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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!

March 2021

In 2014, the American Podiatric Medical Association surveyed 1,000 American adults and found that half of all respondents lived with foot pain. Fortunately, there are ways to avoid foot problems such as following a daily footcare routine and wearing proper footwear at work.

If you have a job that requires you to be on your feet, it is best that you do not wear flat sole shoes. Your heel should be slightly elevated (less than 2 inches, but at least ¼-inch) if you are going to be standing for a prolonged period. You should also make sure that the shoes you wear are not too small. Tight shoes may cut off circulation to your feet, which will result in pain and blisters. It is always best to purchase fitted shoes later in the day, because the feet tend to swell as the day progresses. It may also be helpful to buy shoes a half size larger if you plan on wearing custom orthotics or arch supports.

Your muscles may become stiff when you are constantly standing up. It is important to take breaks every hour to stretch and relax. One tip is to perform calf raises, because this exercise will help improve your circulation. To perform this stretch, you first need to stand on the edge of a step with your abdominal muscles pulled inward. You then need to grip the step with the balls of your feet with your heels hanging over the edge. Next, try to raise your heels above the step by a few inches while standing on your tiptoes; hold this pose for a second. You should then lower your heels back even to the platform. These calf raises should be done ten times for full effectiveness.

You should also take care of your feet while you are at home. One of the best ways to prepare your feet for a long day of work is to soak them in ice water. Doing so for 20 minutes will help fight the swelling and inflammation that results from being on your feet at work.

Nevertheless, if you are experiencing pain in your feet, you should seek help from your podiatrist. Your doctor will help treat any ailments you may have in addition to helping you prevent any other ailments from developing in the future.

If your job requires that you stand on your feet for prolonged periods of time, it is important to do all you can to stay energized and productive while keeping your feet, ankles and legs healthy. First, purchase a good pair of comfortable shoes with adequate sole and arch support that support the ligaments, tendons, and muscles in your feet and legs. Shoe inserts and over-the-counter orthotics can provide additional support, and custom orthotics can even correct alignment and posture issues. Compression hosiery can apply gentle pressure to your legs and feet and help to reduce discomfort, swelling and fluid build-up. You can also change positions while you stand, stretch your legs and feet frequently, use a footrest to shift weight between legs, stand on a rubberized floor mat, and be sure to take all scheduled breaks and elevate your feet if possible while doing so. Also, make an appointment with a podiatrist who can examine your feet and offer more detailed practical steps and interventions to keep your feet healthy on the job.

While working on the feet, it is important to take the proper care of them. For more information about working on your feet, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor will treat your foot and ankle needs.

Working on Your Feet

Standing on your feet for long periods of time can cause stress and pain in your feet. Your whole body may experience change in terms of posture, back pain, bunions, callouses and or plantar warts. There are ways to avoid these conditions with proper foot care, smart choices and correct posture.

Positive Changes

Negative heeled shoe – Choosing this shoe type places the heel slightly lower than the ball of the foot. These are great for overall foot health. Find shoes that fit you correctly.

Go barefoot – Our feet were not designed to be enclosed for all hours of the day. Try to periodically expose your feet to air.

Eliminate Pain

Foot Exercises – Performing simple exercises, incorporating yoga and doing stretches are beneficial. This will allow increased blood flow to the area and muscles of the foot.

Achilles tendon – Stretching the foot out flat on the floor will relax the calf muscles and tendon. These exercises can be performed almost anywhere. Make sure you add these exercises to your daily regimen. 

With a little bit of this information and knowing more about foot health, you will notice changes. Foot stretches and proper footwear will help with pain and prevent further issues.

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.

Read more about How to Handle a Long Work Day on Your Feet
Monday, 22 March 2021 00:00

Foot Orthotics

Orthotics are shoe inserts that are meant to correct an irregular walking gait or provide cushioning to the feet.  Orthotics come in a variety of different models and sizes, including over-the-counter and customizable variants. Customizable orthotics can be shaped and contoured to fit inside a specific shoe and are typically prescribed through a podiatrist who specializes in customized footwear and orthotics design and management.

Orthotics are beneficial because they can help prevent injuries from occurring and provide cushioning to keep pain levels down to a minimum. They also allow for the correct positioning of the feet. Orthotics can act as shock absorbers to help remove pressure from the foot and ankle. Therefore, orthotics can make bodily movements, such as walking and running, become more comfortable as well as help prevent the development of certain foot conditions.

