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FASHIONABLE FEET: PODIATRY INSIGHTS FOR WOMEN OVER 50 · Uncluttered and Unfiltered: The Podcast For Women Over 50

2:08
Welcome to Uncluttered and Unfiltered, the podcast urging
2:12
you to let it go and don't look back, with nationally acclaimed
2:16
professional organizer Christine Stone and self-proclaimed Hot
2:21
Damn Mess radio and TV personality Eden Kendall.
2:26
Welcome everyone to Uncluttered and Unfiltered, the podcast for
2:29
women over 50 with Christine Stone, who's a professional
2:32
organizer. My name is Eden Kendall.
2:33
I'm incredibly unorganized, if that that's the summary of our
2:37
show. But we have a special guest
2:39
today and we're going to talk with Doctor Don Miles of Doctor
2:43
Don Miles Podiatry. And you are the perfect guest
2:47
for us for this subject. Doctor Don Miles.
2:50
Can we call you Doctor Don or Don or anything you like?
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So you're the perfect guess for us because you are a fashionable
2:59
woman. So we're not going to have
3:01
someone in here who's just going to tell us what we can't do.
3:03
We want someone in here to tell us what we can still do.
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And this is, of course, a continuation of a recent episode
3:09
where Christine Chuck Oliver high heeled shoes and made her
3:12
husband cry. So.
3:14
So that's where we have landed. So first of all, tell us a
3:16
little bit about yourself, how you became interested in
3:19
Podiatry, and you know where you think the confusion lies for
3:24
people about what you do, do and don't do.
3:27
Well, I always had a leaning towards medicine.
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My sister was really the driving force.
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She had bunion surgery when she was 14 and she had a ankle scope
3:41
for a sports injury when she was 16.
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So that is, I never had foot problems, never had any reason
3:48
to see a podiatrist, but my sister's life was a little
3:50
different. So with that exposure, I thought
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this was a good field for women because I'm small, I have small
3:57
hands, wanted to work in a small area of the body, and so that's
4:02
what sort of took me that direction.
4:04
And you're an athlete, which isn't a necessity, but it's also
4:07
helpful for your clients. Well, it is.
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And I wasn't always an athlete. I didn't start running until my
4:13
early 40s. Before that I was a mountain
4:16
biker and a gym rat, but now having had a 15 year or so
4:22
running career and had a number of traumatic incidents and
4:27
overuse injuries, I can definitely say I understand my
4:30
patients a lot better. I know your patients are of all
4:35
walks of life and you know it's not a gender thing, but we
4:39
really are appreciative that you're here as a woman because
4:43
Christine has been saying for. For a long time.
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Years now we really need to speak to somebody about my
4:50
aching feet. My aching feet.
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So what are some of the challenges that you see that
4:55
face women over 50 before Christine breaks out her list
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and tells you what they are? Well, there is no doubt that
5:05
lack of estrogen has an impact on our soft tissue.
5:08
So collagen quality deposition, which effects our muscles, our
5:13
tendons, our ligaments, has a profound effect on what happens
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to women over 50. So we see a lot more soft tissue
5:21
injuries. I was actually just at the
5:24
American College Foot and Ankle Surgeon annual seminar,
5:27
attending some sports medicine lectures, and they pointed out
5:30
that women over 50 or 70% more likely to suffer a soft tissue
5:34
injury than men. So our Physiology just sort of
5:39
sets us up for trouble. And then of course, add in
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osteoporosis, which is going to make you at an increased risk
5:45
for fractures, stress fractures and you know, normal non
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pathologic fractures from trauma and then what we would call
5:53
pathologic fractures from osteoporosis.
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So, so that sort of drives a lot of the stuff that I see.
6:01
Bunions hammer toes, they don't start in your 50s, but they
6:05
start to become a problem in your 50s and everybody wants to
6:09
blame it on shoes. It is not the case.
6:12
Really, it is not the case. However, it does absolutely
6:15
aggravate your condition, but it does not 'cause it.
6:18
I see plenty of men with bunions and they've never worn a.
6:20
Paris, Right, right, right. And then they actually looked
6:23
back and we have African communities that have never worn
6:28
shoes ever in their lives, and they still develop bunions.
6:31
So it is a mechanical imbalance that we were set up to have, but
6:35
then the shoes that we choose will affect whether it becomes a
6:40
problem or how quickly it becomes a problem.
6:42
All right before. We that's amazing take.
6:44
Another breath. You have blown my mind twice
6:47
now. First of all, just saying that
6:50
age does correlate and menopause and hormones does correlate with
6:54
our with our feet because it's soft tissue.
