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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!

May 2021

Tuesday, 25 May 2021 00:00

What Are Hammertoes?

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.  

Tuesday, 25 May 2021 00:00

Treatment for Hammertoe

Hammertoe is a type of foot deformity in which the toes bend upward at the middle joint, giving them a hammer-like appearance. This condition is usually caused by a muscle or tendon imbalance, but can be aggravated by wearing shoes that are too tight or narrow in the front or have excessively high heels. In the initial stages, the hammertoe may still be flexible and the toes can be straightened. In later stages, the toes can become rigid and you will not be able to straighten them. Flexible hammertoe can be treated by wearing shoes that are comfortable and have a wide toe box, wearing orthotic inserts, and stretching and exercising the toes. Rigid hammertoe may require surgery to correct it. If you have hammertoe, please consult with a podiatrist to see which treatment options may be right for you.

Hammertoes can be a painful condition to live with. For more information, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor will answer any of your foot- and ankle-related questions.

Hammertoe

Hammertoe is a foot deformity that occurs due to an imbalance in the muscles, tendons, or ligaments that normally hold the toe straight. It can be caused by the type of shoes you wear, your foot structure, trauma, and certain disease processes.

Symptoms

  • Painful and/or difficult toe movement
  • Swelling
  • Joint stiffness
  • Calluses/Corns
  • Physical deformity

Risk Factors

  • Age – The risk of hammertoe increases with age
  • Sex – Women are more likely to have hammertoe compared to men
  • Toe Length – You are more likely to develop hammertoe if your second toe is longer than your big toe
  • Certain Diseases – Arthritis and diabetes may make you more likely to develop hammertoe

Treatment

If you have hammertoe, you should change into a more comfortable shoe that provides enough room for your toes. Exercises such as picking up marbles may strengthen and stretch your toe muscles. Nevertheless, it is important to seek assistance from a podiatrist in order to determine the severity of your hammertoe and see which treatment option will work best for you.

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 What Are Hammertoes?
Tuesday, 18 May 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.

Tuesday, 18 May 2021 00:00

How the Achilles Tendon Can Be Injured

The Achilles tendon is located on the back of the ankle and connects the heel to the calf muscles. The two most common injuries that affect the Achilles tendon are Achilles tendinopathy and an Achilles tendon tear or rupture. Achilles tendinopathy symptoms include swelling, stiffness, and pain that is more noticeable in the morning. An Achilles tendon tear or rupture is often the result of forceful jumping and pivoting and sudden accelerations that result in overstretching and the eventual tearing of the tendon. A complete rupture can cause severe pain and a loss of strength and movement. Because of the seriousness of an Achilles tendon injury, patients who are experiencing pain and swelling in this tendon should consult with a podiatrist. A podiatrist will be able to help provide preventative measures to avoid a rupture, as well as guide you in healing the injury.

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
Sunday, 16 May 2021 00:00

It's Time for Beautiful Feet

You don't need an excuse to have beautiful nails. Step outside without worrying about the appearance of your feet.

Monday, 10 May 2021 00:00

All About Plantar Warts

Plantar warts are warts that are only found on the feet, hence the term “plantar”, which means “relating to the foot.” They are caused by the human papillomavirus, or HPV, and occur when this virus gets into open wounds on the feet. The warts themselves are hard bumps on the foot. They are easily recognizable, mostly found on the heels or ball of the foot. Plantar warts are non-malignant, but they can cause some pain, discomfort, and are often unsightly. Removing them is a common step toward treating them.

Plantar warts can cause some pain while standing, sometimes felt as tenderness on the sole of your foot. Unless the wart has grown into the foot behind a callus, you will be able to see the fleshy wart. A podiatrist should only be consulted if there is an excessive amount of pain. Plantar warts are not cancerous or dangerous, but they can affect your walking and continually reappear. Anyone who suffers from diabetes or a compromised immune system disease should seek out care immediately.

Podiatrists are easily able to diagnose plantar warts. They usually scrape off a tiny bit of the rough skin to make tiny blood clots visible and examine the inside of warts. However, a biopsy can be done if the doctor is not able to diagnose them from simply looking at them. Although plantar warts usually do not require an excessive amount of treatment, there are ways to go about removing them. A common method is to freeze them off using liquid nitrogen, removing them using an electrical tool, or burning them off via laser treatment. For a less invasive treatment option, topical creams can be used through a doctor’s prescription. This treatment method takes more time, however. Keep the wart covered for protection in between daily treatments.

The best way to avoid developing plantar warts is to avoid walking barefoot in public places. Avoid this especially if you have open sores or cuts on your feet. It is also important to avoid direct contact with warts in general, as they are highly contagious.

