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Monday, October 26, 2015

Top Shoe Recommendations for Plantar Fasciitis (Heel Pain) - Podiatrist Recommended.

Top Shoe Recommendations
for Plantar Fasciitis

Podiatrist Recommended

Plantar Fasciitis is surprisingly common in patients of all ages, foot types, body weights and occupations. The plantar fascia is a strong piece of soft tissue that is made up of three connected bands (medial, central and lateral bands) of soft tissue that runs from the bottom of the heel along the underside of your foot and into each of the toes. Plantar fasciitis occurs when there is inflammation, irritation and mechanical strain of the plantar fascial band as it inserts into the heel bone (calcaneus). The typical presentation of plantar fasciitis is that when you first wake up in the morning and when you step down, the heel hurts so badly that you have to hobble or limp. As you continue to walk, the plantar fascia will get stretched out and 'warms up' and then the pain improves. Usually, every time you sit down for any length of time and have to stand up and walk again -- the process repeats itself. 

However, not all heel pain is plantar fasciitis. Many other conditions can mimic plantar fasciitis, including:
*Calcaneal Stress Fracture (stress fracture of the heel bone)
*Partial or complete tear of the Plantar Fascia
*Radiculopathy (pinched nerve in the spine) causing burning pain in the heel
*Foot Fractures / Broken Bones
*Tarsal Tunnel Syndrome
*Achilles Tendonitis
*Nerve Entrapment of the Medial Calcaneal Nerve
*Calcaneal Cyst
*Soft Tissue Mass (Benign or Malignant) 
*Rheumatoid Arthritis
*Psoriatic Arthritis
*Injury to the Fat Pad
*Bone Malignancy
*Flexor Tendonitis or Tear
*Effects of long-term Compensation (limping) caused by another underlying foot, ankle, knee, hip or lower back issue.  

The shoe recommendations listed below are a good starting point for dealing with heel pain. Making basic shoe changes should significantly help with the pain caused by plantar fasciitis. However, if the heel pain is not quickly resolving, I highly recommend that you follow up with your local podiatrist for an office consult and x-rays. There are many excellent conservative, non-surgical treatments for plantar fasciitis, including physical therapy, orthotics, stretching, icing, elevation, topical pain relievers, NSAIDS and rest. 

Shoes that help with Plantar Fasciitis:

Rx Crocs Relief
(also: Rx Crocs Ultimate Cloud, Specialist or the fleece-lined Mammoth for colder climates - or colder feet!)

Rx Crocs are my number one choice for bedroom slippers. Barefoot walking is one of the worst things that you can do when you have plantar fasciitis -- or any foot problem! The only time you should be barefoot and standing is in the shower. Even if you get up at night to go to the bathroom, you should step out of bed and directly into your Rx Crocs. Make sure to wear the strap to the back for more biomechanical control, which will help with the plantar fasciitis. 

The Rx Crocs puts a firm, stable, shock-absorbing surface between your heel and the floor. If you do nothing else but stop walking barefoot and wear the Rx Crocs as a bedroom slipper -- you should see at least a 30% improvement in foot, knee, hip and lower back pain within three weeks. You will also save money in medical bills because the Rx Crocs will help prevent everything from stepping on foreign bodies, developing warts, and preventing broken toes, tendonitis and heel pain (to name a few). An added benefit is that if you wear Rx Crocs on a regular basis for a bedroom slipper, as you get older, you should have prettier feet than if you were walking barefoot. The Rx Crocs will slow the progression of calluses, bunions and hammertoes, which will give you prettier feet, less pain and will pay off big time as you get older. Remember, you are either beating up your feet or you are beating up your shoes. If you think about what your shoes look like after a couple of years of wear -- that is what is happening to your joints if you are not protecting them! It is your feet versus miles and many years of concrete surfaces. If you are not protecting your feet -- the concrete will win. 

If you are ordering online, I have a 20% coupon that will link you to the Crocs website that can be found on the right hand column of this blog. Also, if you do order online, you need to order one-half or one whole size up. If you are a size eight, then order a nine. If you are a size eight-and-a-half, then order a nine. When you try on the Rx Crocs, if your toes hit the front of the Crocs, then they are too small. If the Rx Crocs feel too large, then that is the right size. Remember, the Rx Crocs are to be used as a bedroom slipper so they are for puttering around the house until you are ready for your day and can put on a better, more supportive shoe. Do not try to exercise or do yardwork in your Rx Crocs as those activites require better shoes such as the New Balance 928 or other options listed below.   

