Today, a Chelmsford, MA foot and ankle surgeon urged obese adults to seek immediate treatment for chronic, activity-limiting foot and ankle problems to foster compliance with physician-directed exercise programs.

“It’s unfortunate obese adults get caught up in the vicious cycle of avoiding physical activity due to foot or ankle pain, thereby permitting cardiovascular disease and other life-threatening conditions to worsen as a result,” says Dr. Jerold H. Fleishman, DPM, FACFAS, a member of the American College of Foot and Ankle Surgeons FACFAS in Chelmsford, MA. “For example, in many cases, chronic heel pain occurs from carrying too much weight. Left untreated, it becomes an impediment to physical activity and meaningful weight loss.”

Dr. Fleishman says there’s no reason foot or ankle pain should stop obese patients from exercising. The first step toward breaking that vicious cycle is an evaluation by a foot and ankle surgeon.

According to the ACFAS consumer Web site, FootPhysicians.com, many causes of foot pain can be relieved without surgery through stretching exercises, orthotics and athletic shoes with good shock absorption and support. If a bunion, heel pain or other condition requires surgery, patients can participate during their recovery in non-weight-bearing activities, such as riding a stationary bike, swimming or weight training.
For those moderately to severely overweight, Dr. Fleishman says a thorough physical examination is mandatory before beginning an exercise program.

“Once cleared by your physician to begin exercising, don’t try to do too much too soon. Follow a gradual routine until your body adjusts to the stress of regular physical activity,” HE says. “For example, I counsel overweight patients to avoid working out on treadmills or elliptical machines to minimize pounding and stress on their joints.”

Shedding excess pounds helps diabetic patients control their disease, but Dr. Fleishman notes many who experience foot ulcerations and vascular problems caused by diabetes might think they shouldn’t exercise.
“Every diabetes patient needs regular foot exams to check for possible sore spots and assess nerve sensation,” says Dr. Fleishman. “And with proper diabetic foot care and the right footwear, most patients can follow an exercise regimen that is safe and appropriate for them.”

To Contact Dr. Fleishman’s visit www.nefootankle.com

Timothy M. Downs, DPM, FACFAS, says those symptoms may be caused by a condition called diabetic peripheral neuropathy, or nerve damage. Neuropathy in the feet can lead to permanent numbness, deformities such as bunions and hammertoes, and dry skin that cracks open and won’t heal.

“Diabetic peripheral neuropathy is not only painful but dangerous,” says Dr. Downs, a Fellow of the American College of Foot and Ankle Surgeons with offices in Chelmsford, MA,. “It’s a leading contributor to foot ulcers in people with diabetes.”

Burning, tingling and numbness in toes can also be symptoms of thyroid problems, nutritional deficiencies, back problems and pinched nerves in the ankles. In the United States, diabetes is the leading cause of peripheral neuropathy and can lead to further foot complications.

Out of the 23 million Americans with diabetes, one in four has not been diagnosed. Some people learn they have diabetes only after seeing a doctor for burning, tingling and numbness in their toes and feet. Many people already diagnosed with diabetes are not familiar with neuropathy’s symptoms. According to FootPhysicians.com, even diabetic patients who have excellent blood sugar control can develop diabetic neuropathy.

Medications can treat pain caused by neuropathy. However, nerve damage cannot be reversed.

“When you have diabetes, especially diabetic neuropathy, a minor cut on your foot can turn into a catastrophe,” says Dr. Downs. “The statistics on diabetic ulcers are sobering.”

Twenty percent of diabetes patients who develop ulcers will require an amputation. Patients who are black, Hispanic and Native American are twice as likely as whites to need a diabetes-related amputation. Half of all people with diabetes who have a toe or foot amputation die within three years. The annual cost for diabetic ulcer care in the U.S. is estimated at $5 billion.

For more information on foot problems such as diabetic peripheral neuropathy, contact Dr. Downs at www.nefootankle.com.

Changes in diet, including overindulging in certain foods and beverages, can cause gout attacks this time of year, says Jerold H. Fleishman, DPM, FACFAS. Dr. Fleishman is a member of the American College of Foot and Ankle Surgeons (ACFAS) with offices in Chelmsford, MA.

Gout attacks are extremely painful. They are caused when uric acid accumulates in the tissues or a joint and crystallizes. This most commonly occurs in the big toe joint. Dr. Fleishman explains this is because the toe is the coolest part of the body and uric acid is sensitive to temperature changes.

