Blasted Blisters

Blasted Blisters

Blisters develop from excess friction where the top layer of skin separates from the underlying dermis. The dermis is the white skin seen when an abrasion occurs. The dermal layer of skin has live cells and specialized glands. The top layer or epidermis is protective and without live cells. Over time a callus, an adaptive thickening of the epidermis can occur. Hands and feet are commonly afflicted with blisters.

Direct causes of excess friction and blisters can be from ill-fitting shoes, or simply from a lot of walking or running on any surface. Pivoting the foot in basketball or tennis can bring on a blister under the ball of the foot. Using a tool in your hands repeatedly can cause similar blisters and calluses as seen in the feet.

Indirect causes can be the form or function of the foot. Form is the shape of the foot. For example, a bunion, hammertoe or prominent bone can rub more easily in the shoe. A high arch foot may put more pressure on the heel and ball of the foot.

Function of the foot can affect excess friction. In a flexible hyperpronated foot the toes grab more to compensate and can contribute to blisters at the ends of the toes. A supinate high arched foot might cause more friction on the outside of the heel.

 

Form and function refer to you, and what God gave you to get around on: the shape of your foot and how it pronates or supinates. You get the idea.

 

Identifying the causes, means of prevention, and finally, treatments will be covered here.
A “normal” amount of pronation occurs in the foot followed by a normal amount of supination during the “stance” phase of walking when the foot is on the ground. Shoes alone can be the source of blisters.

They can be ill-fitting, made of non-yielding materials or simply have a design flaw. Man made “uppers” are usually synthetic and non-yielding. Leather or canvas shoes can stretch to give room for normal movement of the foot. A design flaw could be the thick stitching in the upper crossing over the toes or other prominent parts of the foot.

 

Runners soon learn to master self-treatment. This blog will help us compare notes to better prevent those blasted blisters.

 

As we age…

Just when you think you know how to prevent blisters, for example using duct tape, moleskin or Vaseline on the ball of the foot, a new kind of blister developers at the end of your toes. At least this happened to me, and of course, I should know better.

So let’s start with what happens over time. Your feet increase in shoe size. Gravity flattens the arch some over years; a size 10 and a half in college can be an 11 by 40 years of age and a 13 when in your sixties! Now that might be extreme, but in runners, shoe fit is more critical when banging the ends of the toes. At least it happened in my case where my feet are more on the flat side to start with.

Other orthopedic deformities, form or shape conditions, are seen more as we age. Mild hammertoes become more hammered, bunions enlarge, and we lose the fat under the ball of the foot. In losing the fat pad, a metatarsal bone can be more prominent, dropped, or susceptible to pivoting shear force.

I was so surprised when a local running store jumped me to a size twelve when in my 50’s. More recently,  I mistakingly was using my son’s size 13 when doing a Mainly Marathon series (where runs are done up to seven days in a row). After using his 13’s, on series in the Fall, I went back to my size 12’s for a Mobile, Alabama marathon in January. My feet had caught up with the shoe length, and I suffered from blood blisters at the ends of my great toes. I now regularly wear size 13’s.

 

If the shoe doesn’t fit don’t wear it…

Recently, a high school runner presented himself to my office with blisters on the outsides of his feet in back of his little toes. He was a big-boned with wide feet. We have a lot of those in the Midwest. While cross country was his thing, shorter track events took place in Spring. And he was using spikes bought online.

To evaluate the correct shoe size, I had the patient stand on a sheet of paper and drew an outline of his foot. Then I placed the shoe with spikes inside the outline, there were almost two inches of extra width in the outline of his forefoot! He had an early Taylor’s bunion, a knot where the small toe joint connects to the foot. This “form” had a little to do with the blisters; most of the cause, however, was the pair of narrow spikes bought online.

So first and foremost, proper shoe fit, preferably at a running shoe store is periodically recommended. It’s best to fit shoes at the end of the day when the feet are slightly larger from swelling.

