Podiatry

Achilles Tendon

The Achilles is the largest tendon in your body, which, if damaged, can cause a considerable amount of pain. This tendon commonly overtightens, which limits the range of motion in your ankle. This is called Equinus.

Equinus can lead to over 20 issues in the foot and ankle including bone spurs, arthritis in the big toe and midfoot, pinched nerves, flat feet, heel spurs, plantar fasciitis, heel pain. A tight tendon can lead to tearing and degeneration overtime. Eventually, a heel spur can form due to the tight tendon pulling on the bone.

Standard treatment can include: x-rays to check for spurs, an ultrasound to evaluate the tendon, immobilization in a boot, pain creams, a heel lift, physical therapy, a daily stretching brace, taping, and orthotics. Alternative services include non-steroidal injections, amniotic stem cell injections, and laser therapy to help promote healing.

Ankle Instability

If you are someone who’s ankle tends to suddenly “roll” or give out on you, then you should be evaluated. There are many conditions that can lead to unstable ankles. Over time, your ankle ligaments can become stretched out and no longer protect your ankle from giving way. This could eventually lead to serious injuries such as ankle arthritis or ankle fractures.

Standard treatment includes: x-rays and/or ultrasound, ankle bracing, taping, and physical therapy. If damage is minimal, we can give you daily strengthening exercises to help with re-tightening of the ligament and improve stability to the ankle joint itself.

Ankle Arthritis

Typically x-rays are done to evaluate the joint to determine how severe the arthritis is. Sometimes there can be large spur or “potholes” in the cartilage.

Standard treatment consists of x-rays, ankle bracing, ankle exercises to keep the joint from stiffening up, ankle taping, and physical therapy. Alternative treatments include non-steroid injections, prolotherapy, and laser therapy.

Arthritis

Arthritis (aka osteoarthritis) is a degenerative condition that causes pain and stiffness when bones rub against one another from the cartilage in the joints breaking down. There are nerve pain endings in the bones which causes pain.

Typically we perform x-rays to assess the extent of the arthritis. If mild, it can be treated with pain creams, orthotics, stretching and mobility exercises, and injections. Alternative treatment options we offer include nonsteroidal injections, amniotic stem cell injections, prolotherapy, and laser therapy.

Big Toe Joint Pain

Arthritis and Gout are often leading causes of joint pain in the big toe. When there is arthritis in the big toe joint the cartilage wears down and the bones rub against each other causing pain. With time, the bones can start to form bone spurs and you may see lumps and bumps around the joint. Typically, we get x-rays to assess the extent of arthritis. If mild, it can be treated with a variety of things including pain creams, orthotics, stretching and mobility, and injections. Alternative services we offer include non-steroidal injections, amniotic stem cell injections, prolotherapy, and laser therapy.

Signs of gout include sudden redness, swelling, and severe pain in the big toe joint. Normally uric acid is present in the blood and eliminated in the urine; however, during gouty attacks the uric acid crystallizes and accumulates in the joint. Some people do not get rid of enough uric acid through their kidneys, while others ingest too much from their diet or produce too much in their body.

If gout attacks run in your family, you could be at risk. Patients may have a gout flair up after over-indulging in high fatty foods or drinking larger quantities of alcohol. Sometimes, changes in your medication (especially diuretics or water pills) can trigger a gouty flare up. Typical treatment includes xrays, medication, injections, and waiting for the flare up to subside. Diet modification is often important to prevent another flare up.

Bunions

Bunions are a foot deformity caused by shifting of the bones along the great toe joint. The 1st metatarsal( the 1st long bone) shifts outwards causing a boney bump at the base of the big toe. The great toe then starts to deviate towards the 2nd toe.

Over time the 2^nd toe can start to lift up or turn into a hammer toe. While poorly fitting shoes can speed up the formation of a bunion, the primary cause is typically hereditary. Signs and symptoms include a bulging bump on the outside of the base of your big toe, swelling, redness, or soreness around the big toe joint, a callus along the big toe, pain along the big toe, restricted movement of the big toe.

Conservative treatment includes padding, orthotics, taping, injections, and foot mobilization exercises. Conservative treatment can help alleviate pain but it can not fix the deformity.

Bunions do not go away on their own. If you suspect a bunion, we encourage you to schedule an appointment and have it evaluated. Over time, your symptoms may become worse. Proactive treatment can help manage symptoms and slow down the progression.

Children’s Foot Care

Did you know that it is normal for children to have flat feet up until the age of 5? At one year old, they can be the most severe and as each year passes the arch should slowly improve. By the age of 6, if your child still has significant flat feet it should be addressed immediately with x-rays, foot assessment, gait evaluation, and most likely orthotics. Dr. Stouder is trained in biomechanics and can effectively evaluate your child’s foot.

