In 1996, twenty-year old Ray Allen entered the NBA as a fifth round draft pick.  His shoe size: 13.  After a series of ankle injuries that resulted in double ankle surgery in 2007, Allen reported that his feet always hurt and his shoes felt tight.  In this his 16^th season in the NBA, Allen now wears a size 15 shoe (with custom orthotics).  As a 36-year old he’s playing his career best and holds the record for hitting more 3 pointers than anyone else in the NBA.  He doesn’t have the same ankle problems or foot pain, and he feels that bigger shoes made all the difference. 

I often have patients tell me, “Doc, I feel like my feet have gotten bigger.  Is that possible?”  Or just as often patients may not know that their feet have gotten bigger until they order therapeutic shoes from our office and we measure their foot a size and width bigger than they are used to wearing.  To officially answer this question, yes, your feet may be getting both longer and wider.  There are several scenarios where this is the case. 

1.      Pregnancy: During pregnancy your body releases a hormone known as Relaxin.  Relaxin loosens the ligaments (the tissue that attaches one bone to another) in your body so that your ribs can expand to accommodate the growing baby.  Relaxin is not selective about which ligaments it causes to relax, so the ligaments in your foot also relax, which can cause your arch to fall and your foot to get wider.  The excess weight you carry during pregnancy can also exacerbate these changes.  And you can expect these changes to last even after that you’ve lost that baby weight.

2.     Barefoot Running:  African and South American tribes which are “non-shod” (don’t wear shoes) have wider and sometimes longer feet than those in “shod” cultures like ours.  Many people who practice barefoot running have noticed that their feet are wider and sometimes longer than before they picked up the sport.  This is likely due to their foot using and building up muscles that people who wear shoes don’t usually build up.  It could also have to do with a lack of support leading to stretching of the ligaments that support the foot.

3.     Age: A 2006 study of 440 VA patients with the average age of 67 found that only 25% were wearing the right sized shoe.  For a lot of people, after age 40 they gain a half shoe size every 10 years.  This is because as we age, the tissues in the foot weaken like they do in the rest of the body.  Muscle mass declines and ligaments lose some of their elasticity.  As a result, the front of the foot widens, and the foot becomes longer due to the arch falling.  Hammertoes and arthritis can make the foot taller too.   The natural fat pads in the heel and on the ball of the foot get thinner, making walking barefoot (or even in shoes without adequate padding) uncomfortable. 

The bottom line is regardless of why your foot is getting larger, there is one very simple solution- new shoes!  A shoe that is properly fitted should fit the widest part of the your foot, which is usually the front of your foot.  It should be supportive and have some good cushion.  At Advanced Foot and Ankle Care all of our offices have therapeutic shoe stores with a wide array of styles.  Therapeutic shoes have the added bonus of having styles that are wider in the front or “forefoot” but not the heel.  They also feature a higher “toe box” to accommodate for hammertoe deformities.  Orthotics also fit well into these shoes.  It is hard to part with favorite shoes that have become too small, but having a medical reason to shop for new shoes is something to smile about!

Dr. Hillarie Amburgey, DPM

“I Sprained My Ankle”

Sprains of the ankle do not discriminate, as they affect the layperson as well as celebrities (former Olympic gymnast Kerri Strug, ‘American Idol’ winner Kelly Clarkson, ‘Dancing with the Stars’ winner J.R. Martinez, and the NBA’s Dwyane Wade to name just a few).  Here, at Advanced Foot and Ankle Care, ankle sprains are a far too common condition that many of our patients have been diagnosed with and/or have suffered through.  For the sake of brevity, there are 3 common types:

                1. Lateral ankle sprain (most common; outside the ankle)

                2. Medial ankle sprain (inner side of ankle)

                3. High ankle sprain (i.e. above the ankle…rare. Quarterback Ben Roethlisberger of

                    the Pittsburgh Steelers suffered this injury during the 2011 NFL season)

A “sprain” occurs when there is either an abnormal stretching or actual tearing of a ligament, a fibrous tissue that connects’ bone to bone’.  Blood vessels around a sprain can subsequently burst, leaking blood and fluid into the surrounding tissues causing bruising and swelling.  The nerves around the area will feel this abnormal pressure and become more sensitive, resulting in pain.

