​The process of smoking directly involves your respiratory tract: nose, mouth, throat, and lungs; so it makes sense when you hear that smoking causes breathing and lung-related problems such as cough, wheezing, emphysema, and lung cancer. However, smoking also affects your vascular system by impairing your circulation and decreasing your body's potential to heal! 

In a non-smoker, healing of a bone fracture by growing 1 cm of new bone takes 69.6 days. Yet, that same physiological process takes 89.4 days in smokers. Why is there a difference in healing rates? Healing rates are directly affected by blood flow and in smokers blood flow is impaired.

Smoking-induced circulatory disease (which is essentially damage to the blood flow systems of the body) actually causes more deaths than lung-associated diseases. Another alarming fact is that circulatory system damage starts early on in the course of smoking!

What is the circulatory system? The circulatory system is composed of our heart and all the associated pipelines that transport blood to tissues of the body and then bring them back to the heart (arteries, veins and capillaries). Blood is an important element because it carries oxygen and vital nutrients to tissues and organs. The blood vessels (pipelines) need to be clean and unobstructed on the inside to transport blood through them.

The smoke from cigarettes contains a molecule called carbon monoxide that damages the smooth tissue inside walls of blood vessels and as a result, substances such as plaque and fat can start to stick onto them.  These adherent substances start to build up in the vessels and slow the transport of blood. However, carbon monoxide is not the only culprit in smoking causing circulatory disease. Nicotine is another compound that worsens circulatory disease.

Nicotine plays two roles that can greatly exacerbate circulatory disease. 1) It activates the sympathetic nervous system which is the “fight or flight” mode in our bodies – which increases blood flow and thereby forces it through the clogged vessels and 2) the “fight or flight” mode triggers a release of stored fats as a mechanism for instant energy. This increase in fats has a greater probability of attachment along blood vessels damaged by carbon monoxide and further impeding blood flow! 

Do yourself a favor, it's a new year, make the resolution to quit! Even decreasing your intake of one cigarette a day or week will help to slowly whittle down your need for it! Your body will thank you!

If you think you have a vascular issue to your lower legs/ankles/feet, contact Dr. Nisha Krishnan at Beverly Hills Foot and Ankle, PA to schedule your appointment!

One of the most common foot and ankle complaints center around the onset of heel pain. Millions of patients visit their health professional for heel-related pain, so if you have it, you are not alone! The good news is that heel pain can be alleviated with non-invasive treatment with great results if it is evaluated and diagnosed early.
 
What are the roots of heel pain?

It is important to remember that heel pain is caused by some underlying foot deformity or by repetitive trauma. For instance, the most widespread reason for heel pain is due to plantar fasciitis. The plantar fascia is a ligament which is a tissue that connects bone to bone (from the heel bone to the base of the toes) and helps to support the arch of the foot. Plantar fasciitis is the inflammation of said connective tissue and the pain manifests itself in the center heel region. The degree of pain may fluctuate, but the overall commonality is the experience of a sudden flare up soon after becoming mobile in the morning. Excessive running or jumping may lead to this condition.

Inflammation of the Achilles tendon (known as Achilles tendinitis) is also a contributor to heel pain. This pathology has many sources for its origin: injury, increased age, bone spurs, or tight calf muscles. If medical treatment is not received early, this condition may lead to muscle tearing, formation of scar tissue, and adhesions (an adhesion is a band of scar tissue that binds two normally separate tissues together)

The degeneration of the fat pads (also known as fat pad atrophy) in your foot can cause heel pain. The fat pads function as shock absorbers and if your feet strike hard surfaces it can lead to their thinning. Walking on hard surfaces with thin fat pads means your foot bones are absorbing the shock which leads to the pain.

Another reason for the development of heel pain is due to constant pounding of the foot on hard surfaces. Running on asphalt or concrete surfaces will lead to increased mechanical pressure/impact on your bones, joints and soft tissues versus running on turf or grass. You may also irritate tissues in the foot if you participate in prolonged high-impact exercise and play sports without stretching prior to your activity. A more common culprit is wearing ill-fitting shoes.

