Transcription of Dr. Christopher Toth, DPM for the show Running/Spring Feet #36
Dr. Lisa: Today’s show is one that’s near and dear to my heart because it addresses running and also feet. I know feet are very important to me because as a runner, I use them all the time. I think feet are important to most people. Even if you’re not a runner, you use them all the time. We’re happy today to have in the studio with us Dr. Christopher Toth who is a podiatrist and obviously, your practice, Dr. Toth, is on feet so I think you think that feet are pretty important.
Dr. Chris: I do.
Dr. Lisa: Yes and we also have Carol Fortin who is a nail technician and Carol, you also spend time down around the bottom of the body at the feet.
Carol: Absolutely, yes.
Dr. Lisa: Dr. Toth, I’ve looked over your resume and it’s very impressive. You have science and business degrees from McGill. You got your medical education at Temple, internship and residency at Cornell and Mt. Sinai and then you went on and did additional work. You have a lot of education.
Dr. Chris: Thank you.
Dr. Lisa: Is this typical of a podiatrist?
Dr. Chris: Not really. Most podiatrists do 4 years of podiatry school and then they choose to go on for residency. I felt that I wanted to travel a lot in this country and internationally and so the opportunities are much better if you have more trainings. I kind of wanted to do something very narrowly focused, as focused as I could so that’s why I chose to go on and do more education.
Dr. Lisa: What is your narrow focus? Tell me.
Dr. Chris: Well, I specialize in the foot and ankle which podiatrists do. It’s a unique perspective to do it surgically where you’re seeing the foot inside out. It’s almost … I think it’s very artistic in its nature just because you look at a textbook, you look in an anatomy book and it’s not the same when you actually see it in real life. For me, it’s a special sensibility that I love to have and a perspective that makes a huge difference in the work that I do, as far as even basic stuff like choosing shoes, working with people that have balance problems. The unique perspective you get from the surgical education is something that is unique, I feel.
Dr. Lisa: Do you think that this is one of the reasons why working at Akari here in Portland made sense to you, this aesthetic appeal?
Dr. Chris: Yeah, I think that has a lot to do with it. the other thing that has to do with it is that there are things about the foot and ankle that are common, that are painful, that people have, that are traditionally treated by surgery and traditionally treated by medical means using pills that I’m able to do at Akari that are different and that are not invasive and that work very well. I feel that it’s an alternative approach that I think people will find appealing.
Genevieve: What are some of those things?
Dr. Chris: Well, the two things that I would say that are the most common is, it’s not a very sexy topic, but nail fungus is very common. A lot of people have it and I would say 10 to 12% of the population suffers from that in the US and worldwide. Europe has been on the forefront, mostly England and France, treating nail fungus with lasers and it works extremely well. It’s painless and the efficacy rate is much, much higher than the oral medication that can affect the liver and we do need to monitor liver enzymes with that. I find that the laser is very, very useful and I will say that we’ve test-driven a lot of machines and have been done all our research and have become very patient with introducing it to their market because Maine is a state where people are very … They do their education. They’re very patient-centric and I feel that this is a good time to introduce it. I believe I’m the only one in Maine, New Hampshire and Vermont offering this technology.
Dr. Lisa: Is there anything else? Nail fungus is one.
Dr. Chris: Yup, some runners seem to have problems with the term is Metatarsalgia which is a very broad-based term describing foot pain. Also plantar fasciatis, this is a very common pain complaint people have that are runners, that are dancers, that work, women that wear high heels, men that wear dress shoes and sometimes people that have no athletic background whatsoever. What I’ve been doing is, I was trained in New York at the International Aesthetic Foot Society, which is an interesting place to go to inject sculptra which is a filler, a collagen-based filler, that naturally stimulates collagen production and so I’m injecting the substance into feet to naturally augment the fat pad that you normally lose as you age and as you get older.
Dr. Lisa: You lose fat as you’re aging?
Dr. Chris: Yes.
