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, 1150 Professional Court, Suite C, 21740

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

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, 1150 Professional Court, Suite C, 21740

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

"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, 1150 Professional Court, Suite C, 21740

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

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, 1150 Professional Court, Suite C, 21740

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

 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

Surgeon Urges Prompt Treatment for Growth Plate Injuries

Indoors and outdoors, youth athletes stay active year-round in competitive sports, and for many of them heel pain has become “just another part of the game.” Foot and ankle surgeon, Daniel D. Michaels, DPM, MS, FACFAS, advises that when a child complains of heel pain, it should be diagnosed promptly because it may be a warning sign of a serious foot problem.  

Dr. Michaels says heel pain occurs frequently in children ages 6 to 14 as their feet grow and the heel bone develops. “As children become more active in sports they increase their risk for growth-plate injuries and subsequent heel pain,” says Dr. Michaels. This is especially true at back-to-school time when surgeons see an increase in middle and high school athletes experiencing heel pain with football and soccer seasons simultaneously underway.  

“New bone forms in an area behind the heel, known as the growth plate, and cartilage is vulnerable to severe inflammation from strain or stress. With repeated stresses and strains from overactivity, the heel becomes very painful,” Dr. Michaels explains.

Even though growth-plate trauma is the leading cause of heel pain in young people, Dr. Michaels says the condition can be difficult to diagnose. He cautions that parents should be concerned if a child has pain in the back or bottom of the heel, limps, walks on the toes, or seems to have difficulty participating in normal recreational activities. The condition is diagnosed by a thorough examination of the child’s feet and legs and possibly medical imaging tests to rule out other serious causes of heel pain, such as bursitis, tendonitis and fractures.

In most cases, mild or moderate heel pain can be treated successfully with shoe inserts to soften the impact on the heel, anti-inflammatory medications, stretching and physical therapy. In severe cases, the foot and ankle will be immobilized in a cast and, in some instances, surgery may be necessary.

Heel pain in young people often returns after treatment because the growth plate is still forming until the age of 14 or 15. However, the risk for recurrence can be lowered by choosing well-constructed shoes with good support and restricting use of spiked athletic shoes, especially on hard fields. It also is advised that young athletes avoid competition that exceeds their physical abilities.

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

Athletes and parents should monitor seemingly ‘normal’ foot and ankle pain

Many adult, adolescent and child athletes are playing with seemingly normal but persistent foot pain that could be a sign of a more serious injury, according to Dr. Daniel Michaels, DPM, MS, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS).

"Playing with pain often is viewed as a badge of honor among athletes, but they must be aware that the persistent pain they dismiss as normal exercise-related stress could be something far more serious," said Dr. Michaels, whose office is in Frederick and Hagerstown.

Dr. Michaels said athletes of all ages visit his office with foot pain due to overuse injuries from repetitive loading of the foot and ankle during running and aerobics. "When athletes overdo their workouts, it may be normal to experience some temporary discomfort," said Dr. Michaels. "But if pain continues longer than a few days with continued redness, warmth or swelling, the athlete should see a podiatric foot and ankle surgeon for proper diagnosis and advice on treatment options."

Athletes who ignore persistent foot pain and inflammation and continue to train risk potential complications that could sideline them for months. Among possible injuries associated with persistent foot and ankle pain are stress fractures, muscle strains, tendonitis and subtle fractures after inversion ankle sprains.

"Stress fractures sometimes aren’t debilitating and some athletes might continue their normal training despite the injury," said Dr. Michaels. "But continual rigorous activity can worsen the problem. An examination and diagnosis by a foot specialist can determine whether the pain is from overuse or subtle trauma, requiring only a few days of rest, or something that may require surgical intervention."

Heel pain in children often is caused by injuries to the growth plate and secondary growth centers in which tendons pull at the top and bottom of the growth plate of the heel. Boys and girls ages 8 to 14 are susceptible to this problem, and its major symptom is pain on either side of the heel.

"Growth-plate trauma is common in soccer and other sports that involve a lot of running," said Dr. Michaels. "Parents should make sure that their children stretch before playing and apply ice to the back of the heel after the game or practice. In some cases, anti-inflammatory drugs and shoe inserts or lifts are recommended, but the potential for recurrent injury exists until the growth plate closes," he explained.

Foot and ankle surgeons provide many forms of treatment to keep children pain free and participating in sports activities. When treating athletes of any age, they will evaluate several factors that could be the underlying cause of foot pain. They include:

Running or playing surfaces: Athletes who train on asphalt or cement are more prone to stress injuries than those who run on cushioned tracks or natural grass fields.

Shoes: Footwear should be appropriate for the sport and match the biomechanics of the individual’s foot. For example, those who engage in one sport more than three times a week should wear athletic shoes designed for the sport, and shoe technology has advanced to allow for variances in foot characteristics that require stability cushioning.

Training: Injuries often result when athletes fail to build up to a desired training goal. Accordingly, a runner shouldn’t set a goal of 20 miles a week without gradually progressing to that goal.

