July 2013

Each patient is unique and will require specialized care according to their specific symptoms. It is my philosophy that patient care should be centered on the individual needs of the patient. This is accomplished by listening to the patient, communicating with the patient and educating the patient on the most appropriate treatment options for their particular concerns.

 

July 30, 2013

Q:

I sprained my ankle nearly 50 years ago, when I was a child. In my mid-50s I began to develop weakness and stiffness in the same ankle. Could this be related to my old sprain? Is there anything I can do about my ankle?

A:

The pain you are experiencing could be related to your prior sprain, but it also could be from other factors, such as your foot type or structure. If you are experiencing pain, weakness and stiffness every day, I recommend being evaluated by a foot and specialist to identify the cause for these symptoms. If you have not had a radiograph of your ankle, this may be a good place to start, as there may be joint changes that are causing your pain. Some recommendations would be to wear supportive shoes in the house, avoid barefoot walking and attempt gentle foot and ankle range-of-motion exercises. You may consider icing if there is swelling or discomfort toward the end of the day.

July 29, 2013

Q:

Can toenail fungus be treated with over-the-counter remedies? I have had a problem with this on both of my big toes (but not the others) for years. It seems to get better and then will get darker again. Any suggestions?

A:

Treatment of most forms of nail fungus, or onychomycosis, is similar. Traditional topical therapies are generally ineffective in treating nail fungus and even oral therapy is associated with a high rate of initial treatment failure or recurrence.

Treatment options include:

Topical treatment – Less than 10 percent effective

Oral treatment – Likely to be 75 percent effective

Surgical treatment – Often needs oral treatment or other topical treatment; no data on effectiveness

Laser/light treatment – Not currently covered by insurance companies

If you have not confirmed that the nail discoloration is nail fungus through a biopsy, I recommend scheduling an appointment with a foot and ankle specialist to confirm the discoloration is from a fungus, as there are other possible causes for nail discoloration.

July 22, 2013

Q:

Is there anything that can be done once your plantar fat pads (forefoot) have begun to deteriorate? I am only 24 and I want to run again!

A:

It is difficult to provide recommendations without an evaluation of your foot and a full understanding of your medical history.  Atrophy or deterioration of the fat pad can be associated with changes in the foot structure or related to hammertoes, or possibly due to systemic diseases.  I would recommend an evaluation by a foot and ankle specialist for further treatment recommendations.

July 22, 2013

Q:

How is the pain of a bunion different from osteoarthritis pain? What can be done to relieve this pain in a conservative way?

A:

Bunion pain can be felt along the bony bump on the joint at the base of the big toe, around the big toe joint, or when moving the big toe joint.  This pain can be similar to arthritic pain, as it may be felt with reduced motion in the toe, or as a dull, achy discomfort in the toe with activity.  In order to differentiate the two conditions, an X-ray is necessary to evaluate for any joint changes that would suggest osteoarthritis.  Treatment options include: changing to wider shoes, avoiding narrow- or tight-fitting shoes, avoiding high-heels or trying an orthotic.  Other options include: bunion splints or pads, silicone toe spacers or shields, stretching, icing and non-steroidal anti-inflammatory medication, such as ibuprofen or Aleve.  If you are having pain due to your bunion, it is a good idea to schedule an appointment with a foot and ankle specialist for further recommendations.

July 22, 2013

Q:

I have two odd-shaped toenails. They’re so ugly. Can anything be done about them?

A:

It is difficult to provide recommendations for your nails without examining the nails.  If there is discoloration or thickening due to an underlying nail fungus, this can be treated to potentially improve the appearance of the nail.  I recommend scheduling an appointment with a foot and ankle specialist for further recommendations.

July 22, 2013

Q:

I have a hammertoe crossing over the big toe with a bunion. I also experience excruciating leg cramps, especially at night. First, are these issues related? And are there any options for resolving this, aside from surgery?

A:

It is difficult to determine if your night cramps are related to your bunion and hammertoe deformity.  I would recommend an initial evaluation by your primary care physician to see if the reason for your night cramps can be identified, and I would recommend an evaluation by a foot and ankle specialist for further recommendations for your bunion and hammertoe.

