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FAQ

A: There are several characteristics of skin lesions that can be concerning for cancer. Size greater than 6 mm across, border irregularity, asymmetry, color variation and variation in the thickness of the lesion can be concerning and warrant biopsy. I have identified several skin cancers this way, allowing for expeditious referral to cancer specialists. Biopsies can save lives.

A: Athlete's foot is a common foot infection caused by fungi. Fungi are especially common in the warm, moist environments of pools, showers, locker rooms and other sports facilities, where people walk with bare feet. Once fungi contaminate the skin of someone's foot, the warm, moist environment of sweaty socks and shoes encourage them to grow.  Symptoms include itching of the feet, cracked or peeling areas of skin.  It is important to avoid walking barefooted in areas where others have walked barefooted. There is a highly effective prescription medication that is applied daily to the skin. Also, there is a list of daily recommendations for treatment of both your feet and shoes. 

A: Well, that depends upon what type of bunion surgery you are having done. Not every bunion is the same, and thus not every bunion needs to be corrected by the same type of procedure. For some very mild bunions, in which the connective tissues are balanced out and the bump shaved off, partial weight bearing with a walking boot may be allowed. For bunion corrections involving a cut made in the bone and pins or screws to secure the bone, non-weight bearing for about 3 weeks is required, following by walking in a boot for another 4-5 weeks. For the more involved bunion corrections, non-weight bearing with a cast may be required for 6-8 weeks before putting weight on the foot.

A: Ingrown toenails can be frustrating problems. In simpler cases, the ingrown corner may need to be periodically trimmed back in the office to prevent it from becoming painful and infected. For some people who are not candidates for surgery, this (as well as shoes with a roomy toe box) may be the only option. For people with more severe, recurrent ingrown toenails, a permanent procedure may be performed in which the ingrowing corner of the nail is removed surgically in the office, and the nail root in that corner is chemically cauterized to prevent that corner from growing back. The procedure is minimally painful, and its success rate is about 95%.

A: Absolutely! There are numerous chemicals that are sprayed on tobacco while in the field and during the processing of the leaves after harvesting, and these are not necessarily good for one’s health. In addition, recover after surgery requires lots of rest and energy. Cigarette smoking can decrease the amount of oxygen in your bloodstream. What’s more, cigarette smoking can cause constriction of the blood vessels that provide nutrients and oxygen to the body’s tissues, causing healing to be slower. In theory, we live in a free country.  It is not my place to tell you not to exercise your right to smoke.  But please, give it a rest if you are going to have surgery.

A: It depends upon the person, their health, their activity level, and the joint or joints involved. For milder arthritis pains, modifications in shoe styles or custom foot orthotics can help relieve aching feet. Oral or topical anti-inflammatory medications can be prescribed, along with physical therapy in some cases. Cortisone injections can be given periodically to help relieve some of the joint pain and inflammation, and YES, it is possible to give these injections NICELY. For more severe arthritis, prescription braces may be prescribed, or surgical procedures may be appropriate, although surgery should always be considered a last resort, if simpler treatments are ineffective.

A: A joint fusion is a procedure designed to address pain and instability in a joint. Some joints are unstable due to excessive flexibility of the connective tissues connecting the bones. In other cases, arthritic may develop within a joint, rendering it stiff and painful. Joint fusion procedures can be used to stabilize joints that are excessively mobile, thus improving a patient’s ability to bear weight on the foot. In some cases, a joint fusion can eliminate painful movement at an arthritic joint.X-rays and examination of the foot are used to determine the nature of the joint problem and plan appropriate treatment.

A: YES. A difference in the length of the two legs can cause chronic pain and difficulty walking for several reasons. If the legs are of two different lengths, it can make you feel unbalanced when you walk, like you’re swaying side to side, like a weeble-wobble. The foot on the longer leg will try its best to compensate for this by pronating (flattening), which can cause painful, strained joints and ligaments. The difference in leg length can also cause severe back and neck pain, even scoliosis, as your spinal column tries its best to adjust to the difference. One of the simplest treatments for milder leg length differences is a pair of custom foot orthotics with a heel lift for the shorter side.