Behavioral factors: In children, overuse injuries sometimes occur from excessive parental pressure to achieve in sports.

Nutrition: Stress fractures can occur in athletes with poor nutritional habits.

Over-training: Sleeping problems and resultant irritability and fatigue are common among some athletes who exercise aggressively.

Physical characteristics: Variations in bone structure and muscle development are evidenced in individuals who are bowlegged or have malalignment problems.

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, 1150 Professional Court, Suite C, 21740

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

Active women who enjoy running, especially those with flat feet, are prone to develop neuromas.  A nerve located between the toes becomes enlarged and inflamed and produces tingling, burning pain.

Daniel D. Michaels, DPM, MS, FACFAS, is a member of the American College of Foot and Ankle Surgeons (ACFAS). He says the symptoms begin gradually and, left untreated, progressively worsen.

“We see neuromas quite often in younger professional women who wear high heels every day at work and also are active runners,” says Dr. Michaels. “It’s a very stressful combination for their feet.” 

Dr. Michaels explains that neuromas enlarge as the condition progresses, causing pain and numbness to a consistent area at the base of the toes. Patients often complain it feels as if something is stuck inside the ball of the foot. The symptoms may go away temporarily by massaging the foot, wearing wider shoes with low heels, and avoiding running and other activities that aggravate the condition.

“Symptoms become more intense as the nerve enlarges and the temporary damage becomes permanent, so it’s best to seek treatment if discomfort persists for more than a few days,” Dr. Michaels says.

Neuromas can develop in different areas of the foot. The most common occurrence is called Morton’s neuroma, which develops at the base of the third and fourth toes.  Thickening and swelling of the nerve usually is caused by compression and irritation from wearing very narrow shoes or high heels that crunch the toes in the front of the shoe. In addition, neuromas can result from running, racquet sports and other physical activities that exert repetitive stress on the forefoot.

A neuroma isn’t detectable by x-ray, so the diagnosis is based on symptoms and a physical examination to palpate the nerve or a maneuver that elicits an audible click.    

Treatment options for Morton’s neuroma depend on how far the condition has progressed. At early stages, padding lessens pressure on the nerve, icing reduces swelling, over-the-counter anti-inflammatory medications decrease pain and inflammation, and prescription or custom orthotic devices provide support to reduce compression. Patients also are advised to wear wider shoes with low heels and take a break from running or other activities until the condition improves.

If these conservative treatments don’t help then injecting the neuroma with alcohol and utilizing digital diagnostic ultrasound needle guidance can relieve the pain in the vast majority of patients.  It may take between 6-10 injections, sometimes as little as 1-2 to get complete relief.

In severe cases, surgery might be the best option to provide relief.

“Surgery for neuromas has a very high success rate,” said Dr. Michaels. 

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

“Oh my aching feet” is a phrase you hear often from pregnant women. But, are sore feet a symptom they just must deal with during pregnancy? According to Frederick And Hagerstown foot and ankle surgeon Daniel D. Michaels, DPM, MS, FACFAS the answer is “no.” There are many remedies available to help alleviate foot pain.

Dr. Michaels states women often experience foot pain during pregnancy because of increased weight, foot instability and swelling.  “In the last five years, I’ve seen an increase in pregnant women with foot pain because more women than ever before are active, even running marathons, during their pregnancies,” Dr. Michaels says. He recommends the following guidelines 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 occurs due to 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.

Foot Cramps—These painful cramps are caused by increased blood volume and high progesterone levels brought on by pregnancy. To prevent cramps, increase circulation by rotating ankles and elevating feet while sitting. If cramps persist, try a walk around the block and include daily stretching of the calf muscles. 

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 with a foot and ankle surgeon.

It is also not uncommon for women to experience a change in their foot size during pregnancy. “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,” Dr. Michaels adds.

Pregnancy and pending motherhood should be a joy. If foot pain persists, call Dr. Michaels. 

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

Treatment and prevention of adult flatfoot can reduce the incidence of additional foot problems such as bunions, hammertoes, arthritis and calluses, and improve a person’s overall health

Overweight males in white-collar jobs are most apt to suffer from adult flatfoot disorder, a progressive condition characterized by partial or total collapse of the arch, according to the research. Symptoms of adult flatfoot include pain, swelling, flattening of the arch and an inward rolling of the ankle. But because flatfoot is a progressive disorder by nature, the study suggests that neglecting treatment or preventive care can lead to arthritis, loss of function of the foot and other painful foot disorders.

“Flatfoot disorder may gradually worsen to the point that many of the tendons and ligaments in the foot and ankle are simply overworking, often to the point where they tear and/or rupture,” says Frederick/Hagerstown, Maryland foot and ankle surgeon Daniel D. Michaels, DPM, MS, FACFAS

In many cases, flatfoot can be treated with non-surgical approaches including orthotic devices or bracing, immobilization, physical therapy, medication and shoe modifications. “In some patients whose pain is not adequately relieved by conservative treatments, there are a variety of surgical techniques available to correct flatfoot and improve foot function,” Dr. Michaels added.