Toe-walking and in-toeing are other conditions that should be evaluated. If your child is growing quickly and/or has tight calf muscles, they could be developing Sever’s disease which is when the achilles tendon is pulling on the growth plate in the heel bone. Your child may have shin splints due to a combination of increased activity and stress on the muscles.

If your child has flat feet they should be evaluated. It’s possible they were born with a coalition which is when two bones in the feet are fused together that shouldn’t be. We will take x-rays to rule this out. Do not let anyone tell you your child is just having “growing pains” or “they will out grow it”. There is a reason they are having pain. It can be evaluated and effectively treated before it becomes a serious issue.

Orthotics can be very effective for children as well. If they have flat feet it is important to support the arches as they grow. It helps to maintain the integrity of their tendons and ligaments and also helps to support their knees, hips, and back. For example, did you know that flat feet in children can result in scoliosis? If one foot is flatter than the other it creates an imbalance in the legs, pelvis, and vertebrae resulting in scoliosis. Having a foot assessment at an earlier age is a proactive approach you can take for your child. Conservative treatment includes orthotics and sometimes bracing.

Corns/Calluses

Calluses are thickened, hardened layers of skin typically caused by excessive pressure or friction. Corns are dense areas of dead skin protein (keratin) that form a knot-like bump. These can make it feel like you are walking on a stone. They can be caused by an injury, pressure, or unknown cause. Wearing soft shoes with padding can help alleviate the pain but typically corns need to be removed to provide effective pain relief. There are many different forms of treatments for corns. If you just excise it, it is very common for them to return weeks or months later. At On the Move Podiatry, we offer many different types of treatments to help prevent them from returning.

The most basic treatment includes excising out the core of the corn (which is usually painless and doesn’t require anesthetic), followed by application of Cantharone which is a solution derived from the blister beetle Cantharis Vesicatoria. The goal of this solution is basically to “shock” the skin cells into forgetting that they were producing excessive keratin in the first place.

Another simple option is to apply nitrous oxide to the base of the lesion after excision. We then place offloading padding in your shoe to take the pressure off.

Regardless of the cause, we can perform a thorough foot evaluation and come up with a unique treatment just for you. Who says your corn has to be trimmed every 3 months by a podiatrist? The goal is to have permanent removal so that it does not return ever again.

Deformed Toenails

There are many different reasons why toenails can be deformed and they can have many different appearances. They can be thickened, crumbly, discolored, cracking, curvy, have ridges, etc. The most common cause for deformed nails is fungus. Fungus creeps up under the toenail and gets between the skin and nail. It then begins to replicate, which over time deforms the nail. It can make the nail appear thicker, change colors, and cause crumbling underneath. Common treatments include topical medication and oral medication. We offer an effective alternative treatment which includes micro drilling of the toenail, application of topical medicine, followed by class IV MLS Laser therapy. (See Micro Drilling Services)

Trauma is another cause of toenail changes. If trauma only occurred to the nail plate, the nail may return to normal as it grows back in. If trauma occurred to the actual nail matrix (which is located back by the cuticle), the damage may be permanent. For example, if you have a deep cut in your skin, you may develop a scar that never goes away. This is a similar scenario – if the cells that grow the toenail (the nail matrix) are damaged enough, then they are forever altered and the nail will not grow in the way it used to. Treatment can include: routine trimming and smoothening of the nail, permanent removal of the nail, or cosmetic nail reconstruction (See Cosmetic Nail Reconstruction Services).

Another common cause of toenail changes may be related to certain diseases or environmental factors. If you have psoriasis you may notice pitting changes to the toenails or white discoloration. Toenail appearances can also change due to chemotherapy. Although these types of toenails do not have to be treated, the cosmetic appearance of the nail may bother you. If that is the case, treatments include routine trimming or smoothening of the nail, permanent removal of the nail, or cosmetic toenail reconstruction (See Cosmetic Nail Reconstruction Services).

Diabetes

Dr. Stouder is highly trained in diabetic foot care and wound healing. Patients with diabetes must pay close attention to their feet because they can be more susceptible to serious complications. Elevated blood sugar can limit blood flow, decrease nerve function, dry out the skin, cause muscle weakness, delay healing of wounds or blisters, and contribute to toenail changes.

By seeing a podiatrist for routine foot care, your feet can be regularly evaluated for developing conditions. During your appointment, we assess circulation, inspect the skin for changes, and check for neuropathy. We can also provide additional care as needed, including nail and callus trimming, and can measure your feet and recommend appropriate diabetic shoes, which may be purchased through the office. Dr. Stouder has helped many patients avoid serious complications through early identification and treatment of foot conditions. Proactive and early care is especially important for patients with diabetes.

Unfortunately, there are times when diabetic foot conditions become more serious before treatment is received. Infections, wounds, abscesses, and other complications should be evaluated promptly to prevent them from worsening. If an infection is severe, potentially life-threatening, or requires hospital-based care, you will be advised to seek immediate treatment at the hospital.

