Dr. Berg's Foot Facts

Posts for: August, 2020

By Dr. Rion Berg
August 27, 2020
Category: Bunions
Tags: Untagged

It's a common problem. A patient comes into my office complaining of bunion pain. More often than not that patient is a woman with a history of flat feet who has worn problematic shoes. While the tendency to develop bunions is inherited, wearing high heels, shoes that are too tight, and shoes with a narrow toe box can all contribute to progression of bunions.

But what if you have bunions and you don't have pain. Does that mean you shouldn't get them treated? When it comes to bunions, the old adage an "ounce of prevention worth a pound of cure" rings true.

Instead of asking yourself, should I get them treated? Instead, ask yourself "If I knew treating my bunions would prevent pain in the future, would I get them?"

While only you can answer that question for yourself, as your podiatrist it's important for me to let you know that bunions are progressive. The likelihood of them becoming worse and causing pain is great. Fortunately there are a lot of conservative measures you can take to help them stay the same and remain pain-free.

Avoid High Heels

The easiest strategy for decreasing the chance of progression is to avoid the things that cause it. Namely, bad shoes. One of the biggest culprits is wearing high heels (any shoes over one inch in height). When your heels are too high, too much pressure is placed on the ball of the foot. Over time that extra pressure will cause the bunion to worsen.

I know this is bad news for those of you who are fashion conscious. But you have to ask yourself whether the glamour is worth the future pain.

Fortunately many other people have thought about how to get around the fashion issue. Check out my blog "Desperately Seeking Stylish Shoes Without Bunion Pain."

Avoid Narrow Toe Box and Tight Shoes

A narrow toe box will also put pressure on the front of the foot, accelerating the rate of bunion progression. Purchase shoes with a wider toe box. In addition, be sure to have your feet measured each time you buy shoes. As we get older our feet tend to get longer. Wearing shoes that are too tight can also be problematic for those prone to bunions.

Get Casted for Orthotics

The biggest reason people develop bunions in the first place is faulty foot structure. Flat feet are the number one culprit, but a tendency to pronate, neuromuscular problems, and foot injuries can also lead to bunions. The best way to rein in feet that are flat and pronate are by getting cast for orthotics. Custom orthotics will stabilize the toe joint and prevent your bunions from getting worse.

I also recommend orthotics for patients who have flat feet but haven't developed bunions. That's because orthotics keep the feet aligned and prevent the big toe joint from moving out of place and causing the bunion. This is not only true for adults, but also for children. Kids who don't outgrow their flat feet will have them for the rest of their life. And with flat feet comes the tendency for bunions. Instead of using custom orthotics for young children, I treat then with a specially designed product for kids called Little Steps®. These prefabricated orthotics come in incremental sizes and are more affordable than a traditional, custom orthotic.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.


boy and girls sitting on a couch dangling their feetYou're a parent with school age children. Normally this time of year is filled with days of shopping for school supplies, back packs, and new clothes for your kids. But this isn't a normal time. You hesitate to go shopping at a store for fear of exposing yourself and your children unnecessarily to Covid-19. In addition, you're scrambling to figure out how you're going to work at home and monitor your kids school work all at the same time.

Instead you're likely turning to the internet to make your purchases. And that includes new shoes for your kids. Normally I tell parents it's best to go to a store to buy their kids shoes. But I know many of you are going to feel more comfortable ordering them online.

Here are the best ways to make sure your kids get a good fit.

Getting the Right Size

The most important part of getting the right shoe is finding the correct size. In a shoe store, the salesperson would typically use a Brannock device to get the correct length and width of your child's foot.

At home you'll need to do the measuring yourself. Be sure to do it later in the day when feet tend to swell. The Healthy Feet Store has a video that demonstrates how to do it using paper, pen, and a ruler. They also provide a size guide. Stride Rite also has a guide for measuring your kid's feet.

Once you order the shoes, check fit by making sure there's at least one thumb's width between the tip of the big toe and the end of the shoe. If you find that one foot is larger than the other, you'll need to buy the larger size.

Buy Shoes That Feel Comfortable

Comfort is just as important as fit. Keep in mind that shoes should not require a "break-in" period. If your child says they're uncomfortable, return them.

Select A Good, Sturdy Shoe
Your kids might want shoes that are stylish, but fashion should take a back seat to stability. Shoes should have a stiff heel counter (the part of the shoe that goes around the backside of the heel) and a rigid midsole area. The shoe should only bend at the toes and not under the arch. In addition, shoes should be difficult to twist (wring out like a rag). To get a better idea of what this looks like, you can view our video "How to Test Any Shoe for Stability".

