Foot Care 101: Understanding Podiatry with Dr. Nyquist - Transcribed
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[00:00:00] Pete Waggoner: Welcome to the Optimal Health Podcast from Hudson Physicians getting you back to optimal health when you're feeling sick, stressed, overwhelmed, or run down on today's program. We welcome in Dr. Ellie Nyquist, dpm. Topic today is going to be on foot care and of course, Dr. Nyquist practice in podiatry.
[00:00:19] Taking a quick look at Dr. Nyquist background, she went to the College of Texas Tech University and then her medical school was at Kent State University College of...
[00:00:28] Dr. Nyquist: College of Podiatric medicine.
[00:00:30] Pete Waggoner: Check that! College of Podiatric Medicine. So you started at Texas Tech and then you went off to Kent State University, correct?
[00:00:38] Dr. Nyquist: Yes, that's correct.
[00:00:39] Pete Waggoner: And I wanna talk about your journey a little bit about how that all evolved and what got you into those spots in your life. So first of all, welcome aboard Dr. Nyquist and welcome to the Family of Hudson Physicians.
[00:00:52] And one of the things that we do is this podcast called Optimal Health, which for me, it's been absolutely an incredible time to [00:01:00] learn about all of the great doctors that work within your team, and then of course, the patients that are served by you and, and learning a little bit more about you.
[00:01:08] So let's start from the very beginning with you. Your bio says you're a Midwest girl at heart.
[00:01:13] Where did you grow up and what led you to Texas Tech University?
[00:01:18] Dr. Nyquist: That's probably the million dollar question, right? In all honesty, I actually grew up kind of all over the place. So my parents are originally from the Mankato area, so I went to elementary school here in the Twin Cities in Burnsville.
[00:01:31] We lived in Duluth for a short time, but I really say that I grew up and I'm really from Albuquerque, New Mexico. And the only reason I say that is simply because it's the longest place I ever lived. We lived really all over the country. So I have a really diverse kinda upbringing, but Albuquerque is really where, I spent the majority of my middle school and high school years and my first couple years of college. So it's really kind of the foundation for me of where I like to call home.
[00:01:59] [00:02:00] I ended up at Texas Tech University because Albuquerque is pretty close by to the New Mexico, Texas border. And Texas Tech actually offers in-state tuition to New Mexico residents, which financially was a really wise decision I think to try to get a great education, but at the same time save a little bit of money.
[00:02:19] So that's how I ended up at Texas Tech.
[00:02:21] Pete Waggoner: And then what led you to Kent State?
[00:02:24] Dr. Nyquist: So, for podiatry, there are only a few colleges within the whole country. I think it's about nine universities for Podiatric Medicine throughout the entire country. So there's really not a lot of choices when it comes to choosing a podiatric medical school.
[00:02:39] So I knew that I wanted to come back up north and so I only interviewed and only applied to the Northern schools because I really felt that pull and draw back to kind of the Midwest area. And ultimately, the school in Ohio just really blew me away. They have a very [00:03:00] impressive didactic education. It's a really beautiful campus. They really have this wonderful sense of community, and so ultimately it was really the best choice for me.
[00:03:11] Pete Waggoner: So now, you're back to what we would say your second home maybe as you had some experience here and whatnot. But what's interesting though in your bio, there's some discussion how, when you were very young maybe 15, you knew that you wanted to go down that path.
[00:03:25] So to me, I think there would be, two parts of the process. One is that you wanna get into patient care of some sort, and then the other part is there's so many different things you could go to that leads you down those paths. So can you first kind of share a little bit in your background what got you into medicine, and then what made you choose this course?
[00:03:44] Dr. Nyquist: Yeah, absolutely. So I always loved science. I knew I had this kind of natural predilection for the sciences when I was in school, and it was something I always loved. So I knew that that was kind of the route that I probably was gonna be heading. [00:04:00] And I had a really wonderful high school course that I took in my sophomore, junior, and senior years where we were essentially, paired with a mentor.
