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"Is there anything else that can be done for callus pain?" As a podiatrist, I get this question a lot. Many patients develop foot calluses for a variety of reasons, and the most common is age related loss of fat padding on the bottom of the foot. With every step, the bones of the metatarsal head hits the ground and our natural fat padding assists in absorbing those shocks. As we age, the fat pad quality decreases or shifts away from this high pressure point, causing what feels like literal skin and bones with each step. With less fat padding (fat atrophy), there is less shock absorption and so the body protects itself by growing a thick callus and you may experience pain with every step. Overtime, these calluses can damage healthy skin underneath. Worse case scenario, this becomes an open ulcer and can lead to infection and amputation in the most vulnerable including those with circulation disorders or diabetes. Professional maintenance is key in treating and preventing foot calluses. Other conditions may look like a callus but could be a plantar wart, amelanotic melanoma, or another type of growth. Check with your doctor to ensure you have the right diagnosis before self treating. Early treatments of a callus include proper shoe wear and safe pedicures to keep the skin thickness under control. However, even with medical pedicures, calluses do come back as quickly as every few weeks. So patients often ask, is there anything else that can provide longer pain relief from callus pain? Absolutely! I am a fan of medical pedicures because this is the most easy to access. Gentle exfoliation of dead skin can decrease the thickness of developing calluses. This can be done with a sugar scrub or emery board designed specifically for the foot. Be aware that sharp blades and mechanical tools should only be used by a medical professional to avoid accidental cuts that can lead to an infection. Next, I recommend sticky pads that have a cut out window to off-load the pressure point. I love using U-pads made of felt between ⅛" to ¼" thickness to alleviate pressure points particularly at the ball of the foot. Make sure you use nonmedicated pads that don't cover the callus directly. Medicated pads can lead to accidental tissue damage. Eventually the pads need to be replaced, so having custom fitted orthotics would be the next consideration. Custom orthotics is very different from generic inserts purchased from the store. Custom orthotics are medical devices prescribed by a podiatrist, which can be custom fitted to fit inside of your preferred shoes. They only work if you're wearing them so some people prefer to have another pair of orthotics for their indoor shoes. This will also help prevent contamination of bringing outdoor shoes indoors. The podiatrist evaluates your feet and your walking pattern to determine the right kind of prescription for your foot pain. What is also important to know are nontraditional treatments options such as foot fillers that are injected under the callus to decrease pain with walking. There are fat allografts and dermal fillers like hyaluronic acid to increase cushion in the foot. This treatment can last longer than shaving the callus. Touch ups may be necessary depending on the person's activity level. A podiatrist who specializes in minimally invasive options, like myself, is who you should consider learning more about these nontraditional treatment options. Steroid injections should be avoided in these areas since that only covers up the pain rather than addressing the biomechanical issue causing the pain. Steroids can also lead to thinning of the fat pad as well with long term use. Dermal fillers or fat allograft injections for the foot are not covered by insurance but are an affordable option for longer pain relief short of surgery. Lastly, long term benefits are seen with minimally invasive surgery. This is different from traditional surgery in that the incision is only 3mm long and no hardware or hospitalization is required. Patients are able to walk sooner with minimal down time. Minimally invasive surgery decreases the risks typically associated with traditional surgery such as infection, hardware rejection and painful scars. As with any surgery, risks and benefits must be weighed before going under the knife so consult with a minimally invasive foot specialist for options. Dr. Tea Nguyen, DPM Minimally Invasive Foot Specialist Pacific Point Podiatry 831-288-3400 9500 Soquel Drive, #A, Aptos S N O I T C E J N I C I G O L O I B www.trilogymedical.net Soquel: (831) 600-8117 4105 Soquel Drive Medicare Supplement Enrollment Periods Before we talk about supplements, we need to know a bit about original Medicare to see why sup- plements exist. Original Medicare is made up of Parts A & B. Part A is Hospital insurance, and Part B is Medical insur- ance. Parts A & B are pro- vided through the federal government for seniors and people with disabili- ties who have worked and paid into Social Security for ten years or more. Medicare Part A has a $1556 deductible (2022) and this deductible amount changes each year. A deductible means a patient has to pay this amount before Medicare will start to pay for the hospital services incurred by the patient. The deductible is not an annual deductible but a "benefit period" deductible. A benefit pe- riod ends when someone hasn't received inpatient hospital care (or skilled nursing care) for 60 days in a row. One can have multiple benefit periods in a year meaning they could have to pay multiple deductibles in a year! Medicare Part B does have a monthly premium. In 2022 the premium is $170.10 (for someone earning $91k or less annually) and there is a $233 annual deductible. Part B only pays 80% of the expenses meaning the patient must pay the other 20%. As an example, a knee replacement surgery in the U.S. costs somewhere between $30,000 and $50,000. So 20% would be between $6000 and $10,000 that the patient would pay for Part B copay. Now that we have an idea of Medicare Parts A & B expenses, let's see how