Diabetes and Your Feet: How to Avoid An Amputation

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Having diabetes makes you more likely to develop certain physical complications. Your feet are particularly vulnerable when you have diabetes since people with the condition are at increased risk of peripheral arterial disease (PAD) and neuropathy – two conditions that cause nerve damage and circulation problems in your extremities. People with diabetes also have a higher risk of developing infections and a decreased ability to get rid of infections. The combined factors of poor circulation, loss of feeling, and a relatively high risk of infection makes diabetics more prone to frequent – and sometimes severe – foot problems. When diabetic foot problems are at their most severe, the only solution may be amputation of one or more toes, or, the entire foot.

How Diabetic Foot Problems Occur

There are a number of diabetes complications that can affect the toes and feet and eventually lead to the need for an amputation. These include:

Loss of feeling – Nerve damage from PAD causes a loss of sensation in the feet, reducing the ability to sense when the foot has been injured or irritated. Unattended foot wounds can quickly develop into a larger problem.

Poor circulation – Diabetes also damages blood vessels, decreasing the blood flow to the feet. Poor circulation from damaged blood vessels weakens bones and joints in the foot and ankle. As a result, people with diabetes are at a high risk for breaking bones in the feet.

Development of foot abnormalities – Nerve damage can also create motor problems with the foot which can warp and deform its natural shape. Conditions like Charcot foot – a severe foot deformity – contribute to the development of infection and ultimately lead to disability.

Foot injury and infections – With diabetes, the smallest foot blister, cut, or scrape can quickly turn into a severe infection that can be limb-threatening or life-threatening.

How to Prevent Amputation Due To Diabetes

Manage your health

Control the aspects of your health that can cause poor blood flow. Don’t smoke. Keep your blood pressure and cholesterol under control. And of course, be sure to monitor and control your blood sugar by following your medication plan, eating a healthy diet, and getting regular exercise.

Protect your feet from injury and infection

Wear properly fitted, comfy and protective shoes – avoid shoes that expose your feet or toes, and never walk barefoot. Wash and dry your feet thoroughly each day to keep infection-causing bacteria at bay. These tips for avoiding foot infections can also help.

Practice good foot care habits

Inspect your feet closely each day, keeping an eye out for red pressure spots, cracks in the skin, and early corns, calluses, or blisters. Have professional pedicures by a specialist in diabetic foot care, and follow our tips for a safe pedicure. Have your podiatrist show you how to safely groom your feet at home. Be sure you see your podiatrist regularly, especially if you have any existing foot problems or deformities.

Dr. Lamour and his staff have been providing diabetic foot care to Austin-area patients since 1997. Schedule your next foot checkup today to stay on track with your diabetic foot care routine.

Tips to Improve Your Basketball Footwork

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March Madness is finally here! If you’re a college basketball fan, the month-long display of basketball skill and school pride that is the NCAA tournament is probably one of your favorite times of year. Aside from shooting ability, footwork is one of the core skills of top basketball players that fans marvel at and amateur players envy.

Every move that basketball players make on the court involves proper footwork. Those players that master the fundamentals of basketball footwork can often outmaneuver a player with natural talent. Even if basketball isn’t your sport, footwork exercises can help keep you at the top of your preferred game.

The following exercises for better foot coordination and foot health tips will help improve your moves whether you’re a basketball player or cross-training for another sport.

Basketball Footwork Tip #1: Improve balance, jumping ability and agility

By incorporating the right exercises into your training regimen, you’ll gain additional coordination and strength in your lower body. Balance exercises not only engage the core muscles of the abs and back, they are ideal for helping basketball players safely and effectively perform on-court maneuvers like quick turns or lunges.

USA Basketball – the official governing body for both women’s and men’s basketball in the US – recommends a 3-part system to improve vertical jumping ability. It combines a flexibility component, a strength component, and a power component to get your lower body in shape for making jump shots and dunks without injuring your feet and ankles.

Agility – the ability to quickly change speed and direction – is a useful skill for basketballers to work into their training routines. These 6 exercises to improve agility from the American Council on Exercise, recommend the use of equipment like medicine balls and cones, but you could quickly adapt most of the exercises to make use of more common household items. 

