Yoga Journal Article for “Happy Feet”


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Give your feet just a little attention, and your whole body will feel better.

By Melanie Haiken

They hold us up all day long, they get us everywhere we need to go, and they connect our bodies to the earth. Some yoga teachers even call the feet the “roots” of the body.

Yet for all that our feet do for us, we don’t do much for them in return. We cram them into tight shoes, pound along on them all day, and generally ignore them unless they’re giving us serious trouble. The result is that at some point in their lives 7 of 10 people will suffer from foot problems, many of which are entirely preventable.

Robert Kornfeld, a holistic podiatrist in New York City, says he’s seen it all: people hobbling in with knobby, inflamed bunions and hammer toes, the dull throb of tendinitis, the achy soles of plantar fasciitis.

Those aren’t just niggling minor ailments; some foot problems can alter the foot’s structure and trigger pain elsewhere in the body. “I sing that song to my patients,” Kornfeld says: “‘The foot bone’s connected to the leg bone…'” In fact, experts say one of the most important reasons to treat foot problems early is to prevent them from throwing the knees, hips, back, and shoulders out of whack.

And one of the best ways to take care of your feet is with yoga. “I recommend that all my patients start yoga immediately,” Kornfeld says. “When you treat foot problems with yoga, you end up treating back pain, hip pain, all kinds of structural problems. Not only does it stretch out the muscles and lead to a greater range of motion, but it helps heal the root issue of inflammation as well.”

In fact, yoga gives feet a healthy workout that they rarely get any other way. “You couldn’t ask for a better set of tools to reawaken the feet,” says yoga teacher Rodney Yee, of the Piedmont Yoga Studio in Oakland, California. Below, some tips from the experts on how best to use yoga to prevent or treat foot pain.

Throw Your Weight Around

The first place to begin building awareness of your feet is in standing poses such as Tadasana (Mountain Pose). Before you start the pose, think about how you naturally stand, suggests Janice Gates, a specialist in therapeutic yoga and the founding director of the Yoga Garden Studio in San Anselmo, California. Do you tend to put your weight on the inner edge of your foot, which tends to make your legs bow inward, or on the outer edge, which tends to make the knees bow out? (If you can’t tell, check the bottoms of your shoes—you can often tell from the way the soles are wearing.)

Notice how your weight falls, and then play with it by rocking forward and back, lifting first your toes, then your heels. If you tend to stand perched a little forward, try shifting your weight back a bit, and vice versa.

Next, try lifting the arch of your foot while pushing down around the edges, creating both a sense of rooting into the earth and lifting energy up from the center, to form the Mula Bandha (Root Lock). “Sometimes I use the image of a jack-in-the-box: collapsing down, then springing up,” says Gates. “You’re pushing down to lift up.” Once you start to do this, you’ll find yourself more aware of your feet and distributing your weight better in your everyday life.

Work Those Toes

One great way to limber up stiff, underused feet is to work on the articulation of the toes, which in most of us have lost at least some of their range of motion, says Tias Little, director of YogaSource in Santa Fe, New Mexico. Little considers the feet so important he not only focuses on them in his regular sessions, but has also created a separate class he calls Feet as Foundation. “Think of the way babies spread their toes and crawl by pushing off with them,” he says. “We need to regain that.” Little guides students through a routine in which they try to move each toe separately from the others and practice picking things up with their toes.

In standing poses, focus on elongating the toes to stretch the sole of your foot. Press down into your heels at the same time you press forward with the base of the big and little toes, grounding forward with the ball of the foot. “Think of it as stretching the sole of the foot like a drum,” Little says. This can improve circulation, pumping blood and lymph back toward your heart, and potentially stave off edema and varicose veins.

Be Square

Paying attention to—and correcting—the way your feet connect with the earth can correct foot and ankle problems that have repercussions throughout your body. For example, pronated feet (which roll inward from the ankle down) tend to cause knee problems and back pain.

One way to think about foot stability is to think of your feet as having four corners: the big and little toes, and the outer and inner heels. Some teachers use the image of a car with four tires; others conjure up an X on the bottom of the foot. Use whichever works for you, because distributing your weight evenly across your feet is central to healthy alignment. And that, in turn, may lead to a surprise: By resolving foot problems, you may discover you’ve resolved your knee, back, hip, and shoulder problems as well. Anusara Yoga instructor Amy Elias Kornfeld—who works with patients of her husband, Robert Kornfeld—suggests looking down to make sure that the second toe, shin, and knee are all aligned as you start a pose.

If you still need proof of the importance of foot positioning, think of what happens when you try to go into Vrksasana (Tree Pose) or Garudasana (Eagle Pose) and your feet aren’t positioned right. “You have to use the feet or you fall over,” Gates says. “Wherever the instability is, it’s going to show up.” There’s a reason your yoga teacher is always telling you to spread your toes: Creating a stable base is essential when one foot is all you have to stand on.

Stretch for Strength

Any pose that stretches the arch or the sole of the foot improves flexibility and loosens tension. Little suggests a simple exercise to warm up your feet before yoga: Stand on a tennis ball and roll it back and forth under your foot, working the toes, the ball of the foot, the arch, and the heel. Virasana (Hero Pose) stretches the top of the foot and elongates the arch, while kneeling with the toes tucked under is the best way to lengthen the plantar muscles on the sole of the foot, which, when contracted, can become inflamed, leading to plantar fasciitis.

Little also teaches students to go back and forth between Vajrasana (Thunderbolt Pose) and what he calls “broken toe pose.” From Vajrasana, lift your hips, curl your toes under and lift your heels, and then lean back so your weight rests on the “necks” (not the pads) of your toes.

Adho Mukha Svanasana (Downward-Facing Dog) is another way to give the feet a good stretch; Gates teaches her students to lift the arches of the feet as high as possible, then extend the heels toward the floor to work the plantar fascia. “At first it feels impossible when you try to lower your heels, but it just takes practice. And it feels so good when you do,” she says.

Make these exercises part of your life, and your foot bones (not to mention your leg bones, hip bones, and maybe even your head bone) will be forever grateful.

Melanie Haiken is a freelance writer in San Rafael, California.

