Putting Your Best Foot Forward

Dr. Susan Hiraoka
Podiatrist
Interviewed by Melissa Moniz

What medical services do you provide?

I handle anything to do with the foot and some areas of the ankle, as long as it doesn’t require surgery of the ankle. Most of the common problems include ingrown toenails, bunions, fractures and wound care. Diabetic patients also make up a lot of my practice.

Do you have an area of specialty?

I don’t have any specific area of specialty, but I participate with the wound care clinic at Queen’s Medical Center every week. So that is an area that I am interested in. The wound care center is an outpatient clinic that manages wounds of all types ranging from bed sores to traumatic wounds to diabetic ulcers. The clinic is a team approach, where we have several different specialties including podiatry, plastic surgery, general surgery and internal medicine. Patients are referred for wound care and the team evaluates and develops a treatment plan. Patients are usually seen weekly until the wound is properly healed. We may also make recommendations about prevention of future wounds.

Do you see patients who come in for routine checkups, or is it primarily when there’s a problem?

A little bit of both. Patients who come in for acute care will have problems like ingrown toenails, fractures, sprains, heel pain or other types of pain or injury. Patient who come in for routine visits are usually diabetic patients, whom I like to follow regularly and see maybe every two or three months.

With diabetics, what are the most common problems you see and treat?

A lot of times it’s infections and wounds. Unfortunately, with diabetes, the biggest complications are numbness and poor circulation. Many patients are unable to feel, so sometimes they don’t know if they stepped on something and cut their foot, which can lead to infections. With regular visits, I try to make sure they don’t have any problems that could put them at risk of complications. So it’s a maintenance type of thing.

Besides what you see with diabetics, what are other common foot problems you see and treat?

I commonly see heel pain and ingrown toe-nails. Heel pain is mainly an overuse injury. People who spend a lot of time on their feet will have that problem. It’s probably the most common problem we see, and it’s not really age-related but activity related. Ingrown toenails are also fairly common. Many people get them by cutting their toenails incorrectly, from trauma or sometimes heredity.

Are heel pain and ingrown toenails preventable?

With heel pain, since it is activity related, sometimes you just can’t avoid it. Many times you don’t know there’s a problem until something hurts. Once someone develops heel pain, I’ll make recommendations on how you can prevent it from getting worse and prevent it from coming back.

Ingrown toenails are mainly caused by cutting your nails too short. The best thing to do is to cut the nail straight across to make sure you cut the entire nail. You can later file down the sharp corners. Unfortunately, for some people, it’s just heredity and they’re just prone to it.

What are your recommendations for healthy feet?

I think you should check your feet regularly to make sure there are no areas of concern like callusing, ingrown toenails or fungus. Many people put off taking care of these problems, and that can cause unnecessary pain. Wash your feet regularly to minimize fungus or other infection. Apply lotion to your feet and legs regularly to maintain moisture and avoid cracking of the skin. Make sure you have proper footwear for whatever activity you’re going to do. Slippers aren’t the best for protecting your feet, but I understand that it is part of the lifestyle in Hawaii. The best thing you can do is to take care of your feet and be aware of potential problems.

Do you recommend pumice stones?

Pumice stones are OK. I don’t have a problem with pumice stones, as long as you’re not too aggressive with it. They can help minimize callus buildup. The things that I am not a fan of are over-the-counter corn removers and wart removers. Those products are basically little disks of acid that don’t discriminate between good tissue and bad tissue. So if you happen to be really sensitive or are diabetic, you can easily develop a wound. So it’s better to have a doctor treat it.

Is an arch support something that people should be using?

If you’re going to be on your feet a lot, then it’s a good idea to get some type of arch support. This can help decrease the amount of fatigue you may feel. For people with a history of heel pain, you want an insert where the arch area can’t be easily smashed or bent. You want one that’s fairly firm to give you a good support, because that is the cause of your problem. Some people will benefit from a simple insert that is mainly a cushion to act like a shock absorber for your feet.

Do you see a lot of fungus?

Yes, I see a lot of nail fungus and some athlete’s foot. Nail fungus is really easy to get and really hard to get rid of.

How do you get nail fungus?

You can pick it up anywhere - in showers, at the beach, getting pedicures - usually areas were water is involved. Sometimes if you have trauma where you stubbed or dropped something on your toe, because the nail area is compromised, if fungus is in the area it can just get in there and affect the nail really easily. Nail fungus itself will not usually make you sick or infect the body. The main thing is that it makes the nail discolored and thick - not very pretty at all. The way it can become dangerous is because it can make the nail very thick, so when you wear shoes it can put a lot of pressure on the toe and cause a wound.

 

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