Special Report on Accessory Navicular Syndrome

What is the Accessory Navicular? The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. What is Accessory Navicular Syndrome? People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following: • Trauma, as in a foot or ankle sprain • Chronic irritation from shoes or other footwear rubbing against the extra bone • Excessive activity or overuse Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular. Signs and Symptoms of Accessory Navicular Syndrome Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include: • A visible bony prominence on the midfoot (the inner side of the foot, just above the arch) • Redness and swelling of the bony prominence • Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity Diagnosis To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated. X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition. Treatment: Non-Surgical Approaches The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used: • Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. • Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. • Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. • Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated. When Is Surgery Needed? If non-surgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area, and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Oseteoarthritis (OA) of the Foot

What is Osteoarthritis? Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage, the connective tissue found at the end of the bones in the joints, protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one's ability to easily perform daily activities. Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Many people refer to osteoarthritis simply as arthritis, even though there are more than 100 different types of arthritis. Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle. Signs and Symptoms People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following: • Pain and stiffness in the joint • Swelling in or near the joint • Difficulty walking or bending the joint Some patients with osteoarthritis also develop a bone spur (a bony protrusion) at the affected joint. Shoe pressure may cause pain at the site of a bone spur, and in some cases blisters or calluses may form over the surface of the bone spur. Bone spurs can also limit the movement of the joint. Causes Osteoarthritis is considered a "wear and tear" disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint. An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition to develop. For example, osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is also often caused by dropping something on it, or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain. Sometimes osteoarthritis develops as a result of abnormal foot mechanics. People who have flat feet or high arches are at increased risk for developing osteoarthritis in the foot. A flat foot causes less stability in the ligaments (bands of tissue that connect bones), resulting in excessive strain on the joints, which can cause arthritis. A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis. Diagnosis In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. In addition to the foot examination, x-rays may be ordered to help the doctor diagnose osteoarthritis and evaluate the extent of the disease in the foot and ankle. Treatment: Non-Surgical Options To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more of the following non-surgical approaches: • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally a prescription for a steroid medication is needed to adequately reduce symptoms. In addition, certain nutritional supplements may provide some longer-term benefit. • Orthotic devices. Custom orthotic devices (shoe inserts) are often prescribed to provide needed support to improve the foot's mechanics or cushioning that may help minimize pain. • Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and help prevent further deformity. • Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve. • Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication. • Physical therapy. Exercises to strengthen the muscles, especially when the osteoarthritis occurs in the ankle, may give the patient greater stability and help avoid injury that might worsen the condition. When is Surgery Needed? If non-surgical treatment fails to adequately reduce the pain associated with osteoarthritis, surgery may be recommended. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient's condition and lifestyle. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Rheumatoid Arthritis (RA) of the Foot

What is Rheumatoid Arthritis? Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints. RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability. How Does RA Affect the Foot and Ankle? When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, cause swelling and damage to the joint's cartilage and bones. Foot problems caused by RA most commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems -- in addition to the abnormal appearance of deformities -- are pain, swelling, joint stiffness, and difficulty walking. Deformities and conditions associated with RA may include: • Rheumatoid nodules (lumps) -- these cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking • Dislocated toes • Hammertoes • Bunions • Heel pain • Achilles tendon pain • Flatfoot • Ankle pain How is RA Diagnosed? Usually a patient has already been diagnosed with RA prior to visiting the foot and ankle surgeon. However, occasionally a patient first receives a diagnosis of RA from the foot and ankle surgeon. RA is diagnosed on the basis of a clinical examination as well as blood tests. To further evaluate the patient's foot and ankle problems, the surgeon may order x-rays and/or other imaging tests. Treatment by the Foot and Ankle Surgeon While treatment of RA focuses on the medication prescribed by a patient's primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options: • Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking, and give needed support to improve the foot's mechanics. • Accommodative shoes. These are used to relieve pressure and pain and assist with walking. • Aspiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain. • Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule. • Surgery. Often the pain and deformity associated with RA in the foot is relieved through surgery. The foot and ankle surgeon will select the procedure best suited to the patient's condition and lifestyle. Rheumatoid arthritis in the foot and ankle can cause considerable pain and deformity, making walking difficult. Through the treatment approaches selected by the foot and ankle surgeon, substantial relief can be obtained. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Puncture Wounds of the Foot

