Expert Advice on Podiatry

[00:00:00] Pete Waggoner: Hi there and welcome to Beyond the Checkup brought to you by Stellis Health or Neighbors Care for Neighbors. I’m Pete Waggoner, ready to guide you to a healthier, happier life. Today we’re here to inspire, explore, and help you thrive in your health journey. So let’s dive right in as we have a couple of providers here today.

[00:00:22] Pete Waggoner: I’m excited to bring in. Dr. Mark Nelson and Dr. Michael D Oborsky. Both of them work in podiatry. Gentlemen, thanks for taking your time out of your busy schedules to join us here on our podcast. 

[00:00:34] Dr. Mark Nelson: Nice to be here. 

[00:00:35] Pete Waggoner: Thank you. Let’s start with both of you individually. Dr. Mark, we’ll start with you first.

[00:00:40] Pete Waggoner: What led you to this specific practice and what does it mean to you to be a part of it? 

[00:00:48] Dr. Mark Nelson: Well, I’ve always wanted to get into medicine and when I was in college, I had a family friend who was a podiatrist. So I used to spend some time with him and his practice and I saw him in clinic with patients, and I saw him in [00:01:00] surgery, and really enjoyed the variety of work that he was doing and, and his ability to help others and make, you know, make their lives more, more pleasant, more comfortable just by getting, you know, getting rid of their foot pain and helping them function in their, in their lives.

[00:01:12] Pete Waggoner: Dr. Oborsky. How about you? 

[00:01:14] Dr. Michael Oborsky: Uh, similar. When I was in college, I was going down the pre med path and, uh, I had the opportunity to spend, uh, time with a podiatrist in an internship. And I really, uh, appreciated what he was able to do. And, uh, you know, podiatry is kind of unique and we are able to, like Mark said, uh, help people right away and make their feet feel better very quickly.

[00:01:41] Dr. Michael Oborsky: And it’s, it’s rewarding and it’s been a nice, uh, a nice profession for me, uh, personally, and, uh, really, really, uh, it’s turned out well, so I’m very happy that I went down this path. 

[00:01:57] Pete Waggoner: The foot looks like a very complex [00:02:00] thing. It is a lot going on there. We don’t need to like, drill down on the whole thing, but from the two of you, and Dr. Nelson, we’ll start with you. What do you think is the most intriguing part about the foot and its function?

[00:02:13] Dr. Mark Nelson: Just how, how well it’s able to, to help people get Dr. Michael D OborskyDr. Michael D Oborsky around during the day. Without feet, we would not be able to do very much. Just how the muscles, tendons, joints, everything just works together to, you know, help us run, walk, jump, do our daily activities. 

[00:02:32] Pete Waggoner: So then along with that, Dr. Oborsky, there’s a lot of things that could create issues when you walk, run and jump with all of the tendons and the bones that come with it, where, in your opinion, does the foot start on the body?

[00:02:47] Dr. Michael Oborsky: Well, 

[00:02:47] Pete Waggoner: from the head? 

[00:02:48] Dr. Michael Oborsky: Yeah. You know, it’s, it’s all attached, you know, and, uh, your back can play havoc with your feet and your feet can play havoc with your back and your neck. [00:03:00] And so, you know, the foot is very, uh, very complex and it is for the most part able to be very resilient and take a lot of abuse.

[00:03:10] Dr. Michael Oborsky: But yeah, it’s, it’s definitely all connected and there’s so many various conditions and, and problems that can go wrong that will affect your whole skeletal system. 

[00:03:22] Pete Waggoner: It sort of sounds like it starts there, but it starts from other places too. And it’s so intertwined. To me, this is so fascinating. It’s one of my favorite topics. 

[00:03:32] Pete Waggoner: I think if you use your feet in athletics a lot and you understand, you know, you always hear about good feet and mobility and things like that, and this all plays into it and there’s other parts of it too, but there are probably, uh, a number of, of, of common foot problems that you to need to treat on a day to day basis.

[00:03:52] Pete Waggoner: What are some of those? And, you know, I mean, if you can narrow it down and, uh, why don’t Dr. Oborsky, we’ll start with you on this one. 

[00:03:59] Dr. Michael Oborsky: [00:04:00] Yeah. Some of the more common things are, something as simple as ingrown toenails. They are really painful. And we deal a lot with helping people with ingrown toenails, uh, removing the ingrown nail part.

[00:04:13] Dr. Michael Oborsky: And then we use a, a phenol. It’s a chemical that will destroy the nail root for that sliver of nail that keeps getting ingrown. Uh, we even do total toenail removals permanently. We use that phenol. Uh, it’s a nice little procedure done right in the office, so ingrown toenails, diabetic foot ulcers, heel pain, plantar fasciitis, hammer toes, bunions, sprains and injuries, you know.

[00:04:40] Dr. Michael Oborsky: There’s just so many things that, that, uh, right down to just simple things like warts and calluses, which I can say simple, that’s probably the wrong word because those, those are problems that can be very significant for people.

[00:04:54] Dr. Michael Oborsky: And, uh, you know, there, but there’s various injuries for bodies and that we see it’s [00:05:00] listed. It’s amazing what we see in a day, you know, the variety. So. 

