunion?<h1>Can a spring plate treat a bunion?</h1> <p>Can a <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a></span> be used to treat a <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/bunion">bunion</a></span>?  That depends….the classic description of a bunion describes a bump of bone at the medial aspect of the great toe joint that is the result of a poorly-aligned metatarsal bone and great toe. The great toe is pushing against the second toe and this poor alignment results in a prominence of bone at the medial side of the great toe joint. This medial<a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right;" src="/Content/Images/uploaded/Products/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Spring plate" width="200" /></a> bump can be painful and difficult to fit into shoes. </p> <p>But there's another kind of bunion.  <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/hallux-limitus">Hallux limitus</a></span> is sometimes described as a dorsal bunion.  Dorsal refers to the top of the great toe joint.  In a dorsal bunion (hallux limitus), the great toe will be straight.  The big difference between a ‘bunion’ and a ‘dorsal bunion’ is the alignment of the toe.  With a dorsal bunion, the great toe joint doesn’t move – it’s straight, stiff and it hurts to bend it.</p> <p>So if the great toe is pushing into the second toe, you have a medial bump and the joint moves freely, a Spring Plate isn't going to help.  You need to visit our <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/bunion-products">bunion products</a></span>.  But on the other hand, if you have a dorsal bump, the toe doesn’t move and your primary problem is that the joint hurts, you likely have hallux limitus (dorsal bunion) and a <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert">Spring Plate</a></span> would be indicated for you. </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:57https://www.myfootshop.com/i-thought-it-was-just-dry-skinI thought it was just dry skin.<p><a href="https://www.myfootshop.com/content/images/medical/derm/chronic_tinea_2_labeled.jpg"><img style="float: right; margin-right: 5px;" src="/Content/Images/uploaded/Blog images/chronic_tinea_2_labeled.jpg" alt="Chronic tinea of the foot" width="160" height="160" /></a></p> <h1>I thought it was just dry skin</h1> <p>One of the most common problems I see in my private office is <a href="https://www.myfootshop.com/article/athletes-foot#Tab3">athlete's foot</a>. Let me stress the term 'see' because typically, the athlete's foot infection isn't the primary reason for the office call.  The primary reason for the visit may be a sprain or fracture, but rarely is it for chronic dry skin of the bottom of the foot.  Without fail, when you introduce a patient to the fact that they have a fungal infection of the foot, without fail they say, "I thought that was just dry skin."</p> <p>Athlete's foot can be considered both an acute and a chronic problem.  Acute athlete's foot, known as tinea mentagrophytes, is the classic appearance of athlete's foot.  It presents with bubble and blisters that are localized.  The base is bright red and the foot itches.  T. mentagrophytes is common between the toes and on the sole of the foot.  Chronic athlete's foot presents a wee bit differently, without the dramatic bubbles and blisters.  Chronic athlete's foot (tinea rubrum) looks just like dry skin.  T. rubrum is found on the sole of the foot, classically described as a moccasin distribution.  T. rubrum is also the most common contributing cause to fungal infections of toe nails (onychomycosis.)  Infections of the toe nail occur when the nail is injured.  It is easier for the fungus to reside in the skin but once the nail is injured, the t. rubrum infection of the skin can easily seed an infection in the nail.</p> <p>After stating, "I thought that was dry skin" there is always the a-ha moment; "I've tried a number of different skin softeners.  So that's why that never clears up."  Common sense would say that dry skin is treated with the application of a skin softener.  But again, chronic athlete's foot won't respond to just a skin softener.  It needs to be treated with an antifungal.</p> <p>When treating fungal infections of the foot it's important to realize that treating the problem for two weeks will not resolve the problem.  It can't be treated like a bacterial infection that'll clear with the use of antibiotics for 10 days.  In the case of chronic fungal infection you need to have an ongoing treatment plan.  Do you need a prescription?  No, not at all.  In fact, prescriptions can contribute to the failure of treatment.  You go to the doctor, get your prescription and when the prescription runs out the athlete's foot comes right back.  Chronic fungal infections of the skin can easily be treated with over-the-counter (OTC) lotions and creams.  But let me stress again, it can't be resolved with a skin softener, it needs to be treated regularly (daily) with an antifungal cream.</p> <p>Our top seller for chronic fungal infections of the foot is <a href="https://www.myfootshop.com/antifungal-healing-foot-cream">Antifungal Healing Foot Cream</a>.  Antifungal Healing Foot Cream hydrates while <img style="float: right;" src="/images/uploaded/Products/794_Myfootshop_Healing_Foot_Cream_ALT.jpg" alt="Antifungal Healing Cream" width="100" />controlling new growth of fungus.  Used twice a day for two weeks and you'll see how well the dry skin clears.  And I thought it was just dry skin...</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:56https://www.myfootshop.com/hallux-limitus-surgery-fusion-implantTreating hallux limitus - fusion vs implant?<h1>Hallux rigidus- fusion or implant?</h1> <p>When it comes to treating <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/hallux-limitus">hallux limitus</a></span> and <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/hallux-rigidus">hallux rigidus</a></span>, I’ve been an implant guy for years. Implant arthroplasty (Mayo-Keller bunionectomy) is simply what I learned to use in my residency training 30 years ago. In cases of stage 4 hallux limitus (HL), I’ll opt for a great toe implant over a fusion any day. My logic is that it’s simple; what I would want to have?  I wouldn't want a stiff toe. I’d like to maintain the natural range of motion of my great toe joint.</p> <p>I’ve watched with interest as the podiatry community seems to have followed the orthopedics community into a trend to fuse stage 4 HL. Fusion has long been the procedure of choice in orthopedics.</p> <p>But I was heartened by several articles in <span style="text-decoration: underline;"><a href="https://www.jfas.org/">The Journal of Foot and Ankle Surgery</a></span> this year that have been advocating the use of implants in cases of stage 4 HL. Ironically, some of these articles were written by orthopedists (JFAS is a publication of the American College of Foot and Ankle Surgeons – the academic branch of podiatric surgery).</p> <p>Sure, there are indications for great toe joint fusions, but I just can’t see using it on a regular basis when the use of an implant is a reasonable and reliable choice. Heck, foot and ankle surgeons are all gun-ho on doing ankle joint replacements. Why not the same emphasis on great toe implant arthroplasty.</p> <p>Bottom line is the procedure works. So why fuse the joint?</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:55https://www.myfootshop.com/treating-plantar-plate-tearsUsing spring plates to treat plantar plate tears<h1>Plantar plate tear - treatment with a spring plate</h1> <p>The plantar plate is a broad, firm pad of tissue found on the plantar surface of the metatarsal phalangeal joint.  The plantar plate is often referred to as a ligament but is actually firm fibro-cartilage and resembles the menisci of the knee.  Plantar plate is incorporated into the plantar aspect of the metatarsal phalangeal joint capsule and acts as an anchor point for a number of muscles that cross the metatarsal phalangeal joint.  The most common location for a plantar plate tear is the 2nd metatarsal phalangeal joint.  (#4 on the image above)</p> <p>Tears of the plantar plate are categorized as acute or chronic.  In my 30 years of practice, I can count on one hand the number of acute tears of the plantar plate that I have treated.  Chronic tears of the plantar plate do appear more commonly.  Chronic plantar plate tears are the result of repetitive load bearing of the forefoot and fatigue of the plantar plate.  Chronic tears result in displacement of the toe in the sagital plane which results in a hammer toe, or in the transverse plane that results in deviation of the toe against an adjacent toe.  In long-term chronic plantar plate tears, subluxation of the toe does occur.  Subluxation is the term used to described dislocation of the metatarsal phalangeal joint.</p> <p>Acute tears of the plantar plate are the result of an abrupt force being applied to the toe, usually in a dorsal direction (toe toward the shin).  Symptoms include acute onset of pain, swelling and bruising.  A motor vehicle accident or sports accident would be two of the most common contributing causes of acute plantar plate tears.</p> <p>Chronic plantar plate tears are much more common and present over a period of months to years.  Symptoms include pain on the bottom of the metatarsal phalangeal joint.  Pain increases with the duration of time spent on the feet.  Bruising is not found and swelling also varies with the amount of time spent on the feet.  The most common spot for chronic plantar plate tears is the 2nd metatarsal phalangeal joint.</p> <p><a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left; margin-right: 5px;" src="/Content/Images/uploaded/Blog images/spring-plate-carbongraphite-fiber-insole_side_view.jpeg" alt="toe spring on a carbon graphite spring plate" width="90" height="90" /><span style="text-decoration: underline;">Carbon fiber spring plates</span></a> are often used to treat plantar plate tears.  The spring plate acts as a splint or brace for the plantar plate.  The toe spring also helps to off-load range of motion of the forefoot, decreasing the load applied to the injured plantar plate and decreasing range of motion of the joint.  Toe spring is the term used to describe the curvature of the spring plate from the ball of the foot to the tips of the toes.  </p> <p>Use of a carbon fiber spring plate may heal an acute plantar plate tear over time without surgery.  The symptoms of a chronic plate tear can be managed with a spring plate but rarely do chronic plantar plate tears actually heal without surgery.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:54https://www.myfootshop.com/health-care-literacyWhen we talk about health care literacy, how important is the word literacy?<h1>Health Care Literacy</h1> <p>I was getting on an airplane the other day and was following two young women down the aisle of the plane.  One woman held an <img style="float: right;" src="/Content/Images/uploaded/Blog images/mother.jpg" alt="mom" width="200" />infant and the other their tickets.  They had stopped and spoken briefly to the flight attendant upon their entrance to the plane and seems for some reason to be struggling to find their seats.  One of the moms turned to me and asked me where they were supposed to sit.  The young mom was standing at row 12 and showed me a ticket for seats 12 D, E and F.  At first I was a little confused.  But then it all became clear.  Both moms were illiterate.</p> <p>I sat in my seat and thought a bit about what it means to venture out into the world with absolutely no ability to read.  How would you find your gate?  Let alone, how would you be able to find the right parking garage.  I'm sure that in a limited world, like your own small grocery store or gas station, you'd be able to function with a certain degree of familiarity with your surroundings.  But taking an airplane broke all the familiar routines.  The one thought that rose to the top of my mind was the simple fact that for these two moms, this was a really scary thing to do.</p> <p>It's got to be tough to venture out into the world with no reading skills, but how do these moms navigate health care?  How can they complete a meaningful encounter with a medical office?  And how do they follow through on directions, prescriptions or even know when to return for a follow-up appointment?</p> <p>How do illiterate patients survive an appointment in a medical office?  Usually not well.  I've seen many health care providers become intolerant of patients who may not be able to communicate effectively.  Their irritation becomes a wonderful opportunity for the illiterate patient to become angry and leave a medical office.  It's not that the patient was mad.  It's simply that the patient was embarrassed and scared.</p> <p>I'm fortunate that I came from a socio-economic demographic that found reading to be a necessary life skill, and even more fortunate that I was able to use my reading skills to become a healthcare provider.  Yeah, it might take a little extra time to help someone who cannot read, but if health care literacy is at the core of good health care, it's imperative that we all find a way to help those who are illiterate find a way to better health.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:53https://www.myfootshop.com/wiser-than-a-wart-plantar-wart-treatmentWiser than a wart<h1>Natural Wart Treatment</h1> <p>How wise is a wart?  When it comes to the humble <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/article/warts">plantar wart</a></span>, actually pretty darned smart.  As a member of the papilloma virus<img style="float: right;" src="/Content/Images/uploaded/Medical/Derm/wart3.jpg" alt="Common wart" width="150" /> family, plantar warts are remarkably smart in the ways in which they have evolved to spread from person to person.  In comparison to an AIDS virus or common cold virus, plantar warts are real survivors.</p> <p>As humans, we are simply shed machines.  Everywhere we go we shed skin and hair cells.  You might think, 'not me, I'd never do that'.  Remember the Peanuts cartoon character Pigpen who was always in a ball of dust?  Although we might try to deny it, the reality of life is that we all have a little bit of Pigpen in us.  It's a normal process that we continue to shed and renew our skin, turning over a completely new layer of skin once a month.  In many cases, the skin we shed contains remnants of our lives.  So where did you acquire that plantar wart?  Most likely you acquired it from another person who shed a skin cell containing that specific papilloma virus.</p> <p>The plantar wart virus is a saprophyte, living on the tissue of others.  But the interesting thing about the plantar wart virus is its' resilience.  Studies have found the common plantar wart virus able to remain viable outside the body for up to 40 days.  That's pretty incredible considering the fact that an AIDS virus cannot live outside the body.  The virus that causes the common cold is only viable for minutes outside the body.  But 40 days!  That's a smart virus.</p> <p>So how do you fight back?  First, recognize some of the common characteristics of the plantar wart virus.  The virus has a predilection for thick skin, areas that are moist and folks in their teens.  The easiest of these characteristics to change is the moisture component.  Be sure to keep your feet open to the air and sunlight to help keep them dry.  Rotate shoes so that you give <a href="https://www.myfootshop.com/wart-salve"><img style="float: right;" src="/Content/Images/uploaded/Products/790_Wart_Salve_ALT.jpg" alt="Natural Wart Salve" width="200" /></a>ample time to allow the shoes to dry.  And lastly, use a drying solution for feet such as <span style="text-decoration: underline;"><a href="https://www.myfootshop.com/onox-foot-drying-solution-1">Onox</a></span>.</p> <h2>Natural Wart Remover</h2> <p>To really win against plantar warts you need <a href="https://www.myfootshop.com/wart-salve">Natural Wart Remover</a>.  Natural Wart Remover is a beeswax-based wart stick that combines natural ingredients that are indeed wiser than a wart.  Applied three times a day, Natural Wart Remover will decrease the ability of the plantar wart virus to thrive.  Natural Wart Remover eliminates warts painlessly and without surgery.</p> <p>Natural Wart Remover is the way to be smarter than a wart.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:52https://www.myfootshop.com/running-shoes-running-injuriesWhy running shoes aren't making your feet any better<h1>Why aren't running shoes preventing injuries?</h1> <p>The Atlantic recently published an article entitled <em><span style="text-decoration: underline;"><a href="https://www.theatlantic.com/health/archive/2014/06/can-shoes-help-prevent-running-injuries/371517/">Why Aren't Running Shoes Preventing Running Injuries?</a></span></em>  The article looked at the<img style="float: right;" src="/Content/Images/uploaded/Blog images/running_shoes.jpg" alt="running shoes" width="200" /> sport of running, running injuries and describes how shoes just simply haven't benefited runners in the way that we might think.  Although we're lead to believe that the science behind shoe manufacturing and testing has evolved to make a better shoe, it seems that the rate of injuries in runners has stayed at a consistent level in spite of these advances.  