Beauty and the Beach

The summer brings us sunshine and warmer days suitable for a range of fun to be had in the sun, but no pastime is more popular than the annual trip to the beach! While you kick back and put your feet up to enjoy the sights and sounds, there are some foot-related hazards you should keep in the back of your mind. We all know the laughing stock of the beach – the patron wearing his shoes and sandals in the sand. Yuck, right? They actually may be onto something.

Barefoot walking is something I am constantly advising patients against, but the beach just isn’t the same without the sand in your toes for most of us. That being said, the risk or fungus, warts, and foreign objects lie hidden to us until they become a problem!

Foreign objects are one of the main concerns on the beach. Although the patrol officers do their best daily to sweep the sand and clear away any garbage or imperfections that could inhibit a beach-goers good time, sharp objects such as sticks, garbage, or shells can make their way to the surface during heavy traffic times and pose danger to our barefoot fun. The best way to avoid these would be to wear some sort of foot wear, such as a sandal, that will provide some barrier to what lies beneath, and staying vigilant is always key during any galavanting. Sandals can also prevent the hot sand from burning the bottoms of your feet, which can ruin a vacation just as quickly.

We can’t see fungus or warts no matter how vigilant we are, unfortunately. These hidden little monsters favor warm, moist environments and are contagious if they’ve hitched a ride into to town on the feet of other patrons. While this won’t be an issue as much in the sand and surf itself, the areas around the beach, such as the pool deck and the foot rinse area outside most hotels, can be a perfect breeding ground for harmful microbes. The best way to avoid these troubling microbes again is, you guessed it, shoes! Your shoes will keep the barrier between the germs and your skin, and you won’t have to take the time to rinse them off separately – score!

Whether you’re venturing to the east or the west coast, always remember to wear sunscreen as well. Many travelers forget to protect the thin, sensitive skin around the top of the foot and end up with dry, peeling skin. Broken or damaged skin will leave you much more susceptible to germs and other hazards, too. If you run into trouble on your next summer adventure, remember Frederick Foot & Ankle has hours Monday-Saturday to keep you moving!

(#Summer #podiatrist #Fungus #Warst #Barefoot #Sandals #Feet #Beach)

Nicole, Podiatrist in the Making

At Frederick Foot & Ankle we are so proud of our employees. We understand that for some employees the podiatrist office it is just a stepping stone to another destination, and we are happy to be a part of their journey. But there are a few where podiatry becomes their chosen profession. We are happy to announce that our medical scribe, Nicole C., will be attending podiatry school in the fall!

Before Nicole leaves us Dr. Lamichhane had a few questions for her.

Dr. Lamichhane: Nicole, what brought you to Frederick?

Nicole: I grew up in New Jersey and I moved to Maryland for college. While studying at Hood College I fell in love with Frederick and decided to stay after graduation. I enjoy experiencing all that downtown Frederick has to offer and finding new places to visit within Maryland and the surrounding areas. My newest obsession is attending ‘Escape Rooms’ with my friends. You find your way out of an ‘Escape Rooms’ by solving a series of puzzles or riddles with your friends. Check out SureLocked Escape Rooms!

Dr. Lamichhane: Why podiatry?

Nicole: Originally, I applied for the job to get patient care hours for physician assistant school. At the time I applied I never thought this job would have such an impact on my life. Before working at Frederick Foot & Ankle, I never knew what being a podiatrist entailed. I am so thankful for my job and all the opportunities it has offered me.

Dr. Lamichhane: There are many different paths you can take in medicine, what made you decide that this was the medical field for you?

Nicole: Personally, I think podiatry is the best kept secret in the medical field. When people are not able to get around comfortably it really hinders their life, and everyday we live out the Frederick Foot & Ankle motto “We Keep You Moving.” You can tell a lot about a person’s health by evaluating their feet. From feet a trained professional can evaluate your circulation, skin condition, muscle strength, nervous system, and more. After an evaluation a specialist can get people on the right track to living a healthier life. Now I see that a visit to the podiatrist can uncover and solve many lower extremity issues and can be life changing.