Flat Feet

Flat feet are common and occur when the arch of the foot is collapsed, which can cause the toes to point outward and/or the heel to roll inward. There are two primary types of flat feet:

Flexible flat feet: The foot retains motion, and the arch can return to a more normal position when supported with appropriate orthotics. Arthritis is typically not involved in this type.
Rigid flat feet: The arch is fixed in a specific position and cannot be corrected with an orthotic. This type is more commonly associated with arthritis.

Symptoms of either type can include pain in the ankle, heel, arch, and forefoot. The tendon that helps support the arch can become overworked, resulting in pain and tendonitis. Muscle cramping may also occur. Flat feet can contribute to overall foot instability and may increase the likelihood of ankle sprains, bunions, and hammertoes.

Conservative treatment may include x-rays, wearing properly fitting shoes that provide adequate support, taping or bracing, orthotics, foot mobilization, and physical therapy. Alternative services offered may include nonsteroidal injections, amniotic stem cell injections, and laser therapy.

If the tendon that supports the arch becomes inflamed, all-natural injections may be used to help reduce inflammation. Steroid injections are generally avoided in this area because they may further weaken or damage the tendon.

Foot Deformity

From flat feet to bunions, we can check you for any possible foot issues to keep you moving. Sometimes the deformity is mild and not serious, but other times it can be related to a serious condition.

Severely high arches can be associated with a neurological condition (known as Charcot Marie Tooth disease). Flat feet in children may be caused by a birth defect where the two bones are fused together that shouldn’t be (known as a coalition). If your foot deformity has been concerning you or weighing on your mind, call us today so that we can alleviate some of your concerns!

Fractures

If you have had an injury, especially with signs of bruising and swelling, call us right away for x-rays and an assessment of a possible fracture. It is important to have a foot specialist evaluate foot injuries because some fractures or other serious injuries can occasionally be missed.

You may also have ongoing foot pain and swelling that has persisted for several months and has not improved. Stress fractures can also be serious and should be evaluated promptly. Early diagnosis and appropriate treatment can help keep the bones properly aligned and support normal healing.

Depending on the type and severity of the fracture, treatment may include immobilization with a cast or walking boot, activity modification, and follow-up imaging. More serious fractures may require referral for additional care.

Don’t hesitate to have your foot evaluated today!

Fungus

Fungus is very common and can occur in the skin or in the toenail. (See Deformed Toenails Section). Fungus in the skin of the feet is called athlete’s foot. If affects the upper layer of skin and can occur from the heel to the toes, in between the toes, and even up the sides of the foot. It can make the skin pink in color, cause peeling of the skin, itching, or sometimes even small white pus filled bubbles. It is contagious and can spread in places like swimming pools, locker rooms, showers, etc. Fungus loves dark environments where there is a lot of moisture (so a sweaty foot inside of a boot for 12 hour work shifts is a great home for these little guys!)

People who have a weak immune system are more susceptible to developing the fungal infection and should receive treatment immediately. It may start out as mild fungus between the toes, but if the skin breaks down and you develop an ulcer it can lead to a bacterial infection.

Treatment includes topical creams, foot soaks, and sprays. Sometimes oral medication is indicated if the infection is severe and uncontrollable. It is also important that feet are washed and dried thoroughly, even between the toes. Keep socks and shoes clean and dry. Use powder to keep the feet dry, especially if you have sweaty feet. Wearing shoes and socks that are made of breathable materials can help air circulate around the feet. Never share socks or shoes. Wear flip-flops or water shoes in public areas such as showers, pools, and lockers.

Hammertoes

Hammertoes occur when the toes become deformed and contracted. They may bend at the knuckle joint, causing pain or a noticeable “lump.” If the toes curl enough, excessive pressure can develop at the tip of the toe when walking. In some cases, the toes may also shift sideways and rub against neighboring toes. Areas exposed to repeated pressure can lead to skin irritation, pain, corns, skin breakdown, or ulcer formation.

Hammertoes may be flexible, meaning the toe can still be manually straightened, or rigid, meaning it remains fixed in the contracted position. If you are experiencing pain, pressure, corns, skin irritation, or other symptoms related to a hammertoe, we can evaluate the condition and determine the most appropriate treatment options based on your individual needs.

Ingrown Toenails

Ingrown toenails are pretty common and there are a variety of treatment options. Ingrown toenails happen when the edges of the nail curve and grow into the skin. This can cause irritation leading to pain, redness, swelling, warmth, drainage, odor, and infection. Causes of ingrown toenails include trauma, improper foot wear, genetics, and fungal infection. If it is your first time having an ingrown toenail, and it is mild, a simple treatment can include trimming the curved portion out. This is typically painless and does not require injections or surgery.

