Why Corns Aren't Normal

Corns and calluses are so common almost every person on this earth will experience one at some point in their life. Calluses are most often seen on the hands, but also form on the bottom of the feet and other various places. Corns are calluses that are seen on the tops and sides of the toes. These areas of thickened skin caused by focally increased pressure and rubbing are indeed benign. To people that use their hands for a living, calluses can actually provide extra cushion and blister prevention. Considering this, the prevalence of corns and calluses, and their often harmless etiologies many people assume it is normal to have them on their feet, like they do on their hands. However, this is simply not true. As aforementioned, corns and calluses are developed due to increased pressure and friction. While calluses on the hands often indicate manual labor or activities like rowing and lifting weights, on the feet the story is very different. While some people will wear gloves to prevent callus formation on the hands, many people do not, explaining the calluses. In contrast to this, the great majority of people wear socks and shoes during labor and exercise, yet how can areas of hyperkeratosis (thickened skin) be explained if they have a protective barrier (socks and shoes) in place? This is due to an abnormal foot architecture, or poorly fitting footwear.

A classic example of this abnormal architecture is the hammertoe. The actual shape of the toe has changed due to a few different possibilities causing the toes to become contracted in the shoebox, encouraging rubbing, and overtime corn formation. Hammertoes certainly are not the only cause of corns. They are simply one commonly encountered example of an underlying foot problem that has caused an excess of skin formation that may often be disregarded as normal. The recommendation here is to avoid the home remedies that simply treat the corn or callus, and not the underlying cause of the hyperkeratosis itself. A lot of resources can be consumed without even treating the cause.  If you have corns or calluses on your feet and/or toes make an appointment with a Podiatrist like Dr. Michael Garvin. He can evaluate your feet and your footwear, determine the actual etiology, and set up a treatment plan with you.

The following is a short list of conditions that commonly cause corns and calluses on the feet and toes:

Claw toes
Hammer toes
Mallet toes
Curly toes
Bunions
Tailor’s bunions
Pes Cavus
Pes Planus
Haglund’s deformity
Talipes Equinus

3 Great Reasons Diabetics Should Regularly See A Podiatrist

The Mayo Clinic, among other world-renowned health institutions consider diabetes to be an epidemic in America. Not only has diabetes mellitus been proven to shorten an individual’s life, but it also decreases quality of life due to the vast array of complications associated with this chronic disease. What many people who suffer from diabetes don’t realize is that lower extremity care is one of the most important entities of the disease management process. To concisely, and adequately emphasize this thought consider the following 3 facts;

1.  Up to 25% of those with diabetes will develop a foot ulcer.

-Singh, Armstrong, Lipsky.  J Amer Med Assoc 2005

2. People with a history of a diabetic foot ulcers have a 40% greater 10 year mortality than people with diabetes alone.

-Iversen, et al, Diabetes Care 32:2193-2199, 2009

3. Each $1 invested in care by a podiatrist for people with diabetes results in $27 to $51 of healthcare savings.

-JAPMA, 101(2), 2011

Diabetes affects 26 million people in the US and more than 366 million people worldwide. Additionally, diabetes kills more people in the US every year than AIDS and breast cancer combined. The people suffering from it need to understand the importance of receiving proper treatment, and from whom; to have a better outcome. The aforementioned facts clearly demonstrate the importance of proactive care in the disease management and prevention process of diabetes.

Other sources: American Diabetes association

**This blog, and the medical information it presents is made possible by Dr. Michael Garvin of Port Saint Lucie, Florida. He has been practicing board certified podiatry for over 20 years, and accepts new patients. Visit his website for additional information here. To schedule an appointment, or find directions to his office click here.

Lisfranc Injuries in Athletes

Lisfranc injuries of the foot seem to be stealing the headlines lately. Both Cedric Benson, NFL running back for the Green Bay Packers, and Santonio Holmes, wide receiver for the New York Jets both recently suffered from Lisfranc injuries. Santonio Holmes injury was bad enough the Jets team doctors determined he will not play for the remainder of the season. While Lisfranc injuries may not be as common as ACL tears, they definitely are relevant in traumatic sports injuries, and often go undiagnosed.

