December 2024
Wound Care
Diabetics must be wary of all wounds, regardless of depth or size. Diabetes, a chronic disease in which the body cannot properly use glucose the way it normally would, causes various complications that make wounds difficult to heal. Nerve damage or neuropathy will cause diabetics to have trouble feeling the pain of a blister or cut until the condition has significantly worsened or become infected. A diabetic’s weakened immune system can make even the most minor of wounds easily susceptible to infection. Diabetics are also more prone to developing narrow, clogged arteries, and are therefore more likely to develop wounds.
Wounds should be taken care of immediately after discovery, as even the smallest of wounds can become infected if enough bacteria build up within the wound. To remove dirt, wounds should be first rinsed under running water only. Soap, hydrogen peroxide, or iodine can irritate the injury and should be avoided. To prevent infection, apply antibiotic ointment to the wound and cover it with a bandage. The bandage should be changed daily. The skin around the wound may be cleaned with soap.
To prevent further exacerbation, see a doctor—especially if you have diabetes. Minor skin conditions can become larger problems if not properly inspected. As the wound heals, make sure to avoid applying pressure to the affected area.
Expert Diabetic Wound Care Matters

Diabetic foot disease, or DFD, is a serious complication of diabetes that significantly impacts quality of life. Its prevalence has increased due to predisposing factors such as prolonged high blood sugar levels, poor circulation, and impaired immune function. These factors heighten the risk of infections, slow wound healing, and contribute to conditions like diabetic neuropathy, which reduces sensation in the feet. This loss of feeling can lead to unnoticed injuries that develop into diabetic foot ulcers, a common precursor to lower limb amputations. Without proper care, these ulcers can become severely infected, making amputation necessary to prevent life-threatening complications. Podiatrists play a critical role in managing diabetic foot wounds, utilizing advanced treatments such as debridement, specialized dressings, and offloading devices to promote healing and prevent recurrence. If you have diabetes,it is suggested that you schedule regular podiatric appointments to reduce the risks associated with diabetic foot disease.
Wound care is an important part in dealing with diabetes. If you have diabetes and a foot wound or would like more information about wound care for diabetics, consult with John Horlebein, DPM from Northern Cascades Foot & Ankle, LLC. Our doctor will assess your condition and provide you with quality foot and ankle treatment.
What Is Wound Care?
Wound care is the practice of taking proper care of a wound. This can range from the smallest to the largest of wounds. While everyone can benefit from proper wound care, it is much more important for diabetics. Diabetics often suffer from poor blood circulation which causes wounds to heal much slower than they would in a non-diabetic.
What Is the Importance of Wound Care?
While it may not seem apparent with small ulcers on the foot, for diabetics, any size ulcer can become infected. Diabetics often also suffer from neuropathy, or nerve loss. This means they might not even feel when they have an ulcer on their foot. If the wound becomes severely infected, amputation may be necessary. Therefore, it is of the upmost importance to properly care for any and all foot wounds.
How to Care for Wounds
The best way to care for foot wounds is to prevent them. For diabetics, this means daily inspections of the feet for any signs of abnormalities or ulcers. It is also recommended to see a podiatrist several times a year for a foot inspection. If you do have an ulcer, run the wound under water to clear dirt from the wound; then apply antibiotic ointment to the wound and cover with a bandage. Bandages should be changed daily and keeping pressure off the wound is smart. It is advised to see a podiatrist, who can keep an eye on it.
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.
Bunions
A bunion is a bump that forms at the base of the big toe. Bunions form when the big toe pushes against the next toe, which forces the big toe joint to get bigger and stick out. As a result, the skin over the bunion may start to appear red and it may feel sore.
There are risk factors that can increase your chances of developing bunions. People who wear high heels or ill-fitting shoes are more likely to develop them, in addition to those who have a genetic history of bunions or have rheumatoid arthritis.
The most obvious way to tell if you have a bunion is to look for the big toe pushing up against the toe next to it. Bunions produce a large protrusion at the base of the big toe and may or may not cause pain. Other symptoms are redness, swelling, and restricted movement of the big toe if you have arthritis.
Nonsurgical methods are frequently used to treat bunions that aren’t severe. Some methods of nonsurgical treatment are orthotics, icing and resting the foot, taping the foot, and pain medication. Surgery is usually only required in extreme cases. However, if surgery is needed, some procedures may involve removing the swollen tissue from around the big toe joint, straightening the big toe by removing part of the bone, or joining the bones of your affected joint permanently.
Your podiatrist will diagnose your bunion by doing a thorough examination of your foot. He or she may also conduct an x-ray to determine the cause of the bunion and its severity.
The Truth About Bunions

