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Affects of Aging on the Feet

Yes, even as we age, we need to protect our feet and ankles! As part of aging, we gradually have an increased risk of developing foot problems. Our circulation, nerve conduction, muscle strength, flexibility and proprioception (balance), can all be affected individually or collectively as part of normal and abnormal aging.     Problem: Dry Skin As the skin ages, it can become dryer and therefore have a higher risk of developing fissures (deep cracks in the skin) which may become very painful, and even infected. Treatment The skin around your foot and ankle must be kept appropriately moisturized with a “foot moisturizer”, versus just using a standard body or hand lotion. Foot moisturizers contain ingredients designed specifically for the thicker skin on the soles of our feet. It is also important to remember to not apply moisturizers between the toes, where absorption may be diminished.  Poor absorption between the toes could progress to further cracking in the web spaces and fungal infections.   Problem: Wearing down of foot padding The fat padding on the soles of the feet may also wear down over time. This can lead to chronic pain, development of calluses and even wounds or ulcers. Treatment Preventing these problems, can be improved with using the proper foot gear, cushioned socks and cushioned insoles.   Problem: Blood vessels thicken and stiffen Aging can affect the circulatory system of the lower extremity in many ways. The blood vessels thicken and become stiffer.  This leads to slower exchange of appropriate nutrients and stagnation of waste products. As we grow older, our bodies accumulate more fat as muscle tone diminishes and overall we have less total body water. This can lead to anemia and reduced healing time when injuries occur in our feet.  Most of the overall number of white blood cells stay the same as we age. However, certain white blood cells important in fighting infection, (neutrophils) decrease, and thus we have a reduced ability to fight off infection. Collectively, these factors can be associated with an increase in the risk of blood clots, (deep vein thrombosis, DVT), peripheral vascular disease, (often presenting as intermittent pain in the legs when walking), varicosities (superficial prominent veins).   Treatment Having a detailed medical examination with your Podiatrist will help you lower the risks of developing these chronic problems.   Problem: Changes to our nervous system The process of aging causes our nervous system to undergo unique changes. The brain and spinal cord lose nerve cells and weight (atrophy). Nerve cells may begin to pass messages more slowly than in the past, (poor conduction). Gradual deterioration of your peripheral nervous system which may be seen in diabetes, vascular problems, or other primary neurological disorders can all affect your peripheral sensations in your feet, and in certain instances, can result in diminished appropriate reflex responses.  Neuropathy (disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness) can cause people with diabetes to lose the ability to perspire. Neuropathy may affect people with diabetes as well as other diseases. Diabetics can benefit from a thorough evaluation by a podiatrist to determine the exact cause and appropriate treatment before neuropathy worsens. Treatment Evaluation of the nervous system by a podiatrist for the lower extremity is very helpful. From here further testing can be done to determine the "cause" for the nerve problems. Accordingly the treatment plan can be determined to address the specific cause and symptoms.   Problem: Gait and balance deterioration In a 2006 study published in The Journal of American Geriatric Society, gait (ability to walk appropriately), disorders were detected in approximately 25% of persons age 70-74 and nearly 60% of those 80-84 years old. The most common causes of gait and balance disorders include arthritis and orthostatic hypotension.  However, multiple studies have also found that gait and balance disorders are multifactorial in 75% of older patients. Problems related to psychiatric issues, cardiovascular disease, infectious and metabolic disease, recent hospitalization, medication use, among others can all adversely affect a patient’s gait. Treatment Evaluation of gait and balance is an essential step in identifying persons at an increased risk of falling and preventing fractures. A team medical approach with your primary care physician and Podiatrist can help prevent problems that may occur with poor gait.  Your Podiatrist can provide the most appropriate assisted device that can help older patients prevent falls. Preventing falls and the complications related to them, help diminish the overall morbidity that can develop in our elderly patient population. Foot and Ankle Surgeon Dr. Kerry BeckerDr. Kerry Becker works in our Clarksville, MD office. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Kerry Becker and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Kerry Becker and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Kerry Becker and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