Plantar Fasciitis: Overcoming Heel and Arch Pain Naturally

Have you ever thought about the work your feet do every day? Those two small appendages at the bottom of your leg not only support a body which is comparatively massive in size but are also responsible for transporting that body approximately 2,000 miles per year. Your feet are the foundation of your physical form–literally the base on which you are built–but most people treat their feet as though they could unzip and detach them at the end of the day. We mindlessly abuse our feet until we are injured or in pain. Only then do we pay them their due respect.

Sadly, the prevalence of foot and ankle problems has skyrocketed over the past three decades. Millions of Americans suffer from foot and ankle injuries every year, and many people are experiencing these disorders at a much younger age than a generation ago. I’m sure many of you reading this are part of those statistics.

One of the most common foot maladies people suffer from is plantar fasciitis. This condition arises when undue stress is placed on the ligament in your foot that supports your arch–the “plantar fascia”. When that ligament is overworked it leads to the classic symptoms of heel and arch pain which worsens when you get up to walk after periods of rest.

Understand that this isn’t the kind of pain you experience after being on your feet all day at work or walking around Disneyland with your kids. The pain from plantar fasciitis is often intense and debilitating. It is also surprisingly common. Two million Americans suffer from plantar fasciitis every year and 10 percent of the population will experience it in their lifetime. It has become recognized as one of the most chronic and, often times, most difficult foot problems to treat.

Perhaps this is because few podiatrists take an integrative approach to foot problems like plantar fasciitis. Like most people, doctors typically think of the foot as somehow separate from the rest of the body–they focus on treating only the foot and don’t look at the other physiological systems or diet and lifestyle factors that go into creating these problems in the first place.

But your foot is connected to the rest of your body. If you want to heal your foot, you need to treat your whole body. I have had immense success treating plantar fasciitis and other difficult-to-heal foot and ankle ailments in my practice using this kind of integrated approach. Today, I want to teach you how to use these same methods so you can treat the problem yourself. You will learn what changes to make in your diet, what supplements you need to take, and a few tests you may consider. Using the steps in this blog, you will heal your feet and put an end to the pain and debilitation of plantar fasciitis.

Before we get to all that, let’s take a moment to look at why the modern foot is plagued by so many problems.

The Real Reasons Our Feet Hurt

The shocking increase in foot and ankle injury we are seeing today is likely due to the following factors:


Fitness has become a veritable religion amongst Baby Boomers who are much more physically active than their parents were. The increased stress and pounding on the feet, in the name of improved fitness and weight loss, has caused an increase in foot and ankle injuries and repetitive-stress related disorders.

Degenerative Disorders

We are seeing an increase in degenerative disorders such as arthritis, neuropathies, peripheral vascular diseases, and chronic inflammation in its many forms. There are many contributing factors to problems like these, but one of the most important is the increased toxic load modern man is exposed to through poor diet and environmental influences. Exposure to poisonous compounds in our diet and environment lead to increased free radical formation (also known as oxidative stress, a topic I will discuss in more depth in subsequent blogs), a weakened immune system, and may ultimately lead to the expression of genes that set the stage for degenerative illness. When the body is under constant assault this way, it becomes very difficult for it to repair itself efficiently.

Man-Made Surfaces

Another important factor is the surfaces we walk around on. In mankind’s infinite wisdom, we have covered the Earth with concrete and asphalt, created homes with hardwood floors or tile, and designed shoes that crowd the foot and hamper proper foot function. The end result is that the “ground reactive force” placed on the foot (the impact the foot must absorb during usual walking) is way beyond the physiologic capabilities inherent in its structure.

The foot and ankle complex is a miracle of design and function and if left to function on natural surfaces, would not be subjected to these abnormal stresses, which ultimately lead to pathology and pain. Our modern way of life does little to support our feet and much to damage them. The result is foot problems like plantar fasciitis.

But there is good news: By learning to treat our feet and support them properly we can heal from our foot problems, or, you might say, we can get back on our feet again!

One of the keys to doing this is properly managing inflammation.

Inflammation: The Pathway to Foot Health and Illness

When your plantar fascia is stressed–whether you are beating it up with improper exercise, have a congenitally short ligament (which causes a “cavus deformity” or extremely high arch), or your calf muscle complex is too tight and thus pulling it in the opposite direction–the cells in the ligament become more metabolically active and cellular damage occurs.

When this happens, the immune system is recruited to help detoxify the cells and repair the injured and damaged ones. It does this via a cascading pathway known as primary inflammation. When this pathway is operating efficiently and it is able to properly handle the extent of the injury, you will have no symptoms or they will be minor. You may experience some slight pain and swelling in the area that has been affected. This will diminish rapidly (within a few days) as your injured ligament is repaired.

When the stress you have placed on your foot is greater than this pathway can manage, your immune system employs a different set of chemical responses and a different pathway is activated. That pathway is chronic inflammation.

Chronic inflammation is designed to protect your tissues when they are under extreme stress in the hopes of preventing permanent damage to your system. The problem with chronic inflammation is that when it is left unchecked it actually creates further damage and produces profound pain, swelling, heat, and other symptoms. This is usually when people wake up to their feet–when they are hobbling into my office.

The impact that inflammation has on the body is one of the most profound discoveries in modern medicine. Chronic inflammation can contribute to a host of chronic illnesses from heart disease, to diabetes, and more. It is also the driving force in plantar fasciitis.

But what’s most extraordinary about inflammation is that it can either heal your body or make you chronically ill. It just depends on which pathway is activated. In the case of foot disorders, primary inflammation is a powerful healer. So, my job as a holistic podiatrist is to stimulate the pathway to healing (primary inflammation) and block the pathway to plantar fasciitis and other forms of foot pain (chronic inflammation). We need to utilize the body’s inherent ability to detoxify and repair the cells that have been injured, while at the same time eliminating the possibility for further injury.

Understanding inflammation this way is a fundamental shift away from the way most conventional podiatrists understand and treat plantar fasciitis. The most common treatment for the condition is cortisone, a powerful steroid that blocks inflammation. The problem with cortisone is that it blocks ALL inflammation. Sure, it relieves the immediate symptoms of the problem. But it ultimately inhibits the body’s inherent mechanisms for healing itself.

