Foot and Ankle Care During the COVID-19 Pandemic

Press release:

Timely tips from foot and ankle orthopaedic surgeons

Rosemont, Ill. (April 13, 2020) – As the COVID-19 pandemic continues, it may be difficult to determine if your foot or ankle condition requires immediate attention. Follow these guidelines from foot and ankle orthopaedic surgeons to take charge of your foot health, prevent injuries and stay active during this challenging time.

“Most foot and ankle surgical procedures will not occur during the current healthcare crisis in efforts to prevent the spread of COVID-19, but let’s not forget your orthopaedic surgeon is still available,” said foot and ankle orthopaedic surgeon, Jeffrey S. Feinblatt, MD, from Regenerative Orthopedic Center (ROC) in Portland, Oregon.

Your foot and ankle orthopaedic surgeon likely set up telemedicine or limited office hours to ensure continuity of care and answer specific question regarding your condition. Although there is no substitute to consultation, Dr. Feinblatt offers these tips to manage foot and ankle conditions non-operatively during this time:

  • To limit the amount of force put on your foot or ankle, use offloading devices such as a controlled ankle motion (CAM) boot, a cane, crutches, or a walker
  • Manage pain with nonsteroidal anti-inflammatory drugs (NSAIDs), topical pain creams, and Tylenol
  • Wear shoes that fit properly and keep your feet flexible to prevent injuries
  • Remain as active as possible to maintain strength and avoid weight gain

“Staying active may seem like a challenge in states with shelter-in-place orders, but keep in mind there are many online exercise classes that involve stretching, bodyweight lifting, yoga, and other simple exercises that can be done at home,” says Dr. Feinblatt. “Depending on your foot or ankle condition, this may not be feasible, but try to keep your uninjured muscles and joints moving.”

What to do about cracked heels?

Cracked heels develop when the dried skin of the heels split. While it is often the hard, thicker callused outer skin layer (epidermis) that cracks, it can also occur to softer, non-callused (and often dry) skin that is repetitively placed under high pressure when walking. If heel cracks are not, they can progress into fissures, which split the skin at a deeper level and can be very painful.

WHAT CAUSES THE CRACKED HEELS?
Dry skin is the reason most people assume they have cracking heels, but there are other factors involved as well such as increased weight, diabetes, neuropathy, poor circulation and poor nutrition can also cause poor foot health.

Symptoms of heel cracks and fissures vary from none to mild to severe. The most apparent sign is the actual cracks in the epidermis of the heels. Other symptoms may include:

Dry, itchy heels
Hard skin on the heels
Pain when standing or walking
Bleeding or infection


HOW ARE CRACKED HEELS TREATED?
With proper treatment, cracked heels should not evolve into the more serious fissures. Moisturizing with cream applied to the feet two times a day will help the cracks in most cases. If the outer skin layer is thick, it will need to be reduced by a Podiatrist.

Anything new on Chilblains?

Chilblains are a painful lesion that commonly occurs due to a vasospastic response of the small blood vessels to the colder weather. They start out at reddish painful lesions that may also be itchy. If they become chronic they tend to take on a dark blue color and the skin may break down.

There really have been no advances recently in our understanding and treatment or if you follow all the research on them. Still the best way to manage them is to prevent them with avoiding cold and using good socks and footwear and then if one occurs to use creams to stimulate the circulation. Good wound care is needed if the skin is broken.

Having said that, during the COVID-19 pandemic there have been lots of reports on Chilblains and Covid-19 (Covid Toes). For some reason chilblains are occurring with an increased frequency in those who are infected with the novel coronavirus. A lot of research has gone in to trying to find out why. PodChatLive did a deep dive into those reason: Chilblains and ‘COVID Toes’.

Causes of Higher Risk of Stress Fractures in Female Runners

Press Release:

PHILADELPHIA – Running is one of the most popular forms of exercise, enjoyed by a broad range of age groups and skill levels.  More women are running recreationally compared to men; specifically 54% of runners are female as indicated by a 2018 National Runner Survey. Women, however, are at least twice as likely as men to develop stress fractures, an injury that impacts around 20% of runners. However, information is still lacking on how to best prevent and treat stress fractures in women. New pilot research from Jefferson suggests physiological factors that could be included in routine screening for stress fracture risk, as well as changes in training approach to aid in prevention.

The researchers examined physiological differences that might contribute to increased risk of stress fractures in a study published in Sports Healthand also surveyed women’s perception of risk and behaviors that contribute to stress fractures in a separate study published in Physical Therapy in Sport

“Most of the literature focuses on elite runners or athletes,” says Therese Johnston, PT, PhD, MBA, Professor in the Department of Physical Therapy and first author of both studies. “It was important for us to capture the regular or average female runner in these studies, and the main goal was to see how we can prevent a first or subsequent fracture.”