Most people, especially athletes try to ignore the signs of heel pain and keep on executing the action leading to their condition. As you may imagine, this ends up worsening the ailment and the heel pain could proceed into the chronic phase which leads to more problems!

Fortunately there are many non-invasive solutions to help with heel pain should you have it. It is definitely important to make sure an ultrasound of the area or radiographs are obtained to ensure there is no fracture or sprain in the area of question. You may be a candidate for custom-made or over-the-counter inserts that will reorient your foot while walking and distribute the ground reactive forces different. Anti-inflammatory medications may be helpful as well as rest, ice and elevation. You may need to be strapped, braced or placed in a walking boot depending on your diagnosis. Your doctor will know the best treatment option for your condition! 
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Think you have heel pain? Call Beverly Hills Foot and Ankle, PA for an appointment today at 352-513-4867!  

Dedicated to all my friends and family members who are new moms or soon-to-be new moms! :)

Pregnancy is a wonderful phenomenon that brings about so many changes in a woman. Every major body system undergoes alterations in anticipation of the baby’s development and arrival into the world!

Pregnancy brings about certain foot changes such as edema, overpronation and increased foot size. Hormones cause almost all the changes that occur in a woman’s body due to pregnancy. Hormones are involved in almost every biological process including growth, immunity, metabolism, and reproduction. A hormone molecule acts like a little key that is secreted by a gland in the body into the blood. This key travels in the blood to link up with its matching lock elsewhere in the body to open up chemical processes like the manufacture of a certain protein, the multiplication of cell number or the stimulation of a chemical change.

One of the key players in pregnancy is the hormone, relaxin. The purpose of relaxin is to relax the tissues that bind the bones of pelvis together. By loosening up the pelvic connective tissue, the body will allow for the passage of the baby through the birth canal. However, relaxin does not just affect the pelvis.

Relaxin increases foot size because it loosens the hold of the ligaments in the foot. (Ligaments are tissues that connect bone to bone.) As a result, the arch of the foot starts to decrease in height and cause the foot to spread. Another reason that the foot grows in size is due to the increased pressure on it as a result of weight gain. The extra weight stems from the body hormones that amplify breast size and uterus size as well as the growing baby. The pressure also decrease the arch and flatten out the foot. Scores of women have reported that their foot grows by a half-size or more during pregnancy!

An array of foot problems can occur if you do not accommodate your increasing foot size! If you keep wearing tight footwear you can exhaust the muscles at the ball of your foot which play a role in keeping your toes straight! Also the jamming of your foot into tight shoes causes the development of corns, ingrown toenails, and bunions. 

The effects of additional weight and slack ligaments on your foot requires well-fitting shoes with good support. Start with over-the-counter arch supports to maintain the arch and minimize problems. Furthermore, make an appointment with your podiatrist to keep your foot health in check! They may prescribe custom orthoses and advise you on other courses of treatment! 

Having foot and ankle problems? Call Beverly Hills Foot and Ankle, PA today at 352-513-4867 and schedule your appointment! The doctor would love to see you! 

The wonder of pregnancy does not just stem from the fact that there is another human growing within you, but the considerable and diverse internal and external changes occurring throughout the body! Unfortunately, not all of these changes are favorable as they may cause discomfort or pain. Pregnancy may cause a variety of uncomfortable foot conditions stemming from edema, overpronation, and increased foot size like varicose veins, foot pain and leg cramping. To ensure that your foot health remains optimal during pregnancy, it is important to educate yourself and talk to your podiatrist. 

Overpronation
            When the arch of an individual’s foot flattens out when weight is put on it, it is referred to as overpronation. Overpronation is seen in obese individuals, flat-footed people and in pregnant women. A person with this foot condition will find that their feet roll inwards while walking – which leads to all sorts of biomechanical effects such as ankle, knee and hip pain. All the joints in your leg work together to function in gait and balance and improper movement at the ankle will lead to the inappropriate delivery of forces up the leg and cause all sorts of problems.