Finally, keep in mind shoe brands create all kinds of styles from the very sturdy to the very sloppy and everything in between. Buying a particular brand that was sturdy in the past will not guarantee another style in that brand will deliver the same stability. Read the descriptions thoroughly to ensure you're getting what you want and test the shoes once they arrive.

Stick With the Tried And True

You found a brand that works well for your kid. Stick with it. Brands tend to remain consistent in how they're built. That will benefit you once you've found one that fits well.

Buy The Right Shoe for Your Child's Activity

Sturdiness is one factor in helping your kid's feet stay healthy. Sports shoes are also designed specifically to prevent foot and ankle injuries for a particular sport. Make sure you purchase soccer shoes for soccer, running shoes for running and so on. This is particularly important as your kids get older and play becomes rougher.

Avoid Hand-Me-Downs or Used Shoes
Buy Nothing Groups are all the rage these days. Particularly now during the pandemic when we're trying to save some money and avoid thrift stores. While you may feel tempted to grab those cute kid's clothes from your neighbors, avoid it with your kids shoes. Shoes wear down and take on the wear pattern of the user. Loss of support and function occur as a result.  Sharing shoes can also spread infections such as warts or fungus from one child to another.

Is your child experiencing foot pain? Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.


Here is what you'll learn during this webinar:

  • should my nails be treated?
  • what works and what doesn't
  • will laser therapy work for me?
  • what is a comprehensive treatment program for fungal nails and why does it matter

Should the nails be treated?

First we need to establish a diagnosis of fungus. Everyone who comes into the office with thickened toenails thinks they have fungus. While its true fungus is the most common cause of thickened and discolored toenails, other conditions can create changes in the nails that mimic fungus. Psoriasis and eczema are two of these conditions. In addition, trauma is one of the most common causes of nail changes I see in the office. When I see discolored nails I often learn a patient has participated in sports.

What works and what doesn't?

If I'm not certain of a fungal nail diagnosis, I'll send the nails to a lab to get tested. Once a diagnosis of fungus is made, treatment can begin.

Historically treatment for fungus focused on topical medications. These have been used for many years and there are many kinds. Some of them thin the nails and some treat fungus. Unfortunately, topical medications have a low success rate. Patients who have had success with topicals have needed to treat them daily for a long period of time.

Newer topicals have shown higher success rates. Topical medications as a whole are about 20%-40% successful. The success rate depends on the degree of fungal involvement of the nail and length of time it's treated.

Oral medications were developed in the 1960s. Unfortunately, some of the more successful medications had very serious liver side effects. Later oral medications became much safer. The success rate of these medications can reach up to 70%. However, not everyone is a candidate for systemic (oral) medications. Some people have a medical condition which makes taking these medications dangerous. Many others want to avoid taking them for personal reasons.  

Finally, laser therapy was introduced. Laser therapy has been around for many years. In 2010, a pulsed laser was developed. This resulted in the ability to apply therapy longer and without discomfort to the patient. This laser has been more effective in getting rid of toenail fungus.

Will laser therapy work for me?

To determine what will work for a specific person it's important to consider:

  • how long they've had the fungus
  • how much of the nail is involved - the less nail involvement, the better the results. In younger patients with less involvement we can achieve greater success.
  • how committed is the patient to getting rid of the fungus? Fungal nails are one of the most difficult conditions to treat and it takes a commitment on the part of the podiatrist and the patient it order to achieve success.

What is a comprehensive fungal nail treatment program?

A comprehensive program includes all of the therapies combined:

  • topicals (skin and nails) - we treat the skin and the nail with topicals because the skin feeds the toenail.
  • laser
  • oral medications
  • shoe therapy

Why treat shoes?

There's one difference between your fingernails (which typically don't get fungus) and your toenails and that's shoes. An ultraviolet light is very effective in getting rid of fungus in the shoes and preventing it from further infecting the toenails.

Laser treatments

The comprehensive program includes 3 laser treatments and they can be delivered weekly or monthly depending on the level of involvement in the nails. The topicals are used throughout the time of treatment. A short course of oral medications are also delivered during that time.

Together these modalities can offer a success rate of up to 80%-90%.

Toenails grow out slowly

Toenails only grow out 1 mm/month. We'll look at your nails 4-6 months after completing treatment to see how much resolution we've achieved. At that point we'll determine if further treatment is needed.

In summary, fungus of the toenails is tough to get rid of. It's disfiguring, can be uncomfortable, and unsightly. It takes a comprehensive program to get rid of it.