Basketball Footwork Tip #2: Get the Right Shoes

To help protect players from the dreaded ankle injuries that are common in basketball, shoes should be basketball-specific, with lots of ankle support and shock absorption. Well-constructed high-topped shoes offer more ankle support and are recommended for basketball players. Basketball shoes should fit well (see our shoe buying guide for tips) and be replaced before the soles become smooth or before the uppers begin to tear apart. A typical basketball shoe should be replaced every two to three months if used for regular play (4 or more days per week).

Basketball Footwork Tip #3: Have regular foot and ankle check-ups

Athletes of any sport put a lot of wear and tear on their feet, and basketball players are no exception. Be sure to have regular foot checkups with your podiatrist to monitor the health of your foot and catch any problems that might lead to injury or improper foot function.

Don’t wait until you have a sports-related foot injury before making your next podiatrist visit. Contact us today for a complete and thorough assessment of your feet and ankles. We’ll give you personalized recommendations to keep your feet in their best shape for game day.

Everyday Habits That Are Bad For Your Feet

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We’re all creatures of habit. There are dozens of little things that we do each day that feel like second nature to us because we’ve been doing them for so long. But when it comes to habits that affect the health and function of our feet, some of those regular routines can spell bad news.

What’s more, many of us aren’t even aware which habits can hurt our feet. Some habits that we think are beneficial, may actually be doing our feet more harm than good.

Five of the most common bad foot habits that can create foot woes include:

Wearing shoes without socks

Fungus – like the kinds that causes fungal nail infections – grows in dark, moist environments, including shoes. Sticking your feet into shoes without socks exposes them to a potentially contaminated environment and increases you risk of an infection. To cut down on the risk, use an antibacterial spray or powder inside your shoes after wearing them. Wash your feet daily, making sure to dry between the toes where moisture can get trapped. Don’t wear the same pair of shoes multiple days in a row – allow time for them to air out between wearings.

Wearing heels or flip-flops regularly

High heels and pointed-toe shoes contort your feet into an unnatural position and can create structural imbalances throughout the rest of your body that increase your risk for injuries like ankle twists and sprains. Wearing heels for prolonged periods of time can affect the bones of your toes and feet, and can cause existing bunions to get worse. Over time pain, tension, and discomfort can develop from regular wearing of heels, and these symptoms may debilitate into plantar fasciitis, heel spurs, and other chronic foot issues. On the ‘flip’ side, flip-flops and many ballet flats offer little support and can lead to heel pain, and pain under the ball of the foot.

Going barefoot

Flip-flops are recommended, however, in damp public spaces like gym locker rooms, public pools, and showers. Fungi and bacteria can thrive in these environments, so it’s best to always wear flip-flops or shower shoes when you’re in them. Going barefoot in non-moist environments can also expose your feet to injury from sharp objects and accidents. Going barefoot may be especially risky for people with diabetes, who may not be able to feel if their feet have been injured by something they’ve stepped on.

Not replacing running shoes often enough

Old, worn-out running shoes don’t provide adequate support or shock absorption for your arch, heel and ankles, which can make you more prone to injury. As a general rule, running shoes should be replaced every 300 miles.

Treating toenail fungus at home

There are tons of over-the-counter and home remedies for treating toenail fungus. However, many of them can be ineffective. To really treat nail fungus, you’ll need to enlist the help of your doctor, who will be able to prescribe topical or oral prescription medication to get rid of toenail fungus.

Have your unhealthy foot habits started to catch up with you? If you’re experiencing foot or ankle pain, or are concerned about the health of your feet and ankles, contact our Austin podiatry clinic today.

What You Should Know About Toenail Removal

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Toenail removal is a minor surgical procedure that removes either the entire toenail or a portion of the toenail that is diseased, damaged, or very painful. People who have experienced trauma to a toenail, have an ingrown toenail, or have severe or recurring toenail fungus may often resort to toenail removal when other, more conservative treatments haven’t worked.

If you have a difficult to treat fungal nail infection, or if you have a suppressed immune system or diabetes, your podiatrist may recommend removal of the affected toenail to prevent the infection from spreading to other toenails or beyond your feet.

Partial nail removal may also be done for diagnostic purposes to allow your doctor to more closely examine the nail bed and surrounding tissue before deciding whether to conduct a biopsy.

