Immersion Foot

We send our love, prayers and support to those affected by Hurricane Harvey in Texas, Hurricane Irma in Florida (pictured above) and the Caribbean Islands. We feel for those that have been displaced from their homes and some who have been taken from their families too soon.

With all this water across the U.S. and in select islands we wanted to remind our friends the importance of keeping their feet dry. Skin is the first defense against outside microbes that surround us daily and live on our skin. When the skin becomes overly hydrated by excessive perspiration or feet remaining in wet shoes or socks the skin becomes delicate. At this point when the skin turns pale and becomes pruned it begins to peel away. This weakened and broken skin is often the point of entry for bacteria. If the infection is not taken care of there is always a chance that it will travel into the surrounding tissue, which may lead to serious consequences.

During the Vietnam War soldiers would stand for long periods of time in wet boots and socks out in the field. These unsanitary conditions in the trenches would lead to the soldier’s feet becoming numb, painful, itchy, blistered, and infected. If untreated trench foot would set in, today it is called immersion foot and it could lead to gangrene and amputations. Immersion foot is avoidable if proper care is taken by; cleaning feet daily, keeping them dry, changing foot ware regularly, and checking feet daily for any issues.

If you are in an area or in a line of work where your feet get wet for long periods of time please remember to take protective measure by wearing water proof boots are having the availability to change into dry shoe gear. If a professional’s opinion is needed please see one of our highly qualified podiatrists at Frederick Foot & Ankle because we love to keep our patients moving.

Following in my Mother’s Footsteps

Working with a relative can have its challenges but we have found that adding real family to our Frederick Foot & Ankle family has worked out for all parties involved.

Robbie and Shannon are one of our Mother-Daughter working relationships. Shannon has been working with Frederick Foot & Ankle for 7 years in multiple positions. Shannon now holds the title of our Clinical Coordinator, a very fitting position for an employee that has 20 years of clinical experience. Shannon started bringing Robbie around the office on her school breaks when she was 15 years old and she completed odd jobs around the office. Now that Robbie has graduated from high school she has joined the work force full time we now have the pleasure of seeing Robbie’s smiling face at the front desk and check-out. In addition to working at the podiatry office during the day Robbie and Shannon are both dance instructors at a local studio. When asking Shannon about working with her daughter she wanted to make it clear that even though they drive together to work she does not make Robbie lunch.

Our second Mother-Daughter team is Shannon and her daughter Kayla. Shannon came to us with 10 years of Podiatry experience and started with Frederick Foot & Ankle 7 years ago as front desk but has since switched roles and has become a wonderful addition to our billing department. Shannon admitted that when Kayla first applied to Frederick Foot & Ankle she was hesitant about working with her daughter but finds that everything has worked out for the best. When asking Kayla her position with Frederick Foot & Ankle she said she wanted a change from working retail and finds that she is learning new skills that will carry over to future positions.

Danielle and Alexis may look like twins and are frequently mistaken as such, but are actually 5 years apart. Danielle, the oldest, landed a job first at the podiatry office as a scribe and later referred her younger sister for the intern position. Now that Alexis is more seasoned she has joined Frederick Foot & Ankle in a bigger role as full time medical assistant. The sister-sister team works side by side in two different roles one as the medical assistant and another as a scribe. Their bond goes outside the office with carpooling, living together, and sharing lunches. Both sisters are also attending Frederick Community College and working towards their nursing degree. We are lucky to have them both and know that they will both make excellent nurses in the future.

By Nikki Ho

Furry Companions

In the picture above is Abby with Dr. Steinberg. Abby, a French Poodle, is such a smart service dog that she is even able to remove shoes and socks on command.

Service Dogs occasionally make their way into the Frederick Foot & Ankle office. Not only do their owners benefit from their presence but our staff enjoys their company as well. Service dogs are normally distinguished by a tag or a vest, to inform the surrounding population that they are working. Service dogs are trained specifically for one individual and the conditions the individual needs assistance with. Americans with Disabilities Act (ADA) allows service dogs to enter places that are for the public, this provides the service dog’s owner to continue their daily activities with the help of their trained companions. Although we have not yet seen one yet at Frederick Foot & Ankle the ADA also recognizes miniature horses for their service assistant.