If the ingrown portion of the nail is severe and infected, then we recommend surgical excision. The toenail is first numbed up and then only the curved portion of the toenail is removed all the way back to the base of the nail. A solution is applied to kill the nail cells that grow along the border so that the ingrown nail does not return. This is a permanent solution and we only remove the sliver of the nail along the side that is incurvated. It is important to note that antibiotics do not effectively treat an ingrown toenail! They only calm down the infection, but the nail that is curved into the skin must be dealt with!

If you are trying to avoid a surgical procedure, On the Move Podiatry does offer an alternative treatment that is not offered anywhere else in this area. We use a nail correction system which is a nonsurgical treatment option for involuted and ingrown toenails. A composite is applied to the toenail that hardens and provides a “brace-like structure” for the toenail. This brace maintains the normal curvature of the nail and helps hold it straight as the nail grows out without any tension or pain. This is a good option for those where a surgical procedure may be contraindicated (such as a diabetic or someone with poor blood flow lacking healing capabilities).

Injuries

If you have had an injury, we will do our best to see you as soon as possible. We understand that injuries can be serious and should not be overlooked. Whether it is a simple skin tear that needs stitches or a swollen, bruised foot that may be fractured, we can assess the injury and determine the appropriate course of treatment.

A common injury we see is a smashed toenail caused by dropping something on the foot. Schedule an appointment if you have blood trapped under the nail. With an injury like this, the skin under your toenail may be lacerated or torn, and it is important to have it evaluated so that the bone underneath does not become infected. Some fractures may require a cast or walking boot, while more serious injuries may require additional treatment or referral to an appropriate specialist.

We see a wide range of injuries on a day-to-day basis. Call us for an appointment today!

Midfoot Pain

There are many different types of midfoot pain. If you stand on your feet all day and have recently started noticing that your foot aches after long periods of standing or walking, this may be an early sign of excessive stress on the midfoot joints. We can evaluate your arch and gait to help determine the cause. In some cases, tight calf muscles may alter the way you walk and place additional stress on these joints.

Another type of midfoot pain can be caused by arthritis. The cartilage may become worn, causing the bones to rub together or resulting in the development of joint spurs.

Maybe you had an injury to the midfoot in the past and continue to experience pain in this area. It is possible that the Lisfranc ligament, an important ligament that helps support the bones in your arch, may have been injured. If left undiagnosed, this type of injury can lead to ongoing pain and arthritis over time.

We can evaluate and treat many types of midfoot pain using options such as x-rays, orthotics, injections, taping, bracing, laser therapy, and physical therapy. Treatment recommendations will depend on the underlying cause of your pain and your individual condition.

Neuromas

A neuroma is a thickened, inflamed, and irritated nerve that can develop in the foot but is most common in the forefoot. It may feel like you are walking on a pebble, or you may experience pain in the ball of the foot, numbness, tingling, or burning in the toes. If left untreated, the nerve can become increasingly irritated and may result in lasting symptoms.

Common causes include wearing narrow shoes with a tapered toe box or high-heeled shoes. Tight calf muscles can also place excessive pressure on the ball of the foot when walking. People with bunions, hammertoes, and flat feet may also be at greater risk of developing a neuroma.

Conservative treatment may include special padding, orthotics, stretching, and shoe modifications. Another treatment option includes a series of injections containing nerve-blocking medicine, which may help relieve pain without the use of steroids. Steroids can reduce pain and inflammation, but they do not heal the tissue and may increase the risk of injury to nearby structures, including the toe ligaments.

If a neuroma has been present for some time, an ultrasound may be performed to assess its size and condition and help determine the most appropriate treatment approach.

Neuropathy or Nerve Pain

There are many different reasons why people can develop neuropathy or nerve pain. The most common ones including diabetes, sciatica, back conditions (such as herniated discs or stenosis), Lyme’s disease, chemotherapy, trauma, surgery, and nutritional deficiencies. Some neuropathy is considered idiopathic, meaning we don’t know the underlying cause. It is important to address the underlying cause because treatments to address the pain are limited.

The most common treatment is nerve pain medication such as Gabapentin or Lyrica. These medications do not heal the nerves, they help alleviate the pain but can often cause other serious side effects. Other treatments can include pain creams and electrical stimulators to apply along the painful area (pain relief is limited).

At On the Move Podiatry, we offer unique alternative treatments that may help with your nerve pain. One of these treatments includes a series of nerve pain blocking injectables. We use Sarapin which is an injectable analgesic indicated for the management of neuropathic pain. Sarapin has been used safely and effectively for pain management for over 70 years. Unlike steroids (which are known to cause many side effects). Sarapin is a biological medicine derived from the pitcher plant which has virtually no known side effects. A side effect could include an allergic reaction. If you are someone who is known to have many allergic reactions to plants then this may not be an option for you. It works by stopping pain signals coming from the nerve. It only affects sensory nerves which means it will not interfere with your motor functions. The injection regimen is modified for each patient, but typically includes an injection every 2 weeks until the pain subsides.