Vionix Relax Slippers
(If Rx Crocs don't work for you, this is another good option for a bedroom slipper)

If you don't like the Rx Crocs, the Vionix Relax slipper is an excellent option. The sole is thick, rigid and has excellent arch support. I would like it even better if it had rearfoot control, but, because the sole is so sturdy and it has such good arch support, this is another excellent option for anyone with plantar fasciits. You can purchase the Vionix Relax slippers online at many sites including Footsmart.com. 

This bedroom slipper (as well as the Rx Crocs) are approved by the American Podiatric Association for diabetic patients. I would recommend that all diabetic patients go to their podiatrist and eye specialist at least once a year for diabetic foot and eye checks. If you are diabetic, our job as your podiatrist is to keep your feet attached to you! Protective shoegear and proper bedroom slippers are important to helping us achieve that goal. 

Hoka One One Stinsen ATR

The Hoka One One Stinsen ATR is an amazing running shoe! I use this shoe for walking and hiking also. Hoka shoes are designed for people who have been told by a doctor that they should never run again because of knee, hip or lower back pain. The Hoka has three times more support and shock absorption then most shoes. I highly recommend that you add arch support (over-the-counter or a custom-molded orthotic) for better arch control, which will help with plantar fasciitis. The Hokas tend to run small, so I recommend that you find a local store to try on the shoe. I had to go one whole size up for a proper fit. I love this shoe and it is perfect for heel pain! Not all Hokas all appropriate for heel pain, but this particular one is excellent. 

New Balance 928
(also comes in brown, black leather, and grey)

The NB 928 is an amazing walking shoe! What makes this shoe excellent is that it has 'roll bar' technology in the sole so that there is no motion through the bottom of the foot. The plantar fascia is a long piece of soft tissue that starts in the heel, runs under the bottom of the foot and ends under the far tips of the toes, so if there is motion in the forefoot area of the foot (which would happen with a flexible-soled shoe) then the plantar fascia is pulling on the portion of the heel that hurts. The NB 928 also has an extra-depth toebox which works great for anyone with Bunions, Hammertoes, Tailor's bunions, Morton's Neuromas, Hallux Limitus or Hallux Rigidus. I would highly recommend that you wear this shoe with arch support to help control any over-pronation so that there is less 'pull' on the heel by the plantar fascia. Less strain means there should be less inflammation and irritation to the plantar fascia as it inserts into the calcaneus, which means it will get better faster and you will have less pain. 

Brooks Beast 
(Running Shoe) 

The Brooks Beast is my go-to shoe for getting teenage boys into better shoes. Try getting a teenager to wear the NB 928! The Brooks Beast is a maximum motion-control running shoe and, worn with a custom-molded orthotic or a good over-the-counter arch support, this shoe will help with getting the plantar fasciitis to resolve. 

Drew Surge

The Drew Surge is great for men who work all day on their feet -- particularly on concrete surfaces. It's not good enough for the construction site -- for that you might need a Red Wing boot with a full-length metal shank, arch support and a Tully's heel cup on top of the arch support, but the Drew Surge is a great option for men with plantar fasciitis who work long hours on concrete surfaces.  

Wolky Jewel Sandals
(also: the Wolky Tulip, Ruby or the Cloggy)

I love this sandal! It has a thick, rigid and non-flexible sole as well as cushioned insole with good arch support. I also love that it has forefoot, midfoot and rearfoot control, which will allow for more biomechanical control of the foot and ankle. Once you are protecting the foot with better shoes, such as the Wolky Jewel, then the plantar fasciitis will have an opportunity to calm down and heal. When you purchase this sandal, make sure you buy the one with the most rigid and non-flexible sole as that will help you heal faster. Quality varies within every shoe line and I find that about 10% of the time, shoes can be made poorly, be defective or be of poor quality. That is not typically the issue with Wolky shoes, but it is always good to double check each shoe before you purchase it. 

Birkenstock Rio Sandals

Birkenstock sandals are amazing. I prefer the Rx Crocs as a bedroom slipper for plantar fasciitis because they offer more heel cushioning and shock absorption, but the Birkenstock sandals are another option for people who don't like the Rx Crocs. You can wear the Birk sandals as bedroom slippers and/or as your go-to summer sandal. The rigid sole offers excellent protection and support for your foot joints. It also has very good arch support, which helps with over-pronation and will take much of the strain off of the plantar fascia. Make sure that you get the Birkenstock sandals with the rearfoot strap, so you can maximize biomechanical control of your foot and ankle structures. It will help with your plantar fasciitis pain and you will heal faster. 

