Answers to Your Questions
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Disclaimer: Answers provided are meant to be general in nature and are not a substitute for professional medical advice. For specific advice on your own medical situation, consult your physician.
Q: I had bunion surgery a couple of weeks ago and my foctor informed me that I am now able to wet the foot, but she still wrapped the foot in some gaws. Do I remove the gaws when I shower? And how long do I keep the gaws since the next time I will see my doctor will be in the next three weeks. She said I can now walk on my foot and should move into sneakers within the next week. Thank you. Sandra, Boston, MA
A: Given that you had bunion surgery recently and remain under the care of your surgeon, it is probably prudent for you to contact and follow the specific instructions of your surgeon as each surgeon's post-operative care instructions will vary. Dr. Thanh Dinh , Podiatry
Q: About 6 weeks ago after running 3 miles the outside of my left foot started to hurt later in the day. I am athletic (usually do cardio 5 days a week), but haven't run in a year or two. After a day or two of limping I noticed a small pea sized bump under the skin and it began getting larger. I went to my GP 5 days after the pain started and they refferd me to a podistrist. They said it was either a stress fracture or cyst. The x-ray was clear and I was told to come back in 1 week. It left better after a week (so I just took it easy for 2 weeks and CNL the appointment). The bump went down in size and I was walking normal so I decided to not reurn to the doctor. A week later it came back and the pain was there as well. I waited until 5 weeks after the initial pain and decided to visit an orthopedist instead since there was no relief in sight. This doctor took an x-ray (and gave me the same 2 diagnosis'). It could be a cuboid bone stress fracture, a cyst or arthitis (I'm 37 and active). It's now been 6 weeks and it hurts a lot (walking/wearing shoes/laying in bed). The knot/bump is larger and feels rather hard. I'm afraid aspiration could be painful if it's not a cyst. An MRI sounds expensive, but the pain is enough to go back sooner (he wanted to see me in a month). What's your opinion. Do I visit the podiatrist or orthpedist? Should I get an ultrasound first? Thanks. Melissa, Texas
A: Melissa, first I would like to say that this case is difficult to diagnose without a physical exam, but given that both practitioners arrived at similar diagnoses I believe that the stress fracture or cyst sound like plausible conditions. Based on the information you have provided I think that a cyst seems more likely since the size of the bump and pain reduced with rest. Other diagnoses are possible including stress fracture or a partial tendon tear. The MRI although potentially expensive will help differentiate all of these conditions. Ultrasound is an option but really won't be useful for anything beyond the cyst diagnosis. Aspiration with or without cortisone is occasionally a treatment option, but may not be the most effective. Either a podiatrist or orthopedist is fine. Dr. Emily Cook , Podiatry
Q: I have foot conditions ( metatarsalgia and arthritis) in my feet that are causing me pain. I currently have flexible orthotics that aren't doing a good job of stabilizing my feet and easing the pain. My question is what kind of orthotics would be prescribed for me at the BI center and how would an impression of my foot be made? Thank you in advance, Diane, Somerville, MA
A: The type of orthotics made and the method of casting for your specific foot condition would be individually determined by the doctor evaluating your clinical condition in the office. Most doctors dispense both hard and soft orthotics, depending on the patient's condition. Furthermore, casting methods can be non-weight bearing plaster casting or weight bearing foam casting, depending on the pathology present. In your specific case, your failure to improve with the previous flexible orthotics would be taken into consideration in fabricating new orthoses. Dr. Thanh Dinh , Podiatry
Q: My husband has very prominent bunions of both feet which he is finding painful. How does one proceed with setting up an appointment for eval and treatment. Our preference is to be seen and treated by a private doctor. We have very good insurance. Thank you. Michelle, Tiverton, RI
A: Any painful condition of the foot, including bunion deformities, should be evaluated by a doctor. You should set up an initial appointment by calling the doctor's office to make an appointment for an evaluation. Our appointment information, including office locations and directions, are available on our website. While the doctor will evaluate your foot and likely take new x-rays, it is recommended that you bring all records and previous x-rays of the foot condition to the appointment. Dr. Thanh Dinh , Podiatry
Q: I have bunions and severe arthritis in my big toes (R > L). The problem has been ongoing for several years now, but I have continued to work out approximately 4 times a week (high impact cardio like kickboxing and running). Last Fall, on the advise of my orthopaedist, I started wearing Sketchers® shape-ups. This has allowed me to continue to exercise regularly. (Recently, I injured my heel and my orthopedist diagnosed me with plantar fasciitis. That seems to be under control now. I've decided to reduce my cardio to more low impact stuff w/ doing more yoga and pilates.) The arthritis in my toes continues to interfere with my daily activity. I'm considering surgery but don't know what the long term consequences will be. If I had an joint replacement, how limited would I be permanently? What are my options? What you recommend? I am 45. Diane, Atlanta, BA