Back to School Shoe Shopping

It’s that time of year again - the weather is starting to change and the kids are returning to school. This means new classes, new school supplies, and new shoes. While children may be focused on style, there are a few other things to keep in mind when choosing a proper shoe that will help keep your child’s feet healthy and happy:  
  1. Fit is key: Children's feet are constantly growing, typically changing every few months. A shoe that is too large or too small can cause pain, blisters, and potentially other short and long term problems. Make sure to have their feet properly measured by a professional before purchasing any foot wear. Don’t forget to bring socks when shoe hunting.
  2. Buy for the larger foot: Feet are rarely the exact same size. Purchase shoes fitted for the larger foot. Try to avoid shopping for shoes first thing in the morning, as feet tend to swell over the course of the day.
  3. Not all shoes are created equal: Especially when buying for sports, a shoe should have a sturdy heel. The shoe should also have structure, bending primarily at the ball of the foot, not the arch.
  4. Say no to sharing footwear: Much like adults, even though two children may measure the same size, the shape of their feet may differ, and a previously worn shoe has likely conformed to its original owner. Older shoes will also lose their support and cushioning. Sharing can also spread athlete’s foot or nail fungus.
  5. Shop together: Let your child participate in shopping for their shoes. This promotes healthy foot habits as they age and helps ensure a proper and comfortable fit. Try to avoid shopping online to avoid issues with fit and sizing - there is no replacement for walking in the shoes at the store to help assess comfort.
  6. No “break-in” needed: Childrens shoes should fit appropriately and be comfortable immediately.
  Be mindful of areas of irritation, blistering, and uneven shoe wear. Less obvious signs that there may be an underlying issue include tripping, falling, and decreased participation in sports. A podiatrist is specially trained and experienced in treating lower extremity conditions and ailments. Please contact your local FASMA provider if you have any concerns that may require evaluation. For students who wear adult sizes, Richey & Co. Shoe stores have trained associates who can fit your child into proper fitting footwear.   Foot and Ankle Surgeon Dr. Man ChoDr. Man Cho works in our Reston, VA office. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Man Cho and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Man Cho and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Man Cho and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

When Pain Becomes a Problem

Pain -- we have all experienced it at some point in our lives. That unpleasant sensation of a sunburn, headache, or a stubbed toe on the bedpost. Pain, whether acute or chronic, varies from person to person. Early identification and treatment of the underlying cause of pain is important to reduce the prolonged, debilitating effects of pain.  

Pain Relievers

There are many different modalities for managing and treating pain. Often times, over the counter pain medications such as Tylenol, Advil, and Aleve, and are readily accessible and therefore become the treatment of choice for pain relief.  While these medications are generally safe, if taken as directed and at the recommended dose, they also carry risks. This includes side effects such as gastrointestinal bleeding,  drug interactions, or accidental overdosing that can turn fatal. As a precaution, it is important to carefully read the label prior to taking the medication or to consult your healthcare provider prior to taking the medication.  

Risk of Over Medicating

Opioids, such as Percocet or Vicodin, are a powerful class of drug that may be prescribed by your doctor to treat pain, if indicated. Opioids are notorious for causing drug dependency, addiction, respiratory depression, or death if used inappropriately. According to the Centers for Disease Control and Prevention, the United States is in the midst of an opioid overdose epidemic as these drugs have killed a record high of more than 42,000 people in 2016. The best ways to prevent opioid overdose deaths are to improve opioid prescribing, reduce exposure to opioids, prevent misuse, and treat opioid use disorder.   Whether you have been in pain for a few days or for several months, it is important to seek medical professional help.  Your podiatrist can play an important role in diagnosing and treating your foot and ankle pain. Schedule a visit with one of our many foot and ankle specialists today. Foot and Ankle Surgeon Dr. Michelle LeDr. Michelle Le works in our Rockville, MD office. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Michelle Le and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Michelle Le and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Michelle Le and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

Taking on Chronic Heel Pain- a Fresh Option

When that Achilles Tendonitis or Plantar Fasciitis just will not resolve  

Tendon injury is extremely common and can occur with trauma, overuse and aging. Symptoms typically include pain, inflammation and dysfunction. Tendon healing can be very slow, and normal healing can take up to ten weeks. Most people will have relief with conservative measures, including orthotics, anti-inflammatory medication, cortisone injections, and physical therapy. But there are cases where tendons fail to regain full function with conservative management. Even with surgery, tendons may heal with fibrosis and scar tissue, leading to less strength and a higher rate of re-injury. These chronic tendon injuries may show tendon cell depletion, collagen breakdown and a high potential for failed healing. Though it may seem that inflammation is present (which is required for normal healing), the mediators that help progression of the healing process are absent. In these situations the body’s inflammatory response stops and there may be no further healing.    