A: As we grow older, it is not uncommon for us to develop arthritis of the joints of the mid-portion of the foot. When joints become arthritic, the adjacent joint surfaces break down, leading to the characteristic spurring seen on x-rays of the joints. The top of the foot is a common location to develop arthritic spurs, which present as a lump at the top of the foot. Judicious shoe selection and padding can help avoid painful pressure in these areas, but surgery is sometimes necessary to address the arthritic joints and remove the spurs.

A: Metatarsal stress fractures are (usually) tiny cracks in the metatarsal bones behind the toe bones. They can cause pain, redness and swelling just behind the toes. They are usually related to normal walking in soft bones (such as is seen in osteoporosis) or excessive weight bearing on normal, healthy bones. This can cause hairline cracks in the bone, kind of like if you bend a pencil in your hands until it is just about to break and starts to crack just a little bit. That’s a stress fracture. This condition is usually treated with a rocker-bottom walking boot for 4-6 weeks and has a high success rate.

A: If you take a thermal image of your hand before a cigarette, the color will be warm shades of orange and red. TWO HOURS after smoking just one cigarette, if you repeat the thermal image, the colors will be cool shades of blue and green. This is from the constriction of the blood vessels in your hand from just one cigarette. The same process happens throughout the body, and it makes healing very difficult. Healing tissues need as much good blood flow as possible.

A: A neuroma is basically a pinched, inflamed nerve. It can occur in several areas of the foot, but it is most commonly seen at the ball of the foot, in between the metatarsal bones just behind the toes. It can cause shooting, radiating pain into the toes. Wearing wider shoes (like Dansko or Sanita shoes) can help, as well as prescription shoe inserts with special padding to relieve pressure from the balls of the feet. A cortisone injection can improve the symptoms of pain. There is also a series of injections that can be given to chemically inactivate the nerve. Surgical removal of the nerve is rarely required.

A: YES. Any lesion of the skin that does not look or feel right, or that begins to change in size, shape, color, or become painful or bleeds, needs to be examined and possibly biopsied. One patient dropped a can of peppers on her toe. The nail came off, and over a period of months, a blue-black discoloration developed on her skin. I performed a biopsy, and it turned out to be a malignant melanoma. She was referred to a cancer specialist immediately.

A: Children can develop true “growing pains” in their heels, generally around 10-13 years of age. The main portion of the heel bone, or calcaneus, is present at birth. However, at the very back end of this bone, a second portion of the heel bone develops at this age. It eventually joins up with the main part of the heel bone, but during this period of several years, it is susceptible to stress from a “tug-of-war” between the Achilles tendon and the ligaments on the bottom of the foot, especially in children who are athletic. Icing, activity modification, anti-inflammatory medication, and a short period of non-weight bearing casting is effective in treating this condition.

A: YES. One patient stepped on a sewing needle. Because of his diabetes, he did not feel it at first. By the time he did, he was starting to develop a serious infection. The infection put him in the hospital, and he developed gangrene and lost the front half of his foot. The rule with sharp things dropped on the floor is this: the one you do not find will find you. An ounce of prevention...

A: A bunion refers to a bump of bone just behind the great toe or the little toe. It is caused by the metatarsal bone just behind the toe and may be due to the shape of the bone or a gradual change in the angle of the metatarsal bone with respect to the toe. A hammertoe is simply a crooked toe and typically has contractures of one or more of the joints in the toe. The general rule for treatment of these is NON-surgical care initially, although many surgical treatment options may be available depending upon the person’s overall health.

