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Dr. Horlebein will be joining Advanced Regional Ankle & Foot Care LLC as a full time physician in Altoona PA, as of June 1st 2023. Feel free to call our office with any scheduling inquires/questions!

Featured

Featured

Tuesday, 09 November 2021 00:00

An ingrown toenail is a toenail that grows sideways into the nail bed, causing pain and swelling. Ingrown toenails can worsen and cause drainage, turning into a serious infection.

Several factors affect whether a person is at risk from an ingrown toenail. The many causes include being overweight, diabetes, participating in sports, having a fungal infection of the toe, and cutting your nails too short. Ingrown toenails also have a genetic predisposition, causing some people to be more prone to receive the condition than others. Other causes include improperly fitting shoes and shoes that keep the feet damp.

Ingrown toenails can be preventable with certain measures. For starters, allowing your toe nails to grow slightly longer in length will help prevent them from becoming ingrown. If you have already developed an ingrown toenail, soak the affected toe in warm water. This will alleviate the pain and help prevent an infection from forming. Antibiotic soap or Epsom salts may be added to further help the relieving process and avoid infection. Placing cotton beneath the affected area is also suggested, as this may help the toenail grow upwards and not into the nail bed. Swelling and redness can be reduced by resting with your feet elevated.

A podiatrist should be seen if the pain becomes so serious that it prevents you from doing your everyday activities. If a red streak running up your leg appears or if you suspect your infection has spread, contact a podiatrist immediately. Fast treatments can be undertaken to lessen your pain and have you walking comfortably.

An ingrown toenail can be easily treated with a Band-Aid. Simply wrap the affected toe with a Band-Aid to prevent infection and keep the nail from growing out at a painful angle.

In more serious cases, your podiatrist may decide to make a small incision to remove a portion of your toenail. To prevent the nail from growing back, medication will be placed directly into the nail bed. This procedure would be performed under local anesthesia and is a faster method to alleviate discomfort from an ingrown toenail. Post-procedure directions will have you stay off the affected foot for a day. Afterwards, normal activities can be resumed.  

Tuesday, 02 November 2021 00:00

Ankle foot orthotics are shoe inserts that offer support to control the placement and movement of the ankle, correct deformities, and compensate for weakness. These inserts are used to stabilize the foot and ankle and provide toe clearance during the swing phase of gate.

Athletes often suffer foot problems because their feet are not being supported within the shoe. Ankle and foot orthotics are custom made inserts that alleviate stress on the foot. However custom orthotics should be prescribed by a podiatrist who specializes in customized footwear and orthotics design. These inserts are used by athletes for different reasons. Runners use orthotics to absorb shock at heel contact and to set up the forefoot for push-off. Basketball players wear them to control their forefeet while jumping and running.

The two main types of orthotics are over-the-counter orthotics and custom-made orthotics. To be eligible for custom orthotics, an examination of the foot and ankle will need to be completed. Afterward, both the foot and ankle will need to be casted and fitted for the proper orthotic. When the fitting process is complete, adjustments can be made to make sure everything fits perfectly.

Over the counter orthotics tend to be more popular than custom fit ones. Athletes who have less severe aches and pains in the foot, ankle or lower back area can use the over-the-counter version of orthotics. Unfortunately, over-the-counter orthotics tend to not work in treating severe injuries or ailments. Whenever you suspect you may need an ankle foot orthotic, you should consult with your podiatrist to determine which type of orthotic is right for you.

Tuesday, 26 October 2021 00:00

Your feet endure a great amount of stress each day from constantly allowing us to move around. It is important to stretch your feet to help prevent them from becoming injured. Your toes may easily deform into unhealthful positions if they are not stretched.

One of the most common reasons for toe deformities are the shoes you may be wearing. Shoes that are too tight may fold and shift the toes out of place. Heeled shoes may also push your toes upward. Forcing your toes into an unnatural position which may cause the muscles to tighten and prevent them from reverting to normal length. Another common reason is improper use of foot muscles. Many people fail to use the muscles in their feet or toes when they walk. Lastly, the positioning of your feet while walking may also cause toe deformities. If you walk with your feet facing outward, your “push-off” phase is on the side of your big toe instead of the bottom of your foot. This may cause the big toe to eventually tighten into a new shifted position.