This is further complicated by the fact that cortisone is “fibrolytic,” which means it can weaken fibrous tissue. All connective tissue–tendons, ligaments and joint tissue–is fibrous tissue. Your plantar fascia is fibrous tissue. So it’s not a great idea to take medications that weaken this tissue when you are looking to heal and strengthen your ligaments.

Put simply, cortisone cannot be relied on as an effective treatment. However, there are ways you can properly support the pathway to healing and overcome plantar fasciitis. Here’s how you do it.

Treating Your Feet from the Ground Up: Diet and Lifestyle Changes to Reverse Plantar Fascitiis

There are two factors we need to consider when treating plantar fasciitis. The first are the “functional influences” on the foot–that is, the mechanics of how you use your foot and how that influences its health.

As I wrote, there are many reasons the plantar fascia can become painful and inflamed. Common problems that contribute to the condition are:

· Structural deformities

· Repetitive stress injury

· Muscular dysfunction

· Positional deformities

· Abnormal muscle sequencing

· Improper or excessive exercise

· Secondary muscular compensations

You need to identify and address which of these issues is leading to problems with your plantar fascia. The treatment will depend on exactly what you are doing to injure your foot. For example, if you are exercising improperly you can learn better technique. Additional common interventions include:

· Stretching exercises

· Therapeutic exercises

· Orthotic therapy

· Yoga

· Physical therapy

The goal is to correct these biomechanical problems to the degree possible. Once this is accomplished, we can focus on healing the inflamed and injured tissue without fear of continued stress and injury. That is where the second factor in treatment–metabolic influences–come into the picture.

Remember, to heal your feet you need to heal your whole body. Supporting the pathway of primary inflammation means looking at the dietary, lifestyle, and environmental influences that positively and negatively affect it. Put another way, we need to make sure you are giving your body what it needs to heal itself.

Since all injured tissue (including your plantar fascia) requires oxygen and nutrients for healing, the first place to look for any nutrient deficiencies is in the diet. Here is what I recommend you do.

For one week, journal about your current diet. Take careful notes on everything you eat and drink. Don’t just try and keep track of this in your head. Write it down. This will give you a much better sense of what you are eating every day. Then you can assess if there are any ways you can optimize your diet. Do you eat too many refined carbs? If so, cut them out. Do you consume too much or the wrong kinds of protein? If so, cut back or focus on healthy proteins full of omega-3 fats like small wild fish, nuts, and seeds. Are you eating enough vegetables? If not, up your intake. You should be getting at least 5-9 servings a day.

In addition to optimizing your diet, I often recommend the following nutritional supplements to assist in the healing process:

1) Omega 3 fatty acids (from fish oil) – These help regulate the inflammatory process and support the pathway of primary inflammation.

2) Amino acids – The building blocks of all connective tissue are a base requirement for cellular repair processes.

3) Anti-oxidants – Prevent the buildup of free radical compounds in the area of chronic inflammation by taking these in supplement form and you will ward off degenerative changes in your tissues.

4) MSM – A form of dietary sulfur, this powerful supplement aids in the healing of inflamed connective tissue and helps strengthen those tissues.

5) Probiotics – These healthy gut bacteria are needed for the production of short chain fatty acids which literally feed your immune system and make all immune related activities more efficient, thereby reducing inflammatory pain.

6) Curcumin – This extract from turmeric, is a biological response modifier and bolsters primary inflammatory efficiency. It is a powerful anti-inflammatory.

You will also likely need to increase your water consumption. Water is the essential environment for all metabolic processes in the body. Proper hydration facilitates cellular repair, and most people don’t get enough water. You should drink a minimum of eight 8-ounce glasses of water every day.

If you still have problems after taking these steps, the next thing you need to do is identify potential immune system challenges–factors that make your immune response less efficient than desired. This usually involves some laboratory work. Here are some of the tests I typically perform to help tease out these kinds of problems:

1) IgG food sensitivity tests – These tests are done to uncover the possibility of foods that are “irritating” to the immune system. These are not allergy tests. They are done to identify foods, which may be misdirecting the immune system and increasing inflammation in your body. Finding out which foods you are sensitive to and eliminating them from your diet will free your immune system to perform its regular duties more efficiently. I often see great improvement in healing stubborn conditions like plantar fasciitis by treating food sensitivities.

2) Lipid peroxide assay – This test will reveal whether or not your body is properly controlling the rate of formation or elimination of free radical compounds in your body. High levels of free radicals also serve to misdirect the immune system by triggering genes that lead to degenerative diseases, such as arthritis. What does this have to do with inflammation? Well, these genes are “turned on” by the chronic inflammatory pathway–the very same pathway that leads to plantar fasciitis and the debilitating pain it causes.

3) Fatty acid RBC assay – This is a comprehensive test designed to identify all of the fatty acids inside your red blood cells. The test does not determine what kinds of fatty acids are being absorbed into the bloodstream, but rather quantifies the levels of all fatty acids being utilized by each of your cells. This is important because fatty acids determine the type and efficiency of inflammation in your body.

4) Adrenal stress hormones – This is an important test to perform in individuals battling chronic pain. Stress hormones are nature’s protection against stressful life events. They help us adapt in life threatening situations by triggering the “fight or flight response”. But when we are running from danger or protecting ourselves against danger, the body turns all its energy to the task at hand and forgets about repairing injured cells, digesting foods, and other important activities needed for healing. When your stress hormones are out of balance and chronically activated, it becomes very difficult for your immune system to function optimally. That means you heal more slowly and your plantar fasciitis does not resolve as readily.

In some cases it is also necessary to treat local inflammation aggressively when you have plantar fasciitis. But, cortisone is not my favorite medication for dealing with this condition. So when people are in extreme pain and need immediate relief, how do we help them?

We still want to foster primary inflammation, and I have found homeopathic injections extremely helpful in facilitating the healing of inflamed tissue in a localized way. Homeopathic injections stimulate your body to detoxify and repair cells in the area they are injected with absolutely no worry of further damaging your tissues the way cortisone can. Here is how it works.

