- What has 52 bones, 66 joints, more than 200 ligaments, nearly 40 muscles, and thousands of nerve endings?

Your feet.

(upbeat music) (upbeat music continues) (upbeat music continues) Good evening, and thanks for joining us for WTVP's "Docs on Call".

I'm Mark Welp.

Your foot health can affect the rest of your body and show indicators of significant health issues.

Tonight we're joined by Dr.

Jake Ruff, a podiatrist with Graham Medical Group.

Good to see you, Doctor.

- Nice to be here.

Thanks for having me.

- So for someone who's never been to a podiatrist, tell us what a podiatrist does.

- Yeah, we focus on treating your foot health, so anything that bothers your feet, whether it's corns, calluses, hammer toes, things like that, skin conditions, arthritis, things like that.

- Okay, and are there any things that you treat that may surprise people to hear about?

- I think most commonly, there'll be surprise sometimes that we treat fractures, sometimes ankle arthritis.

Just kind of depends on who you're seeing and what they're comfortable treating.

- Now, as far as fractures, would that be something that maybe, you know, the hospital says, "Hey, we think you should see a foot specialist, a podiatrist, to work on this"?

- Yeah, it depends a lot on the relationship the podiatrist has with that facility, and who they're comfortable, or what that physician's comfortable doing.

But generally, yeah, they'd see somebody in the ED, or emergency department, with a fracture, and if it's the foot or something like that, they'd send it to the podiatrist.

- Yeah, we mentioned off the top all those bones and ligaments and stuff.

It's different than breaking your arm, where, you know, it's pretty cut and dry there.

You've got so much going on in your feet that- - Sure do.

- Who knows what's going on down there.

- Right.

- What do you think people should know that they don't know about foot and ankle pain, and foot and ankle health?

- Yeah, that's a great question.

I think a lot of people underestimate how long it can take to get better with some foot issues.

So, I would encourage them that if something's not getting better in a couple weeks, get on it and see somebody.

The sooner we can get on it to treat it, the sooner we can get you better.

- Sure.

So how does someone know if, say, okay, maybe I've got a sprain, or it's just a, I bumped this on the nightstand on my way to the bathroom, how do they know if it's something that's just minor or something that could be more serious?

- Yeah, my rule of thumb is anywhere from two to four weeks.

If you're not seeing improvement by then, it's probably worth having it checked out.

- Okay.

And what things can people do as far as foot hygiene or just taking care of their feet to maybe prevent some of these issues from happening?

- It depends a lot on what their activity levels are.

My big recommendation would be if you're gonna start a new program or a new job, a new activity, start slowly, don't shock the system, so to speak, with regards to your foot.

The other common one that you'll hear is good shoes, good support.

Simple little tests that I recommend my patients is trying to fold their shoe in half.

If they can fold that shoe in half with their bare hands, it's probably not a very supportive shoe.

The harder it is to bend in half, and ideally, when it does bend, you want it to bend where your foot bends, so at your toes.

And that's a good indicator that that's a good shoe for you, and you'll hopefully do much better.

- Is a more expensive shoe necessarily a better shoe, or the better ones typically tend to be more expensive?

- So, that's a good question.

I used to recommend about a running shoe above a normal MSRP of about $125.

You would get a much higher quality.

Since COVID, that's kind of jumped up closer to the 140 range.

But there is a little, you know, price point where you start to pay for a higher quality shoe.

- So if I get my shoes from the dollar store, they're probably not gonna be the best shoes.

- They might not be the best for you, but you never know.

- All right.

What about habits as far as making a difference in overall foot health for people?

- Yeah, I think just your general hygiene would be helpful there.

You know, your bath, your shower, keeping things clean, letting some sunlight get to those feet as well.

Not always in those warm, dark, damp environments that we like in socks and shoes, things like that.

And then if you're an active person, I think stretching the calf muscle can be very important for your long-term foot health overall, and just helping prevent injuries.

- You talked earlier about corns and bunions and all that fun stuff.

- Yeah.

- Things like that, are those mostly preventable?

- You can delay some of them.

So, corns and calluses are usually the result of pressure.

And so there's things you can do like wearing good shoes and things like that to avoid that pressure.

Bunions, not so much you can do.

