John Hollander, DPM

Trench Foot

The mission is set.  There are 11 days to complete the grueling course of hiking mud bogged trails, swimming in frigid waters, running in complete darkness, scaling down waterfalls,  and more.  The goal is to be the first team to reach the finish line.  Sounds easy enough right?  This is describing the newly released show of The World’s Toughest Race, which can be viewed on Amazon Prime.  One of the biggest challenges to this race that many competitors faced was the result of trench foot.

You see, this course takes place on the island of Fiji.  Beautiful, yes, but this course has your feet exposed to cold weather and spending hours upon hours submerged in water.  There are specific gear on the market designed to help keep your feet dry, but they aren’t perfect, and if you didn’t pack enough dry socks for this race, your feet are in for a rude awakening.

Many of the contestants on the race suffered from varying degrees of trench foot.  Trench foot (or immersion foot) occurs when the foot is unable to dry and is constantly subjected to moisture and cold temperatures.

Think of how your fingers and toes get pruney after a long shower or bath.  Trench foot looks a little like that in the beginning stages, but as it progresses the condition worsens.  The skin on your feet begins to peel off, exposing the sensitive under layer of tissue.  You can experience a tingling or itching sensation, pain, swelling, cold blotches, numbness or have a heavy foot feeling.    If left untreated, it can cause permanent damage to the nerves, muscles, skin, blood vessels, and the development of gangrene is possible along with amputation.

There are quite a few scenes in the show where contestants are examining their feet and you can see the onset of trench foot.  Some contestants even had to be airlifted out of the race because their feet were so painfully bad.

While the immediate effects of trench foot can be alleviated, the condition can lead to long-term tissue damage and chronic pain. A person with trench foot may require long-term follow-up care.  The first step to treating trench foot is to remove the person from the cold wet conditions.  Warming up the feet need to be done slowly.  If the feet are warmed up too quickly, it could cause damage.  Your doctor may prescribe a pain killer depending upon the severity of your condition.  Additional treatment steps include: cleaning and drying the feet, wearing clean socks daily, sleeping with bare feet, elevating feet, and limiting walking and taking an anti-inflammatory.

While completing the race in as few days as possible is certainly a tactic in helping to prevent trench foot, this race is rather grueling, so there are other measures racers should consider to prevent trench foot.

  1. Wear thick wool socks for warmth
  2. Change socks 2 or more times a day and massage your feet
  3. Clean feet and allow to dry completely
  4. Limit water exposure whenever possible
  5. Never sleep in wet socks or shoes
  6. Attend to tingling sensations immediately
  7. Use an antiperspirant or foot powder for your feet
  8. Stay hydrated!

The take away from this race, in regards to preparation and care, is to keep your feet as dry as possible.  The taxing race already puts a lot of strain on your feet, with hours upon hours of hiking and running on top of miles of swimming, rafting, and paddleboarding.  Taking every opportunity to keep your feet dry and prevent them from getting wet is a necessity in preventing the dreaded trench foot.

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Gout Tips- Prevention and Management

Gout is a form of inflammatory arthritis that causes pain and swelling of the big toe; and sometimes the ankle or knee.

Gout occurs when there is a high level of uric acid in the blood which causes needle-like crystals to form around a joint.  These crystals are what causes the pain. “Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body but it’s also found in certain foods.  Uric acid is eliminated from the body in urine.

It can be managed with medication and maintaining a balanced healthy diet.  Follow these tips to help manage and prevent another gout occurrence.

Foods to avoid:

-Organ and glandular meats such as, liver, kidney and sweetbreads, which are very high in uric acid.

-Select seafood that contain higher amounts of purine, such as, anchovies, sardines, mussels, trout, and tuna.

-Alcohol. The metabolism of alcohol is thought to raise uric acid production.

-Saturated fats

-Sugary foods & refined carbohydrates

Foods to limit:

-Oatmeal, wheat bran, and wheat germ

-Select Vegetables: asparagus, cauliflower, spinach, mushrooms, and green peas

-Select proteins: poultry, fish, beans

-Meat soups and broths

Foods to use as desired:

-Coffee. It may help reduce your gout risk, so enjoy as much as you’d like.

-Vegetables.

-Fruits, especially Cherries, are shown to reduce gout attacks.

-Vegetable soups and stocks

-Weight loss. A lower calorie diet is always beneficial and the reduction in weight is good for your joints.

-Complex carbohydrates- whole wheat & whole-grain breads and cereal and rice.