Dr. Lamichhane: What surprising skill did you learn from Frederick Foot & Ankle?

Nicole: Initially I was a very shy and quiet employee, but patient care has brought out a more assertive side of myself. I am no longer afraid to speak up. It turns out, I am more of a leader than I thought I was.

Dr. Lamichhane: What will you miss most?

Nicole: I will miss the Frederick Community. It has been a huge part of who I have become and it is going to be hard leaving Frederick. In addition to Frederick Foot & Ankle and the community that I have grown to love I will also miss my second job. On Sundays I am Nursery Supervisor for young children, and it will be so hard saying good bye after watching them grow-up over the last five years.

Dr. Lamichhane: What was the process like applying to podiatry school?

Taking the Medial College Admissions Test (MCAT) was the hardest part. The common application was simple to figure out and made it easy to apply to multiple schools. Writing the essay was a breeze, I just spoke a defining moment at work that made me realize this was the career path for me. Overall, when you are passionate about something it makes the process seem easier.

Dr. Lamichhane: And for one fun question … if you were an app on a phone, which one would you be and why?

I feel like I would be the clock app particularly the alarm because I am always up before my alarm and I always make sure everyone else is up on time.

(#Interview #Frederick #School #Education)

Rock the Red!

Playoff season for the NHL is upon us and it is no secret that fans in our area are beyond excited as our very own Washington Capitals continue their race to the Stanley Cup. While we watch history in the making begin to unfold, the thought of foot and ankle injuries always plague the back of my mind. Hockey is universally known as one of the more aggressive high-impact sports, and no one knows that better than the doctors and athletic trainers who treat these players.

At Frederick Foot & Ankle, we’ve treated hockey players of all ages. It may come as no surprise that we see injuries on all areas of the foot and ankle from this sport, but aside from the obvious breaks and strains that come along with any high impact sport, we see an incredible amount of repeated use injuries. These injuries are caused by redundant movements on specific areas of the body that wear on players until they have pain that they can no longer ignore.

One of the most common injuries is Achilles tendonitis, which we see in not just our hockey players, but anyone ranging from runners and athletes to business men and women. The Achilles connects the calf muscle to the heel bone and has been known to cause soreness in the back of the heel that can range anywhere to mild aches in the morning that are relieved by walking throughout the day, to debilitating pain that causes issues with a patient’s gait. If not treated in a timely manner, Achilles tendonitis can increase the risk of an Achilles tear, which is a much more severe injury that can require surgery. Luckily, we offer a range of conservative treatment options for patients which allow us to address the underlying inflammation and relieve pain so that players aren’t slowed down.

Another incredibly common injury among athlete’s that affects the foot and ankle in surprising ways would be injuries to the back such as herniated disks or nerve impingement. The sciatic nerve runs along the spine and controls sensations all the way down to the foot. These types of injuries could cause sharp, shooting pains as well as numbness and the sensation of pins and needles in the lower extremities. Because of the nature of these pains, we see patients who have acquired these types of injuries a great deal. Our doctors will evaluate the signs and symptoms of the patients and may order an MRI to get a clear picture of the spinal column and, based on the results of the study, can then refer patients to a specialist to have the problem addressed at the source instead of masking the symptoms.

As we continue to watch the Capitals go above and beyond to win the title of Stanley Cup Champions, I’d recommend that our own aspiring hockey stars continue preventative care at home and on the ice. Stretching, wearing proper padding and safety gear, and tending to minor injuries such as blisters at the time they occur can be the difference between a season-ending injury and a minor blip on a player’s radar. If a trauma or repeated-use injury should try to ruin your season, be sure to schedule a trip to a board-certified podiatrist. At Frederick Foot & Ankle, we treat an enormous range of injuries below the knee to keep our patients moving. Let’s Go Caps!