[00:04:13] It was a mentorship program, and it could be any profession. Students could be paired with a professional chef or a police officer, or an engineer, or a physician. It could be really anybody. And being interested in the sciences, I thought, well, let's see what's out there in terms of medicine.
[00:04:32] And so ultimately, I ended up being paired with someone who's now one of my most treasured mentors, someone who I still to this day am very close to, and he himself is a podiatrist. And so I started working at his clinic, it's a private practice office in Albuquerque, New Mexico, and I started working there once a week or twice a week after school.
[00:04:54] I'd go down to the clinic and shadow and really kind of get the whole [00:05:00] experience at the office. And it was a really incredible program because essentially they showed the field of medicine off to me. Not just podiatry, but all areas of medicine. And every week I would essentially choose a topic of interest.
[00:05:17] It might be something, a different disease process that a patient had or some topic of choice. And I would research that topic each week, so a very comprehensive, amazing introduction into the sciences and medicine in general. And I just fell in love with podiatry. It's one of these really incredible fields where you get to spend a lot of time with the patients, talking to them about their problems and helping them kind of find solutions, but it's also a really, really diverse way to practice medicine.
[00:05:50] We do a lot of different things within the lower extremity, so we may be working on a patient with a vascular [00:06:00] problem or someone who has poor blood flow, or we may be working with a patient who has something wrong with one of their nerves, or we may have a patient with an injury or a broken bone.
[00:06:11] Or a diabetic patient where we're just teaching them regular routine and ways to take care of their feet. And so really no two patients are exactly alike and it creates a lot of interest throughout the day and keeps kind of me on my toes.
[00:06:26] Pete Waggoner: Pun intended!
[00:06:27] Dr. Nyquist: It really has just kind of drawn me in for many reasons.
[00:06:30] I spent some time in my college years shadowing other physicians and other professions, and I really loved a lot of other specialties, but I just kept coming back to podiatry. I just really felt like it was where I was meant to be.
[00:06:43] Pete Waggoner: Well, and I think it's great because there's never a shortage.
[00:06:47] Every time I make a turn here on the Optimal Health Podcast. When I speak to everybody that you work with, the passion for the specific study, an area of interest, is authentic and [00:07:00] real. And I think that is one of the most calming influences I would have as a general public to know, no matter what your issue is, you're going to have specialists, people that are focused in certain areas that are there for all the right reasons.
[00:07:14] And I think it's so great. So let's get into the feet a little bit here.
[00:07:19] Dr. Nyquist: Let's do it.
[00:07:20] Pete Waggoner: Healthy feet. What is a healthy foot to start and why is it important?
[00:07:26] Dr. Nyquist: Yeah, that's a great question. So when I'm looking at whether a foot is healthy versus a foot that may need some extra attention, there's a few check boxes that I'm looking at to make sure that you or your loved one, whoever's visiting, has a healthy foot.
[00:07:44] So to start, we wanna make sure that you have good blood flow. So it's really important to make sure you have good blood flow to your feet. That's probably one of the most important things. Secondly, we wanna make sure there's no signs of infection.
[00:07:58] We don't want any anything [00:08:00] wrong with the skin barrier. If there are any open wounds or any scratches or scrapes or anything that might put you at risk for an infection, we definitely would wanna make sure we're addressing those things.
[00:08:11] One of the other things that I'm looking for is, do you have a healthy nervous system to your feet? Can you feel when I touch your feet? Do you have the right nerve responses when certain tests are performed? All of these things are very important in looking at overall foot health.
[00:08:29] The last would be foot structure and foot deformity. So there are a million different foot deformities out there. And not all of them cause problems, but if combined with other issues can lead to more detrimental effects. So I'm looking at whether or not someone has a foot deformity and whether that may be contributing to some of their symptoms.