A: Plantar fibromas are basically masses of painful scar tissue, usually located within the ligaments of the arch of the foot. They may be related to a history of trauma, or they may be related to chronic tension and stretching of the ligaments, such as seen with flat feet. Topical Verapamil 1% gel applied twice a day can often reduce the size and pain of these lesions. Orthotics can be made with special padding to reduce pressure on the fibromas. Surgery can be considered, but they have a high recurrence rate.

A: A plantar wart is a painful sore on the bottom of the foot caused by a viral infection of the skin. This is usually contracted by walking barefooted in public places where others have also walked barefooted. In the vast majority of cases, there is a special acid compound that can be used to create a tightly controlled “chemical peel” of the wart, resulting in a gradual and fairly comfortable removal of the wart over a period of typically 2-6 weeks. There are other treatments available, but they are rarely required. 

A: When a person has bunions, the metatarsal bone behind the great toe does not bear its fair share of weight, which leads to a shifting of weight-bearing pressure to the second metatarsal bone. This causes calluses to build up under this bone. Orthotics (Rx shoe inserts) can be made to off-load pressure from this area, and surgery may be an option for some people, to straighten the great toe and re-establish the normal weight-bearing structure of the foot.

A: Diabetes can be a vicious disease if not controlled. If it is not controlled, there are many potential effects it can have on the foot. Poor circulation into the feet can make it hard to heal from injuries or infections. Loss of sensation in the feet can jeopardize your ability to feel pain, and pain is sometimes necessary to alert you to an injury. Sweat glands in the skin can cease to function well, leading to very dry skin. Muscles can cease to function properly, leading to deformities to the feet. The calf muscles/Achilles tendons can become tight, leading to increased pressure on the ball of the foot. These various conditions can lead to the biggest problems- foot ulcers and possible amputation.

A: Injuries to the toes can result in many problems. When a toe or other part of the foot is injured, its bones can break or dislocate at the joints. There is a good chance that your toe bones were either out of alignment as they healed, or one or more of the toe joints were damaged and have developed arthritis. Radiographs will need to be taken to evaluate the position and health of the toe bones. Anti-inflammatory treatments, changes in shoes, or surgery may be indicated.

A: There is wisdom to our design. The ligaments on the outside of the ankle are loaded with special nerve endings that help us maintain our balance when walking and running. If these ligaments have been damaged by past injury, you may develop chronic ankle instability. An MRI will help identify the location and extent of damaged ligaments. If the damage is minor, physical therapy and ankle braces may do the trick. If the damage is more severe, surgery may be required to repair, or reconstruct, those ligaments. Surgery will typically be followed by additional physical therapy.  

A: Possibly. Over the years, our toenails can grow thicker, even discolored, due to the cumulative results of infection with toenail fungus. This depends upon a mix of environmental exposure, susceptibility, and foot hygiene, which varies from person to person. Topical (and in some cases oral) medication can be prescribed. A history of injury to a toenail can also make the nail become thickened and discolored over time.

A: The old saying, “if it ain’t broke, don’t fix it,” has merit. Flat feet do not necessarily have to be treated if they are not painful. In fact, some very young children “grow out” of this as they age. Painful flat feet can often be treated successfully in young children with prescription arch supports while the joints and ligaments of the arches grow stronger and more supportive with age. In some children, conservative treatment does not relieve the symptoms of pain. In that event, many different surgical procedures are available to correct this deformity and can be selected based upon the specific bone and soft tissue conditions of a given child’s foot. 

A: “Subungual” hematomas are collections of blood that can form under the toenails due to repetitive trauma. This is a common condition in runners, due to repeated “micro-trauma” from the ends of the toes bumping against the inside of the shoes. Wearing shoes that have plenty of room in the toe box will help, as will keeping your toenails from getting too long. Chronic injury to the toenails can lead to scarring of the nail root with permanent thickening of the toenails.