6:56
And then also to find out that shoes are not the main culprit.
7:00
That is mind blowing. Christine, what do you have on
7:02
your list because you've been going through it lately?
7:05
I have been going through it because of shoes.
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Well, because I already had a bunion, so the shoes just
7:13
aggravated it. And it was one of those long
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weekend wedding where you have to be in high heels for a few
7:19
days, not just one event for three hours.
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And I'm still recovering. I'm still, I'm still in
7:26
recovery. So I think for me, everybody
7:31
avoids bunion surgery because they hear such nightmares about
7:36
it and that everyone's hoping, well, me, I'm hoping that one
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day they can laser it or they can do something with a wand and
7:44
make it just go away easy without major surgery and being
7:49
off your feet or being out of Commission for a long period of
7:52
time. So has anything changed there or
7:54
is it the same? No, things have actually
7:57
changed. You know, it's sort of like
7:59
fashion. Things will come into fashion,
8:01
go out and come back in again. So back in the 60s, there was a
8:04
trend towards what we call minimally invasive surgery.
8:07
So this was surgery that was done through tiny holes without
8:10
a big incision. And bunions were one of those
8:13
things that they fixed, but in those days, they had no way to
8:16
fixate what they cut. So the general surgeons that do
8:20
things open, we're a bit skeptical that this was a good
8:23
idea. And it sort of fell to the
8:24
wayside. And traditional surgery, big
8:27
incision, you know, screws, the whole shebang, recovery, all of
8:31
that has been the trend for up until about the last five years.
8:35
And now in the last five years, companies have come up with very
8:40
specific systems and fixation that allow us to go back to
8:44
doing a minimally invasive bunion, hammer toe, things like
8:47
that, that doesn't require an incision, just a couple of
8:50
little poke holes really. You still get the the quality
8:54
fixation I'll show. You Wow, we're gonna.
8:57
Ask you though, what fixation means.
9:00
To hold the bone back together after we cut it and move it.
9:03
So you fix the bunion without cutting it, right?
9:05
Right, right, right, right. And to be specific, just like
9:08
there's one more than one way to scan a CAT, there's more than
9:11
one way to fix a bunion, right? So as a surgeon, we have to make
9:14
the decision about where in the problematic area of the bunion
9:18
needs to be corrected. So sometimes I'm grabbing.
9:21
That and and for those who are listening to this doctor Miles
9:24
has some. They are like acrylic skeletal
9:28
feet and they're super cool. And I want to paint the toenails
9:32
so badly. Right?
9:33
Me too. But that wouldn't make them
9:35
accurate. So she's holding those up.
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And we'll make sure that these are videos that we give everyone
9:39
access to on our social media or on YouTube.
9:42
But but please continue. So, OK, so again, as a surgeon,
9:46
you have to make a decision about where to fix the bunion.
9:48
And so you'll see a little bit different look to each of these.
9:52
You'll see one of these where the plate and the screws is back
9:55
here. This company striker or their
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foot and ankle division has actually come up with a
10:00
minimally invasive way to do this.
10:01
So you could imagine to put this plate, wow, you need to make a
10:04
big incision, right? But they have come up with a
10:07
system that changes this, which I'm about to be trained on at a
10:12
cadaver seminar. But what we were talking about
10:15
that. Sounds like a good time, a good
10:16
cadaver seminar. It's a really good time people
10:19
are dying to get. Into it.
10:22
She did. She did it.
10:24
But with this, this is their actual model of what we do.
10:29
And so we really only just make a tiny hole up here to 1 tiny
10:35
hole back here. And through those two little
10:38
tiny holes, we can actually cut this with a clamping system,
10:43
move it over. And then because we've cut
10:46
across here, we have to hold it in place.
10:48
We're able to put these two screws across it to hold it.
10:52
And these are kind of the bones that are on the in inside of.
10:56
The bunion would be right here on.
10:58
That you know, everyone knows we're a bunion.
10:59
Right. And after you've moved all this
11:01
over, you have a tiny little drill that you can come in and
11:04
smooth that bunion down, which is why you see this little
11:06
deviation right here where it's kind of missing.
11:09
And all of that is done through just two small.
11:13
What's the recovery? So recovery on this, you're
11:16
still going to be restricted for two to four weeks.
11:20
But you're in that beautiful shoe.
11:21
Yes, in the beautiful. Shoe you can bling it out.
11:26
And get the boot. Yes, yeah.
11:28
But but because you don't have such a big incision, you're able
11:32
to mobilize much earlier, less swelling because you're not
11:35
making a big long incision into the skin.
