Your choice of shoes really matters!

On the average, I see more women patients than I do men. There are potentially many reasons for this, which can include men’s reluctance to see a doctor, and the type of shoes worn. Certainly, I would encourage men if they have a problem with their feet to seek treatment – it’s always easier to fix a problem early on before it gets out of hand. Quite often though, the shoes I see my patient’s wearing both in the office and out in public, lead me to believe that the choice of shoes some women make can be extremely detrimental to the health of their feet.

Perhaps few would argue the fact that wearing high heeled dress shoes alters the appearance of not only the foot, but the leg, hips and back as well. Wearing a shoe with a high heel lengthens the leg, and makes the foot appear smaller. Obviously, it also will make a women appear taller. But at what cost?

It should come as no surprise that wearing high heels places more pressure on the forefoot. To add to this, often the shoes worn have insufficient space for the toes. This leads to increasing pain and symptoms from hammertoes, bunions and neuromas. Corns and calluses are also more frequent and symptomatic. But the problems don’t stop there. Because the foot is plantarflexed when high heels are worn, chronic wearing of high heels can and does tighten the achilles tendon. This can make it difficult for women to wear flats as they get older. To accommodate for the plantarflexed position of the ankle, the knees are slightly bent. This causes the muscles surrounding the knee to work harder, leading to pain. Traveling up the leg, high heels alter the position of the hips and lower back, leading to pain there as well.

The pictures attached illustrate what high heels do to a foot. The body’s center of gravity is therefore moved forward over the forefoot. Normally, a body’s weight is distrubuted roughly equally between the heel and the forefoot. The structures of the forefoot are simply not up to the task of taking on the additional burden. You’ll also notice in the picture that shows the foot next to the shoe that the forefoot is actually wider than the shoe itself!

What can be done? Well, just between you and me, I have tried and have decided that my crusade against high heels is a losing battle. Some women will never give them up, regardless of the symptoms they cause. Here’s my compromise then…. If you feel you must wear high heels, limit the amount of time your feet are in the shoes, and equally as important, limit the amount of time you are standing and walking in the shoes. If you feel the urge to take your shoes off because your feet are hurting, don’t ignore it – take the shoes off! Perhaps you could have another pair handy to put in in their place that are more comfortable. Remember, your podiatrist can do some pretty amazing things. But what he/she can’t do very well is fix a foot and expect it to stay symptom-free when the very thing that is causing your symptoms is continued to be worn.

Why Are My Prescriptions So Expensive?

Soaring prescription prices… Why is this?

No one likes spending a lot of money on prescriptions. It seems like when something is really neededto treat a condition you have, you should not be prevented from taking thatmedication due to inability to afford it. At the same time, quite often it is the lure of those very same highprofits that encourage pharmaceutical companies to produce many of the amazing,and quite often, life-saving drugs that we all depend on. Eliminating the reward would, in my opinion,lead us to where fewer and fewer new drugs would be developed.

There is one drug, however, that has been around for years…indeed thousands of years. It is called colchicine. It is a powerful anti-inflammatory medication that is most often used in the treatment of gout. Gout is a condition related to anincrease in uric acid in the body. This can lead to severe pain and inflammation in the joints. Quite often, the joints of the foot are involved. A patient with gout will typically come to my office stating that the pain, redness, and swelling in their foot came on quite suddenly and is excruciating. Colchicine treats acute gout very effectively, relieving symptoms quite often in a matter of hours. So, you can imagine the surprise of patients(and doctors) when it was discovered that generic colchicine was no longer available! Instead, the drug wasavailable only in the form of a non-generic called Colcrys. Same drug. Same benefits. Not the same price. How much has the price gone up? According to as CBS Evening Newsreport, a 23 day supply has gone from $6.72 up to $185.53! Why is this happening? Watch this news report from CBS Evening newsthat aired last night:

http://www.cbsnews.com/stories/2011/10/10/eveningnews/main20118283.shtml#comments

To make a long story short, there are many drugs which pre-date the FDA – one of which is colchicine. The FDA was concerned because there was a lack of modern research on the medication. Now, no drug company will ever do research on inexpensive generic drugs. To get around this, the FDA has taken the generic version of the medication off the market to allow URL Pharma, the company that makes Colcrys, to help recoup money it had spent to study the drug. Now, my patients spend A LOT more on their prescription for colchicine. Is this right? It may not be as clear cut as it would seem. As a result of the studies done by URLPharma, it was determined that a lower dosing of colchicine would be just aseffective as the traditional dosing, making it safer to use. So, you tell me: If it were you paying out of your pocket for this medication, would that information be worth the extra $$$ knowing know that the medication was safer for you to take? As is the case with many medical questions, the answers can be hard to come by.