Both Dr. Jennifer Saam and Dr. Stephanie Kim of Bellevue Podiatry will be there performing free foot health screenings.  Foot health is extremely important for all diabetics, and having regular foot exams and proper care can prevent many of the complications that diabetics experience.  A pro-active team approach that involves you, your podiatrist, and your primary care provider is the best way to keep your feet healthy.

Click Here for more information about this event!

In an article published today in the Seattle Times, Reebok International Ltd., which is owned by Adidas, has been ordered to return $25 million to consumers over reported false advertising with its’ toning shoes, which include “EasyTone”, “RunTone” as well as several types of flip-flops and clothing.

So-called “toning” shoes, which have been available for the last couple of years, have been a popular trend, and are manufactured by many of the big shoe companies such as Skechers, New Balance, Reebok, and MBT.  However, Reebok is the first company to be penalized for making advertising claims that the shoes can result in measurable changes in muscle tone and size, specifically in the buttock and upper legs.  Apparently, there was a lack of scientific evidence to support these claims.

Many of my patients have tried similiar toning shoes, and the overwhelming response has been positive.  I have however cautioned everyone to puchase them because they feel supportive and get you out walking, NOT because they will make your buttocks more toned.  Also, any patients who have balance issues should not wear these shoes, due to the curved bottom of the sole which could lead to falls.

Jennifer Saam, DPM

Helping a Foot in Need

What a busy, meaningful, inspiring time we had at the 3-Day walk in Seattle last weekend!

Pink Tent City

Approximately 2000 walkers participated in the 60-mile (yes- 60!) walking event that wove through the greater Seattle/Bellevue area.  Dr. Stephanie Kim and I had the privilege of attending to many needy feet, and we were truly amazed at each walker’s story:  some were walking in memory of a loved one who was struggling or had lost their battle with breast cancer, and others were fighting cancer or were survivors themselves.  Anything we can do to keep those feet moving is a privilege, and it is what drives us at Bellevue Podiatry to volunteer every year at this important event.  Congrats to all who walked!!  -Dr. Jennifer Saam

Dr. Kim and Medical Director

If you are a walker in the 3-day, here are some tips to keeping your feet healthy for all 60 miles…

1.  Wear properly-fitting shoes which have been broken-in on some of your longer walks.

2.  Don’t wear new shoes or gear, instead rely on comfortable favorites which have been tested on prior walks.

3.  Be sure that your shoes are long enough-  too-short or tight shoes can lead to blistering.

4.  Keep your nails trimmed short.

5.  Synthetic or “sport” socks tend to wick moisture better and keep feet cooler than 100% cotton.

6.  Don’t wear toe rings or other foot/ankle jewelry.

Good luck to all of the walkers!

Our current office hours are: Monday 9-6, Tuesday 9-5, Wednesday 9-6, Thursday 9-5, Friday 9-5, and Saturday 9-2. 

To read more about our doctors, please link to Dr. Stephanie Kim or Dr. Jennifer Saam on our Bellevue Podiatry website.

There are several over-the-counter (OTC) ointments and medications that you can try to treat your toenail fungus. Your doctor can also prescribe oral and topical prescription medications.  Surgery to remove the nail and Laser treatments are also available. The goal of most of these treatment options is to attempt to kill the fungus and allow the uninfected nail to grow out. It takes approximately 10 to 12 months for toenails to grow out.  The choice of treatment modality will vary considerably depending on severity and extent of the disease, coexisting medical conditions, patient medications, physician and patient preference.

OTC( Over-the- Counter medication)

Tea tree Oil and Miconazole Nitrate cream/gel. The over the counter Miconazole Nitrate is usually mixed with ingredients like Alcohol, Cocamide, Benzyl Alcohol, Tocophenol, Isobutane, and Propane and Sorbitan Sesquioleate. Once it is mixed with the ingredients it becomes a good anti-fungal solution for mild and preventive treatment for fungus.

Anecdotally, home remedies such as daily application of Listerine or Vicks Vapo-Rub are thought to help to kill nail fungus.  You may also hear about soaking your nails in vinegar.  While there are no large scientific studies which prove that these methods work, they pose little, if any, risk, and I do not have a problem with patients trying them.

Prescription: Topical medications and oral medication

Topical Medications

The advantage of topical therapy is that it allows for direct application to the affected area and reduces the chance of adverse systemic drug reactions. Prescription topical medication is great choice for the patients with mild- to moderate fungal disease, those with hepatic or hematologic disorders that may put them at risk with systemic medication usage, and for those unwilling to take systemic medication.

• Penlac:  The only topical medicine approved for use in the United States. Penlac needs to be applied to the surface of the entire nail and the surrounding skin daily. Once a week, it is removed with rubbing alcohol along with debris and unattached nail.
• Naftin, Lamisil, and Loprox creams may also be used for onychomycosis. There have only been small studies done using these.  They are typically prescribed for fungal infections on the skin.
• Formula 3:  Antifungal cream+ Urea Cream
• Urea Cream: The use of urea cream may help dissolve the toenail and any topical medication penetrate the nail.

