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Sharp, Zinging Pain or Burning in Your Feet?

woman massaging her foot

Do you experience unusual sharp, zinging pain or burning in your feet? Many Americans do.

What could be causing that?

It could actually be a number of things. Learn about some of the possible causes so you can find relief:

  1. Neuropathy

Generically, “neuropathy” is a burning sensation in your feet believed to be due to distal small-fiber neuropathy (DSFN) affecting fibers. The question then becomes,”What causes neuropathy?”

Peripheral neuropathy can actually be caused by a number of different conditions.

According to Mayo Clinic, these are some:

  • Alcoholism
  • Autoimmune diseases lie Sjogren’s, lupus, rheumatoid arthritis, and Guillain-Barre syndrome
  • Medications, and especially those used to treat cancer
  • Exposure to poisons
  • Infections like Lyme disease, shingles, hepatitis C, HIV, and diphtheria
  • Traumas on the nerve caused by an accident
  • Tumors

As you’ll see, there’s other causes too that are more common.

  1. Diabetes

20% of study participants with type 2 diabetes and 5% of those with type 1 struggled with diabetic peripheral neuropathy (PDN). The study was performed by Hartemann, Attal, Dumont, Gin, Jeanne, Said, and Richard.

PDN is a painful and incurable (though treatable) symptom of diabetes.

  1. B12 Deficiency

Vitamin B-12 is essential to good nerve health. Vitamins B-1, B-6, and E are too. But Vitamin B-12 is the one most closely tied to burning and tingling sensations in your feet.

  1. Anemia

Anemia can cause tingling and pain in your feet. Though if it causes the sensation of temperature, it’s usually cold, and not hot.

Blood loss causes anemia in most cases. This can be due to heavy periods, surgery, cancer, or a physical trauma.

  1. Heavy Metal Toxicity

Heavy metal toxicity can actually cause a broad variety of symptoms, including pain and tingling in your feet.

Definitions of “heavy metal toxicity” vary also. However, they usually include mercury, lead, cadmium, and manganese. You can ingest these metals in a number of ways without even knowing it.

  1. Chemotherapy Drugs

Some, but not all, chemotherapy drugs can cause pain and burning in your feet. Make sure you check with your doctor to see if this is a possible side-effect.

  1. Idiopathic

When the cause of the tingling and burning in your feet can’t be determined, it’s called “idiopathic.”

Unfortunately, great as our technology is, you can’t always find the real cause of sharp and zinging pain in your feet.

Overall, these are many of the causes of burning in your feet, but not all of them. If you have this sensation, consider seeing a doctor and prepare yourself for some trial-and-error before a determination is made.

The Truth Behind 2 Common Home Remedies for Foot Problems

Does duct tape remove warts? Can Vicks VapoRub put an end to toenail fungus?

You hear all kinds of crazy stories about home remedies that people claim work. And because of the internet, you hear thesBarefoote stories even more often than ever before.

So, what’s the deal? Do people make those stories up just to get a rise out of everyone else? Or do they have some truth behind them?

Find out below:

  1. Does Duct Tape Remove Warts as Well as Liquid Nitrogen Treatments?

Liquid nitrogen hurts. It takes some time and a couple treatments to work. It’s unsightly. But, it’s the most common recommendation for treating warts.

What if you could wrap a piece of duct tape around your toes or fingers instead?

One study found 85% of people who used duct tape got rid of their wart, and most did so within 28 days. That compared to 60% who used liquid nitrogen.

But, they had to use the duct tape in a very specific way.

First, they put the duct tape on for 6 days, replacing it if it fell off. After those 6 days, they removed the tape, soaked the affected area in water, and rubbed the wart with emery board or pumice. They then left the duct tape off for 12 hours. A new piece was put on. And the cycle repeated for 2 months, or until they got rid of the wart.

  1. Does Vicks VapoRub Cure Toenail Fungus?

The first question that comes to mind: who got the idea to take Vicks VapoRub, and instead of using it to alleviate their cold, decided to rub it on their fungus-infected toenail instead?