 

Functional Issues

My right foot functions poorly. It turns out more flops or hyper-pronates. To help correct this, the long flexor tendons that insert to the end of the toes tend to grab or pull more, to protect the arch. Its fancy name is “flexor [tendon] substitution”. This can still happen, even with orthotics, when first doing your long run or race of ten miles.

I remember it as a ten-mile race that gave me a large blister on the bottom of my fifth toe, and to a lesser extent on the fourth toe. The fifth toe was so injured that there was blood in the blister, a blood blister.

So function, as well as form of your foot, can be indirect causes. To treat this for future long runs, I Vaselined my toes, but I also cut back my insole so that my toes had more room to grab.

 

Treatment of Blisters

So how do we address blisters? First-aid is, of course, to clean, drain, apply antibiotic and a bandaid.

How we drain the blister is paramount in preventing the blister from re-forming. I believe in the approach that makes a large enough draining hole that won’t reseal, while still leaving most of the skin intact to protect the dermis. One should do this aseptically. I do not burn and sterilize a needle because the resulting hole is not large enough and will re-seal. The dermal cells are alive and have been inflamed; fluid will continue to seep if there is not sufficient drainage.

What has worked for me is to use a pair of scissors to nip a small 1/8″-1/4″ hole in the blister. This usually prevents resealing of the blister. Of course, the scissors are clean and wiped with alcohol for good measure. Again, the blister is covered with antibiotic ointment and a band-aid or a second skin product such as the ones developed by Spenco.

 

Prevention

As mentioned above, vaseline is my first choice in the prevention of blisters. Regular foot or talcum powder works well in triathletes. The shoes are powdered ahead of time. I use orthotics of ¾ length so my toes have plenty of room. This length also can be cut just behind the ball of the foot to effectively lift the ball of the foot more, minimizing friction blisters there. When one does a street marathon like Chicago, the Street-effect is like repeated slapping of the forefoot. The ¾ length insole rise helps keep the feet cool.

Second Skin products, first done by Spenco, help when you are still recovering from a relatively new blister. I have used these band-aids like covers with impregnated gel on the ends of my great toes and on the ball of the foot. Straight moleskin applied to a day old blister works for many. Moleskin is a thin felt product with an adhesive backing. You then cut the pad to cover the affected area. Duct tape has been used preventively, but again I preferred vaseline.

Spenco insoles were originally designed to prevent blisters on the balls of the feet when playing tennis. Consider the shear force. The green cover is on a neoprene rubber with injected air bubbles that help absorb the sideway or shear friction force. Dr. Spencer, behind the Spenco name, liked to play tennis.

Double layered socks help with blister prevention. Avoid cotton as it absorbs moisture, may clump and cause a blister. Most socks made for runners are of synthetic materials. The support stockings are popular these days. They come either toe to knee, or ankle to knee and can vary in pressure from mild (15-20 mmHg) to fairly tight (40-60 mmHg).

With the tight support full-length stocking, it can be a disaster if you get a blister on the foot halfway through a marathon. The calve-only length will allow you access to a burn spot or early blister to Vaseline if necessary. Often Vaseline is available in the latter half of a marathon at the aid stations.

 

Pressure on hammertoes can be eliminated with a wider and deeper toe box, such as the one seen in Altra shoes. In addition, a neutral or negative heel lift can help offload the ball of the foot and blisters that occur there.

The Unstable Ankle

The Unstable Ankle

A recent patient presented with a history of repeated ankle sprains on her left foot. The ankle tends to “give out” from under her, especially going down stairs. Now she favors the foot in gait with pain.

A bad sprain leaves the ankle “unchecked”, abnormal motion can lead to spurs and loss of cartilage. This patient’s ankle was worn with significant cartilage loss, leading to a possible fusion or ankle replacement. Early intervention is important.

An unstable ankle can be controlled with an Ankle Foot Orthosis (AFO), and physical therapy. If the ankle continues to give out, the ligament can be repaired as an outpatient procedure. New “internal braces” are now available to improve results and allow full return to sports.

If I can help you, and for more information, please contact our office for an appointment. An X-ray checks the wear of the ankle and options are reviewed.