“As in most progressive foot disorders, early treatment for flatfoot disorder is also the patient’s best route for optimal success in controlling symptoms and additional damage to the feet,” continued Michaels. “The goal is to keep patients active, healthy and as pain free as possible.”

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

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. Michaels 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 Reconstructive Foot & Ankle Institute, LLC consumer Web site www.rfainstitute.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. Michaels.  They should 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.

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

After wearing flip-flops all summer, students head back to school with painful feet

The sounds of back to school season include the ringing of school bells and cash registers, the slamming of locker doors, the noisy ruckus of school hallways and cafeterias, and the moans and groans of students over tests, homework, relationships, and increasingly, their aching feet.

Flip-flops are the summer footwear of choice for many students. But while these sandals are inexpensive and stylish, they don’t cushion or support the foot, leading to problems. After wearing flip-flops all summer, some students will head back to school this fall with foot pain and even injuries. Dr. Daniel D. Michaels, DPM, MS, FACFAS, a foot and ankle surgeon with offices in Frederick and Hagerstown, Maryland, reminds parents and students that foot pain isn’t normal and can be reduced or eliminated.

“People may not realize that even into your mid-teens, there’s new bone growing in your heel,” says Dr. Michaels. “Flip-flops don’t cushion the heel, so repetitive stress from walking can inflame that heel bone growth area and cause pain and tenderness.”

Heel pain and arch pain rank among the most common complaints among students who wear flip-flops. Other flip-flop feet problems students can take back to school include inflammation of the Achilles tendon, painful pinched nerves, sprained ankles, broken or sprained toes, cuts and scrapes, plantar warts, Athlete’s foot, and callus build-up on the heels and toes.

Foot and ankle surgeons can usually reduce or eliminate students’ foot pain with simple treatment methods including stretching exercises, ice massage, anti-inflammatory medications, and custom or over-the-counter shoe inserts.

Back to school season will always be painful for some students, but it doesn’t need to involve foot pain.

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

Diabetes patients urged to take simple precautions to help save their feet

Taking a minute or two every day to inspect your feet and observing a few simple rules can make the difference in sparing diabetes patients from a preventable outcome of the disease – a foot amputation.

“Of all diabetes-related complications, a serious foot ulcer and subsequent amputation might be the most preventable with proper care and vigilance in checking the feet at least once a day for small cuts and other abrasions,” says Dr. Daniel Michaels, DPM, MS, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS).  “Even those with good control of their blood sugar can experience foot ulcers, especially if neuropathy, a frequent diabetes complication, has caused decreased feeling on the bottom of their feet.”

Loss of sensation inhibits the body’s normal pain response. As a result, walking can apply repetitive, unfelt pressure to a wound, making it larger and deeper. Left untreated, diabetic ulcers lead to serious infections, which may result in amputation. 

Dr. Michaels says foot and ankle surgeons use a variety of surgical and non-surgical methods to heal diabetic ulcers, but stressed early intervention yields the most favorable outcomes.

“Daily self exams are the best protection. Too often, patients fail to check their feet for small cuts or punctures that over time will ulcerate and become infected,” He says. “If you have diabetes and see anything suspicious on your feet, consult a foot and ankle surgeon for diagnosis and treatment. Even a few days can make a difference in preventing serious foot problems from developing.”

An estimated seven in 10 diabetes patients have nerve damage that impairs feeling in their feet. Fifteen percent eventually will develop a foot ulcer. Among those with ulcers, one in four will lose a foot. Each year more than 86,000 amputations are performed as a direct result of diabetes, and studies show half of those who have one foot or leg amputated will lose the other within five years. Proper diabetic foot care, says Dr. Michaels, prevents foot loss.

In some cases, amputation might be the preferred option. If vascular and podiatric surgeries can’t improve blood circulation and foot function, resolve infection or restore foot function, amputation may be the only solution that enables the patient to heal. Today, advances in prosthetics make it possible for patients to return to an active lifestyle, a necessity for keeping diabetes under control.

Foot problems are not an inevitable consequence of diabetes. The risk can be lessened significantly by following a few simple precautions:

• Keep your blood sugar under control to help minimize cardiovascular and blood circulation problems
• Lose weight, don’t smoke and adhere to prescribed dietary, medication and exercise regim   At least once a day, examine your feet for cuts and other small wounds you may not feel
• Never walk barefoot, outdoors and indoors
• Cut nails carefully – straight across and not too short; never trim corns and calluses yourself
• Wash your feet every day in lukewarm water; dry carefully
• Choose comfortable shoes with adequate room for the toes
• Wear clean, dry, non-bulky socks; change daily
• Shake pebbles or bits of gravel out of your shoes before wearing  
• Seek treatment from a foot and ankle surgeon if minor cuts and sore spots don’t seem to be healing

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, 2170

Diabetic patients frustrated by hard-to-heal, infection-prone ulcers on their feet could benefit from a common, minimally invasive surgical procedure to relieve tightness in their Achilles tendons, says a local foot and ankle surgeon. 