[00:08:57] Pete Waggoner: Question for you. In terms of the foot, you mentioned [00:09:00] the open wounds, infections, that type of things. Is the foot more susceptible to maybe a bacteria thing or just kind of where it is in and around stinky shoes or on ground? Is it more susceptible to some crazy stuff than maybe your hands would be, for instance?
[00:09:19] Dr. Nyquist: Yes and no. That's the short and long answer I guess kinda combined. Yes, your feet definitely are prone to infections, whether it's worse than another body part, it could vary depending on the individual.
[00:09:31] But in general, yes, the feet have a high propensity to have infections. And it's not necessarily because of the uniqueness of the foot, but more so that we don't often check our feet.
[00:09:46] When was the last time you picked up your foot and looked at the bottom of it? I guarantee you most people haven't done that in the last week, month, or year.
[00:09:53] It's one of these areas of the body that often gets forgotten, and so sometimes people will put [00:10:00] off issues or pretend that maybe that issue doesn't exist or hope that it'll go away. And sometimes that can just lead to worse issues down the line.
[00:10:07] The other thing that is really important to consider is our cleanliness habits.
[00:10:13] When you take a shower and you bathe all the dirty water that you're cleaning off of you, runs directly down to your feet. So it definitely is something we look out for and make sure that patients are taking good care of their feet overall, because it can lead to infections if not cared for properly.
[00:10:30] Pete Waggoner: Now, there are indicators too, for other things, such as, you know, maybe indicators. But, we know that people who get a little more in depth with diabetes and those types of things start having foot issues too. Are there things where someone comes in that might not have any idea that's going on in their body and then you're doing an exam routine or just looking at it and say, whoa, whoa, we're probably here with it.
[00:10:50] And how many different things are impacted on other parts of your body through what your feet are telling you as a Doctor?
[00:10:58] Dr. Nyquist: Yeah, I think the best way to [00:11:00] answer your question is just to kind of express the complexity of the foot and how it can really relate to the rest of the body. Sometimes there are things that are just isolated to the foot and ankle. But other things, when we're looking at blood flow, for example, if you have poor blood flow to your feet, that may be an indicator that you have an issue with blood flow elsewhere in the body, or that your heart may need to be checked by a general practitioner or cardiologist.
[00:11:25] Diabetes is obviously something we see quite a lot and is something that can have ill effects on the foot and ankle, but you don't necessarily have to have diabetes to have other issues.
[00:11:34] We're physicians first, specialist second. So, we kind of like to think of the foot as like, it's telling the story of the overall health of the individual patient.
[00:11:44] So if there's an issue with the skin barrier, if the skin is really dry or, there are other issues going on with the skin, we wanna make sure we're not missing something elsewhere on the body to make sure we get patients to the right specialist or [00:12:00] the right other physicians to make sure that they're being taken care of as a whole.
[00:12:05] Pete Waggoner: So if I'm walking around, just some random guy, I'm at some sort of music festival and I'm not a big Birkenstock guy, but let's say I've got some flip flops of some sort, can you look down at my at my rides there? Look at my feet and say, Ooh, that guy is in trouble. Or, I mean, can you do that to the naked eye or do you have to kind of get in there?
[00:12:22] Dr. Nyquist: No, I think most foot and ankle physicians would be able to spot problems from a mile away. I think that's a fairly common thing. Believe it or not, we're watching how you walk. We're watching what shoes you're wearing. It's a very common thing. Airports are dangerous because you watch a lot of people walk.
[00:12:37] I've said it before, I'll say it many times again, no two feet are created equal. So just because we see something doesn't necessarily mean that it's a problem that necessarily needs to be addressed.
[00:12:46] Pete Waggoner: Let's talk about toenail health and what matters. I think that's something that's very, you know, a anybody can take that for granted.
[00:12:54] How important is that and what should people be doing with them?