What is a Puncture Wound? Puncture wounds and cuts are not the same. A puncture wound has a small entry hole caused by a pointed object -- for example, a nail that you step on. In contrast, a cut is an open wound that doesn't produce a "hole" but rather a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury. Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are among the most inadequately treated conditions. That's a big concern, because if not properly treated, infection or other complications can develop. Getting proper treatment within the first 24 hours is especially important with puncture wounds because they carry the danger of embedding the piercing object ("foreign body") under the skin. Research shows that complications of puncture wounds could be prevented if the patient seeks professional treatment right away. Foreign Bodies in Puncture Wounds A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles, and seashells are some common offenders. In addition, pieces of your own skin, sock, and shoe can be forced into the wound during a puncture, as well as dirt and debris from the object. By their nature, all puncture wounds are dirty wounds because they involve penetration of an object that isn't sterile. Regardless of what the foreign body is, anything that remains in the wound increases your chances of developing other problems, either in the near future or down the road. Severity of Wounds There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate how severe the wound is. The deeper the puncture, the greater the likelihood that complications, such as infection, will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you've stepped on something and the skin was penetrated, seek treatment as soon as possible. The type and the "cleanliness" of the penetrating object also determine the severity of the wound. Larger or longer objects can penetrate deeper into the tissues, possibly causing more damage. The dirtier an object, such as a rusty nail as opposed to a sewing needle, the more dirt and debris are dragged into the wound, which may increase the chance of infection. Another thing that can determine wound severity is whether you were wearing socks and shoes or were barefoot. Particles of socks and shoes can get trapped in a puncture wound. Treatment of Puncture Wounds The key to proper treatment is this: A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications. Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a foot and ankle surgeon for a thorough cleaning and careful follow-up. The sooner you do this, the better -- within 24 hours after injury, if possible. The foot and ankle surgeon is trained to properly care for these injuries and will make sure your wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. To treat or prevent infection, antibiotics may be prescribed. Once you return home, be sure to carefully follow the foot and ankle surgeon's instructions to prevent complications. See "Puncture Wounds: What You Should Do" table below for more information. Avoiding Complications Infection is a common complication of puncture wounds that can lead to serious consequences. Sometimes a minor skin infection evolves into a bone or joint infection, so you should be aware of signs to look for. A minor skin infection may develop in 2 to 5 days after injury. The signs of a minor infection that show up around the wound include soreness, redness, and possibly drainage, swelling, and warmth. You may also develop a fever. If these signs have not improved, or if they reappear in 10 to 14 days, a serious infection in the joint or bone may have developed. Other complications that may arise from inadequate treatment of puncture wounds include painful scarring in the area of the wound or a hard cyst where the foreign body has remained in the wound. Although the complications of puncture wounds can be quite serious, early proper treatment can play a crucial role in preventing them. Puncture Wounds: What You Should Do •Seek treatment right away. •Get a tetanus shot if needed (usually every 5 years). •See a foot and ankle surgeon within 24 hours. Follow your doctor's instructions: •Keep your dressing dry. •Keep weight off of the injured foot. •Finish all your antibiotics (if prescribed). •Take your temperature regularly. •Watch for signs of infection (pain, redness, swelling, fever). •Call your doctor if you have any of these signs. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Big Toe Arthritis