            Pregnant women experience overpronation and its associated symptoms because of the weight gain and the resulting added pressure on the foot. Overpronation causes your walking experience to be unpleasant and strains the muscles in the foot, leg, and back. In addition, the plantar fascia (a fibrous connective tissue connecting your heel to your forefoot) will become inflamed causing painful plantar fasciitis. Other problems that can occur if overpronation is not corrected are bunions, tibialis posterior tendinitis, metatarsalgia and heel spurs!

            The good news about overpronation is that surgery is not required to correct it, however, if overpronation is not treated – it may lead to foot pathologies that will require surgery! Ready-made orthoses are available to treat overpronation. These will specifically be made to have arch support as well as rearfoot posting for the innermost surface of your foot. You can also make wise choices by selecting comfortable shoe gear that provides sufficient shock absorption and added support.

            If you find that your symptoms worsen, make an appointment with Dr. Nisha Krishnan and Beverly Hills Foot and Ankle, PA.  They will fully evaluate your foot health and make appropriate recommendations! 

This is the first of a three-part series regarding pregnancy and all things feet! 

Pregnancy is no doubt one of the miracles of nature and is a cherished experienced for any mother-to-be! A woman’s body undergoes an amazing array of transformations to accommodate the new life developing within it! Pregnancy is a phase of life that engages the entire body and mind, resulting in a multitude of changes. Along with those changes, an abundance of precautions should be undertaken to ensure that during pregnancy and childbirth the mom and baby will both be healthy, comfortable and safe.

Every bodily system in a woman’s body experiences significant changes, and in regards to the foot, the 3 most noticeable changes due to pregnancy are swelling, overpronation and increased foot size!

Swelling
Swelling (or edema) is a condition that a majority of women experience while childbearing.  Edema usually occurs in the later stages of pregnancy and is caused by an accumulation of fluids in the lower extremity. The enlarging fetus and growing uterus put pressure on the blood vessels in the pelvis and legs. This causes a slowing in blood circulation and as a result the blood accumulates in the lower extremities. In addition, the fetus is also sitting on your lymphatic channels (vessels that drain fluid from all areas of the body) and putting pressure on them, leading to their narrowing. This constriction inhibits their ability to remove the lymphatic fluid which then keeps collecting in the area of your foot and ankle!

Edema is not EXTRA body fluid caused by pregnancy. The total amount of water in the body is exactly the same. Rather, the fluid has just has been shifted to another location due to the obstruction of both blood and lymphatic vessels. Edema will cause an enlargement of the affected body area and may cause that part to tinge purple.

There are various ways to reduce the discomfort of edema. Practice the avoidance of knee-high socks and of pantyhose/socks with elastic bands. Make sure to elevate your feet, take every opportunity to sit rather than stand, and obtain plenty of rest. Although it may sound counterintuitive, it is important to increase your water intake! The extra ingestion of fluid will assist in flushing your system of waste products which may also play a role in the swelling. Also, decrease the amount of salt in your diet since it is attributed to water retention in the body.

Swelling is normal in pregnancy, but if you see that its onset is abrupt and/or that it occurs in your hands simultaneously as they are indications of preeclampsia. Preeclampsia is described as a pregnancy-related high blood pressure and is a dangerous condition!

Stay tuned to see how pregnancy can lead to other problems like overpronation and increased foot size. If you have any this or any other foot/ankle/lower-leg associated problems, call Beverly Hills Foot and Ankle, PA today at (352) 513-4867 to schedule an appointment with Dr. Nisha Krishnan! 

The “Ow” in Ingrown Toenails!
Ingrown toenails are a common and uncomfortable foot condition that cause a lot of pain and discomfort. There are many reasons for ingrown toenail occurrence and some of those causes can be eliminated with education and hygiene.