Most nighttime leg cramps do not have a cause that doctors can find. When doctors do find causes, they can include:

  1. Having a leg or foot structure that is different from normal, such as with your bunion and hammertoe
  2. Sitting in an awkward position or sitting too long in one position
  3. Standing or walking a lot on concrete floors
  4. Changes in your body’s fluid balance; this can happen if you:
    1. Take medicines called diuretics
    2. Are on dialysis (a kind of treatment for kidney disease)
    3. Sweat too much
    4. Exercise
    5. Have certain conditions – for example, Parkinson disease, diabetes or low thyroid
    6. Are pregnant – some pregnant women do not have enough of the mineral magnesium in their blood and this can cause leg cramps
    7. Take certain medicines

Things you can try to improve your pain:

  1. Riding a stationary bike for a few minutes before bed; if you normally get little exercise, this might help.
  2. Stand facing the wall, feet together, about 2 feet from the wall. With your heels firmly on the floor and your shoulders, hips and knees lined up straight, lean forward into the wall. This should stretch the backs of your legs. Hold this position for 10 to 30 seconds. Repeat five times each session, at least twice a day.
  3. Wearing shoes with firm support, especially at the back of your foot around your heel
  4. Keeping bedcovers loose at the foot of your bed and NOT tucked in
  5. Drinking plenty of water, especially if you take diuretics; do this only if your doctor or nurse has not told you to limit the amount of water you drink
  6. Limiting the amount of alcohol and caffeine you drink
  7. Staying cool when you exercise, and NOT exercising in very hot weather or hot rooms

If you get a cramp, slowly stretch the cramped muscle.

July 15, 2013

Q:

I am a PCT and am constantly on my feet. I try to wear comfortable shoes but still … YES, I have BAD FEET DAYS! I would get out of bed and could hardly walk from foot pain. I massage and soak them in Epsom salt and this helps a little. But can you recommend another way to help my feet? I’m not diabetic, but I heard that wearing white shoes is still best. Is this true?

A:

It is difficult to provide further recommendations without physically examining your feet and specific areas of pain.  I would recommend scheduling an appointment with a foot and ankle specialist for further recommendations.

July 15, 2013

Q:

I am so confused when I go to buy athletic shoes. The salespeople offer different inserts, at outrageous prices, but do they really work? Can you provide any guidance?

A:

Here are some tips for selecting An Athletic Shoe.  I recommend first selecting an appropriate shoe for your foot type that will accomplish three main goals, which include: performance, injury protection and comfort.  I do not recommend an orthotic unless you have been evaluated by a foot and ankle specialist to identify your specific needs.

  • Sport specific shoe. Plan to select a shoe specific for the sport in which you will participate.
  • Specialty shoe store. It is best to use a store that specializes in athletic shoes and has a good reputation in your community. If you are a runner, make certain to ask local runners’ clubs and other runners for recommendations. You might also call the office of a local sports podiatrist for suggestions.
  • Bring useful information to the store. What injuries have you had in the past and what if anything is your current problem? Bring your old shoes into the store. Which shoes have been successfully used in the past and which ones caused problems? What is your general foot type and foot shape? How have previous shoe models worn?  Old shoes can provide information about your running pattern and offer information in choosing a new shoe.
  • Have your feet measured each time you purchase shoes. As you age, you’ll find that your foot size may gradually change. Also each manufacturer often changes where their shoes are made and the size dimensions will vary from one manufacturer to another. The measurements should include sitting, standing and heel to toe, heel to ball and width.

In spite of obtaining a number from the Brannock measuring device, you’ll still have to actually fit the shoe to your foot. The measurement itself is only a general guide.
If you have not been evaluated by a foot and ankle specialist, and have further questions, I suggest scheduling an appointment for further recommendations.

July 15, 2013

Q:

What can you do about hammertoes?

A:

Hammertoes can be treated to ease pain and discomfort, however, conservative treatment will not stop the progression of the problem.  A number of non-surgical measures can be undertaken, which include:

  • Padding corns and calluses.
  • Changes in footwear – it is important to avoid shoes with pointed toes, shoes that are too short or shoes with high heels, as these types of shoes can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than 2 inches.
  • Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.
  • Medications. Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Splinting or strapping. Splints or small straps may be applied to realign the bent toe to improve comfort.

If pain persists despite conservative care, you may need to consider other options.  I recommend seeing a foot and ankle specialist for an evaluation if pain continues despite these treatments.

July 10, 2013

Q:

I am 63 years old and have swelling only in one calf, ankle and foot. I wear support hose and the swelling goes down if I lie down and sleep for about six to eight hours. But the swelling is back again in the morning after I’ve been up for an hour or two. I have had the Doppler testing done, and that showed no blockage. What can it be?

