This is the most common question patients ask when they receive new orthotics, or ort

There are many styles of orthotics

hopedic insert. It is an excellent and certainly logical question. If you are prescribed orthotics, we spend a lot of time carefully discussing the effect they have on your feet, gait and skeletal alignment.  When you’re in alignment, there are significant benefits and walking is easier and pleasurable.

So why wouldn’t want to wear your orthotics all the time?

In Austin there is at least one quick answer. Say it’s more than 100 degrees outside and you are wearing sandals which do not accommodate orthotics. You are faced with a choice. You can have hot feet, or you can have balanced feet.

Often women are faced with this choice at a formal occasion, wear dressy shoes which do not accommodate orthotics, or wear inappropriate shoes that are comfortable. What to do?

Our answer, don’t worry about it. Do the best you can. Choose a sandal with some arch support. If the high heel has enough room, we can add an adhesive arch pad which is significantly better than nothing. Many patients who must wear dress shoes frequently will bring us their shoes for a custom-made insert.

In some cases, we can even create an orthotic to fit a particular shoe style. One of our clients desperately wanted orthotics to fit her designer cowboy boots, which are practically a birthright for a Texas woman. We were able to create just the fit she needed.

Designer cowboys can be fitted with an insert or orthotic.

Wear your orthotics as much as possible, and certainly when you are working out or walking long distances. A brief time in a sandal or a dress shoe without an orthotic is not going to cause problems. In fact, it may be a good thing to give your foot some variety.

Personally, I went to visit my brother in New York City this summer and knew we would be walking a tremendous amount. Even though it was sweltering, I wore my sneakers with my orthotics. While my feet were a little hot, I can assure you that I would not have made it through that very long day of walking without wearing my orthotics!

So use your judgment and use your orthotics as often as practical and certainly when you are doing a lot of walking!

Learn more about orthotics here.

Now, medical device designers are using micro-scale materials to make the needle shorter and thinner, which produces less painful shots. Medical designers are also using the tried-and-true method of imitating nature by following the model of the mosquito. Designers hope to design new devices that, like the pesky insect, combine a vibrating smoothed and serrated insertion tube to discreetly extract blood.

Another new development is a small patch consisting of 100 dissolvable drug-loaded polymer micro-needles, which is virtually painless. It is applied like a Band-Aid!

The problem with these ideas is that they are designed to get a small amount of a drug through the skin such as a vaccine. In my field, we may need to inject more volume than a vaccine and often the injection needs to be in deeper tissue.

Fortunately, we have methods to decrease pain. These days, we use a very small gauge needle and combine that with ethyl chloride cold spray which quickly numbs the skin while the injection is performed. The pain is minimal and over quickly, but we will certainly keep our ears to the ground to learn if there are less painful ways to deliver key medications for our patients. It would be great to have a totally pain-free shot!

Keryflex nail restoration is a great option for those with the following toenail conditions:

• Toenail Fungus or Onychomycosis
• Oddly shaped nails due to injury
• Splitting or brittle nails
• Discolored nails
• Spoon-shaped nails

Don’t risk infection at a traditional nail salon. Instead seek a quality replacement for damaged nails in a medical office. The Keryflex system allows medicine to transfer down to the nail bed, making it an ideal choice for patients treating toenail fungus (onychomycosis) or other nail conditions with topical medications.

Benefits after laser toenail fungus treatment

Even after receiving treatment for toenail fungus, the old, damaged nail must grow out before the healthy, clear nail is present. This process often takes six months.

With Keryflex, patients can have normal-appearing nails the same day as laser treatment or the start of topical treatment. In toenail fungus treatment, the thick, infected nail is typically removed in a painless process called debridement. Whether a physician is treating the infection with a laser or topical medication, debridement allows the treatment to better penetrate the infected nail. After debridement, the nail appears rough and dented. With a Keryflex application, the patient can leave the office the same day with ready-for-the-public nails. Best of all, Keryflex allows patients to continue to apply medication because it is created with a porous material that, unlike the gels or acrylics that you find in a nail salon, allows medications to pass through to the nail bed. And unlike salon materials, it breathes, preventing any latent fungus from being trapped underneath and allowed to thrive.

Here are before-and-after photos of treatment completed in our office:

Photos taken of a patients treated for toenail fungus and then followed with Keryflex application.

If you have questions about Keryflex or laser treatment of toenail fungus,

call Arbor Foot Health Center at 512-445-NAIL or 512-445-6245.

or email appointment@arborfoot.com.

Anyway back to The Breeze. We have an Internet radio device that picks up radio stations from all over the world. I was looking for a smooth jazz station that would not put Paula to sleep. We found The Breeze in Auckland, New Zealand has the perfect mix of music to satisfy both of us. A number of our patients have asked us the name of the radio station because they like it as well.

Some of our favorite things about The Breeze are that they are 19 hours ahead of us and when we come into the office on Monday it is already Tuesday morning and on Thursday it’s already Friday! The work week is shorter and Monday is gone! Another neat thing is that the seasons are reversed in New Zealand. When we are in the heat of summer it is winter there. How refreshing it is to hear about sleet when it’s more than 100 degrees outside! Once the patient was in the chair and it was about 95 degrees outside and they heard the radio station say they were predicting sleet and snow- you should have seen that patient’s face!