Apart from Service dogs there are also therapy animals and emotional support animals. Therapy animals are normally canine and are trained to comfort a large population such as those in nursing homes, schools, or hospitals. The therapy animals help alleviates negative feelings associated with anxiety, depression, and other mental disorders. Emotional Support Animals are another category of animals that aid their human in daily life. Emotional supports animals do not need any specific training because just their presence helps their companion with mental stresses. Although these therapy animals and emotional support animals are helpful in multiple settings they are not granted the same rights as service dogs.

Research for pet therapy has presented the medical community with many beneficial effects

  • Decreased the severity of “sundowner” symptoms in dementia patients
  • Alzheimer patients reported recalling more memories
  • Those with PTSD felt a reduction in symptoms
  • Diabetics where alerted when their blood sugar was dangerously low
  • Helping those with drug addiction not feel alone and consider their pets feelings and not just their own

We love our diverse population of patients and feel so lucky to witness the true healing power of their furry friends.

( #Exercise #School #September #Study #Grades #Food #Sleep #Test )

FFA Sends Another Employee to Podiatry School

Our good friend and scribe Mimi has recently departed for podiatry school in Philadelphia. Mimi will be attending Temple University where she will spend four years studying podiatric medicine. Dr. Lamichhane wanted to ask Mimi a few questions about being a new podiatry student, hopefully giving some of our follwers some direction if considering a path in medicine.

Dr. Lamichhane: What sparked you’re interested in the medical field?

Mimi: I’ve wanted to be a doctor/surgeon for as long as I can remember. I always wanted to help people, and I knew the best way I could do that was by becoming a doctor. I always admired the providers I had growing up and the knowledge that they conveyed.

Dr. Lamichhane: Out of all the fields in medicine why did you finally decide on podiatry?

Mimi: Throughout my collegiate years, I never in a million years would have thought I wanted to work with feet. My journey initially started when my fellow friend and future classmate became a scribe at Frederick Foot and Ankle. She introduced me to the field of podiatry, and I essentially took over her position as a scribe when she left for school. After shadowing and watching surgery for the first time, I knew right there that this was what I could see myself doing. Over the past year while working at FFA, I learned so much from all of the doctors and I was able to see patients’ progress despite having a multitude of issues. Seeing the impact an office visit has on our patients made me confident in persuing a career in podiatry.

Dr. Lamichhane: What surprised you about Podiatric Medical School when you arrived?

Mimi: The amount of studying in podiatry school is way beyond what was needed when getting and undergraduate degree. Most of your day when in podiatry school revolves around studying and going class. You really have to love what you do and want to be here in podiatry school to devote 4 years of intense studying.

Dr. Lamichhane: What advice would you give to others looking to apply to podiatry school?

Mimi: I would tell them that this is a great field to go into but to be 100% certain that this is what they want to do, because it is rigorous. Some podiatry school canidates do not realize the amount of work that is required to be in school and that you actually do study the entire human body, not just feet and ankles. Just be ready to have fun and work hard.

Dr. Lamichhane: You had to move to a Philadelphia for school, what is your favorite thing about living in the City of Brotherly Love?

Mimi: I have always felt that Philadelphia was a very live city, always something to do and see. To be honest I am mainly excited for the food! Not only is Philadelphia known for the cheese steaks but all sorts of other dishes and dining experiences.

Dr. Lamichhane: I know you have not been away from us for too long but what do you miss most about Frederick Foot & Ankle?

Mimi: I really miss the staff. The doctors have been such wonderful mentors for me and giving me alot of advice about school and becoming a podiatrist. At Frederick Foot & Ankle I felt that the work environment was enjoyable and easy-going. The people I worked with became my friends outside of the office as well and it makes it hard to leave, but I am excited to start school in a new city.

Dr. Lamichhane: After four years in school and you become a Doctor of Podiatric Medicine, what type of doctor do you want your patients to see you as?

Mimi: I hope they will know how genuine I am in caring for them and helping them in the best way possible. Having a strong doctor-patient relationship is important so that your patients trust that that you will make the best medical decisions for them.