Special Report on Big Toe Arthritis Each day, with every step you take, your big toe bears a tremendous amount of stress -- a force equal to about twice your body weight. Most of us don't realize how much we use our big toe. We tend to take it for granted, unless a problem develops. One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up, or even stand. If you have pain and/or stiffness in your big toe, you may have this condition. What is Hallux Rigidus? Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe, and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body). Because hallux rigidus is a progressive condition, the toe's motion decreases as time goes on. In its earlier stage, motion of the big toe is only somewhat limited -- at that point, the condition is called "hallux limitus." But as the problem advances, the toe's range of motion gradually decreases until it potentially reaches the end stage of "rigidus" -- where the big toe becomes stiff, or what is sometimes called a "frozen joint." Other problems are also likely to occur as the disorder progresses. Early signs and symptoms include: • Pain and stiffness in the big toe during use (walking, standing, bending, etc.) • Pain and stiffness aggravated by cold, damp weather • Difficulty with certain activities (running, squatting) • Swelling and inflammation around the joint • As the disorder gets more serious, additional symptoms may develop, including: • Pain, even during rest • Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing high-heeled shoes can be particularly difficult. • Dull pain in the hip, knee, or lower back due to changes in the way you walk • Limping, in severe cases What Causes Hallux Rigidus? Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis -- the kind that results from "wear and tear" -- often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus. In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse -- especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury -- even from stubbing your toe. Or it may be caused by certain inflammatory diseases, such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment. Diagnosis of Hallux Rigidus The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage. In diagnosing hallux rigidus, the foot and ankle surgeon will examine your feet and manipulate the toe to determine its range of motion. X-rays are usually required to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed. Treatment: Non-Surgical Approaches If your condition is caught early enough, it is more likely to respond to less aggressive treatment. If fact, in many cases, early treatment may prevent or postpone the need for surgery in the future. That's why it is important to see your foot and ankle surgeon when you first begin to notice symptoms. Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies: • Shoe modifications. Shoes that have a large toe box should be worn, because they put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended. Most likely, you'll have to stop wearing high heels. • Orthotic devices. Custom orthotic devices may improve the function of your foot. • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation. Supplements such as glucosamine-chondroitin sulfate and some vitamins and minerals may also be helpful. • Injection therapy. Injections of corticosteroids in small amounts are sometimes given in the affected toe to help reduce the inflammation and pain. • Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief. When is Surgery Needed? In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery that can be undertaken to treat hallux rigidus. These surgical procedures fall into two categories: Some procedures reconstruct and "clean up" the joint. The foot and ankle surgeon removes the arthritic damage from the joint as well as any accompanying bone spurs, and then alters the position of one or more bones in the big toe. These procedures are designed to preserve and restore normal alignment and function of the joint as well as reduce or eliminate pain. More aggressive procedures are used when the joint cannot be preserved. These may involve fusing the joint, or removing part or all of the joint and, in some cases, replacing it with an implant, such as is done for the hip or knee. These procedures eliminate painful motion in the joint and provide a stable foot. The procedure that is used to correct hallux rigidus depends on many factors, including the cause of the condition and the severity, as well as the patient's age, occupation and activity level. Your foot and ankle surgeon is trained to select a surgical procedure best suited to your particular condition and needs. If surgery is performed, the length of the recovery period will vary, depending upon the procedure or procedures performed. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Foot Fractures