11:38
So this is this is the last five.
11:42
Years. I would say the jury's still out
11:45
on what the long term will be with this as opposed to the
11:48
traditional way to do it. Ioffer patients both options and
11:52
leave it up to them, let them do their research and and then we
11:55
just make a decision. So.
11:57
OK. So let's talk a little bit.
11:59
As long as we're landing on bunions for a moment, prevention
12:03
because you were saying that it's a lifetime of and
12:06
genetically we might be predisposed etcetera.
12:09
And so it's not our shoes, but let's just say we know that
12:11
we're predisposed. Should we now be avoiding
12:14
certain shoes? I'm thinking the pointy ones I'm
12:17
wearing right now, although I don't have bunions.
12:19
Yes. So this is actually is not bad
12:21
because it does have a little bit of a what we call a wide toe
12:24
box, but certainly anything that's going to compress your
12:27
forefoot and. That's the pointy toe we're
12:29
looking. Pointy toe that is going to lead
12:32
you towards advancing the bunion more quickly.
12:36
So it's going to form because of bad mechanics or genetics over
12:40
time, but you're going to speed it up and aggravate it further
12:45
in something that's narrow. So what is the worst kind of
12:50
shoe there is? A spike heel with a toe box that
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looks like this. OK, so pointy.
12:57
Pointy. Pointy.
12:58
Close point shoe with a like more of a stiletto heel.
13:02
And just think of it about surface area.
13:04
So the greater the surface area of the shoe, the less pressure
13:09
points you'll have and the the less like a wedge that has all
13:17
of this in contact with the ground is going to distribute
13:19
pressure across all of your joints and you're going to have
13:22
less pain in a shoe like this then you would like this.
13:26
So we're holding up. A wedge and this shoe, but but
13:30
let me ask you a question because IA hybrid kind of that
13:34
like a big block heel. Is that still a little bit
13:37
better than? That this is way better.
13:38
Yes, a big block heel is going to be better than a than a
13:41
skinny. Than a stiletto.
13:42
So since we're on the topic, the we seem to lose a lot of fat
13:47
also on the bottom of our foot, the fat pad.
13:50
And I have so many things in my closet for shoes, you know, like
13:54
the ball of the foot. Meaning like the little insert.
13:59
Clouds, I mean you name it. I've used every single thing to
14:02
stop because I really have lost a lot of fat on the bottom of my
14:06
foot. Nowhere else but on the bottom
14:08
of my foot for sure. It's relocating.
14:10
Yeah, it's relocating. So is that really the only
14:14
solution? I see in some bigger cities they
14:17
inject fat into the bottom of your foot.
14:20
Yeah, like large New York. They also inject silicone.
14:24
There's a lady in New York, a podiatrist in New York that does
14:27
her. Her niche is women in New York
14:32
who still want to wear their 4 inch spike heels and walk in
14:35
them all day. And she literally does inject
14:37
silicone into the fat pad. It's temporary.
14:40
It's going to dissipate. Oh, really?
14:42
So it. Also won't be perfect.
14:44
It has to. You have to have something be
14:46
encapsulated. There has to be a lining around
14:48
something for your body to not particularly in the ball foot
14:51
because obviously every time you put pressure there, things are
14:54
distributing. So eventually it's going to just
14:56
disappear. But yes, there is a, there is a
14:59
small niche where people do do either silicone or fat
15:02
injections. There's also some biologic
15:05
things that can be injected into the ball, the foot, but they're
15:07
all temporary right now. So you are right, I am pleased
15:11
to say that some shoe companies are putting the cushion.
15:14
They are. They are.
15:15
So they've heard our voices. Somewhere along the way, they
15:18
actually maybe put a woman on their shoe design department and
15:21
they have started to put cushion.
15:23
But another way to combat pain in the ball of the foot, I'm
15:27
gonna go back to this one, is to choose a shoe that has a rocker
15:32
on the bottom, really. So if you look at this one.
15:35
And we're not talking about athletic shoes.
15:37
We're talking about actual fashioned sandals.
15:39
These are wedges. So so this is a pair of wedges
15:42
that I use for work and you can see that it's curved at the back
15:45
and curved at the front and I cannot bend the shoe.
15:50
Oh, is that the? Key.
15:51
So that is the key. OK, if you have pain, if you
15:53
don't have pain, you can wear whatever you want, OK, I don't
15:55
care. But if you come into my office
15:57
and tell me your feet are killing you and I look at your
15:59
shoes, I'm probably going to say, well, that's part of the
16:02
problem. OK, so with this, the best way
16:06
to think about it is if I asked you to go out on your porch and
16:09
and rock in a rocking chair, you're going to choose a rocking
16:12
chair that rolls gently back and forth.