The Achilles is the largest tendon in the human body, connecting the calf muscles to the heel bone.  As we age, the tendon naturally tightens.  However, diabetes exacerbates the process as increased blood sugar levels deposit glucose in the collagen of the tendon, greatly reducing its elasticity and making stretching almost impossible. 

“A tight Achilles inhibits ankle movement, forcing diabetic patients to place excessive pressure on the front of the foot,” said Dr. Daniel D. Michaels, DPM, MS, FACFAS, a member of the American College of Foot and Ankle Surgeons (ACFAS). “Pressure normally absorbed by the ankle has to go somewhere else and the forefoot gets most of it, heightening the risk for ulcer development underneath the toe joints.” 

Foot sores or ulcers are a common complication of diabetes.  They result from sensation loss or neuropathy, which deprives diabetes patients of their ability to feel pressure or pain in the lower extremities.  Therefore, according to the ACFAS consumer website, FootPhysicians.com, even the slightest cut, blister or wound can develop into a diabetic foot ulcer.  Such wounds can cause tissue and bone infections and can result in loss of a toe, a foot, a leg or even a life. 

Dr. Michaels said published research has shown that surgery to lengthen the Achilles tendon in a diabetes patient can help prevent ulcer recurrence.  “Our goal always is to close the wound as quickly as possible to avoid infection, and we’re becoming more aware that preventing ulcer recurrence in patients with advanced diabetes is best achieved by a minimally invasive procedure to lengthen a tight Achilles tendon,” He said. 

Lengthening occurs by making three small, pinpoint cuts to loosen and stretch the tendon.  This helps restore ankle flexibility and relieves forefoot pressure.  The procedure allows diabetes patients who keep their blood sugar under control to walk more normally and may lower their risk for redeveloping foot ulcers. 

“I have seen diabetic patients whose foot ulcers heal, yet continue to recur because the untreated Achilles tendon problem is the root cause,” said Dr. Michaels.  He advises diabetic patients who have developed foot ulcers to schedule an appointment with His office to determine if Achilles tendons surgery is appropriate for them. 

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

Some high heels can be healthier for your feet than flats.  For people who have excess pronation which is a condition that causes the foot to flatten and can lead to heel pain, knee and lower back pain, the solution can be a shoe with a slight heel.  Ballet flats can increase pronation as it stretches out the calf muscle causing the foot to buckle or flatten. Further, the flimsy shoe construction allows the foot to collapse and doesn’t support the arch.

When shopping for stilettos make sure the heels are of moderate proportions, not the towering Lady GaGa variety.  Save those for dinner dates where you will be sitting.

Purchase a well-constructed “quality” shoe, especially those that have shock absorbing materials in the ball of the foot.  Also, only wear your highest heels for only short periods of time and if you want to wear these high heeled shoes daily then take another pair of more comfortable shoes to get form and to work.  Wear your higher heeled shoes while sitting at your desk.

The higher the heel the more weight is shifted to the front of your foot so you can beat this trick by choosing a shoe that fits the contour of your foot so the weight is shifted to the entire surface of the foot not just the ball of the foot.  

Zumba participants get lots of exercise but have orthopedic problems as time goes on possibly.  Some injuries that have been reported are compartment syndrome in the heel which is usually caused by trauma crushing injuries like auto accidents.

Others have noticed hip problems such as snapping hip syndrome from a salsa movement in the Zumba class. Over 12 million people worldwide now do the cardio dance Zumba. 

Other injuries include ankle sprains as there are a lot of lateral moves and stress fractures are also common.  Most people have these problems because Zumba is fun and they tend to do it all the time, kind of too much too fast.  

To prevent these injuries work on a low impact exercise at first to tone and strengthen the body and then as you lose some of the weight start increasing the impact intensity.   The body usually takes about 6 months to go from a sedentary life style to being able to withstand high impact exercise.  

Did you know that nearly half of all frostbite cases involve the foot and ankle? That’s a  staggering figure, but avoiding frostbite and treating it quickly are both important lessons we can learn.

According to Dr. Dan Michaels with the Reconstructive Foot & Ankle Institute, LLC, the most effective way of dealing with frostbite is to prevent it from occurring in the first place. If you know you will be exposed to the cold weather, following these tips can literally save your toes:

• Drink plenty of water, avoid alcohol, and dress appropriately.

• If you begin to feel pain, numbness, or tingling in your feet, get out of the cold as soon as possible.

• Seek professional help as soon as possible from your podiatric physician for any foot- or ankle-related concerns.  Prolonged exposure to extremely cold temperatures can lead to severe injury if proper treatment is not provided in a timely manner.

