Our office hours are currently Monday, 10am-5:30pm, and Tuesdays and Thursdays, 10am-5pm.

If you would like to come in for care, please call the office at (301) 330-5666 and leave a voicemail with our answering service.

  • Rheumatoid Arthritis in the Feet

    Although rheumatoid arthritis actually attacks multiple bones and joints throughout the entire body, ninety percent of people who actually develop this condition usually do so in the foot or ankle area. Those who develop this kind of arthritis in the feet usually develop symptoms around the toes and forefeet first, before anywhere else. Rheumatoid arthritis appears to have a genetic component. If it runs in the family, then you will be more likely to develop it as well.

    Rheumatoid arthritis is an autoimmune disorder in which the body’s own immune system attacks the lining of the membranes surrounding the joints. This causes inflammation of the membrane lining, and the gradual destruction of the joint’s cartilage and even bone.

    Some of the most common symptoms that are associated with RA include pain and swelling of the feet. Stiffness in the feet is also another common symptom that people experience. Those who have RA in the feet usually feel the pain in the ball or sole of their feet. This can get to be very painful at times. A person’s joints can even shift and become deformed after a period of time.

    In order to properly diagnose RA in the feet it is usually necessary for a doctor or podiatrist to evaluate the area. Your doctor will also question you about your medical history, occupation, etc., to determine whether anything in your lifestyle may have triggered the condition. There are a number of tests that may be performed to help diagnose RA such as a rheumatoid factor test, although there is no one single test that will tell you for sure if you have RA. There are different X-rays that can be taken as well to determine if a person has RA in their feet.

    There is a range of treatment options for rheumatoid arthritis. Treatment of RA is usually a lifelong process that includes a variety of methods of treatment and therapy. Your doctor can prescribe special shoes that should help with arch support as well as heel support. A physical therapist can help those with this condition learn exercises which will keep their joints flexible. Surgery may be needed to correct some of the issues with the feet, such as bunions, and hammertoes. Fusion is usually the most successful surgical option for rheumatoid arthritis. However, people need to keep in mind that there are some risks associated with these surgeries.

  • How to Prevent Running Injuries

    Many common running injuries are caused by overuse and overtraining. Several common injuries can occur due to running. When the back of the kneecap starts wearing away and starts causing pain in the knee, this is commonly referred to as runner’s knee. Runner’s knee can occur because of decreased strength in the quadricep muscles or shoes that do not offer proper support to the inside of the forefoot. Runner’s knee usually is treated with strengthening exercises focusing on the quad muscle and sports orthotic. To prevent runner’s knee, efforts should be focused on hip strengthening. Physical therapy is also beneficial in helping to learn the best exercises to heal runner’s knee. To prevent runner’s knee, strengthen the quad muscles to keep the kneecap aligned.

    Overtraining is one cause of a common running injury called iliotibial band syndrome, which occurs when the iliotibial band gets irritated, causing pain and discomfort to the outside knee area. Another common running injury is known as plantar fasciitis, which occurs when the bone in the foot becomes inflamed and irritated. This injury primarily causes pain in the foot. Causes can include a high arch, incorrect footwear, tight muscles and flat feet. The best way to avoid plantar fasciitis is stretching and proper footwear.

    Stress fractures are a common injury for runners. These fractures can occur because of overtraining, lack of calcium or running style. In runners, it is common for stress fractures to occur in several locations including the inner bone of the leg, the thighbone, the bone at the base of the spine and the toe bones in the foot. The best approach to preventing stress fractures are proper footwear maintenance and running on a surface with enough “give” to absorb some of the shock produced during running.

    Besides overtraining, other causes of these common running injuries are poorly fitting footwear, irregular biomechanics, and lack of flexibility and strength. The best way to avoid running injuries is to prevent them. Fortunately, each of these common running injuries can be prevented. To avoid running injuries it is highly recommended to wear only footwear that fits properly and that suits your needs. Running shoes are the only protective gear that runners have to safeguard them from injury; therefore, choosing the correct footwear for running is important. It is important, too, to think about other aspects of your running routine like training schedules, flexibility and strengthening, and tailor them to your needs in order to minimize the possibility of injury. Regular stretching before and after running should be considered also when trying to avoid running injuries. Stretching keeps muscles limber resulting in greater flexibility.