Medicare supple- ments play into Original Medicare. There are three different types of sup- plements sold by private insurance firms to enhance Medicare benefits: Part D prescription plans, Part C Advantage Plans and Medigap supplement plans. Part D plans are supple- ments that cover prescrip- tion drugs approved by Medicare. Part D plans are annual plans, meaning they expire each Decem- ber and people should sign up for a plan between October 15 and December 7th of each year for the following year. Each year, two things can change that can affect the cost of someone's prescriptions. The price of a Part D plan can change, and a per- son's prescription list can change. Any change to one of these three things can drastically increase someone's prescription drug cost in a year. It is recommended that Medi- care beneficiaries conduct a Part D plan comparison By Senior Network Services each year. A ten-minute check can save a person hundreds to thousands of dollars. Medigap supplement plans are the only supple- ments that are not annual plans. When someone chooses to purchase a Medigap supplement plan, it is their plan for life if they choose. They are also labeled similarly to the different parts of Medicare by letters A, B, C , D and additional letters through N. Often, people will mix up Parts of Medicare with Medigap plans because of the lettered titles. As men- tioned earlier these plans do not expire each year. In California we do have the Birthday Rule which allows owners of Medigap supplement plans to shop around for plans of an equal number of benefits or fewer on their Birthday and for 60 days after their Birthday. For details about these Medigap Plans look for our HICAP Medicare Basics 101 or Medicare and U webinars. The Part C Advantage What Happens When You Inherit a Home With a Reverse Mortgage? Reverse Mortgages have become better under- stood and more consumer friendly over the past 15 years so don't be surprised if you or someone you know is confronted with the situation of settling the family estate and inherit- ing the family home that has had a Reverse Mort- gage on it. There are many factors that are unique to each family but there are really only three options available when it comes to what to do about the Reverse Mortgage. You can pay off the mortgage with the other holdings in the estate or your own funds. You can pay off the bal- ance of the Reverse Mort- gage with a new forward mortgage. You can pay off the balance with the proceeds from selling the house. The option you pick large- ly depends on whether or not you want to keep the home in the family or if the home would make a good investment for generating rental income, an alternative retirement plan for yourself. If the house is in very good shape the first two options would be your focus and a standard forward mort- gage should be in reach because Reverse Mortgage loan balances are gener- ally low compared to the overall home value. That is because the original loan amount started below 50% of the total property value to begin with and remember that all the remaining equity and all the future equity belongs to the homeowner. This can make the refinance to a forward mortgage easy weather you will occupy it yourself or you plan to make it a rental. If the property has not had the necessary upkeep and is in need of expensive up- grades or repairs then sell- ing is really the only option that makes sense. A unique aspect of the Reverse Mortgage Note is that it is a non-recourse loan. This means that the mortgage repayment amount can't exceed the proceeds from the sale of the property. If there is a mortgage balance remaining after the sale of the property, the estate of the homeowner isn't held responsible for that amount. There is no hurry to make this sale as you will have six months to sell and if you are having a difficult time because of some unforeseen bad housing market, just as Murphy's Law would have it, you may request a three-month extension (twice) with proof of a listing agreement with a Real Estate Broker and continue to do your best to find a buyer. You may not end up with the house but you will not inherit any debt either. Here is an interesting twist. With good health and active lifestyles many seniors are living well into their 90s and beyond. This means that their chil- dren could be in their 60s and could possibly get a Reverse Mortgage of their own to replace that of their parents. They would have to move into it as their primary residence By Donald Dimitruk RFC ® RMA but then they would be inheriting not only their family home but one with "No monthly payment for life" as well and turn their existing home into a rental to subsidize the tax and insurance expense and build a larger Real Estate portfolio for retirement. What a concept! Donald Dimitruk is a Registered Finan- cial Consultant ® and a Registered Mortgage Advisor and is available for a FREE consultation about how a Reverse Mortgage may benefit you at 831.464.6464 Plans are like the Part D plans timeline in that they also are annual plans. Each year enrollees will receive a "Plan Annual Notice of Change" notifi- cation letter about changes to their plan. These letters are normally sent out in September by one's insurance plan. Individu- als should read this letter to determine if the plan is still the best plan to meet their medical needs for the following year. For more details on Medicare Advantage plans, look for our HICAP Medicare Ba- sics 101 or Medicare and U webinars. Like the Part D prescription drug plans, Medicare Advantage plans can be changed from October 15 to December 7 for the following January. To wrap it up, if you are on Medicare, and have a supplement plan, October 15 through December 7th you should be evaluating your Part D prescription plan or your Medicare Advantage plan which will start the following January. Your Medigap supplement plan can be a lifelong plan, but one can shop around at their Birthday and for 60 days after Birthday for a plan of equal benefits or less. Bigstock photo

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