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Newsletter Edition 7


 

Living Life, "Feet First," During Quarantine

 

Amidst these difficult times and all the challenges that we are currently facing with the CoronaVirus outbreak, what we are missing the most right now is the ability to humbly serve and treat you - our patients!

As a medical practice, Gotham Footcare is considered to be an essential business during this pandemic crisis. However, I have decided that it is my moral obligation to voluntarily shut down Gotham Footcare except for emergency visits, for the time being to help stop the spread of COVID-19. This was a tremendously difficult decision to make as I appreciate each and every one of you, but a necessary one, so that we may conquer COVID-19 together. We will certainly  overcome these trying times; it is not a a question of if, but of when, and we will prevail together more rapidly if we are all socially responsible and avoid unnecessary social interaction. Until then we will continue to make ourselves physically available to you for emergency visits only.    

In the meantime, we are proud to announce that Gotham Footcare is now offering Telemedicine sessions that require no out of pocket cost to our insured patients. We will also work with you if you do not have insurance. Whether you are facing a new foot health issue, need a prescription refill, discuss lab results, have questions about how to properly maintain your current treatment regiment, or need to speak with our highly qualified podiatrists, we are here to help! Simply visit GothamFootcare.com to book your video appointment today. 

Also in this issue: which ailments you can treat at home, caring for your feet during COVID-19 and a challenge to you – our patients – in advance of April, which is National Foot Health Month.
 
Stay Healthy,
Dr. Gotham

 

                    Gotham In the News                  

          The Best Workout Shoes, According to Experts


 Picking the right shoes for your feet                       


  One Thing A Podiatrist Says You Should Never, Ever Do To An Ingrown Toenail


 

Dear Dr. Gotham,
 
I like to keep my feet in great condition and am a regular in your office. With the COVID-19 scare, I’d like to treat my feet at home for the next month. What are some common foot ailments that I can take care of in the comfort of my own apartment?
 
Signed,
Frantic about my feet

Dear Frantic,
 
While there are several issues that must be handled in office – like bunions, fractures, fungus and neuromas – that's why we're offering the Telemedicine sessions for our patients. However, there are a few common conditions that you can treat in your own home. For instance:

Calluses: Calluses are a thickened and hardened part of the skin that occurs where the skin is subjected to friction typically over a prominence of the body such a joint or bone.
 
When patients come to my office with thick calluses and cracked heels I commonly recommend the use of urea 40% gel such as Bare 40 Moisturizing Urea Gel, which can be purchased on Amazon. I inform my patients to apply this gel evenly throughout both feet at night, wrap their feet with saran wrap, and wear socks to bed. The saran wrap will promote the penetration of the gel into the foot to help break down rough calluses and dry cracked skin and promote smoother and softer feet. In the morning, I recommend the use of a foot file such as the Amope Pedi perfect foot file in the shower to remove the thickened and calluses areas of the foot that have been broken down and softened by the urea cream overnight. Apple Cider Vinegar can be used four parts water and one part apple cider vinegar with 3 table spoons of Epsom Salt and soak your calluses for 20 minutes. Afterwards apply castor oil, tea tree oil, or eucalyptus oil which are natural anti-fungals directly to the callus for 5 to 10 minutes and then exfoliate with a pumice stone.
 
Blisters: Blisters are caused by friction which generally occurs because the skin is between a rock and a hard place. The best way to prevent blisters is to ensure that your shoes fit properly and are broken in correctly.
 
Whatever you do, do NOT remove the top layer of skin from your blister.  It will only cause the blister to become more painful and expose yourself to more bacteria which could develop into an infection. Instead, you should lance the blister. Take a clean needle, and poke the blister from the side to drain the fluid. Once the fluid is removed, the pressure will subside. Then soak your foot for 15-20 minutes in lukewarm water with Epsom salt. I also encourage using Betadine to help dry up the blister which will speed up the healing process.

Certain Toenail Issues: Some toenail issues can be treated at home – like toenails that have white spots. For this condition we recommend taking a nail fortifying vitamin such as Hair, Skin, and Nails, Biotin, or even Prenatal Vitamins for females.  Be patient and simply allow the healthy nail to grow and gradually replace the white nail over time.  This can take several months to resolve as the toe nails only grow a millimeter per month. You can also allow your nail to grow out when it’s suffering from a bruise on the nailbed which causes it to turn purple or black. 