[00:05:05] Pete Waggoner: Dr. Nelson, is that something that you have seen evolve? Are there more issues or is it, has it been pretty consistent from your career as far as what you’d see in common, uh, foot problems?

[00:05:18] Dr. Mark Nelson: I don’t think anything’s really changed that much over the, you know, over the years and decades. It’s, it’s pretty much, you know, similar, similar issues. Uh, once in a while, when some strange, new, trendy shoe style comes out, sometimes that can cause some more foot issues. But for the most part, it’s always kind of the same thing.

[00:05:36] Dr. Mark Nelson: So, to add to what Dr. O’Borsky had said, we see other, you know, what he had mentioned plus things like fractures, tendon injuries, see a lot of broken bones and feet and toes, broken ankles, achilles injuries, tendon ruptures, tendonitis issues. What else? I think you hit the main things. Flat feet, you know, flat feet can cause a kind of malalignment with the ankles, the knees, the hips, the [00:06:00] lower back, and as Dr. O’Borsky mentioned, can lead to chronic aches and pains in the lower back and joints. And with orthotics and proper foot support, most of those aches and pains usually go away. 

[00:06:10] Pete Waggoner: Let’s talk about ankle injuries a little bit. And one of the things that was brought up as we were preparing for this is any prevention for the weekend warriors, or for people that tend to suffer ankle injuries, maybe even if it’s in the winter, and you slip on some ice and have an issue there. Are there any tips that you can provide whether it’s proper footwear or however else you could strengthen the area? If there’s anything that you can do. 

[00:06:36] Dr. Michael Oborsky: Well, I can, I can talk about that.

[00:06:39] Dr. Michael Oborsky: You want to go 1st? Dr. Nelson or?

[00:06:42] Dr. Mark Nelson: Go ahead. 

[00:06:42] Dr. Michael Oborsky: Okay. You know, number one, proper footwear is, is big. I, and I’ve seen a lot of injuries from pickleball is the new one now that we see a lot of injuries.

[00:06:52] Dr. Mark Nelson: I forgot about that one. Yeah.

[00:06:54] Dr. Michael Oborsky: And I, people are wearing their running shoes to play pickleball. Running shoes are [00:07:00] not a court shoe. So you need to wear a court shoe because running shoes that side to side motion really is sets you up for ankle sprains. But also just the gradual, you mentioned weekend warriors, and I think that that’s a big one because people won’t do anything all week long.

[00:07:16] Dr. Michael Oborsky: And then they go out on a Saturday or whatever day it is. And, and they try to act like they’re a teenager and they end up injuring themselves. We’re seeing a lot of that. So gradually building up your, your activity, your intensity, and your workout routine to get yourself in shape. And if you’ve had previous ankle sprains in the past, you should probably, you know, wear ankle brace of some type.

[00:07:42] Dr. Michael Oborsky: Because multiple ankle sprains over the course of years can cause weakness of those ligaments. So, and, uh, instantly to instability of the ankle and set you up for more injuries that way, too. 

[00:07:55] Pete Waggoner: Dr. Nelson, do you have anything to add to that? . 

[00:07:56] Dr. Mark Nelson: Yeah, I agree with what [00:08:00] he said. Probably about 30 percent of people that have had ankle sprains end up with chronic ligamentous laxity, were basically kind of weak, unstable ankles, wearing an ankle brace as Dr. O’Borksy mentioned is is a good way to try to give yourself a little more stability to prevent the ankle from rolling. If somebody has a really bad injury and they roll that ankle, they could injure the cartilage in the joint.

[00:08:21] Dr. Mark Nelson: They could break the bones around the ankle, either inside or the outside of the ankle joint. Uh, there are procedures that we can do to strengthen the ligaments and repair those ligaments to get that stability back. If people don’t want to deal with an ankle brace on a long term basis. And those ankle, uh, ligament repair procedures are great.

[00:08:37] Dr. Mark Nelson: They very high satisfaction rate, very, very, very effective. 

[00:08:41] Pete Waggoner: How about, uh, well, we’re just final question on the ankle sprain, you know, if you’re a sporto and you like watching sports, especially football, you hear about the high ankle sprain, what is the difference between that and like, what we just spoke of, with someone who maybe had the wrong type of shoe on a court.

[00:08:59] Dr. Mark Nelson: Well, [00:09:00] people can sprain the ligaments down low on the ankle, which are the most common. The anterior talofibular ligament, which is kind of the low and front side of the ankle, is the most commonly sprained one. If the ankle sprain is severe enough, there are multiple ligaments around the side in front of the ankle that can progressively tear the higher up the tearing of those ligaments, the more severe the injury, the longer it takes to rehab and recover from those injuries. 

[00:09:24] Dr. Mark Nelson: The high ankle sprains can really put an athlete out of sports for a long time before it’s healed well enough to get back into sports. Uh, the low ankle sprains and the milder ankle sprains, people can get back in the sports relatively quickly as long as they kind of treat it, treat it well, right off the bat. And, you know, getting to see the podiatrist right away can give you some good suggestions on how to treat it and to prevent future injury. 

[00:09:47] Dr. Mark Nelson: People to treat ankle injuries right off, right off the bat in those initial few weeks, they’re doing a good job of taking care of it. They’re going to get that stability. They’re going to get that strength back in the ankle. If they try to play through it and run around [00:10:00] and don’t let those ligaments properly heal, they end up healing loose. And then they end up with chronically unstable ankles that oftentimes need to go on to surgery.

