Of adults over 40 years of age in the United States, about 4.5% have peripheral arterial disease (PAD). This is a lack of circulation to your legs and feet.  Healing an ulceration where there is a lack of circulation is very challenging for you and your doctor.  The most important part of healing these open sores is bringing blood into the foot.  Dr. Geller works with vascular surgeons, interventional cardiologists and radiologists who can help with this part of your care.  The actual care of the open wound is determined by Dr. Geller.  This will involve something to keep pressure off the sore and medication applied to the wound.  At Desert Foot Surgeons you will find a physician with the expertise and experience needed to develop a program that best suits your needs.

Those of you who have healed an arterial ulceration have suffered a great deal of pain and possibly even undergone surgical correction of the poor artery circulation.  If this is not enough reason to quit smoking I don’t know what is. Part of your recovery will be walking for exercise to increase circulation even if you had surgery. Since most arterial ulcerations are on the feet you will need protection of the scar by shoes and possibly inserts. Your heels may need to be protected while lying in bed. Moisturizing dry skin using specific foot creams is also recommended to help prevent new or recurrent ulcerations.

Dr. Stephen Geller, AZ Podiatrist

The big toe can develop a lump or bump on the inside of the foot. This prominence initially becomes painful in shoes from pressure, but if left untreated arthritis will set in. The lump on the inside of the foot at the base of the great toe is called a bunion. Often mistakenly referred to as a growth of bone, the cause of a bunion is really the result of an unstable joint. The loss of stability in the big toe joint causes the bone behind the big toe to drift inward leading to the lump or bump. The more the bone drifts, the more your big toe falls toward the second toe.

How the joint becomes unstable is related to the way your foot hits the ground when you walk. A detailed examination of your feet while standing and walking is needed to determine why your foot is unstable. If caught early custom molded foot orthoses can restore stability to the joint and prevent further damage.

If painful, damage to the joint has already occurred. Custom molded foot orthoses will restore stability to the joint, which can improve pain, but usually therapy involving anti-inflammatory medication is needed as well. When pain does not respond to stabilizing the foot, surgery is needed. The goal of surgery is to provide stability to the joint from within preventing further damage. This is accomplished by moving the bone that has shifted back into line with the big toe. The more the bone needs to be shifted, the longer the recovery. So getting treatment early is always recommended.

Dr. Stephen Geller, DPM , AZ Podiatrist

Swelling in the legs can be caused by bad veins with valves that no longer work, injury from prior blood clot or phlebitis, weak muscles that pump the blood up the leg, or increased pressure in other organs such as your heart.

In order to heal your wound you were placed in some form of compression wrap. Once your scar was mature enough to handle pressure from socks you were prescribed support hose. Even though we live in Phoenix where temperatures often exceed 100ºF the compression is needed to fight the swelling. Surgery is often used for bad veins, but even so support hose are a required part of this treatment. There is no way around it, you will have to wear some form of compression garment.

Dr. Stephen Geller, AZ Podiatrist

Toes that are bent or buckled hurt when you put them into shoes. Parts of the toe can rub against shoes making areas of hard skin, known as corns. These can be reduced by your podiatrist, but will never resolve unless the toe is straightened. Changing the shoe to keep pressure off the toes might not be possible depending on how severe the toe is buckled.

The treatment differs based on the stiffness of the bent toe. Smaller toes such as the 4th or 5th that can be straightened by hand often can be treated by simple tendon release. This is the easiest hammertoe surgery to recovery from often requiring a single stitch. If more than one toe is done at a time the recovery can be slightly longer.

If the bend in the toe cannot be straightened by hand, removal of the rigid joint is performed. At Geller Podiatry we employ a detailed step-wise approach to straighten all parts of the toe. The more deformed the toe, the more steps will be used from simply fusing the toe joint straight to breaking the metatarsal head and repositioning the entire toe. Tight skin has to be lengthened using plastic surgery techniques so that the toe can stay straight and the scar is more cosmetic. In general these procedures require protection from walking using a cast boot. X-rays are used to follow the toe healing process and you will be returned to shoes when your doctor sees evidence of bone healing.

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Between 30-50% of patients with diabetes have peripheral neuropathy. This is a nerve injury that prevents you from protecting your own skin by losing feeling. In addition, the nerve damage interferes with your muscles leading to deformities and difficulty walking. Pressure increases over these prominent areas leading to callus formation from repeated injury. Damage from the callus or injury leads to open sores or ulceration.

