Podiatric Problems of Seniors with Lanny Rubin, DPM

Larry (00:06):

I'm Larry Barsh. And you are listening to Specifically for Seniors, the podcast for those of us in the remember when generation

Larry (00:28):

Today on specifically for seniors, we're talking to Dr. Lanny Rubin, Dr. Rubin is a doctor of podiatric medicine and a fDisclaimer: Uncorrected AI Transcriptionellow of the American college of foot and ankle surgery. He graduated from temple university school of podiatric medicine in Philadelphia, and practiced in Baltimore, Maryland for 34 years. Lanny served as chief of podiatry at three hospitals, Bon Secours hospital, Northwest hospital center, and Sinai hospital of Baltimore. He conducted foot clinics at Sinai hospital and John's Hopkins hospital and taught foot surgery in the Baltimore podiatry residency program for 25 years. Thanks for being with us today on Specifically for Seniors. 

Lanny, Some of our listeners are confused as to when to see a podiatrist for foot and ankle problems. Can you define the areas of concern to podiatrists?

Dr. Rubin (01:39):

Yes. Well, anytime you have a problem with your foot or ankle, the podiatrist is a foot specialist in this country. So, any foot and ankle problem that you have can be treated by a podiatrist now, not necessarily all podiatrists, because some podiatrists don't have the special training. So it's like going to any medical doctor, you know, you go to the medical doctor, but sometimes you need to see a specialist. So there are many specialties in podiatry from children's foot health to geriatrics, to, , surgical procedures, , specialization and surgical procedures, joint implants. So that's why it's important to go to the podiatrist that can handle your specific type of problem.

Larry (02:33):

So when do you recommend they see a sports medicine doc or an orthopedist?

Dr. Rubin (02:39):

When they have foot problems, from sports, they have questions about, , how to, what to use, what to wear, , what's best to do in sports for their particular problem.

Larry (02:57):

What makes foot problems so complicated?

Dr. Rubin (03:02):

Well, the foot's been called an engineering marvel because one fourth of all the bones in the body are located in the foot and they're all connected in a particular way, bound together, like all other joints with capsules , ligaments, tendons, muscles, nerves, blood vessels. So it's a very complicated structure and it's a weight bearing structure. So that puts extra pressure on the foot, no pun intended, but it's a lot of pressure on feet and people's weight and activity play a role and shoes play a role as well. So depending on your foot type, you should be wearing the proper shoe for your foot type.

Larry (03:51):

I wanna get back to the shoe situation later. but as a weight bearings structure as we get older, I would imagine years and years of bearing that weight, can cause a bunch of destructive situations on the foot.

Dr. Rubin (04:14):

Well it can, but many seniors have no foot problems. The other thing to be aware of is that other things affect the feet, systemic illnesses like diabetes and arthritis particularly have ramifications in the foot. So people with those problems may have problems in their back in their hips, in their knees and in their feet. And many, many podiatrists are concerned with systemic diseases that affect the feet. So those patients need specialized care and, and the podiatrist has to be aware of those problems

Larry (04:55):

On a localized basis. What are the common foot problems of seniors?

Dr. Rubin (05:05):

Well, what we, when we say pain, we're talking about a, a symptom and the symptom is caused by any systemic problems and also by the kinesiology of your foot. So if you pronate or are flat footed, you are more susceptible to certain types of foot problems than a person who has feet that turn out instead of in has different problems. People with rigid high arch feet also have problems. And those things are handled with appliances. , sometimes braces are necessary sometimes, , , orthotics placed in the shoe that are properly made for your specific problem. So, , then you have the distortions. Some people have very straight and, , and nice looking feet. Other people have very distorted feet. Hammertoes or bunion joints. And they cause problems as well. So it depends on what your specific need is as to what's done for you.

Larry (06:25):

What is a bunion?

Dr. Rubin (06:28):

A bunion is, is an enlargement of the first metatarsal joint on the foot,

Larry (06:34):

The big toe,

Dr. Rubin (06:35):

The  joint behind the big toe. And when that's out of alignment, then the toe tends to move inward and the bone behind it, the metatarsal moves out and that makes it difficult for the shoe to fit well. And often they have arthritis, which is a big problem, but there are people with mild bunions or even severe looking bunions that have a very flexible foot and have no problem. They can even wear shoes. Right? So it all depends on the individual and his needs.

Larry (07:11):

What seems to be very common in seniors are problems with the toenails. Yes. Especially when many seniors can't bend over to take care of them themselves. , what do you see? What are the more common nail problems?