Dr. Lisa: Is there also an impact if you are a runner? Is there an impact on the fat pad?
Dr. Chris: There is. Everybody is different and everybody’s gait is different. I work with dancers. I’ve done that for many years and a lot of it is postural in nature. People blame the foot for a lot of different things that really don’t come from the foot. It can come from your neck position. It can come from your spine position. It can come from an imbalance. The center of gravity changes every single time you’re walking with different things that you do so the impact on the foot comes from a wide array of sources including the foot itself as well as what you’re doing. I’ve seen patients and I’ve treated patients that they would like to wear high heels and they’re uncomfortable and this helps. I’ve treated patients that simply cannot walk without this procedure. They’ve tried orthotics and they’ve tried other means and in my traditional practice that I work in Southern Maine at Goodall Hospital York in Southern Maine, I do surgery for this. It’s a procedure that works beautifully however there’s a large downtime and I feel very fortunate to be able to offer something that’s non-surgical before I would even suggest the surgical option.
Dr. Lisa: Now what does running or working athletically with your feet, dancing, what does this to your nails?
Carol: It does a lot actually and a lot of runners will lose a toenail or they’ll develop a really ridged toenail or a lot of calluses and things like that, definitely some damage, yes.
Dr. Lisa: Are you sort of the gateway to diagnosing some of these larger problems? Because I assume you work with a client regularly and you can see changes in their feet.
Carol: Yes, I spend about an hour with each client so they talk a lot about the issues that they may have and then because I work closely with Dr. Toth, then I can see if they’re a good candidate for the things that Dr. Toth does do. We can provide a lot of help or sometimes people, they don’t realize that there are things that they can have fixed without having surgery especially which is great.
Genevieve: I have a really good friend who suffers from bunions and her foot pain led to kind of compensatory actions that have really ruined her physical fitness because she hasn’t been able to really do the things that she’s wanted to. I think she believes it all started with her feet. Do you see that often?
Dr. Chris: I do and a lot of what I see in my practice is almost at the end stage. I kind of wish sometimes that I would see these patients a little earlier so that I can give them suggestions and there’s a wide array of support, people that you can ask to do this, one of which could be a running shoe store like the Maine Running Company that would custom fit a shoe and would let them try it out and return them. Other sources would include athletic trainers so even if you have something that’s … I mean a bunion is considered genetic and it’s considered a dislocation syndrome where the big toe joint is dislocated and is moving differently. It’s unsightly and people come to my office because it looks different however it does affect the biomechanics of your foot. It affects it so much that it can change a person’s athletic career, whether you have it fixed or not so it does. It changes the way that you walk. It changes your fitness level but it is manageable and there’s a lot of different options and sometimes people don’t think of the simple options before they think of actually the surgical options.
Dr. Lisa: What are some of the benefits of being barefoot? I know there’s been a big barefoot running craze lately. Do you have thoughts on that?
Dr. Chris: I do. I have a lot of thoughts on that. a few things, it’s interesting, I’m a surfer and a big hero of mine is Laird Hamilton who’s an extreme surfer and his recent book I read that he walks barefoot everywhere. The reason for that is there’s thousands and thousands of lightning bolts hitting the ground at a certain time and you collect that energy in the sand and the water and it changes you in a meaningful way. I think there is definitely benefits to walking barefoot however the running shoe craze with the typical barefoot shoes, I think you have to be very cautious. I think … I’ve traveled through Africa and I’ve worked with runners in South Africa and Namibia and they run like this from the moment they’re birthed, they’re born practically and they’re used to it. It’s a lifestyle for them. The way they get around is they run. They don’t have cars. They don’t have what we have and so they’re used to it. They don’t have the same injuries that we do. When we try to duplicate that without proper training, meaning a running coach or someone that knows how to do it, it’s very, very difficult and it can create injuries. You have to assess your health level as well and your fitness and also your weight. Weight has a large factor in your running and in the barefoot movement. I think it’s great. I’ve worked at a number of marathons. I’ve run one myself and I’ve seen people run barefoot and they’ve done wonderfully but I think you have to sort of be aware of your pain level and your pain tolerance because I have seen people have stress fractures doing this kind of activity. Their feet may be fine but they have non-specific foot pain and it ends up that it’s a stress fracture. It’s very similar to the military. I worked in the military sector as well and you have these recruits coming from all around the US that have worked on farms or worked jobs but they never actually marched 26, 28 miles in a row. No matter what you do, you have to be very methodical and you have to be conditioned to do it.
