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Flip Flop Foot: Muscle Cramps From Wearing Flip Flops


Have you ever had a strange cramp in your foot (between your big toe and the next one or in the ball of your foot) after wearing flip flops all day?  Do you get sore calves or pain in the bottom of your feet?

Flip flops seem comfortable and easy to wear (I like them because they don’t pinch wide feet) but they actually create more work for your foot and leg muscles than regular shoes.  You may not realize it, but when you wear flip flops your toes must grip them extra firmly to keep them from sliding off or sideways.  So you actually contract many extra toe muscles (like the adductor hallucis and the flexor hallucis brevis) with each step you take.  Wearing flip flops for long hours can give you actual cramps in these muscles and others.

In addition to muscle cramps, flip flops have no arch support so your calf muscles and Achilles tendon have to work extra hard and can become sore.  And finally, the lack of support can strain your plantar fascia (a thin rubbery band on the bottom of your foot), causing pain at its point of origin on the heel bone.

So if you’re having foot pain or muscle cramps – it may be caused by too much flip flopping.  Of course, the cure is simple: wear comfortable shoes with good arch support and sturdy straps.  Luckily for you, summer is almost over and your feet may recover naturally as you pack up the flip flops and pull out the work shoes.This post originally appeared on Dr. Val’s blog at

Slow Down, Dr. Val

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I was a bit tired today, thinking about how nice the long weekend will be.  A colleague wrote me an email reminder to slow down… he said, “go home and have a nice glass of wine and relax.”  I guess research supports drinking in moderation – it’s good for the heart, right?

But then, I noticed this poem in Paul Levy’s blog – and I realized that we docs could all use a little slowing down…

By Warner V. Slack, MD

Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the day
This post originally appeared on Dr. Val’s blog at

You Should Report Adverse Drug and Supplement Reactions

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How do we know when a drug, supplement, or herbal remedy causes harm?  Most people assume that clinical trials provide the only mechanism for determining adverse outcomes but actually, consumers can report concerns directly to the FDA as well.

Did you know that the FDA accepts reports from consumers and healthcare professionals alike on their website, MedWatch Online Reporting?

Herbs, supplements, and “natural” medicines are bioactive substances that many people use to treat diseases and conditions.  They are not regulated for safety and efficacy, and are only now being scrutinized for accuracy of their contents.  Since we’re behind the ball on rigorously testing supplements (though it’s great that NCCAM is evaluating as many of them as their resources allow), it’s important for consumers of herbs and supplements to report adverse outcomes (like allergic reactions, harmful side effects, etc.) to the FDA.  How else will your fellow consumers find out about these unwanted side effects?

MedWatch also welcomes reports about adverse outcomes from prescription and OTC medications, medical devices, or cosmetic products.  I think this is an underutilized resource and could greatly improve public safety if we all pitched in and reported concerning events when they happen.This post originally appeared on Dr. Val’s blog at

Beta Blockers Might Not Be Good First Line Therapy For High Blood Pressure

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A new study in the Journal of the American College of Cardiology (August 14th issue by Bangalore et al.) questions the evidence behind using beta blockers as fist line therapy for high blood pressure.  It seems that these medications may actually increase the risk of stroke, especially in the elderly population.  The following drugs are all beta blockers:

  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol-XL)
  • Propranolol (Inderal, Inderal LA)
  • Carvedilol (Coreg)

As many as 60 million Americans have high blood pressure, and many of them are currently taking beta blockers.  I asked Dr. Frank Smart, chairman of the department of cardiovascular medicine at Atlantic Health in New Jersey, what he thought of this new study.

1.  What is a beta

Beta blockers are a class of drugs that exert their effects on the heart by blocking the effects of adrenaline.  This results in a slower heart rate and reduced blood pressure.  They can also protect you from rhythm disturbances.

2.  What did this study show?

Beta blockers have a lot of important uses, but this analysis shows that they’re not as effective as (and may have more side effects than) other therapies for the treatment of high blood pressure.  In the past, we physicians thought, “Well, shucks, if beta blockers are good to use after a heart attack, and people with high blood pressure are at risk for having heart attacks, then maybe we should use a beta blocker to treat the blood pressure.”  This study contradicts this thinking, suggesting that the beta blockers are inferior to other therapies.  In other words, we should use beta blockers for the conditions that they’re known to be good for, but we should not infer that they are best for blood pressure management when there are better drugs available.

3.  Will the findings of this study
change your practice?

Yes they will.  I’m one of those people who have used beta blockers on occasion to treat high blood pressure in patients whom I thought were also at high risk for heart attack.  I probably won’t use beta blockers as first line treatment in those individuals anymore.  I’m going to stick with diuretics or renin-angiotensin system blockers.

4.  What do these findings mean for
people with high blood pressure?

It means that they should follow the guidelines indicated for the treatment of high blood pressure.  It involves a step-wise approach, with diuretics being that first step.  Any therapy is better than no therapy, and controlling high blood pressure is critically important, but beta blockers (as a monotherapy) are probably not as good as other treatments.

5.  When would you recommend the use of
beta blockers?

Beta blockers are a very important class of drugs for many cardiovascular diseases.  Anyone who’s had a  heart attack needs to be on a beta blocker, anyone who has congestive heart failure (CHF) and can tolerate a beta blocker should be on one, and hypertrophic cardiomyopathy requires treatment with beta blockers.  Beta blockers can control certain heart rhythm disturbances, and can reduce the risk of adverse cardiovascular events during surgery.

6.  What’s the take home message from
this study?

When treating high blood pressure, we should use drugs that have been shown to have the greatest reduction in mortality.  Don’t assume that the valuable effects of beta blockers (for people who’ve had heart attacks) automatically translate into benefits for people with high blood pressure.

Want to hear the full conversation?   Listen to the podcast with Dr. Smart

This post originally appeared on Dr. Val’s blog at

Ringworm – What to do?

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Every once in a while a friend or family member is in a bind and asks me if I can prescribe them some medication.  When people have a case of painful otitis externa (external ear infection), some tinea corporis (ringworm), or just need an allergy medicine refill, for example, and can’t get an appointment to see their doctor for weeks, I generally feel badly and offer to prescribe them something to tide them over.  I know it’s not right to prescribe medications to folks who aren’t technically your patients, but it just seems worse to watch them suffer with a time-sensitive illness that has a simple cure.

Today I had to look up all the various and sundry treatments for ringworm.  According to my Pharmacopoeia (and pretty much any antifungal cream on the market is a possible treatment for it… so how is a doc to choose the best therapy?  Is it trial and error?  Is it pick the cheapest medicine on the list and cross your fingers?

There are times when many different medicines are appropriate treatment options, and the best choice requires a bit of guess work mixed with past experience.  Since I can’t find any literature suggesting that one topical treatment is more effective than another, I just chose a common, inexpensive cream.  Sometimes medical decision making has its gray areas…  Wouldn’t it be nice if everything had one clear answer?

Oh, and if you do have ringworm, keep in mind that 1) you can catch it from your dog – and yeah, Fido could catch it from you 2) you are contagious to others 3) it’s easy to treat with pretty much any anti-fungal cream or lotion (apply twice a day for 2 weeks or so) 4) if you can’t get to see your doctor, using over the counter Monistat may do the trick in a pinch.  If your skin is not responding to the cream – better get checked out to make sure it really is a fungal infection and not something else.This post originally appeared on Dr. Val’s blog at

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