Foot Inserts/Orthotics 101

Foot Inserts/Orthotics 101

Foot Inserts/Orthotics 101

Not everyone is born with perfect feet. And even if they do start out that way, life can throw a few obstacles in your path that end up making your feet hurt — every single day. Certain shoe styles, medical conditions such as diabetes and arthritis, and even healthy-for-you exercise/sports can create foot problems that slow you down.

For many pain causing problems, foot inserts/orthotics are often recommended to help balance foot structures that may be out of alignment or imbalanced. Foot orthotics can be made from different materials, and may be rigid, semirigid, semiflexible, or accommodative, depending on your diagnosis and specific needs.

Determining what type of insert will work for your feet is what DPMs do best. After a thorough evaluation that includes assessing your foot structure, current footwear and how you walk, recommendations for non-custom OTC-type inserts or custom –type will be discussed with you. Many foot problems can be addressed with OTC inserts and proper shoes. A question often asked by patients are about kiosk-type inserts which capture an image of your foot then recommends inserts. These may provide some relief but more frequently only do so for short periods of time then individuals are motivated to make an appointment with a DPM.  NMFAI has several types of OTC inserts that are often recommended and are priced reasonably.

Custom orthotics are recommended for foot deformities where asymmetry is present or more progressed structural malalignment exists. These orthotics are made to an actual model of your foot that is either captured via a casting process or via advanced digital scanning. There are many choices for orthotic materials and the toplines or covers. Your doctor will discuss with you what activities and footwear you will be using the orthotics for then determine the type of orthotic to order. Often, the recommendation is to have different orthotics made for the variable activities and shoes being used.  An orthotic made for a hiking shoe is needing to be sturdier with greater shock absorption then one used in a dress shoe. Instead of compromising how one orthotic will work for you if you are active in different types of sports or work, having different orthotics may be the better choice.

The good news about custom orthotics is that they will last many years. I, personally have an orthotic that is over 30 years and works as well as it did when it was originally made. Just like your home and car, orthotics do need regular maintenance to keep them in the best working condition.  With that said, many patients do require new, updated orthotics as their foot structures may have changed over time so we recommend annual check-ups on your orthotics to make sure their working optimally for you.

Don’t live life in pain, we now have another fantastic option for returning you to enjoy a pain free active lifestyle.

Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

 

Janet Simon, DPM

 

#topdoctors   #bestABQfootdoctors   #nmfai   #wesavesoles #footdoctors   #podiatrist  #albuquerque #newmexico

 

Diabetic Foot Ulcers

Diabetic Foot Ulcers

Diabetic Foot Ulcers

A Patient’s Guide to Understanding Your Care

 

OVERVIEW

If you are reading this, you likely have or know someone who has a diabetic foot ulceration (DFU).  I have been treating DFU’s for the past 30 years and have given many lectures to both professionals and patients to help increase their understanding of these, often complicated wounds.

I present here, some commonly used terms in wound care to define what they mean and give a brief overview of the general care and treatment of a wound.

I know that when patients have a better understanding of their wounds and their treatment plan, they are far more likely to comply with the care plan needed to promote quick healing.  Open wounds carry a risk of infection and possible hospitalization, so it is always beneficial to get them to heal as quickly as possible.

This is not a guide to the healing of any particular wound.  With regard, to healing your particular wound, nothing takes the place of an in-person consultation so that every aspect of the wound and the patient can be considered to create an effective care plan.

I have learned that every ulcer is unique in that each one requires its own care plan of treatment —that is what makes them unique, not their appearance or their location or their size or any other factor.  The care plan, however, is not the end all.  In fact, the care plan may well change at each visit depending on the progress of the wound.

The patient should not be a passive observer in the process.  Ask questions, clarify instructions and be honest in speaking with your doctor about what you’re able to do in helping heal the wound. If you can’t reach it or see it and have no one to help you with that you need to speak up!  There is help available in the form of Home Health Care for those patients who need help in caring for wounds.

ULCER TERMS:

  • Ulceration – A break in the skin of any type.