(#Achilles #Tendonitis #Stanley #Hockey #Sport )

Maryland School for the Deaf- Frederick, MD

Maryland school for the Deaf (MSD) was established in Frederick in 1868 and opened its doors to 34 students. The school was initially housed in the Hessian Barracks, these stone buildings were erected during the revolutionary war by the British mercenaries. Today there are over 14 buildings on MSD’s Frederick campus with a 500 plus student enrollment.

In the 1970’s Maryland needed additional seats to accommodate the increasing enrollment rate of deaf students. In response to the influx of students a satellite campus in Columbia was opened in 1973. Currently, the Columbia campus is in operation with 155 pupils ranging from elementary to middle school aged children.

MSD’s Frederick campus hosts deaf and hard-of-hearing students Kindergarten through 12th grade, tuition free. MSD attendees come during the day for class or they can reside on the campus in the dormitories through-out the week. Students learn directly from staff through American Sign Language (ASL) instructors, as opposed to learning through an interpreter. The school has many resources available to the students on campus including; after school activities, lounges, and athletics. Additionally, the campus is adjacent to historic downtown Frederick where there are many educational and entertainment outlets to choose from.

MSD is an integral part of the Frederick community and we love to see patients that attend this very notable establishment. The school’s mission statement is worth mentioning as it clearly lays out the institutions goals as “a diverse, bilingual community, in partnership with families, provides an equitable and exemplary education in a nurturing, engaging, and challenging environment to ensure our students achieve personal excellence and become responsible lifelong learners”

If you would like to be seen for your foot and ankle concerns and need an ASL interpreter, please contact us through the following link and mention your request in the comments section. We hope to meet the podiatric needs of all the members in our community!

“I Love You” is signed above by our Front Desk Coordinator, Hannah K.

(#Deaf #Frederick #ASL)

Ready to Run

The Frederick Running Festival took place this past weekend, May 5th and 6th, and it was a hit! Frederick Foot & Ankle was honored to be the title sponsors at this event and to be able to support our community in such a positive way. The running festival has been in commission for 16 years and has been a way to bring all the residents of Frederick together and to show off our historic city to out-of-town racers. The Frederick Running Festival had something for everyone; a half marathon, a two-person relay team, a 5k, and a Kids Fun Run.

Visiting the pre-event packet pick-up was an exciting warm-up for the main event. Packet pick-up offered a chance to check out local vendors merchandise, many of which was splattered in the beautiful Maryland flag, and lended the opportunity to chat with businesses about services they offer in the Frederick area. As for race day not only did we trek through beautiful downtown and rural Frederick but the finish line offered beer, bands, and food trucks.

In addition to everything that took place at the Frederick Fair Grounds, one of best aspects of the festival was the charitable donations that were made. A portion of the proceeds from the race were donated to multiple Frederick organizations including; Community Living, Summit Church, Service Coordination, and the Frederick Rescue Mission.

I would be amiss if I didn’t credit the success of the event to the appropriate people and organizations. Thank you to the volunteers, Corrigan Sports, all the athletes that came from near and far, co-sponsors, the City of Frederick, the Frederick City Police Department, and the residents of Frederick! I felt so proud to run next to numerous co-workers and to show off this city that I call home.

Altra Running Shoes

Frederick Foot & Ankle is proud to announce that we will start carrying Altra Running Shoes starting Friday March 23rd!

Our podiatrists agree that the key to healthy feet is proper foot ware for each individual. Many injuries and deformities of the lower leg are rooted in ill-fitting or improper shoes. This is why we have selected the Altra brand for our My New Feet Store.

There are several reasons why we feel the Altra Running Shoes are a suitable and supportive sneaker

Large Toe Box: The front part of the shoe where your toes sit is called the toe box. In many shoes this area is too small leading to deformities like hammer toes and bunions that are caused by limited space in the shoe. When the toes remain in a natural alignment the toe-off of the runner’s gait is more comfortable and efficient.