16:14
And then if I told you to go out onto your porch and put yourself
16:17
in one of these chairs and rock, what are you going to have to
16:19
do? And the answer is you have to
16:21
throw yourself backwards. You have to slam yourself down.
16:23
And then you're going to have to pick yourself back up again
16:25
towards the front. And mechanically, your body
16:28
wants that rocking chair because that's what feels good.
16:31
So you get a shoe like this, you're just going to gently roll
16:35
through your day, as opposed to this where you're going to hit
16:40
and then have to lift the whole thing up to move.
16:43
Yeah, I never thought of that either.
16:44
I never had thought of that. Now, is this a kind of a rocking
16:48
shoe because it's a wedge or because that is a wedge that's
16:50
made to kind of rock? In other words, is that just by
16:53
nature of what it is? No, this is a shoe that's
16:55
purposely made to rock. What brand?
16:57
Is that's a wedge. This is Vionic.
17:01
They have good selection of shoes though.
17:02
Vionic with AV. Yeah, with AV, yeah.
17:05
And they have, the other thing about them is they do have an
17:07
orthopedic foot bed built into it.
17:09
So if you look at the inside, you can see how high the arch
17:12
is. So this really is meant to
17:13
conform to the shape of your arch.
17:15
Since you're speaking on that, every time I've tried to wear a
17:18
high arch though it just bothers my foot so much.
17:21
So what does that mean? So not every foot is the same OK
17:24
right? So I'm making a generic like
17:26
this for me. I have a higher arch OK but I
17:29
would never put a flat footed. Person into.
17:31
A shoe like this because it actually has too much arch.
17:34
OK, so got it. I always wondered about that
17:37
because even the high fashion shoes like this that are meant
17:41
for better foot alignment, they always seem to hurt my feet.
17:46
Well, and and again, a flat foot is is not going to be happy with
17:51
with true. I have an arch.
17:52
Good to know. So what do we need to be
17:54
thinking about in terms of when we do go shoe shopping?
17:59
Do we do we want to say like OK, I could bring some inserts with
18:03
me and try them with inserts? Or is it kind of like if they're
18:06
not going to be comfortable without inserts, don't even
18:08
bother with the shoe in the 1st? Place, I mean, you can
18:10
definitely make improvements. You can take a bad shoe and make
18:13
it better by putting something in it.
18:16
The difficulty that we have living in Florida is most of the
18:19
year we want to be in an open shoe and it flops, yes.
18:22
And you can't really put an insert into something that's
18:24
open because it's going to have a tendency to slide around.
18:26
So it's really meant for a closed shoe, but I did bring a
18:30
couple inserts with me. So this is an example of
18:35
something that is meant for a ladies dress shoe, so you can
18:38
see how low profile that is and then.
18:40
OK. And what we're looking at here
18:41
is, is this a custom insert? This is a custom insert.
18:44
So it and it's small, it's about a little more than half the size
18:48
of the foot. And this is also a custom for a
18:51
woman. You can see it's called Dress
18:53
Elite, and you can use these in a heel up to about two to three
18:56
inches. After that, they're not going to
18:57
conform well, but these are lightweight, slim, low profile,
19:03
and will fit in like a pump like what you have on today.
19:05
You'd have no problem fitting that in there.
19:07
So you have to have those made. These are custom.
19:10
You go to a podiatrist. You would and they would make a,
19:14
these days a digital scan with an iPad and we sent it off to
19:17
the lab. They fabricate and bring it
19:19
back. But there I do have and I didn't
19:21
bring it with me today, but I do have a, a company that does a
19:24
prefabricated just off the shelf one generically good for most
19:29
average feet. So that's sort of the
19:31
difference. If you have an average foot, you
19:32
may be able to get away with a prefabricated one.
19:34
But if you have a specific problem, this is my personal
19:38
running orthotic, you can see it's got all kinds of extra
19:41
doohickeys built into it. And that's because it's specific
19:43
for my pathology. So this can be made specifically
19:48
for your problem. The best correlation is
19:52
eyeglasses, right? So as we age, our eyes age just
19:56
like our feet do. And maybe one day you're finding
19:59
yourself not seeing so well. So you go and buy a pair of
20:02
magnifier glasses off the shelf. Well, that's what a
20:04
prefabricated orthotic is. It's like a magnifier glass,
20:07
generalized, most people can use it.