If that's the case, then what's all the buzz about with a Hoka One One or a Nike Air?</p> <p>I think it all has to do with runners.  Runners are a very interesting group of people.  I'm not going to call them athletes because in most cases, recreational runners are simply goal-oriented folks who are active.  An athlete, on the other hand, was that one kid in your high school class who won every sporting event.  Remember when you tried out for football and that one kid was the star running back?  And in the spring you signed up for track and that same kid won the 100, 220 and 440 races.  He's an athlete.  The rest of us (myself included) are just having fun.</p> <p>Runners are very goal-oriented.  And to a great degree, a runner's self-esteem is tied to the ability to reach those goals.  Although they may not be the fastest in their class, their ability to reach their goals enables them to be a part of that circle of folks called athletes.  So what's a runner going to do to reach that level?  A lot.  And they'll continue to work at it to stay in that circle of athletes even if it means injuring themselves, battling ongoing injuries or even having surgery to continue in their sport.</p> <p>And that brings us back to shoes.  Any committed runner is going to be all over the latest shoe design.  It's their tool.  It's what will keep them in the circle of athletes.  So a new twist to a shoe design or a new bit of gait analysis from a shoe company is big news to a runner - unless you're a barefoot runner, but that's a whole different story.</p> <p>My take-home point from The Atlantic article is that shoe companies seem to have created a market.  It's an old business technique.  The Wilkinson Sword Company created an entirely new market in the late 19th century when they convinced women that they needed to have smooth legs.  And the same holds true for how the underarm antiperspirant industry evolved.  We certainly couldn't have women who perspired. </p> <p>The point is this - even though Nike made false claims about their Five Finger Shoes, they came clean in court.  It's time that the shoe industry comes up with some real science that backs their products.  Real claims based upon research.  And you know, it might be very easy to do.  In this Internet-based world we live in, companies need to realize the value of their customers as advocates for their products and willing partners in testing products.  Involve your customers in your testing and you'll earn their respect - especially if those customers are runners.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:51https://www.myfootshop.com/bone-contusionsBone contusions - are they really fractures?<h1>Bone contusions</h1> <p>With the advent of MRI, we now have a new category of bone injury called a bone contusion (also called bone swelling).  Is a bone contusion really a fracture?  I think so, but thus far, we don’t really have the vocabulary in the literature to call a bone contusion a fracture.  Let me explain…</p> <p>A contusion is a term usually applied to soft tissue injuries that involve numerous structures.  A contusion may involve nerve, subcutaneous tissue, tendon, etc.  When we use the term contusion and refer to a bone injury, we’re describing a crush injury to the bone.  Bone is usually made of a hard, outer surface with a softer, spongy inner surface.  That softer, spongy surface acts as a shock absorber, absorbing load.  But with a contusion, the hard, outer bone and the softer inner bone is crushed.</p> <p>This is a hard injury for the bone to heal.  And often, a hard choice for surgeons to try to rebuild.  We drill it, graft it.  But in most cases, the idea is to restore the bone to its normal load-bearing structure.</p> <p>So is a bone contusion really a fracture?  I think so.  Any thoughts?</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:50https://www.myfootshop.com/health-care-interpreters-a-growth-industryHealth care interpreters - a growth industry?<h1>Health Care Interpreters</h1> <p>I spent a large portion of my afternoon yesterday helping two people navigate end of life issues.  June, a 93-year-old woman presented with her daughter from a local rehabilitation center with an ischemic limb.  Although June had been complaining about left foot pain for days, her rehab was for a right hip fracture.  Therefore, the focus of care was on the hip fracture.  Her referral to our wound center was made by her cardiologist who recognized the signs of critical limb ischemia. </p> <p>June had most of the problems you'd expect to see in someone her age.  The most obvious of her problems was that she couldn't see and she couldn't hear.  These two problems made it difficult for her to communicate in a meaningful way with her caregivers.  Although she had been expressing her leg and foot pain for days, no one at her rehab facility had taken notice of the severity of the problem. </p> <p>June was brought into our clinic by her daughter who we'll call Nancy.  Nancy was extremely helpful in a number of ways.  Nancy was able to provide an accurate history and brought with her a list of medication that her mom was taking.  Although June was unable to express herself with the clarity needed to describe her problems, Nancy was there for her mom as her advocate.  But Nancy also had another role.  She was acting as an interpreter for her mom.  Nancy was there to interpret the reams of forms, layers of instructions and orders given by June's providers.  </p> <p>We've all experienced the difficulties of working with someone who has a hearing deficit.  It can challenge your patience and it can be a time drain.  And although June was unable to describe her condition in any detail, she was able to understand the severity of her condition.  And she was able to understand what was taking place around her.  Most importantly, she could sense the environment around her.  She was able to recognize those providers who cared for her as a person. </p> <p>Due to the severity of June's wounds I elected to admit her to the hospital for evaluation by our interventional cardiology team.  Her problems are significant and life-threatening.  As of today, she was not medically stable enough to undergo an angioplasty to determine the extent of peripheral arterial occlusion.  Until an angioplasty can be performed, it's uncertain whether her leg can be saved.</p> <p>What's the role of an interpreter in health care?  We tend to think of an interpreter as someone who bridges a language barrier.  And in most cases, that language barrier is a foreign language like Somali or Spanish.  But what about June?  The language of medicine was foreign to her.  And without her daughter Nancy, she would have become just another patient; the woman in room 3032.</p> <p>Health care is complicated.  We need more health care interpreters to unravel the subtleties of how care is provided.  We need more people like Nancy.   </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:49https://www.myfootshop.com/pedag-holiday-now-the-viva-miniPedag Holiday becomes the Pedag Viva Mini<h1>Pedag Mini Viva</h1> <p>I don't think it comes as news to any of our current shoppers, but for those who purchased The Pedag Holiday Insert in years gone<a href="https://www.myfootshop.com/pedag-viva-mini-arch-support"><img style="float: right;" src="/Content/Images/uploaded/Products/804_Pedag_VIVA_MINI_Holiday_Arch_Supports.jpg" alt="Pedag Mini Viva" width="200" /></a> by and are looking to replace it, Pedag updated the Holiday a few years back (I know.)  The original Pedag Holiday is now called the <a href="https://www.myfootshop.com/pedag-viva-mini-arch-support">Pedag Viva Mini</a>.</p> <p>Why bring this up now?  It seems once a Pedag customer, you really stick with the product line.  We had a customer contact us today looking for new Pedag Holiday Inserts.  Their original order for Pedag Holiday's was more than 5 years back, and they were so happy to be able to find the 'new' holiday.</p> <p>Great product at a great price.  You gotta love Pedag.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><span style="text-decoration: underline;"><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a></span><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p> <p> </p>urn:store:1:blog:post:48https://www.myfootshop.com/treatment-of-subungual-exostosisTreatment of a subungual exostosis<h1><img style="float: right; margin-right: 5px;" src="/content/images/uploaded/subungual_exostosis.jpg" alt="Subungual exostosis" width="120" height="120" />Treatment of subungual exostosis</h1> <p>A subungual exostosis is a bone spur that forms beneath the great toe nail.  The spur is found equally in men and women and usually presents with an onset between the ages of 30 and 50 years of age.  Diagnosis is made with a lateral x-ray of the foot that shows a pronounced bone spur on the dorsal, distal tip of the distal phalanx of the great toe.</p> <p>The symptoms of a subungual bone spur include pain with direct pressure to the toe nail.  A subungual bone spur is often difficult to differentiate from a chronic ingrown nail.  A subungual exostosis presents with no swelling or redness and is typically diagnosed by placing direct pressure to the nail.  A slight discoloration of the nail may be seen in severe cases where the nail bed has been disrupted.</p> <p>The most common contributing factor to pain with a subungual exostosis is a tight toe box on the shoe.  Hyperextension of the great toe at the interphalangeal joint may make the tip of the toe prone to rub against the toe box.  Symptoms of a subungual exostosis may be improved or made worse by the type of shoe worn.  For instance, steel-toed boots would contribute to the symptoms of a subungual exostosis while an open toe sandal would improve symptoms.</p> <p>Conservative care of a subungual exostosis includes modification of shoes to avoid direct pressure to the toe.  Padding can be used to cushion the toe.  Examples of pads used to protect the toe include <a href="https://www.myfootshop.com/gel-toe-protector-1">Gel toe Protectors</a>, <a href="https://www.myfootshop.com/lambs-wool-padding">Lambs Wool</a>, <a href="https://www.myfootshop.com/toe-caps-foam">Foam Toe Caps</a>, <a href="https://www.myfootshop.com/gel-toe-caps">Gel Toe Caps</a> or <a href="https://www.myfootshop.com/tubular-foam-toe-bandages">Tube Foam</a>.</p> <p>Surgical correction of a subungual exostosis includes filing down the spur (resection) and occasionally interphalangeal joint fusion.  </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:46https://www.myfootshop.com/diabetic-ulcer-care-with-spring-platesUsing carbon graphite spring plates to treat diabetic ulcerations<h1>Carbon Graphite Spring Plates - treating diabetic ulcerations</h1> <p>Diabetes is renowned as the primary disease that contributes to a loss of sensation in the feet.  This loss of sensation is called <a href="/article/diabetic-peripheral-neuropathy">diabetic peripheral neuropathy</a>, abbreviated DPN.  DPN is a symmetrical loss of sensation often described as a stocking/glove distribution, affected the feet and to a lesser degree, the hands.  The loss of sensation that results from DPN is greater distal to proximal, meaning that the loss of sensation will typically be worse in the toes.</p> <p>DPN is the single most important contributing factor to diabetic foot ulcers.  One of the most difficult diabetic ulcers to heal is the recurrent ulceration that forms beneath what's known as the interphalangeal joint (IP joint for short) of the great toe.  The IP joint is the joint between the two bones of the big toe.  The plantar aspect (bottom) of the great toe is a focal point of stress with each step.  During the toe-off phase of the gait cycle, the force to the plantar aspect of the IP joint is enormous.  In patients with diabetic peripheral neuropathy, this focus of force often results in a callus that progresses to an ulceration.  These ulcers as are particularly difficult to heal in that the patient simply can't feel the break down of the skin and formation of the ulcer.  And once healed, th<a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right; margin-left: 5px;" src="/Content/Images/uploaded/Blog images/spring-plate-carbongraphite-fiber-insole_side_view.jpeg" alt="carbon graphite spring plate" width="90" height="90" /></a>ese sub IP ulcers often break down and recur.</p> <p>One tool that I use to prevent recurrence of IP diabetic ulcers is a <a href="/spring-plate-carbongraphite-fiber-insert"> carbon graphite spring plate</a>.  The spring plate has two attributes that decrease load to the IP ulceration.  First, the spring plate very rigid.  The rigidity of the spring plate <a href="/spring-plate-carbongraphite-fiber-insert"><img style="float: left; margin-right: 5px;" src="/Content/Images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon graphite spring plate" width="90" height="90" /></a>decreases the range of motion at the great toe joint, thereby decreasing the load applied to the IP joint with each step.  The second attribute is the toe spring.  Toe spring is the rocker created by the spring plate.  When I speak of a forefoot rocker, think clog.  With a clog, you just roll off the forefoot.  And that's the same thing that happens with the rocker on a carbon graphite spring.</p> <p>Diabetic ulceration beneath the IP joint of the great toe can be a serious wound, often leading to bone infection and digital amputation.  Use of a spring plate certainly can help to heal the initial ulcer and will help to decrease recurrence of the ulcer.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:45https://www.myfootshop.com/health-care-literacy-delegation-of-the-conversationHealth Care Literacy - what's lost by the new business model of delegating the doctor-patient conversation<h1>Health Care Literacy - the conversation</h1> <p>Conversation is one of the most fundamental tools we use each and every day, to guide us in our lives.  We gain and relay <img style="float: right;" src="/Content/Images/uploaded/Blog images/health care conversation.jpg" alt="health care conversation" width="200" />knowledge through conversation.  We share our life experiences, whether happy or sad.  Simply put, conversation is what guides us through our lives.  In medicine, the conversation between a patient and their doctor can be a life-changing experience.  A good patient will be a good listener and will interact, asking questions to ensure they understand the plan for their health care.  And a good doctor will instruct the patient using anecdotes, analogies and perhaps a little bit of humor to help their patient understand the reason for their condition and the steps necessary to improve their health.  Over time, one of the most important aspects of this ongoing conversation is the relationship that develops between the patient and the doctor.  At the core of that relationship is trust.</p> <p>As the financial pressures placed upon doctors increases, a business method used by medical practices has been to delegate the patient-doctor conversation. Delegation of the patient-doctor conversation is a business model used to enable the doctor to see more patients.  In the business of medicine, delegation of the conversation is known as using physician extenders.  If you've tried to see your doctor lately, you might know exactly what I'm referring to.  You make an appointment with your doctor but instead, you see the new nurse practitioner.  At first, you balk, but then acquiesce to see the nurse practitioner just to get your prescription refilled, right?  You just want to get your health care problem taken care of, so, you say, OK fine, I'll see the nurse practitioner.</p> <p>I understand the business model of using physician extenders and to some degree, I think there's some value in it.  For instance, I have days where I have the same conversation, over and over, about the same condition.  Is that using my time wisely?  Would it be better to have a mid-level provider like a PA (physician's assistant) or NP (nurse practitioner) speak with the patient?  And I understand the business challenges today in medicine with decreasing reimbursement.  But to not even see the doctor?  I thought I paid for my 'doctor's visit' to see the doctor.  It may be a good business model for the provider, but as for the patient, what happens to the conversation?  What about the relationship and the trust that comes from meaningful dialog?  Is that conversation between the patient and the doctor still uniquely special or has it just become a commodity?</p> <p>Let me give you an example.  One of my immediate family members developed a lump on her collar bone.  No pain, just swelling.  She tried to make an appointment with our local doctor and was scheduled with the practice's new nurse practitioner.  Bear in mind, one of the standards of care in the practice of medicine is to do a comprehensive history and physical exam prior to making any assessment of any condition.  The nurse practitioner failed to do so.  Her first question was to ask whether there any history of cancer in the family.  The reply, "yes, my mom died of lymphoma."  That was the end of the history and a CT scan was scheduled.  