A: A common cause for this type of pain in the ball of the foot is a condition known as a neuroma, which is basically a pinched, inflamed nerve at the ball of the foot. It can be aggravated by tight-fitting shoes, squatting, and walking barefooted, especially on hard surfaces. A (nicely given) cortisone injection can relieve the pain and inflammation. Prescription shoe inserts called “orthotics” with special padding to relieve pressure from the balls of the feet are extremely helpful, long-term. There is another type of injection that can permanently put the nerve to sleep if cortisone does not provide enough relief.

A: It is most likely a ganglion cyst. These fluid-filled cysts most often appear on the top of the foot or the wrist. They are associated with herniation of the connective tissue around joints or tendons, often caused by pressure or injury to these tissues. These cysts may be painless, but at times, they may become painful, depending upon their location and size. Painful cysts can sometimes be drained in the office, although surgical removal is suggested for recurrent cysts.

A: An ingrown toenail is a common condition in which a portion of nail presses into the skin, causing pain, redness and sometimes infection. In order to relieve the pressure and pain, it is often necessary to numb up the toe and temporarily remove the ingrown nail corner. There is a MINIMALLY painful way to give the shot, too! A permanent correction can be performed, if this is a recurring problem. Oral antibiotics are prescribed for any infection present. The recovery is typically two weeks and involves warm Epsom salt water soaking, cleaning the nail border and applying topical antibiotic ointment. The toe may be just a little sore for one to two days after the procedure. 

A: During pregnancy, some women will tend to walk with the feet spread apart, which can cause the arches to stretch. This can cause increased pain in the ligaments of the bottom of the foot. Towards delivery, the body produces more of the hormone relaxin, which makes not only the ligaments of the pelvis, but also those of other joints (including those of the feet), more flexible, increasing strain of the ligaments of the feet. Prescription foot orthotics can provide much-needed support to the arches during this time.

A: You might have plantar fasciitis, a common cause of heel pain.  This is an inflammation of the band of connective tissue that runs from the heel to the ball of the foot. The pain is most common at the point where these ligaments attach to the bottom of the heel bone.  The most common causes are tight calf muscles, flat feet, obesity, and lack of arch support. X-rays are taken to rule out other potential problems like stress fractures. A nicely-given cortisone injection (YES, there is a way to do this!) often provides rapid relief. Prescription arch supports, icing and calf stretching exercises are also very helpful.

A: Limb salvage is a term that describes the goal of treating foot ulcers in such a way as to preserve as much of the foot and lower leg as possible. It generally applies to diabetic foot wounds and represents a coordinated effort between the podiatrist, vascular surgeon, endocrinologist, primary care physician and orthotist to heal foot wounds, minimize the need for amputation, and provide for a patient’s ability to be able to stand and walk. A rolling stone gathers no moss, as they say, and we want our patients to be up and moving as much as possible.

A: Gout is a very painful condition brought on by the precipitation of uric acid crystals within joints or the soft tissues.  It can be related to consumption of certain foods, i.e. shellfish and organ meats, as well as to dehydration, fluid loss and kidney disease, among other causes. Gout attacks leave part of the foot red, hot and swollen. It is a condition one usually notices upon waking up in the morning. Bloodwork is usually obtained to confirm this diagnosis. Certain dietary recommendations are made, and good hydration is advised. Cortisone injections often provide rapid relief of symptoms, and oral medication may also be prescribed to manage this condition.

A: Spelled “Charcot”, this is a condition usually occurring in diabetic patients who have a severe loss of sensation in their feet, which is called neuropathy. Charcot is a condition affecting the bones and joints, usually of the feet, in which the bones can literally crumble apart and dislocate out of place. This is a serious condition that increases a person’s risk of foot ulceration, infection and amputation. It usually requires a lengthy period of immobilization with a special brace or cast, medical management of blood sugars, and sometimes surgical stabilization of dislocated bones.

