Arthritis in the Feet

Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. There are over 100 different forms of arthritis. The most common form, osteoarthritis (degenerative joint disease) is a result of trauma to the joint, infection of the joint, or age. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage.

Regardless of the type of arthritis, the common symptoms for all arthritis disorders include varied levels of pain, swelling, joint stiffness and sometimes a constant ache around the joint(s). Arthritic disorders like lupus and rheumatoid can also affect other organs in the body with a variety of symptoms. Some symptoms are listed below:

• Redness or heat in a joint.
  
• Malaise and a feeling of tiredness
  
• Fever
  
• Weight loss
  
• Limitation in motion of joint
  
• Swelling in one or more joints
  
• Muscle aches and pains
  
• Tenderness
  
• Difficulty moving the joint

It is common in advanced arthritis for significant secondary changes to occur. For example, in someone who has limited their physical activity:

• Muscle weakness
• Loss of flexibility
• Decreased aerobic fitness
  

Pictured above is a diagram of the foot

The most commonly affected joints in the foot are:

1. The toe joints.


2. The metatarsophalangeal joints. These are the joints located in the balls of the feet (in the forefoot area) — the joints where the toes attach to the feet.


3. The most frequently affected joint in the foot is the 1st metatarsophalangeal joint. When this joint has osteoarthritis it is usually called Hallux Limitus or Hallux Rigidus, and people may experience: a reduction in how far the big toe can be pushed up (dorsoflexion),
   pain in the big toe when it is dorsoflexed, or each time we take a step and "push off",
   a "hard" bump or bone spur seen or felt on the top of the joint, swelling around the joint by the end of the day, which may subside with rest
   

Types of Arthritis

Osteoarthritis is the most common form of arthritis. It can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially one acquired from daily wear and tear of the joint. Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking but soon the pain can be continuous and even occur at night. The pain can be debilitating and prevent one from doing any type of activity. Osteoarthritis typically affects the weight bearing joints like the back, spine and pelvis. Unlike rheumatoid arthritis, osteoarthritis is a disease of the elderly. More than 30 percent of females have some degree of osteoarthritis by age 65. Risk factors for osteoarthritis include: prior joint trauma, obesity, sedentary lifestyle

Osteoarthritis, like rheumatoid arthritis, cannot be cured but one can prevent the condition from worsening. Weight loss is the key to improving symptoms and preventing progression. Physical therapy to strengthen muscles and joints is very helpful. Pain medications are widely required by individuals with osteoarthritis. When the disease is far advanced and the pain is continuous, surgery may be an option. Unlike rheumatoid arthritis, joint replacement does help many individuals with osteoarthritis.

Rheumatoid arthritis is a disorder in which, for some unknown reason, the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis affects joints in the fingers, wrists, knees and elbows. In the foot, it frequently affects both ankles and toes. The disease is symmetrical and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. No one knows why rheumatoid arthritis occurs and all treatments are focused on easing the symptoms. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously. In rare cases, surgery may be required to replace joints but there is no cure for the illness.

Rheumatic fever has now seen resurgence in America primarily because of mass immigration of people from developing countries. The disorder can present with a migratory nature of arthritis with many other features like heart problems, skin rash, gait abnormality and skin nodules.

Arthritis of the foot and ankle can be treated in many ways, including:

• Physical therapy and exercise.
  


• Anti-inflammatory medication (pictured below is an over-the-counter anti-inflammatory) and/or steroid injections into the affected joint. Note: Please consult your physician before taking any medications.

• Orthotics or specially prescribed shoes.


• Arthritic socks like, Silipos, the ones pictured below

If you are experiencing any of the symptoms listed and believe they are related to arthritis in your feet, please contact our office the Advance Foot Care Clinic at 419-423-1888 to schedule an appointment. You can also visit us on the web at www.vailfoot.com . Our website has a link to our online store where you can purchase the anti-inflammatory topical Biofreeze or the Silipos socks. Feel free to browse our site and look for additional product as well.