What Happens During A Toenail Removal Procedure

Toenail removal is a simple procedure and usually takes no more than twenty minutes. It can be performed on an outpatient basis in your podiatrist’s office. To start, your doctor will inject a local anesthetic into your toe to prevent pain. During the procedure, the entire nail or just a portion of the nail may be removed. If you want to avoid future infection by permanently preventing the nail from growing back, your doctor can also destroy the nail matrix. The matrix is the layer of cells at the root of the nail that produces keratin, the material the nail is composed of. After the nail has been removed, a chemical can be applied to the cuticle area which will permanently prevent nail regrowth. After the procedure, an antibiotic ointment and bandage will be applied to the wound.

Toenail Removal Recovery

For the first few weeks after having your toenail removed, you will need to keep the wound clean and dry while it heals. You will most likely wear a bandage for about two weeks, and your mobility may be somewhat limited during this time. It may take several months for your toenail to completely grow back. Side effects and complications are minimal after the procedure. The most common problems experienced after toenail removal surgery are pain, infection, and a nail that grows back with an abnormal shape or appearance.

How To Prepare For Toenail Removal

Before having your toenail removed, be sure to ask your doctor questions about the procedure so you have a thorough understanding of what to expect. Some questions you might want to ask your doctor about your toenail removal procedure include:

  • How long will the toenail removal procedure take?
  • How successful is toenail removal in treating my foot problem?
  • How much pain should I expect after toenail removal surgery? How can I manage post-procedure pain?
  • How long will it take to recover from toenail removal surgery?
  • How soon can I resume regular activities?
  • What post-surgical symptoms should I watch for and report?

If you’re suffering from a painful ingrown toenail or hard-to-treat toenail fungus, a partial or complete toenail removal may provide the relief you need. Schedule an appointment today to speak with Dr. Lamour about your options.

Pedicure Safety Tips

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Getting a pedicure can be a relaxing way to treat yourself and make sure your toes look their best, but if you’re not careful, you can be putting your feet at serious risk for infection. Follow these tips to make sure your feet stay healthy and that you’re getting the safest pedicure possible.

It isn’t always easy to pick up on the little clues that let you know whether your chosen salon gives a safe pedicure. Be on the lookout for the following when visiting a new salon to determine whether you’d put your feet in their hands:

Are the nail stations clean?

Do the nail technicians wash their hands after each client?

Are there dirty tools lying around?

Is your nail technician licensed and/or experienced?

If you’re not sure, don’t hesitate to ask staff how they clean their pedicure tools. 

Make sure pedicure tools are sterilized between each client

Always be sure that your pedicurist is using freshly sanitized metal tools on you. Pedicure tools should be soaked in a liquid disinfectant. This effectively kills most microbial life that can lead to infection. Some salons might use UV lights to sanitize tools, but these are not as effective at sterilizing.

Tell your pedicurist how to cut your toenails

Toenails should be cut straight across along the natural contour of the nail. Make sure your pedicurist doesn’t cut your toenails into rounded shapes. If you already have ingrown toenails, you are more vulnerable to infection, and should hold off on having a pedicure until after you see a podiatrist.

Don’t have a pedicure just after shaving your legs

When shaving your legs, the razor creates tiny tears in the skin, which can allow bacteria to directly enter the body. This can lead to serious infections. You should wait at least two days after shaving before having a pedicure. 

Do your own pedicure if you have diabetes

Some experts recommend that people with diabetes skip spa pedicures because of the risk of complications. Diabetics may get an infection from a pedicure, which may be very slow to heal because of their diabetes.

If your doctor has said it’s ok for you to get pedicures as a diabetic, there are several ways to reduce the risk of problems, including:

  • Bringing your own tools. Providing your own tools at the nail salon is the best way to ensure foot safety. A good pedicure toolkit should include:

o   Nail clipper
o   Nail file
o   Orange stick
o   Nippero   Foot paddle or pumice stone
o   Buffing brick
o   Moisturizer or cuticle oil
o   Nail polish

  • Let your nail technician know if you have nerve damage in your feet due to your diabetes, and may not be able to feel scalding water or skin nicks and scrapes.
  • Don’t clip cuticles. Clipping cuticles opens a door to infections. Instead of cutting them, gently push back cuticles with an orange stick
  • Pay attention to pressure. An overzealous nail technician might vigorously scrape or cut hardened skin or callused feet, which can lead to sores and infection.