A: Your symptoms sound like a stress fracture of one of the metatarsal bones behind your toes. Imagine bending a pencil in your hands until it is just about to start cracking and break. That’s sort of what a stress fracture is like in your foot. It’s like the beginning of small, micro-fractures within the bone, occurring from over-use or from low bone density. Early symptoms are pain, redness and swelling. It may be hard to bear weight on your foot. X-rays often show evidence of the fracture within several weeks (maybe not right away). Pain medication can be prescribed if necessary, as well as an icing regimen to reduce inflammation. A special, rocker-bottom fracture boot is usually dispensed, which allows you to walk on your foot and greatly reduces the amount of weight bearing pressure transmitted through your metatarsal bones. Recovery generally takes 6-8 weeks, and surgery is almost never required for this.   

A: Yes, it can. When blood sugars are in a good range of about 80-120, sores on the foot typically heal in a timely fashion (as long as the blood flow into the feet and legs is good). However, if blood sugars run high, especially over 200, it becomes more difficult for the body to heal from sores. Podiatrists can help treat diabetic foot wounds, but it is also important for diabetic patients to work closely with their primary care physicians and/or endocrinologists to keep their blood sugars in good control.

A: Yes. Having been the recipient of both nice and not-so-nice injections in doctors’ offices over the years, I am very empathetic when it comes to injections. There are special needles that a doctor can order that are much smaller than the needles traditionally used when giving injections. I order these for use with my patients. There is also a type of baking soda solution that you can mix in with your injectable anesthetic, which makes the medication much less painful to administer. I also use a cold spray on the skin to further decrease the pain of the needle. Finally, if you just take your time and give injections slowly, they hurt much less. Be encouraged!

A: You most likely have developed arthritis in the ankle joint. This can develop whether the original fracture was treated by casting or by surgery. X-rays will be taken to evaluate the position of the ankle bones and the quality of the joint. Even with the best set fractures, arthritis may still develop. Sometimes, this does not require any treatment at all. In other instances, simple treatments such as cortisone injections or prescription braces may provide relief. Other times, surgery may be required to re-align bones that are out of place, to shave of bone spurs about the joint, or in some cases, even to fuse a badly arthritic joint.

A: Medicine has made much progress in the treatment of diabetic foot infections. The management of these challenging infections often requires a team approach, involving the medical doctor for blood sugar control, an infectious disease specialist for infection control, a vascular specialist to make sure the foot has the blood supply it needs, and the foot specialist to manage wound care and perform surgery when necessary. In even the worst foot infections, most of the foot, or even the entire foot, can be salvaged in about 90% of cases.

A: Yes, it can. The selection of an appropriate treatment depends upon the extent of damage to the Achilles tendon, how old the injury is, and the patient’s age, health and mobility level. In some cases, a walking boot with a heel lift or a cast with the toes pointed downwards may be all that a person needs to allow the tendon to heal properly. In some cases, surgery may be required to repair the tendon, in which case there are a number of procedures that can be performed to accomplish this. The recovery from this condition has a high success rate but often requires physical therapy.

A: If a patient experiences a recurrent, ingrown toenail, and if he/she is a good candidate for toenail surgery from a medical standpoint, the toe is gently numbed up with anesthetic, and the ingrown corner of the toenail is removed. The rest of the toenail is left alone. I then place several drops of an acid on the nail “root” at the base of the portion of toenail that I removed to keep that portion of the toenail from growing back and causing any more mischief. I use an injection technique that is minimally painful. Generally after two weeks of Epsom salt water soaks and topical antibiotic application, the toe has recovered from the procedure, which has a roughly 95% success rate.

A: YES, it is real. Generally, there is a history of some traumatic or very upsetting event in a person’s life that severely disrupts their sleep patterns for an extended time. This alters the normal production cycle of serotonin by the body, which can make the central nervous system hyper-sensitive to pain. In the feet, as elsewhere in the body, fibromyalgia can make conditions that would normally be painful even more painful. Because of this, treating patients with fibromyalgia often takes a little extra time, patience and understanding.

