December 2017

The fall can be a good time for taking hikes. There are several parks and nature preserves in which you can enjoy a beautiful hike in the Dallas area. We’ve got some tips for caring for your feet, which we hope is informative for new hikers and hiking enthusiasts alike!

• Preparation: Start slowly and on an easy trail. Taking on a difficult hiking trail can lead to pain, swelling, and other symptoms of injury. Try some easier trails in the neighborhood, which is a great way to test and break in your hiking shoes.
• Toenails: Check your toenails for any signs of cracks or thickening, like with fungal toenails. Treat any toenail issues before attempting any long or vigorous hikes. Also, trim them so that they are not too long (which can cause pain at the base of the toenail) and not too short (which can cause swelling at the tip of the toes).
• Toes: Check your toes before putting your hiking your shoes on and take care of any issues like foot fungus or cuts. While hiking, excessive sweating or shoes that are too tight can cause blisters, corns, or calluses. Be sure to bring some bandages or pads to protect any skin issues.
• Arches and Heels: Warm up and protect arches and heels by stretching your feet. Make sure your hiking shoes have excellent arch and heel support, which help your feet to stay in the right position while hiking. This is especially important if you suffer from plantar fasciitis or flat feet pain.
• Stretch and Warm Up: Give your feet and ankles time to adjust before engaging in a vigorous trail by stretching and warming up your feet and ankles.
• Hydrate and Eat Healthy: Bring enough water and healthy food on your trail, especially if you are going on a long hike. Heat or steep terrain can make you expend much more energy. If your body is tired or dehydrated, your feet will be affected too.
• Soothe your Feet: After a long hike, your feet will want some TLC. If they are a bit swollen, you can use ice or a cold compress. For achy feet, a warm foot soak with Epsom salt can do the trick. It doesn’t hurt to get a foot rub either.

Wondering if hiking is okay for your feet due to pre-existing conditions? Got an injury while hiking? Consult with our podiatrist at Texas Foot Works, Dr. Jonathan M. Kletz. He will assess your feet and ankles for a proper diagnosis and provide quality foot and ankle care. Schedule an appointment today at any of our Abrams (Dallas), Athens, and Gun Barrell City, TX offices!

After you take some time to get used to saying the word, you may wonder what that is! Doesn’t really sound harmless, does it? Well, your intuition is correct! It is a condition of inflammation or injury of the tendons around the sesamoids (two small bones near a joint). In this case, they are the sesamoids right under the big toe joint).

As with other forms of tendonitis (like Achilles tendonitis), it is a condition that commonly affects athletes that injure the tendons via overuse from repetitive motions or from traumatic injury. Dancers, basketball players, and runners are prone to this condition, causing them pain and inflammation after putting excessive pressure or force on the big toe joint area. They may experience swelling, bruising, pain, and stiffness. Bearing weight on the balls of the feet or standing at all can become painful.

What can be done to treat sesamoidits?

• If the inflammation or injury is due to overuse, you should stop the activity. Allow the tendons to rest and recover so that it doesn’t become a worse issue. This also goes for if the problem is caused by a blunt trauma injury, in which case, using the foot would probably cause pain anyway.
• For mild pain, be sure to use the RICE method at first sign of symptoms: Rest, Ice, Compression, and Elevation will help to ease swelling and pain. You may also need to use NSAIDs (non-steroidal anti-inflammatory drugs) in conjunction with the RICE method for pain relief and reduction of inflammation.
• If you can bear weight on the sesamoids, tape some cushioning like foam pads under the sesamoids to reduce pressure and minimize pain. Taking steps when you have pain can worsen inflammation, so stay off the feet as much as possible.
• Additionally, shoes should be cushioned and have no heel so that the weight is distributed more evenly across the foot. Any height in the heel can move the pressure forward toward the balls of the feet, increasing pressure on the sesamoids.

If you have pain around the big toe joint, it’s best to consult with our podiatrist at Texas Foot Works, Dr. Jonathan M. Kletz. He will assess your foot for a proper diagnosis for your foot pain, and together with his team will provide quality care to treat your sesamoid issue and get you back on your feet. Make an appointment today at our offices in Abrams (Dallas), Athens, and Gun Barrell City, TX!