Caring for your feet is essential and safe pedicures are a big part of foot care. Contact our Austin podiatry office today for more answers to your questions about pedicure safety.

Common Foot Problems for Athletes

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There’s no one ‘athletic type’. Take football players and golfers, for example. Both are athletes, but each has completely different athletic needs – from training to nutrition to physical demands – based on their respective sports. But there is one thing that almost every athlete shares in common, regardless of their sport: foot problems. At some point in his or her athletic life, almost every athlete will experience a foot injury or issue that can significantly affect performance both during and outside of their sport.

Here are some of the most common foot problems or foot injuries in athletes or highly active people. 

Athlete’s foot

Athlete’s foot is caused by a type of fungus, and is so named because athletes are more likely than most to be exposed to the fungus. The athlete’s foot fungus (which is also responsible for ringworm and jock itch) thrives in warm, humid environments like sweaty, damp athletic socks and shoes. Since athlete’s foot is highly contagious, it can easily be spread in places that athletes frequently come in contact with, such as locker rooms, saunas, swimming pools and shared baths and showers.

Plantar Fasciitis

Located at the back of the heel, the plantar fascia often causes pain for athletes. Plantar fasciitis is the result of inflammation caused by tiny tears in the plantar fascia due to overuse from frequent or intense physical activity. Athletes who over-pronate or active individuals who wear flexible, minimalist shoes that don’t adequately support the foot muscles may also experience heel pain due to plantar fasciitis. Heel pain and tenderness is usually felt first thing in the morning and after periods of activity.

Stress fractures

Stress fractures are tiny, hairline breaks that occur in the bones of the foot. A stress fracture is usually the result of: overtraining or overuse, improper training habits or surfaces, improper shoes, flatfoot or other foot deformities, and even osteoporosis. If left untreated, these tiny breaks in the bones of the feet can lead to a more serious fracture.

Turf toe

Turf toe is a condition that many athletes experience. It’s caused by repeated hyperextension of the big toe joint. This is often seen in athletes who wear light, flexible or minimalist shoes or whose sport requires movements that cause repeated, forced hyperextension of the big toe (e.g., football players). Turf toe causes pain and tenderness at the big toe joint, pain during pushing off, and pain with passive movement of the big toe joint. Taping, switching to a stiff-soled shoe or using turf toe inserts to help limit the motion of the big toe and provide extra support is recommended.

Preventing athletic foot injuries and problems starts with you, the athlete. Make sure you always remember to:

  • Wear supportive shoes.
  • Warm-up before and cool-down after athletic activity.
  • Get medical attention for a foot injury.

If you’re an athlete or an active individual, keeping your feet healthy is critical for the continued enjoyment of your lifestyle. Schedule your next foot checkup with us today, and make sure your feet are in tip-top shape.

6 Signs That It’s Time to See a Podiatrist

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Even though our feet are an integral part of our overall body health, many people will delay seeing a podiatrist or foot specialist for nagging foot problems until it’s too late. Many people wait to see a foot specialist simply because they don’t recognize the signs and symptoms of common foot problems that warrant a closer look.

If you’re experiencing any of the foot problems below, it might be time for you to schedule a visit to your podiatrist!

Persistent foot swelling or numbness

Feet that get swollen or feel numb once in blue moon are usually not a huge cause for concern. But if swelling and numbness are happening fairly regularly, you shouldn’t just grin and bear it. A number of factors could be the cause. Tendonitis, a broken bone, a sprained ankle or even an underlying infection could make your feet swollen or numb. If the numbness is accompanied by tingling or burning, it could be a sign of nerve damage – a condition that people with diabetes are particularly susceptible to.

Especially thick calluses or corns

While corns and calluses aren’t serious problems, the underlying cause of them might be. Problems with your gait or the structure of your foot (including bunions and hammertoes) may be the reason for your stubborn corns and calluses, and may also be reason enough for you to see a foot specialist.

Painful bunions

Wearing the right shoes that don’t crowd your toes can help alleviate the pain of bunions, but since they are caused by a deformity in the foot, it’s only a matter of time before you’ll need to see a podiatrist to actually correct the underlying problem.

Pain walking or performing daily activities

If your feet are causing you pain when you’re active or moving around, you could have a fracture or other foot injury that hasn’t healed properly. Without proper treatment, your injury could get worse over time and make it increasingly more difficult to go about your daily life.