Orthotics alleviate pain and make the foot more comfortable by slightly altering the angle at which the foot strikes the ground surface, therefore controlling the movement of the foot and ankle. Orthotics come in different variants and can be made of various materials. To determine what type of orthotic is most suited to your feet and your needs, it is best to consult your podiatrist. He or she will be able to recommend a type of orthotic that can help improve your foot function or prescribe a custom orthotic to best fit your feet.  

Monday, 22 March 2021 00:00

How Do Orthotics Work?

Orthotics are specially designed shoe inserts that help correct imbalances and provide additional support to the feet. They can be purchased over the counter or be custom made by a podiatrist. Orthotics can help provide relief from a variety of conditions such as corns, calluses, ulcerations, tendonitis, heel pain, recurring stress fractures, and even hip and lower back pain. Since orthotics are designed to address specific problems, they can work in various ways that include relieving pressure by redistributing body weight or by providing extra shock absorption. Patients who believe that orthotics may help relieve their foot and ankle issues should consult with a podiatrist. A podiatrist looks at a variety of factors, such as the foot’s structure and function, biomechanics and lifestyle factors, to determine the right fit for each individual patient.

If you are having discomfort in your feet and would like to try orthotics, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain-free and on your feet.

What Are Orthotics?

Orthotics are inserts you can place into your shoes to help with a variety of foot problems such as flat feet or foot pain. Orthotics provide relief and comfort for minor foot and heel pain but can’t correct serious biomechanical problems in your feet.

Over-the-Counter Inserts

Orthotics come in a wide variety of over-the-counter inserts that are used to treat foot pain, heel pain, and minor problems. For example, arch supports can be inserted into your shoes to help correct overarched or flat feet, while gel insoles are often used because they provide comfort and relief from foot and heel pain by alleviating pressure.

Prescription Orthotics

If over-the-counter inserts don’t work for you or if you have a more severe foot concern, it is possible to have your podiatrist prescribe custom orthotics. These high-quality inserts are designed to treat problems such as abnormal motion, plantar fasciitis, and severe forms of heel pain. They can even be used to help patients suffering from diabetes by treating foot ulcers and painful calluses and are usually molded to your feet individually, which allows them to provide full support and comfort.

If you are experiencing minor to severe foot or heel pain, it’s recommended to speak with your podiatrist about the possibilities of using orthotics. A podiatrist can determine which type of orthotic is right for you and allow you to take the first steps towards being pain-free.

If you have any questions please contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot and ankle needs.

Read more about Foot Orthotics
Wednesday, 17 March 2021 00:00

Reminder: When Was the Last Time...?

Custom orthotics, or shoe inserts, should be periodically replaced. Orthotics must fit properly to give you the best results. Protect your feet and ankles!

Monday, 15 March 2021 00:00

Morton's Neuroma

A neuroma is a thickening of nerve tissue and can develop throughout the body.  In the foot, the most common neuroma is a Morton’s neuroma; this typically forms between the third and fourth toes.  The thickening of the nerve is typically caused by compression and irritation of the nerve; this thickening can in turn cause enlargement and, in some cases, nerve damage.

Neuromas can be caused by anything that causes compression or irritation of the nerve.  A common cause is wearing shoes with tapered toe boxes or high heels that force the toes into the toe boxes.  Physical activities that involve repeated pressure to the foot, such as running or basketball, can also create neuromas.  Those with foot deformities, such as bunions, hammertoes, or flatfeet, are more likely to develop the condition.

Symptoms of Morton’s neuroma include tingling, burning, numbness, pain, and the feeling that either something is inside the ball of the foot or that something in one’s shoe or sock is bunched up.  Symptoms typically begin gradually and can even go away temporarily by removing one’s shoes or massaging the foot.  An increase in the intensity of symptoms correlates with the increasing growth of the neuroma.

Treatment for Morton’s neuroma can vary between patients and the severity of the condition.  For mild to moderate cases, padding, icing, orthotics, activity modifications, shoe modifications, medications, and injection therapy may be suggested or prescribed.  Patients who have not responded successfully to less invasive treatments may require surgery to properly treat their condition.  The severity of your condition will determine the procedure performed and the length of recovery afterwards.

