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I know  I cannot speak for all podiatrists, but most of the ones I know love New Balance sneakers.  I have personally been a big advocate for them for years.  When looking for the best shoe to wear health wise, there are a few considerations.  Proper fit is essential.  Even a well constructed shoe that does not fit well will cause issues.  How many times have I heard my patients complaining how difficult it is for them to get a good fitting shoe.  Maybe they can get the length correct, but they may have very narrow or wide feet.   Here lies the beauty of New Balance sneakers.  They come in a wide range of widths.  The widths range from very narrow all the way to a 6E.  The days of having to get a shoe or sneaker too long to accommodate a wide foot are over.  Proper width really is crucial both for comfort and function.  Many painful conditions of the foot are exasperated when the width is not correct.  Arch support is also important in analyzing a shoe.  Feet that flatten out too much on ambulation often result in painful arches or heels.   Over time, deformities such as bunions and hammertoes may develop.  Some style New Balance sneakers have more arch support than others.  Some people will not tolerate a very high arch. I suggest to my patients that they go to a New Balance store when purchasing.  The staff there is best equipped to make sure you get the proper sneaker for your foot.  There is a great New Balance store in New Canaan.  The owners have been in the business for many years and have a good understanding of proper foot function.  I want what is best for my patients and I always have confidence when they go to the New Canaan New Balance store they will be properly cared for and leave with the best shoe possible.   At this point, I should be clear that I have no financial interests in the New Balance company or the store in New Canaan.  New Balance also provides sneakers with a good amount of shock absorption.  This is important in today's world because we are walking and running on hard surfaces which are not natural for our feet.  We are really meant to be on softer surfaces such as grass and sand.  To be fair,  most sneaker companies do provide products with good cushioning.  Finally, New Balance utilizes high quality materials and many of their sneakers are made right here in the United States.   It is a throw back to my childhood to look at a product and see Made in the USA.  Besides giving me a feeling of pride, I still think it is likely to be better constructed than a  made in China sneaker.  That is just a personal opinion.  New Balance, like the other top sneaker companies, provide sneakers geared for different activities.   For example, you will find running shoes, walking shoes, cross trainers and tennis shoes.  This is another reason why it is best to buy the shoe from a store with the most understanding of feet and your personal needs.  Too many of my patients boast about getting a great deal and it turns out they bought the wrong shoe for their feet because they ventured out on their own without help.  So lets enjoy the warm weather with lots of activities and comfortable feet!  A properly fitting New Balance sneaker will give you a great opportunity to stay active and pain free.

When I was growing up, doctors were viewed with great respect and were top income earners in society.  Today, the level of respect and income has decreased.  A recent NY Times article revealed statistics showing that healthcare dollars are being distributed differently than many would believe.  The highest earners in the system are no longer the providers of the care.  Administrators are the winners.  This includes people who are employees of insurance companies, hospitals and other healthcare administrative groups.  Obamacare has benefited these people further at the expense of doctors and patients.  I show up to work everyday with the health of my patient my number one priority.  The new burdens put on doctors, such as complying with meaningful use requirements for electronic health records, risks harming the level of patient care.  You may notice many of your doctors appear more concerned with clicking the correct box on a computer or tablet than really getting to your problem.  This involves them performing the tasks required to show they are using the electronic healthcare system.  The government will punish doctors with lower reimbursements who do not display they are performing these tasks and recording specific data about their patients.  An example, as a podiatrist I need to record height, weight, smoking history and even information on ethnic background on a significant percentage of my patients.  I believe it is best to leave the doctor the freedom to decide the most relevant information to obtain to care for his or her patient.  My focus has remained on the care of my patient's condition.  At East Avenue Podiatry, providing top care remains our mission and while we will comply with all regulations, we will not let them diminish care.  I urge you, the patient, to support doctors in anyway you can.  Please understand that for all of us to continue to receive top healthcare in this country, doctors need to be able to practice free of extra burdens, no matter how well intended.   They need to be reimbursed fairly.   There are more and more doctors refusing to accept medicare because the reimbursement rates have essentially been flat for so many years.  This is unacceptable. Doctors are the best advocates for their patients and we need to support ourselves by supporting them.  The future quality of healthcare for all of us and our families depend on it!

