 INTERVIEWER: Dr.

Andreone, thank you so much for joining us here on Health

Connection. A real pleasure to have you. Our topic is “What is a podiatrist?” It's a
medical specialty a lot of people aren't familiar with it.
 DR. ANDREONE: What is a podiatrist? Well any doctors can treat a foot problem but
a podiatrist is specifically trained to treat foot problems.
 INTERVIEWER: That is, what we focus on, and that's where our specialty is, what
are the qualifications of a podiatrist and a doctor of Podiatric medicine and how's it
different from being an MD?
 DR. ANDREONE: Well, we go to four years of undergraduate education followed by
four years of medical school and the second two years of our medical school training.
We actually started dealing with surgical intervention, surgical training and
specifically with the foot. Then, we further increase our knowledge and our hands-on
skills in three to four years of Podiatry residency. And this I think gives us an
advantage over the other doctors because that's what we focus on.
 INTERVIEWER: What are the common reasons the patient says should see a
podiatrist?
 DR. ANDREONE: Any pain in your foot that's just not going away after a couple
day. It's better in my opinion to have it looked at. Because, sometimes, you don't
know the difference between something that might be short-term and go away or
something that might be a lifelong problem. And sometimes the longer you wait to
actually fix a problem, the longer it takes to actually solve the problem.
 INTERVIEWER: Recent news story said that three out of four Americans have had a
foot problem, but only one in three have seen a podiatrist for treatment. Why is it
important to see a podiatrist at the first sign of trouble with your feet?
 DR. ANDREONE: Well, first on trouble can be an indicator that something's wrong
and, like anything else, you want to get to it before it reaches a point where there isn't
an easy cure or an easy fix to the problem.
 INTERVIEWER: Why do diabetics have problems with their feet? And why are
diabetic foot problems so dangerous?
 DR. ANDREONE: Well… with diabetics they tend out to heal so well because…
diabetes is basically an autoimmune disease their body cannot deal with or fight off
pathogens as you and I can. Actually, in there if they're not controlling their blood
sugars, it can affect every organ system in their body from their eyes down to their
 feet. Sometimes that high blood sugar level will actually attack, starting in your feet,
the nerve endings… leading to numbness, burning, tingling problems. That it's an
indicator that something's wrong. So, if you have these symptoms and you haven't
seen a doctor or podiatrist. it might be an indication that you might need to do
something. When they don't feel so well, they're more prone to injuries to their foot.
You may not even know it and when they have these injuries, they just start
compounding over time and then their body can't fight it off. It can end up being a
life-changing experience and you can end up with a permanent deformity or
disfigurement.
 INTERVIEWER: Let's talk about some of the more common problems with feet…
you know, either what comes to mind: bunions, ingrowing toenails… What causes
these things and how do you treat them?
 DR. ANDREONE: Well… in the case of a bunion, it's basically an imbalance of the
foot. You'll see a majority of patients who have usually a flat foot in which case the
tendons that balance the big toe joint. There's one on either side and it's pulling the toe
one way or the other. In a normal foot that has a normal arch, the tendons are very
normally balanced. However, when in a flat foot it they allows one of those tendons to
gain an advantage and it starts pulling the toe over. Some people say: “Oh no! I have
this bump that's growing on the side of my foot”. You know what is it and typically
that's the bone right in behind the toe… which would be a bone in this area of the foot
that starts to shift over. That imbalance causes the bunion. Those can be surgically
treated if caught early enough. Sometimes, even orthotic in the shoe which is a means
of supporting the arch can keep that from becoming worse.
 INTERVIEWER: Ingrown toenails, what about them?
 DR. ANDREONE: I see a lot of those. Some are self-inflicted, some come from
pedicures. [While] getting a pedicure, when someone decides they're gonna dig in and
try to get a painful ingrown toenail and can't quite get it all out. Or sometimes, it can
be improper shoe gear which pushes on the side of the toe. Sometimes, in kids that are
growing, they don't realize that their feet are growing so fast. Their shoes are too
small and suddenly get red and hot and swollen on the side their toe. Sometimes
there's a simple little procedure we can do in the clinic and remove that toenail, so
that's not so painful anymore.
