Portsmouth Foot & Ankle - Blog

By Dr. Sartori
June 29, 2018
Category: Health & Wellness
Tags: Untagged

Any trusted medical professional—such as your favorite podiatrist!—is going to encourage you to participate in physical activities on a regular basis. After all, this is essential for your optimal health and wellbeing.

Of course, that “health and wellbeing” extends beyond your physical body.

Sure, there are an abundance of physical benefits you receive when you exercise for at least 30 minutes 3-4 times a week. (Those are just recommended “minimum” guidelines, so don’t feel as if you have to cut your workout short after half an hour!)

Exercising burns calories, improves your cardiovascular system, reduces your risk for heart diseases, etc. 

But you probably already know that.

Perhaps you also know that exercising improves your mood, lowers your risk for depression, helps you sleep better at night, and even contributes to enhanced mental processes. (All the extra oxygen to the brain can really pay off!)


What you might not know—or at least haven’t actually thought about—is the fact that exercise is important for your feet.

And your feet enable you to have so many options in life.

When it comes to exercise, the most popular form in the world is one the human body is pretty much designed to do – running.

Interestingly enough, running also may have played an instrumental role in human development.

Some anthropologists believe our capacity for long-distance running was used by our ancestors in hunting, which led to a protein-rich diet that contributed to the development of the human brain as we know it today.

See, whereas there are many animals faster than humans are in short spurts, we have an endurance that far surpasses theirs. So early humans would chase an animal, which would sprint away. While the animal was resting from the sprint, humans continued to run. As they approached, the animal would have to interrupt its rest to sprint again. And this would continue until the hunters won.

Running is connected to our inherent nature.

That being said, we’ll bet you didn’t have to run down last night’s dinner, right?

As societies developed, running no longer became necessary for survival – but our bodies can still benefit from this activity.

If you’re an experienced runner, please feel free to keep reading if you would like. The tips and advice we are about to give are ones you hopefully already know and practice. But perhaps you will learn something new that can protect you from injury.

For new or going-to-be-new runners, we’ve compiled the following tips and advice so you can participate in this wonderful activity with the minimal amount of injury risk.

At this point, we have to make something clear - it is virtually impossible to completely remove the risk of injury from any physical activity. A human body in motion is one that can possibly become hurt. In other words, accidents happen. Even when using the best possible measures, you still could potentially sprain an ankle if your foot gets caught up on something along a running trail. 

Besides doing your best possible job of paying attention to the running surface at all times—which then leads to the possibility of running into something because you aren’t watching where your going—there’s not much you can do about it.

So please keep in mind that the goal is to reduce your injury risk – not eliminate it completely. 


When you are starting a running program, some measures you need to take include:

MAP OUT YOUR RUNNING JOURNEY. We don’t mean to chart your course—although, it will be rather important to know where you’re going later!—but rather to start by establishing your personal goals and milestones for your running program.

Take the time to think about what you’d like to accomplish. Some want to run a marathon, while others aim to drop a certain number of pounds. Just know that any goal you set is a good one! (Don’t be discouraged if you have no interest in running 20 marathons a year like your sister does.)

Make your running goals SMART – Specific, Measurable, Attainable, Realistic, and Timely. Vague goals that cannot be measured don’t allow you to know if you’re making progress. You need to know exactly what you are setting out to achieve, be able to see the progress you make, and know it can be accomplished in a timely, realistic manner.

Use a logbook to not only mark your progress, but also record future milestones you can be excited to hit. Knowing that you’re coming up on your hundredth mile or have put in 15 hours running over the month will keep you motivated.

Keep the “realistic” part in mind and make sure that your plans and milestones don’t include trying to run a marathon after only two weeks! 

When people try to do “too much, too soon,” it usually doesn’t end well. Instead, plan on building up your frequency, duration, and intensity in a gradual manner. Otherwise, you only increase your risk for burnout and injury (like plantar fasciitis, Achilles tendinitis, stress fractures, etc.).

USE THE RIGHT EQUIPMENT.The good news is that the equipment needed for running—shoes, socks, and clothing—is fairly minimal. That said, it’s difficult to overstate the importance of wearing appropriate running socks and shoes.