Zero Drop: Zero Drop is a phrase used to describe that there is no height difference of the shoe from the rearfoot to the forefoot. This keeps your heel and your toes on an even surface when standing flat, providing a more natural stance. When your heel is elevated in a shoe compared to your toes your Achilles tendon and calf are at a shortened position, over time this can lead to a shorter Achilles. An elevated heel also increases the impact on heel strike where zero drop minimizes these effects.

Gender Specific: Anatomically speaking men and women’s feet are not the same therefore different shoes are in order. Altra’s men’s and women’s line are manufactured to different specifications, in order to accommodate for the differences that are characteristic for each gender’s feet.

Improve Your Techinique: another reason we love Altra is there website provides eductional videos on how to run with better form.

These shoes were formed by a runner for runner’s and altered based on scientific research. We hope that out patients and friends love these shoes as much as we do.

(#shoes #running #Altra)

Skin ABC’s

In the United Stated there are more skin cancer diagnosis than all other cancer diagnosis combined. Podiatrists can detect skin cancer below the knee but we want all of our readers to be educated on the basics of identifying questionable skin lesions.

A – Asymmetry

If a skin lesion in asymmetrical when you draw a line through the middle of it and it will not look the same on both sides. Freckles, age spots, and other benign pigmented skin areas will look more or less like a circle. The lesions of concern are those that do not have a symmetrical look.

B – Border

The border of the area in question should be even and make a roundish shape. An uneven border that changes in thickness, color, and makes many turns is an indication of unhealthy skin.

C – Color

If the spot on your skin is a uniform color or changes only slightly than you are more than likely safe. If the skin spot makes a drastic change from a dark brown to a very pale brown then it is time to show your skin to a professional. Malignant lesions could range from brown, blue, red, tan, white, and black.

D – Diameter

Most normal skin lesions are below 6 mm. Once the area gets larger than a pencil eraser there is a higher potential for malignancy.

E – Evolving

when a mole starts to change in any of the above characteristics it is time to have it looked at. Occasionally benign moles will make alterations especially with sun exposure but large change in color, size, and shape are not normal.

There is reason to be concern if a mole become itchy frequently, bleeds regularly, takes an extended period of time to heal, or frequently crusts over. These are just a few other indications that your skin needs treatment. The above guidelines are valuable considering one in five Americans before the age of 70 will be diagnosed with skin cancer.

Don’t forget to apply sun screen all year around and for any skin questions below the knee Frederick Foot & Ankle is ready to address you concerns.

(#SkinCancer #Skin #Cancer )

Heel Fracture Stops Olympic Athlete

Katie Ormerod, a promising 20-year old snow boarder from Great Britain, must cancel on her Olympic plans the week before the winter games start. Ormerod suffered a wrist injury while training but pushed through, only to fracture her calcaneus days before stepping onto the Olympic stage in Pyeongchang. For a snowboarder a heel fracture cannot be ignored but calls for emergency surgery.

Heel fractures tend to happen in high-energy traumatic events such as; extreme sports, falling from a high distance, or a severe car crash. Often after severe trauma the heel can become deformed. The heel can change shape by widening or shortening after a fracture, often surgery is used to restore the normal calcaneus shape. With a change in heel shape the limb length can differ from the right to the left leg leading to a limp.

Arthritis, joint stiffness and joint pain frequently manifest after trauma because of changes that takes place in the foot with any fracture, but on a larger scale with a calcaneal fracture. The calcaneus is the largest bone in the foot and shares a joint space in multiple locations with 3 other bones in the foot/ankle making the calcaneus an integral part of lower limb anatomy and mechanics. To off-set these issues post calcaneal fracture healing occasionally orthotic devices might be needed. Luckily, heel fractures account for only 2% of all fractures but if you happen to fracture your heel Frederick Foot & Ankle is ready to assist you in your recovery.

(#Surgery #Heel #Pain)

Take Care of Your Foot Ulcer

Taking care of ulcers at home can be intimidating for some patients, but it does not have to be that way.