Bunion Blunders

What are bunions? A bunion is a bone deformity that is caused by an enlargement of the of the joint at the base and side of the big toe. This is caused by the toe moving out of place. This will cause the bone to protrude outward causing pressure and pain to occur as it rubs against footwear. In some cases the protruding big toe can overlap a third toe, which is called hallux valgus, and will cause more pain and irritation. In other cases, the big toe can move toward the second toe and rotate or twist, also know as hallus abducto valgus. Another deformity caused by bunions is hammertoe. The image below shows what a bunion looks like.

Because bunions are a bone deformity they will not heal on there own. There are many different ways to treat bunions. The severity of the bunion will dictate the plan of action required for treatment. In some cases, the bunion(s) have reached a point where the pain level and the degree of misalignment of the toe can not be treated with a conservative approach (non-surgical treatment). In cases like this, bunion surgery, or bunionectomy may be the approach required to correct this bone deformity.

Surgery is typically a last resort. Most podiatrist will try to treat the bunions with a conservative course of action. Here are a few methods that are used to alleviate pressure and pain:

• The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems. Pictured below is a Dr. Jill bunion sleeve that can be purchased at http://www.vailfoot.com/ our online store or by coming into our office.

• Removal of corns and calluses on the foot.



• Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth.



• Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.



• Exercises to maintain joint mobility and prevent stiffness or arthritis.



• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

Bunions are a very slow developing bone deformity. It is important to take care of your feet at an early age and continue to do so through your adult life. This can pay off down the road. Be sure to examine your feet and pay attentiont to the shape as they continue to develop over time. Exercising your feet can help strengthen them. For example, using your toes to pickup small objects is a good way to exercise them. It is also very important to wear shoes that fit properly. Make sure there is enough room in the toe box and in the width so your toes are not cramped. Woman should avoid wearing high heels and pointed toe shoes. They do not allow for enough room and will cause the toes to be pinched or cramped.

So if you are noticing a deformity in your big toe like the one pictured above and it is causing you pain, you should contact your local podiatrist to schedule an appointment. We can be reached at 419-423-1888 or you can visit us online at www.vailfoot.com . You can also browse our online store for products that can be purchased for the treatment of bunions like these Dr. Jill gel bunion guards:

Reduce Swelling in Your Feet & Legs

Swelling in your lower leg and foot is called peripheral edema.  This condition is not painful, but it can be uncomfortable and the swelling can make it difficult to put on socks and shoes.  This can also cause your shoes to not fit properly.  The swelling can be caused by sitting or standing for long periods of time, pregnancy, or a more serious condition such as chronic venous, kidney or liver disease.  Here are some suggestions on how to reduce your swelling at home.  If your swelling does not go away, you will need to seek medical attention.

Reduce your sodium.  High sodium intake can contribute to swelling by causing your body to retain water.  Convenience foods such as fast food, microwave meals, and processed meats tend to be higher in salt and should be avoided when you are experiencing swelling.  You also want to avoid adding any salt to your foods to prevent any additional swelling.

Drink plenty of water.  On an average, you need eight glasses of water per day.  Water not only keeps you hydrated but it also helps flush any excess sodium from the body.  This helps reduce the selling in your feet and legs.  You want to avoid drinks that contain caffeine, because these types of drinks contain sodium which will cause you to retain fluids.

Elevate your feet everyday.  When you elevate your feet, this will encourage the fluid to flow away from your feet and legs.  This will help reduce swelling.  You should lay down and elevate your legs above the heart for best results.

Wear support hosiery.  Wearing support hose or socks will help stimulate circulation.  Not only does this type of hosiery encourage circulation, it also compresses swelling to minimize the uncomfortable effects.

Get up and move.  If you are seated for an extended period of time, you should get up and take a small walk.  Walking will encourage circulation and fluid movement in the legs.  This will help pump the fluid away from your legs and feet and back to your heart.  Standing for long periods of time can also cause your legs and feet to swell.  So make sure you takes breaks in standing and have a seat and elevate your legs.  This will also help reduce the swelling.

