Dr. Berg's Foot Facts

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You know the old adage--out of sight, out of mind. While this phrase dates back to the 13th century it's even more relevant today since so much of our lives are lived at warp speed. We have to continually remind ourselves to take care of the big and little things in life or they can easily fall off our radar.

The same is true for our feet. Unless we're experiencing pain or discomfort we typically won't take action when it comes to going to the doctor. Toenail fungus is one of those things that we forget about once we shelved our sandals and tucked our feet into socks and boots for the winter.

And it's too bad really. Because fall is the best time to start killing toenail fungus.

Why?

It takes a good 9 months for your nails to completely grow out. If you get started now, you'll have beautiful nails this summer.

How do I know its toenail fungus?

Not all discolored or ugly nails are fungal nails. Trauma from wearing tight shoes or running can also cause toenails to change color. To ensure its fungus we'll take a sample of your nail and send it to a special lab.

How do I get rid of toenail fungus?

I'm glad you asked. While there is a bunch of hype out there about using everything from Vicks to Vitamin E, onychomycosis (the scientific name for nail fungus) is quite difficult to eliminate.

Why?

Nail fungus doesn't just live on the top of your nails where topicals are most effective, but beneath the nail in the nail bed and in your skin surrounding your nails.

We've found that using a combination of laser treatment, topicals, a short course of oral medication, and an ultraviolet shoe sanitizer provides the most effective treatment for killing toenail fungus. The PinPoint laser penetrates the nail bed to destroy the fungus. Topical medications destroy the fungus on the top of the nail and on the skin surrounding the nail. Oral medications treat the fungus systemically. And the shoe sanitizer kills fungus in the shoes.

How long does the treatment take?

You'll receive three laser treatments over three months. The treatment involves passing a laser beam over the infected nails and surrounding skin. The doctor will repeat this several times until enough energy has reached the nail bed. Your nail will feel warm during the treatment. A single treatment session takes about 30 minutes. Healthy new growth will be visible in as little as 4 months but will take up to 9 months for your nails to completely grow out.

What will it cost?

Because laser treatment for fungal nails is not covered by insurance, we make it as affordable as possible. Your first visit is covered by insurance. At that visit you'll have plenty of time to talk to Dr. Berg to determine if this treatment is right for you.

What are our patients are saying?

"Although I did have to take the oral medication for toenail fungus, it was a lesser amount than is typically taken. That plus the laser did the trick!"

- Jay N.

"This office is efficient and caring.  The treatment for toenail fungus includes 3 laser treatments and a topical to apply twice daily.  This is a long process but so far is working well."

-Sandy P.

If you or a loved one has toenail fungus, call us today at 206-368-7000 for an appointment. You can also request an appointment online.

For information about other 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.

As a parent of kids who play sports, you want to do everything possible to make sure your child has the best equipment and plays safely. While there's been a lot of news coverage about the problems kids can suffer as a result of concussions, there's scant information about the impact of foot and ankle injuries on youth athletes.

That's why I wrote this guide. I see far too many kids in my office with foot and ankle conditions and injuries that could have been avoided.

Heel Pain in Youth Athletes

While kids can develop the same type of heel pain as adults, namely plantar fasciitis, a condition called Sever's disease is much more common, particularly among youth athletes. This condition affects kids ages 8-14 who have an open growth plate on their heel bone. When this plate is still open it's susceptible to bruising and inflammation during activities like soccer.

To address the problem, I advise young athletes and their parents to ease up on their activity level, reduce their inflammation and pain through use of anti-inflammatory medications and ice, use of heel lifts to help absorb impact, use of over-the-counter inserts or custom orthotics, and go for physical therapy.

To prevent Sever's disease in your youth athlete, start by purchasing supportive shoes that are designed for their particular sport (see below for more information), stretching the Achilles tendon to reduce stress on the heel if they are prone to this condition, and avoiding play beyond your child's abilities.

Stress Fractures in Youth Athlete

Another overuse injury common in young athletes are stress fractures. When muscles are too tired to take on the additional stress of play it's absorbed by the bones. Stress fractures can occur in the lower legs, ankles, and feet.

Youth athletes most at risk are those who play sports that involve running, jumping, and repetitive movement such as gymnastics, basketball, and track and field. Ramping up sports activity too quickly, without rest in between to adequately condition the body, can also increase the chance of a stress fracture.

