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>> Hi, I'm Jennifer Blomquist.

Thanks so much for joining us tonight on HealthLine in case you're new to this program, we are live in the studio here at PBS Fort Wayne and we have a guest we have a podiatrist tonight we're going to talk all about foot problems and things you should and should not be doing so is Dr. Ashley Bouchareb.

We're going to talk to her in just a minute.

But she has a wealth of information to pass on to you and she is more than happy to talk to you live during the show.

So please don't be shy.

Please give us a call.

There's the phone number we keep it up on the screen throughout the show it's (969) 27 two zero.

It's delivery call if you're outside of Fort Wayne just put an 866- in front of there and you have two options when you call you can ask a question live during the show.

They're not going to just throw you on the air.

They will talk to you first a call screener will talk to you first and then you'll get a chance to ask during the show or if you prefer that I ask Dr. Bajram the question for you that's fine.

Just tell Nicole that you'll talk to you on the phones that you have a question.

Just pass it along to her and she will pass it along to us so you have lots of options there.

Call sooner rather than later I feel I feel like everybody waits to almost eight o'clock and then we don't want to miss your question.

So please keep in mind the phone lines are open and we'll be talking about lots of things regarding your feet but feel free to interrupt us at any time.

So without further ado, let's go ahead and introduce you to Dr Ashley Rabb.

Thanks so much for coming back.

Thank you for having me.

>> She has a little baby I was mulling over her pictures and Gushin old already so she's a mom and she's married since since our last show.

>> So yeah, a lot of changes for you.

>> Congratulations.

Thank you very much.

Oh thank you.

Thank you.

I love it that you always bring the foot models and things which I think helps a lot especially for terminology that us common folks are not familiar with and you can kind of point to what we're talking about.

So yeah.

So again ask Dr. Bouchareb anything you want about feet and she can help you out maybe even point to what your shoe is and give you some direction or maybe some advice on what you should do to relieve any issues you might be having.

Well, the first thing we were going to start talking about was something I think everybody's probably heard of it but they don't really know what it is is plantar fasciitis.

>> OK, don't ask me to spell it.

I can do the plantar fasciitis.

No.

>> So what in general is it?

It just always I always associated with discomfort walking.

>> Yeah.

Plantar fasciitis is heel pain and it's one of the most common things we see in our office.

>> It typically happens after the first step out of bed in the morning or after sitting down for a period time and then trying to get back up and it's like a sharp pain right there in the heel but not following any kind of injury or tripping necessarily.

>> Is it just a chronic thing?

>> Yeah, it's more of a they say the most athletic people can get it and the most couch potato people can't get it.

>> All right.

And so what it is is inflammation in the bottom band.

I'm going to use one of these feet here.

>> If you look there's a bottom band that inserts onto the heel bone and it goes into the toes plantar meaning bottom Sasha meaning soft tissue itis inflammation.

So it inserts right here and that's where people most like the most have their pain and inflammation problems.

>> So what we try to do is help that by bringing the inflammation down.

>> Typically it's caused because the Achilles tendon right here it becomes tight.

>> So we want to do stretches and proper shoe years always important.

>> I stress that in your vigor I can't stress enough in my family just loves me for it because I'm like those aren't right.

>> Yeah so they get nervous before before Thanksgiving dinner where the right shoe where they'll get in trouble.

I went to the zoo with my friend this weekend and she was wearing flip flops.

>> She's like how can we be wearing flip.

I know but it's just so yeah it's easy to put on and off right there.

>> Yeah when you're doing long distance walking you really want to keep those feet protected and support because that's going to help with with your pain you're having.

>> So you can see this is an orthotic so that's just something you would put in your shoe.

Yes.

Yeah and it supports the arch and it cuts the heel and basically it would fit into your shoe like that giving you more support.

>> So that's one.

So yeah because I think people get nervous about going to the doctor and the think I don't want surgery, I don't want shots I don't you know so is this I mean I know you guys start conservatively so would this be like your first step?