-Water

-Low-fat dairy, shown to aid in the excretion of uric acid.

-Nuts & peanut butter

-Soda and tea

For a list of purine levels in the foods you enjoy, click here.

To help you navigate your gout diet, visit our Pinterest page for a few gout friendly recipes.

 

What to do when you have a Gout Flare-up?

  • Take medication that you have on hand– “Start treatment immediately with over-the-counter ibuprofen (MotrinAdvil) or naproxen (Aleve), but never take aspirin, which can worsen a flare. If you have had a flare before and your doctor has prescribed an anti-inflammatory medication to take in the event of another, take your prescribed medication as your doctor directed. If you are already taking a uric acid-lowering drug to reduce the risk of flares, continue to take that drug.”
  • Ice the areaApplying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack (a bag of crushed ice or frozen peas will also do) in a dish cloth and apply to the area for 20- to 30-minutes at a stretch several times a day.
  • Hydrate– Drink plenty of fluids. Aim for around 16 cups of water a day.
  • Elevate Your Foot– raising your foot about your heart could help reduce swelling.
  • Relax– Reduce your stress as much as possible.  Stress can aggravate gout.

 

If you are experiencing the symptoms of gout, or have a painful toe, call Dr. Hollander for an evaluation. You don’t need to be uncomfortable anymore! (707) 578-1222.

 

Sarah D.B.

 

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How To Survive a Broken Ankle

You never see it coming. That moment when you take a step and land on your foot wrong. Your ankle and foot start to swell up immediately followed by pain.  Your visit to the doctor confirms it’s a broken ankle. Now what? How are you going to survive a whole month, or more, with only the use of one leg? Not to worry. I have compiled a list of things you can do to survive a broken ankle.

First things first, tell everyone. Let your family and friends know that you have become temporarily immobile. Heck, you can even have fun with the story of how you broke your ankle. I like to joke that I lost to a tree when I tripped.

Accept all the help. I know, it can be hard to accept help when you’re so used to being independent,  but now is the time to move past the ego and say YES. Happily accept all the meal offers, house cleaning, laundry, babysitting, ice pack changes, you name it! And even better, tell them exactly what you need!

Surround yourself with activities to keep your mind busy. While you’d probably want to get up and down all the time, it is best to stay put and keep your foot up as much as possible. Consider making a new list of shows to binge-watch. Utilize the zen coloring book you got for your birthday. Catch up on your pile of reading books. Try a new craft like cross-stitching or miniature watercolor painting.

Research mobility aids. You will quickly find out that crutches stink. If you can afford a walking scooter or an iWalk2.0, get one. They will make life with a broken ankle, so much easier. Sometimes insurance will cover them, if not, the used marketplace can be an affordable option.

If you wish to stick with crutches find something soft and cushy to cover the armrests and save your armpits from bruising and rashes. Another note about crutches, make sure they are tailored right for your height and arm length. You do not want to be bending forward. Here is a video on how you should fit and use your crutches.  https://youtu.be/Za2-OVjaTPc  (Always consult with your care team before using a walking device different from the ones that were originally provided to you).

Get creative.   Find a basket or bucket with a loose handle. You can put items in it like your snack or drink, and hold onto the handle while you walk in your crutches. Use an elastic headband to help keep your ice pack around your foot. Don’t use a headband that is tight.

Embrace the downtime. Chances are your life is go, go, go. Look at this time as a chance to slow down and focus on YOU!  This is especially important if you’re a parent.  Enjoy not feeling guilty about taking a nap, chatting on the phone with your best bud, and not cleaning the house.

Socialize with others. Whether you’re a hermit or a social butterfly, making time to socialize will make this recovery time go by much faster.  Invite friends over and order pizza. It can’t get any easier than that!

Invest in comfort items. Buy pillows that will allow you to rest your leg comfortably during the day and at bedtime. Use a swivel table or tv tray stand to keep necessities within arm’s reach. Purchase a shower chair and scrub brush with a long handle.  Buy cute and comfortable sweatpants with pockets. You can be practical and fashionable while you heal.

Buy quality, flexible, icepacks.  The more flexible and longer the icepack, the better icing coverage your foot can get.

Having a broken ankle isn’t fun, but with these tips, you can certainly make the most of the time by being comfortable and focusing on your healing.

Always consult with your healthcare provider before using any type of walking device.  If your pain worsens or does not improve, notify your doctor. 

