Blog | Stages of Life

David S Klein, MD

Nov 18, 20233 min read

Foot pain Overview: Causes and Diagnosis

Updated: Dec 14, 2023

Inadequate diagnosis leads to inadequate treatment — Foot Pain is a Common Complaint

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Pain in the foot is a very common clinical entity. Causes of foot pain can include arthritis, tendinitis, ligament inflammation, sprain and fracture. Metabolic diseases can cause foot pain, including gout, diabetes and vitamin deficiencies.

Often overlooked causes of foot pain include enthesopathies (tendinitis) of the knee, muscular spasm in the calf and nerve irritation in the thigh.

Foot pain can be a debilitating and distressing condition that affects individuals of all ages and lifestyles. Understanding the various causes of foot pain is crucial for effective diagnosis and management.

Structural Abnormalities: One of the most common causes of foot pain is structural abnormalities. Conditions such as flat feet, high arches, or abnormalities in the bones and joints can lead to improper weight distribution and strain on the feet. This often results in discomfort, especially after prolonged periods of standing or walking.

Footwear Choices: Wearing ill-fitting or unsupportive shoes can contribute significantly to foot pain. Shoes that lack proper arch support, cushioning, or have narrow toe boxes can lead to conditions like plantar fasciitis, bunions, and metatarsalgia. High heels, in particular, can place excessive pressure on the forefoot and alter the natural alignment of the foot, leading to pain and deformities.

Overuse and Repetitive Stress: Engaging in activities that involve repetitive motions or excessive pressure on the feet can lead to overuse injuries. Runners, athletes, and individuals who spend long hours on their feet are prone to conditions like stress fractures, tendonitis, and ligament strains. Poor training techniques and sudden increases in activity levels can exacerbate these issues.

Arthritis and Inflammatory Conditions: Arthritis, including osteoarthritis and rheumatoid arthritis, can affect the joints in the foot, leading to chronic pain, stiffness, and inflammation. These conditions can deteriorate the cartilage and synovial fluid in the joints, causing discomfort with every step.

Trauma and Injuries: Accidents, falls, and sports-related injuries can result in fractures, sprains, and contusions in the foot. These traumatic incidents can lead to acute pain and, if not treated promptly and properly, can result in chronic pain and long-term complications.

Neurological and Systemic Causes: Foot pain can also be a manifestation of underlying systemic conditions such as diabetes, neuropathy, or circulatory problems. Nerve damage, reduced blood flow, or inflammation can affect the sensory nerves in the feet, leading to sensations of burning, tingling, or numbness, along with pain.

Foot pain can stem from a multitude of causes, encompassing structural issues, footwear choices, overuse and repetitive stress, arthritis, injuries, and underlying systemic conditions. Understanding the specific cause of foot pain is crucial for accurate diagnosis and appropriate treatment. Consultation with a medical professional or podiatrist is often necessary to determine the root cause and develop an effective management plan, which may include lifestyle modifications, physical therapy, orthotics, or medication to alleviate pain and improve foot health.

The very first "step" in the treatment of foot pain is to determine the precise cause or causes for any particular patient. Multiple causes are common, for example:

A. Inflammation and swelling from arthritis can cause nerve compression, like tarsal tunnel

B. Hypothyroidism, low thyroid function, can similarly cause impingement of the Tibial Nerve and cause Tarsal Tunnel Syndrome

C. Swelling from Plantar Fasciitis can cause impingement of the same Tibial Nerve, causing similar symptoms.

The treatment for each of these (3) situations is entirely different. Precise diagnosis is essential to the success of treatment in each and every patient and in each and every situation. At Stages of Life Medical Institute, we are fully equipped to perform the necessary electrodiagnostic studies that are needed, we are capable of treatment using a variety of traditional medicines as well as utilizing the best of natural or functional medicine approaches. Moreover, we have our own in-house laboratory to use if needed to evaluate for underlying endocrine causes.