[00:12:58] Dr. Nyquist: Yeah, so [00:13:00] similarly to the foot in general, your toenail is basically a history of your overall health. So the way toenails grow, from the base of the toenail to the end of the toenail, it takes about nine to 12 months for a toenail to grow.
[00:13:15] And oftentimes, what will happen is if your body is going through a stressful period or is fighting a disease or is impaired in some way, it may show up in the nail as some type of color change or a groove or a texture change within the toenail itself.
[00:13:34] So it's actually really a great way for us to kind of look at the overall health of an individual and again, make sure they're seeing the right specialists or going to the right people.
[00:13:44] But toenail health in general is a fairly important topic especially when it relates to ingrown toenails. I think that's something that a lot of people suffer from, and a lot of people struggle with.
[00:13:56] And whether it's a one time thing or something that happens many [00:14:00] times throughout somebody's life, it's something that I think affects a lot of people. ingrown toenails, if not treated properly, or if left untreated, can go on to create some serious infections like we've mentioned before.
[00:14:14] And it's really important to make sure that you're taking care of those on a timely manner and seeing a professional to get advice on what to do or how to treat your toenail, especially in ingrown toenails properly.
[00:14:25] Pete Waggoner: Well, yeah, and it's interesting that the 9 to 12 month period, so that would be, if someone, let's say, lost a nail or something and it, and it would take that long for it to get back ingrown all the way through. Is that, is that what that timeframe is?
[00:14:39] Dr. Nyquist: That's correct. Yes.
[00:14:40] Pete Waggoner: So that's really incremental.
[00:14:41] Dr. Nyquist: Yes.
[00:14:42] Pete Waggoner: But then when you think about ingrown toenails and those types of things, it doesn't necessarily, mostly on your big toes, right? But it doesn't have to be reserved to just them, correct?
[00:14:52] Dr. Nyquist: No, it can be any toe.
[00:14:53] It can be even a fingernail sometimes too. It can be any nail.
[00:14:58] Pete Waggoner: It's crazy how that all works. Okay, then, [00:15:00] while we're on the nails, we might as well go there.
[00:15:01] Cause I know some people are wondering, I've heard so many different things when it comes to the fungus. That you can't really cure it or heal it or there's nothing that really makes it go away.
[00:15:15] Two-pronged question again cuz I'm a big two-parter here guy. What causes all of that and can you really clear that?
[00:15:25] Dr. Nyquist: Yeah, great question. Toenail fungus is extremely stubborn, extremely. So what causes it is actually a fungus, there's a specific species, there's a handful of species of the organism that's an actual fungus that lives underneath the toenail.
[00:15:42] So it gets into the actual substance of the nail and it just lives there. It thrives there, and it doesn't like to leave. And unfortunately, the treatments that we have for toenail fungus, there are good treatments out there, but because toenail fungus [00:16:00] is so difficult to treat, they don't have the best efficacy rates or they're not as good as we would like them to be.
[00:16:08] So what we recommend typically for patients with toenail fungus is first to make sure that it is a toenail fungus. There are some mimicers of toenail fungus and we'd hate to treat somebody for a toenail fungus if in fact they have something different going on. We typically recommend to get a biopsy of the nail and we can actually see what type of fungus is growing and that way we can more effectively treat the fungus. So that's step one.
[00:16:35] Step two is to consider whether or not a topical medication, so like a nail polish type medication or a pill type medication is the best treatment for the fungus. And that will vary from person to person.
[00:16:51] And then lastly, there are alternative options out there. So there are some things such as laser therapy, which can be [00:17:00] effective, but is often not covered by most patients insurances, so can be quite expensive out of pocket.
[00:17:06] And there are also, some home remedy treatments that are out there as well, which again, don't have effective rates, but can help soften the nails. So those things would include tea tree oil and Vic's Vapo rub.
[00:17:22] Pete Waggoner: Really?