[00:10:07] Pete Waggoner: Here’s one. Sorry, you opened up another question, Dr. Nelson. So oftentimes in sport, I remember in baseball, uh, when someone sprained an ankle, a trainer would say, uh, we’re talking eighties here though, walk it off. You know, so, so you, you’d be, you’d be banging around just like, oh my God.

[00:10:26] Pete Waggoner: But the question is, does that keep it loose? Or it sounds to me like it can make it worse over the long haul, Dr. O’Borsky? 

[00:10:36] Dr. Michael Oborsky: Yes, it does. Because the ligaments, when you sprain an ankle, your ligaments are injured and they get, literally get stretched out or partially torn or completely torn. So if they’re stretched out, you want them to try to contract and heal back together close to the way they were.

[00:10:55] Dr. Michael Oborsky: And if you keep being active and running around [00:11:00] and trying to walk it off, so to speak, that doesn’t allow, that there’s no mobilization there to allow for that ligament to get back to close to what it was. You know, I mean, that, that whole thing about walking off, that’s like when you had a concussion and football or hockey, they said, you got your bell wrong, you know? 

[00:11:19] Dr. Mark Nelson: You’ll be fine.

[00:11:21] Pete Waggoner: Get back out there, right? Well, it’s the same thing. So for you coaches who mean well, if you’re listening to this, it’s a good idea to get the player off the field or the rink or whatever it is, and have them really get looked at by you guys to assess the situation and make it better. You can never be too cautious for the long term. 

[00:11:43] Pete Waggoner: The next question is the diabetic foot care component. Obviously, there are different issues that surround that, and they may need specialized foot care to prevent further complications. For people that don’t really know what that entails, what are some of the things, the risks, [00:12:00] that someone that has diabetes needs to deal with? We’ll go with you, Dr. Nelson. 

[00:12:04] Dr. Mark Nelson: With diabetes, the blood sugar is elevated, and it’s elevated for prolonged periods of time, which ultimately leads to damage to the vessels, damage to the nerves, the immune system or body organs. So, it’s, it’s real, it’s critical that diabetics are on a, on a good diabetic management plan with their primary care providers.

[00:12:23] Dr. Mark Nelson: You know, as far as podiatry specific things that we see, 1 of the long term complications of diabetes is, is numbness in the feet, vascular damage, so, people can have poor blood flow to the feet. They can have damage to the nerves, which leads to numbness in the feet. And then that numbness can ultimately lead to developing pressure points and calluses and blisters and foot ulcers, and those ulcers can become infected. And if the, if the infection travels deep enough into the foot, the bone can get infected. 

[00:12:51] Dr. Mark Nelson: And if bone gets infected, that can lead to amputations. So our part of our job is trying to educate diabetics on how to take care of their feet, how to [00:13:00] prevent pressure ulcers. You know, how to prevent sores and, and take care of wounds when ulcers and wounds do show up on their feet.

[00:13:07] Pete Waggoner: So, am I hearing this correctly, Dr. O’Borsky? It’s preventable where you don’t necessarily have to fall into the amputation part of things. Is that fair? 

[00:13:17] Dr. Michael Oborsky: That is fair. Most of the time, these things are preventable. And, uh, it’s just part of the problem is, when you can’t feel your feet, you don’t always know that something’s wrong. On the bottom of your foot or whatever it might be, if you’re not checking your feet, we always recommend that to just look at them, because you can have an open sore on the bottom of the foot, not even know it.

[00:13:40] Dr. Michael Oborsky: But a lot of times, uh, there are preventative things with the shoes. You know, routine follow ups with the podiatrist just to check the feet, to breed any calluses, pressure spots, uh, contracture of the toes, hammer toes, hammer digit syndrome is a very [00:14:00] big problem for a lot of diabetics and they can get open sores on their toes.

[00:14:05] Dr. Michael Oborsky: So if the hammer toe is surgically corrected, prior to developing an open sore, that can be a very good preventative measure that we can, help diabetics with to avoid those problems. 

[00:14:19] Pete Waggoner: Good to know. So if you see something, do something, the old saying, right? All right. 

[00:14:24] Dr. Mark Nelson: Those daily foot exams for diabetics are key.

[00:14:27] Dr. Mark Nelson: Just make sure to check in their feet, especially if they have numbness. It’s not as big an issue if they can feel their feet and have normal sensation. 

[00:14:33] Dr. Mark Nelson: But for those that have numb feet, they should be checking them every day. Look for sores. Foreign bodies, things stuck in the foot, pressure points, blisters, dark spots, red, warm areas.

[00:14:43] Pete Waggoner: Good, good stuff here. I’m learning things. This is good. Thank you gentlemen. I appreciate this so far. Heel pain is another thing. What are contributing factors to heel pain, Dr. Nelson? 

[00:14:56] Dr. Mark Nelson: A lot of different, uh, causes for heel [00:15:00] pain. One of them that includes overuse. People who the weekend warriors who are people aren’t used to exercising if they get out and they’re running around doing sports, doing a lot of walking when they’re not used to it. That can trigger about over stressing, over straining of the planter fascia.