20:09
But if your problem is a little more specific and now you can't
20:12
see far away and things are kind of blurry, then you have to have
20:15
something that's going to be custom made.
20:17
And so that's when a custom made insert comes into.
20:19
Play So one thing I learned through the years of having feet
20:23
that annoy me is people don't realize that your feet affect
20:27
your knees affect your low back at the it's like this effects
20:31
this whole thing from here down and you think it's your back.
20:36
But really, when you figure out that it's your feet and you fix
20:39
the foot problem, then the back pain goes away, or the knee pain
20:43
goes away, or the calf pain goes away.
20:45
Very true. I mean, think about it like a
20:47
building. If you don't have a solid
20:48
foundation, nothing's going to sit right, right above it, and
20:51
the feet are the foundation. So if your foot, something in
20:55
your foot is causing you pain, you're now not walking properly.
20:58
To avoid that problem, people, patients will come with knee
21:02
pain, they'll come with hip pain, they'll come with back
21:03
pain. Once you get them realigned with
21:06
something like this, everything gets back into line again and
21:09
things improve. Let me guess, you're probably
21:11
multitasking while listening to this podcast, aren't you?
23:05
I'm going to ask you one running question and then we won't spend
23:08
a lot of time on it just because I do know we have a handful.
23:11
A couple 100, maybe 1000 people that listen that do run.
23:15
And I want to know if an insert like this, let's say you've gone
23:19
out and you've spent money on a carbon shoes because you want to
23:23
run so fast. Does that affect the the the the
23:30
I guess just the effectiveness of the carbon, so right?
23:33
So I did a carbon plate shoe and it lasted two runs because I
23:38
couldn't fit my orthotic in it. For one thing, I gave them to a
23:41
very capable UNF runner who loved them.
23:45
But yeah, the problem is the carbon shoe has a spring built
23:48
into it, and that's going to change the mechanics of the shoe
23:52
so that you're generally not going to be able to use
23:55
something like this because they're going to be competing
23:57
with each other. OK, so it's probably an either
23:59
or put that in your trainer and then your carbon shoe.
24:02
You just save that for race day or something.
24:04
That's OK. We'll go back to general general
24:07
interest now. I don't want Christine's eyes to
24:09
glaze over. Too terrible.
24:11
Really. Yeah.
24:11
I just wanted to throw that in because I do know that we have
24:13
some some listeners who are thinking I want to get some
24:17
inserts and I would just want to be clear that they're not for
24:20
every running shoe. But you should see, I think you
24:22
should find if you're listening across the country or across the
24:26
world, you should find somebody in your area that you can
24:31
specialize in what you want to specialize.
24:32
I mean, there's Podiatry, but then you really can't focus in
24:36
on a specialty, right? You can, absolutely, yeah.
24:39
I mean, there are truly practices that dedicate
24:41
themselves to just sports medicine.
24:43
There's practices that dedicate themselves to Pediatrics.
24:46
I do no PEDs whatsoever. Just because there's not a
24:51
enough population, more of a big city place is where you're going
24:55
to be able to do that. Some people will be into
24:58
diabetic, you know, limb salvage and you know.
25:01
Wound care is a big thing to to consider too.
25:03
Let's let's go there. Let's talk about pedicures,
25:06
sanitary, sanitary conditions and these kind of things that.
25:10
Kind of toenails. Yeah, so when you try.
25:12
To cut them at a pedicure. When do you know you need to see
25:17
a podiatrist? Well, for situations like that,
25:20
you are right. I do know that the nail salons
25:23
do a lot of back of the nail and sometimes they can be very
25:27
effective, but it is sort of opening Pandora's box because
25:34
it's getting ingrown, not because of the edge of the nail,
25:38
but because of what's going on at the base of the idea that you
25:41
can stick cotton under it and retrain the nail to grow
25:44
straight is absolutely false. The the growth of the nail is
25:48
determined by what we call the matrix or the root of the nail,
25:52
which is underneath the cuticle. So in order to fix an ingrown
25:55
toenail permanently, you really have to address what's happening
25:59
back at the base. And our nails do change as we
26:01
age. We're not sure why, honestly,
26:04
but kind of, I guess the way our hair changes and our skin
26:07
changes, our nails are part of our skin system.
26:11
And so we absolutely see more nail curvature as people age.
26:17
We think maybe that's due to shoe pressure, but I also think
26:20
it's genetics. I've had grandmothers, daughters
26:23
and granddaughters all come to see me with what I call the
26:26
curly nail syndrome, where every single toenail is growing in a
26:29
circle. So that's clearly a genetic
26:31
predisposition. But yeah, you need to come if
26:36
you're experiencing any drainage from the ingrown toenail or
26:41
obviously if what the with the nail salon technician has done
26:45
has not been adequate. And I tell my patients it's not
26:49
baseball, 3 strikes and you're out.