Monday, 10 May 2021 00:00

HPV and Plantar Warts

Plantar warts are caused by the human papillomavirus (HPV). They occur on the sole of the feet—most typically on the balls of the feet, heels, and under the toes—and are spread by human contact when the virus enters the bloodstream through tiny cracks in the skin. They usually present as hard, thick, lesions akin to calluses, and sometimes tiny blood vessels are present, which look like black specks on the surface. Plantar warts can range in size, and are often tender or sometimes even painful. They can form as either independent growths or as part of a cluster of warts. While plantar warts can sometimes go away over a period of years, it is suggested that you seek the care of a podiatrist if you have circulatory problems or diabetes, or if your warts are painful, bleeding, or spreading quickly.

Plantar warts can be very uncomfortable. If you need your feet checked, contact John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor will assist you with all of your foot and ankle needs.

About Plantar Warts

Plantar warts are the result of HPV, or human papillomavirus, getting into open wounds on the feet. They are mostly found on the heels or balls of the feet.

While plantar warts are generally harmless, those experiencing excessive pain or those suffering from diabetes or a compromised immune system require immediate medical care. Plantar warts are easily diagnosed, usually through scraping off a bit of rough skin or by getting a biopsy.

Symptoms

  • Lesions on the bottom of your feet, usually rough and grainy
  • Hard or thick callused spots
  • Wart seeds, which are small clotted blood vessels that look like little black spots
  • Pain, discomfort, or tenderness of your feet when walking or standing

Treatment

  • Freezing
  • Electric tool removal
  • Laser Treatment
  • Topical Creams (prescription only)
  • Over-the-counter medications

To help prevent developing plantar warts, avoid walking barefoot over abrasive surfaces that can cause cuts or wounds for HPV to get into. Avoiding direct contact with other warts, as well as not picking or rubbing existing warts, can help prevent the further spread of plantar warts. However, if you think you have developed plantar warts, speak to your podiatrist. He or she can diagnose the warts on your feet and recommend the appropriate 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 and ankle needs.

Read more about All About Plantar Warts
Monday, 03 May 2021 00:00

Ingrown Toenails

Ingrown toenails (onychocryptosis) are a common foot ailment and it is very unpleasant to experience. The condition is caused by an increase in pressure from the ingrowth of the nail edge into the skin of the toe. Ingrown toenails commonly cause pain in those who experience them. In some cases, the skin surrounding the ingrown toenail may break which may lead bacteria to enter through and cause an infection. Common symptoms of this ailment include pain, redness, swelling, and warmth around the toe.

An imbalance between the size of the nail and the enlargement of the nail skin edge causes ingrown toenails. This condition is often caused by improperly trimming the toenails. If you are trying you cut your nails, you should always try to trim straight across instead of in a rounded shape. Ingrown toenails can also be an inherited condition and they may also be caused by improper shoe fitting.

Another common cause of the condition is wearing shoes that are either too small or too large. Other causes include poor foot hygiene, obesity, diabetes, arthritis, edema, and fungal infections. There are many risk factors that may make a person more likely to develop an ingrown toenail. Athletes who play “stop and start” sports such as tennis, soccer, and basketball are most likely to have ingrown toenails.

People who have diabetes, a compromised immune system, or poor circulation should immediately seek care from a podiatrist if they have an ingrown toenail. It is also recommended to seek professional assistance if at-home remedies are not successful within a week or if there is persistent pain.

Monday, 03 May 2021 00:00

Why Is My Toenail Ingrown?

Ingrown toenails occur when a nail grows into the surrounding skin, rather than over it. This can cause symptoms such as pain, tenderness, redness, and swelling of the skin surrounding the ingrown toenail. While most ingrown toenails are not serious and often heal with home treatment, sometimes the area can become infected and require medical treatment. But what causes toenails to become ingrown anyway? Trauma to the toenail from stubbing the toe can lead to ingrown nails, as can wearing shoes that are too tight and push the nail into the skin, and trimming the toenails improperly. If you are prone to ingrown toenails, it is suggested that you see a podiatrist, who can assess your feet and advise you on how to prevent and treat ingrown toenails. 

Ingrown toenails can become painful if they are not treated properly. For more information about ingrown toenails, 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.

Ingrown Toenails

Ingrown toenails occur when a toenail grows sideways into the bed of the nail, causing pain, swelling, and possibly infection.

Causes

  • Bacterial infections
  • Improper nail cutting such as cutting it too short or not straight across
  • Trauma to the toe, such as stubbing, which causes the nail to grow back irregularly
  • Ill-fitting shoes that bunch the toes too close together
  • Genetic predisposition

Prevention

Because ingrown toenails are not something found outside of shoe-wearing cultures, going barefoot as often as possible will decrease the likeliness of developing ingrown toenails. Wearing proper fitting shoes and using proper cutting techniques will also help decrease your risk of developing ingrown toenails.

Treatment

Ingrown toenails are a very treatable foot condition. In minor cases, soaking the affected area in salt or antibacterial soaps will not only help with the ingrown nail itself, but also help prevent any infections from occurring. In more severe cases, surgery is an option. In either case, speaking to your podiatrist about this condition will help you get a better understanding of specific treatment options that are right for you.

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 Ingrown Toenails
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