It turns out that, whoever it was, they weren’t so crazy after all. The New York Times put this home remedy to the test and found that Vicks VapoRub in fact does relieve toenail fungus. This is good news because over-the-counter treatments are expensive, have annoying and significant side effects, and have a low success rate.

It’s nothing special about Vicks VapoRub though. What it has is a lot of Thymol, a primary oil found in thyme, a well-known herb and antiseptic.

To make it work, coat your toenail 1-2 times per day in Vicks VapoRub. Or, give your foot a bath in thyme essential oil.

Be a little careful. Some people are allergic to thyme and break out in an itchy rash.

Sometimes Home Remedies Make Sense, and Sometimes They Don’t

In this case, these 2 remedies are proven to work. But, you have to make sure you do them in the right way.

Just be careful before you try any home remedy. It’s important to know the truth and what really happens so you don’t make your injury any worse.

Do High Heels Cause Bunions or Other Foot Deformities?

Relaxing after a job well done!Ladies, what makes you feel more stylish, elegant, and attractive than going out with your significant other for the night and wearing heels?

Not every woman likes to wear high heels. But, many do. You know if you have to wear them and walk on them for hours, they can certainly cause you foot pain later that night.

Do high heels have more pronounced, longer-term effects too? Can they cause bunions and other foot deformities that require painful surgery that takes weeks and months to recover from?

Take a look at some of the evidence to see what current thinking holds:

  1. A New York Times Article Implicates High-Heels in Foot Pain

The particular article does not specify exactly which foot problems are caused by high heels. However it does say high heels “…can aggravate, if not cause, problems with the toes” and “women are at higher risk than men for severe foot pain, probably because of high-heeled shoes.”

However, they do add that women can reduce their chances of experiencing pain from high-heels by wearing ones with wide toe room, a wide base, and cushioned insoles. They can also reduce their pain by wearing high heels for a minimal amount of time.

  1. The Mayo Clinic Lists High Heels as a Risk Factor For Bunions

According to the Mayo Clinic, the problem with high heels is they force your toes into the front of the shoe, causing them to be overcrowded. However, they note that experts disagree on the specific role high heels play in bunions. Some experts believe high heels cause bunions, while others believe they simply contribute to the development of bunions.

In both cases, though, heels are believed to play a role.

  1. The Framingham Foot Study Shows the Biggest Factor That Causes Bunions

To make a long research study short, the Framingham Foot Study found that the biggest factor in hallux valgus (bunion) formation is genetics. In fact, the condition was concluded to be “highly heritable” among white men and women of European descent. You can read the fully study here.

What Action Should You Take?

It seems clear that high heels play at least some role in the formation of bunions and other foot deformities. However, the exact nature of that role isn’t obvious.

Mayo Clinic gave the most sensible advice: wear high heels as little as possible. And if you simply have to wear them, make sure they have wide toe room, a wide base, and cushioned insoles.

Gout is a real pain in my…..toe?

gout2What do Dick Cheney, Ansel Adams, Ben Franklin, Sir Isaac Newton and King Henry VIII all have in common? It is true they are all men but not what we are looking for. They are all popular pubic figures but again not the answer. Do you give up? They have all suffered from …. Gout! This condition does not affect only famous males but 1-2% of the western population will suffer from the condition at some point in their lifetime.

Gout is an acute inflammatory arthritis that was historically known as “the disease of kings” or “rich man’s disease” but rates have doubled in the past 20 years and are seen in all areas of society. Typically the condition presents with a hot, red, swollen, tender joint. It involves the big toe most frequently (>50% of case) but can also affect the heels, knees, wrists and fingers. An acute gouty episode is triggered by elevated levels of uric acid in the blood (hyperuricemia) which leads to crystal formation that gets deposited in the joints. Men are most at risk but women are becoming more and more susceptible.

Attacks are known to come on quickly and will usually resolve in 7-10 days but you should seek medical attention and not try to wait it out. The diagnosis can be made clinically but routine blood work should be performed to confirm the uric acid level and x-rays should be taken to make sure there is no fracture. Definitive diagnosis requires joint aspiration to test for the presence of urate crystals. Persons with untreated gout may be a higher risk for cardiovascular disease, kidney dysfunction and more severe permanent joint damage.