The findings of the CT scan were inconclusive and an MRI was recommended.  The MRI identified costochondritis, an inflammatory condition of a joint in the collar bone.  My family member walked away with a scare, a bill for $2500 and a bad taste in her mouth. She no longer goes to that practice.</p> <p>I work with a number of nurse practitioners who are very good at their jobs.  I am most familiar with cardiology NP's who are to point guards for in-patient cardiology care.  But you know what's unique about their care?  In every case, the doctor still sees the patient.  The NP may see the patient first and do the work-up, but the doctor always sees the patient.  When you see an NP on an out-patient basis, like your doctor's office, you'll never see your doctor.</p> <p>So what's my point here?  My point is about the conversation.  What happens to the conversation in the physician extender business model is that it is delegated.  The relationship between patient and doctor and the trust that is built upon that conversation is thrown aside.  My point is that health care literacy is dependant upon the conversation.  Take away the conversation and you'll see patients change.  Patients will be less willing to listen and less willing to follow through on instructions.  Delegation of the conversation may work for the physician's bottom line, but for the patient, delegation of the conversation results in a loss of trust and less effective care.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:44https://www.myfootshop.com/the-conversationHealth Care Literacy - The Conversation<h1>The Health Care Conversation</h1> <p><iframe src="https://www.youtube.com/embed/cGtTZ_vxjyA" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p>When I speak about health care literacy and refer to 'the conversation', what exactly do I mean?  The conversation is the discussion that takes place between a health care worker and a patient.  A health care worker may be a nurse, a doctor, a receptionist at a doctor's office or a therapist.  The health care provider may be giving instructions, taking blood or any host of other activities associated with patient care.  And the patient?  Being the patient is a role that all of us will play in our lives. </p> <p>The conversation requires that two people come together to discuss a common issue, typically a health problem, and come up with an understanding or agreed-upon task.  For instance, the conversation may be between a doctor and a patient to discuss a proposed surgical procedure.  Or the conversation may be with a nurse regarding how often to take a medication.  Another example would include follow-up on a test or to see how effective a particular medication may be working.</p> <p>Think for a second about the last time you met someone new and what took place in that conversation.  Conversations always begin with positioning and posturing.  We feel each other out to determine our levels of compatibility and trust.  Once we've sized each other up a bit, we have a feel for socio-economic status, educational level, and even ethos.  We develop either trust that will allow the other person behind our social wall, or we develop a wall that will never allow that person into our private lives.</p> <p>Now let's take a look at medicine.  What's always intrigued me about the conversation in medicine is the fact that we're always trying to put the most educated person and the least educated person in a room and expecting them to come to some kind of agreement or conclusion within a brief visit.  There's also a trend in medicine to use mid-level providers to deliver the message - providers who are less capable of explaining the message with clarity.  And all of this is done in a business model that rewards us for doing things faster; the less time we spend with a patient the more patients we can see.</p> <p>How then, in contemporary health care, can we expect good outcomes if we can't even have the conversation? </p> <p>The video link in this post is a wonderful example of the problems and challenges that providers and patients have with the conversation.  At first glance, the act of the conversation seems straight forward and simple.  But as we delve into the subtleties of conversation we can see that there are so many ways in which the conversation can yield poor outcomes, and in some cases, even dangerous outcomes.</p> <p>How can we have a better conversation?  I believe that the starting point is that we each need to change roles.  We need to look at the conversation from the standpoint of the other party.  Some call it empathy.  I call it good practice.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:43https://www.myfootshop.com/differentiate-haglunds-deformity-from-achilles-tendonitisHow to differentiate Haglund's deformity from Achilles tendonitis.<h1>Haglund's vs Insertional Achilles tendinitis - what's the difference?</h1> <p>At our weekly all-hands-on-deck meeting we drifted into a conversation about the differences between <a href="https://www.myfootshop.com/article/haglunds-deformity">Haglund's deformity</a> (also called a pump bump) and <a href="https://www.myfootshop.com/article/achilles-tendonitis">insertional Achilles tendonitis</a>.  Both are conditions that are found on the posterior heel and can be very similar in both the location of the problem and the type of pain presented by the problem.  But there are a couple of keys to differentiating the two conditions. </p> <p>First, with a Haglund's deformity, the pain is going to be found adjacent to but not deep to the Achilles tendon.  And the pain of<a href="https://www.myfootshop.com/article/haglunds-deformity"><img style="float: right; margin-left: 5px;" src="/content/images/medical/ortho/haglunds_deformity_mod.jpg" alt="haglund's deformity" width="90" height="58" /></a> a Haglund's deformity is always going to be immediately lateral to the tendon.  And finally, Haglund's deformity only has pain while a shoe is on and pressing against the Haglund's bump.  Take off the shoe or wear an open-backed shoe like a flip flop or open clog, and the pain goes away.</p> <p><a href="https://www.myfootshop.com/article/achilles-tendonitis#Tab3"><img style="float: left; margin-right: 5px;" src="/content/images/medical/surgery/insertional%20Achilles%20tendonitis/achilles_tendonitis2_mod_thumb.jpg" alt="Achilles_tendonitis_surgery" width="90" height="68" /></a>Achilles tendonitis (also spelled tendinitis), behaves a little differently.  Achilles tendonitis will always present with pain at the onset of an activity.  The first few steps of a run or the first few steps out of bed are going to be the steps that hurt the most.  After a few steps, the tendon warms up and functions without pain.  The enlargement found with Achilles tendonitis is circumferential, surrounding the entire insertion of the Achilles (remember, Haglund's was only lateral to the tendon.</p> <p>But interestingly, both Haglund's deformity and Achilles tendonitis can be treated with the same product - a simple <a href="https://www.myfootshop.com/heel-lifts">heel lift</a>.  I say interestingly because the heel lift works for both conditions but actually works in different ways.  For a Haglund's deformity, the heel lift will act to raise the Haglund's bump above the level of the heel counter.  The heel counter is the rigid outer portion of the shoe that encases the heel.  But for Achilles tendonitis, a heel lift will act to raise the heel, weakening the pull of the Achilles tendon.  I guess you could say that a heel lift is the shotgun approach to heel pain in that it can treat Haglund's deformity, Achilles tendonitis, and plantar fasciitis. </p> <p>Be sure to check out the above links to each condition for an in-depth summary of the problems.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:42https://www.myfootshop.com/health-care-its-about-the-conversationHealth Care Literacy - it's about the conversation.<h1>Health Care Literacy - the conversation</h1> <p>When was the last time that you were in the presence of someone who listened?  I mean really listened.  They looked you in the <img style="float: right;" src="/Content/Images/uploaded/Blog images/human_ear.jpg" alt="listening to the health care conversation" width="150" />eye and thought about what you said.  They asked you questions.  Maybe they even laughed a bit with you.  They shared a joke or a personal anecdote from their life that related to the point you were trying to make.  It feels great when someone listens to you, doesn't it?  By the simple act of listening, this person validated your concerns, made you feel reassured and helped you feel as if you are a vital and integral part of this world.  By simply making you a part of the conversation, this person made you feel good.</p> <p>What I've learned in thirty years of practice is that good medicine is all about the conversation.  It's about listening and sharing.  It's about empathy.  And it's about using the body language that says I'm here to listen </p> <p>What'd Doc on the television show Gunsmoke have to give to people?  Honestly, he didn't have much.  But to paraphrase Abraham Verghese, author of Cutting For Stone,  Doc gave the only medicine that can be administered by ear; tender words of kindness.  Doc may not have extended lives with statin drugs and he may not have been able to treat coronary artery disease with a catheter, but he did something better.  He would listen and make people feel good with words.</p> <p>OK.  So you get my point.  Health care is about the conversation between a patient and a provider.  I think it's fair to say that conversation is part and parcel of making a good diagnosis, educating a patient regarding that diagnosis and clearly laying out a treatment plan.  Now think about your last visit to your doctor.  What was your impression of the conversation? </p> <p>As a doctor, you periodically do a little introspective review of your care and wonder what is the value that I'm personally contributing to health care as a whole?  For some doctors, their personal value is literally determined by saving lives.  For others, it may be an ego-driven outcome such as a high number of surgical procedures or a high personal income.  In many cases, saving lives and earning money may not require a conversational skill set.  But most of medicine isn't about saving lives.  It's about educating patients and addressing their concerns.  It's all about the conversation.</p> <p>I plan to write a series of posts based upon my experiences with the health care conversation.  I hope you'll join me in finding a way to restore the value of conversation in health care.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:41https://www.myfootshop.com/what-is-a-scaphoid-padWhat's a scaphoid pad?<h1>Scaphoid Pad - instructions for use</h1> <p>At our last all-hands staff meeting we were talking about <a href="https://www.myfootshop.com/arch-cookies">arch cookies</a>.  An arch cookie is a small insert that is placed just under the arch of the foot.  Arch cookies are used a lot in shoe stores and pedorthics practices to give just a little arch support without using a bulky partial or full-length arch support.  Use of an arch cookie gives support to the foot with decreased bulk in a shoe.  So in cases like a loafer or boat shoe, and arch cookie fits very well.  Arch cookies come in varying sizes so they can be used in both pediatric and adult shoes.</p> <p>I always like how our conversations center around the experiences that our staff has working with customers.  For instance, our conversations about arch cookies started with each salesperson saying which of the arch cookies they liked best and why they've recommended the <a href="https://www.myfootshop.com/pedag-step-arch-cookie">Pedag Step Arch Cookie</a> or the <a href="https://www.myfootshop.com/arch-cookies-gel-2">Gel Arch Cookie</a>.  As we started to talk about the <a href="https://www.myfootshop.com/arch-cookies-ppt">PPT Arch Cookie</a> and the <a href="https://www.myfootshop.com/reusable-gel-arch-pads">Reusable Gel Arch Pad</a>, all of the staff said, "It's so flat.  Why would you want to use either of those?"  That's when they all learned about the use of a scaphoid pad.</p> <p><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Blog%20images/scaphoid_pad_1.jpg" alt="scaphoid pad" width="70" height="94" />The term scaphoid is an older term used to describe the navicular bone.  The navicular is the bone in the top or central portion of the arch and is often called the keystone of the arch.  A scaphoid pad is a pad that is used to support the scaphoid (navicular).  Where would you want to use a scaphoid pad?  In severe cases of <a href="https://www.myfootshop.com/article/pronation">pronation</a> (flatfoot), the foot will actually roll over the medial edge of any insert that you place in the shoe.  A scaphoid pad is placed directly on the medial wall of the shoe and an arch support is placed over the scaphoid pad.  by doing so, the scaphoid pad essentially turns into an extension of the arch support.  The scaphoid pad will also pad the medial wall of the shoe.  Scaphoid pads<img style="float: right;" src="../../../Content/Images/uploaded/Blog images/scaphoid_pad_2.jpg" alt="Scaphoid pad" width="70" height="94" /> can be used with or without a supplemental arch support or orthotic.</p> <p>Another old shoe/orthotic trick that's often used to treat pronation is to extend the top cover of the orthotic beyond the medial edge of the orthotic so that it acts as a scaphoid pad.  This can only be accomplished by a pedorthics shop or qualified shoe repair shop.  So for all of us laypeople, the scaphoid pad is a great way to accomplish the same effect.  It'll pad the medial wall of the shoe and help support the arch.</p> <p>So now the staff is all jazzed about how to use a scaphoid pad.  It sure does help to sit and talk every week.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:40https://www.myfootshop.com/cms-payment-dataCMS Data On Medicare Payments to Doctors<p>The Center for Medicare and Medicaid Services (CMS), also known as Medicare, published data this week that publicly shows how much it paid to individual doctors during 2012.  Here's a link to a <a href="https://www.nytimes.com/interactive/2014/04/09/health/medicare-doctor-database.html"> NY Times interactive tool</a> that allows you to look up payments by doctor and zip code.  The tool shows total payments and frequency of billing. </p> <p>What are the pros and cons of this data?  First and foremost, services provided by Medicare contracted providers are reimbursed with federal funds.  That means that your tax dollars and my tax dollars are paying for these services.  Therefore, payment summaries ought to be public information, accessible to you and me.</p> <p>So like every good doctor I started to snoop and what I found was really quite amazing.  My community has two large independent family practice groups.  When I went to compare reimbursement for each of the doctors in those groups I found two trends.  Let's take a closer look.  Practice A is a four doctor group.  On the low end of reimbursement for providers at practice A, one doctor received $49,000 and a high reimbursement for another doctor of $108,000.  The mean CMS reimbursement for providers at practice A was $65,000.  Now let's take a look at the other practice that we'll call practice B.  Practice B is a 4 doctor group with a low end of reimbursement of $154,000 and a high of $431,000.  Mean for this group was $281,000.</p> <p>Is anyone scratching their head yet?  How could two similar practices, in the same community have a difference in their mean payments from Medicare be so high?  The difference between the mean reimbursement for the two practices was $216,000.</p> <p>But if we move away from the concept of how much we're paying each provider and look a bit more closely at what we're paying each provider for, the data becomes a bit more interesting.  A brief survey of my profession reveals some interesting data regarding the volume of services provided by each individual provider.  It's interesting to look at discrepancies between practices.  And I find it amazing how one practice would have so many of one type of procedure while another seems to rarely provide the same service.</p> <p>For CMS to make payments to individual doctors public, is brilliant.  For the first time, patients can compare providers based upon their volume of services and types of services provided.  It's an opportunity for us as health care consumers to put a finger on the pulse of a practice.  Although the information provided to us by CMS may not be a direct reflection of the practice, it certainly does allow us, for the first time, to look behind the closed doors of healthcare. </p> <p>How does this new information change health care?  The changes don't start here.  Changes begin with the conversation about care.  And now that we are able to take a peek at objective data that details the types and volume of services provided inside these practices, let's start talking.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:38https://www.myfootshop.com/dancers-pads-do-i-use-a-right-or-a-leftDancer's pads - do I buy a right or a left for my problem?