Dermatophytes are the organisms that cause dermatophyte infections. In fact dermatophytes are a type of fungus. Many of us have seen the commercial featuring ‘Digger the dermatophyte.’ This commercial is for a treatment for fungal than nails.

            Dermatophyte infections in the feet is also called ‘athletes foot.’ It derives its name from the high incidence in athletes. The correlation between athletes and dermatophyte infections on the feet is due to the fact that they often used community showers. This was a route for transmission of the dermatophyte infections from one person to another. This however does not mean that only athletes can get athletes foot.

Athletes foot often presents as itching and redness on the bottoms of the feet. This can be accompanied by scaling of the skin. Many dermatophyte infections have a moccasin type pattern on the bottom of the feet. The moccasin pattern means it’s along the bottom of the foot and comes just up the sides but doesn’t infect the top of the foot. The dermatophytes can also get in between the toes and in the nails causing fungal nails.

Fungal infections in the nails are most often seen in the elderly population. The reason for this is that the body’s natural defense systems against the fungal infections have decreased over time. With decreased circulation the body is unable to deliver the defense cells to the feet. This leaves an opportunity for fungal infections to grow and thrive. Though it is more prevalent in the elderly population is seen in every age group, and ethnic group.

The appearance of fungal nails can vary. Often it starts with a discoloration of the nail. This discoloration can vary as well. Some discolorations are white and have a spotted pattern to them. In others the discoloration is yellow and takes up the entire nail. Following the discoloration period the nail starts to thicken. This is due to the fungus metabolizing the nail and causing a buildup of debris. These thickened nails can become painful especially in certain shoe gear. The buildup can also affect the sides of the nails and cause increased pressure and pain

            Preventing dermatophyte infections can be difficult. I have discussed some of the more common areas where you can contract the infections, however fungus can live anywhere. It can be contracted from walking barefoot in your own house. Also, wearing wet socks can lead to a dermatophyte infection. Often times a small amount of fungus is living in the socks or shoes. Given a warm wet climate this fungus can begin to grow rapidly. For this reason changing your socks often when they are wet due to sweating or any other reason is recommended. Also, wearing shoes in any community area where multiple people walk is recommended. This will decrease the amount of fungus your feet come in contact with.

            Treatment of Athletes foot depends on the area and how severe the infection is. In some cases over-the-counter antifungal agents will do the job. However, some cases require prescription strength antifungal. In rare cases a tissue sample is needed to determine the exact type of fungus. This will aid in selecting the correct medication to resolve the problem.

            If you notice itching or redness on the bottoms of your feet you should come to our office for an evaluation. A small problem can turn into a large one very quickly.

Thickening and discoloration of the nails is often caused by a fungal infection. Fungal infections can affect anyone, and can be contracted from many different places.

The key to treating and preventing fungal nails is early detection and creating an environment which does not lend itself to fungus growing.

The appearance of fungal nails can vary. Often it starts with a discoloration of the nail. This discoloration can vary as well. Some discolorations are white and have a spotted pattern to them. In others the discoloration is yellow and takes up the entire nail. Following the discoloration period the nail starts to thicken. This is due to the fungus metabolizing the nail and causing a buildup of debris. These thickened nails can become painful especially in certain shoe gear. The buildup can also affect the sides of the nails and cause increased pressure and pain.

It is difficult to say exactly where a person contracts a fungal infection. Potential places include public pools, walking outside with bare feet, lakes or streams, public restrooms and showers, and even your own bathroom or home floors. Fungus is actually growing almost everywhere. For this reason prevention by avoidance is very difficult.

            Treatments for fungal nails include:

Topical

There are over-the-counter topical treatments which have mild effectiveness on early detected fungal problems. There are topical treatments that are only sold in doctor’s offices that have greater effectiveness at clearing the infection. The most effective of which is Formula 3. This topical medication as a chemical that helps it soak into the nail as well as the chemical that kills the fungus. There is also a money back guarantee for formula 3.

Oral

            Lamisil is the most popular oral medication for fungal nails. It is a pill taken once by mouth daily for three months. Each month the patient must have blood work to check liver function levels. This is to monitor the medications affect on your liver.

Laser

            An additional treatment for fungal nails is the use of a laser to kill the fungus and repair the nail. The results of this have been mixed and are in no way 100%. The cost of this procedure is in the $1000’s, and it is not covered by any insurance plan.

            As you can see there are several options for treatment of fungal nails. If fungal nails affect you should see a podiatrist as soon as possible to prevent the problem from getting worse.