 Get Ready... April is National Foot Health Awareness Month!

 

Unless my patients are experiencing excruciating foot pain, an unsightly toenail or unpleasant scent, they’re content allowing their foot issues to progress. After all, our feet are the most neglected part of our body.

As we all self-quarantine, making an in-office appointment may prove to be difficult. But, with National Foot Health Month on the horizon, I challenge you to make a virtual booking if you suffer from:

1) Athlete's Foot: a fungal infection of the foot that develops commonly on the soles of the feet and in between the toes. Athlete's foot usually produces itchy, dry, scaling skin. In more severe cases, inflammation, cracks, and blisters may form. Athletes commonly suffer from sweaty feet and use the facilities where the fungus is found, thus the term "athlete's foot."

2) Ingrown Nails: a common condition typically affecting the great toe, in which the corner or side of the nail becomes incurvated (turned inward) and grows into the skin and soft flesh of the toe. This results in irritation of the surrounding soft tissue, often causing pain, redness, swelling, warmth, and sometimes and infection.

3) Plantar Fasciitis/ Heel Pain: The most prominent symptom of plantar fasciitis is arch and heel pain. It may feel like a stabbing pain in the bottom of your foot when you get out of bed in the morning, after standing for prolonged periods of time, or when you stand up after sitting for a while. It’s also common to experience pain after you exercise, not during your workout.

4) Tendonitis: an inflammation along the Achilles tendon. The Achilles tendon is the largest tendon in the body and is, therefore, susceptible to overuse injuries from running and jumping type exercises. It is responsible for plantarflexion of the ankle (causing the front of the foot to lower and lift the heel off the ground).

5) Bunions: a biomechanical imbalance involving the great toe joint. It is often described as a bump on the side of the big toe. Bunions start when the big toe rotates sideways towards the second toe and the first metatarsal projects outward in the opposite direction producing the characteristic bump, which increases prominently over time. 

6) Neuromas: a painful growth of nerve tissue in the foot, most commonly found between the heads of the third and fourth metatarsals, the long bones in your feet. When your metatarsals in your feet compress together because of either foot deformities, high-impact activities, or the use of tight shoes such as heels, the nerves between the metatarsals become irritated and swollen.

7) Ankle Sprains: Ankle injuries occur when ligaments are stretched beyond their normal range of motion and the ankle moves in an awkward motion beyond the normal range of that joint. The most common mechanism of ankle sprain is a combination of plantarflexion and inversion, or a downward-inward motion of the foot about the ankle.  When this takes place, the 3 main outer ankle ligaments stretch or tear depending on the severity. With severe ankle injuries, fractures and joint displacement can occur.

 


 

Anyone can develop plantar fasciitis. You don’t have to sustain an injury. Plantar Fasciitis can develop simply because of overuse and walking. New Yorkers are more prone to develop plantar fasciitis because people walk more than average as they typically commute to and from work by foot.  

But, several factors can increase your risk of getting it, such as:

  • Tight calf muscles
  • Obesity
  • Repetitive impact activities such as running.
  • Work that requires you to stand for prolonged periods of time. 
  • Flat feet or high arches.

Here at Gotham Footcare, your doctor will perform a thorough physical examination with x rays and an ultrasound to identify the source of the heel pain.  90% of patients at Gotham Footcare walk out of our offices pain free with 6 weeks of treatment that involves a combination of simple home and in office modalities such as:

  • Home stretching exercises
  • The application of ice (using a frozen water bottle)Topical and or oral anti-inflammatory medications
  • Night Splints that help stretch out the plantar fascia
  • Custom orthotics
  • Physical therapy
  • Immobilization
  • Cortisone injections when necessary

If these treatments do not improve your condition,  your doctor may recommend minimally invasive surgery for plantar fasciitis. Gotham Footcare proudly offers the most advanced minimally invasive surgical treatments in the industry including Shock Wave Therapy and other services. These procedures are low risk and have a high rate of success.  They are highly effective at fully resolving chronic foot pain with a faster recovery time enabling patient to get back to work and being active.