Questions from the audience

Q: How many laser treatments will I receive and what will it cost?

A: The patient will receive 3 laser treatments. The cost of treatment is $625. That includes the initial course of topical medications and the ultraviolet light shoe sanitizer.

Q: Will I have to pay the full amount up front?

A: The program is paid for in advance. We dispense the topical medications and the ultraviolet light and have the patient use this for a couple of weeks. We also provide a nail file to thin the nails to allow the topicals to penetrate the nails before we begin laser treatment. The patient then returns to the clinic to receive the laser treatments. The laser treatments are usually done every week, but can be spaced farther apart if there is less involvement of the nails.

Q: How do I know if I'm a good candidate for laser treatment?

A: I'm very honest about what I think the chances are for success. When a patient has extremely thickened toenails from the end of the nail back to the cuticle in all the nails and a long history of fungus it's much tougher to resolve the problem. It can require more than one round of treatment. I'm cautious in recommending laser or any other approach in that case. When there is less nail involvement, maybe only part of the great toenails and some of the other toenails then we have more predictability regarding success.

Q: How soon can I expect to see results?

A: The nails only grow 1 mm/month. When we first started treating with laser I had patients back too frequently and too soon because I too wanted results. Now I tell my patients they need to wait. The therapies don't eradicate the fungus already on the nail. Instead after several weeks and months we'll see the new nail coming out clear of fungus. Eventually the portion of the nail with fungus will grow out and be trimmed off. That takes at least 4-6 months.

Call us today at 206-368-7000 if you need appointmen for your fungal toenails. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.

 


By Dr. Rion Berg
August 13, 2020
Category: Uncategorized
Tags: Untagged

young woman walking barefoot on rocksWe all love summer. The warmth of the sun on our skin. The ease of looser clothing. The desire to let your toes breathe by going barefoot.

While I'm no different from you in loving that barefoot feeling, as a podiatrist I also know the hazards that come with this summertime activity. Too many of patients have suffered from foot injuries as a result of going shoeless.

Here are 5 hazards to consider when you think about going barefoot:

Thorns, Nails, Glass, and Hair Can Embed in Your Feet

Every summer I have to remove a fair share of thorns, nails, glass, and hair from people's feet. You may think folks are walking barefoot all over the place, but that's not true. Most are simply walking around their homes and their own backyards. Recently I removed a dog hair from a patient's foot, but I've also removed human hairs.

You may love the idea of gardening or mowing your lawn while barefoot. But rose thorns and mowers can wreak havoc on your feet. So make sure you don closed toed shoes particularly when cutting the grass.

Risk of A Heel Pain Flare-Up

If you're prone to plantar fasciitis or Achilles tendonitis you shouldn't go barefoot, even in your own home. During the pandemic I've seen too many people with heel pain caused by barefoot walking and barefoot exercising while at home. Many people at risk for these heel pain conditions have flat feet or low arches. When you go barefoot the plantar fascia is more likely overstretch, which can cause a flare-up.

Plantar Warts

Plantar warts, also called verrucas, are usually harmless but they can become painful. They are caused by human papilloma virus (HPV) and enter the feet through small cuts and abrasions. Children are more likely to get warts than adults. To prevent your child from getting warts limit their barefoot wanderings as much as possible.

Fungal Foot and Toenail Infections

Fungus loves damp places. Pools, gyms, and locker rooms are among its favorite places to hang out. To reduce your chance of acquiring Athlete's foot or a toenail fungus infection, avoid going barefoot.

Avoid Going Barefoot If You're Diabetic

Many people with diabetes have a decreased ability to feel heat or pain through their feet. This means they're less likely to recognize when they've developed a cut or stepped on a hot surface, putting them at greater risk for infection. Infections can lead to ulcers and amputation. For this reason, people with diabetes should never go barefoot.

How to Reduce Your Risk

So you know you need to wear some form of footwear to avoid the risks just described. But which shoes are best?

You may be tempted to simply slip on a pair of flip flops. But first, you need to consider your activity. If you're planning a trip to the beach or pool, flip flops are ideal. But they're a terrible choice if you plan on doing any significant walking or other physical activity. Flip flops have no support and have provide little protection for your feet.

If you want a sandal that will give you that feeling of freedom but won't sacrifice support, choose the Vionic Wave Toe Sandal. is an excellent choice. I recommend these sandals to my patients who are recovering from heel pain. They are ideal for indoor use. If you want a shoe that will go the extra mile, go for a sandal with straps like a Teva, or a more enclosed shoe like a Keen.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.