<h1>Dancer's Pads - selection and fit</h1> <p>We recently got into a discussion at the shop about <a href="https://www.myfootshop.com/dancers-pads">dancer's pad</a> and placement on the foot.  Which pad is the right pad and which is the left?  How does the left fit on the right foot?  How does a right treat a left?  I see how folks can get confused.<a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img style="float: right;" src="/Content/Images/uploaded/Products/680_reusable_dancers_pad.jpg" alt="Reusable Gel Dancer's Pad" width="200" /></a></p> <p>There are three constants that you need to remember when using a dancer's pad -</p> <p>1. Dancer's pads are only sticky on one side.</p> <p>2. Dancer's pads are labeled with the intent of treating problems sub 1 (great toe joint).  The adjacent image shows a dancer's pad treating sub 1.</p> <p>This means that a pack of left dancer's pads is intended to be used to treat problems beneath the left great toe joint.  These problems might include <a href="https://www.myfootshop.com/article/sesamoiditis">sesamoiditis</a>, <a href="https://www.myfootshop.com/article/sesamoid-fracture">sesamoid fractures</a> or even <a href="https://www.myfootshop.com/article/hallux-limitus">stage 1 hallux limitus</a>.</p> <p>3. Dancer's pads also can be used to treat problems sub 5 (little toe joint).</p> <p>Here's where things get tricky.  If you're going to treat a left sub 5 problem, say <a href="https://www.myfootshop.com/article/bursitis-of-the-foot-and-ankle">bursitis</a>, sub 5 left foot, you'll actually need to use a right dancer's pad.  Why?  Remember #1?  Dancer's pads are always right/left labeled to treat problems sub 1.  So if you're going to treat a problem sub 5, you'd actually be using the dancer's pad much like you would if you were treating the opposite or right foot.  Right?</p> <p>Remember, most dancer's pads are used to treat sub 1. If you're treating sub 5 you can't just flip over the pad.  You actually need to buy a dancer's pad labeled for the opposite foot.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:37https://www.myfootshop.com/hallux-limitus-treatment-with-vasyli-dananberg-orthoticThe Vasyli-Dananberg Orthotic - dynamic treatment of hallux limitus<h1><a href="https://www.myfootshop.com/vasyli-dananberg-orthotic"><img style="float: right; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/vasili-howard-dananberg-insole.jpeg" alt="Vasyli-Dananberg Orthotic" width="90" height="90" /></a>Vasyli-Dananberg Orthotic</h1> <p>One of the guys at work was holding a <a href="https://www.myfootshop.com/vasyli-dananberg-orthotic">Vasyli-Dananberg Orthotic</a> and gave me a smirk and said, What do you do with this?  Opportunity was knocking at my door.  We'll be talking this week at work about 1st ray mechanics and how the Vasyli-Dananberg Orthotic is used to treat hallux limitus.</p> <p>By definition, the 1st ray consists of the <a href="https://www.myfootshop.com/article/bone-medial-mod-labeled">1st metatarsal and the great toe</a>.  From a phylogenetic standpoint, we can look at the 1st ray being somewhat akin to the thumb and 1st metacarpal found in the hand.  Although most of us homo sapiens haven't quite achieved prehensile grip with our feet, many species have.   The 1st ray has a unique range of motion that originates from its' proximal attachment to the medial cuneiform.  The first ray range of motion moves separately from the 2-5th met<a href="https://www.myfootshop.com/article/youngswick-modification-of-the-austin-bunionectomy"><img style="float: right;" src="https://www.myfootshop.com/Content/Images/uploaded/Anatomy/Misc_Drawings/HL_osteotomy_mod2.jpg" alt="Youngswick modification" width="300" height="393" /></a>atarsal.  This isolated range of motion of the 1st ray leads to unique pathology of the 1st ray and an opportunity for unique treatment methods.  Much of this 1st ray pathology is due to the 1st metatarsal being either dorsiflexed (up) or plantarflexed (down). </p> <h2>Hallux limitus - treatment</h2> <p>The most common 1st ray problem we treat is <a href="https://www.myfootshop.com/article/hallux-limitus">hallux limitus</a>.  Although there are several reasons why we develop hallux limitus, the primary reason is due to an elevated 1st metatarsal, a condition known as metatarsus primus elevatus.  Met prime elevatus limits the range of motion of the great toe joint resulting in jamming of the joint.  Think of met prime elevatus in this way; to accomplish normal range of motion of the great toe joint, the 1st metatarsal needs to plantarflex to allow the great toe to dorsiflex - a kind of hinge like motion.  If the 1st metatarsal is elevated, this plantarflexion doesn't occur leading to lack of range of motion of the great toe joint and the onset of hallux limitus.  To illustrate this point, the image at right shows the bone cuts made in the 1st metatarsal head to perform a surgical procedure called a Youngswick modification of an Austin bunionectomy.  This procedure is used to treat stage 2 and 3 hallux limitus.  You can see that the cuts are made in such a way to lower the 1st metatarsal head thereby increasing range of motion of the great toe joint.</p> <p>The Vasyli-Dananberg Orthotics works in a very similar manner.  The proximal and distal plugs are used to influence the range of motion of the great toe joint.  Removal of the plugs results in increased range of motion of the great toe joint, thereby treating the primary contributing factor to hallux limitus, metatarsus primus elevatus.</p> <p>We'll talk a bit more about additional uses of the Vasyli-Dananberg Orthotics in a follow-up blog post.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:36https://www.myfootshop.com/how-to-use-carbon-graphite-spring-platesTips for choosing the right carbon fiber orthotic - spring plates.<p> </p> <p>Part 7 of 7</p> <p>In January, I wrote a series of six blog posts regarding <a href="https://www.myfootshop.com/carbon-fiber-turf-toe-plate-flat">carbon fiber orthotics</a>, detailing the uses and applications for each of our carbon fiber inserts.  In our staff meeting this week, my boss, business partner and wife gently reminded me, 'honey, you forgot to write about spring plates.' <a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/882_Spring_Plate_Carbon_Graphite_Fiber_Insert.jpg" alt="Carbon fiber spring plate" width="90" height="90" /></a>Wow, my bad.  Spring plates are the single most popular carbon fiber insert we sell.  Like the old Steve Martin comedy routine, all I could do was hit my forehead with the palm of my hand and say, 'I forgot!'  So, here's part 7 of the original 6 part series.</p> <p>Like the product description says, carbon fiber spring plates are as light as a feather and as strong as steel.  Spring plates are exceedingly thin and will fit into all enclosed shoes.  The term spring comes from the curvature of the spring plate at<a href="https://www.myfootshop.com/spring-plate-carbongraphite-fiber-insert"><img style="float: right;" src="/Content/Images/uploaded/Blog images/spring-plate-carbongraphite-fiber-insole_side_view.jpeg" alt="Carbon fiber spring plate" width="90" height="90" /></a> the ball of the foot.  This curvature is referred to as toe spring.  To describe how toe spring is beneficial, think of how a clog works.  The sole is rigid but the forefoot has a rocker.  So at the toe-off phase of gait, the foot simply rolls off of the ball of the foot, decreasing load to the ball of the foot.  Carbon fiber spring plates work in exactly the same manner.  They create a rigid shank to stabilize the midfoot and forefoot rocker to off-load the forefoot.</p> <p>The indications for spring plates include most forefoot pathology including <a href="https://www.myfootshop.com/article/capsulitis">forefoot capsulitis</a>, <a href="https://www.myfootshop.com/article/bursitis-of-the-foot-and-ankle">forefoot bursitis</a>, <a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a> <a href="https://www.myfootshop.com/article/freibergs-infraction">Freiberg's infraction</a> and <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>.  Spring plates are also used to create a rigid shank in the shoe.  A rigid shank can be used to stabilize forefoot fractures such as <a href="https://www.myfootshop.com/article/metatarsal-fracture">metatarsal stress fractures</a>.  Spring plates are also great for <a href="https://www.myfootshop.com/article/arthritis-of-the-foot-and-ankle">midfoot arthritis</a>.</p> <p>Why choose the Carbon Fiber Spring Plate?</p> <ul> <li>Versatile - it's so thin that it fits into virtually all enclosed shoes.</li> <li>Semi-rigid - flexible enough to be comfortable but rigid enough to provide support.</li> <li>Durable - wears like steel.</li> </ul> <p>Why not to choose the Sport Carbon Fiber Orthotic?</p> <ul> <li>No top cover - many folks like to cover the spring plates with the insert that came with the shoe or a <a href="https://www.myfootshop.com/pedag-soft-shoe-insoles">Pedag Soft Insert</a>.</li> </ul> <p>What can I do in a Carbon Fiber Spring Plate?</p> <ul> <li>Work - no limitations here.  Should fit most work shoes.</li> <li>Sports - should do you well in all sports. </li> <li>Daily use - should do well depending upon your ability to fit it into specific shoes.  Not recommended for use in sandals or flip-flops.</li> </ul> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:35https://www.myfootshop.com/the-frontal-plane-treating-supinationThe frontal plane - treating supination<h1>Supination - treatment options</h1> <p>In my previous blog post, I spoke about the frontal plane deformity known as <a href="https://www.myfootshop.com/article/pronation">pronation</a>.  Pronation refers to the flattening of the arch.  <a href="https://www.myfootshop.com/article/supination">Supination</a>, on the other hand, is a foot that has a high arch.  A high arch foot is usually a rigid foot and referred to as a supinated foot.  Supination is often a bit harder to treat than is pronation.  Because the supinated foot is rigid, it is less 'cooperative' when it comes to the use of pads or supports.  Supinated feet are often associated with <a href="https://www.myfootshop.com/article/peroneal-tendon-rupture">peroneal tendon problems</a> and <a href="https://www.myfootshop.com/article/ankle-sprain">sprained ankles</a>.</p> <h2>Supination - lateral sole wedges and heel wedges</h2> <p>There are two categories of products that we use to treat supination.  Those categories include <a href="https://www.myfootshop.com/lateral-sole-wedge-inserts">lateral sole wedges</a> and <a href="https://www.myfootshop.com/heel-wedges">heel wedges</a>.</p> <p>Example of our lateral sole wedge includes the following -</p> <p><a href="https://www.myfootshop.com/lateral-sole-wedge-inserts"><img style="float: right;" src="/Content/Images/uploaded/Products/958_Lateral_Sole_Wedge_Inserts.jpg" alt="Lateral sole wedge" width="90" height="90" /></a></p> <p>Heel wedges are that secret little tool that is often overlooked when treating supination.  Yup, these are the same heel wedges that we recommended for the treatment of pronation.  Ah, but smart blog reader, you're already a step ahead of me when you guessed what we do with heel wedges to treat supination.  We simply put them in the other side of the heel.  So to treat a supinated foot, the heel wedge would be used under the outer edge of the heel effectively limiting the ability of the heel to roll out (supinate)</p> <p>Examples of heel wedges include -</p> <p><a href="https://www.myfootshop.com/heel-wedges-rubber-1"><img src="/Content/Images/uploaded/Blog images/heel-wedges-rubber.jpeg" alt="Heel wedges - rubber" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/premium-heel-wedges"><img src="/Content/Images/uploaded/950_Premium_Heel_Wedges.jpg" alt="Heel wedges premium" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/heel-wedges-ppt"><img src="/Content/Images/uploaded/Blog images/945_Heel_Wedges_PPT.jpg" alt="PPT Heel wedges" width="90" height="90" /></a></p> <p>Remember, treating pronation and supination isn't an absolute science.  For each shoe and for each activity that you're involved in, there may be a different product or application of a product.  If you have any questions, be sure to contact us for support.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:34https://www.myfootshop.com/the-frontal-plane-treating-pronation-and-supinationThe frontal plane - treating pronation<h1>Pronation - treatment options</h1> <p>Last week I asked the guys at work what they wanted to learn about and Gina had a good suggestion.  She said, "what about products that treat this" - she took her hand, palm down and tipped it side to side.  I knew right off what she was interested in. Frontal plane pathology (my kind of girl).</p> <p><img style="float: left; padding-right: 5px;" src="https://www.myfootshop.com/Content/Images/uploaded/Anatomy/Spacial_Orientation/Cardinal_planes.jpg" alt="Cardinal planes of the body" width="114" height="189" />The reference points for human anatomy begin with the cardinal planes.  There are three cardinal planes.  When we speak of the frontal plane we're referring to an imaginary line that would pass from shoulder to shoulder and from hip to hip.  If you're facing a glass door, the glass represents the frontal plane.  Motion can be described along the frontal plane.  When we speak of the motion of the foot in the frontal plane, we call it <a href="https://www.myfootshop.com/article/pronation">pronation</a> and <a href="https://www.myfootshop.com/article/supination">supination</a>.  Pronation often refers to the flattening of the arch while supination describes the creation of a higher arch.  Be sure to follow each of the links for more information on these topics.  In this blog post, we'll talk a bit about products we use to treat pronation.</p> <p>So is pronation just a flattening of the arch?  In many respects, yes.  You can say that a pronated foot is a flat foot.  But you have to remember that there's a number of different medical conditions that result in pronation.  What we'll be focusing on treating in this blog post are the cases of simple flat feet that result in foot fatigue.  </p> <p>So how do we treat pronation?  There are several categories of products on our website that can be used to treat pronation. Those categories include arch cookies, arch supports, and heel wedges.  <a href="https://www.myfootshop.com/arch-cookies">Arch cookies</a> were traditionally used as a solution for children's shoes.  But for mild cases of pronation, an arch cookie can be a great solution.  Arch cookies can be used by adults to treat mild pronation.  Arch cookies fit well into dress shoes and Oxfords.  The only limitation with arch cookies is that the shoe has to have a firm medial wall on which the arch cookie can be fixed. </p> <h2>Pronation - adhesive-backed arch cookies</h2> <p>Examples of adhesive-backed arch cookies include -</p> <p><a href="https://www.myfootshop.com/arch-cookies-ppt"><img src="/Content/Images/uploaded/Blog images/947_Arch_Cookies_PPT.jpg" alt="PPT Arch Cookie" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/arch-cookies-gel-2"><img src="/Content/Images/uploaded/Blog images/847_Arch_Cookies.jpg" alt="Gel Arch Cookie" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/pedag-step-arch-cookie"><img src="/Content/Images/uploaded/Blog images/929_video.jpg" alt="Pedag Arch Cookie" width="90" height="90" /></a></p> <p>Examples of non-adhesive, self-adherent arch cookies include -</p> <p><a href="https://www.myfootshop.com/reusable-gel-arch-pads"><img src="/Content/Images/uploaded/Blog images/reusable-gel-arch-pads.jpeg" alt="Reusable arch cushion" width="90" height="90" /></a></p> <h3>Pronation - treatment with arch supports </h3> <p>What's the old reliable in terms of treating pronation?  That's the arch support.  Arch supports come in a lot of different makes and models.  For instance, where one arch support might be good for sports, another might be good for dress shoes.  Be sure to look at our <a href="https://www.myfootshop.com/shoe-insoles-and-arch-supports">complete line of arch supports</a> for more examples of what might fit your particular needs.</p> <p>Just a few of our arch supports include -</p> <p><a href="https://www.myfootshop.com/pedag-sport-insert"><img src="/Content/Images/uploaded/Blog images/843_Pedag_Pro-Active_XCO_Insoles_ALT.jpg" alt="Pedag XCO Arch support" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/pedag-viva-full-length-arch-supports"><img src="/Content/Images/uploaded/Blog images/pedag-viva-full-length-arch-supports.jpeg" alt="Pedag Viva Inserts" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/vasyli-dananberg-orthotic"><img src="/Content/Images/uploaded/Blog images/vasili-howard-dananberg-insole.jpeg" alt="Vasili-Dananberg Insole" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/pedag-viva-mini-arch-support"><img src="/Content/Images/uploaded/Blog images/pedag-viva-mini-arch-support.jpeg" alt="Pedag Viva Mini Arch Support" width="90" height="90" /></a></p> <p>The last category of products used to treat pronation is <a href="https://www.myfootshop.com/heel-wedges">heel wedges</a>.  Although not typically considered a power-house of arch support, many customers use our heel wedges to control pronation.  Heel wedges are simple to use and are often used in conjunction with an insole.