Keep in mind that a decent pair of running shoes—and you do need footwear that is, at the very least, “decent”—can run in the neighborhood of a hundred dollars. Some cost more, but you might not need to go much beyond that price point to find a good pair that is comfortable, fits properly, and provides adequate support and stability.

SOMETIMES YOU NEED TO WALK/RUN BEFORE YOU CAN RUN.Instead of trying to hit the ground running (in a literal sense), you may need to start out with a mix of walking and running – and especially if you haven’t been active on a regular basis for some time.

Slowly ramping up is important for lowering your injury risk, but it also can be helpful in keeping you from becoming easily discouraged in the early stages of your running program.

Accordingly, an intelligent strategy is to start your first week by using a 4-minute walk/1-minute run interval and repeating it six times through to provide a solid 30-minute workout. Do this at least 3-4 times in your first week.

Over the course of the next couple of months, gradually decrease the amount of time you spend walking and increase the amount of time running—always keeping the total walk/run time at five minutes—until you are able to run for 30 minutes without needing to walk. 


ALWAYS WARM UP AND STRETCH FIRST.Heading out for a run with “cold” muscles is a risky endeavor, one that makes it more likely you suffer an injury. Instead of jumping right into your run, take some time for 5-10 minutes of brisk walking or light jogging. Follow this warmup with dynamic stretches.

What do we mean by “dynamic” stretches? Well, you can think of the traditional variety (holding a stretch in place for 30 seconds) as being “static.” Dynamic ones incorporate controlled movements that allow muscles to prepare for the activity ahead of them.

AVOID OVERTRAINING.One category of foot and ankle injuries that tends to be quite common are overuse injuries. These are the injuries that develop in response to repeated strain and cumulative force loads from high-impact activities, like running.

Proper footwear can help by absorbing some of the force and promoting good biomechanical processes while you run. Even better is to consider cross-training. 

Cross-training is a matter of mixing up the activities you use for exercise. In this case, you might decide to run for three days of the week, and then swim on three of the other days. Or you run four times during the week and do yoga on the other two days ec.

By incorporating low-impact exercises into your exercise program, you reduce the amounts of force your feet and ankles have to endure. As an added bonus, this strategy can lead to better overall fitness levels!

DON'T PUSH THROUGH FOOT PAIN! If you start to experience any pain from running—no matter if it’s sharp and sporadic or dull and chronic—your body is sending you a message that something is wrong and needs to be addressed.

Depending on the condition, you might simply need to rest a bit – but the best move you can make is to come see us for a professional diagnosis. 

We can evaluate the situation and determine what’s wrong. Naturally, we don’t just usher you out the door at that point and say, “Good luck!” Instead, we take the time to create a customized treatment plan to resolve the core issue.

If you remember, we mentioned earlier that our goal is to allow you to do the activities you want to do. This means we will provide the care you need to get back to your running program in the quickest possible amount of time.

For more information on running injuries, the services we provide, or any questions you might have—or to request your appointment with either our Portsmouth or Nashua offices—give us a call at (603) 431-6070. One of our team members will be happy to help.

By Dr. B
May 17, 2018
Category: Uncategorized
Tags: Untagged

Why do my Calves Cramp Up?

One of the reasons calves cramp during the night (rest pain) or while walking (also called claudication) is a sign of poor blood flow to the lower legs. At night time, blood flow doesn’t have gravity to help it get to the legs causing rest pain. Usually this is relieved by getting up and allowing gravity to bring blood back to the legs. Claudication occurs when there is a lack of blood flow to the leg during exercise. Even something like walking a slightly long distance can cause the cramping. It is usually resolved with sitting down to rest.

Why is this so important? These are frequently the first symptoms experienced by a person with poor circulation. So what can we do to prevent it or gain some blood flow back to the leg?

1. WALK! Walking is a great way to get your heart pumping and your blood moving. The more blood pumps the better the flow.

2. Stay hydrated. Dehydration can negatively affect circulation. Always make sure you are hydrated well throughout the day.

3. Monitor your diet. “Artery clogging” foods high in fat are not good for people with peripheral vascular disease (PVD). Eat foods high in vitamin C and avoid salt.

4. Quit smoking. Smoking is the leading cause of PVD. Within one day of stopping the use of tobacco products blood flow to the extremities increases.

