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Dr. Wellens and Dr. Ortiz Discuss Foot and Ankle Health

Dr. Wellens Discusses Foot and Ankle Health

Rem Jackson: Hello everyone. This is Rem Jackson and welcome to today's call. I'm delighted that today I have on the call with me Dr. Tatiana Wellens and Dr. Narmo Ortiz. They are podiatrists and they practice at multiple locations in Florida. Near the end of the call I'll make sure you know exactly where their offices are located.

But I've asked them to come on the call today because most of the people that I've been speaking to are really interested in the topic of the health of their feet and their ankles for a number of reasons, not the least of which many of them seem to be suffering from different kinds of pains and ailments in their feet and their ankles and really want to understand what's going.

So Dr. Wellens and Dr. Ortiz have agreed to spend a little bit of time out of their day today and share with us some of these answers to these questions that so many people have.

And so first of all Dr. Wellens, Dr. Ortiz, I'd like to say thank you to both of you for being on today's call.

Dr. Wellens: Sure. My pleasure.

Dr. Ortiz: Thank you for having us.

Rem Jackson: It's our pleasure for sure. Now I think really the best place to start, and Dr. Wellens I'll ask you if you would, would you just give the listeners on the call today really a brief definition of what a podiatrist is.

Dr. Wellens: A podiatrist is a physician who has a license to practice medicine and it's the type of medicine that deals with foot and ankles problems. Usually most podiatrists are board certified by either the American College of Foot and Ankle Surgeons or there are several other specialty boards that certify a majority of the podiatrists that hold a licensure.

In the state of Florida, a podiatrist basically deals with foot, ankle and knee problems, basically any type of musculoskeletal problems below the knee.

Rem Jackson: That's great. So I guess in other words a great way to sum that up is you are the experts on the feet and the ankles. Have I got that right?

Dr. Wellens: Absolutely. We are.

Rem Jackson: That's great. Now I know that most of the people who are listening to us today or those that might be listening at a later date are really interested in this topic quite frankly because they have foot or ankle problems or they're responsible for the health of someone who has some concerns right now about the health of their feet and their ankles.

And Dr. Ortiz, what would you say are the most frequent symptoms that your patients are experiencing whenever they come in to see you?

Dr. Ortiz: Yes, here in our practice we encounter a multiple of conditions of course but most of the most common that we see are related to of course ingrown toenails or infections from ingrown toenails. We also see deformities of the foot and ankle including hammer toe deformities, bunion deformities.

Here in Florida we see a lot of heel pain because most people walk on concrete or tile floors so when they come the north they were used to walking more softer flooring like wood and when they move to Florida they encounter the concrete floor that is not good for their feet, especially they walk barefoot.

Also we see athletes with ankle sprains or ankle conditions and in the elderly population we see a lot of patients with diabetic foot problems as well as ulcerations or numb feet, pain in their feet or arthritis.

Rem Jackson: I see, well that's fascinating to me. And you mentioned something called heel pain. I've been doing some research and reading and from what I understand, we're experiencing it the country right now I guess what would be described as an epidemic of heel pain across the country. Is that right?

Dr. Ortiz: Yes, we would call it an epidemic but mainly it could be due of course with the increase in obesity that we have seen in the United States. Basically bearing more weight on your feet is a factor that is also included in one of the causes of heel pain as also shoe gear, inappropriate shoe gear or walking without any kind of an arch support will also strain the arch of the foot and causing that strain or sprain into the ligament that connects to the heel bone, causing the heel pain.

Rem Jackson: I see. And Dr. Wellens, I have actually heard, and Dr. Ortiz just mentioned that it has -- this incidence of heel pain has something to do with the fact that obesity is certainly a big problem in the United States.

I've also heard that it has to do with also the opposite side of the scale basically, which is we are also as Americans now becoming far more active and that many people that experience heel pain might in fact be folks that are exercising on a regular basis and really using their feet for all kinds of sporting activities too. Is that right?

Dr. Wellens: Oh absolutely. In fact the new research in the pathology of heel pain or plantar fasciitis is directly associated with a term called tendonosis, which is sort of different than tendonitis that we're usually used to hearing from our press and from medical literature.

In fact, if you look up the term tendonosis in the medical dictionary, you will find that it's actually more like lack of circulation in the tendon and that's why the new techniques that are developing to treat plantar fasciitis are directly addressing the tendonosis problem, which is usually due to the over utilization of our bodies at an older age. So you're absolutely right.

And it's interesting you mentioned the epidemic. Statistically about two million Americans have plantar fasciitis every year and about one million will go and seek medical help for it. We're true experts in it because like for example in my practice about 60% of new patients are heel pain patients.

Rem Jackson: And I want to ask you another question about heel pain. I have also heard that some extremely high percentage of the people that come to see podiatrists like yourself that have heel pain are actually cured using what you would describe as conservative measures or non-surgical approaches. Is that right? And how high is that number?

Dr. Wellens: 95%.

Rem Jackson: 95%. Wow.

Dr. Wellens: And we do know that those numbers go down if patients wait and do not seek professional attention. In fact, according to the last numbers that I've read, if you have plantar fasciitis over six months, the conservative non-surgical treatment has a higher chance of failing versus if you see a podiatrist within the first couple of months of having the symptoms.

Rem Jackson: So folks the information here is if you're experiencing those kinds of symptoms, which are sharp, stabbing pains in your heel when you get up in the morning that might get a little better later or just problems with your feet that has a 95% chance that you can be cured without any kind of surgery or those kinds of measures and it's much higher if you get in as soon as start experiencing these problems instead of waiting because I also understand that really it doesn't just go away. Even though it seems to recede for a while, it really doesn't go away. Is that right?

Dr. Wellens: Oh absolutely. And it's definitely -- there are studies showing that even if the patient comes in and if it's over six months for example, the cortisone injection only works 50% of the time versus as I quoted 95% of the time non-surgical treatments would work for somebody who comes in right away.

Rem Jackson: Wow. Now, Dr. Ortiz, you mentioned another thing as you were explaining what are the predominant things that you tend to see during the course of the day, and you mentioned diabetes. There's another condition that is sweeping our population in epidemic proportions and from what I've heard if you are a person who has diabetes, getting in to see a foot specialist such as a podiatrist is absolutely critical for the maintenance of your health. Am I right about that? And if I am, how come?

Dr. Ortiz: Yes you are. It's absolutely critical because sometimes we discover other conditions that are associated with the diabetes that the patient may have been unaware of. For example, as you know and it's in the medical literature, diabetes is a condition that affects the small blood vessels or the capillary especially in the lower extremities.

And those same capillaries are the ones that feed the nerve endings of our feet once they start to die off from lack of oxygenation or an increase in blood sugar levels.

The patient starts to suffer from what is known as diabetic neuropathy where they start to -- or stop feeling their feet. Sensations of pain are usually common because of the neuropathy or they can have numbness or tingling sensations or changes in the temperature sensations in their feet.

And through these types of situations they can suffer risks of ulcerations because of the lack of feeling or using their inappropriate shoe gear or walking barefoot on the hot concrete or asphalt when they're for example looking for their mail in front of their house. They can sustain a burn injury in their feet without knowing it or other kinds of conditions.

And due to this we have encountered a lot of patients that suffer from peripheral vascular disease as well that went unnoticed until they came to the podiatrist for a checkup.

Rem Jackson: So again, just really critical, if you have that kind of a condition to make sure that on your team of doctors that are taking care of you, absolutely should be a podiatrist because of the special concerns about feet and ankles and really their distance from your heart and the organs that support them.

Dr. Ortiz: Definitely. As a matter of fact we treat diabetes as a team approach. Basically we can be the screeners or be referred by a family physician or a (inaudible) doctor to us for primary complaints about neuropathy for example but also it is upon us to refer the patient forward when we encounter all of the other conditions that the patients may suffer and usually we work with a team of doctors as neurologists, endocrinologist and also vascular surgeons as well.

Rem Jackson: Wow. And so in other words that's how to really view a podiatrist. I know sometimes those of us in the general population we have a problem with our foot and our ankle we often go straight to our primary care doctor to get care for our feet and our ankles when in fact really you see so many -- so much each day with the feet that that may not be the best approach really going to see a primary care doctor first. A podiatrist probably should be your very first choice whenever you have anything to do with your feet or your ankles.

Have I got that right, Dr. Ortiz?

Dr. Ortiz: Yes, very much so. We pretty much, like I mentioned before, can do a foot screening of the foot, ankle and leg and recognize many other conditions that the patient may have been unaware of. Of course if we talk about the other end of the spectrum, not to be more morbid but sometimes we have unfortunately found out of patients suffering from cancer conditions that they weren't noticed before and because we notice an abnormality in their feet or their bone structure or whatever, we made the proper referral for these patients for treatment and lo and behold they had a cancer condition that went on either to save their lives or going to treatment immediately.

Rem Jackson: That's great. And of course with those situations early detection is often the key.

Dr. Wellens, when someone comes to see you I'm sure that some of the folks today on the call maybe have never been to see a podiatrist before. What should they expect whenever they show up at your office and come to see you for the first time?

Dr. Wellens: They expect as in any medical office we would require that they fill out the paperwork and basic demographic information and insurance information, but obviously we are smaller offices. We're not a huge clinic or 150 physicians so obviously the service is good and we're professionals but we're true specialists to where if people who are afraid or scared or have anxiety of not being able to get a correct diagnosis from their nurse practitioners or family physicians, we are surely not only catering to their needs but also provide the most accurate diagnosis to the patient during the visit.

We have state-of-the-art equipment, we have X-rays, we have musculoskeletal epigrams; we have all kinds of additional devices that help us with a correct diagnosis on -- during the office visits.

Rem Jackson: Very good. And I'm glad you brought that up because I've been doing some reading about medical advances and in all different parts in medicine and some of it is absolutely amazing. And I wondered if podiatry is experiencing the same kind of advancement because of our technologies and if so, what would be a great example of that that in your own office.

Dr Wellens: We have digital X-rays. We have musculoskeletal ultrasound. We have special computerized plates that the patient can walk through to determine the pathology and abnormal pressure distribution in their feet, basically state-of-the-art facility right there, right then so we don't have to refer the patient out.

We also perform diagnostic testing such as Doppler testing to check the circulation in their legs and feet.

Also, at Central Florida Foot and Ankle Center, LLC we have our own nerve conduction study machine to where we perform full never conduction study as well as [PSSD] studies, which is peripheral (inaudible) sensory device testing studies to determine any type of nerve abnormalities in patients.

Rem Jackson: That's absolutely fascinating to me. I just -- it's just we live in an amazing times.

Dr. Ortiz, I want to change the subject and just ask you a real basic question. What can I do or anyone that's listening to this call, what can we do to just take better care of our feet?

Dr. Ortiz: Yes, it's interesting that you ask that question because having the feet being the most distance part our bodies, sometimes our feet go unnoticed by all of us and we don't take too much care of them on a daily basis. So the main thing that we suggest to our patients is to inspect their feet daily, keep their toe web spaces clean and dry, especially after they take a shower or a bath. Sometimes they neglect that.

Nail health is very important with cleanliness. People that usually sweat a lot through their feet, we suggest the use of antiperspirant foot powders or sprays. Also changing shoe gear and appropriate shoe gear is very important. Some people are used to wearing the same work boots or the same working shoes on a daily constant basis and that could be a source of fungal infections of the skin or nails in their feet.

So it's very important that we cater to our feet and put the appropriate shoe gear in them because they're very important to our lifestyle and our daily living.

Rem Jackson: That's great. What should folks do, Dr. Ortiz, if they feel unusual feelings or pain or even start to see their feet changing appearance or think that they're starting to lose feeling in their feet?

Dr. Ortiz: Exactly. If anybody experiences those initial feelings or even pain, we recommend that they visit their nearest podiatrist or foot and ankle specialist for a consult. Sometimes some doctors offer a free screenings or clinics that they can participate in or even in a health fair.

But usually the most appropriate thing would be to call, make an appointment to see your nearest foot and ankle specialist, podiatrist, so they can check on your feel and to try find to see what's going on.

Rem Jackson: That brings me to really my last question, because I think it's probably the number one question that's on the minds of anyone that's actually listening at the moment, and that is Dr. Wellens, how can our listeners get in touch with you there?

Dr. Wellens: Basically they have several options. They can either call the office and obviously Rem, if you don't mind providing that information to the listeners, but we have several telephone numbers they can contact us with and we have operators standing by.

Also if they don't like using the phone, they can actually request an appointment online and that might be an easier way where they can tell us what is the best time to contact them and we would be more than happy to do that as well.

So those are the most efficient ways of getting in touch with the office.

Rem Jackson: I've got that information here so let me make sure everybody has that. Now the main number that they can call and actually I promised at the beginning I would mention the locations where you have your offices and there's quite a few. You have offices in Winterhaven, in Davenport, Lakeland, Cape Coral and Lehigh Acres.

And for all of those except the Cape Coral office the main number that they can call is area code 863-299-4551. And for Cape Coral the number is 239-573-1505. And I will give those to everybody again in a just a moment.

They can also find you on the Internet at and now the other thing I wanted to mention is Dr. Wellens you have a book that you have produced about concerns that people have with their feet and their ankles and correct me if I'm wrong, but as I understand this, you're willing to give that to anyone in the community that requests it absolutely free of charge, am I right about that?

Dr. Wellens: Absolutely. We're so adamant at Central Florida Foot and Ankle Center, LLC, we're so adamant to provide education to the general public so they don't have to live with pain on a day to day basis and they don't have to stop exercising and they can continue enjoying their golf games and their tennis games. They don't have to compromise all of those, Rem. They can come in, we can help them. We can get them back on their feet to where they can enjoy daily activities and not suffer with foot pain.

Rem Jackson: That's just so impressive and I really commend you for doing something like that for the community.

So folks if you'd like to get the book that they have made available, you can call a special number. This is a toll free number. It's 866-415-5442 and just leave your contact information there and the folks at Central Florida Foot and Ankle Center, LLC will make sure that that is mailed out to you in the mail and you get your own copy.

Also you can go to their website, which I mentioned before and there's actually an image of the book there. You click on that and there's a little form and you fill it out and they'll make sure that you get that as well.

And I believe too that you'll send some more information that's just good, quality, educational information to help people stay healthy.

And so I promised before I would give you those phone numbers again. The main number is 863-299-4551 and the Cape Coral office number is 239-573-1505.

Dr. Wellens, Dr. Ortiz, I want to thank you so much for taking the time out of your schedule today. I know you've got to get back to your patients, but I really enjoyed this and if there's any way I might convince you to come back on another call at another time, I would just love to do that.

So first of all, thanks so much for joining us.

Dr. Wellens: Our pleasure. Thank you so much Rem for having us.

Dr. Ortiz: Thank you so much for having us.

Rem Jackson: Just delighted. And folks until next time, this is Rem Jackson and have a great day.

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