We also offer MLS laser therapy for nerve pain. The MLS laser is FDA approved and is a noninvasive, safe, effective, and convenient treatment for those suffering from nerve pain. Light energy enters damaged nerve cells and stimulates intercellular activity. This reduces pain in the area and speeds recovery of damaged cells. The light energy does the following: stimulates cells to remove toxins, allows oxygen and food loads into the cell, blocks pain signals in the brain and releases endorphins and encephalin (a natural pain killer), increases the production and cell growth bringing blood flow into the area, and jump starts healing by stimulating the mitochondria in the cells. A single treatment takes less than 15 minutes and is completely painless and comfortable.

Plantar Fasciitis/Heel Pain

Plantar fasciitis is very common in the general population, and if treated early on, there is a high success rate of recovery. The plantar fascia is a ligament that extends from your heel bone towards your toes and helps provide support to your arch. If you do not provide adequate support to this ligament or the ligament tightens up, it can lead to inflammation. When you sit down to rest or sleep at night, the ligament tightens up like a rubber band. When you go to stand up, the ligament suddenly elongates, pulling on the heel and causing significant pain. As you walk around a little bit, the pain may ease up as the ligament slowly stretches. Treatment includes x-rays, orthotics, taping, and stretching. Sometimes a stretching brace is indicated if you have already failed straight forward stretches at home. If your pain is severe and you need urgent relief, we can perform an injection as well. Our injections are all natural and do not contain steroids. Steroid injections can cause tearing of the ligament or cause thinning of the fat pad in the heel. Our alternative injections do not cause either of these. They can help lower pain and inflammation. By following the above treatment protocol, it is not common to need surgery for this condition.

Skin Conditions Such as Psoriasis, Dermatitis

Because fungus is so common in the feet, diagnoses such as psoriasis and dermatitis can be misdiagnosed. Therefore, if you are prescribed an antifungal lotion it will not treat your condition. It is important to correctly identify your skin condition so that an accurate topical can be prescribed. If necessary, a biopsy can be performed.

At On the Move Podiatry, we try to avoid steroids when possible, so we will recommend alternative topical lotions and oils that do not cause skin thinning or skin damage.

Skin Lesions/Moles

If you have a spot, lesion, or mole on your lower leg or foot that you are concerned about, we can evaluate the area and perform a biopsy in the office. The specimen will then be sent out to a lab to be tested. We will call you with the results as soon as possible. If the skin lesion is suspicious for malignancy then we will refer you out to a specialist such as a dermatologist or plastic surgeon.

Tendonitis

Tendonitis means inflammation of a tendon. Common tendons that can become inflamed include the Achilles tendon, posterior tibialis tendon, peroneal tendons, flexor tendons, and occasionally the anterior tibialis tendon.

It is important to determine whether the tendon is becoming inflamed because of an underlying structural foot condition. For example, if your foot is flat, the posterior tibialis tendon that helps support the arch may become overworked. By identifying the cause of the inflammation, we can develop an appropriate treatment plan. Orthotics are often helpful in supporting the area of the foot where the tendon is painful.

Other treatment options may include taping, stretching, physical therapy, and pain creams. We also offer alternative injection therapies that do not contain steroids, helping to avoid further weakening or damage to the tendon.

If the tendon has been inflamed for an extended period of time, an ultrasound may be performed or an MRI may be ordered to assess the integrity of the tendon and determine the extent of any damage.

Tarsal Tunnel

Tarsal tunnel is when the tibial nerve along the inside of your ankle is somehow being compressed or squeezed which causes burning, tingling, numbness, or shooting pain down into the bottom of your foot and towards your toes. It is very important to determine what is causing the tarsal tunnel and treat the etiology. Covering up your nerve symptoms with pain medication is not a solution. The etiology can be biomechanical in nature, especially if you have a flat foot. Wearing custom orthotics can lift up your arches, taking stress off the nerve.

Sometimes there may be a mass near the nerve, pushing on it and causing pain. If that is the case, we can perform an ultrasound or order an MRI. Other times it may seem like tarsal tunnel but the nerve pain could be emanating from your back. As you can see, your treatment will depend on what is causing the tarsal tunnel. If you suspect tarsal tunnel please call us today for an appointment. If ignored over time you can develop permanent nerve damage.

Ulcers/Wounds

Whether your wound is caused by trauma, diabetes, neuropathy, circulation issues, or another underlying condition, Dr. Stouder has extensive training in wound care. She has been treating ulcerations and wounds for many years and has cared for patients in both hospital and wound-care settings.

There is always an underlying reason why a wound develops, and it is important to identify and address that cause. Contributing factors may include high blood sugar, poor blood flow, ill-fitting shoes, prominent bones or foot deformities, improper nutrition, vitamin deficiencies, or infection. It is important to evaluate the wound thoroughly and develop a treatment plan based on the individual patient, since every wound and every patient is different.