Bunions are bony bumps that form at the base of the big toe causing it to lean toward the other toes. They often look unsightly and can be painful, especially when wearing tight or narrow shoes. Bunions develop over time due to factors like genetics, foot structure, arthritis, or wearing ill-fitting footwear. While some people experience no pain, others may suffer from redness, swelling, and discomfort, particularly after prolonged walking or standing. Bunions are more common in women, likely due to shoe choices, and in those with a family history of the condition. Unfortunately, bunions do not go away on their own. They may worsen without intervention. Treatment includes wearing wider shoes, using orthotics, or padding the bunion to reduce friction. For severe cases, surgery may be necessary. If you have a painful bunion, it is suggested that you visit a podiatrist who can assess your bunions and recommend the best treatment plan.
If you are suffering from bunions, 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 a Bunion?
A bunion is formed of swollen tissue or an enlargement of boney growth, usually located at the base joint of the toe that connects to the foot. The swelling occurs due to the bones in the big toe shifting inward, which impacts the other toes of the foot. This causes the area around the base of the big toe to become inflamed and painful.
Why Do Bunions Form?
Genetics – Susceptibility to bunions are often hereditary
Stress on the feet – Poorly fitted and uncomfortable footwear that places stress on feet, such as heels, can worsen existing bunions
How Are Bunions Diagnosed?
Doctors often perform two tests – blood tests and x-rays – when trying to diagnose bunions, especially in the early stages of development. Blood tests help determine if the foot pain is being caused by something else, such as arthritis, while x-rays provide a clear picture of your bone structure to your doctor.
How Are Bunions Treated?
- Refrain from wearing heels or similar shoes that cause discomfort
- Select wider shoes that can provide more comfort and reduce pain
- Anti-inflammatory and pain management drugs
- Orthotics or foot inserts
- Surgery
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.
Preventing Running Injuries
Over half of all runners encounter at least one injury per year. The reason for this is because many runners do not train properly. Injuries are almost inevitable due to the physical stress that running causes. While our bodies are great at adapting to the stress, it can only handle it in small doses. Injuries occur when the stress is applied too quickly for the body to handle, causing something within it to break down. With each step you take, your leg is absorbing two or three times your body’s weight.
Some of the most popular running injuries are shin splints, plantar fasciitis, Achilles tendinitis, and stress fractures. Shin splints cause pain along the inside or outside of the shins, and this pain is usually felt at the beginning of a run. The condition itself is defined as an inflammation of the muscles or tendons located around the shinbone. To treat shin splints, it is advised that you ice the shin area and stretch the calf muscles. To prevent this injury, you should slowly increase the distance you plan on running, instead of jumping into a more strenuous routine.
Achilles tendinitis is another common injury and it feels like pain along the back of the leg, toward the heel. This condition is defined as an inflammation of the Achilles which is the largest tendon in the body. The Achilles is responsible for connecting your calf muscles to the heel bone and it is caused by tight calf muscles. If you want to treat this injury, you should take a break from running to cross train with a low-impact activity.
There are a lot of common mistakes runners make that are causing them to experience injury. One mistake is stretching too much prior to warming up. If you plan to go on a run, you should warm up with a gentle 3-5-minute walk followed by a 5-minute run-walk. Another common mistake is jumping into a routine too quickly. Consequently, you should incorporate cross-training into your routine. If you are looking to get active, you should slowly weave running into an activity you are currently participating in. For example, you can try bike riding for 40 minutes followed by a 10-minute run.
Another way to prevent running injuries is to choose shoes that are appropriate for running. There are certain things you should look for when buying a new pair of running shoes. An important factor in these sneakers is flexibility. Running shoes should be capable of bending and flexing at the forefoot. However, you should not be able to bend the entire shoe in half with ease because this is a sign that the shoe does not have enough structure. Additionally, you should look for the fit of the running shoes you want to purchase. It is best to visit a specialty running shoe store to have your feet properly sized. Choosing shoes that fit properly can prevent many foot ailments.
If you are suffering from any pain from running injuries, you should make an appointment with your podiatrist to discover the underlying cause of your pain. He or she will be able to help treat your condition in the best way possible.
The Dangers of Wearing Worn Out Running Shoes

