Dr. Berg's Foot Facts

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woman runningWith gyms barely open, many of my women patients have taken up running outdoors. And that's great news since the health benefits of running are well known. However, many of those patients are ending up with painful foot conditions as a result. Women tend to have more painful foot problems when they run than men do. 

Check out the reasons for the most common painful foot conditions in women and how we treat them.

Neuromas
Women runners with flat feet are more at risk for developing a neuroma. High heel wearers are even more apt to develop this painful condition which worsens over time. A neuroma most commonly develops between the third and fourth toes. Symptoms can include tingling, pain, burning, and numbness. As your Seattle podiatrist I use variety of treatments for this condition including orthotics, alcohol injections, MLS laser, and education about proper footwear.

Plantar Fasciitis
Women runners get a double whammy when it comes to developing heel pain or plantar fasciitis. Anyone involved in high impact sports is more at risk and women are more prone to develop it than men. If you’re a woman runner who happens to love high heels you have the trifecta of risk for heel pain. Women who wear high heels often develop a shortened achilles or calf muscle. Shortend calf muscles are often a big factor in causing heel pain. Treatment includes avoiding high heels, low-dye taping, PRP, stretching exercises before running, OTC supportsorthotics.

Stress Fracture
While stress fractures are common in both men and women runners, certain conditions put women at greater risk for developing one. Estogren plays a significant role in bone strength. Once women begin menopause their estogen decreases and they lose bone. Sometimes that bone loss can progress to osteoporosis. Bones can be more fragile in women who are very thin, don’t get proper nutrition to keep bones healthy, or develop amenorrhea from an eating disorder. Immediate treatment requires rest and immobilization with a walking boot. Patients with osteoporosis will require treatment to improve their bone health and patients with an eating disorder will require mental health counseling.

If you’re a woman who uses running as a way to stay fit or just for the sheer joy of it, I recommend taking the extra time to ensure that your feet and physical health are in tip top shape so you can keep doing what you love.

If you run into any foot problems along your daily path, 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 heel pain in runners download our eBook, "The Complete Guide to Stopping Heel Pain in Runners".

For chronic heel pain, download our eBook, "Stop Living With Stubborn Heel 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 FacebookTwitterand Pinterest.

 

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.

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.

 

Woman in pink tennis shoesAs we shelter in place, most of us are stuck at home and unable to participate in many of our usual activities. Without gyms or swimming pools to go to for recreation and exercise many more of us are turning to walking. A great thing with all the lovely weather we’ve been having. Unfortunately, a lot people are calling my office because they’ve suddenly developed heel pain.

During our telemedicine appointments I’m finding that there are three main culprits to this Covid-related problem. People are walking much more than usual. When folks are at home they’re going barefoot more often. And finally, many people are wearing flip flops because the weather has been so nice.

Fortunately, there are a lot of things you can do at home to help with a case of heel pain.

Wear Supportive Tennis Shoes

It’s important to wear supportive tennis shoes or a supportive sandal when walking if you’re experiencing heel pain. To get a better understanding of why people are suddenly developing heel pain, let’s look at how the foot works. To work well, the feet need to bend at the ankle and at the ball of the foot, not in half. Shoes need to support the feet in the same way. They should allow you to bend at the ankle and at the ball of the foot, not in the middle. When the shoe is twisted from side to side it should be fairly firm. The heel counter in the back of the shoe should also be firm.

Instead people have been coming in wearing shoes with mesh and squishy soles. Shoes like that bend in half right with little pressure and can easily twist when wrung out like a rag. This type of shoe provides little support. Instead of the shoe propelling you forward you’re going to spend more time on the heel.

To make sure you’re getting the right support from your shoes, test your shoes to be sure they’re supportive enough.

Instead of Going Barefoot At Home Wear These Sandals Instead

People who are experiencing heel pain or are prone to developing it shouldn’t go barefoot at home. And even flip flops won’t provide you with the support you need. Instead try a shoe or sandal that has some degree of stability. I recommend Crocs, Merrills, Tevas, or Keens.

Reduce Your Inflammation

The pain in heel pain comes from inflammation. Along with all the other tips I provide here, you must do something to bring it down. In the office, I could give you a cortisone shot or provide you with MLS laser therapy. But at home there are some things you can do to treat the inflammation yourself.

First, use Biofreeze. It can provide temporary relief of heel pain.

Ice can also be very beneficial in bringing down the inflammation. Take a water bottle and put it in the freezer. Use is to massage the bottom of your heel while you’re watching television. Use it for 10 minutes and then remove it for 10 minutes and then begin again.

Add Over-the-Counter Shoe Inserts

Finally, adding an over-the-counter insert to the shoe can help prevent your feet from rolling inward or pronating, a problem that can increase your chance of developing heel pain. You might wonder why you’d need to do that with a brand, new pair of expensive tennis shoes. That’s because the insert that’s provided by most shoe companies does not provide sufficient support even if the shoes pass the support test in the video link above.

To demonstrate what I mean, start by taking the insert out of your tennis shoe. When you look inside you’ll notice that it’s totally flat on the bottom of the shoe. Now take the arch support and roll it up from the bottom to the top. If you can easily roll it you’ll understand why it can’t possibly provide the support you need if you have heel pain or you’re prone to it.

The over-the-counter inserts I recommend are Powersteps. These inserts bend at the ball of the foot, not in the middle, and they have a cushioned heel that’s slightly elevated. The combination of these factors can stop you from overpronating relieving stress on your arch. Superfeet are also effective, although Powersteps are little more shock absorbing. Sole Supports are also helpful.

Of course, many people who’ve had heel pain in the past have tried over-the-counter inserts and haven’t gotten much, if any pain relief. If this is true for you, you’ll need to come into the office so I can make you a pair of custom orthotics.

Reduce Your Calf Tightness

The other factor that plays a major role in developing heel pain is tightness of the calf. During two telemedicine appointments, I observed patients walking who also had hard heel strikes and very tight calf muscles. A tight calf doesn’t allow your ankle to bend properly. When that happens the force goes into the foot and adds to the heel pain. It’s imperative to do proper calf stretching to alleviate this problem. Check out our website for more information about how to stretch your calves.

Use A Heel Lift

Finally, a small heel lift can raise your heel just enough to relax the calf muscle temporarily while you’re working to get the inflammation down. I recommend a firm heel lift such as Adjust A Lift. It’s peels apart to provide you with just the right amount of lift. I usually recommend a quarter of an inch. This along with the over-the-counter supports will likely diminish your heel pain.

If these self-care treatments don’t work, please call our office at 206-368-7000 to set up an appointment by telemedicine or in person.

For more information about how to treat heel pain, download our eBook, "Stop Living With Stubborn Heel 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! Sign up today!

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 FacebookTwitterand Pinterest.