</p> <h4>Pronation - treatment with heel wedges</h4> <p>Examples of heel wedges include -</p> <p><a href="https://www.myfootshop.com/premium-heel-wedges"><br /></a><a href="https://www.myfootshop.com/heel-wedges-rubber-1"><img src="/Content/Images/uploaded/Blog images/heel-wedges-rubber.jpeg" alt="Heel wedges - rubber" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/premium-heel-wedges"><img src="/Content/Images/uploaded/950_Premium_Heel_Wedges.jpg" alt="Heel wedges premium" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/heel-wedges-ppt"><img src="/Content/Images/uploaded/Blog images/945_Heel_Wedges_PPT.jpg" alt="PPT Heel wedges" width="90" height="90" /></a></p> <p> </p> <p>In the next blog post, we'll take a peek at how to treat the other frontal plane deformity, supination.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:33https://www.myfootshop.com/off-loading-forefoot-pads-specific-purpose-which-one-is-best-for-my-needsOff-loading forefoot pads - specific purpose - which one is best for my needs?<h1>Forefoot Pads - treatment of forefoot pain</h1> <p>The third and final category of off-loading forefoot pads is the pads that are used to target or treat a specific portion of the forefoot. By off-loading, we're referring to a pad that is placed adjacent to the area that is being treated.</p> <p>Specific off-loading pads are those pads that are used to treat sub 1 (great toe joint) and sub 5 (5th metatarsal phalangeal joint or little toe joint).  Sub one problems might include a <a href="https://www.myfootshop.com/article/sesamoid-fracture">sesamoid fracture</a> or <a href="https://www.myfootshop.com/article/sesamoiditis">sesamoiditis</a>.  <a href="https://www.myfootshop.com/article/hallux-limitus">Stage 1 hallux limitus</a> might also fall into this category.  Sub 5 problems are going to be caused by <a href="https://www.myfootshop.com/article/bursitis-of-the-foot-and-ankle">bursitis</a>.  These pads can also be used to treat focal areas of callus.  These pads also come as a single-use or reusable version.  The adhesive-backed pads can be applied directly to the foot or be applied into the shoe.  Remember, if you're going to apply the pads into the shoe, try them first directly on the foot.  In this way, you'll know how they're supposed to feel when properly positioned.  It's much easier to nail the correct position of the pad directly on the foot compared to placing the pad in the shoe.  But once you become proficient at placing the pads, put them in the shoe.  You'll save by placing one pad in the shoe vs. placing a new pad on the foot each day.  Be sure to watch our videos on each product page for specific instructions on the placement of each pad.</p> <p>The most common example of a specific use off-loading forefoot pad would be a <a href="https://www.myfootshop.com/dancers-pads">Dancer's Pad</a>.  The Dancer's Pad can be used to off-load sub 1.  Flip it over or reverse it and the Dancer's Pad can be used to off-load sub 5.</p> <p>Here's an example of several specific use, single-use, adhesive-backed, off-loading pads including dancer's pads - </p> <p><a href="https://www.myfootshop.com/dancers-pads-economy-felt-1"><img src="/Content/Images/uploaded/Blog images/806_Dancers_Pads_Economy_Felt_ALT.jpg" alt="Economy felt dancer's pads" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/dancers-pads-premium-felt"><img src="/Content/Images/uploaded/Blog images/810_Dancers_Pad_Premium_Felt.jpg" alt="Dancer's pad" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/dancers-pads-premium-foam"><img src="/Content/Images/uploaded/Blog images/dancers-pads-premium-foam.jpeg" alt="Foam dancer's pad" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/forefoot-callus-protector"><img src="/Content/Images/uploaded/Blog images/726_Forefoot_Callus_Protectors_ALT.jpg" alt="Felt callus pad" width="90" height="90" /></a>             </p> <p>Examples of a reusable specific purpose off-loading pad include -</p> <p><a href="https://www.myfootshop.com/reusable-gel-callus-cushions"><img src="/Content/Images/uploaded/Blog images/reusable-gel-oval-callus-cushions.jpeg" alt="Reusable gel callus cushion" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/reusable-gel-u-shaped-pads"><img src="/Content/Images/uploaded/Blog images/reusable-gel-u-shaped-callus-pads.jpeg" alt="Reusable gel U-shaped pad" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/reusable-gel-dancers-pads"><img src="/Content/Images/uploaded/Blog images/reusable-gel-dancers-pads.jpeg" alt="Reusable dancers pad" width="90" height="90" /></a></p> <p>It's interesting how often the general purpose and the specific purpose pads can be interchanged, mixed and matched.  Although a dancer's pad would be the better choice for sesamoiditis, many folks would find relief with the use of a general-purpose metatarsal pad.  So don't think of these guidelines as literal.  Feel free to mix and match.  Hopefully, these guidelines will get you oriented to the groups of pads we sell, how they can be used and which might be best for your intended use.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:32https://www.myfootshop.com/general-purpose-off-loading-forefoot-padsOff-loading general-purpose forefoot pads - which one is best for my needs?<h1>Forefoot Pads - treating forefoot pain</h1> <p>The second category of forefoot pads is general-purpose off-loading pads.  By off-loading, we're referring to a pad that is placed adjacent to the area that is being treated.</p> <p>General-purpose off-loading pads are used in the treatment of <a href="https://www.myfootshop.com/article/capsulitis">forefoot capsulitis</a>, <a href="https://www.myfootshop.com/article/bursitis-of-the-foot-and-ankle">forefoot bursitis</a>, <a href="https://www.myfootshop.com/article/callus">forefoot callus</a>, <a href="https://www.myfootshop.com/article/mortons-neuroma">Morton's neuroma</a>, and <a href="https://www.myfootshop.com/article/metatarsalgia">metatarsalgia</a>.  Off-loading pads generally take up less space in the shoe compared to a <a href="https://www.myfootshop.com/direct-loading-forefoot-pads-which-one-is-the-best-for-my-needs"> direct load pad</a>.  General-purpose off-loading pads can be applied directly to the foot as a single-use or re-usable pad.  They can also be applied to the shoe.  And lastly, general-purpose off-loading pads can be on an insert that resides in the shoe, such as on an arch support.  The pros and cons of these categories are often based upon the intended use of the pad.  For instance, use in a slip-on dress shoe vs. a work boot is very different. </p> <p>Examples of single-use general-purpose off-loading pads that would be applied directly to the foot include -</p> <p><a href="https://www.myfootshop.com/arch-binder-with-metatarsal-pad"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/900_Arch_Binder_with_Metatarsal_Pad.jpg" alt="Picture of Arch Binder with Metatarsal Pad" width="90" /></a>  <a href="https://www.myfootshop.com/neuroma-pads-mini-felt"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/neuroma-pads-mini-felt.jpeg" alt="Picture of Neuroma Pads - Mini Felt" width="90" /></a>    <a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/metatarsal-pad-felt.jpeg" alt="Picture of Metatarsal Pad - Felt" width="90" /></a>  <a href="https://www.myfootshop.com/metatarsal-pad-foam"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/815_Metatarsal_Pad_Foam.jpg" alt="Picture of Metatarsal Pad - Foam" width="90" /></a>  <a href="https://www.myfootshop.com/metatarsal-pads-ppt"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/868_Metatarsal_Pads_PPT.jpg" alt="Picture of Metatarsal Pads-PPT" width="90" /></a> </p> <p>Examples of a reusable general purpose off-loading pad include -</p> <p><a href="https://www.myfootshop.com/reusable-ball-of-foot-gel-cushions"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/reusable-gel-metatarsal-pad.jpeg" alt="Picture of Reusable Gel Ball-of-Foot Cushions" width="90" /></a></p> <p>Examples of general-purpose off-loading pads that can be applied into the shoe include -</p> <p><a href="https://www.myfootshop.com/neuroma-pads-mini-felt"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/neuroma-pads-mini-felt.jpeg" alt="Picture of Neuroma Pads - Mini Felt" width="90" /></a>  <a href="https://www.myfootshop.com/metatarsal-bars"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/metatarsal-bar-ppt-cushions.jpeg" alt="Picture of Metatarsal Bar PPT Cushions" width="90" /></a>  <a href="https://www.myfootshop.com/metatarsal-pad-felt-1"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/metatarsal-pad-felt.jpeg" alt="Picture of Metatarsal Pad - Felt" width="90" /></a>  <a href="https://www.myfootshop.com/pedag-t-form-metatarsal-pads"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/943_Pedag_TForm_Metatarsal_Pads.jpg" alt="Picture of Pedag T-Form Metatarsal Pads" width="90" /></a>  <a href="https://www.myfootshop.com/metatarsal-pad-foam"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/815_Metatarsal_Pad_Foam.jpg" alt="Picture of Metatarsal Pad - Foam" width="90" /></a>  <a href="https://www.myfootshop.com/metatarsal-pads-ppt"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/868_Metatarsal_Pads_PPT.jpg" alt="Picture of Metatarsal Pads-PPT" width="90" /></a>  <a href="https://www.myfootshop.com/gel-metatarsal-pads"><img src="/Content/Images/uploaded/Blog images/925_Gel_Metatarsal_Pads.jpg" alt="Clear gel metatarsal pad" width="90" height="90" /></a>  <a href="https://www.myfootshop.com/pedag-drop-metatarsal-pads"><img src="/Content/Images/uploaded/Blog images/961_Pedag_DROP_Metatarsal_Pads.jpg" alt="Pedag Drop Metatarsal Pad" width="90" height="90" /></a></p> <p>Examples of general-purpose off-loading pads that are also inserts include -</p> <p><a href="https://www.myfootshop.com/hallux-trainer-insoles"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/962_Hallux_Trainer.jpg" alt="Picture of Hallux Trainer Insoles" width="90" /></a>  <a href="https://www.myfootshop.com/pedag-relax-shoe-insoles"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/pedag-relax-shoe-insoles.jpeg" alt="Picture of Pedag Relax Shoe Insoles" width="90" /></a>  <a href="https://www.myfootshop.com/pedag-comfort-supports-1"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/797_Pedag_COMFORT_Insoles.jpg" alt="Picture of Pedag COMFORT Supports" width="90" /></a>  <a href="https://www.myfootshop.com/pedag-sport-insert"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/843_Pedag_Pro-Active_XCO_Insoles_ALT.jpg" alt="Picture of Pedag Pro-Active XCO Inserts" width="90" /></a>  <a href="https://www.myfootshop.com/pedag-viva-full-length-arch-supports"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/pedag-viva-full-length-arch-supports.jpeg" alt="Picture of Pedag Viva Full Length Arch Supports" width="90" /></a>  <a href="https://www.myfootshop.com/pedag-viva-mini-arch-support"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/pedag-viva-mini-arch-support.jpeg" alt="Picture of Pedag VIVA MINI Arch Support " width="90" /></a>  <a href="https://www.myfootshop.com/pedag-viva-summer-insoles"><img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/880_Pedag_VIVA_SUMMER_Insoles.jpg" alt="Picture of Pedag VIVA SUMMER Insoles" width="90" /></a> </p> <p>Each of these pads is going to have one little advantage over another.  For instance, one might be best used in tennis shoes and another in dress shoes.  The inserts with general-purpose off-loading pads are going to be an easy fit in most cases.  Once the insert is in the shoe you just don't have to worry anymore.  Makes life easy.  If you have questions, be sure to contact our sales staff for guidance.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:31https://www.myfootshop.com/direct-loading-forefoot-pads-which-one-is-the-best-for-my-needsDirect loading forefoot pads - which one is the best for my needs?<h1>Forefoot Pads</h1> <p>The first of 3 categories of forefoot pads are direct load forefoot pads.  Direct loading means that the primary intent of the pad is that it is used directly under the area to be treated.  This differs from an off-loading pad that would be used adjacent to the area to be treated.</p> <p>Direct load pads are great for plantar fat pad atrophy, blisters, and generalized forefoot pain.  The advantages of a direct load pad include the fact that the pad will add cushion or protection to a sore spot on the ball of the foot.  The disadvantage of a direct load pad is that it can add bulk to the forefoot making shoe fitting a bit more challenging.  Direct load pads can either be worn directly on the skin or can be placed in the shoe. </p> <p>Examples of direct load forefoot pads that are worn directly on the foot include -</p> <p><a href="https://www.myfootshop.com/metatarsal-cushion-gel"> <img src="/Content/Images/uploaded/Blog images/925_Gel_Metatarsal_Pads.jpg" alt="Gel metatarsal pad" width="90" height="90" /></a>   <a href="https://www.myfootshop.com/metatarsal-cushion-foam"> <img src="/Content/Images/uploaded/Blog images/852_Metatarsal_Cushion_Gel.jpg" alt="Picture of Metatarsal Cushion with Toe Loop - Foam" width="90" /></a>      <a href="https://www.myfootshop.com/moleskin-pads"> <img src="/Content/Images/uploaded/822_MoleskinPads.jpg" alt="Moleskin pad" width="90" height="90" /></a> </p> <p>Examples of direct load forefoot pads that are worn in the shoe include -</p> <p><a href="https://www.myfootshop.com/ball-of-foot-gel-pad"> <img src="/Content/Images/uploaded/Blog images/922_Ball_of_Foot_Gel_Pads.jpg" alt="Picture of Ball of Foot Gel Pads" width="90" /></a>  <a href="https://www.myfootshop.com/foam-ball-of-foot-pads"> <img class="cloud-zoom-gallery-img" src="/Content/Images/uploaded/Blog images/859_Foam_Ball_of_Foot_Pads.jpg" alt="Foam Ball of Foot Pads" width="90" /></a></p> <p>In many instances when a specific forefoot diagnosis is being treated, an off-loading forefoot pad may be a better choice than a direct load pad.  Please see my other blog posts on forefoot off-loading pads - general-purpose, and off-loading forefoot pads - specific-purpose for more information.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:30https://www.myfootshop.com/whats-the-right-forefoot-pad-for-meForefoot pads - which one is best for my needs?<p>At our weekly meeting last week, Sue, aka Susanita, came up with a good idea for a discussion topic.  Sue was interested in knowing more about which forefoot pad was best for each particular foot condition.  Sue's question is actually a very good question in that we've never really had a good method to differentiate the use for each pad.  We've never really tried to segment the forefoot pads in a meaningful way.  <br /> Sue's question forced me to come up with a method by which we could categorize our forefoot pads in a way that our staff could discuss their use with customers.  What I did was to group each of the pads into one of three categories.  Those categories include:</p> <ul> <li>direct load forefoot pads</li> <li>off-loading forefoot pads - general purpose</li> <li>off-loading forefoot pads -specific purpose</li> </ul> <p>What I'll do is break down the next three blog posts based on each of these categories.  Hopefully, this segmentation of the pads will help our staff better understand their use and help our customers select the right product.  Thanks, Sue.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:28https://www.myfootshop.com/plantar-fasciitis-and-plantar-fasciosisWhat's the difference between plantar fasciitis and plantar fasciosis?<h1>Plantar fasciitis vs plantar fasciosis</h1> <p>We all got together this morning at Myfootshop.com for coffee and discussion regarding products and conditions.  Since <a href="https://www.myfootshop.com/article/plantar-fasciitis">plantar fasciitis</a> is such a common problem, we've been spending a few weeks on the topic.  Part of the discussion this morning focused on the differences between acute and chronic plantar fasciitis, also known as plantar fasciitis and plantar fasciosis.  </p> <p>The language of medicine can be confusing to many folks, but like any other language, when you break the big words down into their component parts, the language starts to make sense.  In the language of medicine, the root forms, prefixes, and suffixes all take on significant meaning.  For instance, the suffix 'itis' always refers to a condition that includes inflammation.  Think bronchitis or appendicitis.  The suffix 'osis', on the other hand, refers to a non-inflamed state of being.  Think tuberculosis or sarcoidosis. </p> <p>In cases of plantar heel pain, the most common term used to describe the inflammation at the insertion of the plantar fascia is the term plantar fasciitis.  Plantar fasciitis is used to describe the acute, inflamed state.  Studies have proven that after a period of time, typically months, the inflammation associated with plantar fasciitis fades.  Tissue biopsies of the plantar fascia and surrounding soft tissue show no inflammation.  In cases of long term plantar fasciitis, the more appropriate term used to describe the condition would be plantar fasciosis.