  • Flat Feet

    Affecting about 20-30% of the population, flat feet is a condition in which the foot’s arch either drops or never develops. Flat feet is relatively common in babies and small children as a result of the arch not developing. Adults can develop flat feet as a result of injury or pregnancy due to increased elasticity. However, in adults flat feet is usually a permanent condition.

    Flat feet can make walking difficult since it places undue stress on the ankles. This stress throws off the general alignment of the legs since flat feet cause the ankles to move inward, causing discomfort. Flat feet can also affect the knees since arthritis is a common condition in that area. Fortunately, in many cases flat feet do not directly cause any pain.

    When it comes to runners, there are specific shoes that can help realign the ankles and provide more support while lessening the amount of pronation involved. Running often causes weight shifting very quickly, so it’s important to be informed whether or not you are affected by flat feet. Knowledge about flat feet is crucial, especially when it comes to preventing injuries.

    To be able to diagnose flat feet, a test commonly used is known as the wet footprint test. In the wet footprint test, the individual places a flat foot on a surface to generate a footprint. If there is no indication of an arch or any indentations, that person could have flat feet. In any case, if there is a possibility of having flat feet, a podiatrist should be consulted.

    Once flat foot has been diagnosed, it can be treated by wearing insoles. There are two types of flat feet. The first type is rigid, where the feet appear to have no arch even if the affected person is not standing. The other condition, known as flexible flat feet, occurs when the arch seems to ‘go away’ when someone is standing but appears while sitting. In the case of flexible flat feet, unless pain is caused by the condition, there is no need for treatment. However, in the case of rigid flat feet or pain involved in flexible flat feet, orthotic insoles and exercises are prescribed to help the arches develop.

  • Exercise for Your Feet

    Whether your feet are over-worked or under-worked, chances are they could benefit from some special attention. Even those who exercise regularly probably do not spend any time strengthening their feet. This can be just as rewarding as strengthening the rest of the body, since the health of your feet affects the health of the rest of the body as well, especially the ankles, legs, and spine.

    For those who might not have any idea on how a foot-specific exercise might be conducted, there are several workouts that are fairly easy to perform in the comfort of your home. One of the easiest is the toe rise, also known as the tip-toe. This exercise involves standing on the tip-toes for a count of 15 then resting the feet on the ground. This process should be repeated a minimum of three times a day in order to strengthen the feet.

    Toe pick-ups strengthen the feet by working them in a very different way. In this exercise, small items are picked up using the toes in order to strengthen the muscles on the upper part of the feet. Once again three sets should be performed, with the item in question being held for 15 seconds then dropped. Items that may be picked up using the feet include marbles and even stationery, which works wonders for the toes and the surrounding muscles.

    Yet another simple workout is the ankle pump. This can be done either upwards or downwards, but for the workout to be most effective both can be incorporated into the routine. As the term suggests, this involves lifting the foot off the floor and flexing the toes either towards the shin or towards the ground. This movement puts the feet and ankles through a large range of motion which works muscles.

    Last but not least, feet should be stretched so that the muscles can relax and recuperate. This can be done by placing both feet off the floor and bracing oneself against the wall at a 45 degree angle. This ensures that the feet and ankles are adequately stretched once the workout is complete.

    In short, giving the feet a good workout every now and then is important in order to avoid problems such as plantar fasciitis, as well as to warm-up or cool-down after running or vigorous walking. Foot exercises may be followed by a good foot massage which encourages circulation in the feet as well as muscle relaxation.