To prevent stress fractures in youth athletes make sure they do the following:

  • slow and proper conditioning for their sport

  • eating balanced, nutritious meals rich in calcium and Vitamin D

  • drink plenty of water throughout play

  • adequate warm-up and cool-down

  • stop playing when in pain and visit to podiatrist

  • alternating types of physical activities

  • go for a sports physical before the season starts

  • replace athletic shoes every 500 miles

Ankle Sprains in Youth Athletes

Ankle sprains are common in youth soccer, basketball, and other sports. In fact, researchers have estimated that ankle injuries account for 10 to 30% of all sports related injuries in young athletes. It's almost impossible to tell if your youth athlete has broken a bone or sprained an ankle without imaging--these include X-rays for identifying broken bones and ultrasound to find out the degree of soft tissue damage. Sometimes an MRI will be necessary.

While minor injuries can be treated with rest, protection of the site, and time away from the field, more severe ankle sprains will require immobilization and also rehabilitation through physical therapy. Sometimes surgery will be required.

Ingrown Toenails in Youth Athletes

Another common problem in kids who play sports are ingrown toenails. Tight shoes or cleats in soccer and other sports combined with repetitive actions such as kicking are the major culprits.

Ingrown toenails need to be treated by a podiatrist. To help ease your child's pain in the meantime, soak their foot in room-temperature water with Epsom's salt and gently massage the side of the nail fold to help reduce inflammation.

Nail surgery for treatment of an ingrown nail can be done in the office. Prevention of ingrown toenails includes wearing shoes that fit properly, avoiding tight socks, purchasing (soccer) cleats that aren't too tight, and proper toenail trimming (trim straight across, no rounded corners).

Shopping for Athletic Shoes

Buying proper athletic shoes for your sports minded child is one of the most important things you can do to prevent them from getting foot and ankle injuries on the field.

  • Buy new shoes-it’s important to start out the season with a brand new pair of shoes. Old shoes will not provide the support your child needs to avoid injury and be his or her best on the field.

  • Get your young athlete’s feet measured- these days many parents purchase kids shoes off the shelf or online. Although this is an easy solution it circumvents the need to get your kids feet measured properly. Getting a good fit is always a good idea but its imperative when your kid plays sports. In addition to getting their feet measured, be sure that the shoe is at least one thumb’s length between the top of the big toe and the end of the shoe. Always choose the larger size if one foot is larger than the other.

  • Buy the shoe designed for their sport-choosing the right shoe for their sport is essential. Athletic shoes are designed specifically for the sport they are intended, providing just the right stability and flexibility.

  • Check shoe stability-don’t just go by the name brand of shoe when you purchase it. Even great name brands provide a range of support and may not meet the requirements your child needs. Test the shoe by holding it by the heel and toe. Attempt to bend it in half. It should only bend at the ball of the foot, not in the middle. Then try and twist the shoe. It should not easily twist from side to side.

Checking the field

Many sports-related foot and ankle injuries can be avoided by checking the field before play. The field should be checked for dips, holes, stray objects, and too much water.  Alert coaching officials to any irregularities.

If your youth athlete is experiencing foot or ankle 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 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 Facebook, Twitter, and Pinterest.

 

By Dr. Rion Berg
August 23, 2019
Category: Ingrown toenails
Tags: Untagged

If you, your kids, or other family members have had an ingrown toenail, you may wonder if you can inherit the tendency to develop this condition. The answer is yes, but family history is just one risk factor for developing this common foot problem.

Ingrown toenails occur more often in people who've had nail trauma or toenail fungus, wear shoes that are too short, have nails that grow too fast or too slowly, or trim their nails improperly.

While you can't change your biology, you can take steps to avoid toenail fungus, wear shoes that fit and have a roomier toe box, and learn how to properly cut your toenails.

We often see a lot of kids with ingrown toenails in September--particularly kids who play soccer and other sports. To help prevent your child from getting an ingrown toenail, in addition to a proper nail trim, take them to a shoe store you trust to get their feet measured before they start school. If they play soccer and wear cleats, make sure they aren't too tight.

If you or your child are experiencing redness and swelling near the border of your great toenail, 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.