Upon injection, homeopathic molecules bind to the tissue in the area they are injected into–in this case the inflamed plantar fascia. The immune system then reads that there is something there that shouldn’t be, and enables a primary inflammatory response–the very response you want to encourage to heal plantar fasciitis. The beauty of this is that you get immediate temporary relief from pain while stimulating your body to heal itself at the same time. With continued treatment, the pain intensity and frequency begin to wane until healed. It’s a win-win treatment.

The reason plantar fasciitis is considered so difficult to treat is because the medications conventional medicine uses do not address the cause of the problem. The key is to identify and address issues in the whole body that are either directly or indirectly impacting the plantar fascia. Once you have done that you have a much better chance for healing than simply taking injections of cortisone or anti-inflammatories. These medications do not optimize health in any way, shape, or form, and they certainly don’t treat the cause of your foot problems.

I have been treating patients who come to see me with plantar fasciitis using the steps above for almost 25 years. I have never seen any negative reactions, and most people get completely well. An occasional patient does not respond completely and then, of course, there are more aggressive therapies that I may employ.

You can take most of these steps on your own. Others you can work through with a practitioner of integrative medicine. But what you want to do is focus on treating the cause of your foot pain, not mask your symptoms with medications that may actually make the problem worse.

And who knows? You may see an improvement in other areas of your life as well. Every one of the steps in this blog is part of a larger path toward improved health–not only for your feet but for your whole body. That, in my opinion, should be the goal of every doctor and patient in this country.

Remember, your feet are connected to the rest of your body. They may be way down there at the end of your legs, but they are no less a part of you than your brain or heart or lungs are. Take care of them and they will take you where you wish to go for many years.

Five Ways To Reduce Inflammation Naturally

What happened the last time you felt pain in your body? Did you reach for an ibuprofen or go to your doctor for a prescription drug? If so, you may have suppressed your single most essential bodily function for healing. Too often we think of inflammation as something to get rid of and instead choose to medicate our pain, swelling, or stiffness with drugs like Advil or Celebrex in an attempt to relieve the discomfort. However, what you might not know is that inflammation is, in fact, a critically important defense mechanism. It’s our natural siren to alert us that a body part needs attention — much like the call from the firehouse, which moves firefighters to action.

Inflammation works in two main ways: primary and chronic. The primary pathway works on detoxification and repair. This is a symptom-less pathway when it is efficient. Every day when you walk, exercise, eat, or breathe the body needs to cleanse and eliminate the build up of toxins and repair any cellular injury that has occurred. When primary inflammation is hard at work, you will not experience any pain or even be aware it is occurring.

When the primary pathway of inflammation falls short, then the secondary pathway steps in. Secondary inflammation, or what you may know as chronic inflammation, is a pathway of protection. It protects your cells from rapid destruction by allowing the tissue to change and adapt to the on-going stress in the area and can cause pain, swelling, stiffness and loss of function that signals to us that there is a problem that needs to be addressed. This is when most patients will self-medicate or come to the doctor for help. Unfortunately, when chronic inflammation remains for long periods of time and is not addressed adequately, it will cause the expression of genes that lead to degenerative conditions such as coronary artery disease, arthritis, cancer and others.

While in many cases, anti-inflammatory medications are prudent and potentially life saving in patients with certain conditions such as cardiovascular disease (for example aspirin has been shown to prevent heart attacks) and auto-immune inflammations (when treated with anti-inflammatory medications, these patients can experience improved quality of life), it is still very common for doctors and patients to take a rather cavalier attitude toward prescribing and consuming these medications. It is important to note that anti-inflammatory medication is not without side effects. One problem is that in suppressing inflammation, the medicine is disabling the body’s ability to detoxify, repair, and protect itself. In addition, the medication itself is a toxin that needs to be eliminated through the pathway of primary inflammation, when that pathway would be better spent taking care of the body’s natural needs.

Anybody on a prescription anti-inflammatory medication is required by their physician to take periodic liver function blood tests. Why? Because the drugs are suppressing not only the chronic inflammation which causes pain, but also the primary pathway of inflammation, which, as you know is responsible for detoxifying our cells. When the liver is unable to detoxify expediently, then the cells of the liver will become damaged. The result? Liver toxicity. Other common side effects such as internal bleeding and drug interactions must be closely looked for.

It’s not that I am suggesting that you live your life in pain. But you can now see, every time we use a medication that suppresses inflammation, we are effectively suppressing detoxification, repair of the cells, and protection of injured tissues. What I am suggesting is that you become a responsible advocate for your own good health. Relying on a lifetime of medication alone will not improve your health. Optimizing your health depends on understanding the mechanisms that are responsible for your body’s need to maintain a chronic inflammatory approach. Often, an integrative physician who combines traditional and holistic principles to treat patients can identify these reasons. By ordering certain lab tests as well as examining the patient’s diet, lifestyle and environmental influences on health, many mechanisms can be uncovered and addressed.

So what can we do to help our bodies heal without suppressing inflammation? The answer is to decrease the need for chronic inflammation in our bodies.

*Here are just a few suggestions for reducing chronic inflammation:

1. The primary pathway of inflammation is built primarily from Omega 3 fatty acids. Taking supplements rich in these natural nutrients assists the body in having a more profound primary inflammatory response and at the same time, it minimizes the chronic inflammation responsible for pain and suffering. (Nordic Naturals – 1000 mg 3x a day containing a minimum of 300 mg EPA and 200 mg DHA)

2. Taking supplements rich in plant enzymes such as bromelain assist the body as catalysts for the repair of our cells. Taken on an empty stomach, these enzymes can break down the byproducts of inflammation thus clearing the way for cellular repair. (Bromelain Plus 6 – 250-500mg 3x a day)

3. Efficient inflammation depends on a healthy immune system. 70% of the cells of our immune system are found in the gastrointestinal tract. These cells are fed by short chain fatty acids (that do not exist in nature), which are the result of fermentation of complex carbohydrates — whole grains, vegetables, beans — by the friendly bacteria (probiotics) of our intestinal lining. So it is essential for anyone suffering with inflammation to take an ample supply of probiotics on a daily basis. (Theralac Probiotic – 20 billion CFU daily)

4. Consuming a diet low in Omega 6-rich foods like meat, dairy, baked goods, flour products, and grains (basically the standard American diet), is also helpful when looking to relieve inflammation. Although Omega 6 fatty acids are essential in any diet because they are the building blocks of chronic inflammation (which helps the body protect itself when it can’t repair itself efficiently), it will cause the immune system to bypass primary inflammation and default into chronic inflammation, when consumed in excess.