What are ways to prevent an ingrown toenail?
The most frequent causes of ingrown toenails are improper toenail clipping and tight shoe wear. Both of which can be easily remedied.

Toenail clipping
Many people are unaware that there is a certain technique involved when it comes to clipping toenails.  Toenails should never be longer than the tips of your toes, but do not cut them too short as to reveal the soft pink tissue underneath. This skin tissue is easily inflamed, causing pain.

When attempting to cut toenails, make sure to use proper toenail clippers. A normal nail cutter has slightly curved cutting edges while a toenail cutter has edges that are straight across in order to reduce the likelihood of ingrown toenails. Observe the natural line of your toenails and when grooming toenails make sure to trim them straight across. Do not round off or cut the corners of your nails or pry the corners when cutting.

Shoe wear
Proper-fitting shoes are essential for good foot health. Small, tight shoes not only compress the toes and toenails, they do not allow your feet to breathe, lead to foot discomfort and may even affect the biomechanics of your walking. When shoe shopping, do it in the late afternoon or evening because you feet are at their largest size. In addition, make sure your foot size is measured every time before purchasing shoes to ensure an appropriate fit. 

How do you determine if a shoe is too tight? Do yourself a favor. On a piece of paper, draw the outline of your foot. Then, find a pair of shoes, remove the insole and place it over of the outline of your foot. Does the insole accommodate your foot properly? If it does, you should not be able to see much of the outline of your foot around the insole. If you can see most of your foot, then those shoes are tight. 

What are treatments for an ingrown toenail?
There are a variety of non-invasive and invasive (surgical) treatments for an ingrown toenail. 

• Soak your foot in warm water 
• Place a piece of cotton in the affected corner
• Wear comfortable shoes with a sufficient room for your toes
• Consider wearing open-toed shoes to prevent shoe material from touching the affected area
• Take aspirin or ibuprofen for pain relief

As soon as you detect an ingrown toenail make an appointment with your podiatrist! An ingrown toenail may be complicated by an infection caused by the nail breaking into the skin, so it is best to leave your problem in their hands. In the case of an infection, your doctor may prescribe oral antibiotics. If you have diabetes or poor circulation, seek a medical professional for treatment of your ingrown toenail!

Surgical intervention may be necessary to remove the offending part of the nail and prevent infection. A partial or complete nail avulsion is a procedure where the doctor injects anesthetic in your toe and then instruments are used to cut away the ingrown toenail portion without disturbing the nail bed. If you follow your podiatrist’s recommendations, you will minimize your discomfort and hopefully prevent the recurrence of the problem!

What is an ingrown toenail?
Nails grow from an area called the matrix and are made of keratin, a protein found in human skin. Nails in the matrix grow and multiply and as they do so they get pushed out. Old cells start to compact upon themselves into the nail plate. The half-moon shape on your nail, called the lunula, is a visible part of the nail matrix. The underside of the nail plate and the top of your toe where the nail plate grows each have ridges which allow the nail plate to firmly adhere to the underlying skin.

An ingrown nail is defined as when the skin on one or both sides of a toenail develops over the nail edges or when the nail itself grows into the skin. The medical term for the condition is onychocryptosis. Although it most commonly occurs on the big toe, the lesser toes may also be affected.

Why does it happen more to your big toe than your thumb?
The toenail is much more flat than your thumb and as a result, the toenail endures the most stress between growth and adhesion near the tip. The adhesion force and the growth forces are imbalanced, the stress builds up and they can cause the flat toenail to veer off its ridges and cause ingrown toenails. The round shape of a thumbnail decreases these forces at the tip. When the two forces get out of balance, they are more likely to cause the flat toenail to veer off the rails and become ingrown.
 
What are some reasons for ingrown toenail occurrence and the resulting pain?
Ingrown toenails may be caused by a variety of factors! They can have genetic origins; the nail is just too large for the toe or may be curved, leading to the predisposition of the condition. Or they may be due to trauma to the area such as stubbing your toe, dropping a heavy object or having it stepped on.