He says foods that are high in purines contribute to uric acid build-up. He recommends that people prone to gout attacks avoid purine-rich items such as shellfish (shrimp, crab, etc.), organ meats (kidney, liver, etc.), red meat, red wine and beer.

Gout can be treated with medications, diet changes, increasing consumption of appropriate fluids, and immobilizing the foot. In some cases surgery is required to remove the uric acid crystals and repair the joint.

For contact information visit www.nefootankle.com

With the observance of National Diabetes Month in November, Timothy M. Downs, DPM, FACFAS, a member of the American College of Foot and Ankle Surgeons with offices in Chelmsford, MA, reminds residents with diabetes that following simple foot care tips can reduce their risk of toe, foot or leg amputations.

People with diabetes are 10 times more likely to have a lower limb amputated than people without diabetes, according to the American Diabetes Association. Dr. Downs says the disease can cause poor blood circulation and nerve damage in the feet, making them vulnerable to developing ulcers, infections, deformities and brittle bones.

The ACFAS consumer Web site FootPhysicians.com provides these foot care tips for people with diabetes:

·    Inspect feet daily for injuries that could lead to dangerous ulcers.
·    Gently wash feet in lukewarm (not hot!) water.
·    Moisturize feet, avoiding the area between the toes.
·    Never trim corns or calluses; this can lead to serious infections.
·    Inspect the inside of shoes before wearing.

People with diabetes must always be vigilant, says Dr. Downs, and see a foot and ankle surgeon at the first sign of trouble. Early treatment can keep diabetic foot problems from progressing, and reduce the risk of amputations.

To contact Dr. Downs, www.nefootankle.com.

Jerold H. Fleishman, DPM, FACFAS says the ankle joint is vulnerable to serious injury from hard falls on ice.

“Ice accelerates the fall and often causes more severe trauma because the foot can go in any direction after slipping,” he says.

Dr. Fleishman is a member of the American College of Foot and Ankle Surgeons (ACFAS) with offices in Chelmsford, MA, and Newburyport, MA. He adds that in cases of less severe fractures and sprains, it’s possible to walk and mistakenly believe the injury doesn’t require medical treatment.

“Never assume the ability to walk means your ankle isn’t broken or badly sprained,” he says. “Putting weight on the injured joint can worsen the problem and lead to chronic instability, joint pain and arthritis later in life.”

Some people may fracture and sprain an ankle at the same time, and a bad sprain can mask the fracture.

“It’s best to have an injured ankle evaluated as soon as possible for proper diagnosis and treatment,” says Dr. Fleishman.  “If you can’t see a foot and ankle surgeon or visit the emergency room right away, follow the RICE technique – Rest, Ice, Compression and Elevation – until medical care is available.”

According to the ACFAS consumer Web site, FootPhysicans.com, even though symptoms of ankle sprains and fractures are similar, fractures are associated with:

·    Pain at the site of the fracture that can extend from the foot to the knee
·    Significant swelling
·    Blisters over the fracture site
·    Bruising soon after the injury
·    Bone protruding through the skin—a compound fracture, which requires immediate attention!

Most ankle fractures and some sprains are treated by immobilizing the joint in a cast or splint to foster union and healing.  However, surgery may be needed to repair fractures with significant malalignment to unite bone fragments and realign them properly.

Dr. Fleishman said newly designed surgical plates and screws allow repair of these injuries with less surgical trauma.

“With newer bone-fixation methods, there are smaller incisions to minimize tissue damage and bleeding and accelerate the healing process,” he says.

Dr. Fleishman recommends scheduling an appointment with his office if you have injured your ankle in any way.

“If you fall on an icy spot and hurt your ankle, the best advice is to seek medical attention immediately,” he says. ”This aids in early diagnosis and proper treatment of the ankle injury and reduces the risk of further damage.” For contact information please reach me at www.nefootankle.com.

These popular boots typically feature tall, spiked heels and narrow, pointed toes.

“Wearing high-heels makes you more unstable when walking or standing on dry surfaces, let alone slippery ones like ice or snow,” says Dr. Downs. “A stylish low-heeled winter boot is a lot more fashionable than a cast and crutches.”

Dr. Downs also recommends women scuff-up the soles of new boots, or purchase adhesive rubber soles, to provide greater traction.