Some of our actions are second nature. Walking, yawning, and even brushing your teeth – there are some things that we just don’t think about while we are doing it. But maybe it’s time for us to pause for a moment and think about the way we walk.

If you’ve never thought about it before, it may seem strange to analyze the way you walk, also called your gait. Where do you even start? What do you look for? And why should you do it? Read further and we’ll help you figure it out!

Where to start:

• Stand up straight. Do whatever you think that means. Now analyze how you stand. Your posture should include: a neutral neck, shoulders back, chest a bit forward and slight curve in your spine. Think of it as lifting the upper part of your body to straighten and lengthen the spine.
• Now see assess how you hold your weight. After a little while, are you shifting your weight to one leg or the other? Did you hunch your shoulders and lose the curve in your spine? Are your feet flat on the ground? Or do you have an arch? (If you have flat feet and have foot or ankle pain, consult with our podiatrist) When you have bad form while standing, it may also affect the way that you walk.
• Next, walk (barefoot) normally across the room. You will have to do this a few times to really understand your foot and ankle positioning while you walk.

What to look for:

• First feel for how your feet touch the ground. Your foot strike should go in the order of: heel, midfoot, ball of the foot, toes. Some people may walk on the tips of their toes or stomp the entire foot down with each step. Toe walkers may have a habit since childhood, perhaps along with an issue in the soft-tissue along the bottom of the feet. Stepping with the entire foot can cause higher impact on the joints.
• While you are checking for stomping, plug your ears with your fingers and walk across the room again. Does it sound loud? Try again, while walking a bit softer to reduce impact. 
• Next, check the weight distribution on your feet. Do you tend to put more pressure on the insides or outsides of the feet? The way you pronate can affect or be affected by the ligaments and tendons in the ankles. If you have pain, check your pronation.
• Then, check for the direction of your toes. They should be facing forward. Are they facing inward (in-toeing) or outward (out-toeing)? This could say something about the structure of your legs.

Why you should analyze your gait:

• Gait issues can cause problems down the road. The wear and tear on your soft-tissues can mean pain. Joint issues can be worse with arthritis. Muscles and bones can become deformed.
• Your shoes may wear down faster if you have gait issues. Check your shoe’s outer soles to see if it’s wearing down unevenly, looking on the inside vs. outside part of the feet, or front vs. back. 
• You can also see where you might be getting foot pain from by analyzing your gait. For example, if you are pronating, it may help to get arch supports.

If you are unsure about checking your gait on your own, we can help you. Come in for a gait analysis by contacting our podiatrist at Texas Foot Works. Dr. Jonathan M. Kletz is ready to help. Make an appointment today at any of our Abrams (Dallas), Athens, and Gun Barrell City, TX offices!

Bunions are a bone deformity that can really affect quality of life, depending on how far the issue has progressed. The bony growth on the side of the big toe joint not only causes pain and irritation, but it can also make it difficult to fit into footwear made for the masses. 

Non-invasive treatment of this uncomfortable deformity includes addressing symptoms of bunions, such as: bony growth, swelling or redness, corns or calluses, pain, stiffness, or inflammation of the joint. Treatments may include:

• Changing your shoes to ones that have a wider toe box so that your toes and joints do not experience tightness from shoes.
• Using bunion pads and cushions to reduce external pressure from shoes. 
• Orthotic inserts and custom orthotic shoes to help reduce pain.
• Bunion relief exercises, in-shoe splints, and overnight splints to help slow the progression of bunions.

When these remedies do not work, you may need surgical intervention. Depending on the severity of the bunion, there are different surgical options (bunionectomy):

• Tendon and Ligament Repair – If the problem of the bunion or joint deformity is due to tight or loose soft tissues, surgery to loosen or tighten them can fix the problem.
• Exostectomy – This is considered “shaving the bump”, but usually is not the ideal choice since it only includes removing the bony bump. Truly fixing the bunion issue, however, requires realignment of the joint.
• Osteotomy – In this type of surgery, the bones are broken and realigned. Pins or screws may be needed to hold it in the right place. Tendon or ligament repair may also be required in conjunction with this surgery.
• Arthrodesis – This is a surgery in which arthritic joint surfaces are removed, and then screws or pins are used to hold the bones together until they heal properly.