Diabetics need to take special care of their feet.  Swelling of the feet is a sign that there is a problem with circulation in the body which can lead to neuropathy.  Neuropathy is having nerve damage in the extremities.  When this situation becomes serious, it can lead to amputation of a foot or leg.  Diabetics should check their feet every day and visit their doctor on a regular basis to have them examined to guard against this serious problem.

If you have swelling in your feet that needs attention and want to schedule your appointment with Dr. Vail, you can give us a call at 419-423-1888.  You can also visit our website at http://www.vailfoot.com/ for more information.

What are Plantar warts and how do you get them?

What are Plantar warts?  Plantar warts are noncancerous skin growths on the bottoms of your feet caused by the human papillomavirus (HPV).  The virus enters your body through tiny cuts and breaks in the skin.  Plantar warts often develop beneath pressure points in the feet, such as the heels or balls of the feet.

How do you get plantar warts?  You acquire warts through direct contact with the HPV.  There are more than 100 types of the human papillomavirus.  Some types of HPV tend to cause warts on your hands, fingers or near your fingernails.  Others cause warts on your feet.

The virus that causes plantar warts is not a highly contagious virus, but it does thrive in warm, moist environments.  These would include shower floors, locker rooms, and public swimming areas.  If you walk barefoot in these types of public places, you do run the risk of contracting this virus.

Like other infectious diseases, HPV can also pass from person to person.  If you have a plantar wart, don't touch or scratch at it.  This can cause the virus to spread to other places on your foot.  The virus can also spread by contact with skin shed or blood from the wart. 

Each person's immune system responds differently to warts.  Not everyone who comes into contact with HPV will develop warts.  Some people are just more susceptible to the wart-causing virus, like some people are more likely to catch a cold.  Children and teenagers tend to be especially vulnerable to warts.

You should see the doctor when

• the warts become painful or change in appearance or color. 
• the warts persist, multiply or recur despite treatment at home.  They can spread before they are treated causing A cluster of warts called mosaic warts.  These can become extremely painful.
• the warts interfere with your activities.  If you have a lot of plantar warts, the pain may make it difficult to walk or run.
• If you are diabetic or have a circulatory disorder, don't try to treat any plantar wart on your own.  It is best to seek advice from your doctor.

If you are unsure whether you have plantar warts or not, you should consult your doctor for a correct diagnosis.  You could possibly have a more serious lesion crop up on your feet including cancerous tumors called carcinomas and melanomas.

If you have stubborn plantar warts and home treatment isn't helping, one of the following courses of treatment your doctor may suggest.  Doctors usually start out with the least painful and least destructive methods, especially with younger patients.

• Freezing.  Your doctor can apply liquid nitrogen with a cotton-tipped applicator to freeze or destroy your wart.  This treatment usually isn't too painful and is often effective.  You may need repeated treatments with freezing.  The chemical does cause a blister to form around your wart, and the dead tissue will shed off within a week or so.  Since freezing therapy may be painful, this isn't typically done on young children.
• Cantharidin.  Your doctor may use cantharidin-a substance extracted from the blister beetle- on your plantar warts.  The extract is typically paired with salicylic acid and applied to the plantar wart.  It is then covered with a bandage.  This application is painless, but the resulting blister can be uncomfortable.  Your doctor will clip away the dead part of the wart in about a week.
• Minor Surgery.  This involves cutting away or destroying the wart by using an electric needle in a process called electrodesiccation and curettage.  This method of treatment is effective, but can leave a scar if not done carefully.  You will receive a local anesthetic on your skin before the treatment.
• Laser surgery.  There are several types of lasers doctors can use to eliminate stubborn warts.  This type of surgery is expensive and painful.  Multiple sessions may be required to treat the warts.
• Immunotherapy.  This is an attempt to harness your body's natural rejection system to remove tough to treat warts.  Your doctor can inject the warts with interferon, a medication that boosts your immune system's instinct to reject warts.  Your doctor may also try an injection  of a foreign substance (antigen) that stimulates your immune system.  Doctors who use this type of treatment generally use mumps antigens since most people are immunized against the mumps.  As a result of this type of treatment, the antigen sets off an immune reaction that may fight off warts.
• Bleomycin.   In severe cases where the warts haven't cleared with other therapies, your doctor may inject each wart with a medication called bleomycin, which kills the virus.  This medication is given systemically in higher doses to treat some kinds of cancer.  The injections can be painful.  They are not used if you are pregnant or breastfeeding or if you have circulation problems.