Study Shows Exercising Reduces Risk of Falls For Elderly

Study Shows Exercising Reduces Risk of Falls For Elderly

When we age, we gradually lose muscle and gain fat, which typically contributes to declines in strength and issues with gait and balance. A recent study published in the Journal of the American Geriatric Study examined the effects of various of forms of exercise in lowering fall risk. Findings concluded that while programs including brisk walking had no effect on falls, those that included resistance training and challenging balance exercises were extremely effective in preventing falls. Strength and resistance training, even for the elderly, can greatly improve gait and therefore decrease fall risk. Simple exercises such as balancing on one leg while lightly using a table or chair for support can help gauge balance and strength.

Proper foot care is something many older adults forget to consider. If you have any concerns about your feet and ankles, contact Dr. Mark Landry of Kansas. Our doctor can provide the care you need to keep you pain-free and on your feet.

The Elderly and their Feet

As we age we start to notice many changes in our body, but the elder population may not notice them right away.  Medical conditions may prevent the elderly to take notice of their foot health right away. Poor vision is a lead contributor to not taking action for the elderly.

Common Conditions 

Neuropathy – can reduce feeling in the feet, and can hide many life threating medical conditions.

Reduced flexibility – prevents the ability of proper toenail trimming, and foot cleaning. If left untreated, it may lead to further medical issues.

Foot sores – amongst the older population can be serious before they are discovered. Some of the problematic conditions they may face are:

Gouging toenails affecting nearby toe

Shoes that don’t fit properly

Pressure sores

Loss of circulation in legs & feet

Edema & swelling of feet and ankles

Susceptible Infections

Diabetes and poor circulation can cause general loss of sensitivity over the years, turning a simple cut into a serious issue.

If you have any questions, please feel free to contact our office located in Overland Park, KS. We offer the newest diagnostic tools and technologies to treat your foot and ankle needs.

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Green Bay Guard Hopes to Return After Broken Foot

Green Bay Guard Hopes to Return After Broken Foot

Guard T.J. Lang of the Green Bay Packers faced an upset when he reinjured his already broken foot during the NFC Championship Game against the Atlanta Falcons. Following the 44-21 match, which went to Atlanta, many wondered if Lang’s goodbyes would be his last. Next month, the former Packers guard will officially become a free agent. Lang, now 29, hopes he’ll be returning to Green Bay. “I’m just hoping (the NFC Championship Game) wasn’t the last time I get to put on that helmet,” Lang said. “It’s tough, man. Obviously, I’ll take some time, take a couple days, to rest up and recover and see what happens. I think everybody in this locker room knows that this is where I want to be.”

A broken foot requires immediate medical attention and treatment. If you need your feet checked, contact Dr. Mark Landry of Kansas. Our doctor can provide the care you need to keep you pain-free and on your feet.

Broken Foot Causes, Symptoms, and Treatment

A broken foot is caused by one of the bones in the foot typically breaking when bended, crushed, or stretched beyond its natural capabilities. Usually the location of the fracture indicates how the break occurred, whether it was through an object, fall, or any other type of injury.

Common Symptoms of Broken Feet:

  • Bruising
  • Pain
  • Redness
  • Swelling
  • Blue (foot)
  • Numbness
  • Cold
  • Misshapen
  • Cuts
  • Deformities

Those that suspect they have a broken foot shoot seek urgent medical attention where a medical professional could diagnose the severity.

Treatment for broken bones varies depending on the cause, severity and location. Some will require the use of splints, casts or crutches while others could even involve surgery to repair the broken bones. Personal care includes the use of ice and keeping the foot stabilized and elevated.

If you have any questions, please feel free to contact our office located in Overland Park, KS. We offer the newest diagnostic tools and technologies to treat your foot and ankle needs.