Both studies surveyed the same group of 40 female recreational runners, age 18-65 years. 20 women had a history of running-related stress fractures, and they were matched according to age and running abilities with 20 women with no history of stress fractures. The two studies aimed to assess what contributed to risk of stress fractures, from the physiological, such as – bone structure and density, muscle mass, hormonal status, to ones influenced by training routine, such as training intensity, nutrition, insufficient strengthening, and ignoring pain.

“This mixed methods approach provides a richer context and a more detailed picture of the practices and risks that contribute to stress fractures in every-day women runners,” says Jeremy Close, MD, associate professor in family and sports medicine and one of the lead authors on the research. “It also tells us how perceived risk informs physiological risk.”

For the study focused on physiological factors, the subjects underwent a comprehensive blood panel that examined levels of hormones like estradiol and testosterone, vitamins and minerals important for bone health such as vitamin D and calcium, and bone markers. They also underwent dual energy x-ray absorptiometry (DXA) to test for bone mineral density. The researchers found that while there was no difference in estradiol hormone levels between the two groups, women who had a stress fracture history reported menstrual changes or irregular periods as a result of their training, or during peak training times. The blood panel also examined markers for bone formation and resorption, and pointed to increased bone turnover in the group of women with stress fractures. They also found through the DXA testing that women with a history of stress fractures had lower hip bone mineral density compared to women with no history of stress fractures, indicating decreased bone strength that could increase risk of injury.

“DXA for bone density and blood testing for bone markers are not routinely performed in this population – they are usually reserved for post-menopausal women – so we may be missing important clinical indicators for stress fractures in these women,” says Dr. Johnston. “While the link between menstrual changes and bone strength is unclear, our findings also indicate that asking female runners about any menstrual irregularities during heavier training times is important during routine screening.”

For the study investigating women’s self-perception of risk, interviews were conducted with the goals of finding out which factors women thought were associated with stress fractures or maintaining bone health while running. Several themes emerged from these interviews. Specifically, compared to women without stress fractures, women with histories of stress fractures had increased their training load more quickly. Also, while they knew of the importance of nutrition and strengthening exercises, women with a history of stress fracture more often reported not having or making the time for a balanced diet and proper cross-training to complement their running regimen.

Finally, women in this group reported pushing through the pain and running despite an injury more often than those without stress fracture. “In the interviews, it sounded like these women had trouble knowing which pain was normal, and which pain was abnormal. They also reported not always receiving appropriate guidance from healthcare providers on how to progress running safely,” says Dr. Johnston.

“It is clear that there needs to be more guidance from healthcare providers for woman runners on how to prevent stress fractures” says Dr. Close. “It can be very frustrating for these women who are on a path to wellness, but are impeded by an injury that can take several months to heal. If they don’t have the proper guidance on how to return to running safely, they risk a second injury.”

“We hope that our findings will encourage more thorough and routine screening in women runners for bone density and strength,” says Dr. Johnston, “as well as a comprehensive education plan on how to balance running with cross-training, and how to interpret pain cues from the body, to help women differentiate between normal aches and pains and indicators of a serious injury.”

Dr. Johnston plans to continue this research by studying women with acute stress fractures as they start running again, in order to identify factors related to successful or unsuccessful return to running following a stress fracture. The study will include Dr. Close as well as Marc Harwood, MD, service chief in the department of non-operative sports medicine at Rothman Orthopaedic Institute.

The work was funded by the Thomas Jefferson University Office of the Provost. The authors report no conflict of interest

Global Leader In Recovery Footwear, OOFOS, Accepts The American Podiatric Medical Association Seal Of Acceptance Across All Products

The Seal of Acceptance Further Establishes the Brand as a Leader and Innovator in the Footwear Industry

Press Release:

BRAINTREE, Mass., Aug. 11, 2020 /PRNewswire/ — OOFOS, the global leader in recovery footwear, announces today its full line of products has earned the American Podiatric Medical Association (APMA) Seal of Acceptance, further solidifying them as a pioneer and leader within the recovery footwear category.

The APMA Seal of Acceptance Program recognizes products that have been found to be beneficial to foot health and of significant value when used consistently in a daily foot care program. OOFOS’ full collection is among these products, as all OOFOS styles were found by the committee to promote good foot health, further establishing the therapeutic and health benefits of the brand’s shoes. In receiving the Seal of Acceptance from the APMA, customers and physicians alike are assured that upon purchasing a pair of shoes from OOFOS, they are receiving a product that is of exceptional quality and is manufactured with the consumer’s comfort and well-being in mind.

“This is a huge moment for our brand. It reinforces prior research findings and the benefits of our unique foam technology, which is designed specifically for relief and recovery,” says Steve Gallo, President of OOFOS. “Our mission at OOFOS has always been ‘to make yOO feel better’ and this seal of acceptance by the APMA provides expert validation that our shoes make a difference in the health and wellbeing of our customers day in and day out.”