Mostly more of a hereditary component to that.

And so, unfortunate to tell my patients, "Bad luck with those."

- Now, what's the difference between corns and bunions?

Let's talk about that for a minute.

- Sure.

Corn is like a callus.

It's a thickening of skin.

There's really not so much of a bony component to that.

It's a thickened skin.

Versus a bunion's a bony deformity.

So, one of your bones starts to angle inwards towards your other foot, while your toe, your big toe in particular, starts to drift towards the outwards of your foot, leaving this bony bump on the inside of your foot there.

- What are some of the long-term effects corns and bunions can have if they're not treated?

- Yeah, mostly pain, particularly calluses in a normal, healthy person.

If you end up developing neuropathy or start having some issues where you're not feeling your feet, calluses can be a big indicator that you're putting too much pressure in one area.

That can set you up for things like an ulcer or a wound which can have terrible end results.

Versus bunion, it's mostly gonna be pain, poor fitting in shoes, and then some people don't like them cosmetically.

- Yeah.

We're gonna talk about neuropathy in a little bit, 'cause that's important, but another thing I hear about, hammer toe, what is that?

- It's a deformity of your toe in which it bends up at one joint and then bends back down at another joint, making almost like a triangle of your toe.

And that can increase in the pressure on the tip of the toe as well as on the top of the toe.

Most of that time, those will be bothersome in shoe gear, and sometimes just walking.

- What do you say to people, especially, I think, I would guess, women, who like to wear high heels, feel they need to wear high heels?

What does that do to your foot?

- Yeah.

Not a great amount of evidence that can definitively say those are contributory, but we can only imagine they're not helping.

Some people, you know, do just fine in them.

Others, just their feet are not made for them.

So it's a difficult question to answer in terms of, should I wear them or should I not?

I think it, just like everything else in the world, the difference is in the dose, so, how much you wear them.

- Moderation.

- Moderation is key.

- Yeah.

What about... I always have a debate with a friend of mine.

She's a flip flop fanatic.

I said, "Those cannot be good for your feet."

I mean, they're totally flat.

No arch.

What are you saying about that?

- Not a huge fan, but it beats the alternative, being barefoot, for some people.

So, if you can avoid 'em, there's definitely better quality sandals out there that will give you a little support cushion and not look so geriatric or orthopedic, as some of my patients will say.

- Yeah, how important is it to have that arch support in a shoe?

- It's helpful.

Some people, it's detrimental if they don't have much of an arch.

So, there's always a little give and take there.

Ideally, we do want to support that just to help make our life a little bit easier on our foot, but there's other things we can do to work around it if that's not an option.

- How does our age affect our feet?

- That's a great question.

Just like with the rest of our body, our age can delay our ability to heal and bounce back from injuries, things like that.

Another issue that's more focused on the foot is as we age, we actually lose the cushion in our feet that's called a fat pad.

And as we lose that cushion, it'll start to feel like you're walking on your bones or you feel like you're walking on a pebble or something like that, 'cause you don't have that cushion anymore.

And so that's when we really start to emphasize avoid going barefoot, wearing those, you know, comfortable sandals around the house, something like that.

Age also will contribute to those bunion and hammer toe deformities.

Those are typically progressive things, so the older you get, the worse those are gonna get.

- Tell us about foot alignment and how your feet can get out of alignment.

- Yeah.

So, most of our foot structure is a hereditary thing.

It's something we inherit from our mom or our dad.

So there's not much we can do to cause them to malalign, if you will, besides our body doing it themselves.

Unfortunately, for reasons not always known, people develop a foot structure that's very painful, it's not very stable, and that can cause some issues down the road.

And we've got several options non-surgically that can help with that, and if those don't work, you've got surgical options that can hopefully get you in a much more functional foot position.

- What kind of, if your feet are out of alignment, what can that do to your hips, your back, everything else?

- Yeah, so our body's a big chain, so it kind of starts from the ground up.

And so if there is an issue in your foot or ankle alignment, that certainly can tweak things like your knees, your hips, and sometimes your low back.

Depending on what's going on, we've got a couple options, several options, to help kind of address that issue in hopes of sparing your knee, your hip, and your low back from other issues.