A:

Unilateral or single limb edema may develop as a result of venous insufficiency or thrombosis, or, if there is a history of lymphatic impairment, lymphatic drainage can result in lymphedema, or single limb swelling.  I recommend you discuss this further with your primary care physician, as they may recommend you be further evaluated by another specialist, such as a peripheral vascular specialist.

July 10, 2013

Q:

I stubbed the little toe on my right foot on Friday night. It still hurts when I move it, and it looks swollen and bruised. Could it be broken? I don’t have health insurance, so if it is broken, is there any home remedy?

A:

There is a possibility that the toe is broken, however, you may find splinting the fourth toe to the fifth toe will improve your symptoms.  You should also consider wearing a stiff-soled shoe to prevent the toe from flexing, or bending, while walking.  It is important to rest, ice and elevate the area.  If your symptoms persist, I would recommend being evaluated by a foot and ankle specialist.

July 10, 2013

Q:

Can anything be done for drop foot (also known as foot drop)?

A:

An ankle-foot orthosis splint can be utilized to keep the foot dorsiflexed, and should be used until active movement has recovered, or permanently if active movement cannot be restored.  Physical therapy progressing from passive range of movement to passive-assistive, active and active-resistant exercise under the supervision of a physical therapist also may be helpful.  Walking is particularly important therapy.  Ultimately, your prognosis depends upon the degree of dysfunction and the underlying cause of the injury.

July 10, 2013

Q:

My neuropathy is going crazy with pain, tingling and numbness. I take Lyrica three times a day. Can you please help me?

A:

I would recommend you discuss your neuropathic symptoms with your primary care physician, or the physician that manages your diabetes.  They can fully evaluate your symptoms to determine if a referral to a specialist, such as a neurologist, is necessary.

July 10, 2013

Q:

I have Type 2 diabetes and I had a heart attack last year. I also have two stents. Now my feet are swelling. Do you know why?

A:

There are many different conditions that can cause swelling. Some of these include:

  1. Problems with veins in the legs – Normally veins carry blood from the body back to the heart. Unfortunately, if the valves in the veins do not work well, the veins cannot pump enough blood back to the heart. This can cause swelling in the lower legs.
  2. Medicines – Swelling can be a side effect of some medications, such as prescriptions for diabetes, high blood pressure or pain.
  3. Kidney problems – People who have certain kidney problems can have swelling in the lower legs.
  4. Heart failure – Heart failure is a type of heart problem in which the heart cannot pump normally. People with heart failure can have swelling in the legs, belly or lungs.
  5. Liver problems – People who have certain liver problems can have swelling in the belly or lower legs.

I would suggest scheduling a follow-up appointment with your primary care doctor for further evaluation and work-up of your swelling.

July 9, 2013

Q:

I’ve been suffering with athlete’s foot for 10 years that can’t be treated. I’ve been to more than 30 foot doctors and dermatologists with no help. I can’t take oral drugs so they usually tell me to get Lotramin or any over-the-counter spray. Are there any new creams out there that can help?

A:

I am sorry to hear about your experience with chronic athlete’s foot.  I would recommend scheduling an appointment with one of our foot and ankle specialists to have your feet evaluated so that we may provide further recommendations for your care.  There are multiple over-the-counter and prescription-strength medications available for the treatment of athlete’s foot, however, it is difficult to provide a recommendation without evaluating your feet to ensure there are no other reasons for your complaint.

July 9, 2013

Q:

What is the treatment for a heel spur?

A:

There are many treatments for a “heel spur,” but treatments are typically directed at the reason for the heel spur, which is usually due to a condition called plantar fasciitis.  The symptoms of plantar fasciitis may include: pain in the bottom of the heel, usually worse in the morning or when standing from a seated position.  Because there are several potential causes for heel pain, it is important to be evaluated by a foot and ankle specialist to determine the underlying source of your heel pain.

The first recommendation is to avoid walking barefoot and to wear shoes at all times, even while in the house.  Daily stretching, both in the morning and before standing from a seated position, will alleviate some of the initial discomfort you may experience when you start walking.  Temporary insoles, night splints, icing, non-steroidal anti-inflammatory drugs (NSAIDS) and athletic shoes may be helpful.  If you have not been examined by a foot and ankle specialist, I would recommend scheduling an appointment so they may be able to offer more recommendations.