Monday, 15 March 2021 00:00

Do I Have Morton's Neuroma?

Morton’s neuroma is a painful foot condition caused by damage to the nerve between the third and fourth toes. The tissue that surrounds the nerve thickens due to inflammation, causing symptoms such as toe numbness, a tingling sensation, a feeling akin to “walking on a pebble,” and burning pain in the ball of the foot. Morton’s neuroma is eight to ten times more common in women than in men because it is believed to be caused by wearing ill-fitting shoes.  Morton's neuroma can also result from damaging the foot during high impact sports or from other trauma to the nerves of the feet. Having certain foot deformities, such as flat feet, high arches, hammertoes, or bunions, can also put you at an increased risk of developing Morton’s neuroma. If you have symptoms of this condition, please seek the care of a podiatrist.

Morton’s neuroma is a very uncomfortable condition to live with. If you think you have Morton’s neuroma, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor will attend to all of your foot care needs and answer any of your related questions.  

Morton’s Neuroma

Morton's neuroma is a painful foot condition that commonly affects the areas between the second and third or third and fourth toe, although other areas of the foot are also susceptible. Morton’s neuroma is caused by an inflamed nerve in the foot that is being squeezed and aggravated by surrounding bones.

What Increases the Chances of Having Morton’s Neuroma?

  • Ill-fitting high heels or shoes that add pressure to the toe or foot
  • Jogging, running or any sport that involves constant impact to the foot
  • Flat feet, bunions, and any other foot deformities

Morton’s neuroma is a very treatable condition. Orthotics and shoe inserts can often be used to alleviate the pain on the forefront of the feet. In more severe cases, corticosteroids can also be prescribed. In order to figure out the best treatment for your neuroma, it’s recommended to seek the care of a podiatrist who can diagnose your condition and provide different treatment options.

If you have any questions, please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic and treatment technologies for all your foot care needs.

Read more about Morton's Neuroma
Monday, 08 March 2021 00:00

Achilles Tendon Injuries

The Achilles tendon is the largest tendon in the body; it is a tough band of fibrous tissue that stretches from the bones of the heel to the calf muscles. This tendon is what allows us to stand on our toes while running, walking, or jumping, it is common for this tendon to become injured. In severe cases, the Achilles tendon may become partially torn or completely ruptured. However, this tendon is susceptible to injury because of its limited blood supply and the high level of tension it endures.

The people who are more likely to suffer from Achilles tendon injuries are athletes who partake in activities that require them to speed up, slow down, or pivot. Consequently, athletes who engage in running, gymnastics, dance, football, baseball, basketball, or tennis are more likely to suffer from Achilles tendon injuries. Additionally, there are other factors that may make you more prone to this injury. People who wear high heels, have flat feet, tight leg muscles or tendons, or take medicines called glucocorticoids are more likely to have Achilles tendon injuries.

A common symptom of an Achilles tendon injury is pain above the heel that is felt when you stand on your toes. However, if the tendon is ruptured, the pain will be severe, and the area may become swollen and stiff. Other symptoms may be reduced strength in the lower ankle or leg area, and reduced range of motion in the ankle. When the Achilles tendon tears, there is usually a popping sound that occurs along with it. People who have acute tears or ruptures may find walking and standing to be difficult.

If you suspect you have injured your Achilles tendon, you should see your podiatrist to have a physical examination. Your podiatrist will likely conduct a series of tests to diagnose your injury including a “calf-squeeze” test. Calf squeeze tests are performed by first squeezing the calf muscle on the healthy leg. This will pull on the tendon and consequently cause the foot to move. Afterward, the same test will be performed on the injured leg. If the tendon is torn, the foot won’t move because the calf muscle won’t be connected to the foot.

The large tendon on the back of the ankle connecting the calf muscle and the heel bone is known as the Achilles tendon. When this tendon tears, an Achilles tendon rupture may occur. A rupture is often common in sporting activities that involve pushing off the feet and sprinting, such as basketball and tennis. While Achilles tendon ruptures tend to happen more to males and people between the ages of 30 and 40, they can happen to anyone. Those who have poor flexibility, an inactive lifestyle, or are taking steroid medications may be at a higher risk for an Achilles tendon rupture as well. Signs of a rupture can include abrupt pain in the affected area, the feeling of getting kicked in the back of the leg, hearing a “pop” in back of the leg, weakness, and bruising or swelling in the area. If you believe that you have ruptured your Achilles tendon, or you would like to learn more about preventing a rupture, please consult with a podiatrist.