There are many reasons why stretching your toes may be helpful. One reason is that healthy spacing may aid in avoiding calluses and other injuries that are caused by rubbing.  Stretching will also prevent you from developing toes that curl, hammertoes, or bunions.

A great way to stretch your toes is to place them in your hands and bend them all downward; this will help you stretch the top of your foot. Next, you should repeat this process but instead bend them upward enough to feel a nice stretch in the bottom of your foot. You should then try to pull each toe apart from the next and pull any toes that are bent upward until they are back downward.

If you are looking to practice stretching your entire foot, you can try a towel stretch. This is done by sitting on the floor with your legs in front of you. Take a towel and wrap it around your toes. Afterward, pull the towel toward you with your toes and hold this position for 15 to 30 seconds before releasing. Practice this stretch for three sets. Another stretch your feet are towel lifts. This is done by sitting in a chair and trying to pick a towel up from the ground with your toes. Try lifting the towel with your little toes for five sets before switching feet.

If you are an athlete, or exercise often, it is especially important for you to practice stretching your feet. Those who suffer from foot pain caused by poor footwear, plantar fasciitis, or long hours of standing at work may also benefit from foot exercises.

Tuesday, 19 October 2021 00:00

In foot care, vascular testing may be required in the diagnosing and treatment of certain podiatric conditions. Vascular testing is particularly relevant for patients with high-risk diabetes, poor circulation, peripheral artery disease (PAD), and chronic venous insufficiency (CVI). Procedures typically involve the examination of blood vessels throughout the body for blockages or buildup.

Vascular testing is very important for the diagnosis of various conditions, including peripheral artery disease and chronic venous insufficiency, as these conditions can greatly affect one’s quality of life and cause pain in the lower limbs. Circulatory problems in the feet and ankles can reflect issues throughout the body, making testing of the blood vessels pertinent.

Testing methods vary between practitioners and can be specific to certain foot and ankle problems. Modern technology has brought about the ability to perform vascular testing using non-invasive methods, such as the cuff-based PADnet testing device. This device records the Ankle-Brachial Index (ABI)/Toe-Brachial Index (TBI) values and Pulse Volume Recording (PVR) waveforms. Contact your podiatrist to determine what vascular testing is available for your needs.

Tuesday, 12 October 2021 00:00

Ankle sprains occur when ligaments that support the ankle stretch beyond their limits and tear. These types of injuries are very common and can occur in people of all ages. Sprains may range from mild to severe, depending on how much damage is done to the ligaments. If a sprain goes untreated, a more severe sprain may occur which can further damage the ankle. Repeated ankle sprains can lead to chronic ankle pain.

There are some risk factors that can increase your risk of suffering a sprained ankle. Those who participate in sports, walk on uneven surfaces, have a prior ankle injury, are in poor physical condition, or wear improper shoes are more likely to get a sprained ankle.

There are a few symptoms to look out for if you suspect you are suffering from a sprained ankle. Some common symptoms are swelling, bruising, tenderness, and instability of the ankle. In cases where the tearing of the ligaments is severe, there may be a “popping” sound when the strain occurs.

The RICE method is proven to be effective in treating ankle sprains. RICE stands for Rest, Ice, Compression, and Elevation. Rest is important for treatment, especially within the first 24 to 48 hours. You should also ice your sprained ankle for the first 48 hours for 20 minutes at a time. A small piece of cloth should be placed between the ice and the affected area. For the compression step, you should wear a brace that is snug, but not too tight that it cuts off circulation. When choosing a brace, be sure to choose one that is suitable for the type of ankle sprain you have. Lastly, you should elevate your foot above the heart as often as possible.

After you treat a sprain, you should go through rehabilitation to prevent the injury from occurring again. There are three phases to the rehab process. The first phase involves resting, protecting, and reducing the swelling of the injury. The second phase consists of restoring the ankle’s flexibility, range of motion, and strength. The third phase consists of slowly returning to activity and maintenance exercises.

If you suspect you have an ankle sprain, you shouldn’t hesitate to consult with your podiatrist. Your podiatrist will be able to give you a proper diagnosis and a suitable treatment option for your condition.

Tuesday, 05 October 2021 00:00

Hammertoes are painful deformities that frequently form on the second, third, or fourth toe. The condition is often caused by an issue in foot mechanics. This can be caused by the person’s specific gait or the manner in which they walk, or by shoes that do not comfortably fit the deformity.  Hammertoes can be formed after wearing shoes that are too narrow or short for the foot or have excessively high heels. Shoes that are not properly sized will force the toes into a bent position for long periods of time. This can cause the muscles to shorten and toes to bend into the deformity of a hammertoe.