>> Yeah.

So this is definitely the first step.

OK, the stretching the shoe gear orthotics I think is a big one that's very cheap to do at home.

>> I tell people to take a water bottle, put it in the freezer home once it's frozen you roll your foot on it and then depending on how you like can depending on their medical status anti inflammatories.

>> Sure.

You just might be over the counter ibuprofen.

Yes.

ibuprofen as long as they're able to rise I mean anything.

>> Yeah I guess we should emphasize don't go it alone.

>> You know you probably maybe start with your family doctor and if you thought it warranted they would send you to a psychiatrist.

Yeah.

OK, perfect.

I want to get some more of this and get to the models but I don't want to lose our caller so I think I apologize.

This is Ga ga Ebed am I pronouncing that.

Yes Garbett thank you for taking my call.

Go ahead.

I have a question for the good doctor and I'm thankful that you have a program like this with people who are professionals.

We appreciate you out here.

Oh my question is I have flaky skin on the heel of my foot and I've tried all kinds of remedies but you know, I haven't been successful getting rid of it and I'm just wondering if the good doctor can come up with some kind of solution to help me out that that's a really great question.

>> The summer, summer and even winter time people should very, very dry and it's very common to to have that happen.

So don't feel embarrassed by that by any means.

But what you would want to do is really you would try to keep your skin as hydrated as possible.

You would hydrate your skin one to two minutes out of the shower with a good lotion.

>> There's over the counter lotions you can try can I see certain brands we're not supposed to say brands.

>> OK, but I mean are you talking about more like a cream or an ointment?

It's a it's a cream but there are certain brands that you can try one to two minutes out of sugar petroleum jelly time not petroleum jelly.

>> That's more like a Vaseline and I would avoid that.

You would want to slip your socks on one to two minutes out of the shower and then do that about twice a day and then hopefully that will help and if not and maybe seek your podiatrist or primary care provider to give you some more tips and tricks on how to do that.

There are prescription lotions out there that could be very beneficial for you too.

>> Was there anything else you want to ask Doctor Bajram, thank you for the help.

>> Sure very much.

Thank you so much for calling, sir.

I appreciate it.

And you can ask a question as well see how easy it was and she didn't bite or anything.

So I feel free to give Dr. Bouchareb a call here.

It's (969) to seven to zero again if you're outside of Fort Wayne it's still a toll free call if you dial 866- first and we're only here till just a little before eight o'clock.

So feel free to call us at any time.

>> We're going to keep talking about plantar fasciitis but you don't get any better garbages question.

What do you think of using like he talked about having the flaky skin like a stone like a one of those a pumicestone would be a great idea.

I apologize.

I forgot that I didn't know if those are really because sometimes I've used them and I feel like my foot feels worse afterwards.

>> It's really sore so shied away from them but I would use them with caution.

>> Yeah meaning you don't want to overdo it .

>> I don't like the ones that are battery operated or electric first of all didn't need know that he could be more aggressive with that.

>> Yeah so you would want to try something like a Pumicestone they come in different grades maybe start with the softest one first but just four to five swipes over certain areas that are bothering you.

We never shower.

Yeah when you're in the shower after your skin is nice and soft never pick or pull the skin because that could cause like a ripping or a tear on your skin that could cause you to have more problems.

>> So if anything clip the flaky skin off and then use that pumicestone four to five swipes is all I tell people with a very mild pressure not hard but mild pressure.

>> OK, yeah.

All right.

Well I think we've all had flaky feet.

>> I'm sure it's good to exfoliate your feet so yeah I mean especially and you as you said it's it can be year round.

Yeah we do have another gentleman who had a question for you but I'm I'm shocked we're getting a lot of calls on this beautiful summer night.

So thank you so much, Bill.

Do you have a question for Dr. Bouchareb?

Yes, I do.

But thank you for taking my call.

I have a call right on the end of my second call from the big toe and it's causing me quite a bit of pain and I have used the medicated coronary movers but it's hard to locate over the corn and the corn is still bothering me a great deal.