So, what exactly is a Lisfranc’s injury? It’s an injury to the midfoot that involves either the transverse joint that spans the midfoot, or the ligament that connects the medial cuneiform and 2nd metatarsal bones. Both the aforementioned joint and ligament are named after French surgeon Jacques Lisfranc de St. Martin. When an athlete suffers a so-called Lisfranc injury, most often times the ligament has been sprained or ruptured due to excessive force with abnormal motion, and/or impact. The significance here is that Lisfranc’s ligament has a huge role in supporting the medial arch of the foot during standing, walking, and running for example, and an injury to the area requires proper rehab, and sometimes surgery for full recovery. Symptoms seen with this injury include midfoot swelling, redness, pain, and inability to bear weight.This isn’t an injury that will heal well on it’s own with simple rest and icing. Lisfranc injuries should be assessed for severity, and treated by a doctor to achieve proper healing, prevent osteoarthritis secondary to the trauma, and avoid loss of joint range of motion.


**This blog, and the medical information it presents is made possible by Dr. Michael Garvin of Port Saint Lucie, Florida. He has been practicing board certified podiatry for over 20 years, and accepts new patients. Visit his website for additional information here. To schedule an appointment, or find directions to his office click here.

Why You Shouldn't Buy Drugstore Orthotics

The human foot is one of the most beautifully engineered vehicles that exists. On an average day each one might endure between 8,000-10,000 steps; each one placing 1.5 times your bodyweight of force on it. Despite these amazing statistics, if we care for them, they can last a lifetime. However, this brings up an important point; care. It only makes sense that proper attention and maintenance be given to such an important part of our body since its responsible for our transportation. To podiatrists dismay, many Americans don’t view their feet from such a perspective. Let’s take for example orthotics. They are a mainstay of conservative treatment for everything from plantar fasciitis to congenital anomalies yet it’s often considered normal to pick up a non-customized pair from the drugstore. This may seem cost effective and efficient but if people understood the gravity behind such a casual decision they’d reconsider this choice. Feet are like snowflakes, there isn’t a single pair out there that is exactly alike. It would only make sense that to receive the greatest benefit from a device such as an orthotic it be totally customized to the exact shape of both your left and right foot. If you told your neighbor you had a hard time seeing due to buying non-prescription glasses from the local pharmacy they’d look at you incredulously. Immediately following with the question of why you wouldn’t see an optometrist to receive a pair designed to correct your unique impairment. Orthotics are very much the same. They must be customized and designed exactly for each of your unique feet to truly get any benefit from them.

If you’re suffering from any sort of pain, or are simply looking for a means of better support during athletics, or long stints on your feet consider a pair of fully customized orthotics. Podiatrists like Dr. Michael Garvin of Port Saint Lucie, Florida have the ability and skill to take the most accurate impressions of your feet possible, and have orthotics made from them. There is a reason orthotics have been a method of treatment for foot pain and support for over 50 years.

Even Steven Tyler Suffers from Morton's Neuroma Pain

In a recent interview, Steven Tyler the Aerosmith frontman admitted that he suffered from severe foot pain due to a Morton’s neuroma he developed from years of entertaining. The pain he experienced from the neuroma was great enough that it was part of the motivation behind his decision to judge on American Idol, as it allowed him to stay off of his feet.

A Morton’s neuroma is classified as a nerve compression syndrome; most commonly involving the digital nerves found alongside the metatarsals, & leading into the toes.  A neuroma is a growth of nerve tissue that can develop due to habitual pressure and irritation. A deep ligament in the foot, and the metatarsals that surround the nerve(s) rub against it, causing what is known as perineural fibrosis. Morton’s neuromas are most commonly seen in the 3rd interspace of the forefoot. This condition is most common in women, and during middle age. In Steven Tyler’s case, the compression or irritation that most likely caused the abnormal growth of nerve tissue was due to overuse, and possibly improper footwear as well. The reason women often suffer from neuromas is due to their choice of footwear with narrow toe-boxes, such as high heels. The narrow toe box doesn’t offer the forefoot proper space; this causes all the structures in the forefoot to become crowded, and cause the ligaments and bones to impinge upon the nerves causing irritation and eventually neuroma development. Not all neuromas are due to footwear choices. Some foot types or individuals with abnormal gait patterns are also more prone to developing neuromas.