</p> <h2>Plantar fasciosis - treatment by a restart of the inflammatory process</h2> <p>There are some clinicians who believe that if you can restart the inflammation of the soft tissue surrounding the plantar heel, there would be a strong likelihood that the body's own chemical and cellular properties of healing would get a second chance to correct the inflammation of the fascia.  A number of techniques are used to create or stimulate inflammation.  These techniques include needling, Topaz surgery and shock wave therapy.</p> <h3>Plantar fasciosis - Plantar Fasciitis Reliever</h3> <p><a href="https://www.myfootshop.com/plantar-fasciitis-reliever"><img style="float: right;" src="/Content/Images/uploaded/Blog images/plantar-fasciitis-reliever_70.jpeg" alt="Plantar Fasciitis Reliever" width="90" height="90" /></a>One product we talked a lot about this morning is the <a href="https://www.myfootshop.com/plantar-fasciitis-reliever">Plantar Fasciitis Reliever</a>.  The Reliever is a firm gel heel pad that incorporates a set of firm bars that are used to 'stimulate' the plantar fascia.  The bars can be varied and changed as needed.  In consideration of the discussion above, I see The Plantar Fasciitis Reliever as an overlooked product that actually has a bit of science behind it.  The bars are used to massage the fascia.  That massage can restart the inflammation.  And in theory, the bars act as an active, non-surgical way in which the plantar fasciosis can return to that active state of healing, plantar fasciitis.</p> <p>Funny sometimes where you find the pearls in this business.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:27https://www.myfootshop.com/plantar-fasciitis-horseshoe-padPlantar fasciitis - what's the purpose of a horseshoe pad?<h1><a href="https://www.myfootshop.com/horseshoe-heel-spur-pads"><img style="float: right; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/horseshoe-heel-spur-pads_70.jpeg" alt="Horseshoe heel spur pad" width="90" height="90" /></a>Plantar fasciitis - the horseshoe pad</h1> <p>What's the role of cut-out heel pads or horseshoe pads in the treatment of plantar fasciitis?  From a historical perspective, it's really kind of an interesting story.</p> <p>The use of a cut-out heel pad or horseshoe pad dates back to the days when we believed that the primary contributing factor to heel pain was a spur on the bottom of the heel.  Popular belief was that standing on the spur resulted in pain.  Cut-out pads were used to pocket the bottom of the heel.  The thought being that the cut-out would cradle the heel spur and off-load direct pressure to the heel spur.  But I think today most clinicians will agree that the concept of a heel spur being the primary cause of pain is old school.  What actually causes plantar heel pain is a functional problem that occurs with weight-bearing.  The arch of the foot is supported by an inelastic tissue called the plantar fascia.  When weight is applied to the foot, the arch drops and the plantar fascia is put under load.  If the load applied to the plantar fascia is too great, the fascia will tug and pull on its' insertion on the plantar heel resulting in pain.  This pain is what we call plantar fasciitis.</p> <p>Cut-out heel pads and horseshoe pads have traditionally been used to act as a pocket to off-load that symptomatic heel spur.  So if the primary problem isn't the spur, then why are we still using a horseshoe pad? </p> <p>Well, some traditions are hard to break.  But interestingly, there's still a role for these unique kinds of pads.  A firm horseshoe pad can act as a heel lift.  And as you know after reading our <a href="../../../article/plantar-fasciitis">knowledge base article on plantar fasciitis</a>, using a heel lift is one of the first steps to do when treating plantar fasciitis.  Also, the cut-out pads will take direct pressure away from the pain on the bottom of the foot.  Although this off-loading of the pain isn't really a therapeutic measure, it can still help with the pain found in cases of plantar fasciitis.  Off-loading with a horseshoe pad doesn't really seem to help so much for that sharp tearing pain you feel when you first stand, but does seem to help with the pain found by the end of the day.  That dull, achy pain found with standing.</p> <p>As a clinician, you do have to laugh at yourself sometimes, particularly when you do something that works but you didn't really understand why it worked.  That's exactly what happened from a historical standpoint with doctors treating heel pain.  But hey, if it makes your patient feel better, no need to be analytical about it.  Just keep doing it.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:26https://www.myfootshop.com/plantar-fasciitis-do-i-need-an-orthoticPlantar fasciitis - do I really need an orthotic to treat it?<h1>Plantar fasciitis - treatment with an orthotic</h1> <p>When you're a hammer, everything looks like a nail, right?  So when you're a podiatrist, is everything treated with an orthotic?  Like so much in life, there's no single answer, but let's explore the question. </p> <p>In my experience, I've known a few, true biomechanical evangelical podiatrists who are hyper-focused on their art.  These doctors are very intellectual in their practice of lower extremity biomechanics.  Their exam is comprehensive and includes a non-weight bearing biomechanical exam and gait exam.  And their tool of choice?  Rx orthotics.  I do want to stress that these are doctors who I really trust.  They're bright, logical and help many, many patients.  </p> <p>On the other hand, I've seen orthotics mills.  These are doctors who use orthotics to put their kids through college.  And this practice isn't just with physicians.  One local example in my community is a retail store that sells arch supports for $400 a pair.  These are stock out-of-the-box arch supports.  Wow.  </p> <p>So where's the middle of the road?  How do you know when an orthotic is indicated or when it's just an up-sell?  The first thing is trust.  Whether it's your auto mechanic, dentist or podiatrist, trust is at the heart of the interaction.  As an example, on a recent trip to see my dentist, he told me I needed three major build-ups on my teeth.  I nodded in agreement trusting him.  But then he went a step further and showed me digital images of my teeth once he had carved out the decay.  Holy cow!  From the images, I was amazed that he would be able to rebuild my teeth.  And my auto mechanic - he always has the old parts.  He always takes the time to explain to me why the circuit went out on a switch or why a particular valve was plugged.  I trust these people and as a result, I value them in my life.  </p> <h2>Prescription vs non-prescription orthotics</h2> <p>And orthotics?  Has your doc tried a few methods of treatment prior to the introduction of the orthotics?  Has he or she spent a reasonable amount of time explaining your foot condition?  As you can see from my example of my dentist and my auto mechanic, there's a period of building trust.  The same holds true in a significant purchase like a pair of orthotics.  </p> <p>And what about plantar fasciitis?  Do you really need a pair of orthotics to treat plantar fasciitis?  As in the examples described above, there's a number of treatment options that can be used during the period of building trust.  In my experience, the use of calf stretches and a heel lift has helped 7/10 of my patients reach a point where they're pain-free.  This is particularly true in recent-onset cases of plantar fasciitis.  For many folks with plantar fasciitis who have failed to respond to conservative care (stretches and heel lifts), or their plantar fasciitis has been present for more than three months, they're going to need a higher level of care.  And that might just include orthotics.  I find some of the best orthotic candidates are folks who work in occupations where they can wear tennis shoes or boot and are on their feet for extended periods of time.  Examples that come to mind include grocery store clerks, warehouse workers, nurses, teachers, and landscapers.  </p> <p>How do orthotics treat plantar fasciitis?  First, they act as a heel lift to weaken the calf.  As we've said before though, raising the heel and weakening the calf can be easily done with an inexpensive heel lift.  So why the orthotics?  My logic for their use is two-fold.  First, with each step, as the heel hits the ground, the foot starts to look for what it needs to do next.  The foot runs through a checklist of issues to include - am I on a flat surface or a hill?  What kind of shoe am I in?  Is that shoe supportive?  How high is the heel on the shoe?  And the list goes on and on.  An orthotics make that list shorter.  When the heel hits the ground the orthotic provides a reliable, supportive surface.  Step after step, the orthotic is in place making the foot more efficient.  At day's end, the foot has performed less work.  Less work means fewer issues with over-use syndromes.  And as we've described before, plantar fasciitis is an over-use syndrome.  </p> <p>And the second benefit of an orthotic is the support at mid-stance of gait.  Mid-stance is that position your foot takes as your body weight passes over the foot.  A well-built orthotic will also decrease work in mid-stance.  Less work, less over-use syndromes, right?  You've got the picture.  </p> <p>So do you really need an orthotic to treat plantar fasciitis?  Maybe.  But when indicated, an orthotic can be a powerful, long last solution in the treatment of plantar fasciitis.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:25https://www.myfootshop.com/plantar-fasciitis-heel-cushions-and-liftsPlantar fasciitis - what's the best heel pad?<h1>Plantar fasciitis - treatment with heel lifts</h1> <p>When selecting a heel cushion or heel lift to treat plantar fasciitis, remember that there's a distinct difference between the function of a heel cushion and the function of a lift.  A little background is in order.</p> <p>An old folk remedy for plantar fasciitis was a pair of cowboy boots.  Cowboy boots were a unisex solution for heel pain.  By raising the heel you will weaken the normal force applied to the foot by the calf.  By raising the heel, the force applied to the plantar fascia is decreased thereby granting an opportunity for the plantar fascia to heal. </p> <p>Now, do you need to go and buy a pair of Tony Lamas?  No.  But the point that I'm trying to make is two-fold.  First, the key to success in treating plantar fasciitis starts with lifting the heel and avoiding going barefoot.  That solution may be in your closet right now.  Think wedge heel or tennis shoes with a lift. </p> <p>The second point is to clarify the difference between heel cushions and heel lifts.  Cushions will compress and flatten.  Although a cushion may feel soft, it won't give you the lift needed to weaken the calf muscle.  Be sure to err to the side of a lift.  A lift is firm.  Cover the lift with a cushion if needed.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:24https://www.myfootshop.com/plantar-fasciitis-do-i-need-to-stretchPlantar fasciitis - why do I need to stretch?<h1>Plantar fasciitis - the importance of stretching</h1> <p>When you look at the cross-section of folks who have plantar fasciitis, what you'll come to recognize is that this particular <img style="float: right;" src="/Content/Images/uploaded/Blog images/stretching.jpg" alt="Stretching" width="200" />demographic is a group of people who are active, middle-aged and just a tad overweight.  So why is this particular group of folks prone to plantar fasciitis?  There's actually a couple of reasons, but let's focus in on the calf as one of the primary contributing factors in the onset of plantar fasciitis.</p> <p>If you've read any of my previous blog posts about plantar fasciitis, you'll come to see plantar fasciitis as an over-use syndrome.  An over-use syndrome is simply a condition that results from repetitive activity that your body cannot heal from in a reasonable amount of time.  What's a reasonable amount of time?  In most cases, this time period will be the 24hr cycle we call our day.  Stress/work is applied to the foot by day and we rest at night.  If you can't repair by morning, you're prone to plantar fasciitis.</p> <p>As we age we tend to lose tissue elasticity.  Tissue elasticity is the ability of tissue to bear load, create action and heal in that 24 hr cycle.  Teenagers have such high tissue elasticity and heal so quickly, you'll never see a teenager with plantar fasciitis.  Old folks, even though they have low tissue elasticity, aren't active enough to generate the load needed to cause plantar fasciitis.  But middle-aged folks are prime targets.  They're active and losing tissue elasticity.</p> <p>Calf stretches, whether performed hanging off the edge of a step, leaning against a wall or standing on a stretching block all accomplish the same thing.  With serial stretches over the course of the day (six/day), the calf will become more limber and regain a bit of its' original tissue elasticity.  Remember that it's the calf muscle that's stretching.  The Achilles tendon and plantar fascia are tissues that are inelastic and cannot stretch.  So focus on the calf.</p> <p>Does calf stretching help heal plantar fasciitis?  Yes, very much so.  With a program of calf stretches and heel lifts, I see in my office that 7/10 folks respond to the degree that they no longer need care.</p> <p>So get to stretching.  Stretching is considered the single most important aspect of care in newly diagnosed cases of plantar fasciitis.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:23https://www.myfootshop.com/do-i-need-to-purchase-a-night-splintPlantar fasciitis - do I need to buy a night splint?<h1>Plantar fasciitis - treatment with a night splint</h1> <p>Interestingly, as one of the more common foot problems, there's a lot of confusion regarding how to best treat <a href="../../../article/plantar-fasciitis">plantar fasciitis</a>. <a href="https://www.myfootshop.com/plantar-fasciitis-night-splint"><img style="float: right;" src="/Content/Images/uploaded/Products/906_Plantar_Fasciitis_Night_Splint.jpg" alt="Plantar fasciitis night splint" width="200" /></a>Let's talk a bit about the different methods by which you can treat plantar fasciitis.</p> <p>First, be sure to get an education.  Learning about plantar fasciitis means a lot in terms of your ability to treat it.  As a good starting point, be sure to read our knowledge base article on plantar fasciitis. </p> <p>OK, so you read the article, right?  And have you done your stretches 6/day?  Avoided going barefoot?  If you've stuck with the program, 7 out of 10 people who 1) get the education and 2) follow through on the stretches and heel elevation get to a point where they have very little pain. </p> <p>Now, what about the remaining 3/10 folks who still have heel pain?  Do you need a <a href="../../../night-splints">night splint</a>?  If you're in the 3/10 group, my best answer is, well, maybe.  I'm inclined to recommend a night splint for the folks that I see in the office who say they just can't remember to stretch.  Or they don't have the time. Or...  We hear lots of excuses.  So if you can't get the stretches done by day, then perhaps a night splint is the tool for you.  But heck, stretches by day are free, right?  So get stretching.</p> <p>And a heel lift?  That's easy.  Either switch to shoes that already have a heel lift or just pick up a pair of our <a href="../../../heel-lifts">cork heel lifts</a>.  They're light and inexpensive.</p> <p>Six stretches per day, right?</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:22https://www.myfootshop.com/treating-plantar-fasciitisPlantar fasciitis - why did I get it and how do I make it go away?<h1>Plantar fasciitis - the basics</h1> <p>We meet at the store each week to go over foot conditions and how to treat them.  Just a good opportunity to talk shop.  This week we got into some of the subtleties of plantar fasciitis and how to treat it.  First though, to understand the basics of plantar fasciitis, be sure to read our <a href="https://www.myfootshop.com/article/plantar-fasciitis">knowledge base article on plantar fasciitis</a>.  I think that's really a great springboard to get you oriented to the condition.</p> <h2>Plantar fasciitis - how did I get it?</h2> <p>How did I get it?  Think of plantar fasciitis as an overuse syndrome.  You don't see plantar fasciitis in kids.  They heal too quickly to ever have plantar fasciitis.  And you don't see plantar fasciitis in old folks.  They're just not active enough to generate the mechanical load need to initiate an overuse syndrome.  You see plantar fasciitis in folks who are 35-60 years of age, active and perhaps just a tad overweight.  Think about the onset of plantar fasciitis as a stage in mechanical load-bearing where your tissue just can't heal in time to have you ready to start a new day.  That's basically the definition of an overuse syndrome.  As we age, our tissue elasticity becomes a bit more brittle.  Healing takes longer.  So the onset of plantar fasciitis is really just a symptom of an overuse syndrome where your heel is just can't tolerate the loads applied to it.</p> <h3>Plantar fasciitis - how do I make it go away?</h3> <p>How do I make it go away?  I think you'll read in the attached link to the knowledge base article on plantar fasciitis that one of the keys to treating plantar fasciitis is weakening the calf.  