Achilles tendon injuries need immediate attention to avoid future complications. If you have any concerns, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor can provide the care you need to keep you pain-free and on your feet.

What Is the Achilles Tendon?

The Achilles tendon is a tendon that connects the lower leg muscles and calf to the heel of the foot. It is the strongest tendon in the human body and is essential for making movement possible. Because this tendon is such an integral part of the body, any injuries to it can create immense difficulties and should immediately be presented to a doctor.

What Are the Symptoms of an Achilles Tendon Injury?

There are various types of injuries that can affect the Achilles tendon. The two most common injuries are Achilles tendinitis and ruptures of the tendon.

Achilles Tendinitis Symptoms

  • Inflammation
  • Dull to severe pain
  • Increased blood flow to the tendon
  • Thickening of the tendon

Rupture Symptoms

  • Extreme pain and swelling in the foot
  • Total immobility

Treatment and Prevention

Achilles tendon injuries are diagnosed by a thorough physical evaluation, which can include an MRI. Treatment involves rest, physical therapy, and in some cases, surgery. However, various preventative measures can be taken to avoid these injuries, such as:

  • Thorough stretching of the tendon before and after exercise
  • Strengthening exercises like calf raises, squats, leg curls, leg extensions, leg raises, lunges, and leg presses

If you have any questions please feel free to contact our office located in Chelan, WA . We offer the newest diagnostic tools and technology to treat your foot and ankle needs.

Read more about Achilles Tendon Injuries
Tuesday, 02 March 2021 00:00

Systemic Diseases of the Foot

There are several systemic diseases, or diseases that affect the whole body, that either display symptoms in the feet or affect the health of the feet. Common systemic diseases that affect the overall health of the feet, and the patient’s ability to walk comfortably, include gout, diabetes mellitus, neurological disorders, and arthritis, among others.

In gout, which is caused by an excessive buildup of uric acid in the body, the most common symptoms of pain, inflammation, and redness occur at the metatarsal/phalangeal joint at the base of the big toe. Any excess levels of uric acid crystallize and are deposited in tendons, joints, and surrounding bone and muscle tissue. Gout is commonly treated with NSAIDs to relieve pain and inflammation and other drugs to lower uric acid levels in the body. Gout most commonly affects those who are overweight, have low protein diets and lead a more sedentary lifestyle.

Diabetes mellitus is an increase in the level of blood sugar in which the body cannot counteract with naturally occurring insulin in the body. The three types of diabetes, Type I, Type II and Gestational Diabetes, are all signs the body is either not producing enough insulin or is not efficiently using the insulin that is produced. Gestational diabetes only affects women who are pregnant and have never, prior to pregnancy, exhibited symptoms of the disease.

There are two main issues that affect the feet that are commonly caused by diabetes. They include diabetic neuropathy and peripheral vascular disease. Diabetic neuropathy can lead to damaged nerves and affect the feet through numbness and loss of sensation. Peripheral vascular disease restricts the flow of blood to the foot and can, in extreme cases, lead to the necessity of amputating the foot. Peripheral issues that are caused by diabetes and can affect the foot include athlete’s foot, nail infections, corns, blisters, bunions, severe dry skin, plantar warts and ingrown toenails. These can all be attributed to the decrease of blood flow to the foot.

Neurological disorders and rheumatoid arthritis can also have severe impact on the health of the feet. Neurological disorders can affect the nerves in the main structure of the foot and cause loss of sensation and possible decreased muscle response. Rheumatoid arthritis can affect the bones and joint structures of the foot, making it impossible to walk normally without serious pain.

All systemic diseases that affect the foot can effectively be treated to minimize joint and muscle damage if they are diagnosed early and treated with medication and lifestyle therapy. Diabetes patients must monitor their blood sugar levels and work with their physician to keep their levels as close to normal as possible. Rheumatoid arthritis patients should work with their physician to ensure the proper medications are being taken to reduce the amount of damage to the joints of the body.

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