(Not recommended for anyone with Achilles Tendonitis)

MBT's are a strong shoe and are not recommended for all foot types. If you have a history of Achilles tendonitis -- you should never be wearing a rocker bottom shoe (which is the type of sole shown above). A rocker bottom sole will 'tip' you backwards onto your heel, which can aggravate any existing or healing Achilles tendonitis issue and it can even lead to a partial tear. I would recommend that you go to the store and try on this shoe. If it doesn't feel comfortable or if you feel unstable in it -- this is not your shoe! 

The rocker bottom sole 'off-loads' the forefoot and the rearfoot, which has the effect of lessening strain to those two areas. By lessening stress to the heel, the rocker bottom shoe decreases strain on the plantar fascia, which gives it a chance to calm down and heal. 

The MBT literature states that you do not need arch support with this type of shoe. In my opinion, I do think that the MBT shoe works better with arch support -- particularly if you have plantar fasciitis. If your arch support doesn't feel good in the MBT's, then wear the MBT's without arch support. Ultimately, the acid test is how your feet feel while wearing the shoes and arch supports. If a shoe or arch support hurts, then they are not right for you. If every shoe hurts -- then go to your podiatrist for an evaluation and  x-rays to make sure there is nothing more serious going on.

MBT sandals 

Please see the review above for the MBT as the same recommendations apply. 

Sketcher Shape-Ups
(not recommended for anyone with Achilles Tendonitis)

The Sketecher Shape-Ups have gotten a bad-rap in the media. The company got sued because they made false claims. The company claimed that if you wore the Sketcher Shape-Up that they would shape-up your butt. They had no medical research to back up their claims, so they lost millions in the lawsuit. However, the Sketecher Shape-Ups (like the MBT) are not for every foot type or patient, but they can be an excellent choice for some patients who suffer with plantar fasciitis. I would not recommend this shoe to anyone with a history of Achilles tendonitis, instability, geriatric patients or drop-foot. I would recommend that you go to the store and try on this shoe and see if it works for you. I would also recommend that you wear arch support in this shoe for better results. The rocker bottom soles typically work well for anyone who works long hours on on concrete surfaces.

MBT Mary Janes

Please see the comments above for the MBT or Sketcher Shape-Ups as the same information applies. 

Dansko Professional Clogs
(works well for some people who works on smooth concrete surfaces such as retail or hospitals)

If you work long hours on concrete floors, the Dankso Professional Clog may be an excellent choice for you. It has a rigid, non-flexible sole which is very protective of the foot joints and allows for less motion and 'pull' of the plantar fascia where it inserts into the heel bone (calcaneus). Danskos are not for everyone. If you have extremely high arches or prominent 'bumps' on your feet (particularly the top of your midfoot or severe bunions) these may not work for you. I recommend that you try them on at the store as you are either going to love them or hate them. 

When I switched from all day classes at podiatry school (after 2nd year) and was thrown into the hospitals to stand on my for 10-12 hours per day (3rd and 4th years and residency), I developed a wicked case of plantar fasciitis. The Dankso Professional Clog was a life-saver! They work for my feet perfectly and, to this day, the Dansko Professional Clog is one of my go-to work shoes for all day wear. I do not recommend wearing this shoe if you work on uneven surfaces or you are going to Europe or on vacation to someplace where there is a lot of cobblestone. I also wear a thin heat-molded over-the-counter insert that we make in our ofice in this shoe for added arch control. You may also be able to also use a thin dress custom-molded orthotic for arch control with this shoe.  

(If all else fails - these are excellent for heel pain!)

Okay, if all else fails - where do you turn? The Z-Coil is a strange looking shoe, but it is a great option for anyone suffering with heel pain and/or lower back pain. This shoe will not work for every foot type or for every patient, but I recommend that you go to the store and try it on. You will either love it or hate it. This shoe is not recommended for anyone working on uneven surfaces or who has neuromuscular disorders such as drop foot or weak legs. It is also not for geriatrics. 

(If you don't have custom-molded orthotics)

If your insurance doesn't cover custom-molded orthotics, then the Powerstep insert is an excellent over-the-counter option for added arch support for most of the walking shoes listed above (i.e. the NB 928, Drew Surge and Brooks Beast, MBT's and Sketcher Shape-Ups). 

Our office carries another excellent over-the-counter insert (Footsteps), which is a cash pay product of $50. If you would like to try on the Footsteps with your shoes, make an appointment at our office with Callie (no charge) and you can try them on to see how they feel. 