Hammertoe can also be caused by complications from rheumatoid arthritis, osteoarthritis, trauma to the foot, heredity, or a cerebral vascular accident. Pain and difficult mobility of the toes, deformities, calluses, and corns are all symptoms of a hammertoe.

Someone who suspects they have the symptoms of a hammertoe should consult with a physician—particularly a podiatrist. Podiatrists diagnose and treat complications of the foot and ankle. If the podiatrist discovers that the affected toes are still flexible, treatment for the hammertoe may simply involve exercise, physical therapy, and better-fitting shoes. Treatment for hammertoes typically involves controlling foot mechanics, such as walking, through the use of customized orthotics.

For more serious cases in which the toes have become inflexible and rigid, surgery may be suggested. During the operation, the toe would receive an incision to relieve pressure on the tendons. A re-alignment of the tendons may then be performed by removing small pieces of bone to straighten the toe. In some cases, the insertion of pins is needed to keep the bones in the proper position as the toe heals. The patient is usually allowed to return home on the same day as the surgery.

If surgery is performed to repair a hammertoe, following the postoperative directions of your doctor is essential. Directions may include several stretches, picking up marbles with your toes, or attempting to crumple a towel placed flat against your feet. Wear shoes that have low heels and a wide amount of toe space to maintain comfort. Closed-toe shoes and high heels should be avoided. Shoes with laces allow the wearer to adjust how fitted he or she may want the shoes to be and also allow for greater comfort. To provide adequate space for your toes, select shoes that have a minimum of one-half inch of space between the tip of your longest toe and the inside of the shoe. This will also relieve pressure on your toes and prevent future hammertoes from forming.

Other preventative measures that can be taken include going shopping for new shoes in the middle of the day. Your feet are its smallest in the morning and swell as the day progresses. Trying on and purchasing new shoes midday will give you the most reliable size. Be sure to check that the shoes you purchase are both the same size. If possible, ask the store to stretch out the shoes at its painful points to allow for optimum comfort.  

Wednesday, 29 September 2021 00:00

Fungal infection of the toenail, or onychomycosis, typically appears as a gradual change in a toenail’s texture and color that involves brittleness and darkening.  The fungal infection itself occurs beneath the surface of the nail.  Aside from discoloration, other symptoms include the collection of debris beneath the nail plate, white marks on the nail plate, and a foul odor emanating from the nail.  If ignored, the infection can spread into other nails and the skin; in severe cases, it can hinder one’s ability to work or walk. 

The toenails are particularly vulnerable to contracting infection in moist environments where people are likely to be walking barefoot, such as around swimming pools, public showers, and locker rooms.  Fungal infection may also be more likely to occur in nail beds that have been injured, and sufferers of chronic diseases such as diabetes, circulatory problems, or immunodeficiency conditions are particularly prone to developing fungal nails. 

Fungal nails can be primarily prevented by practicing proper hygiene and regularly examining the feet and toes.  Carefully washing the feet with soap and water and thoroughly drying the feet afterwards are essential.  Other tips include wearing shower shoes in public areas, changing shoes and socks daily, keeping toenails clipped at a short length, wearing breathable shoes that fit properly, wearing moisture-wicking socks, and disinfecting home pedicure tools and instruments used to cut nails.

Fungal nail treatment may vary between patients and the severity of the condition.  Your podiatrist may suggest a daily routine of cleansing that spans over a period of time to ease mild infections.  Over-the-counter or prescription antifungal agents may also be prescribed, including topical and/or oral medications.  Debridement, or the removal of diseased nail matter and debris, may also be performed.  In more severe cases, surgical treatment may be needed.  In some instances, the temporary removal of the fungal nail allows for the direct application of a topical antifungal to the nail bed.  In other cases, a chronically painful fungal nail that has not responded to other treatments may be permanently removed; this allows the infection to be cured and avoids the growth of a deformed nail.  

Tuesday, 21 September 2021 00:00

Corns are hard and thick areas of skin that form as a result of constant rubbing, friction, or pressure on the skin. They are patches of dead skin with a small plug toward the center. They may appear on the tops and sides of toes and can make walking painful.