- And conversely, if you're having issues with your back, your hips, can that affect your feet?

- It certainly can.

If you're certain to favor one side, you'll put more pressure on that foot, and vice versa.

Even just pain on one side of our foot can eventually cause issues on the other side of that same foot just by favoring things.

- I'm curious what you... I don't know how many kids you deal with, but what do you see, or what is possible to see, in kids as far as a feet problem?

I know when I was a kid, I had pigeon toes.

I don't know if they still call 'em that or not, but issues like that- - Sure.

- What do you see?

- Yeah, there's definitely a set of congenital deformities out there that we'll run into, whether it's a webbed toe, you've got juvenile bunions or hammer toes, things like that.

And then there's things like coalitions and even club feet.

So there's a lot of things that can happen to a young kid, obviously beyond their control, that we can run into.

- Are there any kind of problems you see as far as, you know, when parents are teaching their kids how to walk, is there a right and wrong way to do that, or does it kind of not matter?

- I don't see a whole lot of a right and a wrong way.

I think our kids are gonna walk the way they wanna walk, and most parents were just happy to see them start walking and running, and we won't intervene unless it starts becoming an issue.

- Sure.

You talked about neuropathy earlier.

Let's talk a little bit more about diabetes, and kind of tell us how diabetes can translate into foot issues.

- Yeah, so foot issues are a big issue with diabetes, unfortunately.

Just like a lot of things in the medical world, there's a spectrum to diabetes and how bad it's affecting one person versus another.

And so when things start to go south for that diabetic patient, neuropathy is a big component of that.

Neuropathy being kind of a vague term for pore sensation or inability to heal what's going on in their feet.

And so you can kind of think of it, if you don't feel something and you step on a sharp object, you don't know you stepped on that sharp object.

So, circling back to calluses, if they don't feel that callus is becoming painful, the skin will start to break down underneath it, and that's when we get wounds or ulcers.

And obviously, an open wound is not good for anybody.

However, diabetes further affects our ability to heal.

And so if you've got an open wound and you can't heal as well, if you were to develop an infection, that infection can spread a little bit more quickly.

Furthermore, diabetes can also actually contribute to some of your foot deformities, particularly hammer toes.

And it's all related to the neuropathy.

Again, neuropathy being a vague term.

It also can affect how our muscles are innervated, so how the nerves work on those muscles.

And if those muscles stop getting that signal from the nerve, we can develop imbalances, and that usually results in a hammer toe, which will then increase the pressure in certain areas of your foot, leading to those calluses, and potentially, the ulcer or the wound.

- If you don't know you're diabetic, or maybe you're pre-diabetic, are there signs in your feet that you can look for that maybe give you a clue that you may be having an issue?

- Yeah, that's a good question.

Typically, you would see something like tingling, burning, or even numbness.

Some people will report some pins and needle sensations.

Those are typically general signs of neuropathy.

And in our western, well-developed world, neuropathy is most commonly caused by diabetes.

- So what's the treatment, then, if you have, let's say you're diabetic and you have an open wound on your foot, what kind of treatments are we looking at?

- Yeah, our main thing is keeping the pressure off of that area.

So, the way I describe this to patients is I use an ant and an elephant analogy.

So our wounds on the bottom of our feet have to have those tiny cells, C-E-L-L-S.

We can't see 'em with our naked eye.

They're tiny.

They have to grow across that wound to the other side in order for you to heal.

Well, I tell my patients, if those cells are ants and an elephant steps on an ant, what happens to that ant?

There's no more ant.

So we want to save the ants.

And by that, I mean we want to avoid crushing those cells.

And so we'll do some padding options that allow the wound to fall into a pocket, whether it's in your shoe, your insole, or padding that we apply directly to your feet, in hopes of avoiding that pressure on those cells so that they can heal.

- So you could be potentially laid up for a while, 'cause I mean, even a little bit of walking, I guess, would would do some damage.

- Yeah, and people definitely underestimate how much time they spend on their feet and how much pressure we exert on our feet.

And so that's something that's sometimes hard to not only convey to a person, but also just in our daily life, it's hard for us to mitigate some of those things while still having a job, a family, raising kids, and things like that.