Custom-molded orthotics are the best as they are prescriptions and custom-molded to your individual feet -- much like the difference between getting prescription glasses as opposed to 'cheaters'. However, if custom-molded orthotics are not covered by your insurance and you are on a budget -- the Footsteps or the Powersteps are good alternatives to custom-molded orthotics. 

Tully's Heel Cups
(You can place these on top of your current orthotics or the custom-molded orthotics for more heel cushioning)

This is my favorite heel cup. It takes up a bit more room in the shoe, but it provides excellent heel cushioning and shock absorption. You can purchase these in stores and online. 

Golden Rule:
If your foot is not significantly improving quickly with these shoe changes -- follow up with your local podiatrist for x-rays and evaluation to make sure there is not something more serious going on. If it is plantar fasciitis, there are many non-surgical, conservative and gentle treatments that will resolve the heel pain. In my opinion, heel pain can be resolved without surgery or injections 99.9% of the time. Once the heel pain resolves (no matter what treatment type you use) -- if you do not wear protective shoe gear, you have a very high chance of the heel pain re-occuring because, typically, there is an underlying foot type, biomechanical structure or issue that makes you prone to getting heel pain. 

I hope that was helpful! 

Dr. Cathleen A McCarthy


Check out my latest novel - available in paperback, on Kindle and as an Audiobook on Audible.com and iTunes. 

Saturday, October 17, 2015

Comfortable Platform Wedge Heels - American Rag

American Rag 
Kenna Platform Wedge Pumps

This wedge heel is not for every foot type, but it may be a good choice for anyone who can tolerate this height heel and who does not have narrow heels. If your heels are narrow then they will have a tendency to slip upward and out the back of this shoe, which will be uncomfortable and could cause skin irritation and even a possible injury. 

What makes these heels better than most is that they have a thick, rigid and non-flexible wedge sole. The rigid wedge sole eliminates motion through the forefoot area, which will cause less stress and injury to forefoot joints and be far more comfortable than wearing heels with a flimsy or flexible sole. A thicker wedge sole will protect your forefoot from the constant, repetitive microtrauma of walking on concrete surfaces. It's your feet versus a lifetime of damage from walking on unforgiving concrete surfaces, so the more protection you give your feet now, the longer they will last. 

If you are not able to tolerate heels this high or if you have a history of significant forefoot issues then this is most likely not the shoe for you. If you can wear heels this height then you will probably find this shoe to be more comfortable than most heels. 

This shoe should work for patients who have:
*Mild Plantar Fasciitis (heel pain)
*History of previous mild Achilles Tendonitis that has resolved
*Woman who know that they can wear heels this height with no pain. 

This shoe is not recommended for patients with: 
*Moderate to Severe Hallux Limitus (limited range of motion through the 1st toe joint)
*Hallux Rigidus (no motion through 1st toe joint)
*Morton's Neuroma 
*Plantar Plate Injury
*Hypermobility / Ligament Laxity
*Moderate to Severe Over-Pronation
*Peripheral Arterial Disease (poor circulation)
*Peripheral Neuropathy (nerve damage)
*History or Ulcerations
*Charcot Foot
*Previous Lisfranc's Injury or Fracture
*History of Peroneal or Posterior Tibial Tendonitis
*Anyone with foot pain

*Please remember that if you are having foot pain, I highly recommend that you follow up with your local podiatrist for evaluation, x-rays and treatment. Try to find a podiatrist who is conservative and more biomechanical than surgical. Although some patients do need foot surgery, the wide majority of foot problems can be resolved with gentle, non-surgical treatment. If any doctor recommends surgery on your feet or ankles, get a second and even third opinion - especially from a more conservative biomechanical podiatrist. 

For more information, please see two other articles on this blog:

My feet hurt: top 10 things to do to alleviate foot pain today.

Shoe recommendations for patients recovering from Lisfranc's Injuries.

I hope this was helpful!

If you love a good detective story, check out my book Gunning For Angels, which is available on Amazon in paperback, on kindle (free for kindleunlimited members) and as an audible book. 

If you are a member of Audible.com -- get Gunning For Angels as your next Audible book. 

Thank you!

Dr. Cathleen A. McCarthy


Monday, October 5, 2015

Comfortable Casual Ankle Boots for Autumn - Podiatry Recommended

FitFlop Loaff Boots

Podiatry Recommended Comfort Boots
FitFlop makes some very comfortable sandals and many people don't realize that they have a collection of excellent boots. This is one of the cuter FitFlop boots and what makes it so comfortable is that it has a thick sole that doesn't bend or flex, which means that there is less motion through areas of painful joints or previously injured areas of the foot and toes. The boot also has a wide, soft toebox as well as great rearfoot and ankle control. This boot should accommodate a custom-molded orthotics, particularly a dress orthotic, which will allow for better arch support. Due to the extra ankle control, this boot should be a great choice for anyone with hypermobility, ligament laxity, flat feet, weak ankles and a history of ankle instability and sprains. 