If you have developed a bunion issue or have one that is getting worse, contact your friendly podiatrist at Texas Foot Works. Dr. Jonathan M. Kletz is ready to help you find the best treatment for your bunion problem. If surgery is necessary, we will help you prepare and ensure proper maintenance after the procedure. Make an appointment today at any of our offices in Abrams (Dallas), Athens, and Gun Barrell City, Texas!

These days, there are so many technological devices that seem to grab and keep our children’s attention. Many children can spend several hours at a time, engrossed in the screens. This has led to a more sedentary lifestyle for children, making it more important than ever for parents to encourage physical activity. One such way is to have children participate in sports, whether it be in a children’s group setting, after school programs, private lessons, or community leagues.

Participating in group activities can benefit children in many ways, including teaching sportsmanship, promoting teamwork skills, and improving social skills. The increased activity also helps to keep a healthy lifestyle. However, with sports comes the added risk of injuries. Some common injuries include:

• Chronic repetitive stress at the elbow, wrist, knee, ankles, or feet. Repetitive motions can cause strain in the muscles and tissues. Additionally, any repetitive impacts, such as with jumping or kickingequipment can cause stress fractures. If there are symptoms of pain, make sure your child is correcting technique and modifies time spent doing repetitive movements.
• Broken Bones. Falls, collisions, or impact with equipment can cause painful injuries that lead to broken bones. The bones will need to be set (probably through surgery) and cast. To reduce risk of breaking bones, children should follow sports guidelines, as well as wear protective gear and shoes that are appropriate for the sport.
• Sprains. When a ligament(s) is stretched beyond their natural flexibility limits, children can experience a sprain. The most common is an ankle sprain from landing on the ankle in a strange position. Proper footwear can help prevent this injury.

For growing children, one of the most important injuries to pay attention to is an injury to a growth plate. The growth plate is the area that is still growing on long bones such as in the legs or in the feet. It may require specialized care from an orthopedic surgeon. After an injury, assess your children’s feet. If pain and symptoms are mild, you may be able to treat with the RICE method (rest, ice, compression, elevation). If pain and swelling are moderate or severe, it’s important to see our podiatrist, who can determine how to best proceed. 

If your child has sustained an injury, contact your local podiatrist at Texas Foot Works. Dr. Jonathan M. Kletz is ready to help you find the best treatment for your growing little one. Make an appointment today at any of our Abrams (Dallas), Athens, and Gun Barrell City, TX offices!

Feet have the important task of bearing our entire weight and keeping us mobile. The heel part of the foot, in particular, endures a lot of impact and stress. Because of this, heel pain is a common occurrence for many people. For some it is just mild pain, but for others, it can be debilitating and affect mobility. Treating heel pain will depend on the cause of the pain, from injuries to genetic disease, and tissue strain.

Here are some common causes of heel pain and ways to prevent and treat them. 

• Heel Spur from Plantar Fasciitis – When the plantar fascia (tissue along the bottom of the feet) become inflamed. As the ligaments become overstretched or tight, they can pull on the area that connects the midfoot to the heel. This can cause a bony spur to develop, which causes pain against the heel bone. Many who experience plantar fasciitis get it from the arch flattening or because the tissues are overused. Use of heel and arch support orthotic inserts can help. Additionally, stretching the bottom of the foot and the calves can help release the tension.
• Achilles Tendonitis – When the pain is along the back of the heel instead of the bottom of the heel, it can be attributed to an overuse injury of the Achilles tendon. The tightness and inflammation of the tendon, where it connects to the heel bone can cause pain at the back of the heel. Rest, medication, physical therapy and stretching, as well as immobility splints can help reduce symptoms.

