Crossover toe is a common foot problem that can inhibit physical activity for older Americans, but outpatient surgery can correct the deformity and keep senior citizens active and on their feet.

Individuals with hammertoes, bunions or a second toe that extends beyond the big toe are most susceptible to developing crossover toe as they age, according to Daniel Michaels DPM, MS, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS). 

“It’s a common problem among older people in which the second toe gradually moves across the big toe," He says. "It can be painful and, therefore, difficult to walk comfortably or pursue an active lifestyle.”

Dr. Michaels says the first symptom of crossover toe is pain in the ball of the foot. A tear in the joint makes the second toe unstable. It falls out of alignment and eventually drifts.

Doctors normally check the ball of the foot for a possible plantar-plate tear when an older patient complains of pain in the area. Dr. Michaels says pre-existing forefoot problems combined with normal wear and tear or possible trauma can cause the plate to tear over time.

“If the pain persists and the toe starts to drift, surgery is recommended to suture the plantar plate or replace it through a tendon-transfer,” He says.

Surgery to correct crossover toe is an outpatient procedure performed with a local anesthesia.  Patients with bunions or hammertoes are advised to have those deformities corrected during the surgery. Recovery time is about six weeks.

"If you're an older adult with persistent pain in the ball of your foot, it's in your best interest to see a doctor," says Dr. Michaels. "If your foot hurts, you aren't exercising, and your cardiovascular health nosedives."

For further information about foot or ankle conditions, contact Dr. Michaels and the Reconstructive Foot & Ankle Institute, LLC at www.rfainstitute.com or make an appointment with one of our offices in Maryland:

Hagerstown 301.797.8554 (877.797.FOOT), 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014 (866.338.FOOT), 2100 Old Farm Drive, Suite D, 21702

Doctor urges sunscreen use and exams to prevent skin cancer on feet

When at the pool or lake we all lather up with sun screen to protect our skin from the harmful rays of the sun. But do we remember to apply sunscreen to our feet?

Many don’t realize skin cancer can occur on the feet from unprotected sun exposure, and overlook applying sunscreen to the area. But, Daniel D. Michaels, DPM, MS, FACFAS warns skin cancer of the foot is prevalent and can even be fatal if not caught early.

While all types of skin cancer, including squamous cell and basal cell carcinoma, can be found on the foot, the most common is the most serious form, melanoma. Symptoms can be as subtle as an abnormal-looking mole or freckle found anywhere on the foot, and often go unnoticed without routine foot exams.

According to foot and ankle surgeon Dr. Michaels, early diagnosis is key to effective treatment for the condition. But because people aren’t looking for the early warning signs or taking the same precautions they do for other areas of the body, often times skin cancer in this region is not diagnosed until later stages.

“I advise my patients to regularly inspect their feet, including the soles, in between their toes and even under their toenails, for any changing moles or spots and to have any suspicious areas promptly examined by a foot and ankle specialist,” Dr. Michaels explains. 

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554 (877.797.FOOT), 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014 (866.338.FOOT), 2100 Old Farm Drive, Suite D, 21702

Both long-distance runners and casual joggers can improve their performance by keeping their feet in top condition and taking steps to control foot problems common in runners, according to a Frederick/Hagerstown foot and ankle surgeon.

"The human foot is a biological masterpiece that amazingly endures the stresses of daily activity," says Dr. Daniel D. Michaels, DPM, MS, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS). "For runners, the feet are more vulnerable to injury than any other part of the body, and these athletes should be on the alert for signs of foot problems that can slow them down if not treated promptly."

Dr. Michaels says the most common complaint from runners is heel pain. This condition, also called plantar fasciitis, is frequently caused by inflammation of the ligament that holds up the arch.

"In athletes, heel pain can result from faulty mechanics and overpronation in which pressure is unequally applied to the inside of the foot. It also can be caused by wearing running shoes that are worn out or too soft," He explains.

At the first sign of heel pain, Dr. Michaels recommends runners do stretching exercises, wear sturdier shoes and use arch supports. In some cases, icing and anti-inflammatory drugs, such as ibuprofen, are helpful. Should heel pain continue, custom orthotics, injections and physical therapy might be required. Surgery normally isn’t considered unless heel pain persists for more than a year and conservative treatment has failed to bring relief.

Neuromas and tendonitis are other common foot problems that affect runners. A neuroma is a pinched nerve between the toes that can cause pain, numbness and a burning sensation in the ball of the foot. Overly flexible shoes often are the cause and padding, orthotics or injections usually are effective. Sometimes surgery is the answer if pain between the toes continues for more than six months

Serious runners can be sidelined with tendonitis if they ignore the warning signs of this overuse-related condition.

"There are several forms of tendonitis that affect the Achilles and other areas, and all are treated with rest, icing, stretching and anti-inflammatory medications, and sometimes with orthotics and physical therapy."  "Over-zealous training usually causes tendonitis, especially among beginners who try to do too much too soon."

A common myth among athletes, according to Dr. Michaels, is that it’s not possible to walk or run if a bone in the foot is fractured.

"I often hear surprised patients say ‘It can’t be broken, I can walk on it,’" He says. "That’s dead wrong, especially with stress fractures when pain and swelling might not occur for a few days."

If a fracture or sprain is suspected, Dr. Michaels advises runners to remember the word RICE as an abbreviation for Rest-Ice-Compression-Elevation.