The symptoms that generally present with a Morton’s neuroma are pain that radiates to the toes, or more proximally into the foot, burning, numbness and tingling. Additionally, the pain is often times described as sharp. Many patients will describe the feeling or sensation of having a pebble or sock bunched up under the ball of their foot. Pain usually worsens with walking, and is almost always further exacerbated by wearing shoes that cause compression at the metatarsal heads.

The diagnosis of a Morton’s neuroma is based upon clinical presentation. A podiatrist like Dr. Michael Garvin will use a variety of minimally invasive techniques to accurately diagnose this nerve condition, so patients can get back to being pain free as soon as possible. If any of these aforementioned symptoms sound similar to pain you’re experiencing don't hesitate to contact one of Dr. Garvin’s offices in Port Saint Lucie, Florida, or browse through his website for additional information.

5 Suggestions for Keeping Your Feet Healthy

Are you confident that your daily decisions aren’t negatively affecting your foot health? There are a lot of variables that we subconsciously factor into our choices of footwear and care on a daily basis-that we may not even realize are potentially detrimental. Below is a short list of suggestions that will help prevent a trip to the doctor due to your casual decisions.

• Pay close attention to your feet during routine hygiene; this includes noting the skin texture/quality, toenail color, & any irregular lumps and bumps

• If you’re aging, stay on top of keeping the skin on your plantar and dorsal feet moisturized. Dry, cracking skin is more prone to fungal, bacterial and viral infections

• Wear shoes that are well fitting and match your activity levels for each day. I.e. if you’re spending all day walking at a mall, or an amusement park choose a pair of supportive running shoes instead of something fashionable

• There’s a time and place for stilettos and flip-flops. Both can cause a flare-up of plantar fasciitis or achilles tendinitis, so if you know you’re going to have a long day save them for the short and sweet occasions exclusively

• Going barefoot seems so attractive at waterparks, the community pool, and the beach, but sometimes this can be a big mistake. Areas that are high traffic and always wet can be a breeding ground for fungi and viruses. This is the time to grab your favorite pair of podiatrist recommended flip flops and avoid cutting your foot on a shell at the beach, or picking up athlete’s foot in the locker room

**This blog and the medical information it presents is made possible by Dr. Michael Garvin of Port Saint Lucie, Florida. He has been practicing board certified podiatry for over 20 years and accepts new patients. Visit his website for additional information here. To schedule an appointment, or find directions to his office click here.

ABCD Rules for Skin Cancer

As a follow-up to the post written on melanomas of the feet and toes-We’d now like to discuss the criteria to use when making the decision on whether or not to visit a practitioner based upon the appearance of a lesion. Dermatologists and healthcare providers of all kinds like to refer to the “ABCD(E) rule” when evaluating the appearance of a mole, freckle, or recently found lesion of the skin in regards to its malignancy potential. Here is the breakdown of the rule:

• A stands for Asymmetry. A lesion that isn’t symmetrical due to uneven division of skin cells
• Irregular Borders that seem to be ragged, or unusual looking
• Color variations that seem to be inhomogeneous & abnormal
• A large Diameter of the lesion (>6mm) -Yes, use a ruler and measure!
• Lastly, abnormal or uneven Elevations should not be present, & should cause concern!

These 5 criterion should be used in the evaluation of any, and every kind of lesion found on the skin to ensure malignancy isn’t a possibility! The feet are sometimes neglected as part of the evaluative process of the skin performed by dermatologists, so be sure to closely monitor and check all surfaces of your feet when you perform routine footcare on yourself. If you do happen to notice irregularities don’t hesitate to contact a podiatrist. Lesions that are malignant are comprised of rapidly dividing cancer cells and time is of the essence!

*Below is an image displaying 4 or the 5 criteria used to evaluate skin lesions for malignancy
**This blog and the medical information it presents is made possible by Dr. Michael Garvin of Port Saint Lucie, Florida. He has been practicing board certified podiatry for over 20 years and accepts new patients. Visit his website for additional information here. To schedule an appointment, or find directions to his office click here.