[00:15:13] Dr. Mark Nelson: Some people planter calcaneal versus it can get inflamed. 

[00:15:17] Dr. Michael Oborsky: So a lot of times, typically you will see plantar fasciitis is probably the most common heel pain problem that we see. And that a lot of times is from people that have flat feet.

[00:15:30] Dr. Michael Oborsky: And when your foot flattens, it lengthens and that stretches the plantar fascia. And that’s why custom orthotics in your shoes to support the foot are typically the most effective long term management. We see plantar fasciitis in people with high arches also, and orthotics can help them too. Uh, we do cortisone injections. 

[00:15:52] Dr. Michael Oborsky: You know, heel pain in a young person, a lot of times if they’re in a, they’re still growing, you can get, they can get calcaneal [00:16:00] apophysitis, which is a heel, a significant heel pain issues that young people will get. It’s the inflammation of the growth plate in the heel. And it’s very painful. And typically when you see, uh, you know, kids that are nine to 14 years old with heel pain, a lot of times that’s what it is. And orthotics help that as well. 

[00:16:25] Dr. Michael Oborsky: So that’s probably the main treatment that we do for for heel pain. But we also do cortisone injections. There’s different braces and splints, exercises, physical therapy. So there’s a lot of things that we can do for those problems. 

[00:16:41] Dr. Mark Nelson: And I’m stretching icing anti inflammatories. 

[00:16:45] Pete Waggoner: almost sounds like a lot of the heel related things have a lot to do with foot structure. Like, how it’s built and so, in some cases, I don’t know if hereditary is the right thing to say, but how you’re built can lead to these types of things. [00:17:00] I assume.

[00:17:00] Dr. Michael Oborsky: That’s correct. 

[00:17:01] Pete Waggoner: Okay. How about this? Foot pain and, you know, signaling other health related issues.

[00:17:09] Pete Waggoner: How do some diseases play into foot pain? And what do you see with that? Uh, Dr. O’Borsky, we’ll start with you. 

[00:17:16] Dr. Michael Oborsky: You know, there’s a lot of, not a lot, but there’s a lot of, strange, symptoms or conditions that can cause can exacerbate in the foot. But probably what Dr Nelson, I see most commonly are things like rheumatoid arthritis, which is a systemic problem. Peripheral vascular disease creates a lot of issues with the feet. There’s other conditions, psoriatic arthritis. Those are some systemic problems that, uh, but I think, you know, for us, it’s, it’s poor circulation that we really, really struggle with for people and, and trying to get them revascularized.

[00:17:54] Dr. Michael Oborsky: It was a vascular surgeon. Those are things that we do quite a bit of [00:18:00] because, uh, when you lose the blood supply to your feet, things start to go south in a hurry. So. 

[00:18:05] Pete Waggoner: How do you know when that’s happening? 

[00:18:07] Dr. Michael Oborsky: Well, number one, you can usually see it as soon as you walk in the room. The discoloration of the feet, the atrophic skin, the dry flaking skin, sometimes there’s swelling of the legs.

[00:18:19] Dr. Michael Oborsky: And then you do your vascular exam. And if you can’t feel a pulse with your hands, that’s that’s the first thing we typically do. But besides looking at capillary refilled time to the digits, and then there’s other other modalities that we can do, like ultrasounds, uh, to try to check for blood flow as well.

[00:18:40] Pete Waggoner: Dr. Nelson, do you feel as though some people see that discoloration or notice it and maybe ignore it and wait too long, and then it becomes a tougher hill to battle for you guys? 

[00:18:52] Dr. Mark Nelson: Yeah, I think it can happen so slowly for people, people that they don’t even realize that it’s happening. You know, the, the, as the blood flow progress, you know, slowly over [00:19:00] time, it gets worse and worse.

[00:19:01] Dr. Mark Nelson: The start to get the, the thing of the skin, some redness in the toes, discoloration, you know, cold toes, some purplish discoloration in the toes. They don’t even necessarily realize it until it gets bad enough, but we can usually pick it up right away when we see him on an exam in the office. 

[00:19:18] Dr. Mark Nelson: People are, if people have cold toes, aches, pains in the toes that are oftentimes worse at night or when their feet are elevated, those can be signs of vascular disease.

[00:19:27] Dr. Mark Nelson: Cramping in the calves when they go for a walk can be a sign of blood clots or blockages in the arteries in the calf where the muscle’s not getting enough oxygen and blood flow when they’re, when they’re walking. So, they get cramping or discomfort in the calves and they have to stop and pause for a little bit. So, tell the blood flow increases again. 

[00:19:43] Dr. Mark Nelson: Another thing that we see sometimes, uh, on occasion are blood clots in the legs. I call them like, uh, DVTs, deep venous thrombosis. Oftentimes, if those happen, people notice some swelling in their calf and ankle, pain, warmth, discomfort, [00:20:00] especially when they kind of bend their ankle up toward or their foot up towards their knee can cause some pain in the calf.

[00:20:05] Dr. Mark Nelson: That’s something that people need to get in immediately for either to see a podiatrist or, or go to the ER urgent care to get evaluated if they think there’s a blood clot going on. 