Amniotic membrane and stem cell allograft  

Amniotic membrane allograft comes from the innermost layer of the amniotic sac, which surrounds the fetus. The amniotic membrane is harvested from a consenting donor during scheduled cesarean section.  This collection poses no ethical concerns because it is normally discarded after birth and there is no harm or danger to the fetus or mother when it’s extracted. After it is gathered, the amniotic fluid is sent to an FDA approved lab where it is processed and the fluid is cryogenically frozen and stored. Amniotic fluid and stem cells are not immunologically reactive, so there is no reaction between unrelated donors and recipients. Amniotic membrane synthesizes cytokines and growth factors (chemicals needed for proper healing), and amniotic stem cells can develop into different types of tissue. This ability of cells to differentiate into new tendon cells can generate new tendon tissue, while tendon repair may be stimulated by the production of growth factors and cytokines.  

What to expect when your doctor uses this regenerative medicine  

In the office setting, amniotic membrane allograft can be injected into the injured tendon or plantar fascia.  There may be some discomfort associated with the injection, but most practitioners will mix it with a local anesthetic to help limit pain.  It is important that no non-steroidal anti-inflammatory medications be taken for a month before this injection and for a few months following. A period of rest of up to a month for the tendon or plantar fascia is necessary after the injection is given. Many times a positive response to the injection will mean surgery can be avoided. But amniotic stem cell use can be a planned part of a surgery, leading to better long-term healing. Amniotic membrane and stem cell use is a safe option to discuss with your podiatrist if your plantar fasciitis or tendonitis has not resolved with other conservative management.                    Foot and Ankle Surgeon Dr. Erika SchwartzDr. Erika Schwartz works in two offices for your convenience-- Washington, DC (K Street) and Chevy Chase, MD. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Erika Schwartz and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Erika Schwartz and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Erika Schwartz and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

Keeping Your Feet Safe on Vacation

My dad is a podiatrist, and every summer when we were at the beach or the pool, he pestered me (and my brothers) to put sunscreen on our feet. I certainly did not understand at the time just how important it is to protect your feet from the sun. But now I know that it takes even more than sunscreen to keep your feet safe during the long summer days. No matter where you go on vacation, there are some important things to do and to watch for to help keep your feet comfortable. The first thing, of course, is sunscreen. My dad was right to pester us kids- both the top and bottom of your feet can get sunburned. In addition, the skin on your feet can be more susceptible to melanoma (along with other types of skin cancer), especially if you have a family or personal history, or if you already have moles on your feet. If your feet spend any time in a pool or ocean, make sure to apply the sunscreen on them afterward. The beach brings other dangers besides the sun too- it feels nice to walk barefoot on the sand, but shells, glass, wood, and other objects that might lay hidden can all cause cuts or injuries to your feet. If you have gotten a cut on your foot, going in the water can invite bacteria and other organisms to cause infections. Wearing sandals on the beach can help protect you, and checking your feet before you head for a swim can prevent you from swimming with an open cut that you didn’t notice before. If you’re spending a lot of time in a pool, ocean, or lake, investing in a pair of water shoes goes a long way for protecting your feet.   Of course there are other places to vacation besides the water. If you’re spending time camping, hiking, or touring a new city or country, make sure to wear good shoes that protect you from the elements and from the miles. Always give your hiking boots or walking shoes a good test run to make sure they fit well and won’t give you blisters. Keep in mind that feet swell when you’re standing and walking, so you might need a larger size in a hiking or walking shoe. Good arch support can help prevent fatigue and strain in your feet and ankles. If you’re spending time outdoors, always check your feet for insect bites. We’re all pretty familiar with mosquitoes, but keep an eye out for bites or stings from other critters. Ticks, chiggers, bees or wasps, spiders, even crabs or jellyfish can spell trouble. If you’re concerned about the appearance of an insect or animal bite, see a doctor right away.   Summer vacation is a great time for rest and relaxation, adventure and exploring. Remember these tips to keep your feet safe and healthy, so you can enjoy your vacation to the max. Have a great time this summer- and don’t forget the sunscreen! Foot and Ankle Surgeon Dr. Caitlin MaddenDr. Caitlin Mahan Madden works in our Rockville, MD (Shady Grove) and Wheaton, MD offices. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Caitlin Mahan Madden and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Caitlin Mahan Madden and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Caitlin Mahan Madden and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

