So go ahead and step out in your favorite flip-flops for summertime strolls and parties. (P.S. Be sure to protect your feet with sunscreen.) Then, step into well-cushioned shoes when walking on concrete or pavement and exercising to dodge painful problems, say Mount Sinai School of Medicine Orthopaedic doctors who treat an influx of flip flop injuries each summer. Here’s why!

Flip-flops offer limited support.

1. People grip and hold flip-flops in place with their toes. Result: This motion changes the way you walk and can stress the toes, ankles, legs, hips, and back.
2. Flat and flimsy shoe beds provide inadequate foot support for all-day wear. Result: Arch pain, plantar fasciitis, and nerve issues.
3. Lack of shock absorption. Result: Pain in feet, legs, hips, and back.

Flip-flops offer limited coverage.

1. Few people understand or think of the foot as a place where skin cancer can arise. Result: Foot melanoma can be deadly. Mount Sinai Podiatrist Dr. Bryan Markinson reports a sharp rise in foot melanoma among his patients. Alert to sandal wearers: Remember to apply sunscreen to your feet!
2. Flip-flops leave toes and nails uncovered and unprotected. Result: Broken toes and toenails.
3. Feet can roll off the shoe. Result: Cuts and infections.

Mount Sinai’s Leni and Peter W. May Department of Orthopaedics specializes in surgery of the foot and ankle, knee, hip, hand, elbow, shoulder, and spine; total joint replacement for knee, hip, foot, ankle, and shoulder; microvascular surgery; cancer surgery; and minimally invasive surgery.

Flip-Flops For Summer Fun The Saturday Evening Post

Botox for Migraines

Injecting Botox around the head and neck about every 12 weeks helps dull future headache symptoms and improve quality of life in people with near-daily migraines, according to a 2011 study of 1,384 adults. FDA-approved for chronic migraine in 2010, Botox has not been shown to work for migraine headaches that occur 14 days or less per month, or for other forms of headache.

Botox for Urinary Frequency

People with overactive bladders or OAB report improved urinary control for six months or more after injection of Botox into the bladder muscle. Experts say the drug (approved in 2011 for OAB resulting from multiple sclerosis or spinal cord injury) blocks signals that activate the bladder muscle, but doesn’t interfere with the function of surrounding muscles.

Botox for Foot Pain

People with aching feet are also opting for Botox—even though it’s not approved for treating the prevalent problem. Small cushions of fatty acids that protect feet from torque and shear are decidedly crucial as we pound through life. But wearing high heels can wear out the fat pad at the base of the toes. And thin-soled athletic cleats and steroid injections for plantar fasciitis (a frequent cause of chronic heel pain) can sometimes shrink padding under the heel and on the outer arch contact area. Aging, having diabetes, or being overweight also put feet at risk.

“Pain occurs when areas of the feet are subjected to unaccustomed strain as the padding deteriorates,” explains New York podiatrist Alan Berman. Botox injections may relieve pain for about three months or the amount of time the drug remains in the system, according to ongoing research. Plumping up sore feet with newer skin fillers (Juvederm, Sculptra) also seems promising. “Wearing supportive insoles such as Lynco or Spenco inserts and well-fitting shoes remain the gold standard for lasting relief,” advises Dr. Berman.

Happy Birthday, Botox! The Saturday Evening Post

My feet hurt and feel swollen inside. They get worse when I lay down. I am a diabetic and on Glucotrol, Glucophage, and insulin. My sugar count still runs above the 120 limit. Is there anything I can do for my feet?

Regina
Niangua, Missouri

It is very important for you to inspect your feet once or twice daily for any signs of injury or infection. Experts at Joslin Clinic also advise diabetics to wash their feet every day in warm water with mild soap, dry thoroughly, and use an approved moisturizer. Left untreated, a small sore can have serious consequences.

We asked Dr. Edgar Ross, who is the director of the Pain Management Center at Brigham and Women’s Hospital in Boston, about treating foot pain related to diabetes. Dr. Ross replies:

“Diabetes can have many complications associated with it. One of the most common and debilitating complications is a condition called diabetic peripheral neuropathy (or DPN).

“Over time, elevated blood sugars from diabetes can damage nerves throughout the body, and this process usually begins in the feet. Although there are exceptions, DPN symptoms are often slight at first. The pain may gradually worsen and feel very much like what you describe.

“Research shows that improved blood sugar control delays the progression of DPN, and it is important that people are diagnosed early and receive aggressive treatment. Doctors estimate that nearly half of the amputations in the U.S. are caused by neuropathy and poor circulation that could have been prevented by careful foot care. Therefore, regular foot exams to look for loss of sensation are critical, as patients may not be able to feel pain, especially in the feet—a problem that can lead to potentially dangerous and unrecognized injuries.

“Healthcare professionals (e.g., a specially trained nurse, podiatrist and/or physical therapist) may recommend special footwear to help people with numbness in the feet avoid injury.

“In addition, several medications are proven to help manage pain from diabetic neuropathy. Newer anticonvulsant medications such as gabapentin and pregabalin have been shown to be particularly effective, so talk to your doctor about what is right for you.

“About half of all people with diabetes develop DPN. In advanced cases, patients may experience tingling and burning in the feet and even the arms.”

Diabetes and Foot Problems The Saturday Evening Post