 INTERVIEWER: Recently, I saw an article of Sarah Jessica Parker, who was quoted
talking about her experience on Sex in the City. She said shooting that show and
having to be dressed up all the time… the high heels ruined your feet. Let's talk about
those kinds of shoes: high heels and flip flops. Dangers attended to both…
 DR. ANDREONE: Well, that's a good one. Good high heels are pretty good for our
business. The high heel pointed toe shoes can be pretty severe to a foot and another
cause of a bunion is actually shoving the toe over, which can be symptomatic of a
high-heeled shoe. Another problem that we see quite often with the high heel shoes
are neuromas. Neuromas are one enlargement of the nerve that as it runs in between
the long bones of the foot and then separates to go to each toe. It's what gives you a
feeling in your toes. When you have that high heel, it just puts all the pressure of your
body and all the force right on the ball of your foot. This can cause inflammation over
time of that nerve. The often-complained numbness or feel like they're walking on
rolled-up sock or a ball in their shoe. This can be kind of difficult to deal with at times
until you get it looked at. Sometimes the problem can be simply taken care of with an
injection or anti-inflammatories. Usually with changing shoe gear. Some people are
willing to do it, some people are not.
 INTERVIEWER: The other extreme from high heels… flip-flops. Let's talk about
those.
 DR. ANDREONE: Flip-flops can be dangerous. I've seen people who have… A flip-
flop is basically nothing more than a foam pad with what the band that goes around
the toes. When that when you use those, any kind of foot problem you have is actually
magnified because wherever you put your pressure. It just wears out on that side of
the flip-flop. Not to mention it doesn't give you any structural support. I've had
patients who have tripped over them and broken some of the long bones and their legs
to have quite a bit of surgery to fix to fix those bones. I've had people who ridden
bicycles or even motorcycles wearing flip-flops… When you fall off of a motorcycle
with a flip-flop on it can be very disastrous.
 INTERVIEWER: So how do you select the right shoes for walking, exercising, doing
your job…?
 DR. ANDREONE: Well… I'll first tell you what I tell my patients and I give to them
in writing. There's a good way to get your shoes. It's better to buy your shoes at the
end of the day because your feet are always a little bit larger. At the end of the day
 everybody swells, whether you're a child or an adult. So, if you buy the shoes at the
end of the day, they'll fit a little looser in the morning. But, by the end of the day,
they'll fit just fine. They won't be too tight. I'll say to be able to get your finger
between the tip of your longest toe and the shoe. That gives you enough room to not
to wear your toes don't hit the tip of the shoe. When and when you feel the sides of
the shoe is compared to how it presses along your toes. You should feel the toe the
shoe touching the sides of your foot but not pressing. You should slightly be able to
separate your toes in this in a shoe as well. As far as walking and running, probably
my two most favorite pair of shoes are Asics and New Balance. I think they have very
good structure for the shoes. I think they provide enough support and shock
absorption to keep you from causing damage. Then in my opinion I think those are the
best ways to keep yourself from getting hurt.
 INTERVIEWER: Advances in your specialty let's talk about some of the new
approaches to foot care and how podiatrists are helping people get back on their feet
 Well with all the advances today… I'll pick a hammertoe for instance. Sometimes, I
would pick a hammertoe. When we correct a hammertoe. A hammertoe is a very
contracted toe. Some people state it gets very painful, and it rubs and it limits the
amount of shoes that they can wear. It limits their activities because it's always
rubbing. Well… when we would go fix those in the past we would use something like
a K-wire (which is a long wire that would pass out the tip of the toe and all the way
back into the foot) and hold that toe in a good position while we've corrected it. It
would typically stay in for about six weeks. Now I've gotten a new device that I can
actually implant in the toe. It the does not stick out the end of the toe. I don’t have to
worry about infections along that opening and the toe after surgery. And it uses the
toe immediately.
 INTERVIEWER: Someone has a persistent foot problem… what's the next step?
 DR. ANDREONE: the next step is to call your foot doctor. It's always a good thing to
get something looked at before there's a larger problem. Sometimes it can be very
simple if it's caught quickly. As in the case of some people who have heel pain when
they get up in the morning, they state that the first step is so painful or after they've
been on their feet for a while… In these cases the earlier you catch the problem, the
easier it is to get over the pain.
 INTERVIEWER: Very well, doctor. Thank you very much. Thank you.