By Dr. Rion Berg
July 30, 2019
Tags: Untagged

When a new patient comes to my office, it's more likely to be a woman than a man. While it's true that women are more likely to see a doctor for a health issue sooner than a man, women are also at greater risk for many common foot problems. In this guide I'll be discussing the 1) types of foot problems women are likely to encounter, 2) the role of foot type and shoes in developing foot problems, 3) the role of exercise in women's foot and ankle problems, and 4) how to prevent and treat foot and ankle problems in women.

The Role of Foot Type in Women's Foot Problems
All of us have a particular foot type: either a flat arch, normal arch, or high arch. If you have a normal arch, you're fortunate. Although people with normal arches can still develop foot problems they are far fewer than those who have a flat arch or high arch.

It's important to know what kind of foot type you have so you can prevent some of the foot conditions that plague women. Your foot type is inherited, so if your parents had a specific foot type you're more likely to have it as well.

To determine your foot type, wet the sole of your foot. Step onto a blank piece of paper or a shopping bag. Step off the paper or shopping bag to examine the shape of your footprint and compare it to the photo to the right.

If you have flat feet you'll tend to role your feet inward or pronate. Pronation can increase your risk for many painful foot problems such as plantar fasciitis, bunions, neuroma, and hammertoes. High arches can put you more at risk for ball of foot pain.

Painful Foot Conditions More Common to Women
You might wonder why women are more likely to have painful foot conditions than men. While flat feet contribute to foot problems in both men and women, women get them more often for three reasons:
1) a greater amount of weight gain throughout life, 2) rapid weight gain during pregnancy, and
3) improper shoe choices.

Weight Gain Can Cause Foot Problems
Weight gain places more pressure on the feet causing the arch to flatten out. For women who already have a flat arch, weight gain can make them flatter. Women who gain weight are more likely to develop plantar fasciitis, bunions, and posterior tibial tendon dysfunction. Shoe size also increases with extra weight due to the flattening of the arch. It's important for women who have gained weight to get their feet measured when buying new shoes to avoid foot pain caused by wearing a shoe that's too small.

Pregnancy and Foot Problems
Weight gain
Rapid weight gain during pregnancy can bring on plantar fasciitis and Achilles tendonitis. Wearing a supportive shoe during this time is imperative.

Swelling
Another common foot and ankle issue in pregnancy is swelling. In addition to retaining extra fluid, weight from the growing uterus compresses lower extremity veins, impeding their function of returning blood to the heart.  While this usually goes away when baby arrives, it can be incredibly uncomfortable.  Elevating the feet and wearing compression stockings help to control edema. Physical activity, including walking, reduces swelling by activating the leg muscles, which act as pumps on the deep veins. It's important to avoid tight shoes and instead wear shoes with a wide toe box to help prevent other foot problems during that time.

Loss of balance
Weight gain and changes in body shape shifts a women's center of gravity forward. Hormonal changes cause loosening of the foot ligaments. This combination can throw off a women's balance. For that reason women should never wear high heels when pregnant since this type of shoe is already less stable then a lower heeled option. Wearing more stable, low-heeled shoes are essential to prevent falls.

Shoe Choices That Can Cause Foot Problems
Women often make shoe choices that can cause painful foot problems.

Frequent high heel wear can increase your risk for ball of foot pain including bunions, neuromas, and hammertoes. When wearing high heels your weight is placed primarily on the ball of the foot which places a lot of stress on the metatarsals, the toes, and the nerves.

Tight shoes or shoes that are too short can increase your risk for ingrown toenails and fungal toenails. When the toenail is pushed against the front of the shoe, hiking boot, or ski boot an ingrown toenail can result. Shoes that are too tight or too short can cause damage to the nail plate, making it easier for fungus to set up shop.

Flat shoes can increase your risk for plantar fasciitis and Achilles tendonitis. Flat shoes with no arch support can be problematic for anyone but particularly women who have flat feet. When walking or engaging in other activities such as dancing or running the arch will flatten out causing the plantar fascia to stretch beyond its limits. This can result in pain and inflammation in the heel and at the Achilles tendon.

Shoes with no support can also cause foot pain. Women who have had problems with their feet in the past or have flat feet or high arches should not wear these types of shoes.

Pumps can be problematic for women who develop a bony enlargement called Haglund's deformity or so called "pump bump", due the location of the deformity and the rigidness of pumps. Any shoe with a rigid back can cause problems for anyone with this type of foot problem.