Improper clipping of toenails such as trimming too short leads to skin inflammation and shoe friction upon that skin further increases the pain. An impacted toenail can first be seen directly after improper grooming of toenails. The nail looks like it has been cut back too far and there is exposure of the pink tissue around the edge.

Running often and hard leads to formation of ingrown toenails because the pressure on the toes from the shoes. Wearing tight shoes or shoes too small for the feet also lead to the condition because the toes have no room and the nails are becoming compressed.

Why do ingrown toenails seem to affect kids, pregnant women and the elderly?
The prevailing theory for why ingrown toenails seem to disproportionately affect kids and pregnant women is that there is influx of growth hormones in both age groups. As a result, the force of growth easily overpowers the force of adhesion. However, the elderly experience a different type of scenario. As the rate of nail growth decreases, the force of adhesion becomes stronger and the condition of a "pincer nail" usually develops. The pincer nail is when the nail plate curls over the toe tightly. When the forces of growth or adhesion are imbalanced as result of physical trauma or age, the nail can curve into the skin and essentially incise it.

How do you know that you have an ingrown toenail?
Besides causing discomfort and pain, there are other indications that lead to the diagnosis of an ingrown toenail. The signs of a toe with an ingrown toenail are redness, swelling, tenderness and rigidity. In some cases, there may be pus drainage from the area of the impacted toenail. In addition, the condition will not fix itself and the nail will not correctly grow out. The nail keeps growing into the tissue surrounding it and increasing the severity of the pain. When you take a toenail clipper to the nail, it will become harder to trim the nail back. The skin around the ingrown toenail is very sensitive to touch and even contact with socks and shoes will inflict pain! In addition, an ingrown toenail may lead to infection causing further inflammation and pain! 

Stay tuned for the next part in the series of The "Ow" in Ingrown Toenails! If you feel like you may have a foot, ankle or lower leg problem, call Beverly Hills Foot and Ankle, PA and request an appointment with Dr. Nisha Krishnan at (352) 513-4867! We're happy to be of service! 

Winter time conjures up memories of snow angels, snowball fights and snow men! However, care must be taken to prevent cold injuries as a result of prolonged exposure to the weather. Skin injuries due to the cold are due to ice crystal formation in the tissue. To prevent crystal formation from occurring in the vital tissues of your body such as your brain and heart, blood gets diverted from your extremities (arms and legs) into the core (trunk and head). The process of redirecting blood flow to more vital structures is called arteriolar shunting.

The process of transferring blood to the innermost aspect of your body means that your extremities are more prone to dying off with increased exposure to cold. In essence, your body sacrifices your limbs in order to keep its vital functions going. Without blood keeping the area supplied with oxygen, nutrients and warmth – it is easy to see why areas furthest away from the head and heart are most affected by the cold.

Frostnip
Frostnip is a freezing type of cold injury where reversible ice crystal formation occurs. This is the mildest form of frostbite and the nose, ears and extremities are the most likely areas to encounter it. When frostnip occurs your affected areas will become white and have a decreased sensation. Rapid rewarming in water heated to over body temperature (104-108F) is the best way to rescue those areas from further damage. The reasons for the use of very hot water is to shorten the frozen state, increase the local blood flow to the area and decrease the time cells are exposed to ions in the blood.

Superficial Frostbite
Extended exposure to the elements can turn a condition of frostnip into superficial frostbite! In this case, the cold has penetrated the area of skin and its underlying tissue, called the subcutaneous layer. There are a variety of signs that indicate superficial frostbite has occurred: itching/burning that is later replaced by ache, swelling, cyanosis (blueness), excessive perspiration, and coldness of injured parts that occurs 2-3 weeks after the injury and lasts for many months! The cold did not kill off the nerves in the affected area so there is significant pain.

Think you may have some problem in your feet and toes? Come on into Beverly Hills Foot and Ankle, PA for an evaluation with Dr. Nisha Krishnan! Call the office today at (352) 513-4867 to schedule your appointment! 