Dr. Lisa: What type of long-term changes do you see in people who run barefoot or maybe even walk barefoot all over the place?
Dr. Chris: There could be a lot of changes and it doesn’t necessarily have to do with the foot. The foot is a very adaptive structure. We’ve got a lot of bones in there statistically and percentage wise, more bones than the rest of your body and it adapts beautifully well just like your hands do. The foot and the hands are very, very analogous structures. Your hips and your back aren’t so a lot of what happens is with respect to your feet and the center of gravity so when you walk, you have to be very cognizant on how you do it and if you’re going to make the commitment to do the barefoot thing. Like I said, it’s not a bad idea to go see a running coach. That’s the first thing that I would recommend. These coaches, that’s their profession. That’s what they do and they’re very good at it. They can analyze you. They can put you on a treadmill but as far as long-term effects, I honestly don’t think it’s been going on long enough. I think it’s been going on maybe 4 or 5 years. It’s been kind of an exotic thing that I saw people do in marathons back in ‘97, ‘95 but I think we’re going to start noticing changes. I honestly can’t predict what they would be yet. I have seen some people with stress fractures but I wouldn’t say it’s to the point where I would warn people from doing it.
Genevieve: Well, I would think that if you take some attention to … pay some attention to the ground that you’re starting to barefoot run on, I’ve heard a lot of advice to start in sand or grass for instance, not the pavement.
Dr. Chris: Right, I do agree with that but the problem with running on sand and grass is when you try to do the front foot forward first and then the heel to follow, what happens is your heel sinks into the grass and it sinks into the sand more than it would than if you were wearing shoes on pavement and your Achilles can take a pretty severe beating. What I’m seeing is if there’s one injury that I’m seeing the most its Achilles tendonitis from this, because people don’t quite understand that they have to condition themselves and stretch. A lot of runners do yoga. A lot of surfers do yoga. I do recommend yoga to people that would do this or even just a really good stretching regiment.
Dr. Lisa: Dr. Toth, I understand that there is an upcoming event at Akari that will be open to the public.
Dr. Chris: Yeah, thank you. We have on May the 23rd, it’s a Wednesday from 6:00 till … How long does it … 7:30? 8:00?
Carol: Yes.
Dr. Chris: We’ll be there as long as people are there and what we’re doing is we’re doing an open house on the services that we provide at Akari with respect to the foot and ankle. I’ll be there doing consults. I’m happy to talk to anybody with any questions. There’s going to be …
Carol: We’re doing free mini pedicures and reflexology on the feet and sunless tanning on the leg so all focused and serving mojitos and trying to provide sort of a fun, lighthearted way to address issues on the feet.
Dr. Lisa: How can people find out more about Akari and the work that you, Carol, are doing at Akari and you, Dr. Toth, are doing at Akari?
Carol: You could give us a call. The number is 772-9060. You can go online also acaribeauty.com but yeah, come in for a consult. Consults with Dr. Toth are free.
Dr. Chris: Yup, I’m happy to talk to anybody and give any information or advice that they want to have addressed.
Dr. Lisa: Do you have any parting words of wisdom for people about their spring feet or their running feet, Dr. Toth?
Dr. Chris: Yes, I think people should keep running as much as they can. Just do your homework and stretch and consult a running coach and get good shoes and if you’re going to run barefoot then do your research and make it happen.
Dr. Lisa: Well, we appreciate your bringing your expertise into the studio.
Dr. Chris: My pleasure. Thank you.
Carol: Thank you for having us.