Dr. Lamichhane: And finally, for a fun question, what super power would you like to have and why?

Mimi: I want the power to heal people. Hopefully I can aim towards that once I’m a doctor. When people are in pain it changes their whole day; they tend to do less, they become less interactive with others, and overall have a more negative outlook on their day. I want people to be pain free so they can be the best version of themselves.

Frederick Foot & Ankle would like to wish Mimi luck in her future endevours at school, we are so proud of her !

( #Frederick #Foot #Doctor #PodiatrySchool #Maryland #Philadelphia #Scribe #Temple #GraduateSchool)

Plantar Warts

Warts are non-cancerous skin growths that can show-up on any part of your skin. Warts are rough, bumpy, lesions that are often painful with pressure. Blood vessels appear in the lesion and they look like small Blacks dots. Plantar warts are specifically the warts that are found on the bottom of your feet, they become flat from the continued pressure.

Warts are caused by HPV (human papillomavirus), the virus can be picked up from infected surfaces (like shoes or shower floors) or directly from another individual that is infected. An individual with the virus can begin to infect different locations on their body, HPV travels more effectively on perspiring skin and a drying agent can be used to decrease the ease of motility.

Those with weakened immune system are more susceptible to the virus but it can also be contracted by a healthy individual. The virus is more commonly seen on children because they tend to be more active without shoes and less hygienic, increasing their chances of being exposed to the virus.

At Frederick Foot & Ankle treatment starts with an office visit. The podiatrist will remove part of the lesion in question and sent it to the laboratory for a confirmation. Treatment will begin by removing the top layer with a blade and then trichloric acetic acid is placed on the site to remove and kill the virus infecting the skin cells, this process is normally only mildly uncomfortable. The area is then covered for protection.

Between office visits it is the patient’s responsibility to continue to treat of the plantar wart. A wart pack can be purchased from the office which includes all the necessary products to quickly treat the infection. The wart pack includes: wart medication, a drying agent, a pumi stone, and bandages.

The amount of time it takes to rid the skin of the virus depends on the initial size of the wart and the compliance of the patient treating the area at home.

If you have a questionable lesion below your knee let the podiatrists at Frederick Foot & Ankle evaluate and treat it for you.

( #FootCare #HPV #Foot #Specialist #Doctor #Feet #Warts #Plantar #Warts #Pumi #Stone )

FFA Visits Alive @ Five

If you haven’t heard about all that events that are put on in Downtown Frederick then you need to book mark http://www.downtownfrederick.org/calendar. Here you can find all the happenings that are hosted in Downtown Frederick; First Saturday Events, parades, workout classes, and concerts.

Recently Frederick Foot & Ankle Management took a much-needed time-out at Alive @ Five. Alive @ Five is Frederick’s outdoor summer concert series that features different local entertainers each Thursday at the beautiful Carrol Creek Amphitheater. The talent performances ranges from Funk to Reggae to Blues and Acoustic Rock. In addition to the outdoor ambience the $5 admission covers drinks and food provided by the local vendors. Well behaved furry friends are welcome but human guests must be 21 years of age or older.

It amazes me how much Carroll Creek Park has grown up. In the 1970s the creek was put in to save downtown Frederick from flooding and the practical water management feature was solely pragmatic with little emphasis on aesthetics. After Downtown Frederick realized the creeks potential the park blossomed into a hot spot for Frederick County residents. Now the park can boast about its multiple water enhancements, vegetation, bridges, and outdoor art work. The creek has become a place to enjoy the local cuisine, go for a walk, and enjoy the popular events that grace the linear park.

Frederick Foot & Ankle feels so lucky to thrive in such a great community that invests in the quality of life for the surrounding population.

( #Frederick #FootDoctor #Summer #FootSpecialist #CarrollCreek #AliveFive #LinearPark #Concerts #HappyHour #BreakTime #Downtown #TeamBuilding )

Piriformis Syndrome

What is the Piriformis?