- If you're having foot issues like that, you know, you suspect you've got a diabetic wound on your foot, should someone go straight to a podiatrist, or should they go to their family doctor and then maybe wait for a referral?

What's the best way to do that?

- Yeah, it's really kind of up to them and who they're comfortable with.

If they're comfortable with their primary care, start there.

Whatever you're comfortable with will get you in the door quicker.

And so I would rather you be seen by somebody quicker rather than kind of go back and forth on, "Who should I see," and that delay your care.

Ideally, yes, I think seeing somebody in the podiatry world if you have a foot wound would be beneficial to you, but again, I think time is of the essence with those.

- Sure, and once you do get into your family doctor or your general practitioner, eventually it sounds like they're probably gonna refer someone to a podiatrist.

- Yeah, you would hope so, depending on their comfort level with treating those wounds.

But at least you're getting somebody to lay eyes on that wound, and if there's anything that they can do, whether it's an antibiotic or they could expedite the referral, that'd be good.

- If someone does have a wound on their foot and they're not sure if it's, you know, did I step on something, or was it small and now it's gotten bigger, what are some guidelines maybe they should think about when they're looking at this wound and trying to figure out what to do?

- Any questions at all, get it checked out.

Just play it safe.

I've seen too many patients saying, "I wish I would've come sooner."

I hate to be the bearer of bad news when those cases do occur.

So really, if there's any doubt, go get it checked out.

- What are the majority of the patients that you see on a daily basis in terms of, you know, percentage of diabetic wounds to just some of the things we mentioned earlier, like corns, bunions, hammer toes?

- Sure.

So, the corns, toenail fungus, toenail trimmings, we call that routine foot care.

It's probably 20 to 30% of my practice in Canton.

The rest is kind of overuse injuries, so tendonitis, plantar fascitis, things like that, followed by some arthritis related issues, and sprinkled in with some gout and some dermatological issues, so, you know, your foot fungus and dermatitis, things like that.

- With a foot fungus, besides being unsightly, what are some of the bad things that can come out of that?

- Yeah, so certainly, it can be uncomfortable.

You get some itching, even some burning, to the point where some people just can't tolerate shoes and socks, so they physically need to itch or something like that.

Luckily for them and most people, that can be easily treated with something as simple as an over the counter cream.

- Okay.

You mentioned plantar fasciitis and some of those other things.

Once you diagnose something like that, is rehab, for a better term, is that something that people are gonna have to look into, or what is the best way to treat those things?

- Yeah, so it depends on, obviously, the individual and the specific thing we're treating.

- [Mark] Physical therapy is what I was trying to say.

- Yeah, yeah.

In some cases, physical therapy is very beneficial for some of those, particularly those overuse injuries that we see, plantar fascitis.

And it also kind of depends on the person's occupation.

And so we try to take all that into account to determine a proper plan for them to get them better.

- We talked about other aspects of our body having an effect on feet.

Weight has to be a big one.

- Sure.

- Tell us what that means.

You know, I'm sure the heavier you are, the more work your feet are doing.

- Yeah, yeah, there's quite a bit of data out there showing just how much 10, 20 pounds can increase the amount of force that goes through your joints, whether it's your hip, your knee, your foot, your ankle, et cetera.

We do see a good correlation between some of our overuse injuries, our tendonitis type of things, with weight, and as well as with their ability to get better sometimes.

It sometimes can delay their healing there.

There's also a good amount of evidence showing that weight loss can decrease your foot pain, whether it's literally just 10 to 15 pounds can make a big difference in generalized foot pain.

- Yeah, if someone does wanna lose weight, let's say, you know, they find a gym they like, they decide to go there and start working out, what kind of things should they think about before they jump into that workout routine?

Whether it's, you know, a treadmill or the super sled or whatever.

- Right.

Go slow.

Start and work your way up.

Don't overdo it.

Don't shock the system.

If you shock the system, if you go too fast too soon, you're bound to get hurt, you're bound to injure yourself, and that's only gonna make it harder for you to get back into your workout routine.

So, I really encourage them, start broad, do a lot of things involving your body, so, arms, shoulders, legs, and start light and low.

That way, you're not overdoing it, you're giving your body plenty of time to recover, to get used to that activity, before you start ramping things up.

- Do you deal much with orthotics?