Dr. Rubin (07:28):

Well, the most common nail problem is fungus nails and they're almost ubiquitous and they happen because of people who are susceptible to athlete's foot. It's a fungus infection of the foot. There are various different fungi that are responsible for it. And that's why in order to treat it properly, often you need to get cultures to see what specific organism you're dealing with and then treat for that. The problem with mycotic nails is their appearance of course are sometimes very unpleasant. The nails get thicker, they can turn brown or yellow or black. They can be crusty. And, they're, they're very uneven and, , they're not pleasant to look at. And sometimes they cause pain. So there are various treatments. And I have to tell you, not just for feed problems, but for any problems, whenever there are multiple, multiple treatments like for arthritis, there are a lot of things that don't work and there's no one good treatment.

Dr. Rubin (08:39):

If there was a good treat treatment, everyone would use it, but there isn't a really good treatment. So sometimes it's more trial and error depending on the severity and the symptoms it causes. So from fungus nails also known as mycotic nails, there are topical preparations that don't work very well and there are oral medications. They can work better if you get the right one for the problem, and you have to have a liver function test before you start. And sometime during the course, to be sure that it's not creating a problem for the liver, which it usually does not, but sometimes it can. So that has to be checked on. Once the nails are cleared, they can come back again. It's an infection. You can get another infection. So mycotic nails are difficult to treat. In addition, they're ingrown toenails and they're very painful when they get infected.

Dr. Rubin (09:44):

And if you're diabetic or have circulatory problems, many people lose their lower limb because of an ingrown toenail. So there are things to know about it, depending on the shape of the nail and the way the nail is trimmed. And as far as trimming nails are concerned, if you have pretty normal nails and you can trim them yourself, there's no need to see anyone, but if you can't get to your nails or your nails have a deformity, then you can see the podiatrist who can not only take care of it, but give you suggestions as to what to do to prevent problems.

Larry (10:24):

So I just want to emphasize something to those people who are listening, like everything else, nails, it's not a joke, disease of the nail, whether on the hand or the foot is a medical problem. And very often has to be treated medically, not just by something over the counter or by getting a pedicure.

Dr. Rubin (11:00):

Yes, it makes a difference.

Larry (11:05):

We mentioned a little while ago, ,about pain in the foot and people can't describe it. TI hear a lot of complaints from sea about painful feet. What should the person do if their feet hurt?

Dr. Rubin (11:28):

Well, the first thing to do is call a podiatrist and have your feet examined. The podiatrist will take a complete medical history if necessary. If he thinks it will be helpful or take x-rays of your feet, MRIs, CAT scans, whatever's necessary to find out what is the root of the problem. And once that's known, then you can treat it with whatever it might be helpful for that particular patient. And sometimes what works for one patient doesn't work for the other. So sometimes it takes a while before you can be properly evaluated and treated it. Isn't always a one visit thing.

Larry (12:10):

Do you often refer to a neurologist?

Dr. Rubin (12:14):

Yes. There's neuropathy and you can't find a cause for the neuropathy. Then we refer to a neurologist which does his own, that can do his own tests to try to determine what can be done. And then there are various medications that are used used. Some of them are helpful for neuropathy. Others are not. And some people, no matter what you do, the neuropathy does not go away. So a neuropathy is a significant problem. Some of the common causes are alcoholism, diabetes, injury, and, ,other problems with the nerves that are not easily diagnosed as well as diseases, you know, neurological diseases, ,spinal cord problems. And so

Larry (13:09):

When, when is foot surgery necessary? Well, what problems can only be treated by surgery?

Dr. Rubin (13:17):

Well, there are problems that can only be treated by surgery, and they're usually problems that you're unsuccessful with treating in a palliative manner. So surgery's always the last thing that's done, but there's a lot of foot surgery being done and it's being done cause that's the only way to get more permanent relief. So for instance, if somebody has a hammer toe, which is a toe that's bent up, it's rubbed by the shoe, a painful heart skin or corn forms on the toe, it gets irritated. They can get infected. And then people, some sometimes try to treat it themselves with acids and creams and make it worse. If there's no other way to get relief, then surgeries performed. And that involves removing the portion of bone so that the toe can lie flat. Sometimes you have to put a pin in it to few, use that to so, , there are many things bunions. If they're not painful, you leave them alone. If it'd bother you, you'd use palliative care. And if that's not effective, then surgery's indicated. And then there are many different types of surgery for bunions, depending on the measure and the alignment of the bones. So sometimes even implants are used for bunions, sometimes plates and screws have to be put in the foot. And other times it's a simpler procedure. It all depends on the specific case.

Larry (14:55):

So you mentioned before that some people were more prone to foot problems than others.