  • Every Day Foot Care

    Our feet are of great importance in our lives. However, they are something we tend to neglect. When this becomes a habit, it can cause significant trouble. Pain, limited mobility, and expensive doctor’s visits can occur when foot problems are ignored. If feet are cared for and looked after each day, however, they will perform without pain or complication.

    Hygiene is the most basic way to care for your feet. Washing and drying them thoroughly every day is most important. Cleaning between your toes, and keeping your toenails trimmed and short is essential. Using moisturizer is also important if your feet feel dry or appear cracked.

    Remember to avoid using moisturizer between your toes. This can cause fungi and bacteria development if cream sits in that area. The skin can also macerate between the toes when moisturizer is used.

    Footwear is also an important aspect of keeping your feet healthy. Making sure your shoes are the correct size is key when picking them out. Shoes should not feel too tight, but snug. If a shoe is too loose, they can also cause problems. Shoe shopping is recommended to be done later in the day, because the feet will have settled and swelled to their full size by then. Wearing high-heels or flip-flops too often should be avoided to keep their feet healthiest. Wearing shoes that are good for your feet, have padding on your soles, and support the ankles and arches are most important.

    Additionally, socks should be worn when closed-toe shoes are worn. Though they may feel hot during the summer, they are important in absorbing sweat and moisture off the feet. Without socks, the buildup of sweat in a closed-toe shoe can cause fungi and athlete’s foot.

    The right shoes can make a difference in your everyday foot care. Make sure that your shoes show no signs of wear, and chose shoes that offer support for your arches and overall foot. Make sure cleaning your feet is a part of your daily routine. This way, your feet will stay healthy and safe.

  • Stretching Your Feet

    Debilitating foot pain is a problem for many people. But just as stretching the torso can help alleviate back pain, stretching the feet can also mend existing problems and prevent future ones.

    The feet carry the entire weight of the human body all day and can get easily strained from overexertion. Persistent sharp pain and cramping in the feet are common problems. Foot pain and problems can be due to any number of causes, and in many cases pain may be eased without medication or doctor visits; however, it is always a good idea to rule out any serious medical issues first with a physician.

    Stretching may help relax the feet and alleviate pain at any time, but it is especially important before heavy aerobic exercise to avoid painful cramps or straining muscles in the feet. Stretches should be performed slowly and deliberately without forceful pulling. The stretch should be held for several seconds, and then relaxed.

    A great way to stretch out and loosen up the foot muscles while sitting is to cross one leg over the other and pull the toes carefully back without overextending. Start by resting the left ankle on the right knee. With the left hand, gently flex the left foot by pulling back on the toes. Do not pull too hard, just hard enough to feel the stretch in the arch of the foot. Then point the toes of the left foot as far as you can. Rotate the motion of pointing with pulling back on the toes. This should relax and stretch the muscles on the bottom and the top of the foot. Doing this stretch ten to twenty times should bring relief. Repeat the whole process for the other foot by resting the right ankle on the left knee.

    A stretch that focuses on the often injured Achilles tendon involves standing, facing a wall, with your arms out and hands flat against the wall. Step back with one foot, keeping it flat against the floor. Move the other leg forward and lean toward the wall. You should feel a stretch through the back of your leg and your Achilles tendon, but do not push yourself too much. Stop when you feel the stretching sensation and hold for 30 seconds. Ten repetitions may be done for each foot.

    Stretching the feet is important for athletes or those performing aerobic exercise, but it can also help anyone with foot pain caused by poor footwear, plantar fasciitis, or long hours standing and walking. Individuals who tend to their feet by regular stretching every day should be able to minimize foot pain and prevent new problems from arising.

  • Barefoot Running

    Barefoot running is becoming a popular running trend that has been permeating through the running and jogging communities. The act of running without shoes changes more about the motions of your stride than you may think, and choosing to run without shoes is not the only adjustment you will have to make.

    Whenever you run normally, with shoes, your heel strikes the ground first as you land while you roll over the ball of your foot and push off with the front part and toes. Barefoot runners actually land on the front part of their feet and not their heels, shifting the impact from the back to the front of the foot. In order to do this safely and without much injury, runners need to reduce their stride to create softer landings.