One week after Tiger Woods showed some of his old magic, he hobbled off the golf course with an old injury. It was the same Achilles that he injured last year at Augusta National, which eventually caused Woods to miss two majors last year.

Achilles tendonitis is a common disorder seen in both athletes and non-athletic alike is pain in the back of the ankle caused by the Achilles tendon. The Achilles tendon is the tendon on the back of the ankle that is responsible for pushing the ball of the foot down. It is the largest/thickest tendon in the body. It is also responsible for pulling the most amount of weight of any tendon in the body.

            The significant amount of weight that is transferred through the Achilles tendon can cause it to become inflamed. First the tendon becomes contracted. Then when it is overused, through walking or playing sports, small tears start form. These tears are replaced by scar tissue. This scar tissue causes inflammation and pain. The pain can be located along the entire course of the Achilles tendon. The most common location is over its attachment to the heel bone.

            One of the major causes of Achilles tendinitis is exercising or walking without stretching. Stretching the Achilles tendon will decrease the contracture and intern decreased tearing. Below is a picture of a stretch for the Achilles tendon. As you can see one leg is put back behind other leg. The back leg is held straight while the front leg’s knee is bent. The back heel is held on the ground and your weight is transferred to the front leg. This stretch is felt in the calf.

The majority of Achilles tendinitis problems can be treated successfully using nonsurgical measures. These nonsurgical treatments include stretching devices, physical therapy, accommodations.

            When surgery is required there are minimally invasive techniques for curing tendinitis. These minimally invasive techniques require no incision and require a very short postoperative period. The surgeries are designed to clear the inflammation or link then the Achilles tendon.

            Achilles tendinitis can be prevented with diligent stretching before and after exercise or any significant amount of walking. However, if the pain has already occurred sometimes it takes more treatment to and do the inflammation process. If you have this pain should be seen as soon as possible to prevent any further damage to the tendon.

Bunions

A bunion is an outgrowth of the big toe joint. It is often associated with pain in the big toe joint as well as difficulty wearing shoes or finding shoes that fit. What is actually happening with a bunion (also called hallux valgus) is the metatarsal bone which leads up to the big toe is migrating away from the middle of the foot. The cause of this migration can be several different factors.
One of the most common causes of the migration is flattening of the arch of the foot. As the arch flattens this unlocks the bones of the foot allowing them to move more freely. As this happens the body pushes the metatarsal bone away from the center. This migration of the metatarsal bone causes the big toe to migrate toward the middle of the foot. This is usually a progressive deformity which progresses faster as the deformity becomes worse. Some bunions are genetic and can affect young children and teenagers. More often however they are the progressive type. Which get worse over your life time.
The long-term effects of a bunion is arthritis of the big toe joint. Since the big toe and the metatarsal are not aligned properly the joint surfaces on each bone are not in congruent contact. This causes the edges of the bones to rub on cartilage wearing holes in the cartilage. Over time this wearing of the cartilage causes arthritis pain.

Hammertoes

The term hammertoe refers to when the smaller toes of the foot become contracted at one of the multiple joints of the toes. These deformities can vary in where the contracture takes place and the severity of the contracture.
Other than the obvious cosmetic problem associated with hammertoes they can also cause significant pain. These contractures can cause arthritic changes and pain in the joints. Pain can also be caused by a shoe gear rubbing on the toes.
Often hammertoes are accompanied by calluses on the tops of the toes and balls of the feet. The calluses on the tops of the toes are normally due to rubbing of shoe gear. The calluses on the ball of the foot are due to increased pressure due to the hammertoes pushing down on the metatarsal heads.

Tinea Pedis (Athletes foot)

The term athletes foot refers to a fungal infection in the skin on the bottom of the foot. It derives its name from the high incidence in athletes. The correlation between athletes and fungal infections on the feet is due to the fact that they often used community showers. This was a route for transmission of the fungal infections from one person to another. This however does not mean that only athletes can get athletes foot.
The medical term for athletes foot is Tinea Pedis. There are several different types of fungus that can infect the feet. The same fungus that are responsible for infections like ringworm are responsible for Tinea Pedis. The fungus that causes Tinea Pedis often like to live in wet warm places. This is why a shower is a perfect place for the transmission of a fungal infection. Other commonplaces are lakes and streams, community pools, the beach, or any other place where people often walk with bare feet or sandals.

These are all medical conditions that can be treated by a Podiatrist. If a person has these problems it is recommended they see a physician before they progress and become harder to treat.