The contribution of the calf and Achilles tendon to plantar fasciitis is the single most significant contributing factor to the onset and perpetuation of plantar fasciitis.  Weakening the force generated by the calf is actually really quite simple.  Think cowboy boot.  Raise the heel and you'll weaken the calf.  Weaken the calf and you'll see the heel pain respond in kind.  Do you need to buy a pair of Tony Llamas?  No, but hang onto that visual image.  Raise the heel and you'll be a winner.  Go barefoot or wear low heeled shoes and you'll continue to have heel pain.  Let's talk a bit about this over the coming week.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:18https://www.myfootshop.com/hallux-trainer-insoles-2Tips for choosing the right carbon/glass fiber orthotic - Hallux Trainer Insoles<p>Part 4 of 6</p> <h1>Hallus Trainer Insoles</h1> <p>So far in this series of blog posts about carbon fiber inserts, we've talked about several of the carbon fiber orthotics that we use.  But to date, none of these orthotics are 'tailored'.  When I say tailored, <a href="https://www.myfootshop.com/carbon-graphite-foot-orthotic"><img style="float: right;" src="../../../Content/Images/uploaded/carbon-fiber_sm.jpg" alt="carbon graphite shoe inserts" width="90" height="85" /></a>I'm referring to an orthotic that is dressed out as a finished product.  Not to say that you can't use the bare-bones version of a <a href="../../../turf-toe-plates-carbon-graphite-molded">turf toe plate</a> as is.  Many folks will finish the plates with a top cover or <a href="https://www.myfootshop.com/hallux-trainer-insoles"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/962_Hallux_Trainer.jpg" alt="Hallux Trainer Insole" width="90" height="90" /></a>dress it with a <a href="../../../metatarsal-pad-felt-1">met pad</a>.  In fact, a lot of podiatry offices, pedorthic shops, and shoe stores will use these prefab, unfinished orthotics as a base and dress them up for customers.</p> <p>But when it comes to a finished or tailored carbon fiber insert with a Morton's extension, we usually recommend the Hallux Trainer Insoles.  The Hallux Trainer has a Morton's extension, metatarsal pad, and comfortable firm foam top liner.  The bottom of the insert is also covered.  With the Hallux Trainer Insole, you're getting the best of both worlds with a carbon insert that's finished.</p> <p>Why choose the Hallux Trainer Insole?</p> <ul> <li>It's versatile - it acts as a good replacement for the stock insoles that come in tennis shoes or boots.</li> <li>It's rigid - made out of the same carbon fiber as our other models.  We do find the Hallux Trainer to be just a shade more flexible than our other turf toe orthotics.</li> <li>It's durable - top cover and bottom cover wear well. </li> <li>Arch support - much more comfortable than the flat turf toe plates.</li> </ul> <p>Why not to choose the Carbon Graphite Shoe Plate Flat?</p> <ul> <li>Size - as a finished product, the Hallux Trainer is going to fit into only tennis shoes and work boots.  Not a good choice for dress shoes.</li> <li>It's rigid - if you're not in the market for a stiff Morton's extension, you'd be better off to look at our <a href="https://www.myfootshop.com/sole-active-insole">SOLE Active Insole</a>.</li> </ul> <p>What can I do in a Hallux Trainer Insole?</p> <ul> <li>Work - no limitations here.  Should fit most work shoes (unless you work at Ballet Met)</li> <li>Sports - should do you well in all sports.  The top cover reduces sheer forces seen in multi-directional sports such as basketball.</li> </ul> <p> </p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:17https://www.myfootshop.com/carbon-graphite-shoe-plate-flat-2Tips for choosing the right carbon/glass fiber orthotic - Glass Fiber Shoe Plate Flat<p>Part 3 of 6</p> <h1>Glass Fiber Shoe Plate Flat</h1> <p>Why would you choose a flat glass fiber shoe plate?  When we first started to sell flat glass fiber show plates I didn't really see them as<a href="/carbon-graphite-foot-orthotic"><img style="float: right;" src="/Content/Images/uploaded/carbon-fiber_sm.jpg" alt="carbon graphite shoe inserts" width="90" height="85" /></a> a very practical tool.  They're primarily used to stiffen the shoe and my experience that was their sole use (what a pun, eh?  sole use?).  But it's been interesting how our customers have taken to them.  Customer feedback has been <a href="/carbon-graphite-shoe-plate-flat"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/893_Carbon_Graphite_Shoe_Plate_Flat_ALT_border.jpg" alt="Carbon graphic Shoe Plate" width="90" height="90" /></a>very positive.  We've had customers use them for a number of different applications where I thought the <a href="/turf-toe-plate-carbon-graphite-flat">flat turf toe plate</a> or the <a href="/turf-toe-plates-carbon-graphite-molded">molded turf toe plate</a> might have been a better choice.  The indications for the flat plates include <a href="/article/arthritis-of-the-foot-and-ankle">midfoot arthritis</a>, <a href="/article/metatarsal-fracture">metatarsal fractures</a>, <a href="/article/cuboid-syndrome">cuboid syndrome</a>, <a href="/article/hallux-limitus">hallux limitus</a> and <a href="/article/turf-toe">turf toe</a>.  I think the one virtue I've really seen is that the flat glass plates are really good for heavy folks.  They wear like iron and cannot be broken down. </p> <p> </p> <p>Why choose the Glass Fiber Shoe Plate Flat?</p> <ul> <li>It's thin - it really does slip into the shoe well due to the flat shape.</li> <li>It's rigid - made out of the same carbon fiber as the molded version - very stiff.</li> <li>It's durable. - Again, these are tough.  It's hard to wear them down.</li> </ul> <p>Why not to choose the Glass Fiber Shoe Plate Flat?</p> <ul> <li>Arch support - none there.  If you're looking for arch support, check out the Carbon Fiber Sport Orthotics.</li> <li>It's rigid - that's what we're looking for right?  If you want some degree of flex, you might be better off with the flat turf toe plate.</li> </ul> <p>What can I do in a Glass Fiber Shoe Plate Flat?</p> <ul> <li>Work - no limitations here.  Fit the Shoe Plate into the work shoes or boots and you're good.  No limitations on activity or duration of time on the feet.  Many folks who work in construction wear a pair of these to protect against puncture wounds from nails.</li> <li>Sports - here I think you are going to find some limitations.  The Glass Fiber Shoe Plate is built more for pedestrian applications and not for sports. </li> </ul> <p>If our sales tell the story, people do buy a lot of Glass Fiber Shoe Plates.  I'd be interested to get their feedback in this post.</p> <p>Next up - <a href="/hallux-trainer-insoles">Hallux Trainer Insoles</a>.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:16https://www.myfootshop.com/tips-for-choosing-the-right-carbon-fiber-orthotic-molded-turf-toe-platesTips for choosing the right carbon/glass fiber orthotic - molded turf toe plates<p>Part 2 of 6</p> <h1>Molded Glass Fiber Turf Toe Plate</h1> <p><br /><a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded"><img style="float: left;" src="/Content/Images/uploaded/Products/881_Turf_Toe_Plates.jpg" alt="Molded turf toe plates" width="100" /></a>The <a href="https://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded">molded turf toe plate</a> is a glass fiber turf toe plate that has a moderate arch molded into the orthotic.  This differs <a href="https://www.myfootshop.com/carbon-graphite-foot-orthotic-half-length"><img style="float: right;" src="../../../Content/Images/uploaded/carbon-fiber_sm.jpg" alt="carbon fiber plates" width="90" height="85" /></a>from the <a href="../../../turf-toe-plate-carbon-graphite-flat">flat turf toe plate</a> that has no arch. Both have a Morton's extension beneath the great toe to limit range of motion of the great toe joint.   What are the pros and cons of each?  Let's take a peek.</p> <p>First, the indications are the same.  If you read my prior post about the flat turf toe plate you'd find that the primary indications for both the flat and the molded turf toe plate are <a href="../../../article/turf-toe">turf toe</a> and <a href="../../../article/hallux-limitus">hallux limitus</a>.  </p> <p>Why choose the molded turf toe plate?</p> <ul> <li>It's thin - the molded plate is just a hair thicker than the flat plate.  I think you'd be hard-pressed to tell the difference in the shoe.</li> <li>It's rigid - checking the relative stiffness of both the flat plate and the molded plate you'll find them to be about the same.</li> <li>It's durable. - Again, these are tough.  It's hard to wear them down.</li> </ul> <p>Why choose the molded turf toe plate?</p> <ul> <li>Arch support - arch support is really the advantage of the molded insert vs the flat turf toe plate.</li> <li>It's rigid - that's what we're looking for right?  The rigidity is great to splint the great toe joint.</li> </ul> <p>What can I do in a molded turf toe plate?</p> <ul> <li>Work - no limitations here.  Fit the molded turf toe plate into the work shoes or boots and you're good.  No limitations on activity or duration of time on the feet.</li> <li>Sports - again, no limitations.  You can run and play any sport including football, soccer or basketball.  Distance running is no problem.</li> </ul> <p>The molded turf toe plate is the best seller of the turf toe plates.  I think the arch support and unique design speak for themselves.</p> <p>Next up - <a href="https://www.myfootshop.com/carbon-graphite-shoe-plate-flat-2">glass fiber flat plates</a>.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:15https://www.myfootshop.com/carbon-fiber-turf-toe-plate-flatTips for choosing the right carbon/glass fiber orthotic - flat turf toe plates<p>Part 1 of 6</p> <h1>Flat Turf Toe Plate</h1> <p><a href="https://www.myfootshop.com/carbon-graphite-foot-orthotic"><img style="float: right;" src="../../../Content/Images/uploaded/carbon-fiber_sm.jpg" alt="carbon-fiber-orthotics" width="90" height="85" /></a> We get a lot of questions at the shop regarding how to select the correct carbon fiber (also called carbon graphite) or glass fiber orthotics. Let's see if we can't have a conversation that'd help you to choose the best carbon fiber or glass fiber insert.</p> <p>Let's start the conversation with the flat carbon fiber turf toe plate.  A turf toe plate is an oddly shaped insert that has an exte<a href="https://www.myfootshop.com/turf-toe-plate-carbon-graphite-flat"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/turf_toe_plate_flat.jpeg" alt="flat turf toe plate" width="90" height="90" /></a>nsion that protrudes beneath the great toe joint.  This extension, called a Morton's extension, is designed to limit the range of motion of the great toe joint.  Why would we want to limit the range of motion of the great to joint?  The two most common reasons are injuries to the joint and arthritis of the joint.  The most common injury to the great to joint is called <a href="../../../article/turf-toe">turf toe</a>.  Turf toe describes an injury, most commonly a sports injury, to the structures that surround the great toe joint and enable the normal range of motion of the joint.  Arthritis of the joint, often called <a href="../../../article/hallux-limitus">hallux limitus</a> or <a href="../../../article/hallux-rigidus">hallux rigidus</a>, causes significant pain in the great toe joint.  In both cases, the use of a rigid turf toe plate with a Morton's extension is simply used to splint or limit the range of motion of the joint.</p> <p>So why the flat turf toe plate?  Here are several reasons to choose the flat turf toe plate over the other carbon fiber devices:</p> <ul> <li>It's thin - the flat plate is very thin.  It's by far the best choice for dress shoes or when the insert is to be worn under another insert or Rx orthotic.</li> <li>It's rigid - carbon fiber is one of the thinnest yet stiffest materials used in the medical industry. </li> <li>It's durable - the flat plate is rugged and reliable. </li> </ul> <p>Why wouldn't I choose the flat turf toe plat?</p> <ul> <li>It's flat - in has no contoured arch as seen with the <a href="../../../turf-toe-plates-carbon-graphite-molded">molded turf toe orthotic</a>.</li> <li>It's hard - it's hard on purpose.  Plan on putting another insert or cushion on top of the flat turf toe plate.</li> </ul> <p>What can I do while in a flat turf toe plate?</p> <ul> <li>Work - no limitations at work.  you can be as active as necessary.  The flat turf toe plate will easily fit into any work shoe.</li> <li>Sports - no limitations.  You can run, jump and play multi-directional sports such as soccer or basketball.  You could even swim with them.  We have customers who wear them in triathlons for biking, swimming and running.</li> </ul> <p>Versatile and thin.  The flat turf toe plate is a great choice for almost all activities.  Just remember, if you're looking for an arch, you'll need to add one on top of the flat turf toe plate or purchase the <a href="../../../turf-toe-plates-carbon-graphite-molded">molded turf toe plate</a>.</p> <p>Next up - <a href="https://www.myfootshop.com/tips-for-choosing-the-right-carbon-fiber-orthotic-molded-turf-toe-plates">molded turf toe plates</a>.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 12/27/19</p>urn:store:1:blog:post:14https://www.myfootshop.com/showering-with-metatarsal-padsHanging your met pads out on the clothes line to dry.<h1>Metatarsal pads</h1> <p>We had a call from a customer who wanted information about <a href="../../../metatarsal-pads">met pads</a> and which ones were suitable for showering.  She had used our <a href="../../../metatarsal-pad-felt-1">felt metatarsal pads</a> in the past and couldn't remember if they were OK for showers.</p> <p>Felt is probably not the best choice of metatarsal pad for someone who wants to wear the pad directly on the foot and take a shower.  Felt is water absorbent and would remain damp for a few hours after a shower.  The visual image I had was of a row of felt metatarsal pads on the clothesline, each with a clothespin.  Nah, poor choice.</p> <p>So, what would be the alternative?  First, if you prefer the felt met pads, why not put them in the shoe rather than directly on the foot?  Whether on the foot or in the shoe, the pad will function the same.  The one distinct advantage of putting the met pad in the shoe is that you'll save money by using one that'll last for quite some time compared to putting a fresh pad on every other day or so.</p> <p><a href="https://www.myfootshop.com/reusable-ball-of-foot-gel-cushions"><img style="float: left; padding-right: 5px;" src="/Content/Images/uploaded/Blog images/reusable-gel-metatarsal-pad.jpeg" alt="Reusable metatarsal pad" width="90" height="90" /></a>Another alternative would be to use the <a href="../../../reusable-ball-of-foot-gel-cushions">Reusable Ball of Foot Cushion</a>.  The reusable met pad, although a bit more expensive at first, is going to be a pad that can be taken on and off.  It cleans up with soap and water and actually becomes tacky and sticky again when washed.  Tacky and sticky is a good thing.  It's important to keep the pad in place.</p> <p><a href="https://www.myfootshop.com/pedag-comfort-supports-1"><img style="float: right;" src="/Content/Images/uploaded/Blog images/797_Pedag_COMFORT_Insoles.jpg" alt="Pedag Comfort" width="90" height="90" /></a>Or another way is to use an insert with a met pad.  Around the shop, we jokingly call the <a href="../../../pedag-comfort-supports-1">Pedag Comfort</a> a life support system for a metatarsal pad.  The Comfort is flat and fits into all shoes, including loafers and thin shoes, but also has a monster of a met pad.  The Comfort is a great tool to get folks new to the use of a met pad oriented as to how the pad should feel in the shoe.</p> <p>Although felt met pads are by far our biggest seller, I still wouldn't recommend taking a shower with them on.  Squish, squish, squish down the hall, right?</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/23/2021</p>urn:store:1:blog:post:13https://www.myfootshop.com/wheres-the-peppermintWhere's the peppermint? How the dentists can teach the podiatrists a thing or two.<h2>What a dentist can teach us about treating athlete's foot</h2> <p>The history of dental hygiene is actually an interesting story.  At the onset of the 20th century, dental hygiene was virtually non-existent.  A green stick was used to scrape only the most obvious of plaque and toothpaste was scoffed.  Toothpaste recipes that included burnt bread, pulverized brick and chalk were used as abrasives.  But it wasn't until the brilliant Dr. Washington Sheffield of Connecticut discovered that if you put mint into the toothpaste, people actually enjoyed using it (what a concept, right?)  And with pleasure came use.  It was finally a time when dentists could enthusiastically say, "If you brush your teeth regularly you'll probably keep your teeth for most of your life."  And people actually did.</p> <p>What's this have to do with foot care?  Well, the foot lives in a unique environment.  The world inside the shoe is dark, moist and warm.  This environment represents everything conducive to the growth of a fungus.  A fungal infection will often start on the skin and slowly progress to the nail.  