Wearing worn-out running shoes can lead to foot, toe, and ankle problems as a result of inadequate support and cushioning. Over time, the foam and tread in running shoes degrades, reducing their ability to absorb shock and stabilize the foot. This can increase pressure on the arches, contribute to overpronation or underpronation, and lead to conditions like arch pain or Achilles tendon discomfort. Signs of wear include new foot pain, flattened midsoles, or uneven tread patterns. For runners with flat feet or for those who overpronate, worn out shoes can aggravate these structural issues, increasing the risk of foot and other injuries. Experts suggest that active runners replace their shoes every 300 to 500 miles, or approximately every six months. A podiatrist can assess a runner’s foot alignment, gait, and running habits to help them choose appropriate footwear and reduce injury risks. If you are experiencing foot pain after running, it is suggested that you schedule an appointment with a podiatrist for an exam, diagnosis, and treatment options.
All runners should take extra precaution when trying to avoid injury. If you have any concerns about your feet, contact John Horlebein, DPM of Northern Cascades Foot & Ankle, LLC. Our doctor will treat your foot and ankle needs.
How to Prevent Running Injuries
There are a lot of mistakes a runner can make prior to a workout that can induce injury. A lot of athletes tend to overstretch before running, instead of saving those workouts for a post-run routine. Deep lunges and hand-to-toe hamstring pulls should be performed after a workout instead of during a warmup. Another common mistake is jumping into an intense routine before your body is physically prepared for it. You should try to ease your way into long-distance running instead of forcing yourself to rush into it.
More Tips for Preventing Injury
- Incorporate Strength Training into Workouts - This will help improve the body’s overall athleticism
- Improve and Maintain Your Flexibility – Stretching everyday will help improve overall performance
- “Warm Up” Before Running and “Cool Down” Afterward – A warm up of 5-10 minutes helps get rid of lactic acid in the muscles and prevents delayed muscle soreness
- Cross-Training is Crucial
- Wear Proper Running Shoes
- Have a Formal Gait Analysis – Poor biomechanics can easily cause injury
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.
Ankle Foot Orthotics for Athletes
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.
Customized Orthotics for Kids With JIA

Juvenile idiopathic arthritis, or JIA, is an autoimmune disease that causes chronic inflammation in children’s joints, including the feet. This condition can lead to joint pain, stiffness, and swelling, particularly in the ankles and feet, making movement challenging and uncomfortable. For kids with JIA, customized preformed orthotics can provide essential support. These orthotics start with a pre-made structure, which is then tailored to the child’s specific foot shape and needs, offering personalized comfort and stability. By adjusting the orthotic’s arch support, heel cushioning, and alignment, these inserts help reduce pressure on inflamed joints and improve gait, which is often affected in JIA. Customized preformed orthotics can relieve pain, reduce joint stress, and enhance mobility, making daily activities more manageable. If your child has JIA, it is suggested that you schedule an appointment with a podiatrist to discuss if orthotics can help manage pain in their feet and ankles.
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.
Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia is the thick band of tissue that connects the heel bone to the toes. When this band of connective tissue becomes inflamed, plantar fasciitis occurs. Fortunately, this condition is treatable.
There are several factors that may put you at a greater risk for developing plantar fasciitis. One of the biggest factors is age; plantar fasciitis is common in those between the ages of 40 to 60. People who have jobs that require them to be on their feet are also likely to develop plantar fasciitis. This includes factory workers, teachers, and others who spend a large portion of their day walking around on hard surfaces. Another risk factor is obesity because excess weight can result in extra stress being placed on the plantar fascia.
People with plantar fasciitis often experience a stabbing pain in the heel area. This pain is usually at its worst in the morning, but can also be triggered by periods of standing or sitting. Plantar fasciitis may make it hard to run and walk. It may also make the foot feel stiff and sensitive, which consequently makes walking barefoot difficult.
Treatment for plantar fasciitis depends on the severity of the specific case of the condition. Ice massage applications may be used to reduce pain and inflammation. Physical therapy is often used to treat plantar fasciitis, and this may include stretching exercises. Another treatment option is anti-inflammatory medication, such as ibuprofen.
If you suspect that you have plantar fasciitis, meet with your podiatrist immediately. If left untreated, symptoms may lead to tearing and overstretching of the plantar fascia. The solution is early detection and treatment. Be sure to speak with your podiatrist if you are experiencing heel pain.
Symptoms of Plantar Fasciitis

Plantar fasciitis causes pain and inflammation in the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel to the toes. This condition results in sharp heel pain, especially in the morning or after long periods of standing or walking.. The pain may improve with activity but can return after rest. The main cause of plantar fasciitis is repetitive stress or strain on the plantar fascia, often due to excessive pressure from activities or improper footwear. Other risk factors include obesity, tight calf muscles, and flat feet. If you have heel pain, it is suggested that you consult a podiatrist who can accurately diagnose and treat plantar fasciitis.
Plantar fasciitis can be very painful and inconvenient. If you are experiencing heel pain or symptoms of plantar fasciitis, 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 Is Plantar Fasciitis?
Plantar fasciitis is the inflammation of the thick band of tissue that runs along the bottom of your foot, known as the plantar fascia, and causes mild to severe heel pain.
What Causes Plantar Fasciitis?
- Excessive running
- Non-supportive shoes
- Overpronation
- Repeated stretching and tearing of the plantar fascia
How Can It Be Treated?
- Conservative measures – anti-inflammatories, ice packs, stretching exercises, physical therapy, orthotic devices
- Shockwave therapy – sound waves are sent to the affected area to facilitate healing and are usually used for chronic cases of plantar fasciitis
- Surgery – usually only used as a last resort when all else fails. The plantar fascia can be surgically detached from the heel
While very treatable, plantar fasciitis is definitely not something that should be ignored. Especially in severe cases, speaking to your doctor right away is highly recommended to avoid complications and severe heel pain. Your podiatrist can work with you to provide the appropriate treatment options tailored to your condition.
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.