Piriformis is a small muscle in the deep gluteal region that helps with lateral rotation of the lower extremity. The muscle originates on the sacrum and inserts on the femur. The movement of this muscle is important in walking and running. The sciatic nerve runs behind the piriformis and continues from the glute to the leg to supply feeling and sensation.

Piriformis syndrome

When damage happens to the piriformis by overuse or trauma it can cause deep gluteal muscle pain at the sight of the piriformis but more frequently it will cause piriformis syndrome. The piriformis can compress the sciatic due to the proximity of the two structures. In some instances, it has been seen that the sciatic nerve runs through the piriformis muscle.

Signs and symptoms

When the sciatic nerve gets compressed the patient experiences; numbness, tingling, and a dull pain starting in the buttocks and sometimes ending in the lower calf or foot.

Diagnosis

Piriformis syndrome can normally be diagnosed from a patient’s physical and history of the pain. To rule out other causes of the sciatic pain MRI imaging can be performed, but not always necessary.

Treatments

  • Rest – to allow for the piriformis muscle to heal and swelling to decrease
  • Stretching and range of motion exercises – reduce pressure on the nerve
  • Massage – to release the muscle spasm
  • Ice/heat – to decrease swelling and increase circulation

With proper treatment piriformis syndrome will subside in about 4 weeks. Regular stretching can delay the onset of Piriformis Syndrome from returning.

Illustration credit: http://dailyvitamoves.com/sciatic-nerve-pain-relief-releasing-tight-piriformis/

Combating Dry Feet

One particular ailment that is seen on a regular basis from my patients is dry feet. It is unfortunate that such an easily solved condition still manages to plague so many toes, heels, arches, and ankles. Not only does dry skin feel uncomfortable but can lead to cracks in the skin. Why do I care about dry skin that end up with cracks? Not only do patients complain about the unsightliness of their xerotic lower limbs but the cracks are a break down in the skin, and skin is your first barrier against infection. Once the pathogens pass the open skin barrier it has an easier time making a home and causing more chaos, in the form of infected wounds.

First, remove the buildup of excess skin on your heels, and other high-pressure areas. This can be accomplished simply by using a cream with a mild emollient. A common skin softener found in moisturizers is urea. Only use the urea on the tough thick areas of your skin. In our office, we carry a range of moisturizers but one for corns and calluses that has a higher concentration of urea than other drug store brands.

A pumice stone can be used in conjunction with the urea cream. Select a pumice bar with medium coarseness, one that is too rough might cause more damage to your feet. It is best to use the pumice stone after taking a shower, or the day following urea cream use because this is when your skin is the most supple.

Finally, use a good moisturizer and use it regularly. Moisturizer does not need to bear a fancy name or an exotic scent to be effective, most basic moisturizers do the trick. Often lotions with fragrances are the source of skin irritation. Look for moisturizers with as many of the following ingredients; jojoba, ceramides, glycerin, and hyaluronic acid. The best time to moisturize is right after a shower. Once the lotion is on your feet cover with socks to hold the moisture. For socks that even assist with moisturizing the feet, ask any Frederick Foot & Ankle employee to show you the Moisturizing Gel Socks, sold in the My New Feet store.

If the thickness of your calluses is no match for a pumice stone and you need professional help the podiatrists at Fredrick Foot & Ankle are a prime resource. As podiatrists, we are all trained to recommend the best foot products for you and can even skillfully remove any hard thickened skin from your feet and toes. With a little extra effort, your feet will thank you and you will be ready for sandal weather.

Heal Your Wounds This Summer!

As podiatrists, we are also experts in wound care below the knee. I believe it is important for all our patients to be better educated on wound healing so they can continue the healing process in between their visits to the Frederick Foot & Ankle offices. Below are some important factors that affect wound healing.

Circulation – Proper blood flow to the site of the wound is important because of all the necessary healing factors found in blood, such as; neutrophils, macrophages, lymphocytes, and oxygen. Those with circulation disorders, are going to have a slower healing process and therefore need to be even more vigilant of the site.

Nutrition – Although it is not an obvious factor what you consume does play a role in the healing process.