If poor blood flow is contributing to the wound, circulation can be assessed during your appointment. If ill-fitting shoes are part of the problem, we can measure your feet and make appropriate footwear recommendations. Offloading padding may also be applied, or a specialized shoe may be recommended to reduce pressure on the affected area. In some cases, a walking cast may be used to help take pressure off the ulcer site.

If an infection is present, the wound may be tested for bacteria so the appropriate treatment can be determined. More serious infections or wounds that require hospital-based or surgical care may be referred for additional treatment.

You may not always have an open wound but may notice an area of skin that repeatedly appears pink, irritated, or blistered. These areas should also be evaluated before they worsen.

MLS laser therapy is available in the office and may be used as part of a wound-healing treatment plan. Don’t hesitate to have your wound evaluated. Proactive treatment can help reduce the risk of serious complications and support proper healing.

Warts

Warts are caused by a viral strain (HPV) that affects the superficial layer of the skin. They can appear as solitary lesions or in clusters. Warts may look like thickened skin or small black dots and are often painful when pressure is applied. Without treatment, warts can spread to other areas of the feet or hands and can also spread to other people, which is why many patients prefer to treat them promptly. There are several treatment options for warts, and if one treatment is not effective, another option may be considered.

First, the dead skin on top of the wart is trimmed off. This is usually not painful, but topical lidocaine can be applied first if needed. Next, cryotherapy may be performed to freeze the wart, or a solution called Cantharone may be applied. Cantharone is derived from the blister beetle Cantharis vesicatoria and is often very effective. In many patients, the wart begins to reduce in size after the first application, and pain may completely resolve or improve significantly. Stubborn warts may require several applications.

If you have multiple warts, including mosaic warts, wart needling may be recommended. This procedure is performed in the office. The “mother wart,” or largest wart, is numbed with lidocaine, and then needling is performed to help stimulate an immune response so the body can attack the wart. After the procedure, the immune response develops over the following six weeks. There is a 68–86% chance that the mother wart and surrounding warts will resolve. The more warts you have, and the longer they have been present, the lower the success rate of treatment may be. Stubborn or severe cases may require additional evaluation and alternative treatment options based on the individual condition.

Custom orthotics

KevinRoot Medical – The Best Foot Orthoses For Your Patients

In our office we perform a biomechanical evaluation with you sitting, standing, and walking. Then we proceed with a 3d digital scan of your feet using updated modern software. The scan is sent to a lab where the orthotics are constructed. Custom modifications are made to each orthotic according to what the doctor prescribed. Feet can often be asymmetrical, so why would your orthotics be the same? We then dispense the orthotics in the office to make sure they fit, explaining how to break them in and wear them in your shoes.

Orthotics can be life changing if properly made. The earlier you start wearing them in life – the better. If one foot is flatter than the other, then your knees, hips, and back may not be even. This can lead to arthritis down the road. The sooner your foot conditions are supported and balanced, the sooner you can get back to life and lower your risk of developing serious conditions in the future.

Foot care

At On the Move Podiatry we perform a thorough assessment of your feet and take the time to carefully handle your toenails and calluses – whether you have diabetes or not. Since we do not bill Medicare, you can have foot care performed as often as you like. There are no harsh stipulations that you can only be seen every 9 weeks.

Fat pad injection

On the Move Podiatry offers fat pad injections into the foot to help cushion any areas causing pain. A common area is the ball of the foot. As we age, the fat pad in the ball of the foot tends to thin out, or atrophy. This can cause pain along the prominent bones when walking, or it can cause painful corns and calluses. Toe deformities can also cause thinning of skin leading to pain or corns. Fat pad fillers can be injected into either of these areas. They can also be administered to areas prone to ulceration in order to decrease risk of ulcer recurrence. The injection we use is a matrix which is safe and a clinically proven solution to help with foot pain that doesn’t require steroids or surgery!

Cosmetic toenail reconstruction

If you have a severely damaged toenail that is beyond repair or already failed multiple forms of treatment, then cosmetic toenail reconstruction may be for you. We use a cosmetic nail restoration system that uses polymer resins to cover up embarrassing toenails. It has special activators to create a natural looking artificial nail. This is different from an acrylic nail you would get in a salon. The system we use is made of a flexible resin which allows the nail to bend with the natural movement of the toe. It is applied in sanitary conditions under the supervision of a trained medical doctor. It’s natural flexibility ensures that the nail doesn’t suffer more trauma with repetitive motion such as walking. It is non-porous which doesn’t allow moisture to build up between the toenail and prosthetic nail, thus helping you to avoid chance of fungal infection. Your toenail underneath will still be allowed to grow naturally.