Plantar Fasciitis (Heel Spurs)

Plantar fasciitis is inflammation of soft, connective tissue that spans from the calcaneus or heel of the foot, to the ball of the foot (metatarsal heads). Plantar fasciitis is the most common cause of heel pain. It is sometimes also referred to as Heel Spur Syndrome (HSS). There are 3 bands to the plantar fascia, or plantar aponeurosis. Most commonly the central band of the plantar aponeurosis is the culprit of pain due to it becoming inflammed. The causes of inflammation are diverse and can be due to a variety of abnormalities in gait and behavior. The most common cause in the average population is excessive pronation of the foot during walking and/or running. The plantar fascia acts to passively stabilize the arch of the foot, and also assists in propulsion during walking and running. Due to its frequency of use during daily activities (climbing stairs, walking, squatting down on the balls of your feet, etc) it is prone to becoming inflammed in some individuals. A very common complaint seen with plantar fasciitis is pain experienced after periods of inactivity, or rest (Post-static dyskinesia). It also generally continues to worsen throughout the day. 

Plantar fasciitis is a condition that can make daily life difficult and painful. If this sounds like a current or past issue please visit Dr. Michael Garvin’s website for additional information.

Dr. Michael Garvin has been practicing in the Port St. Lucie Florida area for years and utilizes minimally invasive methods to treat and alleviate plantar fasciitis. Call his East or West offices in Port St. Lucie at 772-335-7171, or 772-871-6020, respectively.

 

*The image above illustrates the plantar fascia being strained during propulsion

Haglund’s Deformity

Haglund’s deformity is characterized by pain on the back of the lateral heel. This is due to bony enlargement of the calcaneus, which in turn causes soft tissue swelling when rubbed against shoe gear. Often times in a Haglund’s deformity retrocalcaneal bursitis is present. This is simply irritation of a small fluid filled sac that lies between the Achilles tendon and the calcaneus. As previously stated, patients suffering from Haglund’s deformity generally present with symptoms of pain, redness and swelling on the back of the outside heel. 

Haglund’s deformity is sometimes referred to as a “pump bump” due to its presence being accredited to the “pump” style shoe that often cause it. However, Haglund’s deformity doesn’t only manifest due to calcaneal irritation from pump shoes. Mens dress shoes, ice skates, and any shoes with a rigid back can also cause this soft tissue swelling.
 
If Haglund’s deformity is a condition that parallels something you’re currently experiencing please visit Dr. Michael Garvin’s website for more information, or if you’re in the Port Saint Lucie, Florida area, schedule an appointment at one of his offices.

The Significance of Biomechanics

Biomechanics and a patient's foot health have a strong correlation. Biomechanics can be defined as the science of internal and external forces and their affect on the human body. An example of an internal force would be an individual's body weight. An example of an external force would be the ground's forces upwards on the foot during an individual's gait. 

 

Biomechanics have a strong correlation with an individual’s foot health because these aforementioned forces must be compensated for, so that the human foot properly adapts to this energy. If the foot is not able to adapt to these forces and improperly absorbs the energy created from gait, many pathological manifestations can occur. To name a few of the possible conditions derived from improper biomechanics: plantar fasciitis, shin splints, bunions, hammer toes, stress fractures, claw toes, and the list goes on. 

 

If you are experiencing pain during walking, running, jumping etc.. and think you may have any irregularities in your biomechanical processes, please contact one of Dr. Michael Garvin’s offices in Port Saint Lucie, Florida. Dr. Garvin has been analyzing patients biomechanics for many years and always seeks to treat and correct the underlying causes of pain. To obtain further information regarding your biomechanics and foot health please visit his website!


*This schematic depicts forces applied to the human skeleton that are experienced during normal walking.

A Look at The Gait Cycle & its Importance

The gait cycle can be defined as the interval of time from heel strike of a foot, to heel strike of that same foot, on the next step. In example, the gait cycle consists of a single footstep of say, the left foot that would take place during normal walking. To accomplish that single footstep made by the left lower extremity, the entire gait cycle must be executed. This is in addition to a great deal of other things that must take place for an individual to walk, but for simplification purposes we will only focus on the pedal aspects of the gait cycle. In essence, anytime an individual is walking they are repetitively carrying out the full gait cycle with each step that the individual takes.