The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 28 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones (broken toes) are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room. What is a Fracture? A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures. Traumatic Fractures Traumatic fractures (also called acute fractures) are caused by a direct blow or impact -- like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Signs and symptoms of a traumatic fracture include: •You may hear a sound at the time of the break. •"Pinpoint pain" (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours. •Deviation (misshapen or abnormal appearance) of the toe. •Bruising and swelling the next day. It is not true that "if you can walk on it, it's not broken." Evaluation by the foot and ankle surgeon is always recommended. Stress Fractures Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include: •Pain with or after normal activity •Pain that goes away when resting and then returns when standing or during activity •"Pinpoint pain" (pain at the site of the fracture) when touched •Swelling, but no bruising Is it a Fracture or a Sprain? Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis. Consequences of Improper Treatment Some people say that "the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example: •A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes. •Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected. •Chronic pain and long-term dysfunction. •Non-union, or failure to heal, can lead to subsequent surgery or chronic pain. Treatment of Toe Fractures Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options: •Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe. •Splinting. The toe may be fitted with a splint to keep it in a fixed position. •Rigid or Stiff-Soled Shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned. •"Buddy Taping." "Buddy taping" the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful. •Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins. Treatment of Metatarsal Fractures Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges. For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand. Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your foot and ankle surgeon is an expert in correctly identifying these conditions as well as other problems of the foot. Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include: •Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone. •Avoid the Offending Activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal. •Immobilization, Casting, or Rigid Shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing. •Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced. •Follow-Up Care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on “Fallen Arches” Otherwise Known as Posterior Tibial Tendon Dysfunction

What is Posterior Tibial Tendon Dysfunction (PTTD)? Seemingly overnight, one or both of your arches have flattened. You don’t remember your foot looking like this in the past. What has happened? What is going on? You probably have a condition called posterior tibial tendon dysfunction (PTTD) commonly called “fallen arches.” PTTD is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon's ability to perform that job is impaired, often resulting in a flattening of the foot. The posterior tibial tendon is a fibrous cord that extends from a muscle in the leg. It descends the leg and runs along the inside of the ankle, down the side of the foot, and into the arch. This tendon serves as one of the major supporting structures of the foot and helps the foot to function while walking. PTTD is often called "adult-acquired flatfoot" or “fallen arches” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse -- especially if it isn't treated early. Symptoms of PTTD The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change: • When PTTD initially develops, typically there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. • Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. • As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. What Causes PTTD? Overuse of the posterior tibial tendon is frequently the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs. Non-Surgical Treatment Approaches Because of the progressive nature of PTTD, it's best to see your foot and ankle surgeon as soon as possible. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In many cases of PTTD, treatment can begin with non-surgical approaches that may include: • Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle stirrup brace or a custom orthotic device that fits into the shoe. • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight bearing for a while. • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. • Shoe modifications. Your foot and ankle surgeon may advise you on changes to make with your shoes and may provide special inserts designed to improve arch support. When is Surgery Needed? In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, realigning the bones of the foot, or both. Your foot and ankle surgeon will determine the best approach for your specific case. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Bunions

Although bunions are a common foot deformity, there are many misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

What is a Bunion?
Bunions (hallux valgus) are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment, producing the bunion's "bump." Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.

What Causes a Bunion?
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.

Bunion Symptoms
Symptoms occur most often when wearing shoes that crowd the toes -- shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Symptoms that occur at the site of the bunion may include:
• Pain or soreness
• Inflammation and redness
• A burning sensation
• Perhaps some numbness
• Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.

Diagnosis
Bunions are readily apparent -- you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the foot and ankle surgeon may take X-rays to determine the degree of the deformity and assess the changes that have occurred. Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike--some bunions progress more rapidly than others. Once your foot and ankle surgeon has evaluated your particular case, a treatment plan can be developed that is suited to your needs.

Treatment
Sometimes observation of the bunion is all that's needed. A periodic office evaluation and X-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed.
Early treatments are aimed at easing the pain of bunions, but they won't reverse the deformity itself. These options include:
• Changes in footwear: Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
• Padding: Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your foot and ankle surgeon or purchase them at a drug store.
• Activity modification: Avoid activity that causes bunion pain, including standing for long periods of time.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
• Icing: Applying an ice pack several times a day helps reduce inflammation and pain.
• Injection therapy: Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
• Orthotic devices: In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.

When is Surgery Needed?
When the pain of a bunion interferes with daily activities, it's time to discuss surgical options with your foot and ankle surgeon. Together you can decide if surgery is best for you.Recent advances in surgical techniques have led to a very high success rate in treating bunions. A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the "bump" of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain.