26:52
It's sort of two strikes and you're out.
26:53
If you've had an ingrown at the same location twice, that's just
26:57
a sign that you're fighting a battle you'll never win.
26:59
And at that point there is a permanent way to fix the ingrown
27:01
toenail, the fairly minor in office procedure that takes
27:05
about 30 minutes and you're healed up in 2 weeks and you
27:08
never get an ingrown again. So who knew that ingrown
27:11
toenails are something that also could be affected by age?
27:15
Because again, I think that there are so many things that we
27:18
always want to roll our eyes and say, oh, menopause and blame
27:21
things on getting older, but there actually is science.
27:26
Absolutely, yes, absolutely true.
27:28
The other thing that will happen with nails, especially runners,
27:31
but really anyone that plays any sort of sports, tennis,
27:34
pickleball, very, very popular these days.
27:36
I've got to run on pickleball injuries and ingrown toenails
27:40
because you're in a jamming situation and all of that
27:43
jamming and all the pressure inside the shoe can alter the
27:46
root of the nail, which is going to change the thickness of the
27:48
nail and the shape of the nail over time.
27:50
Hadn't thought about pickleball being a boon to the Podiatry
27:56
career. Much so.
27:57
Lots of stress fractures and neuromas.
28:00
And well, that's what I have on my list is neuromas because I've
28:03
had a couple. What is an aroma please?
28:05
It's nerve. A nerve What you?
28:08
So it's it's it's to simplify it, it's essentially A pinched
28:12
nerve in the ball of the foot. So it's in the bottom of the
28:15
foot, but it's in between the long bones and they essentially
28:18
get pinched through the ligament.
28:20
And the the 2 little metatarsal heads are these two little
28:23
around ones when you come up onto the ball of your foot.
28:25
So to talk about shoes, again, every neuroma patient that comes
28:29
into my office, I say no heels greater than two inches because
28:32
anything that puts you up onto the ball of your foot is going
28:35
to aggravate a neuroma. And I can give myself a neuroma
28:39
in a pair of shoes like this. Dancing at a wedding for three
28:41
hours and the next day I wake up and I think, oh lordy, what did
28:44
I do to myself? How many injections really can
28:47
you have of steroids? Because that's one thing that I
28:51
get really nervous about because, you know, people over
28:55
50 also suffer from arthritis in their joints, whether it's
29:00
hands, toes, ankles, whatever. So how many can you really have
29:06
before it becomes like an ongoing?
29:08
So the amount of cortisone that can be given is going to be
29:12
variable based on the location and the conditions and aroma for
29:16
example. General rule no more than three
29:18
injections. But what I say is if you're, if
29:23
you get great relief from the first one, let's say six months,
29:27
but then you come back and then the second injection I give you
29:31
only lasts for two months, then I'm starting to get a sign that,
29:35
yeah, the third injection is probably not going to work.
29:38
And at that point, maybe it's time to think about surgery.
29:42
It is. It sounds awful, but it's
29:44
actually a very quick recovery from that surgery really because
29:47
it's soft tissue, there's no bone involved.
29:51
So it actually is not as bad as it sounds.
29:55
But there are some patients, one cortisone injection, it never
29:58
comes back. It's really based on the size of
30:00
it. By the time you get to us,
30:02
right, there's only so much reduction in swelling that you
30:05
can get with a cortisone shot. There's a test called a molders
30:11
click where you squeeze in between the toes and I love it
30:14
when the patient goes, oh, I heard that.
30:16
And I'm like, yeah, I heard it and felt it.
30:17
If you have a molders click, it means that the nerve has gotten
30:21
into almost like a a ball of nerve tissue.
30:24
And something that large is never going to dissolve with a
30:27
cortisone injection. So those patients I tell right
30:30
off the bat, probably not going to get very far with this.
30:33
We'll do 1 injection. If you don't get great relief,
30:36
it really just needs to be surgically.
30:37
Interesting. Very important.
30:39
Things interesting? Everything out of your mouth has
30:41
been so fascinating so far. What else do you have on your
30:44
list for questions? I think she's pretty much
30:47
covered all my issues, all my problems.
30:50
Hasn't solved them for you, but giving you a lot of food for
30:52
thought. Good.
30:52
A lot of food for thought. I mean, very interesting and I
30:55
loved the feet, the acrylic. I mean, aren't they so cute?