With cold weather approaching, it’s important to learn how to protect yourself from the bite of cold! Did you know that your skin is the largest body organ and comprises 15% of your total body weight?  Your skin works to protect your body from a host of environmental assaults, but trauma in the form of hot or cold injury can compromise its protective properties.  A cold injury, such as frostbite can cause fluid loss within the skin and increase its breakdown and the likelihood of infection.  

Although frostbite is used as a general term to cover all sorts of cold injuries, there are actually different and specific types of cold injury with frostbite being just one of them. The non-freezing types of cold injury are chilblains and immersion injury (trenchfoot). The freezing types of cold injury are frostnip, superficial frostbite and deep frostbite. 

Chilblains
The mildest form of cold injury is called chilblains and is the most commonly experienced. It occurs when bare skin is exposed to temperatures of 33 – 60 Fahrenheit.  The typical places for chilblains to occur are the ears, fingers and the tip of your nose.  The best way to treat chilblains is prevention: avoiding the cold and protecting those prone areas. Make sure to cover yourself adequately before going out! If chilblains does occur, the best way to treat it is via rapid rewarming and the application of moisturizers.

Immersion Injury
Immersion injury is also known as trenchfoot because in World War I, many soldiers who fought in the trenches experienced this type of cold injury. Unlike other cold injuries that are associated with cold air, immersion injury has to do with cold water. Cold water leads to much rapid heat loss than cold air by about 25-fold! As a result of the water penetrating the skin, trenchfoot can occur at much higher temperatures than the cold you may associate with frostbite. As a result of prolonged skin exposure to water in cold weather, your foot may look dusky and blue with swelling or blister formation. The best way to treat the affected area is to rewarm and dress the area with dry materials.

Stay tuned for Part 2 of Frostbite Factoids! There's a lot to know :) Come on into Beverly Hills Foot and Ankle, PA if you have any questions or concerns about cold injuries! Call us at (352) 513-4867!

Leaves are not the only dry things you'll find this season! The seasons of summer and winter are the harshest time for feet! You may have noticed that your feet become exceptionally dry in the summer due to too much sun while in the winter they become chapped and cracked due to the cold. In both instances, the lack of moisture in your skin lead to the unsightly and uncomfortable conditions of excessive dryness. 

Your feet are accustomed to staying moist and supple; there are over 250,000 sweat glands between your two feet! In one day, your feet may produce up to a pint of sweat! 

The medical term for rough, dry skin on your feet (or in any other bodily area) is xerosis and it may not just arise due to seasonal conditions. Xerosis may also occur if you wash your body and feet too often or may occur due to malnourishment. Basically, xerosis comes about when the natural oils in the outer layer of your skin become depleted. These oils function to retain water, and in the absence of oil your skin loses water or dehydrates. 

Xerosis affects anyone and everyone regardless of gender, race or age; however incidence rises with increased age. In some cases, other medical conditions may cause xerosis: diabets, HIV/AIDS, hypothyroidism, or Down syndrome. Xerosis is dry skin and may be accompanied by other signs such as scaling skin, cracking, and red/pink patches due to inflammation. Itching may or may not be associated with xerosis. 

If you find that you are experiencing these symptoms, there are several care guidelines that you can follow to diminish the discomfort:

• Take short lukewarm showers just once a day to prevent dehydration 
• After bathing, make sure to dry your skin by patting with a towel rather than rubbing 
• While skin is still moist, apply a oil-based moisturizer (Oil-based moisturizers function to keep your skin hydrated better by preventing water escape from your skin and they work better than water-based moisturizers in that respect). 
• Use a humidifier in seasons where you notice dry skin occurring (A humidifier will put water into the air and reduce the rate of your skin drying out).
• Drink plenty of water!

If you find that your condition of xerosis is still bothersome, make an appointment with by calling Beverly Hills Foot and Ankle, P.A. at (352) 513-4867! Dr. Nisha Krishnan can help find the right treatment for you!