Paula likes the cute accents of the disc jockeys. I get a kick out of hearing the advertisements and one day want to call this plumber who advertises on the station and ask him about coming over to fix the office sink! Neither Paula nor I have been to New Zealand, but from everything we’ve heard it sounds like a wonderful place.

UPDATE: October 5, 2011

Q-Clear is NOW APPROVED by the FDA to treat  fungal nails.

After 20 years using and reviewing medical lasers and a year carefully evaluating the laser market for fungus toenail treatment, I have purchased what I consider to be the premier laser – the Q-Clear laser. It offers several significant benefits compared to the competing lasers.

First, the Q-Clear laser is more effective for some podiatric complaints because it uses two wavelengths of light. It’s more comfortable for patients because it pulses at very high power over a short duration. It has a long track record for medical use and is already FDA-approved for 17 medical conditions including tattoos, spider veins and warts.

Patients will also find this laser offers more affordable treatment. The equipment is reasonably priced and the company does not charge a fee every time the machine is used.  Insurance typically does not cover cosmetic procedures, so by containing our costs, we greatly benefit our patients.

The PinPointe FootLaser™ currently is the only laser FDA-approved for treating fungus toenails, or onychomycosis, and holds the largest portion of the market for this treatment. The PinPointe is not only more expensive to purchase, but the company charges a sizable fee every time the machine is used. I believe this artificially inflates the costs of the laser treatment. Also, the FDA approved this laser only for the “temporary” increase of clear nails.

I have more than 20 years experience using the carbon dioxide laser for ingrown toenails and warts. Using my experience serving on Seton Hospital’s Laser Committee, I evaluated the laser market and knew that waiting until the market matured a little would allow me to purchase a superior laser with quality results. In former blogs, I discounted the value of laser treatment for toenail fungus because results for permanent results with the PinPointe FootLaser was mixed, and studies of other medical lasers were limited.

Now, I am excited about adding the Q-Clear Laser with its two wavelengths to treat a variety of podiatric conditions. See what the laser has done for other patients here. Increasing this laser’s versatility, the manufacturer has applied for FDA approval for use on toenail fungus. Though this approval has not been given, off-label use is common in all medicine, and often creates expanded and improved treatment options for patients.

My judgment on the laser market was recently confirmed by David Zuckerman, D.P.M., in a letter on Podiatry Management Online this week. After owning several lasers, Dr.  Zuckerman concludes, “my last laser and the best for podiatry and the public is the Q-Clear. It’s fast, works well and good outcomes. (sic) This laser is FDA approved for 17 indications, e.g. tattoos, spider veins, warts, and can be used for fungus toenails.”

We look forward to being able to better serve your foot health needs with superior laser technology!

An acute gout attack often will wake you up with pain in your great toe joint, (your big toe). Gout can occur in any joint, but it is most common in the great toe joint. Some foods and drinks can bring on a gout attack, but that is beyond the scope of this blog. Learn more about them here.  I refer gout patients back to their medical doctors for evaluation of the cause and long-range treatment of the root problem, excess uric acid in the body. This can be caused by either making too much of the acid, or not being able to get rid of it. Genetics, alcohol use, diseases and other factors can contribute.

Where I create my magic is relieving severe pain from the acute attack. I perform a specific nerve block with a long-lasting local anesthetic. As a board-certified foot surgeon and podiatrist, I am an old hand at finding the precise location for this block, decreasing any pain from this procedure. I prescribe a nonsteroidal anti-inflammatory drug, and provide you a list of foods that can exacerbate gout.

By the time you leave my office, you will have significant relief of your pain. By the time the affected area “wakes up” usually 80 to 100 percent of the pain is gone! You may even think I’m a magician!

Dr. Gary Prant

By Dr. Gray Prant,
D.P.M., Podiatrist

Anyone who treats heel pain — technically plantar fasciitis — glosses over one of the single biggest contributors to that pain – excess weight. Often for a podiatrist, it’s the elephant in the room. Let’s address the elephant.

When we are young, the tight band on the bottom of the foot known as the plantar fascia is elastic. The plantar fascia acts like a spring when we walk. With every step our foot collapses a little bit and stretches the plantar fascia. As we propel ourselves into the next step, the plantar fascia rebounds and helps give us that spring forward in our step.

As we get older, the plantar fascia – like our skin – loses some of its elasticity. Unfortunately, we often gain weight as we get older as well. Weight gain as little as 10 or 15 pounds can noticeably increase stress on the plantar fascia. According to this article from Johns Hopkins Arthritis Center, only 10 extra pounds of weight can increase the force on the knee by 30 to 60 pounds with each step, so imagine what that would mean for the foot.

On the bright side, a relatively small amount of weight loss can produce significant results. In a1997 Framingham study of the elderly, it was found that for every 11 pounds of weight lost, the risk of osteoarthritis decreased 50 percent.

We who treat plantar fascia every day see several broad groups of patients. For many of them, weight loss would greatly improve their symptoms.