This boot is recommended for patients with:
*Hallux Rigidus (no motion through the 1st toe joint)
*Functional Hallux Limitus (limited motion through the 1st toe joint)
*Mild to Moderate Bunions
*Mild to Moderate Tailor's Bunions
*Mild to Moderate Hammertoes
*Morton's Neuroma
*Plantar Fasciitis (heel pain)
*Mild Achilles Tendonitis
*Mild Peroneal Tendonitis 
*Mild PT Tendonitis (wear arch support with the boot)
*Recovered from a previous Lisfranc's Injury 
*Ankle Instability
*Hypermobility / Ligament Laxity
*Over-Pronation (wear an orthotic in the boot)
*Chronic Ankle Sprains

This boot is not recommended for patients with: 
*Charcot Foot
*History of diabetic amputations
*History of diabetic ulcerations 

If you have these conditions, you will need to clear this shoe with your podiatrist to see if it is appropriate for you:
*Peripheral Neuropathy (nerve damage)
*Peripheral Arterial Disease (poor circulation) 
*Rheumatoid Arthritis

If you are not sure if this boot is right for your foot type and/or foot pathology, check with your podiatrist. 

It's best to go shopping for shoes after 2pm when your feet are a little bit more swollen and ask the salesperson to measure your foot to make sure you are in the correct size. I find that most people are in the wrong shoe. Even if you are in the "right" size, if the shoe feels too tight, try on a larger size. It's always better to be in a shoe that is slightly larger than to be wearing a shoe that is too tight. Tight shoes can cause everything from blisters and corns as well as microtrauma to toenails, which is one of the main causes of fungal infections in the toenails. In fact, if you are trying to clear up fungal toenails, you will not be able to get them cleared of fungus until you are wearing proper-fitting shoes that allow no microtrauma to the toenails. When a toenail is injured, even from microtrauma from tight shoes or pointy-toed shoes, it causes the toenail to become injured and loose, which gives the fungal spores the perfect opportunity to get into the nail and cause an infection. For more information on how to clear up fungal toenail - go to the search box and type in 'toenail fungus' for an article on seven things you have to do to clear up toenail fungus. 

For added comfort during the day, if you have varicose veins, try wearing 15 mmHG knee high compression hose, which you can usually purchase over the counter at some pharmacies or online. For anyone who lives in Scottsdale - the CVS on the NE corner of Scottsdale and Shea has a lady works there that will help make sure you get the proper sizing on the compression hose. She is located in the back right-hand corner of the store.  

For more articles on foot pain and proper shoes, please refer to my articles:

My feet hurt: top 10 things to do to alleviate foot pain today.

Shoe recommendations for patients recovering from Lisfranc Injuries (as well as any sprains of the ankle or the foot)

Have a wonderful day,

Dr. Cathleen A. McCarthy


Saturday, September 19, 2015

Comfortable Suede Boots for Autumn - Podiatrist Recommended

Fly London 
Comfortable Suede Boots

Podiatry Recommended for Certain Foot Types 

These are two excellent choices for anyone who is looking for comfortable boots. For a shoe to be comfortable, it must meet these four criteria: 
1. thick, rigid and non-flexible sole, so there is less motion through any areas of pain or mechanical strain.
2. wide, soft toebox
3. rearfoot control
4. arch support (you can add a dress orthotic to these boots) 

Both Fly London boots have a thick, rigid and non-flexible sole, which allows for more comfort for all day wear. A low-wedge heel that doesn't bend or flex through the forefoot area means that there is less mechanical strain to the forefoot joints, muscles, tendons and joint capsules. Less motion through the forefoot area also means less chance of aggravating forefoot issues such as bunions, hammertoes, metatarsalgia and morton's neuromas (to name a few). Even more importantly, the sole has no motion through the midfoot area, which is crucial to prevent (or if you are recovering from) a Lisfranc's joint injury, which is the most common foot fracture that most podiatrists treat. The suede is soft and allows for less pressure on bunions, hammertoes and corns and there is good rearfoot control. An added advantage of the knee high boot is that it has extra-wide fitting. 

