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Sonoma County, a diverse county of over one million acres is famed for its agriculture industry and recreation boasting a booming economy and a unique lifestyle for its citizens described by the theme Luther Burbank as the chosen spot of all the earth. Sonoma County is the place

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to live, work and play as we move into the 21st century. Led by the forward looking philosophy of its governing bodies. Sonoma County's 340,000 residents are a harmonious, successful blend of ethnic and economic backgrounds. We invite you to take a closer look at Sonoma County in

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the nineties with your host Rich McGlinchey. Hello everyone. Welcome to another edition. I'm Sonoma County in the 90s. We're gonna be talking about a very important subject to each and every one of us beat without him. We're in real trouble, you know, Jim McKay on abc

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world of sports says there's the thrill of victory and the agony of defeat and my two guests are specialists in the agony of defeat. We're talking to two podiatrist on the left of your screen is dr larry smith and on the right of screen is dr

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lisa Mueller and we're going to talk to you about podiatry and what you do and how you treat feet. But just a moment we're going to talk about the artwork on our set. Two paintings here by Ted Castle, a world famed photographer who now lives in

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Sonoma County. This is the first tee at ST andrews in Scotland. One of the few pictures I've seen of that. His second photo is a view of the mouth of the Russian river taken from the balcony of rivers and restaurant north of Jenner. And these are

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two beautiful works by TED. He's going to be a guest with us very soon and he'll be showing us more of his magnificent photography. When I talked to TED I usually say I've been taking pictures for 25 years and when he comes on the show we

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get to meet a real photographer and he is thank you TED for letting us have these pictures I should say almost pennies. They look like a painting almost. He does such great work lisa how you doing nervous? You're not nervous, you've been here before. I wasn't

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being facetious when I talked about the agony defeat because the people come to see you for for a variety of reasons. Certainly the agony they're suffering with their feet is their reason for being there and that's where you help them. But I wonder if the audience

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in general knows the answer to this question. So I'll ask it this way, what is a podiatrist and what does D. P. M. Stand for? Well, by the way, stop, I'll ask a question. And if you want to answer or if you think of something you

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want to add to it, just jump right in after not formal on that. Okay, a podiatrist is a medical specialist that specializes in diagnosing and treating problems that might occur to a foot um DPM is the degree that's given after education and training. The stands for

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doctor of podiatric medicine. Okay. Um I don't know. Yeah. Well let's see. Yeah, this is the question. What is your education training and the scope of your practice? Well, we attend undergraduate for at least three years to get in all your pre med requirements. Just like

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a medical student would need we take em cat scores before we can be accepted into a podiatrist school. Then a podiatry school is a graduate school where we we attend for four years in the first two years are just like a medical school. In that we

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learn all the basic sciences and 3rd and 4th years will do more of a clinical approach where we might learn more about lower extremity and biomechanics, physical therapy things along those nature. So it's a four year program just like medical school and then we will go

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on and do a residency which could range anywhere from 1 to 4 years. Our scope of practice differs in each state, in the state of California, we can do soft tissue procedures from the knee down and then any kind of bone procedure from the ankle down.

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I um I've talked to you about your background before but this the first time I've heard the entirety of it and it is very impressive. You spend as much time as the MD. Certainly an earning your doctor dietary medicine degree. Right. Well, a good analogy I

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think um, of the specialty of podiatry is much like the oral surgeons who are licensed to do surgeries to prescribe medicine to do injections, basically anything they need to do to help the mouth and and have to have a great deal of training to be able

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to do that related to the rest of the body. And and with feet, of course, you can't divide the foot from the rest of the body. So you have to have training on pretty much the whole body specializing in the foot. Uh, Lisa is a new

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acquaintance, but Dr. Larry Smith, I've known for a long time factor my patient is. Um, and I do commend you for a lot of things. Larry one of them is you've taken part in the health parents. That's where we first met some 12, 14 years ago.