If you would like to treat the wart at home we recommend using Pendinol Salactic Film-Treatment for Warts.  The salactic film is made with 17% salicylic acid which helps the wart to gradually peel off.  The flexible collodion dries to form a covering over the treated area.  This helps keep the salicylic acid on the area and shield it from possible infection. 

If you have any questions regarding warts or any other foot problem you may have, please contact Dr. Vail at 419-423-1888 or visit us on our website at www.vailfoot.com.

Dr. Vail's Foot Care Facts

Foot Care Facts

- 3 out of 4 Americans experience serious foot problems in their lifetime.

- The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles.

- 1/4 of all the bones in the human body are down in your feet. When these bones are out of alignment, so is

the rest of the body.

- Only a small percentage of the population is born with foot problems.

- It's neglect and a lack of awareness of proper care - including ill fitting shoes - that bring on problems.

- Women have about four times as many foot problems as men. High heels are partly to blame.

- Walking is the best exercise for your feet. It also contributes to your general health by improving circulation, contributing to weight control, and promoting all-around well being.

- Your feet mirror your general health. Conditions such as arthritis, diabetes, nerve and circulatory disorders can show their initial symptoms in the feet - so foot ailments can be your first sign of more serious medical problems.

- Arthritis is the number one cause of disability in America. It limits everday dressing, climbing stairs, getting in and out of bed or walking - for about 7 million Americans. 

- About 60 to 70 % of people with diabetes have mild to severe forms of diabetic nerve damage, which in severe forms can lead to lower limb amputations. Approximately 56,000 people a year lose their foot or leg to diabetes. 

- There are 250,000 sweat glands in a pair of feet. Sweat glands in the feet excrete as much as a half-pint of moisture a day. 

- Walking barefoot can cause plantar warts. The virus enters through a cut. 

- The two feet may be different sizes. Buy shoes for the larger one. 

- About 5% of Americans have toenail problems in a given year. 

- The average person takes 8,000 to 10,000 steps a day, which adds up to 115,000 miles over a lifetime. Thats enough to go around the earth four times. 

Finally, if your experiencing a problem dont hesistate for one second! Please give us a call at (419)-423-1888 and schedule an appointment. We are always accepting new patients, and we would be more than happy to take care of your foot care needs. (click this link) if you don't believe our patients success.

Metatarsal Fracture in Depth

Metatarsal Fracture Explained

Metatarsal fractures are the most common traumatic foot injuries. Broken Metatarsals have been prominent across all professional sports in the past five years, with several high profile athletes suffering Metatarsal fractures. Professional soccer players David Beckham, Steve Gerrard, and a few other noteable ones have all sustained this foot injury in recent years. 

To help everyone understand the Metatarsal fractures further, it is probably best to start by explaining the anatomy of the foot. There are five Metatarsal bones in each foot. They are the relatively long bones which are located between the 'Tarsal' bones of the hind foot and the 'Phalanges' bones in the toes. Functionally, the ankle and foot have two principle functions: propulsion and support. The Metatarsal bones play a major role in these functions. For propulsion they act like a rigid lever and for support they act like a flexible structure that aids balance, thus holding up the entire body.