If you have endured an injury to your ankle, seek medical care.  Dr. John D. Hollander is here to help you recover! Call today to schedule your appointment at 707-578-1222.

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How to Fix Smelly Feet

You might enjoy taking off your shoes and kicking back in Bodega Bay, but if you suffer from foot odor, others around you might not like it as much. Taking care of smelly feet doesn’t have to be difficult or overwhelming. It is a fairly simple thing to do that just requires a little extra care.

Your feet tend to sweat more than any other part of your body. When you mix this excess perspiration and a confined, moist environment (like your shoes), the combination can be quite stinky. People who are on their feet all day or wear the same shoes without giving them time to air out are more likely to suffer from this condition, also known as bromodosis. For extreme odor problems, it’s important to make sure that a fungal infection or athlete’s foot isn’t the cause of your smelly feet.

To prevent foot odor there are a few things you should keep in mind. Shoes take about 24 hours to completely dry out, so don’t wear the same pair two days in a row. Even a little bit of excess moisture can cause an unpleasant smell. To help keep your feet dry you can use an antibacterial foot powder or an antiperspirant. Also, always remember to wear socks. Specifically, wear a pair made of synthetic material that wick away moisture from your skin. If your feet already smell, there are different soaps that can get rid of the odor in a few days.  If you would like help selecting the right over-the-counter product, we do carry many in our office that are available for purchase and we would be more than happy to help you.

Call Dr. John Hollander at 707-578-1222 to schedule an appointment in our Santa Rosa, CA office. Don’t let smelly feet leave you feeling uncomfortable or embarrassed. Call us today and we will help you get rid of your foot odor once and for all!

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What to do when you have foot pain?

With gyms being closed,  walking or running may be your preferred activity for wellness.  But what do you do when you are faced with a nagging pain in your foot?

It is not normal to feel pain in your feet, so should you experience this, it means it is time to do to some investigating!

First, check your shoe soles.  Are they fairly worn out? Are they wearing unevenly?  This could be your first sign.  Try replacing your shoes to see if this remedies the discomfort.

But what if your shoes are fine, or you just can’t afford a new pair of shoes right at this moment?  The next best step is to ice your foot 2-3 times a day for 10 minutes and take an anti-inflammatory (always consult with your doctor before adding medication to your care plan).

If you are noticing some relief, add stretching exercises to your care routine.  Practice picking up towels with your toes, roll your arch over a cold water bottle, and practice these helpful stretches too.

When at home remedies are not providing relief, it may be time to consider another method of treatment called Extracorporeal shockwave therapy, ESWT for short.  ESWT uses shockwaves to penetrate deep into your foot and promote healing.  It is most commonly used to treat plantar fasciitis or Achilles tendinitis, both common causes of foot pain.

ESWT is used when other more conservative treatments have failed, but before opting for surgical methods. There are different levels of shockwaves; some that require a local anesthetic and others that don’t. This therapy offers many of the same results as surgery, but with less downtime and a much faster rate of recovery.

Podiatrists and patients alike prefer ESWT to surgery, because of reduced healing times. You will probably notice, even after the first day, that the pain does not worsen. As the damaged cells begin to repair and new cells grow, you will note that your pain is subsiding even more. After a session of this therapy, you will most likely notice soreness or possibly some bruising. However, these effects are mild compared to those of surgical intervention.

If you want to learn more about ESWT, call Dr. John Hollander, DPM today at 707-578-1222 or schedule an appointment online. We want your feet to be as healthy as they can be. Faster, more effective healing means you’ll be ready for your next adventure.

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Infection Prevention- How to Clean Your Nail Tools at Home

Raise your hand if you are guilty of not cleaning your nail clippers or callus removing tools after each use?  Do you think that just rinsing them off with hot water is enough? Sorry guys and gals, it is not!  We as humans carry bacteria on our bodies that when exposed to a cut in our skin, can potentially cause painful or life-threatening infections.  This is why it is required by law for nail salons to follow specific sanitizing and disinfecting procedures with their equipment.  Today’s blog is going to teach you how to take care of your tools at home by cleaning and disinfecting them so that you don’t find yourself (or a family member) with an unwanted infection.

Cleaning your tools

Always start off by washing your hands with soap and water. Place your scrub brush into a bowl and pour 70% to 90% Isopropyl Alcohol over it until the brush is completely submerged. Allow your brush to soak for 5 minutes.  Once you know your brush is sanitized, you can use it to clean your other tools.  Add antibacterial soap to your brush and use it to scrub your nail clippers, glass nail files, and callus removing tool. Your goal is to remove the debris build-up.  Once you are done scrubbing, rinse off the tools with hot water until all of the soap is gone.