Acute treatment consists of ice and rest as well as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Indomethacin or Ibuprofen to alleviate the inflammation or Colchicine and steroids for those who can not take NSAIDs. In cases of recurrent or chronic gout, Allopurinol is started 1-2 weeks after symptoms subside and decreases the amount of uric acid produced by the body. Prevention can also be achieved by changing the diet to avoid foods rich in purines (meats, seafood, and lentils) as well as staying hydrated and not consuming too much alcohol or tea.

gout4

So you don’t have to be a man or a rich monarch to experience a gouty attack. In today’s society, men and women alike are at risk. Eating a balanced diet and avoiding foods that are high in purines in addition to a healthy lifestyle and plenty of exercise just might save you from a red, swollen, and painful joint. If you are concerned that you are having or have had a gouty episode call us at North Texas Foot & Ankle (972-574-9255) for a consultation.

What is a Neuroma?

neuroma3Do you ever feel like you are walking or standing on a pebble that doesn’t go away? Do your socks always feel like they are bunching up under the ball of your foot? Aerosmith front man, Steven Tyler did until he was recently diagnosed with a Morton’s neuroma and had it surgically removed. A Morton’s neuroma is a benign swelling of a plantar nerve in the foot. Most commonly affected are the branches between the 2nd/3rd or the 3rd/4th toes. Less common are swellings between the 1st (big toe) /2nd or the 4th/5th toes. Contrary to its name, a neuroma is no longer considered a tumorous growth but rather a fibrous overgrowth of the nerve covering or sheath.

The condition is caused by prolonged irritation or compression of the nerve which occurs with certain foot structures or with repetitive activities like running. The symptoms are pain with weight bearing or a sensation of walking on a pebble. The nature of the pain can vary from person to person and has been described as burning, tingling and shooting. Patients sometimes complain of numbness to the toes. Symptoms begin gradually, occurring with particular types of activities or shoe wear and progress over time leading to potentially permanent changes.

Diagnosis of a neuroma is made through thorough clinical examination and history of symptoms. Evaluation is best early in order to increase the success of conservative care. Imaging modalities such as ultrasound (US) or magnetic resonance imaging (MRI) help aid the physician in identifying to inflamed nerve, exclude other potential causes and even guide treatment. X-ray images will not show a neuroma but are useful in excluding potential causes such as metatarsal stress fractures or arthritis.

Treatment is best when started early. Early on treatment is conservative with shoe inserts or orthotics and activity modification. More frequently medications are needed in the form of oral non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammatory response caused by irritation/compression of the nerve. More resistant cases are treated with a series of corticosteroid injections or sclerosing alcohol injections. When conservative treatment options fail to provide relief, surgical removal of a segment of the nerve is warranted. Surgery is a simple day procedure with an average recovery time of 3-4 weeks.

If you are concerned that you have signs and symptoms of a neuroma call us at North Texas Foot & Ankle (972-574-9255) for a consultation.

Oh SNAP…..was that my Achilles?

kobe1Many athletes know the feeling, the “snap” followed by pain in the back of your ankle…you have torn or ruptured your Achilles tendon. It happens under all sorts of circumstances…like when Kobe Bryant landed on a misplaced foot, Erik Karlsson came into contact with an errant skate blade or Ryan Howard sprinted to 1st base, it even happened to Brad Pitt while ironically enough playing the part of Achilles in the movie Troy. Regardless, the result is a long and difficult road to recovery.

The Achilles tendon connects to calf muscles (gastrocnemius, soleus, and plantaris) to the calcaneus or heel bone and is the longest tendon in the body. Its function is to initiate plantar flexion, which points the toes toward the ground. This is vital for walking, running and jumping.

Achilles injuries can be caused by a number of reasons, such as overuse, not properly stretching, over exertion or from long-standing foot structure conditions like flat feet. Injuries can also occur with a history of chronic Achilles tendonitis or recent steroid injections into or around the tendon which causes degeneration of the tendon. Medical conditions such as diabetes, gout and hyperparathyroidism can also lead to tendon weakening. The injury typically occurs while the knee is fully extended and the foot is dorsiflexed or pulled up. This position places the tendon at its maximum length where further stress can be too much to handle resulting in a tear or rupture.