Oral Medication

The oral antifungal medications offer the advantage of a high efficacy rate and short-course therapy. However, not everybody is a candidate for oral therapy.  It is important to select the patient wisely, as some of these medications pose a risk to your liver or kidneys.  Simple blood tests are routinely done first to rule out any underlying health problems.

• Terbenafine (Lamisil): This medication has an efficacy rate of 70-80%, and has been proven to kill most of the fungal organisms that infect nails. It is taken daily for 12 weeks.  It carries the risk of liver toxicity.
• Itraconazole (Sporonox): This medication works by inhibiting the growth of fungus.  It is less commonly used today and also poses a risk to your liver.
• Fluconazole has also been used to treat onychomycosis. It only needs to be taken once a week, for a total of 3 months for fingernails or 6 months for toenails. It does not work as well as terbinafine or itraconazole, but is processed primarily by your kidneys, so carries less risk for liver side effects.

Laser Treatment/Surgery

Laser therapy is a relatively new option for treating toenail fungus.  It is safe and fast, and initial studies show a high success rate.  Laser treatment for toenails is not covered by insurance, and with a total cost of up to several thousand dollars, it becomes cost-prohibitive to many patients.  Only a few physician nationwide are offering laser in their office.  Time will tell whether this will become more mainstream and affordable in the future.

In addition to wearing supportive shoes, it is recommended that you put no more than 300-500 miles on each pair.  For example, if you walk or run three miles per day, you should replace your shoes in the range of every three to five months.

A great initial resource for your shoe search is a quarterly running shoe review published by Runner’s World magazine.  Their Summer 2011 Running Shoe Guide is now available.  If you aren’t sure what foot type you have, or if you have recently suffered from foot and ankle problems, see your podiatrist for guidance.

The causes can be multifactorial.  Basically, anything which can upset the delicate balance of tendons and muscles which keep the toes on the ground can create hammertoes.  Think of a marionette (string puppet), where pulling different strings will cause the puppet to move in different directions.  Your toes are very similiar, where the strings are the tendons located in your foot and leg, all working together.  If you have overpowering of one tendon or group of tendons, the toes will no longer be balanced and the joints will bend in a hammertoe position. 

Having an arch which is excessively high or low can be associated with hammertoes.  Also, any foot type which changes the distribution of pressure across the ball of the foot, such as a bunion, can lead to hammering of the smaller toes.  This is why your second toe can start to curl up if you have a bunion, even if the bunion is not hurting you. 

Certain types of arthritis such as Gout or Rheumatoid Arthritis which damage the joint can destabilize the muscle-tendon balance and lead to hammertoes.  For these diseases, treating the underlying arthritis is critical as part of your overall treatment plan, and I often work closely with other medical professionals in these cases.

Nonsurgical therapy generally starts with choosing shoes which allow for more space around the toes.  There are also various pads and splints available which can help realign the toe, but these generally are more for comfort and do not provide permanent correction.  I carry several of these in my office, and many can be found at specialty shoe stores.  Addressing the overall alignment of the foot and supporting the arch with an orthotic can be helpful as well.

When non-surgical measures fail, there are procedures available to surgically straighten toes.  A thorough exam and X-ray evaluation is important in pinpointing both the cause as well as the best treatment plan.  Sometimes, other causative factors or foot deformities may need to be addressed at the same time to prevent re-occurance.

My personal opinion is that if you have a pretty average arch and foot type, and do not have a history of injuries or other overuse problems, go ahead and try them.  However, I caution even the biomechanically-gifted to do so gradually, perhaps wearing them around the home for the first couple of weeks, then for regular daily walking activities, and then, finally-  go for a short run.  The reason is that your feet, like most of your body parts, need time to adjust to the change. 

Most of the traditional running shoes have a multi-layer, multi-density midsole portion, with many options available to support even the flattest of flat feet.  If you have been wearing this standard shoe for years (or decades), running on concrete or pavement, it will be quite a shock to your body to convert to minimalist shoes quickly.  The injury mantra of “too fast, too far, too soon” will echo through your head as you limp home in your new barefoot-style shoes, hoping to find an ice pack in your freezer. 

You may hear friends mention some of the great barefoot East-African marathon runners who never seem to get injured running miles in nothing but skin, and think, “I can do that too!”  Well, maybe, but most of these great ones have been barefoot runners since childhood, and are extremely fit and slim, and have taken years to get to their current level (NOT too far, too fast, too soon).

The other concern is that walkers and runners in modern society spend a lot of time on concrete and asphalt, not exactly the back-to-nature experience that you envision when trying on your slipper-like new shoes.  Consider venturing to a nearby park or trails for a softer surface which will may help to ease the transition.

As for the final question about whether to put an orthotic into one, I suppose you could, but to me it seems counter to the whole point of wearing a barefoot shoe.  If your foot needs that additional support, it would be better to stick to the traditional running shoe design.