Flat flip flops with no arch support can lead to a myriad of foot problems for women. Flip flops were only created to be worn at the beach, swimming pool, gym locker rooms, and shower rooms. Unfortunately flip flops have become extremely popular and women wear them for long walks and for other activities that require a much more supportive shoe. The constant gripping at the toes to keep the shoe on, the flatness and lack of support, and absence of protection make flip flops problematic for women to wear off the beach. They can cause blisters, hammertoes, Achilles tendonitis, neuromas, heel pain, and worsen bunions. Their dearth of support can also lead to sprained ankles. A better choice is a Vionic sandal which is a flip flop with great support. Even better is a water sandal that has foot support and straps.

Preventing and Treating Women's Foot Conditions
Prevention
Many women's painful foot problems can be prevented or reduced by wearing proper shoes. It's important to select shoes that work well for your foot type, the kind of athletic activity you prefer, while avoiding heels higher than one inch and shoes that are too tight. Shoes also need to provide proper support. To test any shoe before you buy it, watch this video.

Treatment
While treatments vary widely by foot problem, some treatments can help resolve several types of painful foot issues. That's because several foot problems have a similar cause.

Flat feet and pronation
Earlier we talked about how foot type can play a role in women's foot problems. Flat feet and lower arched feet tend to pronate. Together these factors can cause a variety of foot problems such as plantar fasciitis, Achilles tendonitis, ball of foot pain, bunions, hammertoes, and neuromas.

Orthotics can correct the faulty biomechanics of a flatter foot providing relief from heel pain and Achilles tendonitis and preventing bunions and hammertoes from worsening. Initially I suggest patients with mild foot pain start with an over-the-counter insert such as Powerstep. If pain continues then a prescriptive custom orthotic will be required to control the abnormal foot motion.

Tight calf muscles
Heel pain, plantar fasciitis, and Achilles tendonitis will also require adequate stretching of the calf muscle since a tight calf muscle also plays a big role in development of these conditions. Learn more about how to reduce tight calf muscles by reviewing this information and these videos.

Inflammation
Inflammation plays a big role in many chronic foot problems including plantar fasciitis and Achilles tendonitis. Visit our website to learn how to reduce inflammation for these foot problems.

For acute injuries to the foot or ankle such as stubbing your toe or spraining your ankle, it's important to take immediate action to reduce the pain and swelling. The most effective treatment is a protocol called “RICE”. RICE is an acronym for rest, ice, compression, and elevation. 

  • Rest – Stop all activity. Keep weight bearing to a minimum, making sure ankle strength and stability have returned before attempting physical activities.

  • Ice - Apply an ice pack or a package of frozen peas to the affected area (use a layer of cloth between your skin and the ice) 20 mins on and 20 min off for up to 48 hours after the injury.

  • Compression - Hold it in place with an elastic bandage to provide compression.

  • Elevate - the ankle slightly higher than the heart to keep down swelling.

High arches

High arches come with their own set of foot problems. High arched feet primarily contact the ground in the heel and the ball of the foot. Pain can develop in three regions of the foot due to this foot structure.

Ball of Foot
Metatarsalgia or ball of the foot pain can occur with prolonged standing or exercise. Hammertoes can also form as a result of extra weight on that part of the foot.

Heel of the Foot
Pressure on the heel of the foot can lead to plantar fasciitis and Achilles tendonitis.

Middle of the Foot
Because most shoes don't support the middle of the foot, high arches can result in pronounced midfoot pain.

Supportive shoes with good arches are essential for preventing problems in the high arched foot.

Ball of foot pain
Many different conditions cause ball of foot pain including neuromas, metatarsalgia, hallux rigidus, sesamoiditis, and capsulitis. For a complete review of the causes, symptoms, and treatment for these conditions, visit our website.

Nail and Skin Problems

Nail and skin problems of the feet are most often caused by tight and poor fitting shoes, and physical activity, and diabetes.

Ingrown toenails result from shoes that are too tight and by cutting the toenails on an angle instead of straight across.

Toenail fungus is more common in women who wear tight shoes, participate in sports such as running, go barefoot in pool showers and gym locker rooms, or are exposed at nail salons. Sometimes trauma to the nail can look like toenail fungus. It's best to see a podiatrist who can test the nails to be sure it is fungus. Treatment methods include topicals, oral medications, laser therapy, and methods to keep nail fungus low. To avoid toenail fungus it's important to follow these recommendations. If you already think you have fungal toenails, visit our Seattle Fungal Toenail Center to learn more about how it's treated.