Soft corns are typically thinner with a white color and rubbery texture. Soft corns tend to appear between the toes. Seed corns are another type of corn that appear in clusters and can be tender if they are on a weight-bearing part of the foot. Seed corns usually appear on the bottom of the foot and are likely caused by a blockage in sweat ducts.

While corns and calluses are somewhat similar, calluses are a bit different. Calluses are a patch of dead skin that can occur anywhere on the body. In comparison to corns, calluses are usually a bit larger in size. However, both corns and calluses are caused by increased friction on the skin.

There are some risk factors that may increase your chances of developing corns and calluses. If you have bunions, hammertoe, or a bone spur, you are more likely to develop a corn or callus on your foot.

While Corns and Calluses tend to disappear when the friction to the affected area ceases, the help of a podiatrist may be useful in the removal process. It is important to remove the dead skin around the area and this may be done in a few different ways. Moisturizing creams may be helpful in softening and removing the dead skin around the callus. You should never use razors or other pedicure equipment to remove your corns. Doing this may worsen your corn or callus and cause infection. 

In some cases, corns and calluses may be caused by abnormal foot structure or walking motion. In such a case, you should seek a podiatrist’s assistance in order to correct the issue.

Tuesday, 14 September 2021 00:00

Diabetes affects millions of people every year. Blood vessels located all over the body are damaged due to diabetes—even the blood vessels of the feet. Neuropathy, or nerve damage, can result from slower blood flow in the legs and feet. In diabetic patients, neuropathy is very important to monitor, as diabetics are at risk for developing ulcers.

Always washing and thoroughly drying the feet are pertinent parts of diabetic foot care. There should be a focus on cleaning between the toes. Even if no pain is felt, the entire foot should be examined for redness and sores. Neuropathy can often mask the pain of sores and ulcers and can cause these conditions to be overlooked. Use a mirror to examine the underside of your feet if needed. It is recommended that diabetics wear well-fitting socks.

Patients with diabetes should have their doctor monitor their blood levels because blood sugar levels play a huge role in diabetic care. Monitoring these levels on a regular basis is highly advised. It is very important to keep your blood sugar levels in the normal range, which can be determined by your physician. There are medications that may be prescribed to help with any neuropathy experienced by the diabetic patient. It is also advisable to visit a podiatrist if one is experiencing any conditions involving the feet, such as ingrown toenails, which in more severe cases can cause infection.

Diabetic feet must be inspected daily. Diabetic foot care at home is possible if a patient is provided with instructions from their podiatrist. Patients can relieve dry heels with creams or ointments. Suspected wounds should warrant an immediate call to the podiatrist. Gangrene is a serious problem for diabetics and can lead to sepsis and amputation in its worst cases. Early treatment and daily inspection of diabetic feet are keys to staying healthy.

Tuesday, 07 September 2021 00:00

Cracked heels can make life very frustrating and embarrassing when displaying the bare feet. Aside from being unpleasing to the eye, they can also tear stockings and socks and wear out shoes at a faster rate. When severe, cracked heels may cause pain or infection.

Cracked heels are a problem for those who are athletic, those who may walk a lot, and those who have especially dry skin. Those who use medication that dry the skin, those who swim often, wearing certain types of shoes, and those who are diabetic may have trouble with cracked heels. Seniors whose skin produces less oil may also have trouble with cracked feet. There is no one way to develop cracked feet, and there is no cure.

Today, the market consists of numerous products that have a variety of ingredients to promote healing. Some of these are over-the-counter. Others are prescribed by a doctor, especially for those who have chronic dry feet and heels.

Some doctors recommend wearing socks at night for those with rough skin. This helps further healing, and helps creams stay on longer and better absorb into the skin.

One way to alleviate dryness that causes cracked heels is by using moisturizers both day and night. Another way is to make sure the skin is clean and dry at all times. Using a pumice stone to buff away dead skin before putting on moisturizer can also help. Cracked heels will not respond to the cream unless the outer layer of skin is first removed through exfoliation. After exfoliation, lotion or ointment will be absorbed by the skin more easily.

Foods that produce healing and balance can also help the skin from within. Everything that is put into the body can either help it or hurt it. Taking supplements of omega-3 fatty acids and zinc can also be very beneficial.

Nevertheless, not all products are guaranteed to help treat cracked feet. Seeing a professional is best if other treatments options were unsuccessful. A podiatrist should be able to give the best advice to help with this problem.

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