Falls from high-heeled winter boots can lead to a number of injuries, depending on how the woman loses her balance. If her ankles roll inward or outward, she can break her ankles. If her ankle twists, ligaments can be stretched or torn, causing an ankle sprain. According to the American College of Foot and Ankle Surgeons consumer Web site, FootPhysicians.com, broken and sprained ankles can be present at the same time. Dr. Downs is one of 6,000 ACFAS members.

“This time of year I see a variety of broken bones occurring in patients who have slipped on the ice,” says Dr. Downs. “These include broken toes, metatarsals, heels and ankles.”

Dr. Downs urges women hurt from slips and falls in high-heeled winter boots to contact his office in nefootankle.com for prompt evaluation and treatment. In the meantime, immediately use the “R.I.C.E.” method – rest, ice, compression and elevation – to help reduce swelling, pain and further injury.

“Delaying treatment can result in long-term complications such as chronic ankle instability and pain, arthritis, or deformity,” says Dr. Downs. “Even if you’re able to walk on the injured foot, pain, swelling, or bruising indicates a serious injury.”

Toes and feet can take a beating, especially from sports.

Foot and ankle surgeon Jerold H. Fleishman, DPM, FACFAS, says he treats many soccer-playing children for ingrown toenails. He blames improper toenail trimming, snug soccer cleats and repetitive kicking for creating this painful problem.

“Many kids wear hand-me-down cleats that don’t fit,” says Dr. Fleishman. “Older children like tighter cleats. They believe it gives them a better feel for the ball and the field.”

Dr. Fleishman has offices in Chelmsford and Newburyport and is a member of the American College of Foot and Ankle Surgeons. He says there are steps soccer moms and dads can take to prevent their children from suffering a painful ingrown toenail. First, teach children how to trim their toenails properly. Trim toenails in a fairly straight line, and don’t cut them too short. Second, make sure cleats fit properly.

“A child’s shoe size can change within a single soccer season,” Dr. Fleishman reminds parents.

If a child develops a painful ingrown toenail, soaking their foot in room-temperature water and gently massaging the side of the nail fold can reduce the inflammation. But Dr. Fleishman warns parents against home treatments, which can be dangerous. The American College of Foot and Ankle Surgeons lists myths about ingrown toenail home treatments on its Web site, www.FootPhysicians.com.

“If your son’s or daughter’s ingrown toenails show signs of infection, it’s definitely time to seek medical care,” says Dr. Fleishman.

A foot and ankle surgeon like Dr. Fleishman can remove a child’s ingrown toenail, and prevent it from returning, with a simple, 10-minute surgical procedure. During the short procedure, the doctor numbs the toe and removes the ingrown portion of the nail. Various techniques can permanently remove part of a nail’s root too, preventing it from growing back.

“Most children experience very little pain afterwards,” says Dr. Fleishman, “and can resume normal activity the next day.”

For more information on ingrown toenails and other pediatric foot problems, contact Dr. Fleishman’s office at www.NEfootankle.com.

As they transition from open-toed sandals to closed-in boots and shoes, foot and ankle surgeon Timothy M. Downs, DPM, FACFAS says he notices more women seeking relief for painful bunions. Dr. Downs has offices in Chelmsford and Newburyport MA. He says this trend plays out in the examining rooms of many foot and ankle surgeons every autumn.

“Some of my female bunion patients are in agony,” says Dr. Downs. “They describe a constant, throbbing pain, even when they take their shoes off.”

While the changing weather brings more bunion patients into his office, Dr. Downs says some women inquire about surgery in the fall because they’re less busy than in summer months. Many are also closer to meeting their insurance deductibles.

Dr. Downs emphasizes that surgery is a last-resort treatment for women with painful bunions.

“For many women, simple changes like wearing shoes with wider toe boxes can significantly reduce bunion pain,” he says. “Custom shoe inserts, gel- or foam-filled padding and anti-inflammatory medications may also provide pain relief.”

When the pain of a bunion interferes with a woman’s daily activities, it’s time to discuss surgical options, according to the American College of Foot and Ankle Surgeons.

The College provides answers to frequently asked questions about bunion surgery on its Web site, FootPhysicians.com.

Dr. Downs can be contacted at (978) 441-9241.