In selecting the procedure or combination of procedures for your particular case, the surgeon will take into consideration the extent of your deformity based on the X-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.




Committed to your health,


Dr. Craig Conti
Sarasota Foot Care Center
sarasotafootcarecenter.com

Special Report on Neuromas

What is a Neuroma?

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. "Intermetatarsal" describes its location - in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot. The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.
Symptoms of a Morton's Neuroma
If you have a Morton''s neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring:
• Tingling, burning, or numbness
• Pain
• A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.
The progression of a Morton's neuroma often follows this pattern:
• The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
• The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
• Over time the symptoms progressively worsen and may persist for several days or weeks.
• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
What Causes a Neuroma?
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities -- bunions, hammertoes, flatfeet, or more flexible feet -- are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.
Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests may be performed. The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton's neuroma greatly lessens the need for more invasive treatments and may avoid surgery.
Treatment
In developing a treatment plan, your foot and ankle surgeon will first determine how long you've had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate cases of neuroma, treatment options include:
• Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
• Icing. Placing an icepack on the affected area helps reduce swelling.
• Orthotic devices. Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
• Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
• Changes in shoewear. It's important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Injection therapy. If there is no significant improvement after initial treatment, injection therapy may be tried.
When is Surgery Needed?
Surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma the affected nerve is either removed or released. Your foot and ankle surgeon will determine which approach is best for your condition. The length of the recovery period will vary, depending on the procedure or procedures performed. Regardless of whether you've undergone surgical or nonsurgical treatment, your foot and ankle surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities that cause repetitive pressure on the foot.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

Special Report on Orthotics

First of all, what are orthotics? Orthotics are custom made devices that fit inside your shoes and improve the function of your feet and ankles. You can think of them as “glasses for your feet.” Just like a pair of glasses causes your eyes to function in the proper way, a pair of orthotics improves the function of your feet and ankles. It also decreases pressure on the bones and skin of the foot, decreases pain and aligns the joints of the foot, ankle and knee.

What aren’t orthotics? Orthotics are not soft, gel or foam things that you can bend with your fingers. For an orthotic to work it must put your foot into a position that your foot does not want to go. During walking, all your weight is on one foot at a time. Imagine all of your weight on a soft, gel or foam device. It will flatten to nothing and will not improve the function of your foot.

Are orthotics comfortable? Absolutely, when they are made properly you don’t even feel them in your shoes. The only way that a pair of orthotics will be strong enough to work and yet comfortable enough that you will actually wear them, is to have them custom molded exactly to your foot.

But what about the ones you can get at the drug store from “the machine” or from the “foot store?” Collectively, the doctors of Sarasota Foot Care Center have been practicing medicine for well over 65 years. Not only do we know how to get you the true orthotic you need, but we will be there to help you down the road if anything happens and adjustments are needed. Try that with the “machine” or the “foot store.”

But aren’t they expensive? Expensive is when you pay good money for something and get no results. We don’t care if the so-called orthotics you can get at the shoe store only cost $60 dollars, they won’t help you. So is $60 dollars for a worthless pad a good deal? I don’t think so.

A pair of custom orthotics will last for about 3-5 years. It will improve your foot function and decrease your pain. Is that worth two installments of $225? How much does your heel hurt? How much would you pay to get out of the bed in the morning without that stabbing, shooting pain? How much would you pay to be able to exercise and finally lose those pounds you need to?

In these very sensitive economic times we completely understand priorities. If the decision is food or orthotics…that is a very simple decision. Another question you have to ask yourself is if you can afford not to get orthotics? Can you afford to miss more work because of your foot pain? Can you afford to take 6 weeks off because of a possibly avoidable surgery? There is not one golfer we know that would not pay that cost to shave a few strokes off of their game. How much easier would tennis be without the pain in the ball of your foot?