Most people down in South Florida know the name Dwayne Wade. He is a player for the Miami Heat. He is considered one of the big three, also including Lebron James and Chris Bosh. However, lately the Heat have been the big two and missing Dwayne Wade. This is due to a nagging foot injury that has kept Dwayne off the floor. Wade missed multiple games with the injury, which occurred on Dec. 28. Lingering soreness forced Wade to shut it down a week later.
At first Wade said that he could be dealing with plantar fasciitis, which can be a slow-healing injury. The Heat have been calling it a foot contusion. “I don’t know, it’s just hurting,” Wade said. “It could be three different things. It could be (plantar fasciitis), a bruise, or maybe it’s a combination of the two. I don’t know. I just know it’s in the area of plantar fascia. I know it’s bruised as well. Whatever it is, it’s just taking its course, taking its time to get healthy.”
Heel pain is one of the most common problems we see in our podiatry office. The most common cause of heel pain this plantar fasciitis. However, there are other causes and a full examination is necessary.
Plantar Fasciitis is an inflammation of the plantar fascia. The plantar fascia is a ligament that runs along the bottom of the foot from the heel to the ball of the foot and even has slips that go into the toes. The main job of the plantar fascia is to hold the arch up. As you walk and your arch falls it puts extra strain on the plantar fascia. This causes small tears and eventually thickening of the plantar fascia. The thickening causes pain on the bottom of the heel.
A second cause of pain in the bottom of the heel is a bone bruise or stress fracture of the heel bone. This bone is called the Calcaneus. With repeated stress from walking or running bruises or stress fractures may occur. The Calcaneus may also be fractured with injury, but this requires a significant amount of force. The fractures are usually caused by a fall. The pain of a bone bruise often feels as though it’s coming up the sides of the heel rather than pinpointed on the bottom. Bruises and stress fractures are more difficult to diagnose. Often they are not seen under normal x-rays. An MRI may be required to diagnose a stress fracture of the heel.
A third cause of pain in the bottom of the heel is entrapment of a nerve that comes around the inside of the ankle can be perceived as pain in the bottom of the heel. The disorder is called tarsal tunnel syndrome, and is similar to carpal tunnel syndrome. It is due to the collapsing of the arch of the foot, and pinching of the nerve to the bottom of the foot.
There are several other disorders which can cause pain on the bottom of the heel. Still the most common cause is plantar fasciitis. If you begin to have heel pain you should come to our office for an exam. There are many treatment modalities that may be used to resolve your pain and get you back to your normal activities.

A common problem that we as Podiarist seen in our office is children with flat feet. This can often be seen with the children intoeing or out-toeing. The flattening of the arch in a child’s foot can cause pain, incoordination, fatigue, and a decrease in activity level.
A flatfoot deformity as well as intoeing and out-toeitng is easily recognized. Watching the child walk will demonstrate that the arch in the middle of the foot disappears, or in the case of intoeing in out-toeing the feet are deviated to the inside or out. The difficult aspect is diagnosing the cause of flattening, intoeing or out-toeing. The deformity can occur anywhere from the lower back to the hips and knees or to the foot and ankle itself. The other question arises in whether the problem will fix itself as the child grows. Children are not fully skeletally mature until their late teens. This means that the bones are constantly growing and changing their angular relationship. In some cases deformities are so severe that surgical intervention is required. However, in the majority of cases, simply bracing or having the child where orthotics will cure the problem.
Orthotics will keep the bones in the feet and proper alignment. As the child grows the bones will adjust and realign into a more normal alignment.
One concern when parents consider orthotics is that the child will grow out of them too quickly.In these cases there is an alternative. The recently developed ‘Little Steps’ are prefabricated orthotics for children. They come in seven sizes and accommodate children from toddlers to teenagers. We have started utilizing Little Steps in our practice and have had extremely good results. Along with correcting the deformities listed above the pediatric orthotics can increase coordination, decreased pain, and increased desire to play sports.

If your child begins to have a problem with his or her feet often times it can be solved very quickly. Children are very resilient and often by eliminating the causing force the child will feel immediate relief.

A common problem seen in our Podiatry offices that historically has had few treatments is peripheral neuropathy. Peripheral neuropathy is a condition in which the nerves of the feet and/or legs do not function properly. Common symptoms include tingling, numbness, sharp pains and/or burning pains to the affected parts of the body. There are over one hundred known causes of peripheral neuropathy. Treatments for peripheral neuropathy vary depending on its cause.