  • Protein rich foods have been noted in several studies as providing the necessary building blocks for your skin to recover; beans, nuts, chicken, milk, and eggs are some examples of protein packed foods.
  • Fatty Acids are what make up each of your cell membranes. Just remember to choose the healthy fats that are found in olives, avocados, salmon, and nuts.
  • Carbohydrates are needed for their source of energy. Carbohydrates are good in moderation and the whole grain cereals and breads are the better choice.
  • Vitamin C contains antioxidants and helps with the production of collagen. Antioxidants protect your body from potentially damaging oxidizing agents and collagen is a main component of skin and connective tissue. For a daily dose of vitamin C eat your leafy greens and citrus fruits.
  • Vitamin A is needed for each of your cells to reproduce and keep chances of infection minimal. Many vegetables contain vitamin A, carrots, sweet potatoes, and squash, to name a few.
  • Zinc is needed for your immune system to stay alert and to aid in cell division. Zinc comes from some meats like turkey and lamb. For those that don’t eat meat zinc can be obtained from quinoa, pumpkin seeds, and lentils.

Smoking – Wound healing is another added benefit to quitting that habit. Cigarettes are toxic and slow your circulation causing less of those needed healing factors to reach the site of the wound.

Compression and Wound Care Bandages – With your skin no longer intact the wound care dressing acts as a temporary barrier from microbes as your skin continues to regenerate. The dressing doubles as a compression to the wound. Compression helps reduce swelling in the area, keeps blood flow moving through the veins, decreases pain, and reduces chances of a blood clot. Compression bandages can be paired with other compression aids like; compression socks and lymphedema pumps.

Wound Environment – In addition to keeping the wound covered, you should keep it moist. “Drying-out” the wound so a scab can form is an outdated and ineffective way to treat a wound. When the area is dry the scab creates a barrier that the wound healing cells of the body must work around.

For additional questions on how to properly care for your wound, do not hesitate to make an appointment with one of our well-trained podiatrist.

Flat Feet

Flat feet have carried a stigma in the past, although many people have them without even realizing it. There are three types of stances that appear in feet, and these stances can change when standing: pes planus (flat foot), neutral, and pes cavus (high arches). Each foot type has its own type of care that can keep them from causing you any kind of pain, and even perfectly arched feet can benefit from preservative care.

Flat feet can be deceiving, because the arch of your foot changes when you are weight bearing. This means that even if your feet look like they have an arch when you’re sitting, the bones in your feet can collapse when you stand, causing the bones to rub against each other and the tendons in your foot to stretch quickly and more than necessary. This can lead to arthritis in the joints in your foot, tendonitis in your ankle, and/or plantar fasciitis in the bottom of your foot.

Alternately, high arched feet have are composed as a more rigid structure, with an angle higher than that of the neutral arch. This can be compensated for with custom inserts or padding, preventing pressure injuries on the ball or heel of your foot.

While high arched feet can cause issues, it is more likely that flat feet could be the root of foot pain, many of which you feel primarily in your heel or the arch of your foot. Without the proper supports, flat feet can even change the alignment of your hips and lower legs. It may feel uncomfortable at first, but rigid arch supports are the best for this foot type.

To test the rigidity of the orthotics, simply bend the orthotic at the arch using your hands. If the insert folds in half, especially if it is very easy for you to fold it, the arch is not rigid enough and you should look for another insert. While such a hard insert may seem counterintuitive, the soft inserts are of no use to provide support, leaving your foot to work overtime on its own. The overworking of the tendons and ligaments would be what is causing your foot pain in the first place.

We offer different types of supports in our office, ranging from braces that extend up the ankle to provide extra stability, to simple inserts that can be placed in the sole of the shoe, never to be seen when the shoes are on. Custom orthotics are covered by many insurances, and are made to match your foot using casting material or a digital scanner to notate the shape and depth of all areas of your foot. If your insurance does not cover custom orthotics, or if you are hesitant to try them, we also offer many different forms of semi-custom inserts, all of which feature a rigid arch support and will become shaped to your foot with recurrent wear. Make an appointment with our office today to have your foot evaluated to see if you would benefit from supports in your life.

( #FlatFeet #Feet #Arches #PesPlanus #PesCavus #HighArch )