"If pain and swelling continues after following the RICE procedure for three or four days, you should see a foot and ankle surgeon for an x-ray and proper diagnosis."

Other common foot ailments runners should watch for are:

Athlete’s Foot: This fungal skin disorder causes dry, cracking skin between the toes, itching, inflammation and blisters. It can be prevented and controlled by washing the feet regularly and carefully drying between the toes; switching running shoes every other day to allow them to dry; wearing socks made with synthetic material instead of cotton; and applying over-the-counter ointments.

Toenail Problems: Ingrown nails can cause inflammation and possible infection and usually are treated by cutting the corner of the nail with sterile clippers. Black toenails happen when a blood blister forms under the nail from trauma, and it’s best to let the nail fall off by itself. Fungal toenails are yellow, brown or black and sometimes are irregularly shaped and thick. They are best treated with oral anti-fungal medications.

Foot Odor: There are more than 250,000 sweat glands in the foot and daily hygene plus regular changing of shoes and socks are best for controlling sweat and odor. Runners should avoid wearing cotton socks and running without socks. Foot powders, aerosols antiperspirants and vinegar soaks also are helpful.

Blisters, corns and calluses: Never pop blisters unless they are larger than a quarter or are painful or swollen. Use a sterile instrument to lance the corner, leave the top as a biological dressing, wash, apply antibiotic ointment, and cover with a Band-aid. Corns and calluses are caused by repeated friction, and should be treated by aseptically trimming the dead skin and eliminating the underlying cause.

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554 (877.797.FOOT), 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014 (866.338.FOOT), 2100 Old Farm Drive, Suite D, 21702

Hagerstown, Frederick Maryland foot and ankle surgeon has a message for Baby Boomers getting back into fitness and sports: Get your ankles checked for chronic instability caused by injuries that might not have healed properly years ago.

Daniel Michaels, DPM, MS, FACFAS, says many Boomers who have suffered ankle sprains in their younger years could be at risk for more serious damage as they age and try to stay active. It is estimated that one in four sports injuries involves the foot or ankle, and a majority of them occur from incomplete rehabilitation of earlier injuries.

“Pain isn't normal in the ankle, even if you're just getting back into shape," says Dr. Michaels.

He says swelling is another symptom these previously-injured Boomers may experience. Both amateur and professional athletes often misunderstand how serious a sprain can be, and they rush back into action without taking time to rehabilitate the injury properly. 

“A sprain that happened years ago can leave residual weakness that isn’t noticed in normal daily activity, but subjecting the ankle to rigorous physical activity can further damage improperly healed ligaments, and cause persistent pain and swelling,” He said.

“For anyone hoping to regain past athletic fitness, it’s recommended that you have that old ankle injury checked out before becoming active again.”

Some sprains are severe enough to strain or tear the tendons on the outside of the ankle, called the peroneal tendons.  Research shows that more than 85 percent of athletes who had surgery to repair a torn peroneal tendon were able to return to full sporting activity within three months after the procedure.   

“Peroneal tendon tears are an overlooked cause of lateral ankle pain,” said Dr. Michaels. “Although surgery for athletically active patients shouldn’t be taken lightly, surgical repair of the peroneal tendons is proving to be very successful in helping athletes with serious ankle problems return to full activity.”

Dr. Michaels added that persistent pain and tenderness after a sprain, especially if the individual felt a ‘pop’ on the outside of the ankle and couldn’t stand tiptoe, might be a warning sign that the tendon is torn or split.  The injury is best diagnosed with an MRI exam. 

For further information about foot or ankle conditions, contact Dr. Michaels and the Reconstructive Foot & Ankle Institute, LLC at www.rfainstitute.com or make an appointment with one of our offices in Maryland:

Hagerstown 301.797.8554 (877.797.FOOT), 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014 (866.338.FOOT), 2100 Old Farm Drive, Suite D, 21702

Each year we make a list of resolutions on New Year’s Day and by the spring, most of us have watched those same resolutions go by the wayside. If you’re one of the few who are still on track with your list, kudos to you. But for those of us who put exercise on our list in January, but have yet to live up to our commitment, here are some tips to get back on track.

 It’s a good idea to use this new season as an excuse to update your walking or running shoes. A new pair of shoes can often be just the incentive you need to get an exercise

routine started. If you’re new to walking or running, you will want to take it slowly at first and build up your stamina and endurance.

Walking is great exercise and you can rapidly increase your mileage and see results quickly. A podiatric physician is a great resource for suggestions about the best walking or running shoes.

At your next appointment, make sure to ask for his or her suggestions.  If you’re having foot pain when exercising, mention this to Dr. Michaels who can recommend solutions that will alleviate your pain and get you back into your exercise routine.  One common mistake often made by beginners is to leave out the stretching before and after exercise. Easy stretches prior to walking or running and a good five minutes of more rigorous stretches after exercise helps alleviate pain on the first day and on all subsequent days as well. Often, stretching can even help you to avoid injury. Common injuries that may be avoided are shin splints, ankle sprains and Achilles tendon pulls.

Find a buddy who has similar goals for exercise. On those days where you “just don’t feel up to it,” your buddy can give you motivation and get you back on the road. You can be the motivator for your buddy as well. Setting goals (such as walking four days each week) can also motivate you to keep up the good work.  Talk up your exercise routine. Once you tell your friends and family about your goals, you have more people to be accountable to and you can laud your successes every time you see them. The more people who know how hard you’re working, the more support you’ll get. Keep up the good work!

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702