These boots are recommended for patients with:
*Mild to Moderate Bunions 
*Mild to Moderate Hammertoes
*Corns & Calluses
*Mild Metatarsalgia
*Mild Morton's Neuroma
*Mild Tailor's Bunion
*Functional Hallux Limitus (limited range of motion through the 1st toe joint)
*Hallux Rigidus (significant limited range of motion through the 1st toe joint) 
*Plantar Fasciitis (heel pain)
*Mild Achilles tendonitis
*Mild Hypermobility
*Mild Over-Pronation (I recommend you wear a dress orthotic with the boot if you over-pronate) 
*Mild Osteoarthritis
*Mild Rheumatoid Arthritis
*Previous History of a Lisfranc's Injury 
*Mild Tendonitis (wear a dress orthotic if possible)

These boots are not recommended for patients with:  
*Peripheral Neuropathy (nerve damage)
*Peripheral Arterial Disease (poor circulation)
*History of Foot Ulcerations
*Charcot Foot
*Severe Hypermobility / Ligament Laxity
*Severe Over-Pronation
*Ankle Instability
*Drop Foot
*History of Instability and Falling
*Severe Over-Supinators

Please check with your podiatrist to see if these boots are appropriate for you. What shoe is appropriate for you is dependent on your foot type, any history of any previous injuries and any underlying systemic conditions such as diabetes. 

For more information, please refer to other articles on this blog:

Shoe recommendations for patient's recovering from Lisfranc's Injuries.

My feet hurt: top ten things to do to alleviate foot pain today.

I hope this was helpful and thank you for reading!

Dr. Cathleen A. McCarthy


Sunday, June 21, 2015

Recommended Shoes for Broken Toes -- and how to PROPERLY treat a broken toe!

Shoe Recommendations 
for Broken Toes
and how to properly treat a broken toe!

It is a common myth that there is no treatment for a broken toes. 

Many time, I have had patients say to me, "I was told that there is no treatment for a broken toe." 

This is completely false. 

This article will tell you what to do if you think you broke your toe, what can happen if you do not get proper treatment for a broken toe and what are the best things to do if you think you broke your toe but you do not have access to a doctor. It will also have shoe recommendations that will help heal the broken toe faster and with much less pain. 

First, if you think that you broke a toe, I highly recommend that you make an appointment with your local podiatrist who will be able to evaluate and diagnose your toe pain as well as take foot x-rays, which can usually be taken in the office at the time of your appointment. 

Assuming it is a simple fracture, the podiatrist will dispense and fit you with either a surgical shoe or, if it is a more serious injury, a below the knee removable walking boot. You should leave the office feeling much more comfortable and you will decrease your chances of developing long-term side effects that can be caused by an improperly treated broken toe, which I will discuss later in this article.

Most broken bones take six weeks to heal. Stress fractures can heal sooner. Your podiatrist will be able to differentiate between an acute fracture and a stress fracture by looking at your x-rays. Whether you have a bruise, a stress fracture or an acute fracture, there is a early phase of bone healing that doctors commonly refer to as the 'golden period' of healing. This is one of the reasons why it is so important to go to your podiatrist as soon as you can after any foot injury. During the early stages after an injury (10-14 days), it is especially important that you immobilize the site of injury (with the surgical shoe or CAM walker) as well as elevate and rest your feet as much as possible. The human body is pretty amazing and if you help it out with the "RICE" method: rest, ice, compression and elevation - you will greatly increase your chances of healing faster with much less swelling and pain and you will get a better cosmetic result. 

You must be careful with icing your feet. There are some medical conditions that, if you have them, you should not be icing your feet. Anyone with a history of gout should never ice their feet as it can trigger an acute gout attack. If you have a history of Raynaud's disease, a previous frostbite injury or peripheral arterial disease (poor circulation), you should not ice your feet. If you are diabetic or have nerve damage, you need to consult your podiatrist as to whether you should be icing your feet, as it depends on the severity of your disease. You should never ice longer then twenty minutes. Icing your feet longer then twenty minutes can cause tendon and nerve damage that can cause frostbite that can lead to amputation. 

After your podiatrist diagnoses you with a toe fracture, he or she will usually make a follow up appointment in six weeks to verify that the toe has healed correctly. On the six week follow up, if the podiatrist verifies that the fracture has properly healed, he or she will have you return to wearing proper shoes and ease back into all activities. 

Occasionally, the toe fracture is so severe that you might need surgery. This is one of the reasons it is important that you get x-rays. My experience has been that the majority of toe fractures do not need surgery. To state it in rather broad terms: if you have a bone sticking out of the skin and you are bleeding out of that open wound, you probably need surgery. If you have a painful, swollen toe and no open wounds with the bone not sticking out of a bleeding wound, you probably don't need surgery. This is a broad generalization and I highly recommend that you get proper evaluation and treatment from your local podiatrist - or the ER doctors!