Diabetes is hereditary and also more common among women who are overweight, don't exercise, and have a diet high in fats and sugars. People with diabetes are at greater risk for developing wounds or ulcers of the feet which can be very dangerous. Dry skin on the feet is very common in people with diabetes and is treated with special moisturizers. An annual visit to the podiatrist to get a Comprehensive Diabetic Foot Exam is essential to prevent ulcers from forming.

Foot and Ankle Problems in Women Who Are Physically Active

Women who are physically active are more prone to foot and ankle problems due to the repetitive movements, high impact, constricting or unsupportive footwear, or increased risk of trauma due to the nature of the sport. It's important to understand the particular risks of a sport to help prevent pain and injury.

Women runners are at greater risk for plantar fasciitis, Achilles tendonitis, neuromas, and stress fractures. Purchasing supportive running shoes at a store that specializes in running, switching out the shoe insert for a better insert such as Powerstep, avoiding high heels, and doing dynamic warm-ups will help prevent many foot problems in women runners. Here's a more complete description of foot problems in women runners.

Women hikers need to assess the type of hiking they'll be doing before purchasing boots. The right socks are also extremely important in preventing blisters. Check out my "Definitive Guide to Prevent and Treat Heel Pain in Hikers".

Learn how to prevent foot and ankle injuries in other sports such as Zumba, martial arts, soccer, and tennis.

If you're experiencing foot or ankle pain, call us today at 206-368-7000 for an appointment. We'll often appoint you the same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

You can also download the following book for runners.

"The Complete Guide to Stopping Heel Pain in Runners".

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!

By Dr. Rion Berg
July 12, 2019
Category: sports injuries
Tags: Untagged

Seattle is one of the best places to cycle in the country. Along with the famed Burke Gilman Trail, the area boasts multiple urban and regional trails as well as a great biking network for commuting. Whether you bike to work on a daily basis or use cycling for recreation and a great workout, there are many things to keep in mind to ensure your feet remain pain-free.

Cycling is a repetitive sport. During one hour of cycling a rider can average up to 5,000 pedal revolutions. Add that to tight or narrow shoes and that can be a prescription for foot pain.

Ball of Foot Pain

One of the most common foot conditions found in cyclists is metatarsalgia or "hot foot". Symptoms can include hot, painful, burning sensations and swelling and numbness. These symptoms can be particularly problematic in the summer when your feet are more likely to swell. If you're in the middle of a ride you'll need to stop, get off your bike, and let the swelling and heat subside.

Sesamoiditis can occur when the sesamoids or small bones found underneath the first metatarsals get inflamed or rupture from too much pressure from sports such as cycling.

Morton's neuroma is caused by an enlarged bundle of nerves to the 3rd and 4th toes. Although cycling is likely not the cause of this condition it can put extra pressure on that area of the foot, worsening an existing neuroma.

Achilles tendonitis

The Achilles tendon can become inflamed and irritated due to improper pedaling and seat height, but can also occur due to ramping up your training too quickly if you're a competitive rider. Flat feet and a tight calf muscle can also be the culprits behind this common condition.

Luckily there's a lot you can do to prevent these conditions.

  • Purchase new shoes - your shoes are often one of the first things to consider changing when developing foot pain. If your feet have gotten larger (common in adults), your shoes are too tight and narrow, or if your shoes are worn out head to REI or another shoe store you trust.
     
  • Types of shoes
    • casual riders can purchase a cross-training shoe while more serious riders will benefit most from bicycle touring shoes (can still walk in these) or shoes with cleats.
    • a stiffer shoe can help redistribute pressure over the metatarsal heads.
    • a roomier toe box can help accommodate your feet when they swell to prevent ball of foot problems.
  • Purchase inserts or over-the-counter orthotics with a metatarsal pad or button - these devices can lift the metatarsals to maintain their natural arch and prevent nerve pain and numbness.
     
  • Custom orthotics made be necessary to alleviate and prevent sesamoiditis and Achilles tendonitis. Orthotics for cycling will need to be thinner to accommodate cycling shoes.
     
  • Move your cleats back. Cleats that are too far forward can cause ball of foot pain.
     
  • Wear thinner socks to make more room for your feet.
     
  • Wear socks made of man-made materials to help wick away moisture from your feet. This will help prevent blisters.

If your foot pain is keeping you from cycling, 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.