Signs and symptoms of frostbite include:

• Pain or prickling progressing to numbness

• Pale, hard, and cold skin with waxy appearance

• Flushing due to blood rushing to area after it's re-warmed

• Burning sensation and swelling from collected fluid that may last for weeks

• Blisters

• Black scab-like crust, which may develop several weeks later Mild frostbite is treated by re-warming the affected area, washing it with an antiseptic, and applying a sterile dressing. If medical care is not available immediately, seek shelter and re-warm a mildly

frostbitten area in warm water (101° to 104° F) or by repeatedly applying warm cloths to the area for 30 minutes. Never use hot water, fire, a heating pad, or other dry heat because these methods may burn the skin before the feeling returns.  Frostbite is a very serious injury that can involve significant damage to the feet. In severe cases, surgery may even be necessary, depending on the depth and extent of tissue damage. Therefore,

prompt diagnosis and proper treatment by the Reconstructive Foot & Ankle Institute, LLC is essential.

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.comor 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

Skiing and Your Feet

Shush, shush, shush. That’s not the sound of a teacher asking the kids to be quiet—it’s the sound of your skis pushing through fresh powder as you head down the slopes. As with most other sports, you need to keep close attention to your feet when choosing ski boots and when preparing your feet for skiing. 

Every pair of feet is different, and boot manufacturers design ski boots to fit a variety of feet. When choosing ski boots for either buying or renting, it’s important to remember that the boots need to be comfortable. It is best to have a professional work with you to fit your boots. Try to find a technician who is familiar with foot types and boot lasts. This will ensure that you choose the right boot for your foot and for your ability.  Since ski boots do not allow normal gait and limit the flexion at the ankle, the orthotics that you wear every day are not  appropriate for insertion into your ski boots. Special orthotics for skiing can be designed and developed by a podiatric physician, when necessary. When purchasing new boots, you will need to bring those boots to the Reconstructive Foot & Ankle Institute, LLC so that your foot can be evaluated with the boot. 

If you want to ensure that your feet stay comfortable and warm as you manage the moguls, consider purchasing toe heaters. The heaters have a small disk that can be placed in the sock or under an orthotic. Combined with a rechargeable battery pack, these heaters can provide a heat source throughout the day.  Finally, the socks you choose can make the difference in how long you’re able to tolerate the temperatures. When your feet are dry, they feel warmer. Look for socks with wicking ability.

Tips for Snowboarding

Since boots for snowboarding differ from ski boots, here are a

few tips to keep in mind when purchasing or renting snowboard

boots.

• In snowboarding, the heel drives everything. So a snug, firm fit is important. A boot that is too loose is a safety hazard. The heel should be stable in all directions in order to ensure maximum performance.

• To determine a proper fit when trying on a snowboard boot, you must completely lace the boot and stand up in it. This will allow the heel to settle back into the boot.

• Try on your boots while wearing a thin synthetic sock. Wearing a sock that is too heavy will prevent a proper fit. Synthetic socks are preferred to control moisture as well as prevent friction. 

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

Because diabetes is a systemic disease affecting many different parts of the body, the ideal case management requires a team approach. Your podiatric physician is an integral part of that team, and he or she can be one key to your health management.  Therefore, routine foot screenings by a podiatrist should be standard for all patients with diabetes and those at risk as well.

No one knows exactly how or why people develop diabetes, but once diagnosed, the disease is usually present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing the disease. What we do know for sure is that the incidence of diabetes in the U.S. is increasing at a staggering rate. We also know that some populations, including African-Americans, Latinos, and Native Americans, are at higher risk for the disease.

Of all the risk factors, weight is the most important, with more than 80 percent of people with diabetes classified as overweight or obese. If you have already been diagnosed with diabetes, there are a few things you can do to prevent further complications from your disease:

• Wash and carefully dry your feet daily

• Inspect feet and toes daily

• Establish a healthy weight loss plan if you are overweight

• Wear socks designed specifically for diabetic patients

• Stop smoking

• Exercise

• See your podiatrist regularly for all foot care issues

• Never try to remove calluses, corns, or warts by yourself

• Don’t go barefoot

• Don’t drink alcohol in excess

• Wear properly measured and fitted shoes.

While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious consequences of the disease at bay and enjoy a long, full life. Working with all your doctors together will ensure that your health and well-being are in good hands. Your podiatric physician is an integral part of your healthcare team; make sure to make time to visit your podiatrist on a regular basis if you have been diagnosed with diabetes.

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.comor 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

Whether you regularly give your feet a hard workout on the field, or just keep them comfortably elevated in “couch potato” mode, you might be surprised to hear that your feet are susceptible to a common ailment—athlete’s foot. No matter what your level of exercise may be,  owever, your podiatric physician is your best defense against this unwelcome condition.

Athlete’s foot is a skin infection caused by a fungus, usually occurring between the toes or on the soles of the feet. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment, which encourages fungus growth. The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because this infection is common among athletes who use these facilities frequently, the term “athlete’s foot” became popular. But anyone, regardless of their exercise level, can contract athlete’s foot.