Disinfecting your tools*

Place your nail clippers, glass nail files, and callus removing tool into a clean bowl.  Again, using Isopropyl Alcohol, cover your tools completely.  Allow them to sit in the solution for 30 minutes. If you do not have Isopropyl Alcohol, you can boil your metal tools in water for 20 minutes.  Be sure to wash your hands before picking up the disinfected tools. When soaking is complete, allow them to dry on a clean paper towel.

Storing your clean tools

Always store your clean tools away from other tools and supplies.  Never place them in a plastic bag or storage container as that can create a breeding ground for unwanted bacteria. Instead, keep them wrapped in a clean paper towel, in a designated “clean” drawer or makeup bag specifically for your nail tools.

If you would rather have someone else maintain your nails and feet, try one of our medical pedicures!  We offer several different types of services depending on your needs and desire.  Take a look at our medical pedicure menu for more details and pricing. Medical Pedicure Menu.  For appointments please call (707) 578-1222. 

*Please note these techniques are not directions for nail salons. Nail salons should refer to the cleaning and disinfecting requirements of their specific state, which in California can be found on the Department of Consumer Affairs barbering and cosmetology page.

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10 Tips for Happy Feet This Summer

With the summer season upon us, our feet will probably become exposed to the traditional summer conditions of sunshine, sandy beaches, flip flops, and hot weather.  Follow these tried and true tips to keep your feet looking fabulous all summer long.

#1. Prevent and treat dry cracked heels. Use a pumice stone or exfoliant once a week to keep your calluses from building up and getting rough.

#2. Protect your skin.  Don’t forget to apply sunscreen to the tops of your feet- they too can get sunburned.

#3. Keep your nails trimmed. Trim your nails straight across-not too short and not too long; you don’t want to cause an ingrown toenail.

#4. Don’t go barefoot. Keep sandals on while walking around the beach, pool, or ocean to prevent contamination of foot fungus or plantar warts, and to protect your feet from cuts and scrapes.

#5. Use a 5-Free or 8-Free nail polish.  Keep the harmful chemicals out while nourishing your nails and preventing fungal infections with a Podiatrist approved polish such as Dr.’s REMEDY.

#6. Travel with a first aid kit.  Keep essential tools nearby for possible cuts and burns including bandages, an emery board, antibiotic cream, and aloe vera.

#7. Give your feet an ice bath.  After a long warm day, feet can swell up.  Soak your feet for 15 minutes in cold water to reduce swelling.

#8. Moisturize.  Apply lotion to your feet at the end of your day and try to use one that is designated for the feet, as the skin on our feet absorbs lotions differently.

#9. Prevent Blisters.  Save strappy sandals for cooler summer days and wear your roomier sandals or flats on days that are warmer.

#10 Stay hydrated.  Drinking plenty of water keeps our skin happy and healthy and reduces dryness and swelling.

We hope that you find these ten summer tips helpful and that you have a wonderful summer season, where ever you may be!

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How to Care for Swollen and Sore Feet While Pregnant

Many women experience general fatigue and soreness throughout their entire body while pregnant but a large complaint is sore feet and swelling.  Swelling in the feet is often caused by extra fluid in the body and pressure caused by the growing uterus.  Although sudden swelling in the face or hands may be a sign of a condition known as preeclampsia, mild swelling of the ankles and feet is usually no cause for concern.  Because pregnant women are susceptible to achy and swelling feet, it is very important to watch for symptoms and address them.

In women who experience swollen feet during pregnancy, the swelling typically:

  • appears gradually
  • is equal in both feet
  • appears worse by the end of the day
  • lessens when they lie down or raise the feet
  • is worse in hot weather

Achy feet are a common condition in pregnant women as well.  What tends to happen as the pregnancy progresses, more weight and pressure are put on their feet.  This extra pressure can cause arches to stretch and feet to widen.  These changes can cause pain.

Here are a few tips to help reduce swelling and pain and for general foot care while pregnant:

  • Wearing orthotics can provide extra support for the feet and help distribute weight evenly
  • Minimize the amount of time spent walking barefoot. Wear a supportive sandal, house shoe or slipper as an alternative
  • Wear shoes with good arch support – no flimsy shoes that are easily rolled up like a burrito
  • Wear shoes that allow for good circulation to the feet
  • Elevate your feet if you experience swelling. Sleeping with a pillow under your legs is helpful.
  • Get foot massages
  • Get regular, light exercise, such as walking which will promote blood circulation to the feet

If you or a pregnant woman that you know are having foot pains call Dr. Hollander today, 707-578-1222, as he can give you a proper treatment algorithm that will help heal your symptoms and give you relief.