There are people who have gained a little bit of weight and stand on cement surfaces for many hours. These people are particularly hard to treat because their jobs require them to stand on a rigid surface. For these patients, the best long-term treatment may be addressing what they can change, and sometimes that means losing a little bit of weight.

The second and largest group of people we see with heel pain are those who have gained more than 15 pounds over the years. This group does respond well to various foot treatments, however, I often observe that the most effective treatment can be reaching a normal weight. If medical efforts relieve that person’s pain and allow them to move more and lose weight, our treatment’s effectiveness improves exponentially. In addition, I can almost guarantee those who are 50 or 100 pounds overweight can get relief of their foot problems if they lose that 50 or 100 pounds.

Just think what other health and lifestyle benefits those with foot pain would enjoy from being a normal weight! With the dawning of the New Year, consider this just another reason to pursue healthy lifestyle changes.

Learn more about heel pain treating the cause of heel pain and non-invasive, high-tech treatments here.

There’s much hype lately about treating the humdrum problem of toenail fungus with a high tech laser. Many forget the less glamorous but inexpensive and effective treatments for this problem. Combining one ancient treatment with a new topical drug is proving extremely effective for my patients without the use of far more expensive laser treatment.

Ten percent of the U.S. population – some 35 million Americans – suffer from toenail fungus, or onychomycosis. Before they head out for the “latest and greatest” treatment of toenail fungus, they might want to try longtime remedies and new medications.

The mainstay of fungus nail treatment for podiatrists going back maybe hundreds of years – maybe thousands – has been debridement of the toenails. Debridement is an ugly, yet fancy, medical word for grinding down the toenail so it is thin and then using an instrument to clean out the debris underneath the toenail. This reduces the fungus in the toenail by removing some of the fungus underneath the nail. Also, thinning the toenail allows topical medicine to penetrate the nail and kill the fungus within it. An important side benefit of debridement is that the toenail immediately looks much better. I have seen fungus toenails almost an inch thick. A toenail that thick can be painful in a shoe and is nearly impossible to cure with a topical medicine because nothing can penetrate that thick toenail.

Combined with the age-old treatment of debridement, there are several new topical medications which are remarkably more effective then medications available just a few years ago. We have been getting excellent results with a new form of topical terbinafine. Terbinafine is the exact same medicine which was used in oral Lamisil. Oral Lamisil is the most effective medication for fungus toenails but there is a concern about side effects. The new topical version of terbinafine avoids the systemic side effects. There are several other effective new topical medications which we use for fungus toenail problems in specific patients.

It takes about nine months to one year for a new toenail to completely grow in. Whether you spend $750 or more for a laser procedure, or pay your co-pay for an office visit and buy the new topical fungus toenail treatments, you will need to be patient for a clear toenail.

Read my opinions of currently offered laser treatment for toenail fungus here and my thoughts of the procedure in general here. While I DO support the use of lasers for certain podiatry complaints and have had great success in my office with conditions like ingrown toenails, I recommend my patients wait a bit longer to treat toenail fungus until the next generation of lasers is released — and that may be in just a few months.

Despite recent government approval for laser treatment of fungal toenails, I recommend patients wait just a little longer before they pursue such treatment.

I served on The Seton Hospital Laser Committee, a North Austin hospital, for some years and have reviewed the research on the treatment options carefully in order to recommend lasers the hospital should purchase for treating patients. Invariably over the years, after one product received FDA approval, within six months there were new, superior lasers on the market making that first-approved laser literally a “piece of junk.” I have personally spoken to experts in the laser field. These people say that the nearly approved lasers are superior to the Pinpointe laser and should treat the problem much more efficiently.

Ten percent of the U.S. population – some 35 million Americans – suffers from nail fungus. Until now, the only approved treatments were topical antifungal treatments, which were often not effective, or an oral medication that had serious potential side effects, like liver damage.

In October, the use of the PinPointe™ FootLaser™ (PathoLase) was approved for the treatment of nail fungus (onychomycosis) by the U.S. Food and Drug Administration, FDA. PinPointe USA, Inc., the company that makes the laser, is heavily advertising this approval. But before you rush out to have your nails zapped, I advise caution.

First, the announcement is somewhat misleading and overstated. The approval is for the temporary clearing of fungal toenails. The approval is also for a type of laser protocol used for fungal toenails. Cast your attention on the word “temporary.” Fungal toenail infections are notoriously difficult to treat because they return again and again, largely due to the moist, dark environment inside the shoe, which offers a perfect growth environment.

Second, the other thing I had against the Pinpointe laser is that the company charges a sizable fee every time the machine is used. I believe that this artificially inflates the costs of the laser treatment.

Finally, in just a few months other laser manufacturers may receive approval from the FDA for better lasers.  None of these other laser manufacturers charge a fee every time the laser is turned on. This should bring down the cost of treating fungal nails with the laser significantly!

So I advise my patients to hold your horses and wait for a more long-lasting and less expensive treatment option. Meanwhile, they may consider a combination of an ancient treatment with a newer topical medication. Read more about that here.