Running is a wonderful way to get aerobic exercise.  It keeps the heart pumping and the lungs breathing.  It also represents an inexpensive way to stay healthy.  A good pair of running sneakers and you are on your way.  There are definitely safety concerns when it comes to running.  Many injuries that we see on a regular basis result from running.  Some are of the immediate type such as sprains, bruises or fractures.   Many are slow developing after years of running, such as arthritis.  The good news is the risk of developing these conditions can be reduced.  I am constantly recommending good running shoes.  I am especially happy with New Balance sneakers.   I feel New Balance shoes tend to fit the feet very well.   They come in all widths as well as lengths.   A proper width is just as important as the proper length.  All the major sneaker companies make a full line of running shoes.  I suggest buying the sneakers at a quality sneaker store where you can discuss with the sales associate your running needs.   Different shoes are better for people with flat feet vs high arches.  The amount of miles you run in a week will also help determine which sneaker is best for you.  Minimalist type sneakers have been popular recently.  These are sneakers that give less support and are supposed to simulate barefoot running.  While barefoot running is most natural in theory, please remember that we are usually running on hard surfaces, which are not natural.   My experience has been many injuries, including sprains, plantar fasciitis and stress fractures occur in people running in these shoes.   The shoes may work well for some depending on their foot type.  With all runners, gradually increasing your intensity is highly recommended.  A proper evaluation by your podiatrist can help you enjoy running while limiting the injury potential.   I am a big fan of speed walking.   By walking at a brisk pace, great aerobic benefits will result.  There is a lot less risk of injury with speed walking.  Regardless of your activity, please utilize our services at East Avenue Podiatry in Norwalk, CT.  The phone number is 203-853-6570 and the website is norwalkpodiatrist.com.  A podiatrist's job is to help you with the quality of your life and keep you moving into your very old age.  Now get out there and enjoy the warmer weather!

March 25, 2014
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Should I use ice or heat for my injury?  This is one of the most common questions I get in my practice.  The answer is "it depends".   Both can be beneficial.  For most conditions and injuries I see in my practice the answer is ice.  The general rule is to use ice for injuries within the first 24 hours and for injuries that continue to produce pain and swelling.  Most injuries to the lower extremity are being "re-injured" all day long as we walk on them.   Therefore, icing the area is effective after activity and again at the end of the day.  I  recommend utilizing an ice pack (frozen peas or corn work well too) for about 15 minutes at a time.  It is generally safe to ice an area for 15 minutes per hour.  A paper towel or similar material should first be placed on the skin so the icepack is not in direct contact with the body. Some people like to soak their feet in ice water.  I do not recommend this due to the risk of frostbite.  It is crucial to ice the area immediately following an injury.   A certain amount of swelling is ok because that is how the body brings the proper cells and nutrients to the area that are required to heal.   However,  our body tends to overreact and excessive swelling will add to the pain and time it takes to heal.  The icing works by causing the small blood vessels to constrict and limit the fluids moving into the area.   Icing also has a numbing effect on the nerves, which is welcome when you are in pain.

  Heat has the effect of relaxing muscles and is generally used in postural muscles, such as the lower back.  Heat is also often helpful in easing arthritic joints.  Heat serves as a vasodilator.   This means it opens the small blood vessels.  Extra blood flow is helpful to an arthritic joint and can help temporarily increase the range of motion.  Heat alone should not be used in acute injuries because the dilating of the blood vessels will increase the swelling further.  Moist heat is most effective and there are many heating pads available today.  Usually applying the heating pad for  20 to 30 minutes is ideal.   One needs to be careful not to make the pad too hot and risk a burn.   Falling asleep while a heating pad is on can be dangerous too.

There is a treatment utilized on athletes that need swelling to an extremity reduced quickly called contrast baths.  It involves alternating between soaking the injured limb in warm and cold water baths.  This works by forcing fluid out to the area by alternately constricting and dilating the blood vessels.  The extremity is in each bath for 5 to 10 minutes and then switched to the other bath.   Total treatment time is 45 minutes.   This technique is best left to trained professionals.  

March 16, 2014
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Achilles tendinitis is generally viewed as an overuse injury of the Achilles tendon, the band of tissue that connects the calf muscles to the back of the foot.  Achilles tendinitis is often seen in runners who have suddenly increased the intensity or duration of their runs. It is also common in middle-aged people who play sports on the weekends or somewhat infrequently.  The injury results in inflammation and minor tears within the tendon.   More serious cases may result in larger tears and/or partial or complete ruptures requiring surgical repair.  The injury is first evaluated by physical examination for changes in the achilles tendon.  Diagnostic ultrasound may be used to visualize the tendon.  Ultimately, an MRI may be ordered to best determine the extent of the injury.   Radiographs can be ordered if bony injury is suspected.

The achilles tendon does not receive a good blood supply.  Therefore, healing may take an extended amount of time.   It is not unusual for healing to take multiple weeks or even months.  Common treatments include icing, taking anti-inflammatory medications, supportive shoes and heel lifts, limiting activity and physical therapy.  In more severe cases, using crutches and/or a walking boot are beneficial to decrease the stresses on the achilles tendon and provide rest to the area.   I like to say that if we have an "overuse" injury, then "underusing" it is important for it to heal.  

I like to utilize night splints to hold the foot in a neutral position while the patient sleeps.   This prevents the achilles tendon from tightening up overnight in a shortened position, while not putting too much tension on the fibers of the tendon.  

Achilles tendon injuries are relatively common and efforts to lower your chances of an issue developing are worth taking.   Performing stretching exercises of the calf muscles increases flexibility and lowers the risk of injury.   Supportive shoes and sneakers support the arch and result in less pull being applied by the achilles tendon.  Finally, gradually increasing the intensity of any new sport or exercise is highly recommended.   

 




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