31:00
Yeah, so cute. I mean, just it's interesting to
31:03
hear that things are up and coming.
31:06
New things always come out and there's always something new.
31:10
That is true, yes. There's always new technology,
31:13
always new techniques. I did my residency over 30 years
31:17
ago and we had very limited options and over a 30 year
31:22
career, you know, now it's amazing to have all of this.
31:26
Right. You know, equipment that makes
31:29
my job easier, It makes surgery more predictable.
31:33
It takes less guesswork out of it.
31:35
I mean, this is the same in orthopedics as well.
31:37
Joint replacements, things like that.
31:39
Everything used to just be freehanded and you were at the
31:42
mercy of the angle of what you did.
31:44
And now everything is done by very specific guides that show
31:49
you exactly where to place your cuts and where exactly where to
31:52
put your screws. So a lot of the a lot of the
31:55
free handing has gone away with technology which is great for
31:58
patients, more reproducible and and quicker for us.
32:03
So are there any parting thoughts you have?
32:06
Anything we didn't cover? Anything that you think will
32:09
blow our listeners minds about our feet as we age?
32:12
Or should we just say, hey, you've got a great blog where
32:17
people can go and read this and send them your way?
32:20
Yes, I mean, there is clearly a lot of information on my
32:22
website. We try to choose a couple
32:24
different topics every week. They're really, you know,
32:27
there's 28 bones in the foot. I think I read recently 107
32:34
ligaments, 38 joints, I think. So there's a lot of territory
32:39
for things to go wrong. There's certainly a lot of
32:42
availability of education out there for patients to educate
32:45
themselves, but anything that's painful beyond a couple of days,
32:49
you really need to come in and be evaluated.
32:51
Because just like a plumbing leak in your house, if you sit
32:55
and watch it leak for weeks on end and then decide to do
32:59
something about it, sometimes you have less options.
33:02
And if you catch things early, they're much more fixable.
33:07
I do want to mention one thing that I'm so surprised you guys
33:09
didn't ask me. What plantar fasciitis?
33:13
OK, my husband has had that. I mean, you know, this is all
33:17
day long my life, the number of people that come in and.
33:20
What exactly is that? Well, I my daughter had to get
33:23
special socks. Yeah, and that is stretching was
33:26
on my list is because I'm supposed to be stretching, but
33:31
you know. Yes, I'm surprised at us too,
33:33
honestly. Yeah, I don't know.
33:34
Asberg Sock, is that what your daughter got?
33:37
So I highly recommend a. Really, Sock?
33:39
These are the ones that have like a it holds your foot up.
33:42
And it has a, it has a strap that comes up and it has a
33:46
Velcro attachment. And you, you basically are
33:49
putting yourself into that stretched position which will
33:53
keep the plantar fascia stretched out, which avoids it
33:56
tightening up at rest because it's really the tightening at
34:00
rest and then standing up and asking it's to do its job that
34:04
causes that. We have a very fancy word called
34:07
post static dyskinesia, post after static sitting dyskinesia
34:11
pain. So it really is pain after
34:13
sitting for a period of time. And that comes from all of the
34:17
joints, muscles and fascia shortening up as you're at rest
34:20
because your foot sort of curls and then you go to stand up and
34:24
everything has to straighten out and the fascia has to go from a
34:26
contracted position to a stretched out position.
34:28
So it's that rubber band situation.
34:31
So that Strasbourg sock keeps you in that stretched position
34:35
so that then when you do go to stand up, and it's really easy
34:38
because all you have to do is undo that little hook and
34:41
you're, you know, off and running in the middle of the
34:42
night to let the dog out. Or is that only for plantar
34:45
fasciitis though? That's the only thing I use it
34:48
for. OK, so.
34:50
That's it. Something you could use to
34:52
prevent it or would you? I mean, once you've had a case
34:55
of it or once it's gone away, just.
34:57
Good stretching is a good preventative.
35:00
What about compression socks? So for plantar fasciitis?
35:04
No for just in general. I do recommend them, especially
35:08
for my nurses, you know, people that have, you know, jobs where
35:11
they're able to. Again, the barrier in Florida is
35:15
nobody wants to wear compression socks in the summer, right?
35:18
So, But yeah, for anyone who spends long periods of time on
35:21
their feet, if they have the ability, we do recommend them.
35:25
OK, very good. You know, I've been waking up in
35:27
the middle of the night lately with cramps and in my legs and
35:31
I'm thinking, I keep thinking it's from wearing these.