Peripheral Neuropathy – Burning pain along the bottom of the foot and heel can also be caused by plantar fasciitis and peripheral neuropathy. At the onset of diabetic neuropathy, you can experience a burning sensation as you lose feeling. At the onset of any burning feeling, or if you have been diagnosed with diabetes, make sure you check your feet and get an assessment with our podiatrist.                                                                                                                                                                                               

Are you concerned with ongoing heel pain that just won’t go away? Contact your local podiatrist at Texas Foot Works. Dr. Jonathan M. Kletz is more than happy to discuss this topic more in detail and find solutions for any problems you may come across. Make an appointment today at any of our Abrams (Dallas), Athens, and Gun Barrell City, TX offices!

Highly active people (athletes in particular), or those with a very sedentary lifestyle, are very prone to stress fractures. When muscles weaken—either from too much or too little use—the muscles cease providing cushion for the foot and ankle as they impact the ground. As there is very little to protect the bones in your feet, each step you take causes the bones to absorb the full impact, and this causes cracks to form, or stress fractures, to form in the pressurized bones.

Basketball, tennis, and gymnastics are three of the top activities in which stress fractures appear consistently and frequently. On the other side however, those people who have previously lived an inactive lifestyle may incur a fracture when transitioning abruptly to an active lifestyle—such as those starting a high-impact, intensive workout. The muscles, unused to such vigorous work, are not used to handling and cushioning against a vigorous activity. Also, those patients who suffer from osteoporosis, or any condition in which their bones are weakened, frequently suffer stress fractures simply from normal wear and tear.

At the localized site of the fracture (typically where the symptoms originate) the pain can be immense. Sharp or dull pain is paired with swelling and possibly tenderness—engaging in any kind of further activity, especially high-impact, is highly discouraged. Though stress fractures heal in time, they are not as serious as say, when you receive one and continue engaging in high-impact activity; the condition may turn into a full fracture. A full fracture is very serious and may prevent usage of the foot wholesale.

From this point, treatment can vary patient to patient with the severity of the fracture. Rest is absolutely required for the foot. Fractures vary in healing time, some can be healed with short bursts of rest, and others require prolonged periods of resting paired with crutches. In cases in which the fracture is very serious, surgery may be authorized to install pins supporting the fracture and aiding in healing.

On diagnosis of a stress fracture—immediately cease the activity that caused the fracture and rest! Prevention is always your first step, however, if relief of the symptoms does not occur naturally and within a reasonable time frame, an orthopedic specialist is highly recommended.

Folks who have been diagnosed with diabetes will quickly learn that there are many changes they must make in their lives. From checking their blood sugar levels to changing their diet and activities, there are many lifestyle changes involved. This includes checking the feet daily in case of secondary issues that arise due to the way diabetes affects the body.

The following are common secondary issues that affect the feet for people who have diabetes:

• Diabetic peripheral neuropathy: The most common of issues, diabetes can cause high blood sugar levels, which can damage nerves. This results in a burning sensation that turns into a reduction or loss of sensation.
• Diabetic dermopathy: Occurring mostly on the lower parts of the leg, there may be increased pigmentation that look like small scars. This may even begin to occur before diabetes is diagnosed. However, this may not necessarily cause other health problems, other than skin appearance.
• Diabetic callus build-up, ulcer, and infection: Calluses form on the foot due to external friction and pressure on the feet. When there is some loss of sensation, it’s more likely that there is a breakdown of skin under the calluses. A hidden ulcer can occur, which can be hard to treat and cause infection. If the callus and ulcer are not properly treated by our podiatrist, infection can affect deep parts of the tissue and even the bone.
• Diabetic Charcot foot: A type of arthritis that can lead to fractures and dislocations of bones and joints from nerve damage and poor circulation. Leaving these untreated can lead to foot deformity or severe infection.

Make sure you treat your feet well to prevent incidence of secondary issues. Check them daily and take care of any issues that arise sooner than later. If any foot-related developments occur, it’s best to see our podiatrist quickly.

If you have further questions about diabetic foot complications, contact your local podiatrist at Texas Foot Works. Dr. Jonathan M. Kletz is more than happy to discuss this topic more in detail and find solutions for any problems you may come across. Make an appointment today at any of our offices in Abrams (Dallas), Athens, and Gun Barrell City, TX!