5. Since we require water to serve as the vehicle for all chemical reactions in the body as well as to flush out toxins, proper hydration becomes paramount (the daily requirement varies from individual to individual, consult your physician for what’s right for you). I am not talking about dehydrating liquids such as caffeinated beverages and alcohol, but rather, clean, fresh water preferably filtered, distilled, or from a reliable spring.

There are many things that influence inflammation and many other things that you can do (in addition to these 5 recommendations) to keep inflammation working efficiently in your body and minimizing the uncomfortable and often disabling effects of chronic inflammation.

My next blog: 5 more things you need to know about inflammation.

*If you are taking any prescription medications or anti-coagulants, check with your physician before following any of these recommendations.

Diabetic Neuropathy: Preventing and Reversing the Damage

Imagine living with the haunting possibility that one day, you may lose all feeling in your feet and that this lost sensation could ultimately lead to ulceration, infection, and even amputation of your unsalvageable limbs. This grim but very real condition is called diabetic peripheral neuropathy (DPN), and according to the National Institute of Diabetes and Digestive and Kidney Disease 60-70 percent of diabetics suffer some kind of nerve damage.

That means as the number of type 2 diabetics continues to spiral out of control, we are facing a growing population suffering from pedal disasters like these. What’s tragic is that with all we now know about diabetes, many of these conditions are preventable and largely reversible when they do occur.

To help you prevent DPN or reverse the damage if you are already suffering, in today’s blog I will review some of the issues that lead to the onset of the condition and outline some simple dietary measures and supplements you can take to properly support your feet and reverse the damage.

Sadly, these conditions typically begin with one major medical assumption: Diabetes can be controlled by medicine alone.

Controlling Diabetes with Medication: Can it Be Done?

In my opinion, one of the biggest misconceptions in modern medicine is the assumption that diabetes can be controlled by medication alone. The truth is that it simply can’t be. Somehow our culture has developed this fantasy that people can eat anything they want, do no exercise, and any health complications will be resolved with a few pills or injections. Nothing could be further from the truth.

On the surface it may appear that diabetes can be successfully treated with pharmaceuticals. Fasting blood sugar and hemoglobin A1C levels both seem to improve. And while these are important indicators, looking at these tests in isolation from the larger picture of a person’s diet and lifestyle can be misleading. Here’s why.

Fasting blood sugar tests are a snapshot of your sugar levels in the present moment under controlled conditions (an eight hour fast). They do not accurately identify what happens to your blood sugar over time. Hemoglobin A1C tests, on the other hand, take an average of your glycated hemoglobin levels over a three-month period (which is the life span of the red blood cell). This provides a long-term portrait of blood sugar levels. The problem is that a lot happens with blood sugar in between.

I typically have patients with DPN keep a food journal to get a more accurate assessment of their daily diet. What I usually find is surprising: Their diet is predominantly refined carbohydrates. These processed, high glycemic load foods are one of the driving reasons they are diabetic in the first place!

Instead of removing the driving factor that causes illness (the foods they eat), most patients simply rely on their prescribed medication. This lulls patients into a false sense of security. They think their illness is being effectively treated and there is nothing more to worry about. But this isn’t the case. Diabetics who take medication but don’t change their diet could still be damaging their bodies.

Think of it this way. Each time a diabetic consumes carbs, their sugar levels rise above normal. When this happens they may suffer glycation damage–the damage sugar causes to microscopic blood vessels. This leads to the degeneration of nerves that are fed by these microscopic blood vessels. Hence diabetic neuropathy.

Fasting blood sugar levels miss these events, because after an eight-hour fast we find that many diabetics’ blood sugar levels normalize. A1C levels may also miss these spikes, because they take an average of blood sugar levels over time–they do not identify what happens on a day-to-day basis with blood sugar.

As a result many supposedly “well-controlled” diabetics still develop neuropathy, and other diabetic complications that can be prevented.

So what can a diabetic patient do to ward off or reverse neuropathy?

Healing Your Feet (and the Rest of Your Body) When You Are Diabetic

First and foremost, every diabetic must become his or her own best health advocate. Take your medications as prescribed, but also learn what it takes to eat healthfully. This is the most important step you can take if you want to prevent or reverse DPN and all of the complications that come along with it.

A diet containing 70 percent carbohydrates–most of them from refined sugars such as white sugar, white flour, and white rice–will not support good health but it will support diabetic complications.

If you have diabetes, you need to change your diet. Here is what you should be eating:

Protein. Approximately 40 percent of your diet should be lean, healthy protein. Examples include fish (ideally small and wild-caught) and lean, grass-fed chicken, beef, lamb, or pork. Of course vegetarian sources of protein like traditionally processed soy and tempeh are also good choices.

Fat. Approximately 30 percent of your diet should be fat. Use healthy forms of fat to cook with like olive oil, sesame oil, safflower oil or grapeseed oil; and add nuts and seeds into your diet as your primary snacks and only small amounts of dairy.

Carbs. No more than 30 percent of your diet should be carbohydrates, and you need to focus on fruits, vegetables, whole grains, and sprouted grains. Avoid processed carbs, starchy vegetables and fruits, fruit juices, sweetened beverages, alcohol, and baked goods.

Organic. Consuming organic foods lessens the toxic load in your body and makes for a more efficient immune system.

Eating a healthy balanced diet like this will reduce the need for medications and, in many cases, may eliminate the need for them altogether. Normalizing your diet and preventing high sugar peaks minimizes glycation damage and gives your body a chance to heal the damage that has already occurred.

Next let’s look at how you can use supplements to protect vital nerve and vascular tissue. Notice that they are called supplements because they are intended to supplement a healthy diet. They are not intended to replace a healthy diet. The first step is to change your diet. Then add the supplements.