What foot conditions do orthotics treat? Orthotics treat a large group of conditions that all stem from the movement of the muscles and bones of the foot. These conditions include, but are not limited to: heel pain, heel spurs, flat feet, “fallen arches,” bunions, neuromas (pinched nerve in the foot), painful corns and calluses under the ball of the foot, sore feet and ankles, tendonitis and joint pain.

What will happen if I need orthotics but I don’t get them, can I do permanent damage to myself? Yes you can. Flat feet are genetic and are usually noticed early in life. If untreated, the excess pressure and abnormal wear and tear on the joints can lead to severe arthritic conditions and loss of function. Heel pain is ultimately a problem with alignment and no amount of stretching or cortisone shots will cure the problem with out addressing the underlying alignment issues. In fact, all the conditions that are treated with orthotics have a major alignment component to them. Leaving this alignment uncorrected only leads to further pain and loss of function. It is critical to correct the root cause of these conditions and the root cause is the deranged alignment. Orthotics are the only thing that can correct this alignment problem.

Will I have to get bigger shoes to fit the orthotics? No, you should not need a larger size to fit your orthotics. Most athletic shoes have a removable foot bed that will create the room needed to fit the orthotics. The same goes for most lace-up loafers or boots. In fact, there are some sandals that have a removable foot bed and work with orthotics as well. There are, of course some shoes that will not work with orthotics. High heels and flip-flops come to mind immediately. Have no fear. If you wear the orthotics when you are most active, occasional flip-flops and high heels are acceptable.

If you have been experiencing pain or soreness in your foot, what are you waiting for? Biomechanical problems, which is to say bone, muscle and joint problems, do not just heal themselves. You would never expect your vision to miraculously improve and you should not ask for miracles with your feet either. If your feet have been hurting you, or you have been watching someone you care about suffer with foot pain, stop waiting and get the pair of orthotics you need, today.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

X-rays Negative on NBA MVP Derrick Rose

Derrick Rose, the Chicago Bulls superstar and likely leage MVP, had some good news the other day. The x-rays on his injured left ankle came back negative. That is to say that there is no fracture of the bones. The ligaments, soft tissues that hold bones together, can not be seen on an x-ray. The most frequent ankle injury is called an inversion ankle sprain. This is when the foot rolls to the pinky toe side of the foot. Rose suffered this injury coming down on another players foot in a game against the Pacers. Rose continued to play and the Bulls put away the Pacers but now that the Atlanta Hawks have won game one, all of a sudden Rose's ankle is very important. I do respect Derrick Rose's determination, but if the ligaments are truly torn he will be very limited in his lateral movement. This could be very bad for the Bulls. Lucky for Derrick Rose that he has around the clock access to physical therapy on his ankle. For anyone who is not an elite, multi-million dollar athlete, the treatment for ankle sprains is P-R-I-C-E. Protection, Rest, Ice, Compression and Elevation. Motrin or Advil will also help with the pain. If the pain lasts longer than a week or if you are unable to bear any weight on the ankle, you should see a podiatrist immedatly to have an x-ray. Often bracing combined with physical therapy will get you back out on the court in a few weeks. Lucky for you, the entire city of Chicago is not counting on you to bring home a championship!