Experienced pain management physician — David S. Klein, MD, FACA

Stages of Life Medical Institute

1917 Boothe Circle

Longwood, Florida 32750

T: 407-679-3337

F: 407-678-7246

www.suffernomore.com

David S Klein, MD

Nov 8, 20232 min read

Manuka Honey cough drops for that nasty persistent cough. Another sweet victory for nature.

Manuka Honey is effective in the symptomatic treatment of cough — Manuka Honey for that Sore Throat and Cough

Tricks of the trade often come from feedback from the Patient. This one is a winner, inexpensive and came from one of my most loyal and pleasant patients!

With its potent antibacterial properties, Manuka honey offers benefits that may improve wound healing, provide cough relief, and many other such claims. Manuka honey is native to New Zealand.

Viral upper respiratory tract infections (URI) will cause nasal congestion and post nasal drip. This will irritate the throat, tonsils, uvula and cause cough. The cough itself can cause sore throat. Using a cough suppressant is sometimes helpful but topical relief can help you get some well-needed rest and do so without causing additional troubles.

An old reliable way to help irritating cough — Halls Menthol Cough Lozenges

Generally, I use Halls Cough and Cold lozenges. They keep well wrapped in my pocket. If left out, the packaging can stick to the lozenge making it harder to use. This makes a good first line OTC product.

One of my patients saw me open one of the Hall's drops, and offered me one of her Manuka products. (Many thanks, if you get a chance to read this.) It changed my approach to self-treatment.

The Manuka lozenge adds a little 'kick' to the process by soothing the throat mechanically and may give you a slight antiviral effect to help things heal. The good news is that they work together. Manuka is made from honey, a very special honey, and has the potential of affecting blood sugar. Diabetics should use with due caution. Neither of these products is addictive, of course, and both are inexpensive.

I buy my cough drops in the large jar, above. With a family with young grand children, somebody is usually a little sick, so we stay well stocked.

Orlando Florida Longwood Florida Functional Medicine Hormone Replacement Pain Medicine — David S. Klein, MD Functional Medicine Physician

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

David S Klein, MD

Nov 6, 20235 min read

HSA Advantages: Never use an Insurance company product. Use a Brokerage Account and save.

Advantages of using a brokerage account to hold an HSA — Use a Brokerage Company to Hold your HSA

Start Savings TODAY

Health Savings Accounts (HSAs) have gained popularity in the United States as a tax-advantaged way for individuals and families to save and pay for healthcare expenses. These accounts come with several advantages and disadvantages, which are important to consider when evaluating their suitability for your financial situation and healthcare needs.

If you have even a modest amount of money that you can set aside for the future, consider using the HSA. While it may seem like a modest amount of money to set aside, incrementally it can be substantial by the time you reach retirement. It costs very little in administrative fees to use most brokerage firms. The advantage is that any unused contributions roll over to the next year, and the years that follow, growing with time. Insurance companies generally take any unused funds at the end of the year, and keep them.

Advantages of HSAs:

Tax Benefits: One of the primary advantages of HSAs is the tax benefits they offer. Contributions made to an HSA are tax-deductible, and any interest or investment gains within the account are tax-free.
Triple Tax Advantage: HSAs offer a triple tax advantage, as contributions are tax-deductible, earnings are tax-free, and withdrawals for qualified medical expenses are tax-free. This makes HSAs a powerful tax-advantaged savings tool.
Flexible Use: Funds in an HSA can be used for a wide range of qualified medical expenses, including doctor's visits, prescription medications, dental care, and even some over-the-counter items. The flexibility in spending is a significant advantage.
Portability: HSAs are portable, meaning you can take the account with you if you change jobs or insurance plans. This allows you to continue using the funds for healthcare expenses in different situations.
Roll-over: Unlike Flexible Spending Accounts (FSAs), HSA funds roll over from year to year, so there's no "use it or lose it" requirement. This provides long-term savings potential.