[00:17:22] Dr. Nyquist: Yeah, so it's very interesting. So we, we typically recommend for patients that, depending on the severity of the toenail fungus, if they just have one or two nails that's only mildly affected, you know, we can treat them with certain products. Versus someone who has all 10 toenails who is greatly affected by the fungus and has a difficulty walking or difficulty fitting in shoes because the toneil fungus is so thick.
[00:17:49] Pete Waggoner: Oh god.
[00:17:49] Dr. Nyquist: There's a wide variety of, I guess the spectrum of severity. It's not impossible to treat, but it is difficult. So there are options available. It's just a [00:18:00] challenge and I think patients need to go that know that going into it.
[00:18:03] Pete Waggoner: How does it get there?
[00:18:04] I mean, can we avoid it in any way or is it just your number was called and you're kind of stuck.
[00:18:11] Dr. Nyquist: No. So there are definitely clear ways to help avoid getting toenail fungus.
[00:18:16] Pete Waggoner: Please do tell.
[00:18:17] Dr. Nyquist: So things to help to avoid getting foot fungus. Whether it's on your skin or your nail, include you know of changing your socks daily, making sure you're wearing a different pair of socks every day.
[00:18:29] Cotton socks can help wick moisture away from the foot and can help prevent the fungus. Also, making sure to always wear a shower shoe in any type of, you know, public gym, public shower, public swimming pool area, like a locker room. Because the fungus can spread through kind of wet areas, like locker rooms and pool areas.
[00:18:53] And keeping your shoes clean and dry. What they actually can do to help prevent fungus [00:19:00] from coming on in the first place or from recurring, is spraying a antifungal spray in your shoe. So when you take it off, just spray the antifungal spray in the shoe. That can be helpful for people who wear the same shoes day in and day out.
[00:19:15] So if you're someone who works at a construction site, for example, and you wear the same pair of shoes, it would be helpful to treat those shoes once you take them off and allow them to breathe. Unfortunately, toenail fungus has a genetic component, so if you do all the things correctly, you still may get toenail fungus.
[00:19:35] Yeah, unfortunately. But it's definitely worth trying these different measures to help prevent it from coming on.
[00:19:42] Pete Waggoner: Do you ever run into or deal with MRSA from a person who might have had an open sore wound on their foot and maybe it's a person who wears a work boot that has some sort of bacteria in it, or a hockey player with a skate, or a football player with a shoe. Do you ever run into that[00:20:00] from the actual shoe or skate that could create that problem?
[00:20:06] Dr. Nyquist: Potentially, yes MRSA or staph infection, that is resistant to certain antibiotics and we do see it. Yes. The difficulty with any staph infection is that staph is a bacteria that lives on your skin. It's there all the time. It's on everybody's skin. It's basically all around us.
[00:20:27] Pete Waggoner: Oh, wow. I didn't know that.
[00:20:28] Dr. Nyquist: Yeah, so staph is something that everybody has it on their skin. Now, MRSA or the more resistant version of staph, not everybody has that on their skin. MRSA is only on some people's skin. And so We have no way of predicting who harbors that bacteria and who doesn't.
[00:20:47] So we do see MRSA infections quite frequently whether it's due to exposure from a shoe or an open wound of any kind. Really, any time there's a break in the skin,[00:21:00] there is a potential for any type of staph infection or any infection, but depending on the individual patient, we can sometimes see MRSA as well.
[00:21:09] Pete Waggoner: So I guess the component of that question was really designed to, it kind of comes back to a common theme. There are a lot of things that you can do based off of what you were saying, to keep yourself as much away from trouble as possible. And some of that's just being a little bit more disciplined with the things you do.
[00:21:26] How about in where we see all kinds of crazy shoes out there and you know, I thought Jean Simmons in the seventies with KISS was outta control, but now we're seeing those as like everyday things. Right? But in the end, it's definitely, there's some things, maybe guidelines. Do you have anything that you would, could share in that regard?