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

The Ghost in the Machine

If you have been to the drug store or grocery store lately you may have noticed the Dr. Scholl's machine. It looks impressive enough, with colorful images of your feet that show the different pressures. After standing on the machine for a few seconds it spits out a number and that is the pair of foot supports that you are supposed to use. Simple right? Wrong.
Custom foot supports, or orthotics as they are called by foot doctors, are a complicated science. The science of how living things move is called biomechanics. This is the science that one must you to properly diagnose and treat conditions with a pair of orthotics. The machine has none of this training. The foot is a very dynamic structure with 28 bones, 33 joints and over a hundred ligaments in each foot. Placing the foot in the proper position is crucial in obtaining a good representation of this moving target.
As an example, we have all heard of someone having 20/20 vision. What that means is that at a standard of 20 feet a person can see a size of type that has been designated as the standard font. This system breaks down if you measure people at 10 feet or with a different font size. When molding someone for an orthotic in my office I have similar standards that I have to abide by. The foot, ankle and knee must be in the standardized position. If not taken in this very specific way the mold is useless. This is exactly what happens with these machines. There is no uniformity. There is no standardizing.
As someone who has prescribed hundreds of orthotics in my career I can tell you that there is an art as well as a science involved. You have to know the activity level of the patient and the types of shoes they most often wear. There are some sport specific adjustments that can be taken into account and let us not forget the follow up. When you get a pair of orthotics from me or my colleagues you are sure to have the devices evaluated and any adjustments made in order to get the results you want. Every year thousands of people buy a 1/4 inch drill bit. None of these people want a 1/4 inch drill bit...they want a hole that is 1/4 inch around. The same can said for orthotics. No one really wants a piece of custom molded plastic in their shoe...they want pain free walking, running, golfing etc.
People often ask why orthotics are so expensive. The answer is because they are time consuming if you are going to do them correctly. You can get a piece of padded plastic out of a machine in a grocery store all day if you want to, just don't call that an orthotic. The ghost in the machine is not going to follow up with you. The ghost does not care if the device works. The ghost is not going to adjust the device and improve your comfort and quality of life.
You do get what you pay for in life and this is just another example of cutting corners and you will suffer for it. Remember that when you do end up with a inferior device you only have yourself to blame...the ghost in the machine doesn't care.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

New York Mets 2nd Baseman has a Foot Injury

The New York Mets second baseman, Louis Castillo, could end up on the disabled list due to a foot injury. The injury is being reported as a bone bruise of the left foot. What is a bone bruise? Most people think a bone is either broken or not. In order to explain that I want you to think of a dimmer switch on a light. You see, a bone can be either broken or not, just like a light can either be on or off. That said, there are also the dimmer options. Using an MRI (a special medical device that takes images of the bones and soft tissues and feeds the results into a computer) a radiologist can add more options to the mix. Thinking of a spectrum, where one end is normal bone and the other is a broken bone, now we can add bone bruise (also called a stress reaction) and stress fracture.
Despite his desire to play, the treatment for a bone bruise is rest, stiffer shoes and time. If he continues to play on this foot he can end up with a stress fracture (the next phase on the dimmer switch) or ultimately a fracture of his bone. If he does fracture the bone he is looking at 6 weeks of healing time.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
www.sarasotafootcarecenter.com

Do These Genes Make Me Look Fat?

For a long time now, scientists have know that there are certain genetic variants that increase the likelyhood of obesity. One of those gene clusters, the FTO gene, is affectionately called the "fatso" gene. This genetic variant is very common. In fact, 1 in 6 people have the FTO gene variant and these people weigh an average of 7 pounds more than people with the regular variant.
Many experiments with animals have proven that specifically inhibiting these genes will cause rapid weight loss, yet no magic pill has come out yet that can help the millions of overweight and obese Americans.
In a recent study, just published in the April addition of the Archives of Pediatric and Adolescent Medicine scientists discovered some very encouraging news. We do not have to be slaves to our genes. In the study of over 700 teens it was found that those teens with a high genetic tendency for obesity could compensate with one hour of moderate exercise a day. Those teens who did one hour of exercise a day were found to have statistically similar waist measurments, body mass index scores and body fat levels as their peers with regular genes. Playing sports, running, jumping rope and cycling were all forms of exercise that qualify.
So if you or your children are one of the over 200 million overweight Americans, the time is now to start getting active.
In the process of getting active make sure you have the proper shoes for your exercise program. If you do have foot or leg pain that is stopping you from reaching your exercise goals, see a foot doctor and learn what you need to do to exercise safely and efficently. Your genes do not have to determine your destiny. You have control over your life.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com

Should Kids Wear High Heels?