Is there any other procedure that can be used to remove that?

>> That's a great question.

Well, thank you for calling in.

It's a very common thing that we also see is Korn's or callouses which is a buildup of skin.

That buildup of skin is typically due to rubbing or friction in the area.

So making your sure your shoes are fitted properly but when you want to try to take care of yourself, using that pumicestone with light pressure would be helpful if you aren't able to do padding is failing then you might want to see a professional to actually what we call debride or debride down the dead skin in office and then offer padding and shoe modifications if needed.

>> Bill, did you want to ask do you have anything else?

No, thank you very much.

Appreciate your answer.

Yeah, good question.

Do those always do those tend to like a corn?

Would it look red or are they really painful?

They're so tiny you know I don't know if it when you say Calice like I don't know like I'm thinking like when you write you know or hold a pen or pencil like you get a careless in your middle finger.

Well actually you can get like a clock sweat gland on the bottom of your foot and that can cause skin to build up and then when I breathe it down what you see is literally a pinpoint of or like a core of dead skin and so that's all it is and they can be really like painful and deliberating to people so militating to people I'm sorry.

Yeah.

And so yeah just trying to keep that dead skin down once again exfoliating using that lotion but do it like gingerly I guess.

>> Yeah yeah I was going to say I think and there are a lot of different products I'm glad you mentioned that they have different strengths or you know degrees of of harshness I guess with the Pumicestone so start start simple so yeah right.

Well we have yet another call so thank you so much.

Everybody's got these great questions Marshall, go ahead with your question.

>> I would like to know what underlying health problem causes are now fungus on the toes and even on the finger.

>> OK, nail fungus I know it's it can be just ugly unsightly and it's an embarrassing thing for most people and nobody likes to have their nails thickened and discolored.

You ask what the cause is.

It's very hard to pinpoint a low like what actually causes the nails to be become fungal.

You know I've seen it where people get athlete's foot and the ones you have athlete's foot the nails can become infected walking around in public places with without like shoe gear on those are reasons why people can pick up nail fungus.

>> Nail fungus is very, very hard to get rid of and it's very challenging as the nails become thickened.

What can happen is it could become a permanent problem.

You can try to treat with topical the over the counter ones you could try some people have good success from it prescription tropicals would be the next route.

Then there's an oral medication you could try and then there's always removal.

That is something that you can have either come back or sorry you can have the nail come back or just kill it so you don't have to worry about it anymore because unfortunately once you get that nail fungus it's just really hard to get rid of .

I mean you said also your fingernail and that could be because of you kind of treating your toenail and then it gets to your fingernail.

That's something that could happen to once again you would probably have to talk to your provider for the fingernail.

>> Sure.

All right, Marshall, I don't know if you're still on the line.

Did you want to ask anything else?

No, I think it should be OK. >> Thank you.

That is a great question.

It is unsightly and I've heard that that it's really hard to get rid of .

I mean it can I heard even with some of the medications it can take months.

Oh yeah that's right.

So we're all medication takes three months.

Oh we like to check the liver during that time period because it's metabolized in the liver and so we want to make sure we're not overworking that liver.

So I personally when I'm in the office I'll test at the beginning middle and end just to make sure we have no harm to the liver whatsoever.

>> OK, all right, great.

Well good advice and these are all things sometimes people try and write it on their own for a little bit and I understand everything is expensive these days and people are trying to do what's most cost efficient but sometimes to get to the point where it's it's beyond what we can do ourselves so OK, we have another question why these are all rolling in great questions.

>> I hope I'm pronouncing your name right.

>> Does it Rindell or Rindo it Wandell Bable right now.

OK, thank you.

Thanks for calling.

>> Go ahead with your question.

Thank you.

My wife bought me some brand you can and I work on Grissom and Webb our whereby both Leibold two three hours when we're working on the field the azzara my foot it's well up in heart.

Oh I don't want to return to you know I got them as a gift wedding gift.