Some of the symptoms of athlete’s foot can include one or more of the following: dry skin, itching, scaling, inflammation, and blisters.  Blisters often lead to cracking of the skin. When blisters break, small, raw areas of tissue are exposed, causing pain and swelling.  Itching and burning may increase as the infection spreads.  While it may not be possible to prevent athlete’s foot, you can do much to avoid infection by practicing good foot hygiene.  Washing the feet daily with soap and water, drying carefully, especially between the toes, and changing shoes and hose regularly to decrease moisture, help prevent the fungus from infecting the feet.  Also helpful is daily use of a quality foot powder if recommended by your podiatric physician.

There are many effective medications that can be used to treat and help control fungal infections like athlete’s foot. A visit to your podiatric physician and an evaluation of the infection will result in much better outcomes than most over-the-counter treatments.  The podiatrist will first determine if a fungus is the cause of the problem. If it is, a specific treatment plan, including the prescription of antifungal medication, applied topically or taken orally, may be suggested. If the infection is caused by bacteria, then antibiotics appropriately targeted against the bacteria may be prescribed.  In most cases, the podiatrist can work with you to resolve the issue in just a few visits.

Podiatric physicians recommend a number of ways to lessen your chance of contracting athlete’s foot. These include avoiding walking barefoot, using shower shoes in public areas, and attempting to reduce perspiration by using a good powder. It is also recommended that patients change shoes regularly and wear socks that keep feet dry and wick away moisture. Your doctor can recommend appropriateshoes and socks for your condition. 

For sterilization of your shoes RFAI recommends and has available ultraviolet shoe horn sterilizers which are very smart devices that kill all organisms in your shoes in a short period of time.  UV light will destroy fungus and bacteria and can hurt your eyes so these shoe horns have safety devices built in so they will not leak UV light.  These shoe horns come in 3 sizes and we utilize these devices in our evidence based treatment for Athlete’s Foot and toenail fungus. Combining these devices with our antifungal foot cream will provide rapid relief of your Athlete’s Foot.

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

A stress fracture is a tiny or incomplete crack in a bone that is often caused by overuse. Stress fractures occur most frequently in the foot and ankle, so your podiatric physician is well trained to diagnose and treat this problem.

Stress fractures may be caused by a number of factors. Overuse or strain in the foot (fatigue fracture) is one of the most common causes, while weak bones (insufficiency fracture), caused by medical conditions such as osteoporosis, can also be a factor. Medications such as steroids can lead to stress fractures, as can a sudden increase in activity levels. All of these causes can and should be evaluated by your podiatrist when you have the signs and symptoms of a stress fracture.

Those signs may include pain that increases with activity and decreases with rest, pain that increases over time, or pain that persists even at rest. Often a stress fracture will result in swelling and a spot that feels tender to the touch.

If you experience any pain during physical activity or any of the symptoms described, you should see your podiatric physician.  Prompt diagnosis and treatment of a stress fracture can often prevent further injury. The doctor will ask you to describe the signs and symptoms and then physically evaluate your foot or ankle.

While x-rays will most likely be used for diagnosis, often stress fractures do not appear on regular x-rays for several weeks after the symptoms begin. In some cases, the fracture may never appear on an x-ray. In those cases, the doctor may recommend other diagnostic testing such as MRIs, ultrasounds, or bone scans.

Many stress fractures can be treated with rest, ice and over-thecounter pain relievers. For most people, an appropriate period of rest will be sufficient for the bone to heal. In other cases, your podiatrist may need to immobilize the affected bone with a cast, cast boot, fracture shoe, or a splint. In the most severe cases, a pin may be surgically inserted into the bone to hold it together and promote proper healing.  However, surgical intervention is the treatment of last resort. 

Here are a few simple steps to prevent stress fractures:

• Start new exercise programs slowly and progress gradually.  Work with your doctor to design a routine that fits your fitness level.

• Avoid sudden intensity changes in your exercise routine.

• Always use the proper equipment for your sport. This includes finding the best shoe for your foot type.

• Cross-train to avoid repetitively stressing your feet and ankles.

• Visit your podiatrist to have custom shoe inserts (orthotics) made to improve foot function.

• Eat right and make sure that you include plenty of calcium and nutrients in your diet.

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.comor 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

Move It—Especially

when Travelling

Deep Vein Thrombosis (DVT) and

How to Prevent Clots during Travel

Are you planning to travel this summer? If you’ll be spending

long periods of time sitting still (either in your car or on

an airplane) you may want to take heed of deep vein thrombosis

(DVT). What is DVT? It can be painful and dangerous

if you don’t know what it is and how to identify it while

you’re travelling.

DVT can affect anyone but is most prevalent in adults over

60 years of age. DVT mainly affects the larger veins in the

lower legs and thighs. A blood clot can develop and block

blood flow, causing pain and swelling. A blood clot that

breaks free and moves through the bloodstream is called an

embolism. An embolism can lodge in the brain, heart, or

lungs and cause severe damage.