Note also that when a particular area on the foot has had an ulceration in the past, it is often still referred to as an ulceration that is “Grade 0” or a “previously ulcerated site” long after it has healed because it has the potential to re-ulcerate again.

  • Diabetic Foot Ulceration (DFU) – Typically a pressure ulcer on the bottom of the foot but really any open wound on the foot ankle of a patient with Diabetes.
  • Decubitus – Special name for a pressure ulceration typically found on the back of the heel. Term is also used for bedsore ulcerations on buttocks area of bed confined patients.
  • Venous Stasis Ulceration (VSU) – An ulceration related to Vein Dysfunction (poor blood return to the heart), Typically occur on the medial (inside) portion of the ankle or lower leg.
  • Arterial Ulceration – Ulceration due to Arterial Disease (poor blood supply to the foot), typically seen at the tips of the toes but can occur anywhere.

ULCER DRESSINGS/BANDAGES/TOPICALS

  • Unna Boot – this is a medicated roll bandage that is put on the from the base of the toes up to just below the knee. It is wet when it goes on and usually stays moist until it is removed.  It is covered with cast padding and an ACE wrap or Coban to hold it in place.  Commonly used for VSU’s
  • Hydrocolloid – Such as Cutinova or Duroderm is a gummy type of dressing applied directly on the wound to provide a moist wound environment. Often used on wounds on the bottom of the foot.
  • Medihoney – Surgical honey. Honey has been used since the Egyptions for wound healing. It is applied directly onto the wound.
  • Alginate – “Angle Hair” A specialty dressing that helps to absorb and contain drainage from a wound. May have silver or collagen in it as well.
  • Bacitracin – Topical antibiotic ointment or cream used directly on a wound
  • Triple Antibiotic – Topical antibiotic ointment or cream used directly on a wound
  • Gentian Violet – Liquid topical used directly on or around a wound as a drying agent. Leaves a purple stain where it is applied.
  • Hypafix Tape – Brand name of a particular tape that is far superior to paper tape for adhering dressings. Is breathable and flexible and tends to work well with fragile skin
  • Coban – Stretchy ACE bandage type of dressing that adheres to itself
  • H-Bandage or Knuckle Bandage – “H” shaped bandage with two tabs on each end. Works very well for areas that are hard to get a typical band-aid to adhere to.

CARE BASICS:

Physician Responsibility

  • Evaluation – A thorough examination is the first step in treatment to determine the type of ulceration and establish a care plan to include testing of circulation and nerve function.
  • Testing – Appropriate testing based on clinical exam which may include: X-rays, Blood Tests, Vascular Testing, Sensory Testing
  • Collaboration –  As needed with other care team specialists which may include: Home Health Care, Vascular Surgeons, Endocrinologist, Primary Care, and/or Infectious Disease

Patient Responsibility

  • History – Providing a complete health and ulcer history. If patient is unable to provide it, having someone at visit to help with that recall.
  • Understanding – Listening and asking questions about what caused the wound and what needs to be done to get it to heal.
  • Participation – Making and keeping appointments. Actively trying to control their Diabetes. Completing home care as directed and reporting problems.
  • Follow-up – After the wound has healed, understanding what needs to be done to keep the wound closed and what needs to be done to prevent it or others like it from coming back again.

CARE PLANS:

  • Typical Office Visit – Involves inspecting and treating the wound at each visit and reviewing what has happened since the last office visit. Photographs are often used to help monitor the wounds progression.
  • Debridement – Is the term used for removing the dead or non-viable tissue from a wound to help promote healing. Not every wound needs to be debrided at each visit. There is sometimes bleeding of the wound when they are debrided.
  • Care Plan – This is the patient instructions on what to do until the next visit. It typically covers how to care for the wound (dressings, frequency, etc.), what home/work activities are allowed, and instructions about weight bearing.
  • Advanced Therapies – There are many ways to treat wounds. Cost-benefit needs to be considered with all therapies. Not every therapy is appropriate for every wound. Many wounds heal with a normal progression once professional treatment is started.  Slow healing wounds have a high priority for advanced therapies. The types of advanced therapies available are enough to fill an entire separate blog on that issue.
  • Antibiotics – Every open wound is not infected. If there are signs of an active infection oral antibiotics are prescribed.  In severe cases of advancing infection, IV antibiotics and/or hospitalization are frequently needed.
  • Home Health Care – Is available in certain cases where the patient is unable to perform the wound care or may not be able to come into the office as often as needed for care.
  • Follow-Ups: Frequency of follow-up visits depend on the type of wound and the progress it is making. Active wounds often require weekly visits
  • Referrals – Patients may need referrals to other providers to help in the diagnosis or treatment of their ulcerations. That may include procedures to aid in the treatment of the ulceration such as vascular surgery or testing such as MRI or CT that cannot be done in the office.