Cracked or bleeding heels

Dry, cracked heels can usually be remedied with a bit of sloughing and foot cream. But the longer dryness and split skin on your heel persists, the more problems you’re likely to experience. Over time, your heels may begin to bleed or become more susceptible to infections. If you have diabetes, it’s especially important that you see your doctor to remedy the problem.

Ingrown toenails

Ingrown toenails can quickly go from being a minor nuisance to being extremely painful or infected. Many people attempt to treat an ingrown toenail on their own, but it’s better to seek professional help to make sure the condition is treated properly without damaging either your toenail or surrounding tissue.

Even if you don’t have a current foot problem or injury, it’s a good idea to schedule regular visits with your podiatrist. Whether you’ve got a foot problem you’ve been ignoring or if it’s been awhile since your last foot checkup, we can help! Contact us today for an appointment to evaluate the current health of your feet.

Common Myths About Foot Health

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Despite recent advances in the availability of health information, foot health is still somewhat a mystery. There are many old wives’ tales and colloquial advice about feet and footcare that are well-known, but aren’t necessarily based in fact. When it comes to foot health, it’s important to separate fact from fiction, so we’ve rounded up some of the more common myths about foot care and foot health, along with the real facts behind them.

Foot Myth: Going barefoot is good for your feet.

Foot Fact: Walking barefoot can actually be quite harmful to your feet, since it makes your feet more vulnerable to cuts, scrapes, wounds and fungal nail infections. While it’s always best to wear some sort of protective foot covering, if you must go barefoot, be sure to do so only inside the comfort of your home.

Foot Myth: Shoes cause bunions.

Foot Fact: It is true that the shoes with a narrow toe box or lack of support can make bunions worse, however bunions are most often caused by a genetically inherited defect in the structure of the foot. This structural defect makes it more likely that a person will develop a bunion.

Foot Myth: A doctor can’t do anything for a broken toe.

Foot Fact: Any time a broken bone occurs, it’s important to seek medical attention. A doctor can perform diagnostic X-rays to identify the severity of the break, help ensure the toe heals properly and prevent future issues, and even perform surgery on a broken toe. Failure to see a doctor for a broken toe can end up making walking or wearing shoes more difficult or painful.

Foot Myth: Soaking feet in vinegar cures toenail fungus.

Foot Fact: An antifungal medication that can reach the site of the infection is the best way to effectively treat toenail fungus. Vinegar can’t penetrate beneath the nail where the fungus resides to clear up the infection.

Foot Myth: Foot problems are a natural part of the aging process.

Foot Fact: Many people think that foot problems are an inevitable part of growing older, but that’s not always the case. Many times the culprit for foot problems is years of accumulated damage from wearing bad shoes or not addressing problems with foot structure or mechanics.

Foot Myth: If you can move or walk on your foot or ankle, it’s not broken.

Foot Fact: This myth prevents many people from seeking the medical treatment they need for foot or ankle fractures. Depending on the severity of the break and the individual’s pain threshold it could be possible to walk on a foot or ankle even with a broken bone. But it’s never a good idea, since walking with a broken foot bone can cause serious damage! If you suspect your foot or ankle is broken, stay off of it until it’s been diagnosed by a medical professional.

Traditional wisdom isn’t always the cure for what ails you. If you’ve got a problem with your feet or ankles, it’s best to seek professional care to be sure you don’t do any further damage. Don’t hesitate to give us a call for solid advice on all your foot health concerns!

What to Do When A Gout Attack Strikes

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Now that the holiday season is in full swing, the added stress and non-gout-friendly foods that are characteristic of the season can increase your chances of having a gout flare. Even if it’s been years since your last flare, you may still be at risk for the painful discomfort that a gout flare can produce. But if you know what to do when a flare occurs, you’ll be in a much better position to manage your symptoms and ease your suffering!

Why Gout Flares Happen

A gout flare occurs when a person with higher than normal levels of uric acid in the body has a buildup of uric acid around a joint – most commonly, the big toe joint. Crystals form in the joint, causing pain, tenderness, and inflammation. Some of the most common factors that can increase uric acid levels and make a gout attack more likely, include:

  • alcohol,
  • high-fat or high-purine foods,
  • stress, and
  • some medications.