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And just as as just a service to your community. I think the podiatrist in general are an unselfish group and they're constantly trying to better the community by by offering their services are helping these projects along. And I commend you for that. I think that there's

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too little of that, maybe in some cases in the medical profession. What type of patients to the two of you see, I mean, humans, I presume, except for me, all of them human. Um, basically the whole age group of people we uh see uh from infants

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and Children who might have uh developed birth defects. And if it's spotted either by parents or pediatrician, they sometimes refer those patients to us um All the way through our most senior patients who generally developed problems that progressively get worse as the years go on. And

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then in the mid range can be people who have sporting injuries or problems that that come to fruition with different shoes, particularly some of the ladies that we see. And in more of the middle year. So pretty much a whole gamut of different ages. Um Just

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different problems that affect those different groups. Um Any other thoughts Computers. There are some some podiatrist who might want to specialize more in a certain area like sports medicine or diabetes ology or Gerontology. But in general I think most of us will see patients ranging from

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newborns to over 65 group outside of stark carer. What can a patient expect from an initial office visit? Everybody worries about, oh my gosh, what's going to happen when they go in with a foot from? But what can the patient expect during an initial office visit?

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I think initially we talked to them about their feet. What kind of problems they may have? Um We might do quite an extensive history and ask about what kind of medical problems they might have that could be related to their foot problems. As far as an

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examination is concerned, an initial visit would include examining four different areas that would include um your circulation, your skin, um your nerves, and any kind of muscular skeletal problems. And we might do a biomechanical evaluation, Watch the way they walk you deal with a lot of

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different things. I know that because I've been waiting to see you and seeing the various patients that come in and out. Um What are the most common conditions affecting the skin and the nails? Well, maybe one of the most common problems that we see in this

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actually occurs in pretty much all age groups. Um with skin and nails is ingrown toenails. Um It's something that uh very often people wait until the bathroom surgery that's been being performed for a while, uh no longer is getting the job done and they may have

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an infection with it or a lot of pain. Um Generally I find my lady patients tend to come in and take care of those problems a lot quicker than sometimes the men do. Um You know, there's the common joke about the ingrown toenail has been a

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subject of levity for ages and ages. But damn, there's nothing in the world more painful. You know, you practically cannot get around if that toenail is in ground so badly that it's just painting you all the time. So this this is no laughing matter. That's for

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sure. Right. Well, certainly pain is what usually brings people in first. I mean, most people don't come to see us if they have nails that they think look funny unless it's hurting also. But for some groups of patients um diabetics for example or people that have

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poor circulation. The pain is not the only problem but potentially it could cause other problems related to those secondary problems. So um not only you know a painful problem but also one that might be you know more serious than with levity lisa. What are the most

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common conditions that affect nerves and muscles. Um Sometimes we might see problems where the sensation of the nerve is diminished. Um For example diabetes is a real common um disease that can cause your sensation to be lost. Um Anemia, zor hypothyroidism, history of syphilis, leprosy alcoholism

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all of those can cause decreased sensation in your nerves. So once you have decreased sensation in your nerves it's important to keep an eye on your feet because you don't have your normal pain mechanism to tell you that something may be going on neuroma zara. Common

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problem that um are related to the way of foot functions and abnormal biomechanics per se. With an aroma is a benign tumor of a nerve that can grow and cause quite a bit of pain muscles, tendonitis is a real common problem in the foot. Just like

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tendinitis in other parts of your body. So we see a lot of that and treat it. Um Let's take another area, bones and joints. What are the what are the most common problems that you deal with. Um Probably two of the most that off the top

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that I can think of. One would be bunions, um bunion deformities. Um Unlike what has probably been spread for years as part of the myth being a problem that's caused by shoes. Um Aborigines and folks that have never seen a shoe have been found to have

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the same bony deformity where the the bump at the big toe joint is sticking out where it shouldn't the role that shoes seem to play in. That deformity is one of rubbing over the bump and causing it to hurt. But by and large bunions as as

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one bony problem is something that is inherited. Um You see whole family lines of people in one stage of development or another that are developing this as a problem? Um Another problem that we see quite a bit is hammer toes, toes that don't lay straight toes

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that curl up and when they curl up like that and and then you're in a shoe. That's when you can get rubbing over different parts of the toes and and corns developed. So those are probably two of the most common problems that we see bone wise.

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Would it be a fair statement to say the worst enemy of man is shoes well, unless you're a podiatrist man meaning mankind, men and women of course lisa, what do you find that the most common conditions that affect circulation? Well, diabetes would be one of them.