Don’t Live Life in Pain! Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Gerard J. Kerbleski, DPM, FACFAS

#topdoctors   #bestABQfootdoctors   #nmfai   #wesavesoles #footdoctors   #podiatrist   #covid19 #keepyourappointment   #keepyourfeet #NDAM   #DiabetesAwarenessMonth   #diabetes   #feetmatter   #TodaysPodiatrist

 

 

 

 

 

 

 

 

 

 

What’s with the MLS laser?

What’s with the MLS laser?

What’s with the MLS laser?

MLS Laser Therapy

MLS Laser

Here at New Mexico Foot & Ankle Institute we continuously deal with painful conditions.  We see arthritis, tendonitis, nerve pain, sprained ankles, broken bones and lots and lots of deformities that limit activity levels for various reasons, but the #1 reason is pain.  With the 100’s of different problems we see there are still only a limited number of solutions.

Personally, I struggle occasionally with a pinched nerve in my left foot.  Despite my good orthotics and great collection of good shoes sometimes it still bothers me.  It came down to getting a steroid injection or using the MLS Laser on it.  I chose the MLS laser and it worked great for me.  So why chose the MLS laser over a steroid injection?  For me, the answer was as simple as the shot hurts and the laser doesn’t.

Low level lasers have been around for many years and studied extensively and shown to be effective in increasing blood flow to an injured area which in turned helped the healing.  Our MLS laser is short for a class IV multiwave locked system laser.  Additonally, te new MLS laser that we are now using is a high energy laser and overcomes the limitations that the older lasers had of not being able to treat conditions that were deeper down from the skin.  High energy lasers like the MLS laser have been shown to have analgesic, anti-inflammatory, and anti-edema effects.  There is a lot of science behind how this works which is well beyond the scope of this discussion today.

The take home message is that the laser can be used to treat almost all of the painful conditions I see in clinic.  Similarly, it opens another door for us to offer more treatment options to patients who are looking for immediate relief of their pain and for safe and pain free ways to achieve that goal.  The laser worked well for my inflamed nerve and we’ve seen tremendous results with the laser on postoperative patients, slow healing wounds, tendonitis, plantar fasciitis, sprained ankles and many other conditions.  In brief, we are always striving to enhance our services to our patients by offering the best available treatments on the market and this is just another way we do this.

Don’t live life in pain, we now have another fantastic option for returning you to enjoy a pain free active lifestyle.

Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Nathan Ivey, DPM

#topdoctors   #bestABQfootdoctors   #nmfai   #wesavesoles #footdoctors   #podiatrist

 

Happy “Dogs” while Walking & Hiking

Happy “Dogs” while Walking & Hiking

Happy “Dogs” while Walking & Hiking

Walking and Hiking

Dr. Janet Simon

Dr. Janet Simon

With limited activities due to COVID emergency, many New Mexicans are hiking and exploring outdoor trails. We are obviously blessed with these opportunities to get out and enjoy the natural world. The term “dogs” has dual meaning here – 1) feet, often referred to as dogs in the early 20th century and 2) canines. While walking and hiking both “dogs” need to be prepared and protected from injuries and overuse.

As a podiatrist, I am often asked for recommendations on sock and footwear choices. Having properly fitting socks is important along with shoe/boot fit. Sock fit is often overlooked and from what I’ve recently observed on the trails sometime absent for a few newcomers to hiking. A synthetic blended sock is recommended over 100% cotton and I advise individuals that the thickness is a personal choice. Obviously, when purchasing new shoes/boots try them on with the thickness of sock you’re planning on using.