One cause of peripheral neuropathy is thiamine deficiency. Diabetics and non-diabetics alike may be thiamine deficient. Groups that have been shown to have a high incidence of thiamine deficiency are, among others, the elderly, people with diabetes, people who have had gastric bypass surgery, people who drink alcohol or patients on certain medications.

If you have tingling, numbness, sharp pains and/or burning pains to the feet, legs and/or hands you may be thiamine deficient. Reversing thiamine deficiency is a well known and often highly successful way to nutritionally manage peripheral neuropathy.

NeuRemedy may nutritionally manage peripheral neuropathy by delivering a highly bioactive form of the micro-nutrient thiamine to where it is needed, the nerve cells. In a very real sense, NeuRemedy works by nourishing the nerves. Some people are helped within a few days of taking NeuRemedy. Some need to take NeuRemedy for as long as two months to determine if the nutritional management provided by NeuRemedy is effective for them.

Neuremedy, also called the ‘Nerve Vitamin’ is available only in doctors offices. If you are experiencing any of the symptoms listed above you should contact your Podiatrist to see if they have it available in their office.

As a Podiatrist that has a special interest in sports medicine, and a triathlete in my spare time I have taken special notice of the debate over barefoot running versus contemporary running. Barefoot or minimalist running has become trendy after a book was published called ‘Born to Run’. This book chronicles the reclusive Tarahumara Indians of Mexico’s deadly Copper Canyons, who have practiced barefoot running for hundreds of years.
The book starts with the author, who is having foot pain, trying to find another way of running that will decrease his pain. After spending a significant amount of time with these Indians he changes the way he runs and his foot pain resolves.
Barefoot running is completely different than contemporary running in that there is no heel strike. In normal running the heel strikes the ground first and force is transferred through the foot until the big toe is lifted off of the ground. In barefoot running the ball of the foot strikes first. This is followed by the heel coming down towards the ground, sometimes not touching the ground at all.
The benefits and risks of barefoot running have been studied recently. However, there are no long-term studies with respect to barefoot running. The advantages of barefoot running include better proprioception, or balance. This means that your body is in better control of all of the small movements made during running. This can decrease excessive motion at the ankle joints, knees, and hips. There is also less of an impact force on the heel with barefoot running. The adverse effects are extra strain on the plantar fascia (a ligament along the bottom of the foot), Achilles tendon, and leg muscles. A person with plantar fasciitis, Achilles tendinitis, or history of muscle strains should avoid barefoot running.
If you are considering switching to barefoot running, there are shoes called minimalist shoes that will give the same benefit of barefoot running while still protecting bottoms of your feet. Many of the large shoe companies have come out with minimalist shoes. It is also a good idea to follow a strict training regimen when transitioning to barefoot running. If you switch to quickly, you’re more than likely going to have an injury.
In summation, it remains to be seen whether barefoot running is here to stay or passing fad. It has shown benefits for some. However it is not for everyone. It’s important to transition slowly, to find out if barefoot running is really for you.

As you may have seen reported recently there has been an increase in Achilles tendon ruptures since the NFL players started practicing again. There have been as many as 10 Achilles tendon ruptures over the past two weeks, which is a significant increase from this time last year.

The Achilles tendon is the tendon on the back of the ankle that is responsible for pushing the ball of the foot down. It is the largest/thickest tendon in the body. It is also responsible for pulling the most amount of weight of any tendon in the body. A rupture of the tendon requires a significant amount of force accompanied by a lack of elasticity of the tendon.

The majority of Achilles tendon ruptures occur in men after the age of 40. These men do not exercise all week then play sports on the weekend. These men are often called weekend warriors. Due to the lack of physical activity and stretching throughout the week the Achilles tendon is tight with decreased elasticity. Then when a significant force is applied to the tendon it ruptures rather than stretching and absorbing the tension.

The reason for the increase in the tendon ruptures can be explained by the NFL lockout. During the lockout the players were not allowed to practice at the team facilities under the direction of the training staff. This led to the players not conditioning themselves as much and in the proper fashion.

            Playing NFL football applies a significant amount of stress on all of the joints, muscles and tendons of the body. Due to the players not having the proper amount of preseason conditioning their Achilles tendons are tighter than last season. With the same physical demands being put on the players it is predictable that an increase in injuries would occur.

            Tendon ruptures in all people (athletes or not) require surgical repair, and a significant amount of rehab. It is important to remember to stretch before any athletic activities to prevent injuries.