- [Jake] We do.

- Tell us a little bit about who may benefit from that and what kind of conditions people might have that would require an orthotic.

- Sure.

So an orthotics is a custom molded arch support, to put it vaguely, that we can wear in our shoes, that gives us much better support.

Obviously, being custom fitted, it's gonna fit like a glove, so to speak.

It should feel comfortable off the bat.

And there's lots of different types of those.

A great example would be plantar fasciitis.

That needs that extra support to support the ligament that's involved with that condition.

And the research indicates that a custom orthotic is about five times more helpful than an over the counter arch support.

So there's definitely a benefit for those.

- Yeah, I've had those custom ones.

They're a little more expensive- - Can be, yeah.

- But they do do the trick, that's for sure.

We talked about age and we talked about young people, and of course, older people.

Let's go right in the middle.

Let's talk about teenagers, young adults, who may be playing sports.

What kind of precautions do they need to take to prevent some of these injuries?

- That's a great question.

Right now, we're kind of in this era where we're seeing a lot of one sport athletes, and we're not seeing our youth participate in multiple sports, so that's setting them up for injuries from overuse because they're not getting that cross training.

So I really encourage not only the kid but also the parents to be involved in several sports.

That way, you get a cross training, you're training your whole body, and not focused on just one thing that can lead to those overuse injuries.

Kids heal remarkably well, so if they do get hurt, just give 'em a few days, and you'll be surprised how much they can get better.

But don't force 'em and don't keep getting them hurt by not giving them their rest.

- And again, you know, kids get hurt all the time, and that's kind of their job.

But, you know, when you do get hurt, let's say a kid twists his or her ankle, again, you know, what kind of things are we looking for in terms of if you twist an ankle, after a couple days, should you start to worry if it still hurts?

- Yeah, so that's a great question, something that we get asked a lot.

The main thing for me with an ankle sprain is your inability to bear weight.

So, are you able to walk on that?

And if you're not, for how long?

If it's going past a couple days, there could be something more serious going on that you need to get that checked out.

If it's a not so severe sprain, it's not uncommon for you to be unable to walk on that for a day, maybe two, but hopefully by then, you're able to put that weight on it and start moving a little bit better.

- Is there anything visually you can look at, whether it's bruising, redness, anything you should pay close attention to?

- Yeah, so bruising can be a good indicator that something more structurally has occurred that you might want to keep an eye out for.

Most of them will swell, and that can be a lot at first, and sometimes can be overwhelming for some people, but that bruising is a key to me that something a little bit more deep has possibly been injured.

- Sure.

Well, as we wrap this up, we've had a lot of great information, is there anything we haven't talked about that you'd like folks to know about podiatry or how they should take care of their feet?

- Yeah, I think we've covered a lot of great stuff.

I just, I'm a big fan of prevention.

So, diabetes in particular, we're seeing a huge increase of that in the last 10, 15, 20 years.

So, really watch what you're eating, consuming good healthy foods, and avoid diabetes.

Diabetes can be deadly, and people don't realize how deadly diabetes can be, even in a podiatry world.

A lot of people don't realize that if you were to undergo an amputation related to your diabetes, it can be more deadly than some of the cancers that we hear about all the time.

Lung cancer, prostate cancer, to name a few, lymphomas, even, are less deadly than having an amputation related to diabetes.

The other startling statistic with diabetes related to their amputation, if you unfortunately did lose half of your leg from diabetes, the research indicates you have a 50% chance of living past five years because of that amputation.

So that's very startling, and that's something I always very politely, and I try not to scare them straight, so to speak, but I do make sure they're aware of that in hopes of them taking a little bit more serious.

- That's pretty startling.

I wasn't aware of that.

- Very, yeah.

- So, yeah, sometimes you do have to scare people straight.

Sometimes that's what it takes.

Well, Dr.

Jake Ruff, podiatrist with Graham Medical Group, great information, we appreciate you coming on, and have any good foot jokes you wanna end with?

- I better not.

- Okay.

- But thank you, thank you for having me, it's my pleasure to be here.

- Appreciate it.

It was great.

- Absolutely.

- All right, and we wanna thank you for joining us.

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Thanks for watching, and take care of yourself and your family.

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