[00:20:14] Pete Waggoner: So you mentioned, uh, feet hurting, uh, or, or, or in the evening. What about in the morning, uh, when there’s foot pain, uh, and it could be related to anything, I, I guess.

[00:20:25] Pete Waggoner: You know, and I was mentioning to Dr. O’Oborsky, how, uh, I have Halox Rigidus on my right big toe. Well, both actually, I’ll probably be coming to see we were chatting about it shortly here. But I’ve had it for a while, but in the morning, it doesn’t hurt at all. So I’m curious to know about other foot issues where it could hurt in the morning. What is that related to, and what why why if you’re off them like that you mentioned elevation, what creates that pain?

[00:20:56] Dr. Michael Oborsky: Well, a lot of times, uh, that’s that’s the [00:21:00] kind of the hallmark of plantar fasciitis, is that that pain right away in the morning or after you’ve been sitting for a while you get up to go. That’s because the ligament has had time to contract overnight. Or if you’re riding in your car, the ligament tightens up.

[00:21:17] Dr. Michael Oborsky: So that when you step down initially, it’s very tight and it really pulls and you get these what we call micro tears. So plantar fasciitis is 1 of those that we see that other things like arthritic problems are very commonly more painful in the morning after you haven’t been moving those joints. So that can. That could be an issue also. I don’t know if Dr Nelson has anything else to add to that, but. 

[00:21:43] Dr. Mark Nelson: Yeah, a lot of tendinitis issues are usually a little bit worse in the morning. When you first get up, things are kind of stiffened up over the night. And once they stretch them out, it feels a little bit better.

[00:21:53] Dr. Mark Nelson: Yeah, I would also commonly, well, it’s kind of hit people in the morning when they get up. Usually it’s related to what they ate the night [00:22:00] before, but I see a lot of people that come in complaining of a red, hot, swollen, painful joint that suddenly appeared when they woke up in the morning. 

[00:22:06] Pete Waggoner: Does that diet portion of it know any particular food, or is it individual to individual?

[00:22:13] Dr. Mark Nelson: There are a lot of foods that increase uric acid in the blood. Gout is a buildup of uric acid, either from eating too much or your body not getting rid of it fast enough. And those little uric acid crystals come out of your blood and deposit in tissues, typically areas that are a little bit, have a little bit lower body temperature, such as the big toe joint.

[00:22:30] Dr. Mark Nelson: Uh, the little toes, sometimes the ankle, sometimes the mid foot. It can also hit other parts of the body too, like the hands, elbows, things like that. Gout is largely a genetic problem. There can be a family history of it. Sometimes it’ll just show up spontaneously for without a family history, but that it is something that is modifiable with proper diet.

[00:22:51] Dr. Mark Nelson: It can, people can control those gout attacks and reduce the number of attacks that they’re having a problem with a lot of attacks, there are medications that we can put people on to [00:23:00] besides reducing the pain and also to help prevent future attacks. 

[00:23:02] Pete Waggoner: How about end of the day, swollen feet? Is that normal, Dr. O’Borsky? 

[00:23:08] Dr. Michael Oborsky: Uh, I don’t know if it’s normal, but for some people it’s normal. There are various problems that can cause that as well. It can be very complicated. A lot of times it’s uh, in the, where the, the valve, the valves in the veins that, that keep your blood flow moving in the right direction so that it doesn’t, Go back down.

[00:23:31] Dr. Michael Oborsky: Your leg can be incompetent where those valves aren’t working in the veins that are bringing the blood back up to your heart. And then I can that can lead to swelling. You know, just gravity. If you’re if you’re just sitting and not moving around, that can lead to swelling. 

[00:23:50] Dr. Michael Oborsky: Because when you’re walking, it’s called a muscle pump, basically in your calf that when your muscle contracts, it helps push blood up your [00:24:00] leg so that walking and that mobility is helpful versus just sitting. There’s there’s other problems. Lymphedema is a chronic issue for a lot of people. Poor blood supply is peripheral vascular disease.

[00:24:16] Dr. Michael Oborsky: Those are all things that can lead to it as well in various other medical conditions. 

[00:24:20] Dr. Mark Nelson: Yeah, there’s heart disease like congestive heart failure can lead to swelling in the legs. Kidney disease can cause fluid retention in the legs. Certain medications like blood pressure medications can, goal of the medication is to kind of lower the blood pressure, but which can end up leading to swelling in the legs.

[00:24:39] Dr. Mark Nelson: Sometimes for women, hormonal changes, menstrual cycles can lead to some swelling in the feet and legs. I’d say probably the number one cause, as Dr. O’Borsky mentioned, is the venous insufficiency where those valves just aren’t working and can lead to some swelling in the legs. 

[00:24:53] Pete Waggoner: So, Dr. Nelson, uh, what type of footwear advice would, would you give? I’m sure it can, you know, very depending [00:25:00] upon activity level and existing foot conditions, but can you talk about that a little bit? 

[00:25:06] Dr. Mark Nelson: I don’t have any real good specific recommendations. I usually tell people the shoe fits, wear it. But generally, if there’s, you know, people, wider feet or hammer toes or bunions, things where there’s bones poking out, they’re going to want a softer shoe. A lot of the, there’s a lot of fabric shoes that have been more trendy and more commonplace in recent years.