July 9, 2013

Q:

My daughter just turned 3 years old and has severely turned-in ankles/feet. Would a podiatrist or orthopedic surgeon need to see her? We also have bad insurance so no one by us will take her. Not sure what I should do at this point.

A:

If you daughter is tripping, or having difficulty walking, I would recommend having your daughter evaluated by a foot and ankle specialist that sees children.  You can schedule an appointment by calling 1-888-LUHS-888 (888-584-7888).

July 9, 2013

Q:

I am a 57-year-old female who has walked many miles over the years as my main form of exercise. I now find that my ankles and the top of my feet feel stiff and somewhat painful after I have been sitting even for relatively short periods of time and when I get up in the morning. After walking for several minutes the stiffness/pain gradually subsides. Could this be arthritis?

A:

Your condition does sound like it may be related to osteoarthritis of the foot and ankle.  If you have not been evaluated by a foot and ankle specialist, I would recommend you do this for further treatment options to improve your pain and discomfort.

July 9, 2013

Q:

What can I do for a heel spur? I have had an X-ray and it is definitely a spur.

A:

There are many treatments for a “heel spur,” but treatments are typically directed at the reason for the heel spur, which is usually due to a condition called plantar fasciitis.  The first recommendation is to avoid walking barefoot and to wear shoes at all times, even while in the house.  Daily stretching, both in the morning and before standing from a seated position, will alleviate some of the initial discomfort you may experience when you start walking.  Temporary insoles, night splints, icing, non-steroidal anti-inflammatory drugs (NSAIDS) and athletic shoes may be helpful.  If you have not been examined by a foot and ankle specialist, I would recommend scheduling an appointment so they may be able to offer more recommendations.

July 9, 2013

Q:

A severe ankle sprain eight weeks ago is still swollen and gives me occasionally aches and “shooting pains” across the top of my foot at bedtime. What can I do?

A:

If you have not already done so, I would have your ankle evaluated due to the continued pain and swelling you are experiencing.  There is a possibility that you may have more than an ankle sprain and this should be further evaluated by a foot and ankle specialist.  In the meantime, I recommend wrapping the ankle in an ACE wrap for protection and compression.

July 9, 2013

Q:

Are there been any new treatments besides an orthotic or surgery for plantar fibromatosis?

A:

Typically, plantar fibromatosis is asymptomatic and treatment for patients with early disease requires observation. Patients who have an early-stage lesion will be given a trial of conservative treatment, which should include: padding, orthotic management, non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy.  Intralesional injection therapy with corticosteroids may be considered in the initial stages of the disease, but if the lesion increases in size its success rate is reduced.  Topical application of transdermal Verapamil (15 percent gel) may be considered as a treatment option, however, there are certain contraindications to this topical medication, and you should discuss this further with your foot and ankle specialist.

July 8, 2013

Q:

What is the best and safest way to remove hardened, cracked skin and calluses from the feet, especially the heels and big toe? Is it bad to use a disposable shaver or scissors to remove calluses?

A:

Dry, cracked heels and toes can be treated conservatively with different emollients and the use of a pumice stone. It is not recommended to use a scissors or a shaver. Topical creams are documented to be the best skin care treatment. Creams that use keratolytic and humectant agents containing urea, salicylic acid, alpha-hydroxy acids, saccharide isomerate, and petroleum jelly may all be successful and are found over the counter. Apply these agents two to three times a day until healed. It is best to cover the emollient with a bandage or a white cotton sock to help these moisturizing agents work more effectively and to prevent moisture loss. A pumice stone can remove some of the excess dead skin that is preventing proper healing, and is often useful after a shower. If you have tried these treatments and they were not effective, I recommend you see a foot and ankle specialist for further evaluation and recommendations.

July 8, 2013

Q:

What is the best treatment for plantar fasciitis, and will it ever go away completely?

A:

Plantar fasciitis typically resolves with conservative care. The first treatment recommendation is to avoid barefoot walking and to wear shoes at all times, even while in the house. Daily stretching, both in the morning and before standing from a seated position, will alleviate some of the initial discomfort you may experience when you start walking. Temporary insoles, night splints, icing, non-steroidal anti-inflammatory drugs (NSAIDS) and athletic shoes may be helpful. If you have not been examined by a foot and ankle specialist, I would recommend scheduling an appointment so they may be able to offer further recommendations and advice.