There are many different types of supplements that can be used to help protect nerves and repair the damage done by DPN. Today I want to focus on the ones I most commonly prescribe, but you should be aware that supplement protocols are very patient specific, and your needs may be somewhat different. The following are a good starting point for most people:

• Alpha lipoic acid. This fat and water soluble antioxidant can protect nerve cells from further damage and assist in the repair of damaged nerve cells. A trained and qualified health care professional should determine the dosage that is right for you. In most cases, you will start with 300mg with each meal.

L-arginine. This important amino acid improves blood flow, an important step in repairing nerve damage. A dose of 250 mg three times daily is the starting dose. Note that patients with a history of Herpes should not take this amino acid as it has been implicated in an increase in outbreaks.

Omega-3s and omega-6s. Since nerve cells depend on fat for repair and healthy function, supplementing with these important fats can create great imrpovements in DPN.

A blood test is often used to examine RBC levels of these fats to determine specific needs. Since both omega 3’s and 6’s need to be in ideal balance in DPN, it is best to determine actual blood cell levels for optimum dosing.

B vitamins. Taking a balanced B complex may help with symptoms of peripheral neuropathy. Make sure the B complex has what we call synergistic levels of B vitamins (not just every B vitamin in the same dose), and that it has adequate levels of folate in it (400 mcg).

Vitamin B12 can also be given by injection weekly, and this will increase your levels more rapidly if they are not improving orally.

Note that high levels of B6 may worsen symptoms over time. So be careful not to take too much. On the other hand benfotiamine, another important B-vitamin derivative has proven helpful in many cases of DPN .

Remember that drinking alcohol can block how your body uses thiamine, folate, and vitamin B12, and can only worsen symptoms of neuropathy. So stay away.

Clearly, the best treatment for neuropathy is prevention. However, once DPN manifests, there are ways you can reverse it if you become educated and pro-active. Use the steps in this blog and do more research on your own so you can take the necessary steps to prevent diabetic foot disasters like these.

You will find more helpful hints about DPN in my next blog.

Robert Kornfeld, DPM

Barefoot Running Shoes: How Effective Are They?

Fads come and go. In my practice, one of the most frequent questions asked is about the effectiveness of barefoot running shoes. My answer? We are in the midst of another passing fad of products, this time designed to mimic or support “nature.” And who doesn’t want to be more natural these days?

Barefoot running shoes are designed to re-create a “natural,” barefoot running dynamic on “unnatural” surfaces like concrete, asphalt, red top, black top, etc. How can we have a barefoot running shoe? Doesn’t barefoot denote without shoes?

Choosing to run on non-yielding surfaces without the protection afforded by proper running shoes can be harmful to the foot and ankle and cause even more problems downstream from compensation patterns. So what really are these pedal marvels and why is everyone running to take their shoes off?

Barefoot running shoe manufacturers believe that the human foot, unimpeded by synthetic surfaces and restrictive running shoes, should function at its best. That is a correct assumption, save for the fact that the human foot was designed long before the paving of roads. In fact, uneven, grassy surfaces are the most natural surface for the human foot because it helps the body navigate and respond to uneven terrain, while at the same time absorbs shock, stabilizes weight and propels the body forward. In order for this to occur successfully, most of us are born with a flexible forefoot and a rigid or stable rearfoot. In other words, at heel strike — when your heel hits the ground — your leg from the hip down is aligned for optimal function and is stabilized during normal walking.

As weight passes forward over the forefoot, on the natural yielding surfaces of grass, the foot is flexible enough to respond to the stress of uneven terrain yet stable enough for the rearfoot musculature to propel the body forward. In fact, because the rearfoot houses the Achilles’ tendon, the posterior tibial tendon and the peroneal tendons (the powerhouses of propulsion), the actual heel strike against the ground becomes much less necessary when running on natural surfaces like grass and soil.

It is this dynamic — the decrease in heel strike — barefoot running shoes seeks to achieve. This is precisely why this technology is failing its mission. The lack of heel strike on unnatural surfaces is not mimicking the way the foot would perform barefoot on natural surfaces. For this very reason, these shoes will eventually come up short, as the foot requires either cushioned heel strike on an unnatural surface or minimal heel strike on natural surfaces.

Since the majority of body weight passes through the first metatarsal bone and big toe — the first ray — during the process of forefoot propulsion, it becomes obvious that any abnormalities in this part of the foot spell disaster. Since we find that the greater majority of humans have a flexible first metatarsal bone, and since we know the greater majority of runners are running on non-yielding surfaces like asphalt and concrete, we find that a flexible first metatarsal will meet the non-yielding surface and will be pushed hard, up away from the ground surface upon contact. This dynamic then creates a decreased range of motion in the first metatarso-phalangeal joint (what we know as the bunion joint).

Try this. Hold your first metatarsal and pull it up as hard as you can, then with your other hand try to pull your big toe upward toward your ankle. You will find the joint will jam up and feel restricted. Now, hold your first metatarsal and apply pressure down toward the floor, then with your other hand, pull your big toe up toward your ankle. You will find a dramatic increase in the upward range of motion of the big toe — this is normalized function.

Runners wearing barefoot running shoes will experience the first dynamic: decreased power of propulsion afforded by the big toe because the muscle contraction is now restricted and less efficient. This in turn causes the rearfoot powerhouse muscles to compensate for this decreased propulsion power. If this dynamic happens over and over with every step, and our barefoot running shoes are depending upon forefoot stability for propulsion power, can you begin to see the pathology that eventually occurs?

We will see things like first metatarsal phalangeal joint pain, pain under the second metatarsal head, Achilles’ tendinitis, plantar fasciitis, posterior tibial tendinitis and/or peroneal tendinitis. Eventual stress fractures of the metatarsals may occur in addition to knee, hip and back problems.

So who should be using barefoot running shoes? The answer is very few people should. Only those people with stable (not flexible) first metatarsals will do well with these shoes, as well as those with very powerful lower leg musculature (although even those with powerful lower leg function will ultimately go on to some type of pathology).