Always seek help if you are having any concerns about blood flow to your feet or legs.

May 03, 2018
Category: Events

Portsmouth Foot and Ankle joined the American Diabetes Association’s third annual National Get Fit Don’t Sit Day!

Held the first Wednesday of May each year, National Get Fit Don't Sit Day™ is an opportunity for the American Diabetes Association (ADA) to increase awareness of the dangers of excessive sitting and the importance of getting up and moving throughout the day—especially at work.

Research shows that sitting for long periods of time increases the risk of health complications. The ADA recommends breaking up sitting time with three or more minutes of light physical activity—such as walking, leg extensions, or overhead arm stretches—every 30 minutes.

Each year, thousands of businesses and organizations participate in National Get Fit Don’t Sit Day, and take steps to support the health of their employees and members through organized walks, movement break stations, yoga classes, and more. We hope you'll participate in this year’s National Get Fit Don't Sit Day on May 2, 2018.

Here are some additional resources from the ADA:

8 Ways to Be More Active During the Workday

Desk Moves Handout

How we participated this year! 

Portsmouth Team 

Walked at The Great Bay National Wildlife Refuge located in Newington, NH, on a portion of the old Pease Air Force Base.The refuge covers more than a 1000 acres of New Hampshire seacoast. There are two trails open the the public; The Ferry Way Trail runs due east in a two mile loop that touches the shores of Little Bay, and the Peverly Pond Trail makes a 0.5 mile loop to the shores of Upper Peverly Pond along as raised, handicapped accessible board walk. The Ferry Way Trail leaves the parking area, crosses the street and runs along the northern boundary of this fence. Once past the fence line, the trail heads turns left and heads into woods and offers views of the bay. 

Nashua Team

Walked at Mine Falls Park which is one of the most enjoyed recreation areas in Nashua. The 325-acre park,  with 9.7 miles of trail which include forest, wetlands, and open fields; it is bordered on the north by the Nashua River and on the south by the Millpond and canal system. 

What we're about!

MEETUP.COM > Public Group "Walk With Us"

All ages and fitness levels are WELCOME. Meet new people, have fun, get healthy and get outside! We primarily offer lunch time & afternoon walks in the greater Portsmouth area. Our group is sponsored by the podiatrists at Portsmouth Foot and Ankle. Click Here For More Info or to Join (free to join and walk!).

Read More:    New Workout, New Foot Woes   November is Diabetes Month    Shoes For Sports    Contact Us    Walking Club



There are many gratifying aspects to my job,

- getting patients feeling better quickly

- having same day treatments available

- seeing a variety of foot ailments making two days never the same

But one of my favorite things is how rarely I have to utter the words “today we HAVE to do __________treatment”  to a patient. Podiatry offers so many opportunities for shared decision-making (the practice of an informed patient participating in treatment decisions) and as a physician I really enjoy the highly collaborative treatment planning.

When see a new patient my goal is to not only give them a timely and accurate diagnosis but to tailor a treatment plan that works for them. Most of my patients know that following all the questions I ask regarding their symptoms comes, “What do you do for work? What is your day to day like?”  I enjoy getting to know each of my patients and arming them will a full gamut of options to help treat their foot pain.

Let’s take plantar fasciitis (or heel pain) for example. I can see upwards of 10 patients a day, either new or in follow-up for heel pain, and each of them are at a different stage in their treatment and have chosen different treatment paths. Some are in physical therapy, others for a cortisone injection, or our EPAT (shockwave) therapy and one post-operatively after a plantar fascial release. None of these patients I treated the same because every one of them has different goals and lifestyles.

By giving my patients all the treatment options available to them I can create a truly patient focused treatment regime, aimed at getting each individual person better on their terms. Every day I am delighted to work with my patients and actively involve them in the decision making process regarding their foot pain versus saying, “this is what you have to do”.

I believe that an informed patient is a happier and in the end healthier patient and many industry executives agree…

Real Word Example: Why Value-Based Care Must Include Shared Decision-Making : Shared decision-making is a key patient engagement strategy, but not yet widespread.  By Sara Heath (February 26, 2018)  - via, patientengagementhit.com

Shared decision-making integrates the patient into the healthcare process and gives the patient more claim in her wellness journey.