Recently there has been a lot of press about Suri Cruise and her little silver high heels. There is nothing quite like a celebrity (or the child of one) to bring these types of things to the forefront of the public consiousness. So, should kids wear high heels? My answer is no, they SHOULD not wear high heels. That said, they certainly CAN wear high heels. The question is similar to should kids eat cheeseburgers and fries. No they shoud not, but they can, in moderation with adult supervision without any major disasters.
Many of my female patients in Sarasota, Florida are afraid that I am going to tell them that they can never wear high heels again. The truth is that high heels do increase pressue on the balls of the feet(what we call the metatarsal heads), can cause shortening of the Achilles tendon and increase the chances for falling or spraining an ankle. That said, many of the sports that I enjoy can possibly lead to all kinds of injuries. Tennis, basketball, skateboarding, roller blading, marathon running etc, can all possibly cause injury to the foot and ankle. All of these activities have the same warnings as high heels. Where is the outcry to stop kids from doing any of these?
Do I think it is a little silly for a kid to wear high heels, I guess. What I find even more silly is that it has become such a big news item in the complex world we live in.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com

New Therapy for People Suffereing With Neuropathy

According to some recent studies, 66% of diabetics have some form of neuropathy. Neuropathy is a condition that affects the nerves. It causes numbness, tingling, loss of balance and in about 10% of cases pain. Those people who have suffered with painful diabetic neuropathy have only a few treatment options. There are several pills that can treat neuropathic pain with differing levels of success, but none of them increase sensation or improve balance.
Recently, a new therapy has been used on neuropathy. This therapy is called electric stimulation or just e-stim for short. The benefits of this therapy are many. First, this is not a medication so it does not interfere with any medications the patient is already on. Second, not only does the therapy decrease pain but it also improves sensation and restores balance.
E-stim is available in the office setting and it is covered by major insurance plans including Medicare.
The therapy takes a hour per session and it is delivered in our comfortable treatment room equipped with a television and reading materials. A total of thirty sessions must be completed for maximal effectiveness. The treatment is painless.
If you have neuropathy, with or without diabetes you should seriously consider e-stim therapy as a safe effective treatment.


Committed to your health,

Dr. Craig Conti

Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com

Buying the Proper Shoes for You

Feet are prone to more injury than any other part of the body according to the American Podiatric Medial Association (www.apma.org). One good way to limit these injuries is to wear properly fit shoes. I am often asked, "What is a good shoe?" This is an impossible question to answer. The question really is, "What is a good shoe for my particular foot for the particular activity I plan on doing." Now that is a much easier question to answer. Specific sports require different things of your feet. Running is all about impact, the constant pounding in a vertical direction. Tennis is more about quick stops and starts and lateral movements. Bottom-line, different activities require different shoes.

Here are some simple, common sense tips to help you choose a "good" shoe.

Have your feet measured while you’re standing.

Always try on both shoes, and walk around the store.

Always buy for the larger foot; feet are seldom precisely the same size.

Don’t buy shoes that need a “break-in” period; shoes should be comfortable immediately.

Don’t rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers’ sizing molds) also vary.

Shop for shoes later in the day; feet tend to swell during the day, and it’s best to be fitted while they are in that state.

Be sure that shoes fit well—front, back, and sides—to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe.

Buy shoes that don’t pinch your toes, either at the tips, or across the toe box.

Try on shoes while you’re wearing the same type of socks or stockings you expect to wear with the shoes.

If you wear prescription orthotics—biomechanical inserts prescribed by a podiatric physician—you should take them along to shoe fittings.

My best advice if you are planning to start a new exercise program is to invest in a new pair of shoes. Go to a store that specializes in athletic shoes. I recommend a store like Fleet Feet (www.fleetfeetsports.com) if they are in your area. The knowledgeable staff do a very good job with fitting and they can guide you to a sport specific shoe.
Remember, you would not start a new sports activity without the right equipment and shoes are big part of that.


Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com