MoCo365 Features FASMA

Dr. David Freedman, a founding member and Vice President of Foot and Ankle Specialists of the Mid-Atlantic, is featured on MoCo365. This initiative highlights businesses from all sectors of Montgomery County, Maryland with the purpose of showing the diversity of the area through the stories of successful leaders, entrepreneurs, and inventors. While FASMA began in MoCo, it has expanded throughout the Mid-Atlantic with 35 offices reaching from Pennsylvania to North Carolina. Learn more about our history and what makes us unique by watching this video.  

Injuries to Your Toenails

What are some possible causes of toenail injury?

Everyday injuries can cause your toenail to fall off. Hitting your toe on a chair or bedpost, dropping something on your foot, or simply pulling your socks on too fast can damage your toenail. Injuries to the nail may lead to a subungual hematoma, which causes blood to collect under your injured toenail. This can delay growth of the toenail and be painful for the first few days or weeks. If it can be tolerated, the best way to treat it is to soak the area in cold water for 15 minutes, clean the area with betadine or an alcohol swab, apply antibiotic cream, and trim straight across the toenail. If the subungual hematoma extends to a little over a quarter or half of your toenail, then you must seek treatment at a doctor’s office. If you experience throbbing or severe pain near the hematoma, your doctor will determine if the hematoma needs to be drained to relieve the pressure.  X-rays may also be taken to make sure a fracture has not occurred. In diabetics, or immune-compromised patients, care is important so that infections do not occur. Keep in mind, toenail growth will slow down significantly after the injury. It can take anywhere from six months to two years for the nail to completely grow back. Pressure on the toenail can cause it to weaken and lift off the nail bed. Make sure other toenails are trimmed neatly and wear well-fitting shoes to prevent any future injuries. A half centimeter of room should always be present in the front of shoes to prevent pressure of toenails. A good shoe store can help fit your shoes and make sure you are not feeling extra pressure around your toenails. It is also possible to develop a fungal infection of the nail after a toenail injury. The injury provides an invitation for fungus to grow between the nail bed and loose toenail. If this occurs, your doctor should take a sample of your toenail to confirm that it is fungus, and then treat accordingly. Your doctor will discuss when antifungal medications are necessary on a case by case basis, depending on the results of a nail biopsy. People who have athlete’s foot and diabetes are prone to fungal infections. Diabetic patients have a harder time fighting off a fungal infection and must take extra precaution. Another cause of toenail detachment is psoriasis, an autoimmune condition. With psoriasis, the skin cells begin to build up at a faster rate and cause the toenail to lift off. Many cases of nail psoriasis are mild and don’t persist. Some of the symptoms may include thickening/pitting of nails, unusual nail shape, yellow-brown discoloration, or a chalky-like buildup. If the foregoing remains an issue, your doctor may prescribe topical steroids to rub into your toenail and cuticle.  

What to do when your toenail is injured or falls off.

Step one: Don’t panic. If your toenail starts to fall off, you must follow a few basic tips to avoid worsening your prognosis.
  • First, clean the area with an antiseptic agent as tolerated.  
  • Second, apply an antibiotic ointment with a band-aid. If part of your toenail has fallen off or is detached, it is wise to let a doctor remove the remaining portion to avoid more pain or exposing your nail bed to infection.  
    • Do not lead the band-aid on all day and night-- leave the band-aid on during the day, but leave your toe open at night to let the area get some air.
    • Change your band-aid regularly regularly-- a dark, moist environment creates a way for infection and fungus to form.
  • Also, the doctor will determine how much of your toenail to remove, depending on how much of the toenail is detached.
Do not wait to seek treatment until your entire toenail falls off. While these tips provide a basic understanding of toenail injuries and detachment, they are not substitutes for medical treatment, especially if the pain persists or you are unsure about how to proceed. In such cases, please contact your doctor.   Foot and Ankle Surgeon Dr. Reema DuaDr. Reema Dua works in our Rockville, MD office. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Reema Dua and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Reema Dua and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Reema Dua and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