Shared decision-making has shown to reduce preventable hospital readmissions among cardiac patients by at least 19 percent, and can also decrease patient anxiety and healthcare costs.

“Although shared decision-making has been around for quite a few years, and although there is a significant evidence basis about the expected outcomes of shared decision-making interactions, it is really more the exception than the rule in clinical practice today,” Goldbach said in a recent interview with PatientEngagementHIT.com (Peter Goldbach, Chief Medical Officer for Rite Aid’s RediClinic and Health Dialog).

“There are islands of excellence that do exist, specifically people that have taken an interest in shared decision-making,” Goldbach added, making a nod to SDM researchers and specialists.

Some medical professionals do believe they are practicing shared decision-making, but when Goldbach spends more time with the provider and breaks down the details of shared decision-making, it becomes clear that the art has not yet been perfected.

The healthcare industry landscape has never been conducive to integrating shared decision-making, Goldbach explained. Although shared decision-making has fairly clear benefits, evolving healthcare initiatives such as emerging technologies and reporting requirements have made it hard for providers to adopt the technique.

 “Shared decision-making has not been part of providers' education,” Goldbach noted. “It's not part of the current culture. And people who practice medicine today are beset by a very busy, difficult environment where they have a lot of new requirements and a lot of new operating systems distracting them. That is a difficult environment to bring in new ways of working with patients.”

The time is ripe for more widespread adoption of shared decision-making, Goldbach added. Healthcare professionals are becoming more comfortable with new technologies, and strategies have emerged to enhance, not distract from, shared decision-making.

Shared decision-making has a considerable human component to it – educating and partnering with patients for better care is an important part of the patient experience and puts patients in control of their own health.

We support and encourage collaborative medicine at Portsmouth Foot and Ankle. It is our goal to offer patient focused care and to encourage our patients to make informed decisions about their treatment options.  

Read More:  Dr. Natasha Baczewski  Extracorporeal Pulse Activation Technology (EPAT)  Plantar Fasciitis  Sports Injuries  ... and rememeber - no foot pain is normal! -  Appointment Request

By Reid Christie, DPM
March 20, 2018
Category: Injury
Tales of a Barefoot Diabetic
It has long been known that one of the most common pedal side effects in a diabetic patient is peripheral neuropathy which manifests into a loss of protective sensation in the feet and lower legs.  The symptoms of diabetic neuropathy can be described in many different fashions, including burning, tingling, numbness, stiffness, as well as many other descriptions. 
However, one thing remains true of all patients suffering from diabetic peripheral neuropathy – they are at increased risk of pedal complications due to their lack of sensation.  Complications can arise when insensate patients walk barefoot around their home or outside. Due to the inability to feel sharp things on the bottom of their feet, patients can step on any number of things (glass, splinter, metal object) and not even know it.  The area can become infected and lead to a much deeper infection if the injury is not quickly identified and treated.  Often times a patient will not be aware they stepped on something until blood or drainage is noticed on a sock or slipper. 
The following is a very common case presentation of a neuropathic:
An 82 year old diabetic male with peripheral neuropathy presented to our office with complaint of drainage and blood noted to his sock.  He denied any pain, as well as any signs of systemic infection such as fevers, chills, nausea or vomiting.  He said that if he had not noticed any of the drainage on his sock, he would not have known anything was wrong.  After examination, the patient had a small puncture wound in the area of concern with surrounding blister and subdermal hemorrhage (bleeding) formation noted.  Following debridement of the area, a small piece of glass was removed from the patient’s foot.  
Luckily, the patient acted quickly by presenting to our office as soon as he noticed the problem, allowing for prompt assessment and treatment before any aggressive measures (such as amputation) was required. 
Unfortunately, sometimes these issues can progress towards amputation because neuropathic patients do not always act quickly enough. If infection is not noticed quickly, it can spread rapidly.  If infection goes deep enough and reaches bone, the indicated treatment is amputation of the associated bone. 
For these reasons, daily foot exams in the neuropathic diabetic patient can be critical!
Helpful Links: Foot Check Friday  +  Foot Self-Exam
Dr. Reid Christie is a podiatrist working out of our Portsmouth & Nashua, NH locations. He is currently accepting new patients. If you would like to request an appointment with Dr. Christie please go here - Appointment Request

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