The risk factors for DVT and blood clots include:

• long periods of bed rest;

• cigarette smoking;

• fractures in the pelvis or legs;

• giving birth within the last 6 months;

• heart failure;

• medications such as estrogen and birth control pills;

• obesity; and

• recent surgery.

There are ways to avoid DVT if you happen to have any

of these risk factors. First and foremost, moving your

legs often during long plane trips, car trips, and other

situations in which you are sitting or lying down for long

periods of time can help prevent DVT. You can do ankle

circles, knee bends, and thigh lifts right in your seat. It’s

also important to get up and move during plane travel. If

you are travelling by car, stop periodically and walk for a

few minutes. By moving around, you decrease your risk

of DVT significantly.

Clinical evidence suggests that wearing compression socks or

tights while travelling reduces the incidence of DVT on long

flights, especially if you have any of the risk factors identified

above. These products help improve circulation, which can

be particularly important to decrease the risk of DVT

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.comor 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

“I have heel pain” is a comment that podiatric physicians hear nearly every day. Patients complain that their heel hurts when they get out of bed in the morning, or after they’ve been sitting for long periods of time. Heel pain is non-discriminating; just about anyone can have it. For example, runners complain of heel pain and so do kids. Patients with diabetes can also have heel pain. Despite the many causes, it’s a prevalent problem, but one that can have solutions.

Let’s think about that lonely bone in the bottom of our foot, the heel bone. This bone, the largest in our foot, withstands a great deal of abuse as we cram it into our shoes day after day and subject it to our full weight with every step. With such abuse, it’s no wonder that heel pain (most commonly called plantar fasciitis) is a problem for so many of us.

In our pursuit of healthy bodies, we often let our heel pain go without treatment for much too long. Heel pain is generally the result of faulty biomechanics (walking/gait abnormalities), that places too much stress on the heel bone and the soft tissues that

attach to it. The stress can also result from injury or a bruise incurred while walking, running, or jumping on hard surfaces. It can also be due to wearing poorly constructed footwear or from being overweight. Many people complain of heel pain after a night’s sleep. As you walk, the heel pain may lessen or even disappear, but that may be only a false sense of relief. The pain usually returns after prolonged rest or extensive walking.

Heel pain is commonly accompanied by a heel spur, a bony growth on the underside of the heel bone. The spur, visible by xray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs are a result of strain on the muscles and ligaments of the foot, or a stretching of the long band of tissue that connects the heel and the ball of the foot. Your podiatric physician can evaluate and treat this condition and recommend

options that help to alleviate pain.

Plantar fasciitis can usually be treated without surgery, using exercise or orthotics (custom-made or prescription shoe inserts). There are many other causes of heel pain other than plantar fasciitis. These can include arthritis, Achilles tendonitis or bone bruises. Stress fractures of the heel bone can also occur, although infrequently. Often, heel pain can be attributed to bursitis, a neuroma (a nerve growth), or Haglund’s deformity (or “pump bump”). When children suffer from heel pain, a visit to the podiatrist is imperative because their problems may be quite different from those of adults. Regardless of the cause, evaluation by an APMA member podiatrist is your first step to relief.

To prevent heel pain, try some of these tips recommended by podiatric physicians:

• Always wear properly fitted shoes specific to your activity with shock-absorbent soles, rigid shanks and supportive heel counters.

• Replace shoes frequently and avoid excessive wear and tear. • Warm up and stretch before and after exercise. Pace yourself when starting new exercise routines.

• Remember that we all need rest and good nutrition to remain healthy.

• If you are overweight, consider losing weight to reduce the stress on your feet and other bones and muscles in your body.

• Avoid walking barefoot on hard surfaces, both inside and out. Your podiatrist has extensive training in the diagnosis and treatment of all manner of foot conditions and plantar fasciitis is one of the most common ailments.

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.comor 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

Just like milk in your refrigerator and cans in your pantry, your athletic shoes have a specific shelf life. Unfortunately, shoes have no expiration date noted on the bottom. Nevertheless, there are a number of factors that you should consider before sending your shoes “out to pasture.” 

How long your athletic shoes will last depends on several factors, including how often you wear them, where you run or walk, how your foot functions, and your workout conditions and mileage. Contrary to popular opinion, however, you cannot always tell whether a shoe is worn out by visual inspection.

With the technologies available today, the outer sole can hold up and not show deterioration even after the shock absorption and stability capacities of the shoe are gone.

Wearing old athletic shoes, specifically for running, or wearing the wrong type of shoes for your foot or for a specific sport can lead to injuries. For example, running in a shoe that no longer provides traction, support, and cushioning can lead to a number of musculoskeletal complaints, among them heel pain, shin splints, and stress fractures. A basic rule of thumb for runners is to replace shoes every 300-500 miles. Other factors to consider are:

• Type of shoe/type of foot: Ask your podiatrist about specific shoes that are best for your foot type. Some shoes are designed to accommodate pronation or supination, and your doctor can give you good reasons to choose one brand over another.

• Environment: A humid climate can contribute to a shoe’s rapid breakdown because running in a wet shoe will overstretch the upper part of the shoe while over-compressing the lower part.