If a broken toe is not properly treated then these complications can occur: 

1. Sausage Toe. As the name implies, a 'sausage toe' is a red, hot, swollen toe that is chronically painful as well as cosmetically unpleasing. 

2. Non-Healing Fracture. If a toe is not properly treated or if there are underlying medical issues such as diabetes, poor circulation or osteoporosis, a simple toe fracture can develop into a non-healing fracture, which means it remains chronically unstable and simply won't heal. This can be difficult to treat and lead to chronic pain, swelling and, in some cases, amputation. The best way to prevent a non-healing fracture is to get early and proper treatment of any foot injury.

3. Osteoarthritis. If the toe fracture involves the joint, an improperly treated broken toe can cause osteoarthritis, which also leads to chronic pain, swelling and degenerative joint changes. It also gives you the dubious advantage of being able to predict rainy weather. 

4. Toe Deformity.
An improperly treated broken toe can result in joint damage, chronic low-grade swelling and displacement of the broken bones that can cause toe deformity. The toe deformity can make it painful to wear shoes, cause low-grade pain and be cosmetically unpleasing. 

There are a bevy of other complications, but these are the main ones. 

Broken toe information for patients with diabetes and peripheral neuropathy (nerve damage):
If you are diabetic or have peripheral neuropathy (nerve damage), please remember that you may not be able to feel the pain of a broken toe. I recommend that all patients with diabetes, nerve damage and poor circulation inspect their feet at least twice a day. If you have any of these conditions and if you see any problems such as swelling, bruising, or open sores on your feet, then you need to make an appointment with your podiatrist as soon as possible. If you have numb feet from nerve damage, you can't trust how your feet feel because you can't feel pain caused by a fracture. Broken bone pain and neuropathy pain are two different things. You may have pain caused by nerve damage, but don't make the mistake of thinking that just because you can feel nerve damage pain that you can feel the pain from a broken bone. Biomechanical pain (broken bones) and neuropathy pain (pain from nerve damage) are two different things and should be treated as two different things. As a podiatrist, I can get big improvements on biomechanical pain such as broken toes, tendonitis or osteoarthritis (to name a few) while neuropathy pain is more challenging, but not impossible, to treat. 

The truth about strapping toes together as a treatment for broken toes:
For those of you who have been told to strap your toes together - here is a little known but important caveat: you can strap toes 2-3-4 together, but you should never strap the 1st toe to the 2nd toe or the 5th toe to the 4th toe. The 1st and 5th toes have different ranges of motion and if you strap them to their neighbors, it will cause irritation and increased swelling and pain. Also, if you have diabetes, neuropathy, peripheral arterial disease - strapping your toes together can cause problems such as open wounds, infection, gangrene and even amputation. 

For best results, if you want to try strapping the toes, it is crucial that you wear proper shoes. For a fracture to heal, you must have no motion through the site of injury, which is why the surgical shoe and the CAM walker are able to heal fractures. No motion through the site of a fracture means that the bones can heal faster with less swelling and pain and less chance of forming 'bone callus', which is excess bone formation caused by motion through the area of a fracture. Bone callus formation can cause permanent bone spurring that can be painful in certain shoes. For a fracture to heal, you need immobilization (no motion through the site of injury), elevation, rest and time (usually six weeks). There's no use strapping the toes if you are going to walk barefoot, wear flip flops or wear a shoe that is too flimsy and flexible. You will just be setting yourself backwards by slowing the healing rate and setting yourself up for complications such as chronic swelling, pain, toe deformity and the dreaded 'sausage toe' which is surprisingly difficult to treat. 

Advice on what to do if you do not have access to a doctor or health care and you think you broke your toe:
1. Get a Birkenstock sandal (with the strap in the back) and wear that as much as possible. Birkenstock sandals have a rigid-sole and an open toe, which will allow for decreased motion through the site of the fracture. It is very important that you purchase the sandal that has the strap to the back as that will help prevent the toes from scrunching down to stay in a backless Birkenstock. Any extra motion through the toes will cause more swelling and pain and will slow the healing process. Click her for pictures of what a Birkenstock sandal looks like:

2. REST. Nothing speeds up healing and decreases pain more than just good, old fashioned rest. 

3. Whenever you are at rest, elevate your foot above heart level as much as possible. Elevation helps decrease swelling, which helps with decreasing pain and speeds up healing. 