July 8, 2013

Q:

I have a bunion on the upper left side of my right foot. I never wear high-heeled shoes but until very recently had a job where I was on my feet for many hours at a time. The bunion can throb with pain even if I am sitting without any weight or pressure on it. Outside of surgery, what can I do for this?

A:

Try changing your shoes to a pair that is wider to provide more room around the toes. Perform stretching exercises to improve the range of motion and reduce the stiffness of the joint. You may consider wearing a bunion sleeve or pad. You can purchase a silicone sleeve or spacer at a medical supply store or online.  When you have discomfort at the end of the day, try icing the area to reduce the pain. You may consider taking over-the-counter pain medication such as ibuprofen or acetaminophen to reduce your discomfort.

July 1, 2013

Q:

What is nail fungus?

A:

A fungus is an organism that lives in warm, moist areas. Fungus of the toenails is a common problem that can affect people of all ages.  Fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.  A foot and ankle surgeon can diagnose the cause of toenail problems and recommend treatments.

July 1, 2013

Q:

What is an ingrown toenail?

A:

This occurs when the border of the toenail curves into the side of the skin, which can irritate the skin and cause pain, redness, swelling and warmth to the affected toe.  There are many reasons a patient can develop an ingrown toenail. Some common reasons include: tight socks or stockings, narrow or ill-fitting shoes, nail fungus, nail trauma, heredity or inappropriate trimming of the toenail.  Surgical treatment may be necessary if an infection develops, or if the condition causes chronic pain.

July 1, 2013

Q:

I have flat feet, or fallen arches, should I be concerned?

A:

“Fallen arches” is a common term used to describe a flat-foot condition that develops during adulthood.  Most cases of “fallen arches” develop when the main arch-supporting tendon becomes weakened or injured, causing the arch to gradually become lower. With time, the shape of the foot changes and pain may develop in the arch or the ankle.  Common problems associated with fallen arches include plantar fasciitis, tendonitis, increased fatigue, and arthritis of the foot and ankle.  If you have this condition and it is painful or limiting your activity, you may benefit from a consultation with a foot and ankle specialist.

July 1, 2013

Q:

What is an ankle sprain?

A:

An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle.  They usually occur while participating in sports, wearing inappropriate shoes or walking/running on an uneven surface.  Some ankle sprains are much worse than others.  Symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains. Instead, they may simply feel the ankle is unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is important to prevent long-term complications.

July 1, 2013

Q:

What is a bunion? How is one treated?

A:

A bunion is a condition where there is a prominent bump on the outside of the great toe, and oftentimes the great toe will drift toward the second toe.  A bunion is the result of a muscle imbalance and can be a progressive disorder.  There are several reasons bunions develop. These can be related to your foot type or structure, and abnormal foot mechanics.  Although wearing shoes that crowd the toes won’t actually cause bunions, it can cause a progression of the deformity and increase symptoms related to the bunion.  If you are having pain due to your bunion, it is a good idea to schedule an appointment with a foot and ankle specialist.

Treatment options include: changing shoes to a wider option, avoiding narrow or tight fitting shoes, avoiding high-heeled shoes, or trying an orthotic. Other options include: bunion splints or pads, silicone toe spacers or shields, stretching, icing and non-steroidal anti-inflammatories like ibuprofin. If you are having pain due to your bunion, it is a good idea to schedule an appointment with a foot and ankle specialist.

July 1, 2013

Q:

Why do I have heel pain?

A:

Heel pain is most often caused by pain in the long plantar ligament of the heel, otherwise known as plantar fasciitis.  Heel pain may also be due to other causes, such as a stress fracture of the heel bone, tendonitis, arthritis, nerve irritation or, in children, growing pains.  The symptoms of plantar fasciitis may include: pain in the bottom of the heel, usually worse in the morning or when standing from a seated position.  Because there are several potential causes for heel pain, it is important to be evaluated by a foot and ankle specialist to determine the underlying source of your heel pain.

July 1, 2013

Q:

What is a podiatrist?

A:

A podiatrist is a doctor of podiatric medicine (DPM), also known as a podiatric physician or foot and ankle surgeon.  Foot and ankle surgeons provide comprehensive medical and surgical care for a wide spectrum of foot and ankle conditions including common to complex disorders, injuries and fractures that affect people of all ages. They are uniquely qualified to manage foot conditions that may pose an ongoing threat to a patient’s overall health.