[00:25:24] Dr. Mark Nelson: And those have been great for people with bony prominences, uh, because they don’t put as much pressure on the bone. People with glenons and hammer toes have to be careful if they’re wearing a, like a vinyl or leather shoe, especially if there’s a seam that overlaps on the inside of the shoe, that those, those seams can put pressure on the foot and the toes and cause sore points.

[00:25:42] Dr. Mark Nelson: In diabetics, they can cause pressure sores and ulcers. Dr. O’Borsky mentioned for, you know, make sure that people are wearing sport appropriate shoes, like for the court shoes that they’re playing tennis or pickleball. Runners need to wear a running shoe for those activities.

[00:25:58] Dr. Mark Nelson: People that have hammer toes or bunions that where the [00:26:00] toes are curled up, they should wear a shoe that’s a little deep, has a little more space in the toe box area, a little bit deeper shoe. 

[00:26:06] Pete Waggoner: Dr. Oborsky, how often do you find yourself having to consult in that area with what you do? 

[00:26:12] Dr. Michael Oborsky: Uh, very commonly, and it’s, it’s a difficult topic that a lot of people don’t want to hear. So, you know, over the years, it’s, it’s, I’ve tried to come up with some good responses to these various things. And, and I, I get this one a lot, people say, well, what’s the best shoe? And there isn’t a best shoe. If there was a best shoe, then everybody would be wearing it.

[00:26:35] Dr. Michael Oborsky: You have to find something that works for you. And like Dr. Nelson said, I mean, that, that kind of, simplifies it enough where, you know, if the shoe fits good for you, you find something that works for you as far as whether it’s a running shoe or everyday casual shoe. Go with it. It’s got to be comfortable right away.

[00:26:52] Dr. Michael Oborsky: And there shouldn’t be a break in process. The other thing that I have to really try to [00:27:00] help people with is a lot of people go barefoot in the house. And a lot of people have tile floors, wood floors. And just going barefoot in the house and and doing your chores, that can really have an effect on your feet and can set you up for some of these problems that we’ve been talking about, you know, especially things like plantar fasciitis.

[00:27:21] Dr. Michael Oborsky: So, uh, wearing shoes in the house, good supportive shoes, you get what you pay for. There’s another kind of cliche, you know. If you’re going to, I’m not going to say any names, but you should be buying, you don’t have to spend top of the line. You don’t spend 200 on a pair of shoes, but you should be spending some extra money to make sure you have a well made shoe that’s supportive and fits you right. 

[00:27:49] Pete Waggoner: How about, uh, this topic when it comes to, let’s say, fungus or toenail fungus? You know, I don’t know if anybody really understands. Like you, you hear [00:28:00] things, you know, you hear things, obviously, when it comes to the medical profession, but you never really know things if you’re not, you know, if you’re someone like me.

[00:28:07] Pete Waggoner: You know, you hear things like, well, it never really goes away and things like that. So can you guys touch, we’ll start Dr. O’Borsky with you, on fungus and how you get through that and if you can get rid of it? 

[00:28:22] Dr. Michael Oborsky: Yes. And this is a conversation that I have every day, maybe multiple times. And number one, I start with, you can’t avoid fungus.

[00:28:32] Dr. Michael Oborsky: People say, Oh, I must’ve picked it up in the locker room or I got it at the nail salon. No, it’s everywhere. It’s like bacteria. You can’t avoid coming in contact with fungal elements. So what you want to do is minimize your contact. Uh, but certain people are susceptible to toenail fungus. Certain people are susceptible to athlete’s foot, which is fungal infection of the skin.

[00:28:58] Dr. Michael Oborsky: And so those people have to manage [00:29:00] um, have to understand it and try to manage it the best they can. You know, it’s spraying the insides of your shoes with an antifungal spray, using an antifungal cream on your skin of your feet. For toenail fungus, topical meds don’t work great, especially if the fungus is more involved.

[00:29:19] Dr. Michael Oborsky: We try to avoid oral medications to get rid of a toenail fungus, but sometimes that is something we will use. But again, if you’re susceptible to it, and you know you are one of those people, a lot of times it is genetic, familial, you just have to manage it using the appropriate antifungal medicines, try to minimize your contact.

[00:29:41] Pete Waggoner: Dr. Nelson, anything to add? 

[00:29:43] Dr. Mark Nelson: I agree with what he said. There’s unfortunately a small percentage of the population who, they have a genetic mutation where their bodies do not recognize the fungus as being something that the body should fight off, that the immune system should fight. And they, they have chronic, they have just chronic problems with athlete’s foot, [00:30:00] corneal fungus.

[00:30:01] Dr. Mark Nelson: It’s just a lifelong thing. And they go on medications and maybe get rid of it for a while. I don’t know. But it usually comes back again down the road. So those cases are frustrating. For the majority of people, you know, we can, using a variety of treatments, we can usually, usually get rid of fungus. In the skin, it’s usually pretty easy to clear up with medical, with topical medications.

[00:30:21] Dr. Mark Nelson: Toenail fungus, more, more often than not, we can get rid of with, with, with like pill, pill medication like pills, antifungal pills, or laser treatment for the toenails. But there’s even, even among those, there’s still a significant portion, maybe one third that can’t get rid of it no matter what they do.

[00:30:38] Dr. Mark Nelson: So those cases are frustrating. 