When an injury occurs there is often the sensation of a “snap” or “pop” in the posterior ankle followed by intense pain and inability to plantar –flex the foot. Diagnosis can be made via clinical examination but some imaging is required to confirm the diagnosis. Xrays are of little use but are helpful in excluding bony injuries such as an avulsion fracture. Magnetic Resonance Imaging (MRI) and ultrasound (US) are best at both locating the tear or rupture and estimating its extent.

Treatment options are simple…operate or don’t operate. Non-operative treatment options included 6-8 weeks of immobilization with a rigid boot or cast with the foot in a plantar flexed (toes down) position. This places in the tendon in its least stressed position and allows the tendon ends (if ruptured) to be as close together as possible. This treatment option is not recommended for athletes or individuals who plan on returning to “at-risk” activities. Surgical repair allows for more predictable course of healing but most importantly provides a reduced risk of re-injury. Surgical correction can be performed via an open or percutaneous procedure by which the tendon is sutured back together. Various grafting techniques are also often used to enhance strength and decrease adhesions of the tendon.

Return to activities varies depending on the treatment. Non-surgical correction can take up to 1 year for return to full activities whereas return after surgical correction without complication can be 6 to 9 months. Prompt recognition of injury along with proper treatment and perhaps most importantly thorough rehabilitation can prevent recurrent Achilles injuries.

So if you or someone you know have suffered possible Achilles tendon injury, contact North Texas Foot & Ankle for a consultation @ 214-574-9255.

Is beauty pain or bunions?

bunions4What’s the one thing a woman cannot live without? Some would say make-up, clothing, but many others agree that high heel shoes are it!  So what’s the hype about high heel shoes? Some say wearing high heel shoes can make the appearance of women seem taller. Some may say that legs look longer and sleeker. Others state that wearing high heels add a “pop” or “flare” to an outfit. All in all, women love their high heels and some cannot live without them. But be careful, if high heels are worn long enough they can cause significant problems. Not only can it result in a tight Achilles (another topic altogether) but it can contribute to the formation of bunions. According to the American Podiatric Medical Association about 43% of women admit to wearing shoes even if they caused them discomfort and 72% say that have had shoe related issues related to their feet.

Let’s talk about bunions. This deformity is caused by deviation of the great toe.  Many people misconstrue what a bunion actually is and believe it’s an “enlarged big toe bone or joint”.  Bunions are typically hereditary, but they can also be caused when pressure is applied to the big toe; this causes the big toe to be pushed inwards towards the other toes. The pressure can sometimes force the big toe over or under the other. Increased pressure can be caused by wearing tight fitting shoes or shoes that sometimes cause the foot to be pushed forward for example high heeled or pointed toe shoes.

So, how would you know if you have a bunion? Some signs and symptoms include pain when walking, joint irritation, redness, and pain, possible deviation of the big toe toward other toes. Sometimes people may form blisters around the big toe as well. Having bunions may make finding shoes difficult. Many people may have to buy shoes a size larger and/or often wider.  Bunions are mostly genetic. Foot structure may also be a factor. This anomaly includes conditions such as “flat feet”, abnormal bone structure, the disproportionate flexibility of ligaments, and certain neurological circumstances. Despite genetics, there is no doubt that high heeled shoes can exacerbate the condition and pain associated with bunions!

Treatments for bunions may only include conservative care, such as changes in shoe wear or obtaining orthotics, inserts, or padding. Rest, ice, and oral medications may also be used. These treatments only address the symptoms, but not the actual deformity itself. Surgery may be a necessary if the condition causes extreme discomfort or if it’s desired by the person with the deformity.

So women, whether you have an extended family tree of bunions or you just have to have the newest pair of trendy pumps, always remember to make sure your heels are comfortable and be sensible on how often and where you wear them. Ensure that your feet have enough room so no discomfort is being caused. If you believe you or someone you know may have a bunion, contact North Texas Foot and Ankle @ 214-574-9255 for a consultation.