I don't want to return the boots from my wife the only thing I can do oh you ask the right question because you are these are all of that type of footwear.

You are in pain there.

I'm really sorry about that.

Hopefully I can give you some suggestions, you know, getting a pair of shoes or boots that are gifted to you that's that's a really nice thing.

But it is hard because you really need to make sure that they're fitted for you and you not fit into them because it doesn't work that way.

But if there's a few things I can suggest are maybe you need a little bit more support so basically you would want to take insult out of the current boot and maybe slip in a nice orthotic like this or you can find them over the counter depending on what you need.

If you need more cushion, if you need more support, it's kind of up to you if you need padding like you said it was rubbing in the area so you might want to have some extra pad inside the shoe.

>> But honestly, if they are really tight and snug and you're getting you some discoloration of your feet, I would be I would definitely advise you from not wearing them all day, maybe break them in.

But if they're continuously bothering you or giving you blisters, you might have to forgo them.

>> Did you want to ask anything else?

No, thank you.

>> Saved my marriage.

OK, well she's a good worker.

Thank you Randall.

That was a great question.

You know before we do have someone else Don's waiting to ask a question but I want to ask you a question about those inserts because I know I think you've said in the past to get them fitted for you because you can I've seen places like these things you step on it and it supposedly tells you like what kind of orthotic to buy it at like a grocery store.

But should you go to a podiatrist or a specialist at least to get one for yourself?

That's a great question.

The ones I brought here today are actually custom made me they were made specifically for a person obviously you know, they're not being used for a person this time but you get molded or they take Sencer you walk over some sensors kind of offload those certain high pressured areas but the over the counter ones are good to try.

You know, I want to spend a lot of money on them because they can become really costly.

So if you want to try them out first but if they're not doing it for you or if you need more support then see specialists go to a shoe store, get measured.

I know a lot of people have lost that tradition but it's actually really important to get measured.

>> They'll measure you.

They do have a better supportive insoles there for you and podiatry offices also have them as well.

So that's something I would tell you to do before you keep going and going.

But to spend more than I would say forty five fifty dollars get pricey I wouldn't spend anything more than forty five or fifty bucks so I wonder if insurance would cover that as opposed to over the counter some insurance do some insurance does portion some insurance doesn't do any but as I tell my patients it's an investment into them and their livelihoods and it keeps them going at work.

So it's really important that you take good care of your feet.

You're only given one pair, right?

That's true.

You got to take care of them.

>> Yeah, for sure.

All right.

Well thank you.

I Don you have been very patiently waiting to ask your questions so go ahead.

>> OK, hi.

I was just calling about my two children.

>> I think that they have planned towards maybe and I was just wondering what doctor might recommend for treatment of those words if they are watsky them.

>> That's a great question.

Well what is the name of them again?

What kind of words verruca.

>> Verruca ok ok yeah.

So really words are kind of tricky as they're hard to to treat as well and they it's a virus that gets into the skin by a little crack and basically once you have the words then you're going to have for the rest of your life and they'll they'll come out on your hands and your feet.

So it's something that you just then have to treat and take care of so you could try the once again over the counter topical that could be very beneficial.

>> You know, you said you weren't sure if there was though before you try anything you might want to talk or collaborate with your pediatrician or your nurse practitioner provider just to see if they are used.

Words typically can be kind of tricky to diagnose.

As you know, they might look like a callus and might look like a form body or it might be a war and what you would want to do is look at them warts look like a cauliflower you like appearance or have black little specks.

>> Those are the ones that typically are seen on their feet.

All right.

Dawn, did you want to ask anything else about your little ones?

>> And I think that that'll be good.

Do you do you see children in your practice?

>> I do actually.

I see children quite often.

I had a two month old recently so you know, I see from I guess two months or a month I've seen but all the way up so yeah, I'll see any age group.

>> Thank you for your question .

Thank you, John.

Best wishes to you I guess we've had so many questions about shoes and I know we were talking about planthopper say this but let's quickly talk about footwear because I was just thinking when Don and talk about younger children I mean should you make sure your baby has really good shoes once they start walking or even before?