First we evaluate your toenails and determine if you are a candidate for the nail restoration. We prepare the area by removing dead, damaged, or infected tissue from your toe (this is not painful). The resin is then applied to the residual toenail and allows for sculpting and contouring of the area. A sealant is applied followed by UV light to harden the substances into a flexible artificial nail. Cosmetic toenail reconstruction is not recommended if you do not have more than 20% of your residual toenail, suffer from circulation problems, have suspicious pigmented lesions, and/or infection.

After the procedure is done you can treat the reconstructed nail like your natural toenail, which includes painting it with nail polish. It is best to avoid wearing tight shoes that could put extreme pressure on the nail. The toenail can last about an average of 6-8 weeks.

Microdrilling and Laser Treatment for Fungal Toenails

Fungal toenails can be a stubborn and frustrating issue to deal with on a day-to-day basis. The most common treatments today include daily application of a topical polish or an oral medication. The topical must be applied every day for months on end and can still have less than a 20% success rate. Not to mention the most effective topicals can be expensive and difficult to get coverage through insurance. The oral medication can be more effective and cheaper however the pills are processed by the liver. It requires 3 months of the oral medication, so prior to and halfway through the process you have to get blood work to assess your liver enzymes and ensure there have been no changes. If you are someone who takes many medications (especially those metabolized by the liver, such as cholesterol medication) it is usually advised to not take the oral medication. Therefore, you are not left with any great treatment options. At On the Move Podiatry we offer a cutting edge service that is effective, non-invasive, and doesn’t include oral medication.

Topical agents are usually ineffective at penetrating the nail plate to reach the active infection underneath (between the skin and the toenail). Our treatment includes drilling micro holes in the nail plate with innovative and specially designed micro burrs. These act like tunnels for the antifungal solutions to seep through to the active infection under the nail. The topical medication is applied in the office, and then daily thereafter, by you in the comfort of your own home. As you walk, your foot wear presses against the toenail, and the medication continues to spread through the nail and underneath. Lastly, this is followed up by MLS class IV Laser Therapy. We apply a painless, FDA approved laser to the affected nail for approximately 10 minutes. This light is beneficial because it helps break down the fungal cells, increases the permeability of the medication all the way down to the skin, and also increases the clarity of the toenail. There have been many research studies showing that the most effective laser wavelengths include 635nm, 830nm, and 970nm. Our MLS laser actually emits 3 wavelengths- 635, 808, and 905nm! Overall, we are combining multiple forms of alternative treatments to help drastically increase the efficacy rates and get rid of your toenail fungus!

How many treatments does it take? The first day we do a thorough trimming and debridement of the affected nails, followed by micro-drilling and topical medicine application. The MLS laser is applied.

We then recommend the MLS laser treatment be performed once a week for a total of 4 weeks.

At 6 weeks we bring you back and reassess the toenail. If needed, we perform another round of micro drilling and another 4 weeks of laser treatments. You continue to apply the topical medication at home on a daily basis

Am I a candidate? If you have thickened, discolored, crumbly, distorted, breaking toenails you are likely a candidate. The only patients we advise on not proceeding with treatment are those whose fungus extends all the way back to the cuticle, because this means the fungus has extended past the toenail and all the way down into the nail matrix itself (the cells where the nails grow out of). Treatment can still be performed however the success rate is not as high. You will likely have improvement but there may still be some persistent fungus present.

Bracing for ingrown toenails

On the Move Podiatry does offer an alternative treatment that is not offered anywhere else in this area. We use a nail correction system which is a nonsurgical treatment option for involuted and ingrown toenails. A composite is applied to the toenail that hardens and provides a “brace-like structure” for the toenail. This brace maintains the normal curvature of the nail and helps hold it straight as the nail grows out without any tension or pain. This is a good option for those where a surgical procedure may be contraindicated (such as a diabetic or someone with poor blood flow lacking healing capabilities).

MLS laser therapy

MLS laser therapy is one of the safest and most effective methods of treating a variety of foot and ankle pain. The MLS laser is FDA approved and is a noninvasive and convenient treatment for those suffering from pain. It accelerates healing of tissues, reduces scar tissue, increases blood flow, and decreases inflammation. Light energy enters damaged cells and stimulates intercellular activity. This reduces pain in the area and speeds recovery of damaged cells. The light energy does the following: stimulates cells to remove toxins, allows oxygen and food into the cell, blocks pain signals in the brain and releases endorphins and encephalin (a natural pain killer), increases the production and cell growth bringing blood flow into the area, and jump starts healing by stimulating the mitochondria in the cells.

A single treatment takes less than 15 minutes and is completely painless and comfortable, creating a warm soothing feeling. Some of the most common conditions we treat with MLS include: tendonitis, ankle sprains, pinched nerves and neuropathy, arthritis, ulcers, and skin conditions. Acute injuries heal much faster as laser therapy is applied close to the time of injury. It can also speed up healing following a surgery and reduce post op pain levels. The treatment protocol varies depending on what diagnosis is being treated.