Have you seen my comb?

diabetic-neuropathy-200

Spend some time in a podiatry clinic and you will see and hear it all. Recently, a diabetic patient being treated for an aliment of his right foot stated, “I think there is something in my left shoe.” I expected to find a fold in his sock, a pebble but no… he took off his shoe and removed a six inch black comb! We looked at each other with mutual surprise and he said, “I’ve was wondering where that went…I’ve been looking for it all day!” This just illustrates that diabetics with neuropathy can never be too careful when it comes to their feet.

Diabetes is a metabolic disorder characterized by the bodies inability to process glucose (sugar) leading to elevated levels circulating throughout the body. Diabetes Mellitus can be categorized into two types: Type 1 (Lack of Insulin) and Type 2 (Inability to respond to insulin). Type 1 is typically diagnosed early in life before elevated sugars can cause damage to your body. Type 2 on the other hand is not typically diagnosed until later in life, meaning elevated sugar levels have had 10-15 years to damage the eyes, the heart, the blood vessels and the nerves.

neuropathy4

Neuropathy refers to damage of the body’s nerves. This can occur in a number of different ways but diabetes is a very common cause. It typically starts out affecting the peripheral nerves of the hands and feet and is described as a “glove and stocking” distribution. Later on the nerves of the heart, GI tract and bladder can occur. People suffering from neuropathy describe altered sensations of the hands and feet such as burning, tingling, numbness or even shooting pain.

Diagnosis can be made with the combination of a thorough history and examination along with simple blood work looking at sugar levels along with the body’s levels of vitamins B12 and B9. If examination and lab work indicate diabetes and/or neuropathy, studies such as an EMG (electromyogram) or NCV nerve conduction velocity) or epidermal nerve fiber testing can help determine the severity of progression.

neuropathy3

Not much can be done to “cure” neuropathy due to long standings diabetes. Vitamin B12 and Folic Acid levels can be checked and if low supplements can help reverse the symptoms. In the majority of cases treatment is aimed at managing diabetes and controlling sugar levels. Calming the nerve related symptoms of burning and tingling can be achieved with prescription medications like Metformin, Lyrica, Cymbalta or topical compound creams.  Physical therapy with VST or anodyne treatments has also proven helpful in decreasing symptoms. In some cases, patient may be a candidate for nerve decompression surgery.

The importance of proper management is in the prevention of complications like ulcerations, infections and amputations. Like the patient mentioned above, neuropathy causes decreased feeling in the hands and feet.  This means patients do not feel rubbing or foreign objects in the shoes, which can lead to open sores and wounds and/or infection. So, if you or someone you know is suffering from the signs and symptoms of diabetes and/or neuropathy, call North Texas Foot & Ankle at (214) 574-9255 to schedule a consultation.

Sandal season is coming…..are your toenails ready?

How do I go from this to this?

fungus-toenails-300x120

It is an all too common story, a patient comes to the office (usually female) concerned that spring and summer are fast approaching and they want to wear sandals…but their toenails won’t let them. The male patients sometimes present wearing socks with their sandals in order to hide their nails and many women exclaim that there is not enough nail polish in the world to hide the state of their nails. Fungal nails can be both an embarrassing and problematic condition…but there are things you can do!

Dermatophytic onychomycosis, aka Tinea Unguium (Ringworm of the Nail), is the most common nail abnormality and affects, on average 6-8% of the population. It is a fungal infection and occurs in both the fingernails and toenails; however toenail involvement is by far more common. The condition causes the nails to be discolored, thickened, brittle and cracked.

Initially, the condition is of cosmetic concern to patients and many are dissatisfied with the appearance of their nails. If left untreated the condition can progress causing pain and difficulty in walking. Nail thickening causes increased pressure in shoe wear leading to decreased mobility which can worsen peripheral circulation.

Onychomycosis accounts for 30-50% of nail abnormalities. Other nail abnormalities such as psoriasis or previous traumatic injury can be mistaken as fungal infections; therefore diagnosis should be confirmed with nail sampling. Scrapings or trimmings from the affected nails should be collected prior to initiation of treatment and sent for periodic acid-Schiff staining to confirm fungal involvement.