Off-loading the ulcer site – Reducing the pressure that is placed on the wound site is beneficial because it decreases the amount of damage to the site and keeps a larger blood supply to the wound. An important part of offloading is wearing the correct shoe, padding around the ulcer, and walking only if permitted by your podiatrist.

Use the correct wound dressing – Ulcers need to have the proper environment to promote healing. You do not want the environment too wet or too dry. Excessively dry wound beds hinder the movement of the healing cells. When an area is really wet the skin becomes very fragile and is easily disrupted. The proper treatment should be applied directly to the wound and then covered with a secure wound dressing. The area should always be covered when it is not being assessed or cleaned. Keeping the wound covered is necessary for many reasons; keeps out potential infections, allows the topical treatment to stay at the wound site, and applies a small amount of pressure to combat excessive inflammation.

Never miss your appointment – Your appointment with your podiatrist is to check and make sure that the area has not become infected. If the site does become infected the open wound can lead to infection spreading into the blood stream or perhaps into the bone. Debridement, when the hard-callused skin is removed with a blade from the wound site, allows for the area surrounding the wound to have a healthy tissue with a blood supply.

The above steps are general guidelines, be sure to follow your doctor’s orders for your specific case.

APMLE Boards Prep

Second year podiatric students are required to take the American Podiatric Medical Licensing Exam (APMLE) step 1. This exam tests the students on the knowledge that they have acquired through their first two years in school. General Anatomy, Biochemistry, Microbiology, Pharmacology, Physiology, Pathology, and Lower Extremity Anatomy are covered by AMPLE standardized test. After having gone through the whole process of taking multiple boards exams myself several years ago, I compiled some pointers to direct current students in the right direction and hopefully to a passing grade.
Focus on the Main Three
Although there are seven categories in total on the exam there are “The Big Three.” These three categories will be where the largest percentage of questions originate from, therefore spending the most time on “The Big Three” will be the best use of your time. Lower Extremity Anatomy, Pharmacology, and Microbiology are known as “The Big Three” will be the largest percentage of the test.
The percentage of questions are broken down as reported

· Lower Extremity Anatomy: 25%

· Pharmacology 15%

· Microbiology and Immunology 15%

· General Anatomy: 13%

· Physiology 13%

· Pathology 12%

· Biochemistry 7%

Make a Schedule
With your study partner choose deadlines for yourself that are obtainable to stay on track. Even if you and your study partner do not study together as a team they can be someone to show-up at the library and hold you accountable for being present for a study session. Having a schedule will show you how far out it might be necessary to study, and when it is ok to take study breaks. Many students make the mistake of starting too late because they underestimate the amount of time needed to get through their study material. No student has ever said “I started studying too early.”
Choose Your Resources Wisely
Pick 3 or 4 strong resources to learn the material from. When you start jumping around and using multiple resources for different subsections there is a higher chance that you will miss necessary topics and that you will be wasting time going between different sources. Listen to upperclassman, do a quick online search, and follow guides set-up by your professors to narrow down what you want to use for your study materials.
Useful Information
From my experience the following materials are worthwhile for boards part 1 studying.

  • Take Advantage of resources made available by APMLE which include study tools, an outline by topic, and practice questions
  • Anatomy TV is a free online resource for helping you visualize the structures for lower extremity anatomy.
  • First Aid USMLE for Step 1 is a concise book that over views all of the necessary topics. The book is well organized, includes mnemonics, and includes pictures. Although obviously written for those taking the USMLE it works great for APMLE.
  • Pathoma is a great book and video content combo for studying anything pathology associated. Sign-up for the free trial first to see if it will work for your studying style.
  • SketchyMedical is for all you visual learners out there. SketchyMedical includes a story along with a picture full of mnemonic devices to help you remember microbiology, pathology, and pharmacology topics. Follow the website below to view a free trial and potentially purchase the subscription.!/homeTo all the medical students out there Frederick Foot & Ankle wishes you the best of luck in your studies!