Since 1992, Dr. Nirenberg has been bringing attentive and expert foot care to the Northwest Indiana community. In this issue of "Ask the Expert," Dr. Nirenberg addresses some common concerns about foot health and hygiene.
Q: What is the biggest difference in your clientele from when you first started your business in 1992 to now?
A: The biggest change is that today’s patient wants to be much more involved in deciding their care and more than anything wants a lot more information about their treatment. I and my partner Dr. Michael Lacey believe this is great. The more a patient understands and participates in their medical care the better the faster they are going to get well. To meet these patient expectations, I recently joined the Society of Participatory Medicine. We have created handouts on almost every possible heel, foot or ankle problem too. We also now have electronic medical records so patients can access their chart online anytime of the day or night. Basically, everything in the office is centered around the patient.
Q: Can you name one or two growing health issues (such as obesity or diabetes) that has significantly affected your business?
A: A growing health issue we are seeing is carrying too much weight, whether this is 10 pounds or 100. It does not take much extra weight to cause a foot problem, such as heel pain. If you walk 6000 steps a day and you are 20 pounds overweight, that ends up being thousands of pounds of extra pressure crashing down on the heel by the end of the day. Worse, if your heel hurts it is harder to walk or do other exercise, which creates a vicious cycle where you just gain more weight and your heel hurts more. Some overweight people believe if they lose the weight their heel, foot or ankle pain will go away. This is often not the case. Once a tendon or ligament is injured it needs to be treated.
Q: We read that you are so thorough during an examination that you actually correlated a patient's foot pain to a tumor they had in their neck. What other health conditions might you discover just from examining a patient's feet and ankles?
A: That tumor was among the most serious of problems that I have diagnosed from a patient’s feet. More commonly, Dr. Lacey and I have diagnosed diabetes, thyroid problems, rheumatoid arthritis, fibromyalgia, and some others, including sexually transmitted diseases.
Q: Why is it important for kids to wash their feet so well? Not just scrubbing the bottoms of their feet but in between their toes and such?
A: Our feet are often confined to spending more the day encased in dark shoes. Often our shoes are damp. This dark, damp environment is perfect for bacteria to grow. It is important to scrub between your toes (not just let the shower splash on them!) with warm water and soap to kill bacteria. Otherwise, you risk infection, both in your foot or around the edges of your toenails. Many people will wash their underwear but rarely clean their shoes. It is important that we to set our shoes out in direct sunlight to help kill bacteria and to also routinely spray the insides of our shoes with Lysol spray. If you do notice an infection, see a competent podiatrist immediately. Infections in the foot can become very serious and even lead to gangrene.
Q: You have said that a person's feet and ankles mirror overall health. While someone is clipping their toenails or washing their feet in the shower, what are some signs they can look for that would indicate medical problems?
A: Anything out of the usual needs to be checked by us. Even a simple mole could turn out to be cancer. Specifically, watch for any unusual lesions, swelling, or redness. Most importantly, do not ignore pain. Many people try to ignore heel, foot or ankle pain, hoping it will go away. However, it usually gets worse! Human beings feel pain for a reason: it is to warn us there is a problem.