[00:30:41] Pete Waggoner: So that is, so there’s some truth to what you hear. 

[00:30:44] Dr. Mark Nelson: There is, and people who have diabetes or older people, their immune systems are weaker to begin with. So they’re all, they’re always at higher risk of toenail fungus or athlete’s foot. 

[00:30:53] Pete Waggoner: How about this is going to be a personal story to the next topic, which is persistent foot odor.

[00:30:58] Pete Waggoner: Now I don’t have it, [00:31:00] but, uh, when I used to coach and or play hockey, you know how that stuff smells like a bag of corn chips or whatever it would be. You’d wear your skates. I always skated barefoot cause I like to feel it. And when it didn’t matter what shoe I’d put on or boot, whatever it was, it was in the winter. They just reeked. It just was what it was, you know? So can we talk about foot odors, addressing hygiene, potential submersive thrown in there and, uh, what you should do to combat that? you know,

[00:31:32] Dr. Michael Oborsky: Well, a lot of times foot odor is due to excessive perspiration. And you know, an excessive perspiration is going to rot out the inside of your hockey skates, especially if you’re going barefoot. You’re one of those guys. I I knew, players that did that. 

[00:31:48] Dr. Michael Oborsky: Um, that’s just what, how they did it, but it’s excessive perspiration can be. What I’ve been telling people is use an underarm antiperspirant, like a roll on [00:32:00] antiperspirant, and rub it, roll it on your feet. Because you want to, you want to contract those, constrict those, sweat glands. And that’s what an antiperspirant does. It puckers those sweat glands up so you can’t sweat so much. So that can be used, uh, there are various, uh, I mean, people will say, Oh, I use a vinegar. So can you put a little bit of vinegar and water and soak them? And that’ll kind of pucker up those, uh, sweat glands. 

[00:32:27] Dr. Michael Oborsky: There are other medications just generalized foot odor is called brome hydrosis, and there are lotions that can help with that. The one’s called broma lotion. That can be prescribed or ordered.

[00:32:42] Dr. Michael Oborsky: So there are, there are things that can be done. There’s another one called certain dry that you rub on the foot. I think, you know, and that’s just an antiperspirant again, it’s got the aluminum chloride. So that, uh, those things can be effective, but you have to do it. You have to realize that you have this situation [00:33:00] and it’s a maintenance thing, like brushing your teeth. I tell people, you know, you just gotta, it’s just something you gotta do. 

[00:33:05] Pete Waggoner: Well, you’ll be happy to know. I stopped coaching two years ago after 34 years. Uh, I changed out all my shoes. No more odor, we’re good. But yeah, it’s interesting if I would have known those tips that you just threw out. I for sure would have put that into play.

[00:33:21] Pete Waggoner: Dr. Nelson, anything to add to that? 

[00:33:23] Dr. Mark Nelson: No, I agree with what Dr O’Borsky had mentioned. Another 1 of the topical any perspirants to try to control the sweating is drysol. D. R. Y. S. O. L. It’s another commonly used one. I tell people to, you know, use the antiperspirants to reduce the sweating on the feet.

[00:33:38] Dr. Mark Nelson: It’s the moisture and the sweating that provides a really good environment for those bacteria. And it’s the bacteria that cause the odor. It’s not the sweat itself. It’s the bacteria living within those sweaty feet, sweaty shoes, and sweaty shoes. So if you can reduce the sweating, that ultimately reduces the bacteria, which in turn helps reduce the odor.

[00:33:55] Dr. Mark Nelson: You know, they have some salt or vinegar soaks can help a little bit. Charcoal inserts for their [00:34:00] shoes, that helps absorb some of that odor too. 

[00:34:02] Dr. Mark Nelson: Changing the socks several times a day to reduce some of the moisture, can help with, uh, controlling foot odor.

[00:34:08] Dr. Mark Nelson: What else? Try to stay, I usually recommend staying away from the anti, like the deodorants and just use antiperspirant. Try to stay away from those perfumed topical things on the feet. There’s a product called an ultraviolet light. It’s, uh, one there’s one brand named Steri Shoe. That’s, that’s common.

[00:34:24] Dr. Mark Nelson: Those ultraviolet lights can kill bacteria and fungus in shoes, something people are going to have to use on a kind of a long term basis to kind of keep the fungus under control. That helps a little bit. It’s not great, but it helps a little bit. If the insoles of the shoes are really smelly and dirty, just throw them out, get some replacement insoles.

[00:34:40] Dr. Mark Nelson: Changing shoes, alternating shoes, if the shoes are sweaty and wet, take them out. Take 1 pair off where another pair of the 2nd day. Once those dry out, you know, but the 1st pair back on again, we’ll get shoe dryers, like little blowers and fans to put their shoes on to dry them out at the end of the day, if they’re sweaty. That is try to keep that that moisture content than [00:35:00] shoes as low as possible. 

[00:35:01] Pete Waggoner: Yeah, I mean, there’s, there’d be nothing worse than going over to a friend’s house, you take the shoes off, and everybody’s like, put them back on, man. But, but that, that’s good stuff, guys. Final topic for you, uh, to you go through all of these various things.