Most of the population doesn’t even know that some people suffer from hyperhidrosis. If you’re among those who don’t know what it is, it’s essentially a condition in which people experience excessive sweating on certain parts of the body. Most of excessive sweating happens on the hands and feet, but can be in the armpit and the body overall. There isn’t a particular known cause, other than the fact that it is inherited. There isn’t even a known solution to stop the excessive sweating – only some short-term treatments to reduce the sweating.

The biggest concern for hyperhidrosis is more of a social aspect of embarrassment and discomfort, rather than a severe health issue. A handshake or taking shoes off at a friend’s house can be embarrassing. A clammy handshake or smelly wet socks are not something that most people are comfortable with. Furthermore, sweaty feet can mean slipping on slick floors, which can lead to injury.

There are, however, some health-related side effects. Due to the constant wetness on the feet, skin can break down if not properly cared for. Bacterial, viral, or fungal infections can be common and may not resolve as easily. Additionally, foot odor can affect all shoes and become an emotional stress for those affected.

Things you can do to reduce problems with sweating and risk of infection:

• Good foot hygiene. Clean your feet each day with soap and warm water, and allow them to fully dry.
• Change your socks at least once, midday. If your socks tend to get soaked by lunchtime, you’ll be wearing wet socks all day, increasing foot odor and risk of blisters.
• You can use antiperspirants directly on the feet, but that may redirect sweat to other parts of the body. You can also try foot powder or cornstarch to absorb sweat.
• Rotate the shoes you wear each day to allow for the footwear to fully dry in between wears. This will reduce odor and risk of infections.

Some treatment options include:

• Iontophoresis, in which you submerge your hands or feet in water and subject it to a mild electrical current through the skin. This can reduce sweat to a certain degree. A machine can be purchased for home use.
• Botox injections are also an option, but they are temporary and are not guaranteed to work after a while.
• Sympathectomy is a surgical procedure that interrupts the nerve signals that tell the sweat glands to release sweat.

Is your hyperhidrosis severely affecting your quality of life? Come see our podiatrist, Dr. Jonathan M. Kletz of Texas Foot Works. Make an appointment today at any of our offices in Abrams (Dallas), Athens, and Gun Barrell City, TX to find the right solution for your excessive sweating problems. 

Unless it becomes painful, you may not even notice that you have a plantar wart, which can look like calloused skin. In fact, some can come and go without needing treatment. But when they don’t go away, they can become annoying and unsightly. Taking your shoes off, especially at a friend’s house during summer would feel like a no-no.

So what can you do about it?

First, be sure to spread love, not warts. Plantar warts are caused by the Human Papillomavirus (HPV) and are contagious through direct contact, shared towels and clothes, or while walking barefoot in locker room floors. The virus enters the skin through any breaks in the skin, such as cuts or scrapes. To prevent spreading warts, make sure you don’t share towels or socks, and use flip-flops in communal areas.

Second, you can try some home treatments using over-the-counter items.

• For some, duct tape occlusion therapy can work. By keeping duct tape over the wart, it “treats” it by smothering it.
• Salicylic Acid drops, ointments, or bandages are available to treat warts. Follow the instructions on the box, which include a warm foot soak to soften the warts, and then filing down the wart with an emery board or pumice stone (unless it causes pain)
• Over-the-counter cryotherapy treatments are also available – begin with the same foot soak and filing for more effective treatment.

Third, if over-the-counter treatments do not work, our podiatrist can treat you in the office using stronger cryotherapy or chemicals. He can also safely surgically remove some of the hardened skin.

Finally, take prevention measures. If you’ve been infected, the virus may live on in your body and reappear. However, to prevent a new infection, make sure to keep your feet clean. Wash your feet each day and fully dry them. Moisturize if necessary and treat any cuts or scrapes. Also, wear flip-flops in communal areas in which people might be going barefoot. And don’t be part of the problem – don’t go barefoot in communal areas when you’ve got an active plantar wart!

Do you have wart problem that won’t go away or has gotten out of hand? Come see our podiatrist, Dr. Jonathan M. Kletz of Texas Foot Works. Make an appointment today at any of our Abrams (Dallas), Athens, and Gun Barrell City, TX offices.