Some people with gout have reported a burning, itching, or tingling feeling in a joint a few hours prior to a gout flare-up. There may also be stiffness or soreness in the big toe joint. Soon after, the telltale signs of gout appear – redness, swelling, and severe pain, usually in the big toe. Sometimes, there are no early warning signs of a gout attack. Many gout sufferers are simply woken up in the middle of the night with a painful, inflamed big toe joint.

How to Treat A Gout Flare

There are a number of ways to get relief from a painful gout attack and reduce the amount of time that a gout attack lasts, including:

  • Ditch footwear – Socks and shoes can be unbearably painful during a gout flare, so keep the foot and lower part of the leg bare to reduce added pain.
  • Rest – Avoid activity or walking around during a flare. Lie down and elevate the joint on a pillow or other soft object.
  • Try ice packs / cold compresses – To reduce inflammation and ease pain, apply an ice pack or cold compress to the joint for 20 to 30 minutes several times a day.
  • Avoid high-purine foods and alcohol – High-purine foods (e.g., some seafood, organ meats, and fatty foods) and alcoholic beverages (especially beer) can aggravate a gout attack, so avoid them completely.
  • Drink plenty of water – Drinking enough water can help flush the uric acid crystals out of your body.
  • Try OTC pain meds – non-steroidal anti-inflammatory drugs (NSAIDs) can be taken to help alleviate gout pain.
  • Wait it out – Most gout attacks will go away within a few days. Sometimes a little rest and patience is all that’s needed to get relief.
  • Talk with your doctor – If you feel like your gout is not under control, be sure to talk to your healthcare professional about ways to reduce gout attacks. Your doctor may even recommend gout-specific medications to prevent future gout flares.

Are you struggling to keep your gout under control? Don’t let painful gout flares keep you awake at night. Contact us today for an appointment and let us help you get the relief you need!

Runners and Heel Pain

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One of the most common physical problems that frequent runners experience is heel pain. With the repeated pounding and pressure on the structure of the foot during regular runs, it’s understandable that many runners will experience foot problems like heel pain at some point in time. When it comes to treating heel pain in runners, there are several factors that must be considered to make sure the right treatment is being used for the underlying problem.

Diagnosing Heel Pain in Runners

First, the source or the type of heel pain being experienced needs to be identified. A qualified podiatrist or foot specialist can perform a thorough physical examination and ask questions that will help target what’s causing your heel pain. During the examination, the following factors might be examined or assessed:

  • Specifics about your running and / or training habits, including how often you run, the intensity, distance and duration of your runs, the types of surfaces you run on, recent changes to your training routine, etc.
  •  Is your heel pain limited to a small area or is it more pervasive?
  •  How intense is the heel pain you experience?
  •  What methods or actions seem to relieve your heel pain?
  •  Have you been treated previously for heel pain?
  •  What kind of footwear do you use when running?
  •  When do you experience heel pain? During a run, after a run, or at any time of day?

While plantar fasciitis is the most common cause for runners’ heel pain, there may be other, less obvious factors contributing to your heel pain, such as Achilles tendonitis, stress fractures and bursitis, or systemic illnesses like gout and rheumatoid arthritis. A complete physical exam will include a review of muscular, neurological and, biomechanical factors to identify where the source of your heel pain is originating from. Once your podiatrist has a complete picture of your running habits and pain profile, providing an accurate diagnosis and treatment plan will be much easier.

Treating Heel Pain in Runners

Developing an effective treatment plan for heel pain involves a two-pronged approach – managing the symptoms of the pain while also addressing the cause of the pain. Most heel pain treatment protocols will involve one or more of the following approaches:

  • Rest – Your doctor may recommend taking a break from running and / or switching to other physical activities that put less stress on the heel
  • Pain medications – Medications can include OTC non-steroidal anti-inflammatory drugs (NSAIDs), prescription pain medications, cortisone or steroid injections depending on the severity of the pain
  • Physical therapy – Physical therapy, including cross-training and stretching exercises, may be recommended to ease pain and help correct biomechanical issues
  • Orthotics – Pre-made or custom orthotic inserts can help relieve heel pain caused by structural issues with the foot
  • Footwear – Shoes that provide additional support or cushion to the heel when running may also be recommended

Are you an avid runner struggling with occasional or recurring heel pain? Don’t suffer through it! Make an appointment with us today for a thorough assessment and customized treatment plan for your heel pain.