Fractures to the Metatarsal bones can be caused by direct trauma, excessive rotational forces or overuse. During football, direct trauma is usually caused by a player accidently kicking the sole of an opponent's boot, or by an opponent stepping on a player's foot. As there is very little soft tissue to protect the top of the foot, bone injuries are common. The second, third and fourth Metatarsals are the most commonly fractured with this type of injury, although the fifth Metatarsal is fractured more often in soccer.

The fifth Metatarsal is divided into four anatomic segments (the base, the junction of the base and the shaft, the shaft, and the neck) and different types of fracture can occur at each segment.

Fractures of the base of the fifth Metatarsal are the most common fifth metatarsal injuries, and occur as a result of a twisting injury of the foot or ankle. The ankle rolls inward and there is a strong ligament that attaches to the base of the Metatarsal which pulls off a small bone fragment. This type of fracture is invariably treated without surgery, and immediate walking in a removable plastic cast is ideal.

The junction between the base of the Metatarsal and the shaft is the area which creates most problems when fractured. The reason for the difficulty is that bone healing relies upon a good circulation, and this particular area of the bone has a notoriously poor blood supply. Fractures of the shaft of the Metatarsal occur commonly as a result of twisting of the foot when landing from a jump, for example in ballet dancers, and these heal very rapidly with immobilisation, without any need for surgery.

Overuse can cause stress fractures of the Metatarsals. These fractures are common in army recruits as well as sporting individuals are commonly known as 'march' fractures. The patient will normally report about two weeks of gradually increasing pain in the region before an incident 'converts' the stress fracture to a full fracture. The second Metatarsal is the most commonly affected, but the fifth Metatarsal can also be affected. While the stress fracture of the second Metatarsal usually heels well, the healing of a stress fracture to the fifth Metatarsal can be more worrysome.

Metatarsal Fracture Signs & Symptoms

There is severe foot pain with a Metatarsal fracture and the patient will usually find it difficult to walk. Often there will be pain if the fracture site is touched. A swollen foot is fairly common and bruising is usually evident after a day or two.

Metatarsal Fracture Treatment

If a Metatarsal fracture is suspected the patient should be transferred to an emergency department where a doctor can confirm the diagnosis by ordering an x-ray. Immediately following a Metatarsal fracture ice therapy can be effective to help with pain relief, although medication prescribed by a doctor is usually necessary. Ice Packs for a period of twenty minutes every couple of hours may help with the pain.

The ultimate treatment of Metatarsal fractures varies depending on the type of location of the fracture. If the fracture is due to direct trauma and the fracture ligaments are well aligned then the treatment is immobilisation in a Removable Plastic Cast and non-weight bearing for 6-8 weeks. One good way of helping your healing process is to try our Pedifix Forefoot Compression Sleeve (pictured on the left). The Forefoot Compression Sleeve gently controls forefoot edema. This is great for metatarsal stress fracture and following bunion surgery.

The removable plastic cast is better than a plaster cast, because the boot can be removed for physiotherapy treatment, which is aimed at preventing stiffness in the ankle joint. In addition, cardiovascular fitness can be maintained by performing non-weight bearing exercises in a swimming pool uising a Buoyancy Belt.

A removable plastic cast is also usually adequate for 'march'' (stress) fractures of the second Metatarsal and rotational fractures of the fifth Metatarsal. However, stress fractures of the base of the fifth Metatarsal sometimes show a poor healing capacity. For this reason, many orthopaedic consultants now favour surgical fixation. A small incision is made on the outside border of the foot and a small crew is placed down the middle of the fractured bone. With this method a return to sporting activity is usually possible after 6 - 8 weeks. You can also visit our online store, and check out any product that might suit your needs regarding any fracture or broken bones (click highlighted link to visit store).

Metatarsal Fracture Prevention 

If the force applied to the foot during a traumatic incident is high then there is very little that can be done to prevent a Metatarsal fracture. However, it is always important to wear appropriate footwear that gives the foot some protection. Also, for more protection regarding your foot, try out Metatarsal pads (viewable on the left). They can be had here at the office, or by visiting our online store (please click the highlighted link to view the Metatarsal pads).