Made with proprietary OOfoam® technology, OOFOS shoes absorb 37% more impact than traditional foam footwear materials for the perfect blend of cushion and stability, based on a 2018 University of Virginia laboratory study.

The use of the proprietary technology in conjunction with their patented footbed allows the shoes to cradle and support the foot’s arches for more even distribution of pressure across the sole of the foot. The combination has also shown to reduce energy exertion in the ankles by up to 47% when compared to traditional footwear. The APMA committee has further championed this technology through review of the research the brand has done on these footwear components, how the products interact with the human body and the benefits consumers receive compared to traditional footwear.

This seal is just the latest example of how OOFOS is helping yOO recover and feel better with every step. In addition to the APMA Seal of Acceptance, thousands of consumer reviews online rave about the footwear’s positive impact on their lives, including relief of pain due to ailments, bringing comfort to long working hours and maintaining body health for professional athletes. 

“These are the most comfortable slides I’ve ever worn in my life,” says OOFOS brand partner and Pro-Football Hall of Famer, Deion Sanders. This is coming from a dude who is 52, has had three toe surgeries, and is in need of a 4th, these shoes changed the game for me!”

About OOFOS
OOFOS is the global leader in recovery footwear, founded by a team of industry veterans looking to help runners and fitness enthusiasts recover better from their workouts. Made with revolutionary OOfoam™ technology, OOFOS are designed to absorb 37% more impact than traditional footwear. They reduce stress on joints to keep anyone, of any activity level, feeling their best. From professional athletes to casual walkers, OOFOS footwear will make your hard-working feet and body feel better – all you have to do is feel the OO. 

Arch Supporting Flip Flops

Are the arch supporting flip flops any good?

People with foot problems like to ask this a lot. Can those flip flops with an arch support built into them be used instead of foot orthotics? The amount of arch support that they have is similar to the amount that you get from an over-the-counter type foot supports that are widely available, so it is reasonable to assume that they will have some use. They could be used to supplement and be an adjunct to foot orthotic therapy when the wearing of foot orthotics can be compromised by the choice of footwear to accommodate foot orthotics. This is often the case in warmer climates when closed in shoes which are needed for foot orthotics are not worn that often. They may be an alternative to foot orthotics if the problem is minor and the patient spends the bulk of their time in this type of footwear and they have the need for an average type arch support. The amount of support would not be the same as you would get from a custom made device that is specific for the individual.

Athletes often like to use them as recovery footwear. After a hard workout, the feet and legs need a rest to help recover, so an arch supporting cushioned type of footwear is probably going to help that. The flip flop type footwear also ‘frees’ the toes from the constrictive toe box of typical shoes, so this can also be useful for use for a period of time by athletes.

One brand that is getting a lot of attention is the Archie brand from Australia, where it is widely stocked by podiatry clinics. In Australia, they call flip-flops, thongs, so you do need to be careful about the terminology of this footwear genre. You often see comments from Podiatrists in Australia, just how much patients like these with almost all who try them on buying them. There are many other brands on the market that are worth considering.

Heel Pain on the Rise among Americans in Quarantine

Press Release:

BETHESDA, Md., May 27, 2020 /PRNewswire/ — Members of the American Podiatric Medical Association (APMA) have noted an increase in reports of heel pain from patients stuck and home as a result of the COVID-19 pandemic. APMA member podiatrists are physicians and surgeons who treat the foot, ankle, and related structures of the leg, and they say footwear—or lack thereof—may be to blame for the upsurge in cases.

“Adults are shifting routines and adapting to new working environments, and it’s easy to neglect proper care and support for your feet,” said APMA member podiatrist and spokesperson Priya Parthasarathy, DPM. “Many podiatrists now have telehealth and in-person appointments. Foot and heel pain is never normal, so see your podiatrist right away!”

Plantar fasciitis, one of the most common causes of heel pain, is inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. This condition may cause intense pain in the heel, along with redness, swelling, or heat. This pain may be most acute when a patient takes the first step in the morning or after sitting. Many Americans in quarantine are wearing unsupportive shoes—or wearing no shoes at all—which can contribute to inflammation.

“The top priority when treating plantar fasciitis is to reduce the mechanical strain on the plantar fascia with arch supports and supportive footwear,” said APMA President Seth A. Rubenstein, DPM. “Most cases of plantar fasciitis respond well to conservative (non-surgical) treatment, including anti-inflammatory measures and stretching. However, podiatrists are also well-trained to provide advanced, cutting-edge treatments, including EPAT therapy, platelet-rich plasma injections, and surgical intervention, for more complex cases.”

Although some patients assume all heel pain is attributable to plantar fasciitis, many conditions can cause similar symptoms. Seeing a local APMA-member podiatrist at the first sign of heel pain allows for proper diagnosis and treatment. Other causes of heel pain include heel spurs, Achilles tendinitis, stress fractures, and excessive pronation.