[00:35:17] Pete Waggoner: We covered a vast array of topics, and there have been a lot of treatments and things that you do for, uh, helping patients. How often do you guys get into the surgical type procedures? And is there any, I don’t know, indications for it, from what to expect from those interventions?

[00:35:38] Dr. Mark Nelson: Yeah, we do a wide variety of, of foot and ankle surgeries. Basically anything that can be done, we can do to the foot or the ankle. Ankle fractures, flat feet, there’s surgical procedures we can do to actually reconstruct the foot and rebuild the arch. If there’s tendons that are torn or ruptured, we can repair those tendons to get that muscle and tendon function back to the [00:36:00] foot.

[00:36:00] Dr. Mark Nelson: Bunions and hammer toes are common procedures. We’ll, you know, we’ll usually cut, have to end up cutting and realigning the bones to get the bones back in position. Sometimes I’ll have patients come in and tell me that they hear that bunion surgery doesn’t work or hammer toe surgery doesn’t work, but I disagree with that.

[00:36:15] Dr. Mark Nelson: If the procedure is done properly and those bones are cut and realigned, the chances of that bunion coming back or getting bunion pain again is pretty small. It’s not zero, but it’s a small percentage. Fractures, broken bones, broken toes, broken metatarsals, broken heels, things like that. We commonly repair those. Achilles tendon ruptures are another common injury. 

[00:36:38] Pete Waggoner: Dr. O’Borsky? 

[00:36:39] Dr. Michael Oborsky: Yes, uh, you know, I can add to that a little bit. Totally agree. We do have sometimes surgery is necessary and and you hear some bad advice from even from doctors. They’ll say, well, if it doesn’t bother you, don’t fix it. And I think sometimes that’s bad advice.

[00:36:56] Dr. Michael Oborsky: If you notice that your bunion is getting a lot [00:37:00] worse. So your hammer toe is contracting more and it’s irritating in shoes. But yeah, it hasn’t created a problem yet. And it doesn’t hurt. Well, it probably should be corrected because We see it way too many times where elderly people will come in with these significant deformities on their feet and they do now have open sores.

[00:37:23] Dr. Michael Oborsky: And we can’t do surgery on those people because of the poor blood supply typically. So there’s not a lot we can do. Our hands are tied. So if you have a significant deformity of your foot, such as a bunion or a hammer toe or whatever it might be that should be repaired in my opinion. Typically, if that person meets the correct medical criteria.

[00:37:48] Dr. Michael Oborsky: So that those are things. Uh, is it interfering with your lifestyle? Is this is this problem, whatever it might be, interfering with your things you do every day? You don’t [00:38:00] want to go for a walk, maybe because your foot’s bothering you. Or you’re worried you’re going to get a blister or an open sore because you have this tailor’s bunion or, or whatever it might be.

[00:38:11] Dr. Michael Oborsky: Those are times when I tell people that you should really surgery seriously consider the surgery to get it corrected and then put it behind you so that you’re not 90 years old and still dealing with this problem. So.

[00:38:24] Pete Waggoner: Really, really good stuff. And, uh, gentlemen, I think if I walk away from 1 simple thing that I learned from this podcast and there was so much, but I mean, to me, it’s the most basic of basic, but it gave me the big aha moment. It was to wear footwear around the house. A great preventative thing that is, cause we all never, we just don’t. And I think for me, that’s a simple thing that everybody could do to help their quality of life and kind of avoid some of these issues.

[00:38:54] Pete Waggoner: I don’t know if that’s kind of minor, but I felt like that was a simple takeaway for me. I’m like. I’m going [00:39:00] to tell everybody that. So.

[00:39:01] Dr. Michael Oborsky: And they don’t want to hear it. People don’t like to hear it. 

[00:39:05] Pete Waggoner: They don’t? 

[00:39:06] Dr. Michael Oborsky: No. But I tell him, you just wear a pair of, uh, supportive clogs with a low back and that there’s some, you can kick on and off easily, but at least you’re wearing something in the house to protect your feet because you know, when you’re 16, you can get away with it.

[00:39:21] Dr. Michael Oborsky: But when you start getting our age, it’s, uh, it starts to cause problems. 

[00:39:24] Pete Waggoner: I’m going to start doing it. I mean, great stuff. 

[00:39:27] Dr. Mark Nelson: There’s even some slippers now that are made that have arch support built into the slippers too. And those, those work well. 

[00:39:33] Pete Waggoner: That’s wonderful. So hopefully everybody heeds this advice and they get a little smarter about things.

[00:39:39] Pete Waggoner: To both of you, Dr. Nelson and Dr. O’Borsky, thanks for joining us today. And that’s going to be a wrap. For today’s episode of Beyond the Checkup brought to you by Stellis Health, where we believe in neighbors caring for neighbors. I’m Pete Waggoner. Thank you for joining us on this journey. And remember your journey to wellness doesn’t stop here.

[00:39:57] Pete Waggoner: We’re always here to support, guide, and [00:40:00] inspire you. Be sure to reach out to your Stellis Health provider for personalized care. And also, don’t forget to subscribe to Beyond the Checkup for more health insights and stories. Share this episode with friends and family. Let’s spread the word on living healthier, happier lives together.

[00:40:15] Pete Waggoner: Until next time, stay healthy, stay connected, and continue to thrive. Thanks for listening.