Once the diagnosis has been made there is a variety of treatment options that can be tried alone or in combination. There is a number of topical treatments available, like prescription strength Penlac or FFN, to name a couple. These options are best when used in combination with other options or for maintenance of cleared infection. Oral medications such as Lamisil (terbinafine) or Sporanox (itraconazole) have been the mainstay of treatment. These medications are taken for 3-4 months and concentrate themselves in the nails, providing continued treatment beyond that time. These medications are processed through the liver so routine blood work should be done while on the medication in order to avoid complications. Newer treatment methods are also available for the patients trying to avoid medication. Various nail lasers are becoming a popular treatment option and are proving to be just as effective as oral medications in the clearing of infection. Regardless of treatment method, full resolution of infection and replacement with clear healthy nail may take 9-12 months.

Prevention is important as effective treatment only clears the infection but does not guarantee there will not be recurrence. Continued use of topical lacquers is recommended. Use of sterilization devices, such as the SteriShoe® have been effective at eradicating residual fungus found in the shoes of affected patients. If you or someone you know suffers from a fungal nail infection call 214-574-9255 for a consultation.

Is Your Nail Polish Toxic?

166319237-300x199 They say that beauty is only skin-deep, but toxic chemicals in nail polish, go much further. The familiar chemical odor of standard nail polish comes from a group of ingredients that have come to be known as the “toxic trio” by health advocates, such as Alexandra Scranton, director of science and research for Women’s Voices for the Earth, and Sonya Lunder, a senior analyst at the Environmental Working Group.

All three “toxic trio” chemicals are classified as the most toxic by the Skin Deep Cosmetics Database, a repository for the science behind the chemicals in personal care products which is maintained by the Environmental Working Group.

The “Toxic Trio” includes:

Dibutyl phthalate (DBP): A possible trigger of asthma attacks, this phthalate has also been associated with developmental and reproductive effects, and cancer in lab animal testing. Lunder calls it a “potent hormone disruptor that affects the male reproductive system most dramatically.”

Toluene: A solvent, also found in gasoline, that can cause dizziness and short term intoxication. Like DBP, it is a volatile chemical that can be inhaled and absorbed through the skin and nails. It could also be listed on the label as “toluol” or “phenylmethane.”

Formaldehyde: Considered a human carcinogen by U.S. health agencies, formaldehyde is an irritating chemical that causes allergic reactions in some people. It may also be listed as “formalin” on the nail polish label.

Unfortunately, there are no certifications or labeling in the United States that indicate a ‘safe’ or ‘better’ nail polish or polish remover. You should look for packaging that says that the nail polish is free specific chemicals, ie “DBP-free” and “toluene-free,” etc…

Avoid all gel manicures, even “chemical-free” gel manicures, because gel polish coats skin with multiple chemicals that can cause itching, burning, hives, and more. It also must be removed by acetone and soaked for up to 30 minutes, which can cause skin irritation and nervous system effects.
When visiting a salon, ask about the ingredients in the products they use, or bring your favorite toxic-free brand of nail polish.

North Texas Foot & Ankle podiatrists recommend Dr.’s REMEDY® Enriched Nail Polish. It is the only over the counter enriched polish, created by doctors, designed to be free from harmful toxins. Dr.’s REMEDY® does not contain the toxic trio of DBP, toluene, formaldehyde or formaldehyde resin.

It is also enriched with natural ingredients such as tea tree oil, a naturally occurring anti-fungal agent that is effective against multiple fungal organisms found on the skin. The high-quality Wheat Protein has effective moisture-binding capabilities and naturally increases shine and helps maintain optimum moisture in the skin. It also includes Garlic Bulb Extract which contains allicin, a powerful antibacterial, antifungal and anti-viral agent that joins forces with vitamin C to help kill harmful germs.

Dr.’s REMEDY® Enriched Nail Polish is available in a variety of beautiful and trendy shades. Visit North Texas Foot & Ankle to see the latest colors and purchase your own bottles!