FASMA Docs Recognized for Sports Med Care

Congratulations to 9 of our doctors, who were declared the “Best of Washington” in the June 2018 issue of Washingtonian Magazine! Each year, the magazine sends out a survey to doctors in the Maryland, Virginia, and DC region to vote for their peers, which results in their Top Docs list. The doctors featured in the June “Best of Washington” issue were compiled from their annual Top Docs list and emphasized which doctors to turn to if you’re facing a sports-related injury. The following doctors have been named to the list of the DC area’s Top Docs for Sports Injuries:

Ian Beiser, DPM

Man Cho, DPM

Lee Firestone, DPM

Eric Masternick, DPM

Gene Mirkin, DPM

Howard Osterman, DPM

Seth Rubenstein, DPM

Erika Schwartz, DPM

Adam Spector, DPM

  Thank you to our patients who entrust us with your care, and to our professional colleagues for their continued and generous vote of confidence.

Fall Risk in Older Adults

Fall Prevention

Fall prevention is not a sexy topic but as we get older (> 60 years of age) physical changes, health conditions and medications can make falls more likely. Stepping on a crack and breaking your mother’s back, is an old childhood game that we didn’t take too seriously.  Something we should take seriously: the 1 year mortality rate for seniors over the age of 60 after a hip fracture is between 14 - 58%. Therefore fall risk prevention is of utmost importance.  

Footwear Style and Risk of Falls in Older Adults

The results of a study reported in the Journal of the American Geriatrics Society 16 August 2004 showed that athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk. Relative to athletic/canvas shoes, other footwear was associated with a greater likelihood of falling, varying somewhat by style. What this means: Contrary to findings from gait‐laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.

Fall‐Risk Assessment and Management in Clinical Practice: Views from Healthcare Providers

Another study reported in the same edition of the Journal of the American Geriatric Society from the August 16, 2004 revealed the following: healthcare providers were most likely to report directly intervening with or referring older patients for gait and transfer impairments and balance disturbances and least likely to do so when encountering foot or footwear problems and sensory or perceptive deficits. Patient compliance was the most commonly reported barrier to successful direct intervention across several risk factors, whereas inadequate availability of other healthcare providers and lack of Medicare reimbursement were the most commonly reported barriers to successful patient referrals. What this means: see your podiatrist for foot or footwear problems and any problems with numbness or loss of balance as these are the key areas that are being overlooked by other health providers.  

Begin Fall Prevention now:

  1. Make an appointment with your Podiatrist for Fall Risk Assessment: (bring with you the following information)
    • Medications - that make you tired or affect your thinking
    • Previous falls - have you fallen before, near misses where you caught yourself or someone else caught you
    • Health - dizziness, joint pain, shortness of breath or numbness in feet and/or legs, loss of balance, weakness
  2. Physical activity
    • Develop a walking, water workouts, tai chi program in conjunction with your podiatrist and physical therapist.
  3. Appropriate shoes
    • Wear shoes with firm non-skid, non-friction soles.
    • Avoid wearing loose-fitting slippers that could cause you to trip.
    • Do not walk around barefoot or in your stocking feet. Your podiatrist will help you select or will prescribe appropriate shoes that will not add to your fall risk
  4. Remove hazards to make your home safer
    • Remove loose items from walkways, move furniture like coffee tables
    • Secure loose floor coverings, repair loose flooring, store things you use regularly in an easy to reach place
    • Immediately clean spills
    • Use non-slip mats in bath or shower
    • Do not take chances! Stay away from a freshly washed floor. Never stand on a chair or table to reach something that is too high.
  5. Keep your living space well lit.
  6. If your doctor suggests that you use a cane or a walker to help you walk, please use it! This will give you extra stability when walking and may help you avoid a bad fall. Use assistive devices and get help learning to use them.
  7. Do not use stairs without rails on both sides for support. If you must carry something while you are going up or down, hold it in one hand and use the handrail with the other.
  8. Know your limitations.
  9. See your physician if you have dizzy spells or fainting spells; see your eye doctor at least once a year and have your hearing tested too.
  10. When you get out of bed in the morning or at night to use the bathroom, sit on the side of the bed for a few minutes before standing up. Moving too quickly can make you dizzy, and you might lose your balance and fall. If your feet are numb from neuropathy they don’t know where they are so turn on the lights and look them onto the floor.