Disadvantages of HSAs:

High Deductible Requirement: To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP). These plans come with higher deductibles, which can be a disadvantage if you have significant healthcare expenses.
Limited Contribution Amounts: There are annual contribution limits for HSAs. While they have increased over the years, they may not be sufficient to cover all medical expenses, especially for those with chronic conditions.
Not for Everyone: HSAs may not be suitable for individuals with high healthcare needs or low income, as they may struggle to fund the account adequately or face financial strain from the high deductible.
Penalties for Non-Qualified Expenses: If you withdraw funds from your HSA for non-qualified expenses before age 65, you'll face a 20% penalty, in addition to paying income tax on the withdrawal. This can deter misuse but may also limit access to your savings.
Investment Risk: While HSAs can be invested in stocks, bonds, or mutual funds for potential growth, there's also the risk of losing money due to market fluctuations. Some individuals may prefer more stable savings options.
Complex Rules: HSAs come with rules and regulations that can be confusing for some people. It's essential to understand the eligibility criteria, contribution limits, and qualified expenses to make the most of the account.
If you enroll in Social Security you will be automatically enrolled in Medicare Part A, which will disqualify you from contributing to an HSA.

Using a brokerage firm for your Health Savings Account (HSA) has certain advantages over going through an insurance company. Here are some of the key benefits:

Investment Options: Brokerage HSAs typically offer a wider range of investment options compared to HSAs provided by insurance companies. With a brokerage HSA, you can invest in a variety of assets such as stocks, bonds, mutual funds, and exchange-traded funds (ETFs). This can potentially lead to higher returns on your HSA funds compared to a traditional savings account offered by an insurance company.
Greater Control: When you use a brokerage HSA, you have more control over how your HSA funds are invested. You can tailor your investment strategy to your risk tolerance and financial goals, which can be beneficial if you have a longer investment horizon and want to maximize the growth of your HSA.
Lower Fees: Brokerage HSA accounts often have lower fees compared to HSAs offered by insurance companies. These lower fees can result in more of your contributions being invested and growing over time, rather than being used to cover administrative costs.
Flexibility: Brokerage HSAs offer flexibility in terms of investment choices, and you can manage your investments to suit your financial objectives. This can be particularly advantageous for individuals who are comfortable making investment decisions and want to grow their HSA funds over the long term.
Diversification: With a brokerage HSA, you can diversify your investments across different asset classes, reducing risk and potentially improving the performance of your HSA. Diversification can be challenging to achieve in a traditional HSA savings account provided by an insurance company.
Potential for Higher Returns: By investing your HSA funds in a brokerage account, you have the potential to earn higher returns over time, which can help your HSA grow faster and cover more of your healthcare expenses in the future.

While brokerage HSAs have their advantages, it's important to consider a few potential disadvantages as well:

Risk: Investing in a brokerage HSA carries investment risk, which means that your HSA funds can fluctuate in value. If the market experiences downturns, you may lose money, which can be a disadvantage for individuals who prefer a more conservative, low-risk approach.
Expertise Required: Managing investments in a brokerage HSA requires some level of investment knowledge and experience. If you are not comfortable with investment decisions or don't have the time to manage your investments, you may prefer the simplicity of an insurance company HSA.
Fees and Costs: While brokerage HSA fees can be lower than insurance company fees, they still exist. You should be aware of these fees and how they can impact your overall returns.
Administrative Complexity: Brokerage HSAs can be more administratively complex than traditional HSA savings accounts. You'll need to monitor your investments, make asset allocation decisions, and potentially deal with tax reporting requirements.

NOTE: With many insurance company sponsored HSA's, it is a 'use it or lose it' proposition. Any money you do not spend by being frugal goes back to the insurance company.

With a bank or broker, any unused funds remains in the account and hopefully grows over the years. It remains with you, to be used for health related problems, or it becomes part of your estate.

In summary, HSAs offer significant tax advantages and flexibility for those who can manage the high deductible requirement and are willing to invest time in understanding the rules. However, they may not be suitable for everyone, particularly those with high healthcare expenses or limited income. Evaluating your financial situation and healthcare needs is crucial in determining whether an HSA is the right choice for you.