A: A typical “bunion” is a structural abnormality of the alignment of the bones of the great toe and the metatarsal bone just behind it. It is usually an inherited condition that worsens with time. The rule of thumb should be non-surgical care initially. This may involve prescription orthotic shoe inserts, changes in shoe style, icing, padding, cortisone injections, or oral anti-inflammatory medication. If a reasonable period of simple, non-surgical care does not relieve the symptoms of pain, and if the patient is a good candidate for surgery from a medical standpoint, there are many different surgical procedures to correct a bunion deformity. This typically involves some carpentry work to re-align the bones, tendons and ligaments that control the position of the great toe. Judicious selection of the appropriate procedure typically leads to a high rate of success.

A: Growth plates are areas of bones where the bones are still growing. For example, the long bones of the legs have growth plates that allow the leg bones to grow as a child grows. These areas eventually close when the bones stop growing. However, these areas of bones are susceptible to injury. Sometimes the growth plates at the back of the heel or the side of the foot (at the base of the 5th metatarsal bone) can get inflamed by blunt trauma or by tension and stress from athletic activity. These may require oral anti-inflammatory medication, icing, or sometimes several weeks of non-weight bearing with a cast and crutches to heal. If a child sprains his/her ankle, sometimes the bones can break or dislocate along the growth plates. These injuries are more serious and often require casting, sometimes even surgery to set the bones.

A: Warts are caused by a viral infection of the skin. Although there are many treatments available, I have had the best results with regular trimming of the warts with application of a special, very concentrated acid preparation. This is painless to apply and is washed off with soap and water in 24 hours. Most people have only mild discomfort for perhaps 2-3 days afterwards. The acid causes a superficial, chemical peel of the top layer of skin where the wart virus lives, creating some callus and blistering, which is then gently trimmed back in two weeks. If there is any remaining wart tissue, the process is repeated. Most people experience a complete cure of the wart in 2-4 treatments, with no scarring and no recurrence.

A: If someone has an ingrown toenail and lets it go, the nail can keep ingrowing and literally cut into the skin at the side of the toe as the skin becomes more swollen. Talk about painful! Once the skin is cut, bacteria on the skin surface can then enter the toe and cause infection. If this condition is treated promptly, antibiotics and removal of the ingrowing side of the toenail can stop this from getting worse and allow the toe to heal. However, if this is not treated soon enough, it is possible that the infection can get worse and even spread into the bone beneath the toenail. This requires much more work, including surgery and sometimes even intravenous (IV) antibiotics to treat.

A: Absolutely. High-arched feet absorb shock poorly, which can place too much pressure on both the ball and the heel of the foot, leading to a premature thinning of the fat pad in these areas. This in turn can make the foot absorb shock even more poorly and can lead to the development of inflamed, pinched nerves on the bottom of the feet (neuromas). Excessively high weight bearing pressures are transmitted through the metatarsal bones behind the toes if the arch is too high. This can lead to the development of painful arthritis in the mid-portion of the foot. High arches are also frequently associated with the development of contractedtoes (hammertoes).

A: This sounds like PAD (peripheral arterial disease), AKA poor circulation in the legs. If PAD is not treated, it can be a risk factor for amputation. If there are blockages in the blood vessels that carry blood from the heart to the feet, the amount of blood flow is restricted. During exercise, leg muscles require more blood and oxygen. If they cannot get enough, the muscles will begin to ache. This temporarily improves with rest. Many signs of this can be found on the feet, and simple tests in the office can tell me if you need to be referred to a circulation specialist for further treatment.

A: Flat feet benefit from having a strong arch support to hold up their arches, thus taking pressure and stress off the ligaments and bone structure of the feet. High-arched feet absorb shock poorly and often develop thinning of the fat pad at the balls of the feet. Orthotics with thick cushioning and special “metatarsal” pads shift pressure from the balls of the feet to just behind the balls of the feet, relieving painful pressure. This kind of orthotic can also help relieve pressure on a Morton’s neuroma at the ball of the foot. Leg length differences can often be addressed with orthotics by adding a heel lift to the orthotic on the short side.


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