Treatment is geared first at “RICE” (Rest, Ice, Compression, and Elevation) therapy and immobilizing or splinting the injury.  Depending on the extent of the injury, what usually follows (during the subsequent weeks) is bracing or physical therapy to get you back on your feet as quickly (and safely) as possible.  In those unfortunate cases where perhaps chronic pain or instability (ligaments have torn too much and leave the ankle loose and unstable) persists, surgical intervention may be warranted where ligaments can be repaired and/or a minimally invasive “clean out” of a painful ankle joint (i.e. arthroscopy) may be performed.  (New England Patriots tight end Rob Gronkowski had arthroscopic surgery on his injured ankle after Super Bowl XLVI)

Oftentimes, sprains that occurred years ago are still painful due to either an inaccurate diagnosis or an incomplete rehabilitation in the first place.  Some sprains are severe enough to “strain” or tear the tendons around the ankle.  Along with a physical exam, diagnostic modalities such as musculoskeletal ultrasound (available at Advanced Foot and Ankle Care) or even an MRI may be warranted to fully understand the extent of your “sprain” and help guide your rehab.  Sometimes, a “sprain” turns out to be more involved, including an actual fracture (i.e. broken bone). 

The bottom line is this…pain in and around your foot or ankle is not normal. But, first and foremost, it is imperative that you see an appropriate physician for an accurate diagnosis.  Our team at Advanced Foot and Ankle Care are trained and fully equipped to accurately assess and treat these types of injuries.  If you’ve had the misfortune of suffering a recent ankle sprain or are still experiencing symptoms from an older injury, contact any of our Advanced Foot and Ankle Care Center locations including our Troy office for an evaluation.

Dr. Michael Jones

Zumba: Party Yourself Into Shape, Not Injury

If you haven’t heard about Zumba, the high-energy aerobic workout that’s more like a dance party than an exercise routine, then you’ve probably been living under a rock for the past year.  An estimated 12 million people worldwide now do the cardio-dance classes that are a combination of merengue, salsa, and other Latin dances. 

Zumba is so much fun, it seems like everybody is doing it.  That’s where I, your friendly Podiatrist, come in.  A lot of the people who participate in Zumba are enthusiastic new exercisers who live an otherwise sedentary life.  Add their eagerness, inexperience, Latin dance beats, and bad shoes and you’ve created the perfect storm for a foot injury.   

If I had a dollar for every Zumba-induced foot injury I’ve seen I could pay for a month’s worth of Zumba classes at my local Urban Active.  The four most common Zumba-induced pathologies and injuries I see at Advanced Foot and Ankle Care are

• Plantar Fasciitis- Heel pain caused by an inflammatory process in the plantar fascia, a thick band of connective tissue on the bottom of your foot.

• Intermetatarsal Neuroma- Pain, burning, tingling, or numbness in the front of your foot or toes caused by thickening and enlargement of a nerve in the foot usually as a result of compression and/or irritation.

•   Tendinitis- Pain caused by injury and inflammation of a tendon, which is where a muscle attaches to bone.  The most common types of Zumba-induced tendinitis I see affect the achilles tendon and posterior tibial tendon.

•  Stress Fractures- Pain caused by a cracked or incompletely broken bone.  In my Zumba-ing patients the most common stress fractures I see affect the heel bone (calcaneus) or metatarsal bones.  Stress fractures are often the result of overuse or repetitive stress and are a notorious culprit of pain in people who start an exercise program and do too much too soon.

A more detailed explanation of each of these injuries and how we treat them can be found on our website (www.footandanklecare.org).

All is not lost though.  If you’ve avoided injury thus far or are recovering from a Zumba-related foot injury, there are several things you can do to stay injury-free to ensure that you are getting the most bang for your buck and the most benefit for all that sweating.

Your shoes (not your brightly colored leotard) are the most important article of clothing you wear to Zumba class.  The ideal shoes for Zumba are supportive, especially in the arch area.  The front of the shoes (where your toes bend) should be flexible.  Cross-trainers are great shoes for this type of activity because they allow side-to-side motion and don’t have deep treads like a lot of running shoes do.  This allows them to maneuver through the dance moves easier.  We have several shoe options in our office shoe stores in all three office locations (Huber Heights, Troy and Piqua) that are perfect for Zumba.  And as an added bonus, we have a helpful and knowledgeable staff to help you choose the right shoe. 

An orthotic, a custom-made insole, is also a great option to help prevent injury (especially in certain foot types) or to prevent re-injury if you are recovering Zumba-er.  Orthotics work to support your foot, reduce weight bearing forces on certain areas, and correct the function of the foot to make motion easier and less painful.  At Advanced Foot and Ankle Care we can provide you with a custom-made device that will change your life in and out of Zumba class. 

One of the best things about Zumba is that it lets you customize your own work out.  You can make the class high impact or low impact.  Some gyms now offer Aqua Zumba and  Zumba Gold- the low-impact version.  Be sure to tell your Zumba instructor about previous injuries or special health concerns like pregnancy.  Know your limitations and don’t start out too fast, even if it’s hard to control your hips with those infectious Latin beats blasting.

As always, it’s a good idea to consult your healthcare professional before starting any new exercise regimen. 

Dr. Hillarie Amburgey