Dr. Rubin (15:02):

Yes. And the reason for that is sometimes it's hereditary. Sometimes if you're on the beach and you see a mother and a daughter, you look at their feet, you have to laugh. Cause they have the same, the same distortions in their feet. So you know where they got it from. So, there are other problems like injuries. Some people have accidents, drop things on their feet. I've taken, , at least several sewing needles out of feet and women come in and they have pain in their heel or the ball of their foot. They take an x-ray, you see the sewing needle. You tell them you have a sewing needle. They say, what are you crazy? I never got a needle in my foot. I'd say, well, here is the picture of it. You didn't feel it go in at the time, but there it is. And then it formed a cyst around it. Cause the body walls off those things. And if it presses near a nerve, it can get, , very painful. So, there are all kinds of injuries. People get up at night and go barefooted, run to the bathroom, get the big they get the door jam between their fourth and fifth toes and break the fifth toe. It's a common injury in podiatry offices.

Larry (16:21):

And there's not much you can do.

Dr. Rubin (16:23):

Yes. Well, depending on, on how bad it is, sometimes you can just splint it and it'll heal itself. If it's separated, it could require surgery in order to put the bones together. So again, , circumstances, alter cases in everything and in foot surgery or foot treatments for various problems, that's the case. It's gotta be specific to what's in front of you.

Larry (16:51):

I have to laugh at something you said of minute ago. So podiatrists do look at feet on the beach because as a dentist, the first thing I see our teeth, , where did you get those? Why?

Dr. Rubin (17:11):

Well, you know, there's variability in that as well. Sometimes it depends on the dentist you go to.

Larry (17:17):

Oh yeah.

Dr. Rubin (17:19):

And, and that's true in every, in every field, in every profession, you know, in law, in medicine and in anything. So, um, getting to the right doctor is not always easy, but the best way to do that, I think is to talk to anyone. You know, who's had a similar problem and ask them their experience. If they have a guy who's helped them, that's a place to start. And if he can help you, he can refer you to someone who may be able to help you better than he can. There's nothing wrong with referring patients. We do it all the time and sometimes we get patients that way. Now I'll just give you one quick and interesting story. I once did a hammer to surgery on a little toe for a woman and took out that piece of bone. And that was all she needed.

Dr. Rubin (18:11):

About 12 years later, I get a call from a colleague of mine. He says, Lanny, I have Mrs. So and so here. She says, you took that little piece of bone out of her foot. I just x-rayed her. And I don't see where you took the bone out. It's still there. So I said, let me check on this, got her file out. Got her x-ray sure enough clean cut bone is out. I said, send me your x-ray. So I got a copy of his x-ray and sure enough, that little piece of bone had grown back. When I had an x-ray with her name, the date erect foot, you see the bone is missing and there it is again. So things do happen. That seems strange, but that's an interesting story.

Larry (19:00):

Well, I've gotta admit that when I've taken out something, it doesn't grow back.

Dr. Rubin (19:30):

Right? Well, the tooth is not a bone. The tooth doesn't regenerate. My bone can. And by the way, , when you have injury to your joints in your feet, sometimes boney, spurs or growths come out and cause a problem. So people say, oh, I have a bone spur. I don't know how I got it. Well, you to kick the door, drop something on your foot or stub your toe. And then years later, a little spur comes and interferes with the function of the toe and it's got to be removed in order to get relief. So, , there are many, many, many, many problems with feet and, , not all of them have an answer

Larry (20:13):

Like everything else. , I want to get to one more thing. We started to talk about it at the beginning, determination of proper shoes, ,sole design, running versus walking, the rights size, high heels. What do you recommend to people when they're looking for shoes?

Dr. Rubin (20:40):

Well, an interesting topic and a very important one and my finding is that, the right shoe really helps to prevent problems for you and alleviate problems you may have that could be caused by the wrong shoe. So shoes come in different lists. There's a straight last, which means the shoe is built on a model. That's fairly straight. There's an in curve and a slightly out curving and people have different foot types. So you gotta get a shoe that matches your foot type. Then there are people who pronate or supinate supinate when the foot rolls out a little bit and pronation is when it rolls in or the so are called flat foot. And there are shoes that are better for your foot type than another shoe. And that, and that’s very important. , if you have problems with your feet, go to a good shoe store with a professional who can look at your foot and say, this is the style of shoe or type of shoe or brand of shoe, that would be best for you.

Dr. Rubin (21:52):

Now, the problem is that, , many people wear the same size shoe that they wore in high school. And now they're 70 ,75 and they still wear the same size shoe. And that is seldom appropriate because our feet expand as we get older and our ligaments stretch a little bit, our feet get fuller. They either get longer or wider or both, and you have to wear a shoe that fits your foot. So if a man has five pair of shoes and they're all the same size and they're different brands, they may not all fit properly. Women have 20 pair of shoes, and then you have shoes for different occasions. So you can't play tennis in the loafer and tennis shoes are specifically made for the motions of people who play tennis, but then there's each brand has its own style. So I may wear a certain brand of shoe and say, this is what I wear.