Shoe/boot choices are dependent on the type of walking/hiking. My observations on the Sandia trails are that experienced participants have “proper” shoes and the less experienced have footwear that I know will be bringing them soon into my office for foot problems. I’m not totally opposed to walking sandals on paved trails but do not feel they’re appropriate on rocky, cactus laden trails. Using a boot that provides increased ankle support will be beneficial especially if you’ve had history of ankle sprains, posterior tibialis tendonitis or overpronation.

Not only are humans out on the trails but their dogs too and it’s clear that many dog owners have not given much thought about their dogs paws or other wellness concerns on the trails. Recently, I’ve witnessed many small dogs being carried on trails that clearly were not appropriate for them to be on. Furthermore, their paws need to be conditioned for longer distances, as well as, their joints and muscles too.

Dogs do feel pain and unlike humans cannot complain vocally. Similarly, to what was stated about matching up the type of footwear to the difficulty or type of trail, matching up your dog is wise too along with providing booties or applying Musher’s wax to their paws. Dog’s “dogs” need protection too.

Additional advice that veterinarians share is making sure your dog is current on their vaccinations and well hydrated and nourished. Our Sandia trails require dogs to be leashed and I will opine that this is not only safety for others but also for your dog to stay on the trail and hopefully away from cacti.

Summing up – being safe during your walks/hikes is the message for both you and your “dogs”. My office is open and if concerns arise about human feet/ankles please call. We can see you in person or schedule a virtual visit. If your dog is having paw or other problems, please contact a veterinarian.

Don’t Live Life in Pain! Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Janet Simon, DPM

 

#westandopen #topdoctors #bestABQfootdoctors #nmfai #wesavesoles #footdoctors #podiatrist

 

The Coronavirus & Podiatry

The Coronavirus & Podiatry

The Coronavirus & Podiatry

COVID 19

The Coronavirus & Podiatry

I would like to spend a few minutes clarifying how the Coronavirus, aka Covid19, is affecting the private podiatry practice in New Mexico. Healthcare has been deemed an essential service and has remained open but we have changed who we are seeing and in some cases how we are seeing them. People who have foot issues that can wait have been asked to stay home.

Many of our patients are high risk and skipping a visit could result in an infection or even an amputation. Our goal is to make sure we keep the pressure off the hospitals and to keep people from having to go to the ER or even worse needing to be admitted to the hospital. As we continue to flatten the curve and lessen the stress on the hospitals it becomes more essential that people who have been putting off care of their feet and ankles come in to be seen.

We now know that the healthcare system in New Mexico will not have an overwhelming surge as we initially thought. Our responsibility is to keep our patients safe. Furthermore, we see infections or possible infections in our clinic daily and have always followed protocols and procedures to make sure we don’t pass those germs from patient to patient. Additionally, we have many patients who are elderly or who have multiple medical problems that puts them at high risk for infections.

Each patient is treated as someone who may be carrying a potential cold or flu and we continue to follow strict safety protocols. We have increased this significantly by making sure our waiting room does not break any social distancing rules and our staff screen patients for potential infections. Our goal is a safe environment for anyone to come to our office to be seen so that everyone with foot and ankle issues can be treated safely.

For those times where we can adequately treat via telemedicine we offer that as well. We rely heavily upon physical exam so we will continue to need to see patients in person more than not. Even being stuck at home it can be miserable to have pain and limitations in activity. In order to keep ourselves and our immune systems healthy we need to exercise, even if it is to go for a short walk.

We will continue to provide these essential treatments to anyone in need and we know that fear of infection keeps many people from seeking necessary care. Our commitment is that we will provide that care in a safe and caring environment. Delay in treatment more times than not will result in worsening of the problem and in some cases make it much more difficult to treat or cure. If you have pain or problems with your feet and ankles please call and either make an appointment or be screened to determine if you need to come in. Let us help you get back to a healthy active lifestyle.

Don’t Live Life in Pain! Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Nathan Ivey, DPM

#westandopen #topdoctors #bestABQfootdoctors #nmfai #wesavesoles #footdoctors #podiatrist #coronavirus #covid19

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