    One of barefoot running’s biggest advantages is the reduced risk of injury. Landing on the front of your foot with a reduced stride lessens the stress placed on the back of the foot, heels, and ankles. It also works out many muscles in the feet, ankles, and lower legs that you do not normally get to strengthen because of the different motion. Your posture and balance are also improved with barefoot running, as is your sensory input from your feet to the rest of your body. Studies have shown that ironically, countries that have large populations of people who do not wear shoes every day are at lower risk for foot and ankle injuries and complications.

    However, there is still some skepticism behind barefoot running because of some disadvantages it brings. One of these is the complete lack of protection for your feet while running. Bruises, scrapes, cuts, and even blisters can easily form when you have no protection from sharp or rough objects on the ground. Landing on the front of your feet can also cause Achilles tendonitis because of the overuse of the Achilles tendon.

    Despite this, barefoot running can be made safe and enjoyable if you make a slow transition from your normal running routine into barefoot running. You cannot simply start the activity out of the blue one day, but instead gradually work your way from walking to jogging to running, increasing the distance each time. It is also recommended to start off on flat, even surfaces that do not contain sharp or dangerous objects because your feet are now unprotected. Minimalist running shoes are a great middle ground to start with because they combine the protection of shoes with the fit and feel of barefoot running.

  • Everything You Need to Know About Gout

    Gout, typically found in diabetic patients, is an unusually painful form of arthritis caused by elevated levels of uric acid in the bloodstream. The condition typically strikes the metatarsal phalangeal joint on the big toe; though it has been known to strike the knees, elbows, fingers, ankles and wrists—generally anywhere that has a functioning, moving joint.

    The high level of uric acid in a person’s bloodstream creates the condition known as hyperuricema—the main cause of gout. Genetic predisposition occurs in nine out of ten sufferers and the children of parents who suffer gout will have a two in ten chance of developing the condition as well.

    This form of arthritis, again noted as being particularly painful, is the leftover uric acid crystallizing in the blood stream and travel to the space between joints where they rub causing agonizing friction when the patient moves. Symptoms include: pain, redness, swelling, and inflammation. Tertiary side effects may include fatigue and fever though reports of these effects are very rare. Some patients have reported that, as the temperature drops (when you sleep for instance) the pain may intensify.

    Most cases of gout are easily diagnosed by a podiatrist’s assessment of the various symptoms, however there are defined tests that can be performed. A blood test to detect elevated levels of uric acid is often used as well as the use of an x-ray to diagnose visible and chronic gout.

    Treatment for gout simply means eliminating symptoms; non-steroid anti-inflammatory drugs or NSAIDs (Colchicine and other corticosteroid drugs, etc.) will quell the redness, the swelling, and the inflammation, however, diet, lifestyle changes, and preventative drugs are necessary to fully combat the most severe cases.

    Those that lead a sedentary lifestyle are at a higher risk for gout. Any amount of exercise decreases probability of repeat encounters with the condition. Also, staying away from, or reducing drastically, consumption of red meat, sea food, and fructose-sweetened drinks reduces the likelihood of chronic gout as well.

    As for diet, beyond what has already been mentioned, ingesting Vitamin C, coffee, and particular dairy products help on the preventative maintenance side of healthy living. While new drugs are out on the market that inhibit the body’s production of uric acid-producing enzymes, reducing or eliminating as much as possible your overall levels of uric acid will ensure you lead a gout-free life.

  • Dealing with Stress Fractures of the Foot and Ankle

    Stress fractures occur in the foot and ankle when muscles in those areas are weakened from too much or too little use. When this happens, they stop cushioning the foot and ankles from the impact of hitting the ground. Because there is nothing to protect them, the bones of the foot begin to absorb the full impact of each step someone takes. The added stress causes little cracks to form in the bones that are under the most pressure. These cracks are called stress fractures.