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Fun With Foot Anatomy

We thought it would be fun to compile a list of resources focused on educating others about feet.  Here you will find coloring pages, crafts, quizzes and more.  There is something for everyone to do and learn from.

 

Lower Leg & Foot Anatomy Coloring Page

Lower Leg & Foot Anatomy Quiz

Muscles of the Lower Leg & Foot Coloring Page

Q-Tip X-Rays Hand & Foot Activity

Games with Feet

21 Other Super Fun Human Anatomy Activities for all ages

 

Enjoy!

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Custom Orthotics vs. Shoe Inserts (OTC “orthotics”)

When you experience foot pain, it interrupts your day.  In order to find relief you may find yourself looking into shoe inserts available at your local store or visiting your podiatrist.  But how do you know whether you should use a custom orthotic or a shoe insert?  While they may appear to solve the same problems, custom orthotics and shoe inserts are quite different and serve different needs.

First and foremost, it is always best to consult a podiatrist when you are experiencing any kind of foot pain.  Attempting to self diagnose and treat your foot pain could actually lead to more damage.

When you visit your podiatrist to discuss your foot pain they will look at several things: your overall health, lifestyle and activity level, location of discomfort, evaluate the biomechanics of your lower extremities and assess your gait (how you walk).

Once all of these details have been reviewed your podiatrist can determine whether or not an orthotic device is going to resolve your discomfort.  If an orthotic device is what you need, they will present you with either a custom orthotic or a shoe insert.  Let’s look into each type of device for a better understanding of their functionality, purpose, and cost.

Custom Orthotics

Custom orthotics are prescription orthotics fabricated off the specific structure of your feet using either a plaster mold, foam mold or 3D scan.  The details of your gait, problematic area of your foot and the method of treatment all go into determining how your custom orthotics will be made.  There are two main categories of orthotics:

Functional – these are meant to control range of motion by holding the foot in place. They are used to treat such things as tendinitis or shin splints.  Functional orthotics are usually crafted of a semi-rigid material such as plastic or graphite.

Accommodative – they provide extra cushioning and support and can be useful in treating calluses or diabetic foot ulcers.

Custom orthotics typically last 3-5 years and can be refurbished a few times before needing a new pair. They are made from a more durable material designed not to collapse under your weight (meaning they can withstand higher weight ranges), can hold up to increased activity and, can be designed to handle unique shoe situations, all making them superior to OTC retail devices.  Their cost can range in the low to mid hundred dollars and may or may not be covered by your insurance provider.

Shoe Inserts

Shoe inserts are any type of non-prescription foot support that is inserted into your shoe.  They are mass-produced and can be found in many retail stores.  They can be beneficial when you need arch support, additional cushioning, or addressing leg pain.  They cannot treat biomechanical issues, should you have them.  Shoe inserts, specifically medical-grade shoe inserts, can be a wonderful option when custom orthotics are out of reach.  There are a few different types of shoe inserts which include:

Arch supports – for people with either high arches or flat feet. They offer support for the arches and ease discomfort.

Insoles – they offer support on the inside of your shoe. They are typically made out of soft material such as gel or foam.

Heel liners – often used in patients with thinner skin or fat pads, they provide extra cushioning in the heel area.

Foot cushions – used to protect your feet from rubbing against your shoes. They are good for the treatment of calluses or blisters.

Shoe inserts (over- the- counter “orthotics”) typically last up to 6 months at a time.  They are better served for average weighing individuals (up to 120lbs).  Shoe inserts are budget friendly, most can be found for under a hundred dollars and from a variety of suppliers.  Keep in mind that not all inserts will fit all people or shoes and most insurance companies will not cover the cost for them.  They can be a great option when also incorporating a stretch routine to address the pain.

With all of this being said, it is best to see a podiatrist instead of attempting to self diagnose your pain.  At Dr. John D. Hollander, DPM, we will discuss your concerns, determine a plan of action, and if needed, provide you with custom orthotics or shoe inserts that work best for your needs and budget.   Call today to schedule an appointment in our Santa Rosa, CA office (707) 578-1222.

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