Recommended Products for Metatarsal Fracture Injury:

Removable Plastic Casts

Faster Bone Healing

Insoles and Orthotics

Ice Packs & Cold Therapy

Rehabilitation Kit

Acute Metatarsal Fractures

This is a fracture to the metatarsal bones caused by a violent impact. Something is often dropped on the foot or the foot might be stepped on. Also, a violent twisting or turning motion at the ankle may cause a fracture in the 5th metatarsal in the particular. These can include an avulsion fracture, where the tendon of the Peroneus Brevis muslce pulls a piece of the bone away. Or a jones fracture which occurs at the base of the 5th metatarsal. This area typically has a poor blood supply and so healing may be affected.

What are the symptoms?

- Acute pain at the point of trauma

- Rapid swelling

- Inability to weight bear

- There may be deformity in the foot.

Bruising will usually develop within 24 hours.

What can the athlete do?

- See a doctor as possible.

- X-rays will be taken of the foot to confirm a fracture.

How are they Treated?

- If the bones are not displaced then a short cast or boot will be fitted for the first three weeks.

- After six weeks the foot should be X-rayed again to ensure it has healed.

- More complex or displaced fracture may require surgical fixation.

- Jones fractures require 6-8 weeks of non-weight bearing immobilization.

- Once the cast has been removed, a thorough rehabilitation plan should begin to regain full mobility and strength.

- A gradual return to sport can then begin!

Wouldn't you like to know the "Secrets to Foot & Ankle Health?" Well here is your chance. Follow this link and fill out the required information needed on our request form to get your free copy today!

Power Mowers Cause Damage to Feet

Thousands of Foot Injuries Can be Prevented Each Year

The later stages of lawn care is near and you have made it this far! We just wanted to check-in and make sure we keep everyone safe and sound for the home stretch. We wanted to caution homeowners to protect their feet and the feet of those around them when using rotary-blade lawnmowers.

Each year, some 25,000 Americans sustain injuries from power mowers, according to reports issued by the U.S Consumer Products Safety Commission. The blades whirl at 3,000 revolutions per minute and produce three times the kinetic energy of a .357 handgun. Yet, each year we continue to see patients who have been hurt while operating a lawn mower barefoot.

Children under the age of 14 and adults over the age of 44 are more likely to be injured from mowers than others. We advise anyone who operates a power mower to take a few simple precautions:

- Don't mow a wet lawn. Losing control from slipping on rain-soaked grass is the leading cause of foot injuries caused by power mowers.

- Wear heavy shoes or work boots when moving (NO sneakers or sandals).

- Don't allow small children to ride on the lap of an adult on a lawn tractor. Children can be severly injured by the blades when getting on or off the machine.

- Mow across slopes, never go up or down.

- Never pull a running mower backwards.

- Keep children away from the lawn when mowing.

- Keep the clip bag attached when operating a power mower to prevent projectile injuries.

- Use a mower with a release mechanism on the handle that automatically shuts it off when the hands let go.

If a mower accident does occur, immediate treatment is necessary to flush the wound thoroughly and apply antibiotics to prevent infection. Superficial wounds can be treated on an outpatient basis, but more serious injuries usually require surgical intervention to repair tendon damage, deep clean the wound and suture it. Tendons severed in lawnmower accidents generally can be surgically reattached unless toes have been amputated

Join us on Facebook!!  =)

Enjoy Pregnancy without Foot Pain

As a pregnant woman, the most coined phrase you''ll ever here is "Oh my aching feet". But, are sore feet a symptom they just may deal with during pregnancy? Most foot and ankle surgeons would say "no." There are many remedies available to help alleviate foot pain.

Women often experience foot pain during pregnancy because of increased weight, foot instability and swelling. In the last five years, there has been an increase in pregnant women with foot pain because more than ever before are active, even running marathons, during there pregnancies.