    Stress fractures are common for individuals whose daily activities cause high levels of impact on their feet and ankles. Individuals who run, play tennis or basketball, or practice gymnastics tend to experience these fractures more frequently. Anyone is susceptible to this problem, though. Individuals who are normally sedentary and suddenly begin an intensive high impact work out may get stress fractures. This is because their muscles are not strong enough to handle and cushion the intensity of their activity. Osteoporosis may also cause someone to get stress fractures, because the disease weakens an afflicted person’s bones and makes it easier for them to break down.

    The pain from these fractures will occur in the general area of the fracture. It may be intermittent or constant, and will cause sharp or dull pain along with swelling and tenderness. Engaging in any kind of activity, high impact or otherwise, will aggravate the pain. If the intensity of the activity increases before the stress fracture has properly healed, it can cause a full fracture. This is a much more serious problem, and will probably prevent you from applying any pressure on the foot at all.

    Treatment can vary depending on the individual and the degree of injury. The primary way to treat a stress fracture is to rest the hurt foot. Some fractures will heal quickly with only a little bit of rest, while others may require a long rest period and the use of crutches. Under certain circumstances, surgery may be required to install support pins around the fracture to assist in healing.

    In order to avoid getting stress fractures, make sure to get plenty of calcium and Vitamin-D. They will help to keep your bones strong, and make them less likely to break under pressure. If your new exercise regimen is running or some other kind of high impact activity, set incremental goals on a weekly basis so you can build up muscle strength. For example, if you plan to walk every day, you could ride a bike on some days to take the stress off of your feet. Make sure to wear supportive shoes to better protect you feet.

    If you begin to experience any symptoms of stress fractures, you should stop exercising and rest. If the symptoms do not go away, see an orthopedic specialist. Remembering these tips can help you prevent stress fractures to your foot and ankle, and allow you to continue living normally.

  • Bunions

    A bunion is an enlargement of the base joint of the toe that connects to the foot, often formed from a bony growth or a patch of swollen tissues, and is caused by the shifting of the big toe bone inward towards the other toes. This shift can cause a serious amount of pain and discomfort and the area around the big toe will become inflamed, red, and painful.

    Bunions are most commonly formed in people who are already genetically predisposed to them or other kinds of bone displacements. However, even if you do not have a history of this in your family, you can still develop bunions if you are wearing improperly fitting shoes, such as trying to cram your feet into high heels, or by running or walking in a way that causes too much stress on the feet. High heels are a major culprit in the formation of bunions because not only do they push the big toe inward, but your body weight and center of gravity is shifted towards the edge of your feet and your toes, which can cause bone displacement.

    Bunions are quickly and easily diagnosed by podiatrists. However, because of their nature, they can appear similar to arthritic conditions or gout, so sometimes a blood test is required to fully diagnose a bunion. A full radiological or x-ray exam could also be done by a podiatrist to examine the bone structure of your feet. One thing that is looked for specifically is an enlargement of that base joint or evidence of the big toe bone being pushed inward.

    One of the first things to do if you have bunions is to get a larger, wider shoe that can remove pressure from your toes. This usually means that high heels should be eliminated from use for a period of time to allow the bunion to heel. Oftentimes, eliminating the pressure placed on a bunion is enough to eliminate the pain involved with them, however, pain can persist in some instances and anti-inflammatory drugs may be prescribed. If the pain is too severe, steroid injections near the bunion or even surgery may be required. Orthotics for shoes may also be prescribed which can alleviate the pain of bunions by removing pressure from them. However, these methods simply stop the pain of bunions but do not correct the problem at its source.

    As previously mentioned, surgery may be an option to completely eliminate your bunions. Surgery is done to reposition the toe bones so that they no longer face inward. This can be done by removing a section of bone or by rearranging the ligaments and tendons in the toe to help them align properly. Even after the surgery, it may be necessary to wear protective shoes for a while to ensure that the bunions do not return.