 


 Health Focus: Your Feet In The Time of COVID-19

 

As most of you remain in quarantine, there are few tips I want to leave you with to ensure the proper care of your feet over the next several weeks.
 
1) Don’t walk barefoot ever. Yes, I know most of you will be in the comfort of your own home, but walking barefoot on hard surfaces allows our foot to collapse which can lead to a tremendous amount  of stress not only to the foot but to the rest of the body. Walking barefoot also exposes our feet to bacterial and fungal organisms that can infect the skin and nails. These organisms can lead to infections that change the appearance, smell, and comfort of the foot such as athletes foot or fungal nails, which leads me to my next tip…
 
2) Don’t wear your outside shoes indoors. The filth from the New York City streets can expose your feet to a variety of fungal and bacterial organisms that can result in plantar warts, athlete’s foot and much more. Make sure you have a pair of house shoes that exit your front door.
 
3) Change your socks frequently. Socks are used to provide a layer of warmth and protection between your skin and the outside surface. Once they become moist, they are a breeding ground for bacteria. Even though most of us are restricted from hitting the gym, I recommend you change your socks (preferably wool or cotton and not nylon as they absorb moisture better) at least once a day. 
 
4) Soak your feet. There are several benefits of regular foot soaking that may benefit not only the feet but also your overall health. Soaking your feet helps to relax muscles and reduce pain/ strain because it helps promote circulation of the feet. Going to a (sanitary) foot spa may also help in detoxification of the feet by promoting the transfer of toxins to the lymphatic system and kidneys which helps improve the health of your feet but also of the body. The effects of soaking your feet includes reducing and headaches and stress ultimately helping your disposition and overall health. 


Product Plug: Vionic Unisex Wave Toe-Post Sandal 

 

Most of us walk barefoot while indoors and doing so is horrible for our feet especially if you suffer from heal or arch pain. When we walk barefoot, our arch collapses and this can cause the ligament on the bottom of our feet called the plantar fascia to pull and tear, leading to aches and pain. The plantar fascia is a bowstring ligament that originates below the heel bone and inserts in the ball of our feet. Every time you stand and bear weight onto your feet, the distance between your heel and the ball of your feet increases as your arch collapses. Walking barefoot on on hard indoor surfaces can lead to repetitive stress and ultimately micro tears of the plantar fascia which can be quite painful. I recommend using the Vionic Unisex Wave Toe-Post Sandal - Flip-Flop with Concealed Orthotic Arch for indoor purposes only if you tend to walk on hard surfaces at home. 


 

Patient Testimonial

On January 1, 2018, I woke up with the idea to pick up running, yet I couldn’t run to save my life. And guess what I did… I signed up for the SHAPE Magazine Half Marathon (13.1 miles) on April 15, 2018. Talk about being all in or… having no brain! I had no idea what to expect, I never run before, and on top of that, I had no time to train as I was starting a busy season. April 15 came and went, and so did two of my toe nails! And this is how I met Dr. Sanaz Lalehparvar, an ankle and foot surgeon, at Gotham Footcare, in Manhattan. I really had no idea that I injured my toe nails that badly that had to be removed, but that’s what happens when you think you are superwoman.  

One thing I noticed, walking into Gotham Footcare, was the friendly and homey atmosphere. I felt I was walking into someone’s living room! A warm and inviting living room that makes you forget your pain! I connected with Dr. Sanaz immediately. She put my mind at ease, explaining the procedure, the way every step would work and how it would feel like, what to expect right after and the few days that followed. She was in contact with me right after, to see how I’m healing. I have completed several runs since then and as I’m now officially a runner, I am also an expert on foot related injuries. Last year I went back as all of sudden I couldn’t put my foot down without experiencing excruciating pain. I was diagnosed with plantar fasciitis and sesamoids. My case was a little unique as I didn’t have the classic symptoms for plantar fasciitis and one thing that impressed me about Dr. Sanaz was that she exhausted every possible scenario and various avenues of treatments to see what worked and what didn’t until she narrowed down the diagnosis. Gotham Footcare is one stop shop. They provide physical therapy in house, the physical therapists take the time to listen and are in constant communication with the doctor that treats you. It’s a great team and everyone makes you feel at home. It felt like Cheers and I was Norm! I highly recommend them, and if you go, tell them Athina sent you!

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