If a nail is injured, the nail becomes susceptible to cross infections from the skin.  <a href="../../../article/athletes-foot">Dermatophytosis</a>, or what is commonly called athlete's foot will progress to a fungal infection of the nail known as <a href="../../../article/onychomycosis">onychomycosis</a>.  And the connection?  Foot docs need to find their peppermint.  How can they make foot hygiene happen without the peppermint?</p> <p>Any measure to improve health begins with health care literacy.  You need to understand the problems to be able the effectively treat it.  So first, be sure to read the links above.  The basics?  First, change the environment in the shoe.  Make warm dark and moist, cool, dry and open to the air.  Identify that fungus of the skin and treat it twice daily with a topical antifungal for the skin of antifungal for the nail.  And remember, it's not a 2-week cure.  Proper foot hygiene and treatment of fungal infections is an ongoing task - no different than brushing your teeth.  It needs to be done on a daily basis. </p> <p>And the peppermint?  Where's the peppermint?  Ah, we're working on that part of the equation.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/23/2021</p>urn:store:1:blog:post:12https://www.myfootshop.com/bone-edema-on-mriMy MRI says I have bone edema. How long will it take to heal?<h1>Bone Edema - how long does it take to heal?</h1> <p>Bone edema describes swelling within bone.  Bone swelling is typically identified on MRI and is the result of either a direct injury to bone or load-bearing that is greater than what can be sustained by the bone (<a href="../../../article/stress-fractures-of-the-foot">stress injuries</a>).  Bone edema can also be found secondary to an inflammatory injury of bone such as infection or <a href="../../../article/arthritis-of-the-foot-and-ankle">arthritis</a>. </p> <p>How does bone edema heal?  The first issue to consider in healing bone edema is the primary cause of bone edema.  For instance, if bone edema is secondary to an infection, the infection has to be treated for the bone edema to heal.  Or if the bone edema is due to a stress injury, the mechanical stress needs to be eliminated. </p> <p>Once the primary cause for bone edema is identified and eliminated, then we can look at the dynamics of bone healing in response to bone edema.  One tool that helps to determine the rate of bone healing is a classification scheme.  In many types of bone fractures, we use classifications schemes to define characteristics of the injury such as depth of the injury, overall size of the injury, etc.  But when we discuss bone edema, we have a problem - to date, we no classification scheme.  And without a classification scheme, we then have a difficult time answering that question…how long will this bone edema injury take to heal?</p> <p>In my practice as a hospital-based podiatrist I’ve tended to find that when we discover bone edema on an MRI, and we've excluded the diagnosis of infection, the injury to the bone may take as long if not longer than most fractures to heal.  For instance, a common foot problem that we’ll see is a metatarsal stress fracture.  If the stress fracture doesn’t show on plain x-ray, we’ll send our patient for an MRI.  And if that MRI comes back with a diagnosis of bone edema within the metatarsal (precursor to a stress fracture), we then have an idea about overall time that it’ll take for bone healing.  What’s the typical healing time for a <a href="../../../article/metatarsal-fracture">metatarsal stress fracture</a>?  I’d tell most folks 8-12 weeks.  But with bone edema in the metatarsal, it may take as long if not longer than a traditional fracture.  Additional variables that influence the duration of healing of bone edema include the size of the bone that is injured, the type of bone that is injured, the depth of the injury and the overall size. </p> <p>Some of the most challenging issues related to bone edema involve injuries to joints.  The two images here show bone edema on MRI.  This bone edema in the ankle (left) and subtalar joint (right), are due to injuries that occured when localized stress was applied to the joint, passing through the cartilage.  These injuries are often called <a href="https://www.myfootshop.com/talar-dome-fracture">transchondral or osteochondral fractures</a>.  In a transchondral fracture, the cartilage stays intact but the underlying bone is injured resulting in bone edema.</p> <p>Treatment of osteochondral injuries that result in bone edema can include:</p> <ul> <li>rest</li> <li>microfracture</li> <li>subchondroplasty</li> </ul> <p><a href="/images/uploaded/Medical/X-ray/transchondral fracture of the subtalar joint.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/transchondral fracture of the subtalar joint.jpg" alt="transchondral fracture of the subtalar joint" width="150" /></a></p> <p>Prior to any surgical intervention in bone edema, I'll let a joint rest for 8 weeks to see how the bone responds.  Depending upon the location of the injury, rest may include partial weight-bearing or complete non-weight bearing. </p> <p><a href="/images/uploaded/Medical/X-ray/MRI_ankle_osteochondral_fracture_talus_mod.jpg" target="_blank"><img src="/images/uploaded/Medical/X-ray/MRI_ankle_osteochondral_fracture_talus_mod.jpg" alt="transchondral fracture of the ankle joint" width="150" /></a></p> <p>Microfracture is a technique used to reactivate bone healing.  Microfacture is a technique where a small thin wire is used to drill the edema site.  The intent of drilling the site is to stimulate bone healing.  And lastly, subchondroplasty is a technique where the patient's bone marrow or other substance is injected into the area of bone edema.  Here's a link to the Zimmer website with <a href="https://www.subchondroplasty.com/">additional information on the subchondroplasty technique.</a></p> <p>Unfortunately, until we can develop a classification scheme for defining the healing rate of bone edema, each doc just draws from his or her experience with previous patients and similar injuries.  So if your doctor recommends an MRI and your MRI comes back with a diagnosis of bone edema, be patient with your doc.  She/he will try to guide you with answers, but defining how long bone edema will take to heal can be a challenge.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/23/2021</p>urn:store:1:blog:post:11https://www.myfootshop.com/psoriasis-of-the-footPsoriasis of the Foot<p><a href="/images/uploaded/Medical/Derm/psoriasis_foot_2.jpg" target="_blank"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Medical/Derm/psoriasis_foot_2.jpg" alt="Psoriasis of the foot" width="150" /></a></p> <h2>Psoriasis of the foot - treatment recommendations</h2> <p> </p> <p>Every doctor knows that pathology comes in threes.  If you see one case, you're bound to see several more soon to follow.  There's no science to this, but it just seems to be a part of practice.</p> <p>This week was my week to see cases of psoriasis.  <a href="/images/uploaded/Medical/Derm/psoriasis_foot_3.jpg" target="_blank"><img style="float: left; padding-right: 5px;" src="/images/uploaded/Medical/Derm/psoriasis_foot_3.jpg" alt="Psoriasis of the foot" width="150" /></a> Psoriasis is an autoimmune disorder that is manifested by the rapid turn over of skin cells resulting in disruption of normal skin production.  There are 5 different classifications of psoriasis based on their appearance.  The two most common that we see in foot care are plaque and pustular psoriasis.</p> <p>From a histological (cellular) standpoint, psoriasis occurs as T-helper cells of the immune system attack the skin.  The attack by the T-helper cells results in rapid turnover of the cells.  The result is either a plaque (build-up of layers of skin with an erytematous base) or a pustule (a small abscess).  Stress also seems to be a trigger for the onset and perpetuation of psoriasis.</p> <p><a href="/images/uploaded/Medical/Derm/pustular_ psoriasis_foot_2.jpg" target="_blank"><img style="float: right; padding-left: 5px;" src="/images/uploaded/Medical/Derm/pustular_ psoriasis_foot_2.jpg" alt="Psoriasis of the foot" width="200" /></a></p> <p> Medicine has a lot to learn about psoriasis.  That being said, we also have a lot to learn about the treatment of psoriasis.  Exposure to UV light seems to decrease the rate of turn over of the skin cells and can be used to treat psoriasis.  Topical medications including tar preparations have been used for years to slow the turnover.  Steroids have been universally used the address the inflammation associated with psoriasis.  Although steroids are successful in reducing the symptoms of psoriasis, they can only be used short term.  <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/biologic-agent">Biologic agents</a>, such as Humira or Enbrel, are now being used to treat severe cases of psoriasis, but they also have a serious profile of side effects. </p> <p>The three cases of psoriasis that I saw this week were all treated with a short course of prednisone, an oral steroid.  We'll follow-up with a topical steroid in most cases.  I'll speak with each patient regarding ways in which they can reduce stress in their lives.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="https://www.myfootshop.com/Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/23/2021</p>urn:store:1:blog:post:9https://www.myfootshop.com/when-and-why-to-cancel-surgeryWhen and why do you cancel surgery?<h1>When do you cancel surgery?</h1> <p>I'm on call this week for our hospital's Critical Limb Care program.  First thing Monday morning I had a call from a cardiologist who <img style="float: right;" src="/Content/Images/uploaded/Blog images/surgery.jpg" alt="surgery" width="200" />wanted to know whether to proceed or cancel an angioplasty (PCA).  The case was an ablation of the right atrium.  The problem was that the patient presented with a mid-shin wound that had been present for 3 weeks.  The question at hand was whether the wound was infected and would contaminate the procedure.  'What should I do?  Cancel the case?'</p> <p>This is a question that has no definitive answer.  Could the cardiologist proceed with the case and complete it without a risk of infection?  Maybe.  But to really answer the question, you have to drill down a bit further.  Start with the patient history.  How old is the patient?  What sort of comorbidities do they have?  Are they a diabetic?  What is their nutritional status?  Are they a smoker?  Drink alcohol?  Are they active?  Obese?  The list goes on...</p> <p>The cardiologist still wanted to proceed and sent me a text image of the wound.  'What do you think?  Is this OK?'  The call was really a deferral of responsibility.  If the case did get infected, he would have documented that he had spoken to me and I had given the green light to do the procedure.  When in doubt, cancel the case.  This was an elective procedure that could be performed once the patient was cleared of the infection.  I canceled the case.</p> <p>So what are some of the conditions that might result in a case being canceled?  I'll often get calls from patients a day or two prior to their surgery saying that they have a cold or sore throat.  I think it's great that our patients are comfortable with our office, checking in to be sure.  Our policy is that when it comes to surgery, we're a team (doctor, staff, and patient).  And there are no dumb questions.  With a cold or sore throat (with the exception of strep throat) the case goes.</p> <p>Eating food or liquids within 6 hours of performing the case?  The case is canceled for sure.  Every surgeon has seen a case where the stomach contents are aspirated, ultimately resulting in aspiration pneumonia.  In elective surgeries, that's just a problem you can avoid.</p> <p>High blood pressure?  Maybe.  How high is too high?  First, you have to ask whether there is a history of hypertension.  Transient hypertension or newly diagnosed hypertension can typically be managed in the OR if the patient is below 150/90.  Anything higher and I start to worry about a cardiovascular event in surgery.  No strokes, thank you.  Chronic hypertension can result in cardiomegaly (enlarged heart) and would require cardiac clearance for surgery.  Surgery causes physiological stress and in particular, stress to the heart.  Why take a chance.  Just cancel the surgery.</p> <p>These examples are is just a few of the thousands of questions posed to surgeons on a daily basis.  And it's a rare day that any of these questions are the same.  On one hand, it's a heck of a challenge, but on the other hand, that's the art that is known as medicine.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/23/2021</p>urn:store:1:blog:post:7https://www.myfootshop.com/does-methotrexate-influence-wound-healing-2Does methotrexate influence wound healing?<h1>Methotrexate and wound healing</h1> <p>Methotrexate is an antimetabolite that works by inhibiting dihydrofolic reductase.  This enzyme is important in the production of <img style="float: right;" src="/Content/Images/uploaded/Blog images/arthritis.jpg" alt="arthritis" width="200" />DNA.  Methotrexate targets rapidly growing cells such as inflammatory cells in rheumatoid arthritis or psoriasis.  Methotrexate was originally used as a cancer drug for malignancies including acute lymphoblastic leukemia and lymphomas. </p> <p>My first patient has a severe deformity of the right foot that includes plantar fat pad atrophy and multiple plantar, forefoot bursae.  Rheumatoid nodules are prevalent on the bottom of the foot.  If you think of a foot with multiple ping pong balls on the bottom of the foot, then you have the right mind’s eye vision of this foot.  I had corrected her left foot 3 years ago by performing a pan-metatarsal head resection (Hoffman procedure) and <a href="https://www.myfootshop.com/bunion#Tab3">bunionectomy</a>.  She came back to us with a great result on the left and wanted to pursue correction of the right foot.  In an elective case, when the patient is in active treatment using methotrexate, we have the distinct advantage to work directly with the patient’s rheumatologist.  His suggestion is to discontinue the methotrexate three weeks prior to the surgery and restart it 2 weeks following the surgery. </p> <p>Surgery should be thought of as premeditated trauma.  The body can’t tell the difference between a fireplace log and a scalpel blade.  Trauma is trauma.  The response to a traumatic wound is always the same; stop the bleeding, become inflamed, close the wound and remodel the wound.  But when a patient has methotrexate on-board, that typical cascade of wound healing is interrupted.  Hemostasis (stop the bleeding) occurs, but there is no inflammation.  Inflammation in a wound in the beacon that calls for the cellular and chemical response that sends the necessary components to the wound to begin the process of healing.  Knowing that methotrexate affects cells with rapid turn over, we can then assume that methotrexate will have a direct effect on inflammatory cells.  Methotrexate essentially stops healing. </p> <p>My second case was not elective.  The patient is a 60 y/o female referred to our critical limb care center (wound center).  She had a 5-year history of vasculitis that was in remission with continued use of methotrexate.  She had visited a vein center to have a few spider veins treated by multiple injections (a technique called sclerotherapy).  6 weeks after her sclerotherapy, she had multiple, nonhealing wounds of the right ankle where the solution used in the injections had extravasated (escaped) from the vein.  My assumption is that the sclerotherapy was poorly performed.  In a healthy patient, the extravasation would have been accommodated by healthy cells adjacent to the vein.  But in this case, the sclerosing solution simply sclerosed the tissue surround the vein.  In a healthy patient, the inflammatory response to this problem would have initiated healing.  But since the patient was taking methotrexate, there was no inflammatory response, and subsequently no healing. </p> <p>My sclerotherapy patient had tried in the past to get off of her methotrexate but was not able to do so.  She told me that when she did try, she had a terrible time getting readjusted to her dose.  So our goal was to heal this wound while keeping the patient on her methotrexate.  She’s 8 weeks now into her treatment.  The smaller wounds have healed with the use of a topical enzymatic agent called Santyl.  The larger wounds are responding to the use of Oasis, a matrix of collagen made from the submucosa of pig intestine.  Oasis acts as both a cover and scaffold for the fibroblasts in the wound.  A few more weeks and I think we’ll have her healed.</p> <p>Does methotrexate influence healing?  Absolutely.  If you’re taking methotrexate, be sure to tell each of your doctors.</p> <p>Jeff</p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv"><img style="float: left; padding-right: 5px;" src="../../../Content/Images/uploaded/Dr_Jeffrey_Oster_small.jpg" alt="Dr. Jeffrey Oster" width="50" height="74" /></a></p> <p> </p> <p> </p> <p> </p> <p> </p> <p><a href="https://www.myfootshop.com/t/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br />Medical Advisor<br />Myfootshop.com</p> <p>Updated 9/23/2021</p> <p> </p> <p> </p>