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It affects circulation as well as the nerves like we discussed before. Um high blood pressure can cause decreased in circulation. Any kind of cardiovascular problems or arterial problems that naturally would affect the circulation. And certainly the circulation to the Sure, sure. And your feet are the

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furthest part of your body away from your heart. So there is diminished circulation there compared to other parts of your body. It's important to have good circulation. So you can heal areas that may be affected by ulcers or sores or blisters. And so we we try

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to prevent problems like that from occurring and especially in patients that are vascular early compromised. I have a have a humorous thought. Larry always tells me that my main problem is I only have one car puzzle and it runs like hell all the time. He doesn't

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really tell me that. I'm only kidding. Um You did mention a couple of other things that you mentioned and he said um what type of sports medicine injuries do you see and treat? I mean um one that's called runner's knee syndrome is one that's fairly common

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where the inside part of the knee um is irritated by the way that the foot is is flattening when you walk and run and the more one runs, the more that seems to be irritated. Probably another real common problem that we see as shin splints where

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the front part of the leg can be very uncomfortable shin splints um which is just an inflammation along the shinbone or tibia that's on the front of the leg. And that's something that seems to be aggravated a lot by running down hills. If you happen to

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have inherited a a type of mechanics, how you're put together bony wise, that makes your foot, uh what they used to call have falling arches, we call that pronation now, but it's essentially a rolling motion, the foot goes through. And if you do enough running, that's

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a problem. We see a lot of plantar fasciitis is a big one where he was plantar fasciitis. Well, there's connective tissue that holds your arch up and as he was talking about pronation and rolling over on your arch that can cause inflammation at the area where

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the plantar fascia or the connective tissue attaches to the heel. And of course inflammation causes pain. So we try to treat those kind of problems with maybe a custom molded orthotic, which is an insult that that you can wear to keep your foot from flattening too

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much or prone ating too far. I think we're gonna pause here in just a moment for a moment for the station to bring our audience a public service announcement, we'll be back in just a moment. We'll be talking with larry smith and dr larry smith and

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dr lisa Mueller. We'll talk more about, as we said in the facetious late, the agony of defeat and that'll all take place right after this message, former stage and screen actor William Greaves has produced and directed more than 100 films and earned more than 60 film

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festival awards. Greaves films are powerful dramas such as this one about the great abolitionist Frederick Douglass. His film classic from these roots has won at least 20 international awards from these roots tells the story of the Harlem renaissance when Harlem was exploding with energy, creativity and

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a new sense of racial identity. The african american experience most often is either excluded or distorted on the screens of America with my films, I try to set the record straight William Greaves Excellence has many faces. Welcome back to this edition of Sonoma County in the

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90s, an interesting program. I hope you're finding it. So we're talking about feet, we're talking to two podiatrists and we're talking about the feet of the ankles and people that the that people have problems with and how our two doctors work with these problems and benefit

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us all. Um and I have to be very careful because my own podiatrist is seriously. What does the term biomechanics mean? Oh, biomechanics is a term that describes the study um of looking at the human body as it moves and how it relates one part to

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another, essentially. It's the science that that was developed to look at sports medicine injuries. Why is it that when a person runs this certain amount, they develop this injury or why do the people that do aerobics, they develop these injuries. And so this study of looking

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at the body as it was walking and running and moving is biomechanics um makes sense. What are orthotics? Orthotics are custom molded insoles that custom molded insoles that we utilize as far as um part of our bio mechanic approach to taking care of feet and ankles.

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And they, like I mentioned before, can help hold the arch up so that you don't over pro Nate normally pro Nate or they could they can treat other abnormalities in the way of foot functions. So what we do is make one that would be custom molded

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for for you and your particular foot type. But there are three types of orthotics. One would help control function. Another one may be used for more of a protective as a protective agent to help decrease pressure points um of areas that are painful or areas that

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may have source. And the third type would be one that could could be made to to use function and protective agents as a combination. Okay. We touched on the subject of Children just briefly earlier in the program, but Children often counter are born with lower extremity

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disabilities. I guess you'd call them or abnormalities do they outgrow most problems or should they be treated right then. Um Generally we find that most parents when they approach their doctors about a foot problem that they're perceiving they the parent are perceiving with a child are

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told that they'll outgrow it. And uh, an awful lot of those problems aren't outgrown their problems that that particular pediatrician or other um medical practitioner may not see down the line because the child grows into adulthood and then you get adult problems as a general rule.