Dr. Rubin (22:58):

And I'm perfectly fine. You should wear it too, but that may not be the case. So you have to find when you find a brand that feels good on you, then that's what you should buy. And the shoe and athletic shoe should always be at least a half, if not a full size, longer than your regular shoes. Because when you play pickle ball or run or even walk fast, your foot tends to move forward in stretch. And as you're on eat and pounding them, they tend to get a little bigger. They get fuller., they're not really swollen, but they're almost a little swollen compared to when you were sitting and your shoe has to be able to accommodate that. So shoes are very important because that's your covering. So if you try to put on a glove that doesn't fit, you'll know right away, my hand doesn't fit in there, but with shoes, there's more play.

Larry (23:59):

That's very interesting. I'm glad you said that because I just went I up a full size. Yes, in shoes that I use to walk the dog because I walk kind of quickly.

Dr. Rubin (24:13):

And if you talk about ingrown toenails, let me tell you about that. If your shoes too short, and it keeps putting pressure on the nail, it can deform that corner of the nail and push it into the flesh. And that's what causes an ingrown toenail. The other thing people do is tuck the bed covers at night over the edge of the bed. So when you get in bed, it's tight over your foot, and that can cause an ingrown toenail. So it's better to pull the covers out from the edge of the end of the bed and have it just lying lightly on your feet rather than tucked in where they're pressing on your feet.

Larry (24:57):

Boy, am I glad I asked that question?

Dr. Rubin (25:00):

What you learn as you go. So people say have a terrible ingrown toenail, when does it hurt you? Mostly embedded might say, pull the covers out of the end and call me if it still hurts

Larry (25:15):

Loose two covers and call me in the morning.?

Dr. Rubin (25:19):

Exactly. Same thing.

Larry (25:23):

Why can't we buy shoes in two different sizes, one for one foot, one for the other.

Dr. Rubin (25:33):

It's very difficult because manufacturers, first of all, when they make a shoe, they may not only make it all the different sizes. But as I stated before, they make it over different lasts and to get odd shoes in different lasts and different sizes and different colors and different styles is an expense and they just simply won't do it. Now. There are, as you know, , for instance, what's called diabetic shoes. Diabetics have a lot of problem with their feet and they can wind up with serious problems. So, , diabetic shoes are covered by Medicare. You can get a pair per year, , with prescription that you need it. You know, that's just, because you're diabetic, you get it. But if you have a foot problem that the shoe would be helpful for, then the podiatrist can write a prescription for it and you'll be covered. So, the shoe has to be right for the type of foot and type of problem that you have. And the manufacturers can't get involved in the individual ones. And there are people who have shoes made, not just the diabetic shoe, but there are places that will actually make shoes and make one size bigger than the other. Of course they're very, they're very expensive,

Larry (26:57):

Right? So the best thing to do is find somebody with different size feet on the opposite side and then share shoes.

Dr. Rubin (27:08):

We can make a of those people and

Larry (27:12):

How do people find the best podiatrists for themselves?

Dr. Rubin (27:21):

Well, , it's always been said that , board certification is important. So if you're going to a podiatrist, that's a surgeon and by the way, I know surgeons who are not board certified for couple different reasons who are very good surgeons. However, if you’re board certified it, least it shows that you've met a certain standard. And if you belong to some of the surgical organizations like the American College of Foot surgeons or , different certification advances, if they've had a fellowship in addition to their residency, um, the best way is to find a hear of people who have a similar problem to yours, ask them who they've seen. And if they're happy, if they're not happy, they'll tell you right away, don't go to him. And sometimes you'll see on Facebook or next door, somebody says, I need a rheumatologist. I need a podiatrist. I need an orthopedic surgeon for my hand. And then you'll see people put a list of five or six different doctors. Three people say, oh yeah, he's great. Two say no, I would never go back to him. And it's the old story. Luck is the most important thing in life. So you have to be lucky enough to find a guy that can help you. But if you ask someone that's had a good experience, that's a place to start

Larry (28:49):

Lanny. This has been terrific. I really enjoyed that conversation about shoe size because I was beginning to feel a little silly going up a full size.

Dr. Rubin (29:01):

No you the right thing for yourself.

Larry (29:04):

Thanks for being with us on specifically for seniors. I really enjoyed this conversation.

Dr. Rubin (29:11):

I enjoy doing it with you. Thank you.

Larry (29:13):

Thanks again, Lonnie. Bye. Bye.

Larry (29:24):

If you found this podcast interesting, fun or helpful, we'd appreciate it. If you tell your friends and family and click on the follow or subscribe button, wherever you listen to podcasts until next time I'm Larry Barshand you've been listening to specifically for seniors.