So let’s get real. If you are a serious runner, you need to see a podiatrist who is also trained in functional foot typing, as developed by Dr. Dennis Shavelson to find out if barefoot running shoes are for you. If not, you can safely wear conventional running shoes manufactured by companies who have spent years on research and technology with the addition of a proper running orthotic.

Smelly Feet? What To Do About It

As a practicing podiatrist for over 30 years, I have listened as thousands of my patients over the years have apologized for their foot odor. When I ask them what they do to try and control it, most often the answer is either powder or nothing. Yet, it causes them extreme distress and embarrassment. There are many causes of malodorous feet and the underlying etiology gives rise to excessive perspiration (hyperhidrosis) that is a great breeding ground for bacteria.

Excessive perspiration can often be controlled through antiperspirant therapy. Just because we don’t often see TV commercials for foot odor, the first line of therapy would be to “fix” the problem with a roll-on or spray antiperspirant, the same ones used for underarm issues. When these don’t work, there are more powerful prescription antiperspirant that may be beneficial. Side effects of some of these products are excessive drying of the skin or skin irritation/sensitivity.

For those patients who are willing to be more proactive, changes in lifestyle and diet can be very helpful in controlling foot odor. Diets high in refined carbohydrates will often serve as food for bacteria and fungus in the body, giving rise to discharge phenomenon. One such discharge is to expel these bacteria and fungus into the skin to slough off with dying skin cells. However, when they collect in the skin of the foot through perspiration and are enclosed in a shoe, the odor can become extreme. Correcting the diet by eliminating refined carbohydrates and balancing protein, healthy fats and complex carbohydrates can be very effective in reducing or eliminating foot odor. Additionally, reducing alcohol consumption and cessation of cigarette smoking will also go a long way to relieve the perspiration and therefore, the odor.

Another cause of excessive perspiration is adrenal stress. The hormones that alert the body to danger can become elevated in patients that are exposed to chronic stress. These patients will experience increased perspiration and hence, succumb to malodorous foot problems. Moderating stress can be accomplished in many ways. Developing a calming meditation practice, yoga, regular exercise, psychotherapy, massage therapy, diet and lifestyle adjustments and herbal and nutritional supplements are all helpful in reducing the stress reactions that ultimately can worsen the odor.

But what if none of the above works? Are patients doomed to suffer with the stress and embarrassment of smelly feet? The answer is no. For these patients, we can inject Botox® (botulinum toxin) to reduce perspiration. Although Botox is primarily used to relieve chronic muscle spasm and facial wrinkles, it is an excellent alternative for disabling the sweat glands and minimizing the release of moisture in the form of perspiration.

The process is fairly simple. Each foot is treated at a separate session. The entire bottom of the foot is divided into a small grid system. An anesthetic injection is then given at the side of the ankle, numbing the entire bottom of the foot. The Botox can then be injected into each of the small grid squares at the level of the skin (usually around 40 to 50 injections per foot). Care is taken not to inject the Botox® into the deeper structures, as this will not stop perspiration and may disable some of the intrinsic muscles of the foot (causing temporary disability).

Other than some possible tenderness in the foot for a day or two, side effects are extremely rare and mild (other extremely rare side effects can be discussed with your doctor). The effects of the Botox can last anywhere between three months and up to one year. Some patients will notice considerable improvement, while others will still need to use a topical antiperspirant in addition to the Botox injections for maximum results.

There are some patients who will notice increased perspiration in the lower leg, however, since it is not contained in a shoe, there is no associated malodor as a result. In addition, some patients will need to come back for a second treatment to address areas that may have been missed in the first session. Results may be noticed in as quickly as a few days or up to a few weeks after injection. And yes, unfortunately, there are those patients who do not improve after treatment with Botox.

Botox represents a viable alternative for the large number of patients suffering with hyperhidrosis of the feet when other therapies have failed to control or reduce the symptoms. It is also used successfully in patients with excessive underarm perspiration as well.

A Solution for Chronic Foot Pain

In the world of foot problems, there are many repetitive stress and traumatic injuries that affect connective tissues (ligaments and tendons). These conditions can be responsible for chronic pain and disability in many patients. Due to the extreme forces that affect the foot, healing in many of these conditions may be inefficient and incomplete, leaving the patient to suffer in chronic pain. Conditions such as plantar fasciitis, achilles tendonitis, posterior tibial tendonitis, peroneal tendonitis, repetitive ankle sprains as well as ligament and tendon tears are commonly found to be chronic sources of pain and disability in many patients.

Since connective tissue has no direct arterial supply and relies on microscopic circulation for the delivery of nutrients and oxygen required for healing, this puts these conditions at a distinct disadvantage in terms of the turnover time for cells to heal or be replaced by new cells.

In the foot, as in all other areas of the body, when healing is incomplete, the immune system will default into chronic inflammation as a means to protect the injured cells. This is the pathway that attempts to prevent further damage to the injured tendon or ligament, but is not the pathway needed for repair of the injured tissue. The pathway that is needed, known as primary inflammation, is the pathway that activates a cascade of events designed to detoxify and repair the injured cells.

There are many reasons why many patients do not properly heal in spite of medical therapies. Some of these issues may be a burdened immune system from a) a poor diet resulting in lack of essential nutrients needed for proper healing, b) food sensitivities that misdirect the immune system, c) digestive disorders that leave the GI tract chronically inflamed, hence preventing genesis of short chain fatty acids needed to feed the immune system, d) therapies that do not enhance microscopic blood flow, e) cortisone injections that weaken connective tissue, f) non-steroidal anti-inflammatory drugs that suppress the primary inflammatory response, g) adrenal dysfunction from chronic stress that directly inhibits immune system efficiency, h) heavy metal poisoning and many others.

Once these burdens are identified and lifted, provoking primary inflammation is often the best way to facilitate healing in these chronic problems. This means we get to support the body’s natural pathway of healing. In my experience, supporting, rather than suppressing primary inflammation, will foster healing of tissues, even when they have been chronically inflamed and painful for years.