35:34
I have a they're not Uggs. They're like a knock off of Ugg
35:37
boots that I'm wearing when I'm at work all day after I'm off
35:41
the TV set, I take off my high heels and I put on these fuzzy
35:44
little boots, but they're so flat.
35:46
And so lately in the middle of the night, I'm waking up with
35:49
these cramps and I'm just thinking, I don't know if I
35:52
can't identify if it's coming from like upper leg.
35:55
But when you mentioned that every part of our feet affects
35:58
every other part of our body, now I'm really thinking it could
36:01
be the shoes it. It could be, I'll say.
36:04
Nocturnal night cramps remain a mystery to the medical
36:07
community. We're really not sure why they
36:10
happened They. Started when I started this job.
36:13
I say it's the shoes because I've even bought.
36:16
In some cases I think it probably.
36:18
Is I bought expensive shoes that weren't supposed to hurt your
36:21
feet, you know, because the leather was really soft and you
36:25
know, to wear around the house and where to run to the grocery
36:28
store because my feet were hurting so bad No, they're like
36:34
those where they're just flat and they they I think that's
36:38
part of what started my issues as well before the high heels at
36:43
the wedding but. Well, those definitely I would
36:48
criticize because you're right, there is no support.
36:52
Also, you know a completely flat shoe is not necessarily natural
36:57
for your foot, so. She doesn't like my shoes
37:00
either, so don't. I don't feel bad I wasn't
37:02
working. I feel like people probably
37:04
think you're judging all of their shoes when they meet you,
37:06
even though you're probably not, because what are you going to
37:07
do, think all day about people's feet?
37:09
No, but it's clearly as a patient in my office, what you
37:12
walk in with. And I always have to be careful
37:14
because they'll say to me, oh, I just wore those because I was
37:16
coming here and I wanted it to be easy to take them off.
37:18
Like they'll show. Up with these.
37:20
They'll show up with these little Flojo flip flops, you
37:22
know, which are basically a price.
37:24
That no support. Right and then they'll complain
37:26
to me, oh, the heel hurts all the time.
37:28
I'm like, well, let's talk about what you showed up in.
37:31
Oh, but I only wore those to come here.
37:33
But I also only wore them to. Go to the groceries exactly
37:35
mailbox exactly is you. Have to have something right
37:39
with stability, shock absorption.
37:42
Yeah. And so there are plenty of flip
37:45
flops out there that do that. Vionic being one.
37:47
Yes, fit flops are an excellent choice.
37:50
UFOs and UFOs, Yes, they used to be super ugly.
37:54
But what about Birkenstocks? A big fan of Birkenstock.
37:58
You are. For the most part, they don't
38:01
work well for Achilles tendonitis because the heel
38:03
drops a little bit too low. See it to me, they're really
38:06
hard. They are hard.
38:08
I have a company in Arizona that takes the Birkenstock shell.
38:13
I I cast or digitalize your foot and then they put the orthotic
38:19
the foot bed of the Birkenstock is your orthotic.
38:23
So we're the ones that I showed you are just loose.
38:27
This is built. Into the shoe.
38:30
Great. And NAOT, which is an Israeli
38:32
shoe company, I can do it with those shoes as well.
38:35
Same company in Arizona. So for some women that want
38:40
something that's like an all in one, right, that's actually a
38:43
sandal and Naot has sandals that I can also incorporate a custom
38:48
orthotic into. So so that's another way that
38:51
you can try. Interesting.
38:52
That is so interesting. Wow, really?
38:55
That's amazing. I think you need to to have all
38:58
of your shoes hollowed out. I know exactly I need a shoe
39:03
overhaul of the. I'm laughing at the people
39:05
walking into your office in the flip flops because I'm thinking
39:07
of a time that I went in to see my doctor with shoulder issues
39:10
and I was carrying a giant purse.
39:12
Wait. A minute.
39:14
Do you carry that everywhere? That's part of the problem.
39:17
I'm just going. To assess you well, Doctor Don
39:20
Miles, we appreciate it. Your information will be in our
39:23
show notes so everybody knows exactly where to find you.
39:26
And maybe one day you can come back and see us.
39:29
Because I feel like we're just now getting to the tip of the
39:32
iceberg. And we always close our show
39:34
with some kind of way of saying what you can kind of let go of.
39:37
And while we were talking, I was thinking about it and I was
39:39
thinking that the idea of having to always wear high heels to
39:44
look fashionable, but now you're in pain, meaning that you can
39:49
change shoes to something that still looks great but kind of
39:52
fits the criteria of what you said.
39:53
So the idea of having to always wear those high heels, you can
39:56
let it go. And don't look back.