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Causes of Hammertoe

Causes of Hammertoe

Hammertoes occur when there is an imbalance in the muscles and ligaments that would normally hold the toe straight. This results in the toe bending over time and ultimately becoming deformed. Hammertoe typically affects the second, third, fourth, and fifth toes, not the big toe. If discovered and managed early, treatments can be non-invasive and the hammertoes may be able to be corrected without surgery. Although hammertoe may be a congenital disorder in some, usually the cause is either a previous toe injury or wearing ill-fitting shoes. The toes can become cramped and start to bend gradually if there is not enough space for them. This is especially the case for people with longer than average toes. If you notice your toes are bent up in a cramped position, seek medical attention. Catching this early is crucial.

Hammertoes can be a painful condition to live with. For more information, contact Dr. Mark Landry of Kansas. Our doctor can provide the care you need to keep you pain-free and on your feet.

Hammertoe

Hammertoe is a foot deformity that affects the joints of the second, third, fourth, or fifth toes of your feet. It is a painful foot condition in which these toes curl and arch up, which can often lead to pain when wearing footwear.

Symptoms

  • Pain in the affected toes
  • Development of corns or calluses due to friction
  • Inflammation
  • Redness
  • Contracture of the toes

Causes

  • Genetics – people who are genetically predisposed to hammertoe are often more susceptible
  • Arthritis – because arthritis affects the joints in your toes, further deformities stemming from arthritis can occur
  • Trauma – direct trauma to the toes could potentially lead to hammertoe
  • Ill-fitting shoes – undue pressure on the front of the toes from ill-fitting shoes can potentially lead to the development of hammertoe

Treatment

  • Orthotics – custom made inserts can be used to help relieve pressure placed on the toes and therefore relieve some of the pain associated with it
  • Medications – oral medications such as anti-inflammatories or NSAIDs could be used to treat the pain and inflammation hammertoes causes. Injections of corticosteroids are also sometimes used
  • Surgery – in more severe cases where the hammertoes have become more rigid, foot surgery is a potential option

If you have any questions, please feel free to contact our office located in Overland Park, KS. We offer the newest diagnostic tools and technologies to treat your foot and ankle needs.

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Hard Surfaces Contribute to Foot and Ankle Injuries

Hard Surfaces Contribute to Foot and Ankle Injuries

Athletes who play on hard surfaces, such as basketball players or tennis players, typically participate in sports that often give their feet a harsh workout. Fast and rough movements can contribute to foot and ankle injuries such as plantar fasciitis, ankle sprains, stress fractures, bone spurs, and Achilles tendon issues. Many of these injuries can be prevented by proper stretching, wearing proper footgear appropriate for the sport, and wearing orthotics as needed. For younger athletes, heel pain should be monitored. The heel growth plate is especially vulnerable to injury for growing children. If pain persists, activity should be stopped immediately.

Sports related foot and ankle injuries need proper treatment before players can go back to their regular routines. For more information, contact Dr. Mark Landry of Kansas. Our doctor can provide the care you need to keep you pain-free and on your feet.

Sport Related Foot and Ankle Injuries

Foot and ankle injuries are a common occurrence when it comes to athletes of any sport. While many athletes dismiss the initial aches and pains, the truth is that ignoring potential foot and ankle injuries can lead to serious problems. As athletes continue to place pressure and strain the area further, a mild injury can turn into something as serious as a rupture and may lead to a permanent disability. There are many factors that contribute to sports related foot and ankle injuries, which include failure to warm up properly, not providing support or wearing bad footwear. Common injuries and conditions athletes face, including:

  • Plantar Fasciitis
  • Plantar Fasciosis
  • Achilles Tendinitis
  • Achilles Tendon Rupture
  • Ankle Sprains

Sports-related injuries are commonly treated using the RICE method. This includes rest, applying ice to the injured area, compression and elevating the ankle. More serious sprains and injuries may require surgery, which could include arthroscopic and reconstructive surgery. Rehabilitation and therapy may also be required to get any recovering athlete to become fully functional again. Any unusual aches and pains an athlete sustains must be evaluated by a licensed, reputable medical professional.

If you have any questions, please feel free to contact our office located in Overland Park, KS. We offer the newest diagnostic tools and technologies to treat your foot and ankle needs.

Read more about sports related injuries.