One excellent way to accomplish this is through the use of the patient’s own platelets. The technique we use is called platelet-rich plasma injections (PRP). These injections contain high amounts of concentrated platelets, which are very rich in bioactive proteins, including growth factors that are needed for the repair of cells. When tissues are injured, platelets migrate to the area to minimize bleeding and to deposit these growth factors in the area to stimulate healing. PRP is a great way to improve outcome by taking what nature does and making it more efficient.

The technique is fairly simple. A vial of blood is drawn from the patient and placed in a special centrifuge that is capable of separating platelets from the other formed blood cells. The platelet-rich plasma is then injected into the area of pathology, (usually under ultrasound guidance to insure correct placement of the platelets) and this concentrated solution of platelets is often able to substantially increase the primary inflammatory response by mimicking injury.

After the injection, we restrict the use of the foot/ankle by placing it in an immobilizing walking boot. This decreases stress on the area we are trying to heal, thus making it more likely that we will be able to see the results we are looking for. There is sometimes a fair amount of post-injection pain brought about by the temporary increase in inflammation, but it is well worth the discomfort when we can heal tissues that have been chronically painful for long periods of time.

Some patients will require more than one treatment, however, the prognosis improves dramatically when the immune burdens we spoke about previously have been dealt with prior to the procedure.

It is a very safe procedure. Since we are using the patient’s own platelets, allergic reactions are avoided. My experience with platelet-rich plasma for foot and ankle problems has been very good for a myriad of problems commonly seen in a podiatry office.

Cortisone Controversy

Understanding how the body works to heal and repair itself is critical information when it comes to understanding the effects of medications such as cortisone. Since injections of cortisone are so frequently used for foot and ankle pain, it is important to arm yourself with certain facts about the drug and how it affects the human body.

Before we get into the specific effects of cortisone, you will need to learn a little about what inflammation really is and what it’s purpose is. Although we think of inflammation as something bad and something to be suppressed, it, in fact, is an essential function mediated by the immune system.

For purposes of clarity and ease of understanding, we will talk about 2 pathways of inflammation commonly utilized by our bodies. Whenever there is a particular problem in our body that involves either a functional or metabolic stress, there will always be an increased rate of cellular respiration in the area. In other words, the cells of the area under stress will speed up their rate of metabolism. This causes the area to create more toxic by-products of metabolism than would usually be found in the area under normal circumstances. These are toxins that must be neutralized and eliminated by the body to prevent cellular damage in the area. This is where the first pathway of inflammation comes in.

The first pathway, or primary inflammation, is a pathway that is involved with detoxification and repair. This pathway will address the build-up of toxins. Once the area is detoxified, the repair of all injured tissues in the area takes place. When the primary pathway of inflammation is efficient, we will not be aware of any symptoms of pain, swelling, redness or heat in the area. In other words, we don’t feel this pathway at work. This pathway is utilized either in the early stages of a problem, or ongoing when it remains efficient and effective at managing the stress in the area.

There are various reasons why the primary pathway of inflammation may prove inefficient. The first is a compromised immune system, which is unable to drive the necessary detoxification and repair pathway. The second reason is that the level of functional or metabolic stress in the area is beyond the capabilities of the primary pathway. When this happens, there will be an added level of toxification of the tissues (areas under this type of stress serve as free-radical magnets, free radicals being electrically unstable compounds that are responsible for attacking and damaging our cells). A higher degree of tissue damage may then ensue. This is where the secondary pathway of inflammation steps in.

Secondary inflammation, or what you may know as chronic inflammation, is the pathway that takes over when the primary pathway fails to manage the problem. This pathway is not a pathway of detoxification and repair, but rather it is a pathway of protection. Cells of the area are protected from rapid destruction by this pathway and it also works to allow the tissues to adapt and compensate for the ongoing problem. Although this is a degenerative pathway, secondary inflammation prevents the tissue assault from spiraling out of control.

Now that you understand the purpose of inflammation, we can discuss cortisone as a medical intervention for inflammatory problems. Of course, cortisone has as its major application in medicine, the ability to suppress inflammation. It does so by blocking the ability of the immune system to address the problem in a manner that we have just discussed. This might seem good on the surface because inflammation produces pain and cortisone has the ability to suppress the pain-causing inflammation. But remember what we said about inflammation, it is designed for 3 main purposes; detoxification, repair and protection. Therefore we are, in fact, suppressing the body’s ability to detoxify, repair and protect. Empirically then, we see that this approach leaves the body wide open for other problems when these pathways are crippled. And, it is well known in medicine, that areas that have been repeatedly injected with cortisone suffer from accelerated damage over time.

The second thing we must be aware of is that any time a drug is used as a blocking agent (e.g. a blocker of inflammation), we know we will encounter side-effects. In other words, if we put up a roadblock to a natural bodily function, then the body will undergo a physiologic compensation in an attempt to “go around” the roadblock. Some of the unwanted effects of cortisone also put the body in danger of further injury and add a level of chronicity to the situation. One of these side effects is cortisone’s capacity to damage connective tissue. It does this in two ways. The first is that cortisone is fibrolytic, which means it is capable of breaking down fibrous connective tissues, the very tissues that support our joints, ligaments, tendons and joint capsules. This certainly does not make much sense if these are the very tissues we are attempting to treat with the cortisone injection. Additionally, as we said before, if the body is unable to repair the involved tissue, it will ultimately compound the problem. Other side effects such as water retention, elevated blood sugar, suppression of the adrenal glands and the immune system, loss of bone calcium, increased susceptibility to bacterial, viral and fungal infections and others, are common effects of cortisone.

Now you will be able to understand the reason for the protocols we use at The Kornfeld Center. Rather than suppress the pathways of inflammation, we work to selectively stimulate the primary pathway of inflammation. This, as you remember, is the pathway of detoxification and repair. This is the pathway ultimately responsible for any and all healing. We do not have to suppress the secondary pathway when we are able to support the primary pathway and make it more efficient. When this is done, the body will naturally release the second pathway while concentrating on healing rather than protecting. This is accomplished with homeopathic injections, which are diluted natural substances capable of stimulating, rather than suppressing, the targeted physiologic pathway. In addition, there may be certain natural supplements and dietary changes that will be used along with the homeopathic injections. When we use protocols that support, rather than suppress, we naturally find a far lower incidence of side effects.