I mean I've seen some kids who are just on the crawling stage where they have shoe little like gym shoes on.

Yeah.

So definitely when they start walking you do want them in a supportive shoe.

You know the ones that are made of cloth I would say are more for fashion and style believe me that all the ballet slipper yeah.

>> As I have one at home and I want to make sure that they match my my nephew's two and so I definitely want to make sure that their feet are good but but yeah more of a supportive shoe for them once again something that doesn't Benfold or twist my my nephew DNF it's OK to talk about him you know he was walking and he was having some hard time with his with his gatins so we put in an orthotic an issue and he's doing much better so even little little children like Daniel Benjamin my nephews they can definitely use some support here and there.

>> Yeah, I'm glad you said that because we normally associate that with folks like my age or middle age older.

>> You need help.

So that's good to know and I know sometimes it's worth the expense when your kids are younger to go to some of these stores that they do specialize in because you're in the proper footwear and sometimes you know younger kids it's probably not a bad idea to invest in that.

>> Yeah.

Grow so, so fast.

So it's really important to keep an eye out.

You know, are they being watched for their little signs?

Are they are they complaining that they don't want to run any more because their feet hurt pick up the little signs that they like show they might not say my feet hurt.

Yeah, they may not not want to do it.

Good point.

Good point.

Why don't we just quickly kind of talk about plantar fasciitis again?

So we talk about the conservative out is just you know the trying the the inserts and maybe some ibuprofen i.e crutching stretching the fake one because that will help prevent it from coming back.

You really want to stretch the Achilles tendon, you get rid of it altogether or is it something that's just going to keep like maybe it'll go away for three months when I come back because it's something you would want to keep up with certain things like stretching shoe gear because you do want to be mindful of that for the rest of your life so it doesn't come back but more aggressive treatment for something plantar fasciitis would be a steroid injections or injections.

>> There's different avenues you can go but injections and then we would do X-ray to see make sure that everything is OK oral steroid medication those are things that you do physical therapy, Neitz blends those are all things that we can offer.

And then last option would be to basically do a surgery where you would cut and sever that that ligament so it allows more stretch.

I try to avoid that on on all my patients though because I do believe and I do know looking at the patient as a whole we could try to really get that taken care of prior to surgery all good to know and I'm going to Jim I know you've been on the phone but I'm just going to quickly ask this question form because we have less than two minutes.

So the gentleman named Jim is wondering what a good treatment would be for neuroma pronouncing that right?

>> Yeah.

OK, so a neuroma that's a great question.

A neuroma is a benign tumor of the nerve and nerves go in between each of these long bones called your metatarsals.

And so the traditional neuroma that we see is between your third and fourth right about here and it feels like you're walking on a pebble or a bunched up sac.

>> OK, and good treatments are for something like this would be once again support and then like an orthotic would help with that.

But you would also put maybe an extra padding in there to offload the the metatarsals to take some of the pressure off the area.

I see anti inflammatories.

They all help things to do a little bit more aggressively would the injection steroid and then the last thing to do is to remove that and when you do remove that, remember you are removing a nerve so you will have numbness in that area for for the rest of your life .

Things to think about but I guess we'll emphasize that they always start conservatively.

So I think people get scared but then it's baby steps definitely.

>> Yeah.

I look at the patient as a whole and try to work with whatever the best for them and their lifestyle.

Sure.

Oh that's awesome.

Well we have to have her back.

We need an hour with you at least so next time we have so really great it does go fast and so many of you were so kind to call in and ask great questions.

So thank you to all of you and Dr. Bajram, best wishes to you come back soon.

I hope you get a good night's rest though.

That little one at home.

All right.

That's going to do it for us tonight.

I'm Jennifer Blomquist again.

Tune in next week it'll be Mark Evans hosting and the topic will be neurology again.

Questions are more than welcome.

Take care and have a good rest of the week.

>> But I