“Hikers, hunters and others who love the outdoors often don’t realize how strenuous it can be to withstand constant, vigorous walking on uneven terrain,” said Jerold H. Fleishman, DPM, FACFAS , a member of the American College of Foot and Ankle Surgeons (ACFAS). “Lax physical conditioning and inappropriate footwear bring scores of outdoor enthusiasts into our office each fall for treatment of foot and ankle problems such as chronic heel pain, ankle sprains, Achilles tendonitis, fungal infections and severe blisters.”

“Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven’t conditioned properly before hitting the trail,” said Dr Fleishman. “Also, many don’t realize that cross-training athletic shoes aren’t the best choice for extended hiking and hunting. Had some of my patients worn sturdy, well constructed hiking boots, they wouldn’t have suffered sprained ankles or strained Achilles tendons.

”Dr Fleishman advises hikers and hunters to make the investment in top-quality hiking boots. He said strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. “The supportive shank decreases strain on the arch by allowing the boot to distribute impact as the foot moves forward. So if a boot bends in the middle, don’t buy it.”

In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections and frostbite. Dr Fleishman recommends synthetic socks as the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable. “Wool lets moisture evaporate more readily than cotton, so fewer blisters develop,” He added.

What happens if your feet or ankles hurt during a hike or hunt? Dr Fleishman said pain usually occurs from overuse, even from just walking. “If you’re not accustomed to walking on sloped or uneven ground, your legs and feet will get tired and cause muscles and tendons to ache,” He explained. “To avoid a serious injury, such as a severe ankle sprain or an Achilles tendon rupture, rest for awhile if you start hurting.”

According to the ACFAS consumer website, www.FootPhysicians.com, pain is a warning sign that something is wrong. “Serious injury risk escalates significantly if you continue hiking in pain.” He likened hiking to skiing, in that beginners should take on less difficult trails until they become better conditioned and more confident.

Evaluation by a foot and ankle surgeon is recommended if there is persistent pain following a hiking or hunting outing. “I’m most concerned about ankle instability and strained Achilles tendons. Inattention to these problems at their early stages may lead to a serious injury that will keep you off the trails for a long time,” Dr Fleishman said.

Hikers and hunters seeking further information about ankle sprains, Achilles tendon injuries and other foot and ankle problems may contact Dr Fleishman at (978) 441-9241.

“Kids will play with lingering, nagging heel pain that, upon testing, turns out to be a stress fracture that neither they, their parents nor their coaches were aware of,” he said.  “By playing with pain, they can’t give their team 100 percent and make their injuries worse, which prolongs their time out of soccer.”

Dr. Downs said he has actually had to show parents x-rays of fractures before they’ll take their kids out of the game. “And stress fractures can be subtle – they don’t always show up on initial x-rays.”

Symptoms of stress fractures include pain during normal activity and when touching the area, and swelling without bruising. Treatment usually involves rest and sometimes casting.  Some stress fractures heal poorly and often require surgery, such as a break in the elongated bone near the little toe, known as a Jones fracture.

“Soccer is a very popular sport in our community, but the constant running associated with it places excessive stress on a developing foot,” Dr. Downs said.  He added that pain from overuse usually stems from inflammation, such as around the growth plate of the heel bone, more so than a stress fracture. “Their growth plates are still open and bones are still growing and maturing – until they’re about 13 to 16.  Rest and, in some cases, immobilization of the foot should relieve that inflammation,” Dr. Downs said.

Other types of overuse injuries are Achilles tendonitis and plantar fasciitis (heel pain caused by inflammation of the tissue extending from the heel to the toes).

Quick, out-of-nowhere ankle sprains are also common to soccer. “Ankle sprains should be evaluated by a physician to assess the extent of the injury,” said Dr. Downs. “If the ankle stays swollen for days and is painful to walk or even stand on, it could be a fracture.”

Collisions between soccer players take their toll on toes. “When two feet are coming at the ball simultaneously, that ball turns into cement block and goes nowhere. The weakest point in that transaction is usually a foot, with broken toes the outcome,” he explained. “The toes swell up so much the player can’t get a shoe on, which is a good sign for young athletes and their parents:  If they are having trouble just getting a shoe on, they shouldn’t play.”

To contact Dr. Downs’ office:
Chelmsford Podiatry Office: (978) 441-9241
or Newburyport Podiatry Office: (978) 463-0086