Your wound care treatment has included some form of “off-loading” by padding or casting. This is how we remove pressure from the open sore to allow the body to heal. Under the care of Dr. Geller you also had to remain in this cast or padding 4 weeks after healing to allow the scar to mature. To prevent return of the ulceration you will need protection from pressure on prominent areas.

You should be very proud of yourself. You have accomplished what more than 90,000 Americans failed to do this year. You saved your leg from amputation due from diabetic ulcer.

More than 90,000 people lost a major part of their foot or the entire leg to complications beginning as a wound on their foot. Some of these were not avoidable, but it is estimated that 64% of these could have been prevented with advanced wound care such as you have done.

Now our focus switches to prevention. You and your physician do not want you to experience anything like this ever again. You have most likely been treated using some form of cast or padding to keep the pressure off your foot and swelling down. Since this was necessary to heal the wound it should be no surprise that something will be needed to keep the wound healed.

Prescription shoes with custom-made inserts are used to cushion and protect the feet. You will have to wear these shoes with inserts everyday for quite some time. Every year your insurance will pay for new shoes. You should receive three pairs of inserts for these shoes to be changed every four months. The longer you stay healed and the better you control the callus formation the more flexible your shoe selection will become.

In some patients surgery was performed to correct deformity and decrease pressure. Even these patients have to wear the prescription shoes with insoles.

Dr. Stephen Geller, AZ Podiatrist

Hammertoes develop when the toes buckle under the pressure of walking on an unstable foot. When your foot pronates too much, the muscles work harder to support your arch. If your foot remains unstable the toes bend as muscles fight to prevent the arch collapsing while you walk. Left untreated the toes will stay curled leading to corns, calluses, and pain.

Early treatment is important. At Desert Foot Surgeons we perform a detailed examination including video gait analysis to identify the reason for the unstable arch. If you do not correct the true cause of the problem it will only return. Foot orthotics are used to stabilize the arch and prevent hammertoes in the early stages. Once the toes stay bent treatment involves changing the shoes that push on the painful toe or surgically straightening the toe.

Dr. Stephen Geller, AZ Podiatrist

If the shoe fits…How do you know?

Introduction

On average a person takes 3,000 – 5,000 steps per day, or roughly 4.3 miles. A 150 pound-person walking one mile exerts 127,000 pounds on each foot. That’s more than 540,000 pounds (273 tons) per foot in one day. By the time you are 35 years old the average person has walked 55,000 miles. With that much stress on our feet it is estimated that every person will suffer from foot pain or injury at some point in his or her lifetime.

As a podiatrist, the majority of people I treat have already experienced the pain or injury. I spend a great deal of time working with my patients to find shoes that are best suited for their needs. This doesn’t mean that foot surgery is not a necessary part of treatment, but I often tell my patients that it is easier to change the shoe than it is to change the foot. Even surgically corrected feet need a stable shoe before returning to walking. Changing shoes is often the first line of treatment.

In public the most common question I get is,

What are good shoes to wear?”

That’s not such a simple question to answer. First of all I usually know nothing of that person’s daily activities and usually have not examined their feet. Unfortunately that doesn’t stop people from showing me their feet in public places, but still there are many things to consider. What is your foot type, activity level, are you a pronator or supinator, do you have any deformities, is perspiration a problem, what’s the quality of the shoe materials, do you wear orthotics or not, and so on.

Advertising might make you want one brand of shoe so you can play basketball like LeBron James or run like Usain Bolt. Don’t be fooled, professional athletes possess special physical abilities that most of us don’t have. It is not the shoes that make them able to jump higher or run faster. Think of it this way. Usain Bolt wears his shoes for at most 200 meters, which takes him less than 20 seconds. His shoes are so uncomfortable that he has to remove them in order to run his victory lap barefoot.

Patients like to know what brand of shoe I use. The shoes I wear are comfortable for me and perform as I need, but that does not make them a good shoe for you.

Another problem is that there is no standardized sizing in the shoe industry. One company’s size 9 medium width is another company’s size 8 ½ wide. Knowing how a shoe is supposed to fit is more important than knowing what size you wear. But who teaches you that? If you were lucky enough to grow up without hand-me-downs you might have been shown by an educated shoe salesman or woman. Even so, most of us don’t receive any training in how shoes are supposed to fit.

If the shoe fits…How do you know?” was written for you.

In this report you will learn how to determine your foot type, what pronation and supination are, how to tell if the shoe fits correctly, the anatomy of a shoe, and how to care for your shoes.  You can download it here: (insert link to report)

Dr. Stephen Geller, AZ Podiatrist