• Body type: Your body weight is a big factor in determining which shoe is best for you. In general, the more you weigh, the more cushioning your feet will need to withstand the impact.

• Usage: The amount you wear your shoe and how many miles you log can also affect the life of your shoe. Runners and walkers can easily track their mileage. Shoes used outside will break down more rapidly than those in the gym.

About half-way through the life of your shoes, buy a second pair to rotate in during workouts. Having a newer pair as a point of reference will also help you identify the feel of shoes that have run their course. Your feet can last a lifetime, but your shoes are not designed to do the same. Replace worn athletic shoes as often as needed and work with your podiatrist to keep your feet healthy and injury-free.

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.comor 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

Local foot surgeon urges patients not to ignore foot pain

Unexplained foot fractures may be the first sign of osteoporosis, a bone thinning disease which affects over 28 million Americans and accounts for 1.5 million bone fractures a year.

According to Hagerstown/Frederick foot and ankle surgeon Daniel D. Michaels, DPM, MS, osteoporosis is frequently referred to as the “silent crippler” since it often progresses without any symptoms or isn’t diagnosed until a person experiences pain from a bone fracture. Dr. Michaels, explains that the porous nature of bones in people with osteoporosis makes them more susceptible to bone fractures, especially in the feet. “Because the bones are in a weakened state, normal weight-bearing actions like walking can cause the bones in the foot to break,” says Dr. Michaels. “In fact, many patients visit their foot and ankle surgeon suffering from foot pain only to find out they actually have a stress fracture, without having experienced an injury.”

While osteoporosis is most commonly seen in women over age 50, younger people and men are also affected. Early symptoms can include increased pain with walking accompanied by redness and swelling on the top of the foot. “Oftentimes patients don’t seek treatment for their symptoms for weeks or even months, thinking the pain will pass,” says Dr.Michaels. “The best advice is, don’t ignore foot pain of any type. Early intervention can make all the difference in your treatment and recovery.”

Foot and ankle surgeons are able to diagnose osteoporosis through bone densitometry tests, which measure calcium and mineral levels in the bones through low-dose radiation x-ray, or possibly through a routine x-ray. “This is why prevention and early intervention are key; women should make sure bone densitometry tests are part of their wellness examinations when indicated by their physicians,” Dr. Michaels explains.

If you are diagnosed with osteoporosis, it’s important to protect your feet from stress fractures. Wear shoes that provide support and cushioning, such as athletic running shoes, to provide extra shock absorption and protection. Custom orthotics may also be recommended to protect the foot from pressure and provide shock absorption, particularly during exercise. 

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.comor 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

Foot and ankle problems in children often go unnoticed. Signs and symptoms can be subtle, and sometimes children can’t explain what’s wrong. But it’s important to protect growing feet and have problems checked out early.

Daniel D. Michaels, DPM, MS, offers five warning signs parents should watch for.

1. Your Kids Can’t Keep Up with Their Peers
If children lag behind in sports or backyard play, it may be because their feet or legs are tired. Fatigue is common when children have flat feet. The muscles in the feet and legs tire easily because the feet are not functioning as well as they should. 

2. Children Voluntarily Withdraw from Activities they Usually Enjoy
If they are reluctant to participate, it may be due to heel pain — a problem often seen in children between the ages of 8 and 14. Repetitive stress from sports may cause muscle strain and inflammation of the growth plate, a weak area at the back of a child’s heel.

3. They Don’t Want to Show You Their Feet
Children may feel pain or notice a change in the appearance of their feet or nails but don’t tell their parents because they fear a trip to the doctor’s office. Dr. (LAST NAME) encourages parents to make a habit of inspecting their child’s feet starting at a young age. Look for any changes such as calluses, growths, skin discoloration, or redness and swelling around the toenails.

4. Your Child Often Trips and Falls
Repeated clumsiness may be a sign of in-toeing, balance problems or neuromuscular conditions.

5. The Child Complains of Pain
It is never normal for a child to have foot pain. Injuries may seem minor, but if pain or swelling last more than a few days, have your child’s foot examined.

If you've noticed any of these signs in your children, call Dr. Michaels office for an assessment.

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.comor 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

Welcome to the Blog of Reconstructive Foot & Ankle Institute, LLC

Whether you are an existing patient or searching for a podiatrist in the Hagerstown area, we're excited you are here. With the podiatry industry advancing, we recognize the importance of keeping our patients and visitors up to date with all of the new and exciting things taking place in our practice.

As we move forward with our blog, we hope to promote podiatric awareness as a vital part of your healthy, active lifestyle.Here you will find a variety of articles and topics including the latest developments in podiatry, podiatric treatments and helpful foot care advice from Dr. Michaels and his staff.

We hope you find our blog to be helpful, engaging and informational to ensure the long-term health of your feet.
As always, feel free to contact us with any questions or concerns.

-- The Reconstructive Foot & Ankle Institute, LLC Team