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Um, most folks do find most kids, you know, come out fine and don't have problems, but if it's enough of a problem that a parent can notice that there's a problem probably ought to at least be looked at to see if it's something that, that can

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be helped or not. If there are things that can be helped the earlier they're found certainly the much easier that they're helped if they're 234 years old, all of a sudden some treatments just can't be done. They're too old. I think the first year of development

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is the most important and like he said, a lot of problems can be prevented if they're treated right away. So we see patients as soon as day one really, I said this a while ago, the enemy, how does shoes affect our feet? Well, I think, um,

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a lot of the shoes are, are doing better. I mean if you look at what your foot looks like when it's standing barefoot, the shoe really should be sort of the same shape and an awful lot of styles of shoes and here we get to pick

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on ladies particularly um often are you know, half the size or half the width of, of what their foot looks like when they're standing on it. And if you have any tendency to bone problems with your foot, those kind of shoes then we'll rub on those

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problems and cause irritations. So they are the enemy. They certainly can be, you know, they're attractive. But I just in Hawaii see very different problems than we do here. I can't believe it. Yeah, over there our seniors have to have foot pain. It would seem as

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though they would be. I mean they've been walking on the feet for all those years. The majority of problems we see are progressive problems, the hammer toes, the bunions, some of the different calluses that develop if you live long enough and keep walking on these these

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these feet they slowly and progressively get worse. Which is why generally speaking, an awful lot of podiatrists see patients that are somewhat older because it takes a while for those problems to get painful lisa. I think you mentioned diabetes a little earlier. At least one of

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your remarks touched on that. What are some of the foot conditions associated with diabetes? We talked about decreased circulation. We talked about decreased sensation of nerves. Both of those problems can set up a patient towards further complications. They don't have the pain mechanism to tell them

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that they're developing a sore an area that is painful that most of us would be able to identify and so they can develop, they can develop ulcers and potentially infections that won't heal because their circulation is not the greatest. So we like to see diabetic patients

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on a routine basis to help prevent those problems from occurring, diabetes can result even in the loss of limb. There are a lot of them were coming a couple of minutes left. I think there are a lot of questions Nowadays about laser surgery. What can you

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treat with laser surgery? Laser laser is a tool that's been around for an awful long time back in the 70s when I was in school. I mean we thought it was gonna be the tool that was better than sliced bread. It was going to stop bleeding

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in surgery. It was going to do an awful lot of things and what we found is that it works fine on cuts in soft tissue. But the problem that we found with it back then was that if you use it to cut bone, that any bone

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that's cut with it is left charred, all of those were infected because of the charring of the bone. So it pretty much is a tool that's used only to to cut soft tissues. Um different kinds of skin lesions can get rid of warts with them. You

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can get rid of tattoos, um easier and cleaner than, but not not any bone kind of problems. Did you bring your laser along? I have this problem with this board over there. One thing I want to be sure to get in a couple of minutes. We

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have left, what I noticed is a sign in your office. What is the shoes for the needy program? Well, our american podiatric Medical association has sponsored issues for the needy program all over the country. And just recently our local chapter got involved with this where we

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will collect shoes in our offices from people in the community and then distribute them two different shelters or any place that we might find people in need, mostly homeless shelters. And, and there are quite a few here in Sonoma County. Um, there are several podiatrists who

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are willing to to have their offices be drop off points so that people in the community can, can bring their shoes to us and to find out which podiatrists are involved with this program. We have a 1 804 04 ft number that people in the community

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can call. 804 04. All right, one other thing that's very important. Did I cut you off? Uh, one of the things important Community hospital has a majority poor dietary clinic once a month. How does that clinic function very well, actually even turns out that we now

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have it twice a month. Uh, and it's, it's um, it's a referral clinic only essentially was set up for two purposes. One was to expose the family practice residents that are up at community hospital to the world of feet so that there are members, podiatrists in

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the community that donate their time to help teach the residents what sort of foot problems occur because they'll be seeing them in their own practices. And the other reason it was set up was so that those patients who who may not be able to mainstream into

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offices as well folks that don't have the insurances and things that way would have a chance to have their feet taken care of whatever their problem might be. So you say now that there is two a month. Our time has escaped. Thank you both for being

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here. Ladies and gentlemen, we've been talking to two local podiatrists, Doctors of podiatry medicine, larry smith left your screen and lisa Mueller on the right of the screen. Obviously the lovely one. And my name is rich McGlinchey in the program. As you may know. I hope

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so. I'm counting the 90s. I'll be back with you next week with either members of the county government family or another profession such as proprietary tellin. Good night. Good luck, good health to each and every one of you. Mhm.