The following guidelines however, should be followed to help reduce foot pain during pregnancy:

Painful, Swollen Feet - Pregnant  women often experience throbbing, swollen feet due to excess fluid build up (edema) in the feet from the weight and position of the baby. To reduce swelling, put feet up whenever possible, stretch legs frequently, wear wide comfortable shoes and don't cross legs when sitting.

Arch Pain - Pain in the arch can be due to both arch fatigue or over pronation (or the flattening of the arch). Over pronation causes extreme stress to the ligament (the plantar fascia) that holds up the arch of the foot. The best way to prevent arch pain is to stretch daily in the morning and before and after any exercise, don't go barefoot and wear supportive low heeled shoes.

Ingrown Toenails - Excessive stress from tightly-fitting shoes causes painful ingrown toenails. Give your feet a break: wear wider shoes during the last trimester of pregnancy to avoid ingrown toenails. If you do experience an ingrown toenail, avoid attempting "bathroom surgery". Repeated cutting of the nail can cause the condition to worsen over time. It is best to seek treatment here at Dr. Vail's with your foot and ankle surgeon.

It is also not uncommon for women to experience a change in their foot size during pregnancy. In some instances a permanent growth in a women's foot, up to half a size, can occur from the release of the same hormone, relaxin, that allows the pelvis to open to deliver the baby. It makes the ligaments in your feet more flexible, causing feet to spread wider and longer.

Pregnancy and pending motherhood should be a great lifetime experience. If foot pain exists, please call Dr. Vail's office at 419-423-1888. Dr. Vail can provide relief with conservative treatments such as physical therapy, foot orthotics, supportive shoes and minor toenail procedures.

Back to School Shoe Fitting

     With kids soon back in school after a summer of bare feet and sandals, parents are shopping for shoes for feet that seem to have grown longer in just a few months. To help busy parents with shoe choices, a Chicago foot and ankle surgeon recommends some simple guidelines to prevent or minimize possible foot problems. from inappropriate shoes, such as painful ingrown toenails, blisters, heel pain and flat feet.

     When choosing kids' shoes, size and shock absorption are the key considerations, especially if your child has flat feet that can worsen from improper fitting or worn-out shoes. Also, a child's foot can grow a size or two within six months, so it's critical to allow room for growth in the toe box--about a finger's width from the longest toe.

     Snug shoes put pressure on the toes, causing ingrown nails. The nail compresses and grows down into the skin. Most noteably, infection can occur when an ingrown nail breaks through the skin. If there's pain, redness and fluid from the area, it's probably infected. The ingrown nail can be removed in a simple, in-office procedure. Don't try to remove a child's ingrown nail at home; this can cause the condition to worsen. Tight-fitting shoes also cause blisters, corns, and calluses on the toes and blisters on the back of the heels.

     Never buy shoes that feel tight and uncomfortable in the store. Don't assume they will stretch or break in over time. Also, remember shoes that are too loose can cause problems as well. Parents should carefully inspect there child's shoes to check for proper cushioning and arch support.

     Shoes lose their shock absorption over time, and wear and tear around the edges of the sole usually indicate it's worn out and should be replaced. If a child keeps wearing worn-out or non-supportive dress or athletic shoes, it elevates the risk for developing heel pain, Achilles tendonitis and even ankle sprains and stress fractures. A good tip for all parents when buying there kids shoes is this: The toe box should flex easily and the shoe shouldn't bend in the middle of the sole.

     For children with flat feet, parents should buy oxford, lace-up shoes that have enough depth for an orthotic insert, if necessary. Unfortunately, there isn't much choice for kids with flat, wide feet. They need shoes with a wide toe box and maximum arch support and shock absorption. If you have any questions regarding your kids "back to school shoe choice" please feel free to contact us via email: vailmedassist@sbcglobal.net or by phone: 419-423-1888.