Radial Shockwave Therapy

Radial shockwave therapy (RSWT) is a method for the treatment of orthopedic disorders developed over the past 20 years. A projectile accelerated in the handpiece generates a mechanical pressure wave, which is transferred to the human body by an applicator head and which radiates out in the tissue.
The mechanical energy is absorbed by the tissue and triggers reactions in the tissue that have a positive influence on a wide range of orthopedic and neurological conditions.
RSWT stimulates healing, improves blood flow, breaks down scar tissue, and decreases pain. It works wonders for plantar fasciitis, achilles tendonitis, sprained ligaments, neuromas, joint pain, and so much more. There is approximately an 85% success rate depending on the diagnosis. Do not underestimate the power of this device- it is strong enough to break up kidney stones. This is a great alternative to surgery!

Biomechanical exam

Nowadays it can be difficult to find a specialist who has the time to thoroughly evaluate your foot structure and the way you walk. At On the Move Podiatry we make sure to take the time to do so. It is important to assess for any issues that can contribute to foot deformity, pain, or future injury. Our feet all function in a unique way depending on our foot structure and joint movement. Often times our limbs are not symmetrical, leading to imbalances that can throw off your knees, hips, and back leading to arthritis in the future. Therefore, having a thorough individual assessment makes sense. We evaluate your feet when sitting down, standing, and walking. We can measure your legs for limb length discrepancy (unequal leg lengths). Then we come up with a plan which typically includes orthotics and in severe cases, bracing.

Orthotics can be made uniquely for you to even out your gait and take stress off the joints, tendons, and ligaments. Orthotics do not make your muscles weaker, in fact they help preserve your muscle’s strength and help maintain the integrity of the tendons over time. We do a painless 3d foot scan in the office which only takes seconds. Those 3d scans are electronically sent to an orthotic lab where the orthotics are constructed. We can also assess your shoes and determine if they are appropriate for your foot type. If you have old orthotics we can assess those as well. Sometimes foot mobilization therapy can be prescribed too. X-rays can be a great way to assess your foot structure. We have the patient put their full weight on the foot while taking the picture. By doing so we can see what the bones in your foot look like during stance. If you have foot pain or maybe you are just concerned about your foot structure – give us a call and schedule a biomechanical assessment today!

Injections

All natural injections (no steroids): At On the Move Podiatry we feel it is of utmost importance to lower your pain and help you heal as quickly as possible without causing further damage using steroids. This is why we have several injectable options that do not contain steroids. We use homeopathic injectables (such as Traumeel and Zeel) that are made from all natural botanicals and minerals. No harmful or potentially hazardous side effecs are known. They are not known to interact with any other medications. There is no limit to how many injections you can receive, which is the case with steroids.

Sarapin: Sarapin is an all natural injection made from the pitcher plant. For over 50 years Sarapin has been used to treat the scope of nerve pain and muscular pain. All this time we have never known of a drug induced significant reaction. It is non-toxic, and is only contraindicated in areas of local infection. It can be very effective at lowering nerve pain, which is what we commonly use it for at On the Move Podiatry.

Prolotherapy: Prolotherapy is a non-invasive regenerative medicine therapy practiced for nearly a century by doctors. It is a treatment that involves the injection of a solution into a damaged or weakened area of the body to help regenerate and repair tissue by inducing the inflammatory response. The injection can often consist of dextrose (sugar), lidocaine, and sterile water. By initiating inflammation, it can cause production of fibroblasts (the body’s repair cells) which can deposit new tissue fibers and help with healing. Depending on the injury or joint involved, a series of 2-3 injections are performed about every 4 weeks. Fewer treatments may be needed depending on resolution of symptoms. Healing time is different for everyone, most people can expect to see improvement after 3-4 days of their visit, however, it can take weeks to see full results. The injection site may feel sore and achy for several days, often resolving after 3 days post injection. At the On the Move Podiatry we tend to use this treatment method often for joint arthritis.

Amniotic stem cell injections: These injections are made from amniotic fluid. The fluid is collected from women undergoing a scheduled C-section. It is not a harmful intervention, and the fluid is typically discarded after the C-section. Once the fluid is collected and processed, the amniotic derived stem cells are isolated and removed. Amniotic injections can be used to successfully treat patients when other conventional treatments have failed. Amniotic stem cell injections offer the ability to heal damaged tissues naturally without using steroids. The stem cells have strong anti-inflammatory properties. While cortisone only provides temporary relief, stem cells actually restore degenerated tissue while also providing pain relief. The growth factors in the solution can replace damaged cells in your body. We use an ultrasound to guide the injection and ensure it is appropriately positioned in the joint or soft tissue. If you have failed conservative treatment, it is recommended to try an amniotic injection if indicated prior to proceeding with surgery.