[00:21:45] Dr. Nyquist: Yeah, absolutely. Shoes are a huge component of what we do. The right shoe for the right foot is one of probably the best things that any individual person can do for their overall foot health. The trouble is finding the right [00:22:00] shoe for your foot type. That's really the big question. So this is where it's really important to seek out professional help and come and see your podiatrist.
[00:22:08] Make an appointment with us so that we can help you find the right shoe for your foot type. Now, you know, as controversial as it may be, there are lots of different shoe choices out there. As a professional, I do like to wear fashionable shoes myself, but we often see patients who would kind of resist some of the recommendations because of fashion forward versus function forward shoe gear.
[00:22:36] And my recommendation for that is to try to maintain a 70, 30 compromise. So 70% of the time you should be in shoe gear. That is well fitting and is something that does not cause your foot pain or problems.
[00:22:54] If you want to go to a special event, a wedding, or church on a Sunday [00:23:00] morning, or some type of special event where you would wear a dress shoe, a high heel, or something along those lines, 30% of the time or less is generally okay for the vast majority of people, but we do recommend trying to maintain that 70 30 balance.
[00:23:16] That way you know you are supporting your foot and allowing your foot to function at its most ideal form which is guided by your shoes and your footwear.
[00:23:27] Some things that we recommend for patients who are going to pick out a pair of shoes for the first time or for the first time in a while, we recommend always going somewhere to have your feet measured.
[00:23:41] Probably the majority of adults haven't had their feet measured since they were maybe kids or teenagers. And you know, foot size can change over time. Foot structure can change over time. So going to a place, a local place anywhere that will actually physically measure your foot, not only in [00:24:00] length, but also in width can be extremely beneficial in choosing the right shoe.
[00:24:05] We also recommend going in the evenings for whatever reason, feet and lower extremities do tend to swell a little bit at the end of the day, so having a shoe fit at the end of the day is gonna be a better fitting shoe than one that you had tried on in the morning.
[00:24:23] Pete Waggoner: Wow. Interesting.
[00:24:25] Dr. Nyquist: So, yeah, these are just a few tips that we have. Every brand out there, we have to remember that footwear brands are a consumerist industry. They're trying to sell you a product. So just because something is really beautiful or has new shoe, doesn't necessarily mean it's the right shoe for you. Within every brand of shoes, even brands that most podiatrists love, there are gonna be good shoes and there are gonna be bad shoes.
[00:24:53] So kind of like I was saying before, this is really where it's helpful to get professional help. You know, it's probably [00:25:00] one of the most common questions we get about what shoes do you recommend and you know what, she would be best for me. I urge you to come and talk to your local podiatrist and we can give you some guidance and help you out and help you pick the right shoe for you.
[00:25:15] Pete Waggoner: How often should someone come in to see you?
[00:25:19] Dr. Nyquist: It depends. It absolutely depends. Our diabetic patients that are at higher risk for things like amputations or infections, we like to see much more frequently. But if you're someone who has a foot problem such as planter fasciitis or a bunion it, you may see your podiatrist less frequently, and that's okay.
[00:25:38] Even just one time a year or whenever you're having problems is perfectly okay. So it can really vary.
[00:25:46] Pete Waggoner: To schedule your in-person appointment with Dr. Nyquist. Call 7155316800 as well, you can go online at hudsonphysicians.com/appointments and you [00:26:00] can book your appointment there as well.
[00:26:02] Hey, absolutely terrific speaking with you here today. And Dr. Nyquist breath of fresh air, really fun. Appreciate all of the work you do with the patients in and around the area. And thanks for joining the Optimal Health Podcast today. We wish you the best of luck with Hudson Physicians.
[00:26:19] Dr. Nyquist: Thank you so much for having me.
[00:26:20] Pete Waggoner: That's gonna do it for this edition of the Optimal Health Podcast. I'm Pete Waggoner. So long everybody.