The gait cycle is comprised of two major components; stance phase which is also known properly as closed kinetic chain, and the swing phase which is also known as open kinetic chain motion. To be precise, 62% of the gait cycle is occupied by the stance phase, or when the foot is in contact with the ground (weight bearing portion). The other 38% of the gait cycle is naturally comprised of swing phase, or when the foot is not in contact with the ground.

In podiatry it is imperative to dissect, and analyze these two major components of the gait cycle, and the gait cycle in whole. This allows a doctor to understand, diagnose, and treat all of the lower extremity pathologies that exist due to irregularities in an individual’s gait cycle.

To further review these components of the gait cycle, stance phase, or the weight bearing portion of the gait cycle can be sub-divided into three phases. Those are the contact period (when the foot initially strikes the ground), mid-stance, and toe-off (also known as propulsion). During contact period, the heel of the foot being observed is striking the ground, and almost simultaneously the forefoot of the same foot, is loaded with the force that is being transferred from the hind-foot to forefoot (this is when the majority of pronation* occurs). Next, mid-stance is immediately taking place. This is a transitional period that takes place after the contact period, but before the same heel lifts off the ground, and toe-off (propulsion) occurs. Supination** of the foot starts during mid-stance period, and does not end until immediately after toe-off. Lastly, propulsion or toe-off occurs. This is the third portion of the stance, or weight bearing phase of the gait cycle. Throughout toe-off the foot is being supinated, and the momentum of the lower extremity and the upper body is being directed forward to make forward progress (walking or running).

After these three sub-phases of the stance phase have occurred, the foot is immediately carried into swing phase. During swing phase the foot is elevated from the ground, and is being carried forward by a variety of the lower extremity musculature. This non-weight bearing portion of the gait cycle is where the most visually evident portion of forward progress is made.

To summarize, the complete gait cycle consists of stance phase and swing phase. Stance phase is further divided into contact, mid-stance and toe-off periods. Again, immediately after toe-off, swing phase takes place, and ends once the heel of this same foot strikes the ground again, to start the whole process over, hence the term gait cycle. Walking or running simply consists of the complete gait cycle alternating between the two limbs of an individual. In essence, the gait cycle of each foot has a converse relationship. For example, while the left foot is in stance phase, the right foot is in swing phase. This succinct process occurs throughout every step that is taken and most people have no idea it even exists. To clarify any potential confusion, there are certainly short periods in most gait cycles where both feet may be contacting the ground, or especially in running, both feet are not in contact with the ground. Yet, in general, the cycle occurring at each foot is alternating in a conducive manner for walking or running.

With a vast majority of the pathologies that podiatrists like Dr. Michael Garvin see, certain portions of a patients gait cycle have abnormalities that cause improper force transfer, and eventually translate to some type of disease manifestation-“something has to give”. These abnormalities of the gait cycle can occur for a great variety of reasons. These causes are all hugely important in the overall treatment, and prevention of further injuries to the patient’s foot, and their overall health. Dr. Garvin recognizes this, and does his best as a Podiatric physician to observe, listen, address, and heal his patients. 

If you feel you have an abnormal gait, or you have any kind of pain while walking, do not wait until you injure yourself to see a doctor. Call Dr. Garvin’s office and make an appointment at the East office- 772-335-7171, or the West office-772-871-6020, in Port St. Lucie Florida. Or e-mail him at info@doctorgarvin.com .

Below is a schematic of the gait cycle.

 
Below is a list of pathologies commonly seen in the lower extremity that often times manifest due to poor biomechanics (abnormalities in the gait cycle):

• Hallux Valgus (Bunion)
• Tailor’s Bunion
• Plantar Fasciitis
• Hammer Toe(s)
• Claw Toe(s)
• Generalized Heel pain
• Morton’s Neuroma
• Hallux Rigidus (“Pump Bump”)
• Shin Splints
• Tarsal Tunnel Syndrome

*pronation consists of tri-plane motion of the foot; dorsiflexion, eversion & abduction of the foot.
**Supination consists of tri-plane motion of the foot; plantarflexion, inversion & adduction of the foot.