What to do if you fall

If you fall at home, remember:

  • Step 1. Stay quiet for a moment — don’t panic
  • Step 2. Decide whether or not to try to get up.

If you decide to try to get up:

  • Step 1. Use strong, stable furniture for support as you try to get up.
  • Step 2. Take some time to recover from your fall after you get up.
  • Step 3. Tell someone that you had a fall.
  • Step 4. Get medical advice if necessary.

If you cannot get up, or if you decide not to try:

  • Step 1: Slide or crawl to get help if you can. You might be able to reach one of the following:
      • Telephone
      • Door to the outside
      • Personal alarm device
      • Something to make a loud noise
  • Step 2: Tell someone you have fallen and need help.
  • Step 3: After calling for help, lie quietly until help arrives. Keep as warm and comfortable as you can.
  • Step 4: Get medical advice if necessary.
  Foot and Ankle Surgeon Dr. Gregoy SmithDr. Gregory Smith works in two offices for your convenience-- Gettysburg, PA and Hagerstown, MD. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Gregory Smith and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Gregory Smith and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Gregory Smith and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.

Which Way’s the Beach, Bro?

We made it to June!  Can you smell the summer warmth in the air? With the summer, comes dreams of sitting by the pool, going to the beach, outdoor hikes, and long bike rides. June also happens to be Men’s Health Month! The purpose is to create awareness of preventable health problems and injuries among men and boys and encourage them to seek regular medical advice and early treatment. It is well established that males typically have less flexibility than females. Testosterone, a male sex hormone, plays a pivotal role in muscle size and flexibility. It increases the size and mass of muscles on the skeleton. This means that men are going to naturally be “tighter.” This muscle tightness and limited flexibility can lead to lack of normal range of motion at certain joints, inability of tendons to stretch to their full capacity, and lead to injury. Every year, as winter comes to an end, the weight room fills up with men dreaming of, and working toward, their perfect beach bodies. As your muscles get bulkier and more toned, the tendons attached to those muscles become less flexible.   In the lower extremity, the most common muscle tightness that we see is in the calf muscle. The calf is made up of 2 muscles, the gastrocnemius and the soleus. These muscles combine to form the Achilles tendon. This muscle group spans from above the knee, where the gastrocnemius starts, and ends at the Achilles insertion on the back of the heel bone. This muscle group controls almost all of the range of motion at the ankle and secondarily controls the motion of the foot. During walking, running or jumping, the calf muscle pulls the heel up to allow forward movement. As a foot and ankle specialist whose majority of the day is spent treating sports injuries, I can say that almost all of the injuries and chronic conditions that I treat stem from lack of flexibility in the calf and Achilles tendon.   When the calf and Achilles tendon are tight, motion at the ankle is restricted and it causes our foot to naturally compensate for this by overpronating. This leads to increased flexibility in the other small joints of the foot that shouldn’t normally have that amount of range of motion. If these compensations persist, it can lead to injury. The common injuries I see that stem from a tight calf and Achilles tendon in men and boys are:
  • Calf strain
  • Achilles tendinitis
  • Peroneal tendinitis
  • Plantar fasciitis
  • Calcaneal apophysitis (Sever’s disease)
  • Metatarsalagia
  • Sesamoiditis
  We are all victims of not taking enough time to stretch-- but men especially. Stretching to maintain the flexibility in the joints and tendons is the key to preventing injuries.  Stretching before, but more importantly, AFTER exercise can go a long way.   Shown below are my favorite stretching exercises to get into the habit of doing.         Foot and Ankle Surgeon Dr. Erin Robles-ShermanDr. Erin Robles-Sherman works in two offices for your convenience-- Washington, DC (K Street) and Chevy Chase, MD. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Erin Robles-Sherman and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr. Erin Robles-Sherman and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Erin Robles-Sherman and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk.