S01_E14 - Get a Foothold on Feet with Specialist Dr. Nicole Bauerly

Speaker 1: 0:04

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:21

Hey everybody. Dr. David Hilton here, your host of the healthy matters podcast. This is episode 14, and we're gonna talk about something near and dear to all of us, our feet, but I don't know very much about feet. So I invited a colleague and a friend of mine, Dr. Nicole Bowerly. She is a podiatrist at Hennepin healthcare where I work, Nikki, welcome to the show.

Speaker 3: 0:41

Thank you for having me.

Speaker 2: 0:42

Okay, Dr. Barley, what's a podiatrist.

Speaker 3: 0:46

<laugh> what is a podiatrist? A podiatrist is a foot and ankle specialist starting with our education. After our bachelors, after college, we do four years of medical school, pediatric medical school, and that can be hooked with an MD or a do school. We will sit for the first two years taking the same tests and the same classes as the MD and do physicians. And then in our second two years, we kind of split off and really focus in on the lower extremity, doing foot and ankle, and really specializing in on that in our rotations. When we get to our surgical residency, all residencies now are three years surgically trained for the reconstruction of foot and ankle. So anything of the bone that's related to the ankle and below, and, um, every state has their own statute of how high up we can go here in Minnesota. We can go all the way up to the knee and then bone, including ankle and down.

Speaker 2: 1:45

Did you always know you wanted to be a surgeon? Um, because I hate, I hate being an operating room. I did it for like 12 seconds back in med school, and I decided, no, no,

Speaker 3: 1:53

No, not for you. Um, I really did like the procedure part of it. Um, and foot and ankle, the surgeries are great because we really can help patients skip back to their level of activity. These are reproducible and reliable outcomes for surgeries and patients really do well with foot and ankle surgery.

Speaker 2: 2:12

How bet people love their foot surgeon.

Speaker 3: 2:13

They do

Speaker 2: 2:14

<laugh> oh, I, I mean, assuming it all goes, right, nobody loves you if it doesn't go right. But I bet most of the time it

Speaker 3: 2:20

Goes most of the time. It does. Absolutely.

Speaker 2: 2:22

So in your practice, what are, what do you see the most of? What do people come to you for

Speaker 3: 2:27

A variety of foot and ankle issues? Anything from overuse, um, where I'm getting aches and pains, where I didn't, before we do a lot of diabetic work here at HCMC, uh, where people end up with open wounds or ulcerations that can lead to infections or amputations. And so we try and prevent that. And then we also do a lot of trauma here as well. So any type of foot or ankle fracture, um, coming through the doors, whether it's through the ed or they limp into clinic, um, we have same day walk-in appointments in clinic, and we will help anything that comes through the

Speaker 2: 3:03

Door. So in your clinic, what's the most common cause of foot pain.

Speaker 3: 3:06

We see a variety of stuff coming in, and I would say kind of the pandemic planner fasciitis is very common right now. And what does that mean? That's never really been termed before.

Speaker 2: 3:18

I think I had that. It was awful.

Speaker 3: 3:20

<laugh>

Speaker 2: 3:20

My, so my arch and my heel hurts.

Speaker 3: 3:22

Yeah. So plantar, fasciitis. Um, we can review that, but I see it more commonly now because people have transitioned to working at home and their barefoot, and they're not getting the support from their shoes anymore. And so as we sit at home, walk around at home, we're not getting the support from our shoe or our previous insert. And so we're seeing an uptick in kind of biomechanical related pain, or just kind of wear and tear aches and pains. Um, that is simply helped by better structure, either with shoes, orthotics, simple things like rest icing stretching. So plantar fasciitis is a structure that starts at the heel bone, kinda runs through the arch and out to the metatarsal heads or toes. And that can get as simple as inflammation in there. Or if it's left, untreated can get, um, some really small tearing in there. It's very painful. It feels like your heel's broke. It's not, it's just the attachment of the fascia on the heel bone. So when you get outta bed in the morning, the first couple of steps can be very painful. You're kind of limping off around your day. It works itself out, um, where you get on with your day and your, your activities. And then by the end of the day, it's really sore. Again, those are the ones that if it lasts longer than a couple of weeks, once you come into clinic and we can give you really supportive tips to get that to go away, the longer it's left untreated, the harder it is to treat. So you do wanna see your provider early.

Speaker 2: 4:46

I think I had it when I was running. Do runners, get it?

Speaker 3: 4:48

Runners can get it as

Speaker 2: 4:50

Well. I kept running that probably wasn't the right thing to do.<laugh> are you supposed to stop doing what you're doing? That's I always say, well, if it hurts when you're doing that, why don't you stop doing that? Yeah. Good

Speaker 3: 4:58

Advice. Everything in moderation<laugh>

Speaker 2: 5:01

Okay. So, so someone comes in, they've got this. What do you tell'em? I've got heel pain. I've got arch pain. What, what things can you do? Mm-hmm<affirmative> are there any things people can do on their own without seeing a foot surgeon?

Speaker 3: 5:10

Yes. So if you are one of those, uh, patients or people that now that it's nice weather out, everyone's going out for a walk or a jog, which is great. But if you do it seven days in a row, because of the nice weather right now, you're gonna end up with some foot pain. So very simply we always forget an ice pack can be very helpful. So put a towel down first, five or 10 minutes. It's a great anti-inflammatory versus taking medication to help with that inflammation. So an ice pack is great, good supportive shoes. The other thing I would say is if you're pulling out your walking or running shoes from last year or the year before, it's time to update them. So if you,

Speaker 2: 5:47

Uh, but they look good,

Speaker 3: 5:48

They might look good, but that bacteria and fungus can break down the lining.<laugh>

Speaker 2: 5:52

Whoa. Now that took a turn. I didn't see that coming. So bacteria and fungus mess up your running

Speaker 3: 5:58

Shoes. It can. Yeah. And so if you do high mileage, um, or there, I would say over a year old that lining can start to break down and it's not giving you the cushion and support that you need. If you're in the market for new shoes, there are quite a few shoe stores around town that are very helpful. They will actually sit with you and measure you and get you into the right shoe. But a good rule of thumb. If you're on your own, if you can bend or twist your shoe, it's not gonna offer any support. Oh. So go through the, the shoes, bend and twist and look for one that's pretty firm. Um, so you don't want those really lightweight kind of toe, uh, the VIM, the toe shoes. Yeah. Those, those will keep me in business. Yeah. Unless you have a very neutral foot type. So those are not meant for most patients.

Speaker 2: 6:44

And do people know how to wear the right size? I mean, because let's face it, a lot of us order our stuff off online things, you don't even barely try it on and disorder the same size you bought last time in some other brand. Yeah. Yeah.

Speaker 3: 6:55

So shoes run very different. So, uh, you know, a size nine and one shoe company is, is a very different size nine in a, in another one. So always try on both pair of shoes, make sure they're comfortable. Um, that's why I suggest kind of buying them in town with somebody that will help fit them. Um, then you know, you're getting the right one,

Speaker 2: 7:14

So that's not working for me. Let's just say, I've got my heel hurts. My arch support. I, I got good shoes, doctor, you know, I'm now, now I come to see you. Yeah. Is there anything more to be done? So

Speaker 3: 7:25

We'll give you a, a home regimen of stretching exercises. So we won't necessarily get you into scheduled physical therapy right away. We'll give you some home physical therapy. That's very doable. So if you can do your stretching, your icing good supportive shoes, not everyone needs a custom insert, but for some, we do offer orthotic clinic right. In our podiatry clinic, um, where our orthotist is there. She does a quick scan with an iPad, takes her about two weeks to make and we mail'em to you. Right. So it's a really nice service to get a custom pair of inserts if necessary.

Speaker 2: 7:57

That sounds lovely. So an orthotist. Yeah. I don't know if I've ever heard that term. Yeah. So they're the one who makes those tics

Speaker 3: 8:04

Mm-hmm<affirmative> yes, correct.

Speaker 2: 8:05

Do the ones you buy down at the store, you know, those little jelly things, do those do anything.

Speaker 3: 8:10

Um, so if you are looking for an over the counter insert, you're gonna wanna look for one that's a little firmer to give you support the gel or Spano, um, span Spano, S P E NCO Spano.

Speaker 2: 8:23

That's the name of something?

Speaker 3: 8:25

Yeah.<laugh> it is. That's that foam one. Okay. Um, or there's silicone or gel. Those are meant more for corns or callouses. Oh, if you have kind of a sore spot, but a firmer one is gonna be more appropriate for somebody who has a tendonitis or a planter fasciitis that needs actual structural support.

Speaker 2: 8:44

So those are some great tips. When we come back from a short break, we're gonna talk about something you mentioned earlier, Dr. Boley and that's about wounds and sores on the feet. We'll do that right after this break.

Speaker 1: 8:55

You're listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk that's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 9:19

And we're back. I've got Dr. Nicole, Bowerly a doctor of pediatric surgery. Is that the right way to say it? Doctor?

Speaker 3: 9:25

That

Speaker 2: 9:25

Is correct. Yes. That's a hard one. Pediatric

Speaker 3: 9:28

Pediatric surgery. Yes. She

Speaker 2: 9:29

Is a foot surgeon and she's also a leader in our healthcare system here at Henon healthcare. So she wears some other hats as well. But today we're talking about her clinical practice in the care of your feet earlier, you mentioned that you do a lot with people largely with diabetes, not exclusively, but largely with diabetes who have sores and wounds on their feet. First of all, why do people, especially people who live with diabetes, get sores on their feet.

Speaker 3: 9:52

It's related to the neuropathy. And neuropathy is kind of the inappropriate sensation where the nerves don't work correctly because of the years of high blood sugar, that damages the nerves can damage a lot of other things as well. But specifically in the feet where if we lose sensation, a diabetic patient might end up with a blister or kind of a, a sore spot from a shoe, but not know it. And then they'll end up rubbing into a deeper wound, whereas you or I would take our shoe off and look at it right away, change shoes, figure out why it's hurting. They don't have that pain sensation and we'll end up with a wound. They also have an increased chance for infections. So even though we would heal from a simple wound care for you and I would in a diabetic patient, they have a harder time healing that wound and might lead to an infection.

Speaker 2: 10:38

So we have a cool thing here, um, about people who don't have enough circulation to their feet. Yeah, what's a Luna.

Speaker 3: 10:45

<laugh>, what's a Luna Luna, micro angiography. It's pretty specialized technology that shows us in real time. So in an, in angiogram, we can look at the arteries. The larger arteries can be in our legs or our heart, but the Luna micro angiography is real time where we put a little dye in, through an IV in your hand, and it will fluoresce, um, with a special camera. And we can see in real time how long it takes for our foot and especially our toes to light up with that dye. And we're looking for under 30 seconds to look for normal flow into those toes. And so we can look at the wound and see if it takes longer to fill, or if it doesn't fill, then we know we're into some small vessel disease, which really can slow down wound healing in our diabetic patients or in our patients with just P a D peripheral arterial disease.

Speaker 2: 11:40

Do these wounds ever heal in diabetes? Cuz you know, they don't have very good blood supply. They've the neuropathy, you've done it. The Luna, the micro angiography. When do you make the call? The decision and you have to tell this patient, I'm sorry. I don't think this is ever gonna heal. That's gotta be a hard decision.

Speaker 3: 11:57

It is a hard decision. We have a program here called limb preservation, um, and Lin limb preservation program combines four departments. And we know through years of medical research that having multiple disciplinary specialists kind of look at, um, the patient. So we it's vascular surgery, interventional radiologists, who do the angiograms, we have hyperbaric medicine and then we also have the pediatric surgeons. So we've got four departments here, all looking at our diabetic patients and our patients with ischemic, um, wounds. And we have a pretty great success rate. So our goal is to not have to amputate. So when you come see us here, if you have a non-healing wound, we will get you plugged in with those four departments and we will see where you qualify and what we can do to help. So it might be improving the blood flow. It might mean surgery or it might not. It does sometimes qualify you for hyperbaric medicine as well. And we have the largest multi place chamber, meaning multiple patients can dive or have an oxygen treatment at one time in the five state area. We're pretty proud of that.

Speaker 2: 13:06

Yeah. It's the coolest thing in Hennapin and when I say cool, I don't just mean G whiz. Cool. Although it's G whiz cool too. It sure is. They shipped that thing from Australia.<laugh> it is GWiz.

Speaker 3: 13:16

Cool. To shut down a few roads. They streets to, to get it in here. Yes.

Speaker 2: 13:20

So super cool on the limb preservation program and I have seen it and maybe you, you listening want check it out too. The Luna machine and the our limb preservation program is well worth another look, especially if you wanna geek out on some really cool pictures, go to our wound healing and limb preservation site at Hennepin healthcare. And I'll put a link to that in the podcast description as well. Okay. We've talked about wounds. We've talked about plantar fasciitis, Dr. Barley, earlier, you said that you also do a lot of trauma to the feet. You have ankle injuries, you have foot injuries. How do people injure their feet? What are the common things you see?

Speaker 3: 13:52

We see lots of fractures, foot and ankle. So anything from a soup can falling on your toe, uh, that can fracture it seriously. Seriously, a

Speaker 2: 14:02

Soup can, you've seen a soup can injury.

Speaker 3: 14:04

I've seen a frozen Turkey break, a foot<laugh><laugh> uh, so we will fix those if needed, um, even toe fractures, meta Taral fractures are common in our running group that end up with stress fractures. And don't take a break.

Speaker 2: 14:19

I've had that too. Yes. I've had a metatarsal fracture and I've had a toll fracture when I kicked the radiator.

Speaker 3: 14:23

Mm-hmm<affirmative> yeah, yeah. Very common. Uh, and then more of our high velocity, uh, where we get a fall from height, either from a ladder or a tree, we might get into a CALCAN fracture that heel bone or an ankle fracture where we get a twisting injury. If we step off a curb that can be enough to twist our ankle and fracture that

Speaker 2: 14:44

I bet you alcohol sometimes involve in some of those

Speaker 3: 14:46

Can be. Yes. So

Speaker 2: 14:47

What do you do about those? Do, do you, do you have to like set people's feet, uh, when they get an ankle injury, do you have to put hardware in there? Do you just cast it? What is usually done?

Speaker 3: 14:56

It depends on the type of ankle fracture. Um, some do not require surgery, uh, where we can just put them in a mobilize, their boot. Um, so those are kind of the ankle fractures that are a little bit lower just involving those tendon injuries. Other ones that involve the ankle joint itself. Most of those do require reduction and then internal fixation with

Speaker 2: 15:16

Hardware. What other kind of trauma do

Speaker 3: 15:17

You see? Um, well we will see, um, gunshot wounds here. Uh, that is something that we do see and, uh, take care of very

Speaker 2: 15:25

Well to the feet, to the feet. So how does that happen?

Speaker 3: 15:28

Uh, sometimes, um, it really is truly an accident, um, where folks are at the gun range and think their gun is unloaded. They're putting it away and there's still a bullet in the chamber and it goes off, it goes into their foot and it goes into their foot, very common, um, unfortunately through the boot or shoe. Um, and then it can disrupt a lot of soft tissue and, um, fracture. And those usually, if they're an open fracture, we will take those straight to the operating room, rinse them out really well. We'll be picking out grass and sock and shoe from the inside of the foot. Um, so we wanna make sure that those don't get infected and then that they're appropriately fixated if needed.

Speaker 2: 16:07

That's fascinating, you know, and I know loads of people who do like to do things like that, they like to go to gun ranges and stuff. It kind of speaks to the need for, you know, gun safety and the handling of your firearms. Absolutely. And now for something on a totally different subject, uh, bunions. Okay. So I've seen patients where their big toe crosses over the second toe and they're not happy about it. Yeah. It hurts. What's a bunion. It does. It hurt it. It's a

Speaker 3: 16:34

It's for most patients they

Speaker 2: 16:35

Hurt. They're not gonna be a foot model anytime soon. No, but it hurts.

Speaker 3: 16:39

Yeah. So you can blame your mom and your dad for that one. It's hereditary. Really. Yeah. Um, but not all bunions hurt. So the size of the bunion doesn't determine the pain. So sometimes patients come in with really big bunion deformities and they don't have a whole lot of pain. And sometimes we see these really small deformities and they hurt a lot. So everyone's very individual and kind of determining if you need surgery or not is based on a couple of things. Do I have pain every day are no shoes comfortable? Am I avoiding activities? Then you know, you're ready for elective foot surgery. If you don't fit that criteria, then try and avoid foot surgery.

Speaker 2: 17:16

You just let it go then. So what causes it, explain it to it, to our listeners. What, what is a bunion?

Speaker 3: 17:21

Yeah, so it is, um, the first meta Taral phenal joint that big toe joints, excuse

Speaker 2: 17:26

Me,

Speaker 3: 17:27

The big toe joint.<laugh>

Speaker 2: 17:28

The big toe joint.

Speaker 3: 17:30

Okay. The big toe joint, the metatarsal head or that last part of the bone can either be round or square. And if it's round, the big toe can tip towards the second toe. Mm. If it's more square, then you actually get jamming of the two bones and where you end up with arthritis called HAX limitus or HAX Rous in that foot deformity, depending on the shape of the bone, you will either end up with arthritis or a bunion that swings over to the second toe.

Speaker 2: 18:01

I never knew that. So it literally just kind of pivots on that mm-hmm<affirmative> and you're born with a rounded metatarsal mm-hmm<affirmative> or a square one. Just genetics.

Speaker 3: 18:08

Genetics. Yes.

Speaker 2: 18:09

Okay. So when, when someone has a painful, symptomatic bunion, that's when they should come see

Speaker 3: 18:14

You. Uh, yes. Correct. We can give you tips and tricks to kind of help, uh, with that pain to manage it without needing surgery. So conservative care. So wide shoes, try and look for material that is more mesh or stretch, um, no stitching or hard leather, right over that big toe joint, you can get into some custom inserts that help support that joint. So it doesn't bend as much and you have less pain. Um, sometimes we get into a little bursitis where it gets kind of swollen and red ice packs, Tylenol, or ibuprofen. If you can take those over the counter medicines and then just kind of be more supportive when you get into, um, some, a flare of that big toe joint pain.

Speaker 2: 18:55

So if you're looking at your mom or your dad and you know, and you're on, you're in on your floor to vacation and they've got that and you look down and go, Ooh, mom, I'm doomed to get that. Or is there anything they can do?

Speaker 3: 19:06

There's

Speaker 2: 19:06

Not

Speaker 3: 19:07

To prevent it. There's not, there's not really a whole lot of prevention that you can do. There are some splints that you can buy online. I would tell you to save your money. Ah, uh, they won't prevent the, the deformity from happening. Um, it doesn't really prevent the pain. Uh, so save your money on any of those kind of gimmicky splints, but padding or shoe gear icing custom orthotics can be helpful in the early stages for sure. But even if your parent or grandparent had bunion surgery, it doesn't necessarily mean that you will have bunion surgery, but

Speaker 2: 19:39

It's more than cosmetic. Oh, absolutely. It really causes pain. Absolutely. In some people.

Speaker 3: 19:44

Yes.

Speaker 2: 19:45

Yeah. That's a good tip. If you are having pain and you have bunions, that's, you know, it's symptomatic, it's a good time to go see your foot surgery.

Speaker 3: 19:50

Correct.

Speaker 2: 19:51

The thing I see the most in clinic, new subject, the thing I see the most in clinic, it's probably the least exciting thing for your whole practice. But somebody comes in with those nasty toenails that you knew. I was gonna say that I could tell I'm looking at Dr. Bley and she's like, oh my God, he's gonna ask me about toenail, fungus. And you know, seriously, I'm asking you about toenail, fungus, because so many people have it, it looks nasty. And I tell him in clinic,

Speaker 3: 20:17

Don't worry about

Speaker 2: 20:17

It. Live with it.<laugh> and they all look at me like I'm not, no that isn't gonna happen. Is there anything people can do about it?

Speaker 3: 20:23

Yeah. So, um, trying to avoid, uh, toenail fungus in the beginning. Good hygiene. If you're a patient that has, uh, sweaty feet. So you're socks and shoes end up sweaty, come

Speaker 2: 20:35

On. Everybody has sweaty feed,

Speaker 3: 20:36

Uh, some more than others. Really? Yeah. So if your, your shoes and, and socks get wet, bring an extra pair to work or wherever you're going and change them out over the lunch hour topicals. When we talk about over the counter topicals, so things like tea, tree oil, um, it's a, non-prescription, uh, natural plant oil that has some antifungal, uh, properties, very good for skin and toenails. If you're looking for something to soften the toenails, to help file them at home, cuz sometimes you just want help. Um, sometimes trimming is a little bit more difficult. So a foot soak and filing, or actually Vic's vapor rub will help soften the toenail. And then you can do a little filing. Yes.

Speaker 2: 21:20

Is it true that the ultimate treatment that you can do or somebody can do is take your toenail off?

Speaker 3: 21:25

Um, so that

Speaker 2: 21:26

Makes me squeamish to think about it. Oh,

Speaker 3: 21:27

We do that every day. You do.<laugh> we

Speaker 2: 21:30

Do. Do you seriously take people's toenails off

Speaker 3: 21:32

Every day? Sometimes all 10<laugh>. Oh,

Speaker 2: 21:35

Oh. So about half the listeners are going, oh my gosh. He takes

Speaker 3: 21:40

Yes. Um, so if you know, more than 25 or 50% of that toenail has that bruising underneath or sub angle hematoma, it will likely fall off anyways. So if it's painful or loose, we will take it off. Um, or if it's very difficult to care for, uh, we will also remove those.

Speaker 2: 21:59

Please tell me you do that under like some controlled environment and you numb it up or something.

Speaker 3: 22:03

We are in clinic. It takes us about five minutes. We numb you up with a little lidocaine and it is a clinic procedure. Um, that patients are very comfortable through.

Speaker 2: 22:12

I get a weekly pedicure. You I'm kidding. I had a pedicure once I did, I was in Palo Alto, California. A bunch of us went out and got a pedicures. I bet it was lovely. I hated it. Oh, everybody else thought it was the greatest thing in the world. And I was, so it was like weird to have someone, you know, filing your toenails and everything. I always thought that was a good thing to do is to get a pedicure, but it is right

Speaker 3: 22:32

In a clean, safe place. Okay. So good. If you're looking for advice on that, make sure that you find a clean, safe place, um, that the community bowl that the water circulates through, they have liners. I would suggest that they actually can sterilize instruments there. Just like we do here at the hospital. Look for peel pack that they're sterilizing and not just wiping with alcohol. Um, and if you have medical conditions like diabetes or poor blood flow, then we would not recommend getting a pedicure.

Speaker 2: 23:05

That's some high yield advice right there. Mm-hmm<affirmative> good advice.

Speaker 3: 23:08

Yes. There are ways to do it safely.

Speaker 2: 23:09

We've been talking to Dr. Nicole, Bowerly a physician here at Hennepin healthcare. She is a doctor of pediatric surgery, a podiatrist, otherwise known as a foot surgeon. Nikki, do you have time for a couple of questions from listeners? You

Speaker 3: 23:21

Bet.

Speaker 1: 23:22

Okay. Our first one comes in from Samantha in Morehead. She says, I'm a runner. And in my running club, you hear of a lot of people getting stress fractures. What are they exactly. And what do I need to know about them?

Speaker 3: 23:34

So stress fractures happen, uh, in our long bones called the metatarsals. So there are five metatarsals in our four foot area when we have high impact, um, training or running that, uh, we don't give ourselves a break from, we can get into a stress fracture or even a stress riser where we get, uh, kind of a change or inflammation in the bone. If we don't immobilize that or reduce our activities or, or running, then we can actually end up with a true, uh, fracture. So we wanna take those warning signs like we would on our car very serious and, and treat them early. Uh, we would get an x-ray sometimes advanced imaging can be helpful, but usually just a simple x-ray some rest time off from our activity. And that should heal up just fine,

Speaker 1: 24:20

Some good information there. And our next one comes in from Kenneth in Illinois. What is turf toe? I'm curious as well. You hear a lot about it in sports.

Speaker 2: 24:28

Yeah. I wanna know that.

Speaker 3: 24:30

So turf, toe, um, most common in soccer or football, uh, where that big toe kind of jams into the ground when we're trying to kick the ball. And, um, it kind of stretches out the capsule and the ligaments. Most of the time, it does not require surgery. Sometimes the, the joint itself, uh, can get a little cartilage damage or even a little fracture that would require surgery. So if you have an injury, an acute injury, uh, where it's instant pain, if you can't bear weight or walk, then definitely get in for an x-ray and have a pediatric surgeon evaluate that and get you on the track for proper care.

Speaker 2: 25:11

That sounds worse than Stubing your toe. Yes. Is it basically stubbing your toe, but we call it turf toe because you don't want a million dollar athlete to say, yeah, I stub my toe.<laugh>

Speaker 3: 25:21

It's a little, well,

Speaker 2: 25:21

You've just described as a pretty bad injury.

Speaker 3: 25:24

It is a pretty bad injury. Yes. Um, and if it involves the joint and the cartilage, it's more than just, I stubbed my toe.

Speaker 2: 25:32

Cause that's something I do, but mine, mine doesn't make it on the front page of the sports section that yeah. Hedon stubbed the to<laugh>. Wow. There's been a lot of really good tips, Dr. Nicole Bowerly. Thank you for being here. Thank

Speaker 3: 25:42

You for hosting.

Speaker 2: 25:43

I appreciate you coming on here. There's been great tips for listeners. Thanks to watch out for, and if you happen to have diabetes or other wounds, we've got some tips for you. So it's really been chockful of good information. Thanks a ton. And I hope you'll be back for a future show.

Speaker 3: 25:55

You bet. Thank you so much.

Speaker 2: 25:57

Thanks for listening to this episode and I hope you'll join us for the next show as well. And in the meantime, be healthy and be well.

Speaker 1: 26:05

Thanks for listening to the healthy matters podcast with Dr. David Hilton, to keep up to date with the latest in healthcare and your health, subscribe to this podcast, wherever you get your podcasts for more information on healthy matters or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us@healthymattersathcmed.org, or give us a call at six one two eight seven three. Talk to catch all the latest from Dr. Hilton and the healthy matters podcast. Follow us on Twitter at Dr. David Hilton. Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Camuto and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician. If you have more serious or pressing health concerns until next time, be healthy and be well.