4. Ice (on and off) for 5-10 minutes per day. Use a bag of frozen vegetables for 5-10 minutes at least twice a day. You can ice in increments of 5-10 minutes as many times as you like as long as you are not icing continuously. If you are diabetic, have nerve damage, poor circulation, Raynaud's disease, a history of frost-bite or gout - do not ice your feet. 

MBT (Rocker-Bottom Soled Shoes)

Rx Crocs Ultimate Cloud (with the strap to the back)
(Use the 20% Coupon link in the upper right hand corner of the blog)

Rx Crocs Relief (with the strap to the back)
(Use the 20% Coupon in the upper right hand corner of this blog)

For a shoe to be comfortable when you have a broken toe or are recovering from a broken toe, it must meet four criteria:
1. Thick, rigid and completely non-flexible sole
2. Wide toebox
3. Rearfoot control, so the toes aren't gripping down to stay in the shoe
4. Arch support

Once again, if you think you broke a toe (or broke any bone in your foot), please make an appointment with your local podiatrist. If your podiatrist is recommending surgery, there is nothing wrong with getting a second opinion. Most foot fractures do not require surgery and can be successfully treated with immobilization, rest and elevation.  


For more articles on painful feet and proper shoes, please check out my articles:

My feet hurt: top ten things to do to alleviate foot pain today.

Shoe Recommendations for patients recovering from Lisfranc's fractures.


I hope this was helpful and, if you want to thank me, please refer any 'limpers' in your life to my blog or, if you love detective novels, check out my novel 'Gunning For Angels' on Amazon. 

Thanks for reading and have a great day!

Dr. Cathleen A. McCarthy


Monday, June 15, 2015

Podiatrist Recommended - Steve Madden's Brooklyn: A Comfortable Wedge Sandal for Summer

Steve Madden Brooklyn
A comfortable low wedge for summer

This sandal is a great option for anyone looking for a comfortable sandal for light summer activities. Although it may not be appropriate for being on your feet all day for heavy activities (like walking around at a music festival on uneven surfaces or going to Walk Disney World for the whole day), I would recommend it to most patients for light activities. The wedge is thick, rigid and has minimal flexibility, which allows for more comfort. The topcover material is stretchy, which is great for anyone with bunions as it can hide the bunion with minimal pressure on the bunion. This shoe also has the forefoot, midfoot and rearfoot strapping that is required for a shoe to be comfortable and make my list for a 'podiatrist approved' shoe. I also like that the material on the insole is soft against the bottom of your feet, which is helpful to anyone who has calluses or sensitive feet. This shoe will not accommodate an orthotic, so if it is crucial that you wear your orthotics, this may not be a good choice for you. 

This shoe is recommended for patients with:
*Mild to Moderate Bunions
*Tailor's Bunions
*Mild to Moderate Hallux Limitus (limited range of motion through the 1st toe joint)
*Hallux Rigidus (no range of motion through the 1st toe joint) or if your 1st toe joint has been surgically fused at the standard 15 degrees of dorsiflexion. 
*Mild Osteoarthritis
*Mild Rheumatoid 
*Morton's Neuroma
*Mild Capsulitis
*Mild Plantar Plate issues
*Mild Sesmoiditis
*Mild Plantar Fasciitis (heel pain)
*A 'bump' (exostosis) on the top of the midfoot

This shoe is not recommended for patients with: 
*Severe Over-Pronation
*Ligament Laxity / Hypermobility
*A history of chronically rolling your ankles
*Achilles Tendonitis
*Posterior Tibial or Peroneal Tendonitis
*Recovering from a Recent Lisfranc's Injury 
*History of Foot Ulcerations
*Peripheral Neuropathy (nerve damage)
*Peripheral Arterial Disease (poor circulation)
*Charcot Foot
*Geriatric patients with a history of imbalance or falling

I hope this has been helpful. For more information, please refer to my blog articles:

My feet hurt: top ten things to do to alleviate foot pain.

Shoe recommendations for patients recovering from Lisfranc Injuries. 

If you are experiencing foot or ankle pain, I would highly recommend that you make an appointment with your local podiatrist. Do not jump into foot surgery! Most foot and ankle pain can be resolved with better shoes, inserts and changing some simple habits. If you are considering foot surgery, I would recommend that you exhaust conservative treatment before you decide to do surgery. For more information, check out my article:
Ten things you need to think about before having foot surgery.

Have a wonderful day!

Dr. Cathleen A. McCarthy


Please share my blog with any 'limpers' in your life who you may thing this information will help. Thank you so much for reading the blog - and sharing the information!