A: Diane, arthritis in toes is a common problem but does not have a simple solution. Arthritis is often progressive with many different potential causes. If the pain from this problem is diminishing your quality of life and preventing you from staying active, then it is recommended that you see someone who specializes in foot and ankle surgery. This physician will determine the underlying cause or causes of the arthritis as well as stage the severity of the arthritis. This, in combination with your physical examination and assessment of your complete medical history, will determine the treatment recommendations. Treatment may include conservative management such as orthotics, injections, physical therapy, or medications. Surgical management may also be recommended, one of which may include joint replacement. Whether or not to recommend joint replacement depends on a variety of factors which includes but is not limited to the severity of the arthritis, the clinical and x-ray examination, and your medical history. If joint replacement is recommended then you will need to speak with your surgeon regarding the specific risks and benefits as there are different joint replacement options. The goal of joint replacement is to relieve pain and maintain some motion of the joint as opposed to a joint fusion (which eliminates joint motion that was the cause of pain). Joint replacement and joint fusion have their advantages and disadvantages, both of which are dependent on the clinical and medical evaluation. Dr. Emily Cook , Podiatry
Q: My mentally challenged forty two year old son with type 1 diabetes for 22 years just tore one half of the third and forth toe nails off when they were caught in a sock - there is no bleeding but the nail is ragged and the skin slightly pink - what is the best treatment. Alice, Andover, MA
A: Thank you for your question, Alice. Patients with diabetes have to be especially careful with their feet. Foot problems is one of the most common complications of diabetes. Torn nails can be problematic for several reasons. First, the torn jagged edge can cause lacerations (cuts) in adjacent toes, creating a potential entry point for bacteria. Secondly, if nail plate is loose and jagged, it can catch on socks and be torn a second time. Third, when the nail is torn, it can also tear the underlying skin or nail bed. This now creates an open wound that can become infected.
The first step in your son's case is to stop any bleeding by applying gentle pressure to the nail bed, cleanse the nail bed with an appropriate antiseptic and cover the nail bed with an antibiotic cream. The second step is to have it evaluated by a professional to see if any additional treatment is needed, for example for cleansing of the nail bed or oral antibiotics. At a minimum, any sharp jagged edges should be trimmed to avoid causing any further injury. This should be by doctor familiar in treating diabetic foot problems. Dr. John Giurini , Podiatry
Q: My brother in-law is 34 yrs old found out about 7 yrs ago that he has diabetes. It is out of control. He got an infection in his foot a couple of years ago and has lost 3 of his toes. the infection has moved up his leg and is now in both legs. They are really big, swollen and black. He weighs about 450lbs. Currently he can not walk his dr keeps giving him antibiotics but its not helping. I need to find a local Dr and fast. My fear is he wont be with us much longer. can you help me please? Leslie, Watsonville, CA
A: Leslie, thank you for your question. I am sorry to hear of the serious situation your brother-in-law finds himself in. From what you describe, it appears that your brother-in-law may have severe vascular disease in addition to an infection. When infections do not respond to appropriate antibiotics and toes or feet change color, it can often be the result of blood flow to that area that is severely compromised. This is a very serious condition and requires immediate attention and action. Vascular studies and a consultation with a vascular surgeon is warranted in this scenario.
Vascular disease is a common complication of diabetes. Like all complications of diabetes, it is most commonly related and exacerbated by the number of years someone has had diabetes and their diabetes control. The longer someone has had diabetes and, more importantly, the poorer control of their diabetes they exhibit, the more likely they are to develop any of the complications of diabetes. Vascular disease is only one of these complications. Neuropathy is the other common complication of diabetes. The combination of the two in any one patient can have very serious and life changing effects.
Because of the personal nature and urgency of your situation, I will contact you and respond personally with specific recommendations. Dr. John Giurini , Podiatry
Q: Dear Dr. Rosenbloom: I have Hallux Limitus or Hallux Rigidus for the past 6 years in both feet. I have done all sorts of things to make my feet feel better - half orthotics, Merrill shoes with very stiff soles, Dansko shoes, etc. I now have a Morton's extension full orthotic and I sometimes wear "Drew" sneakers which have a "rocker bottom" sole, but they are disguised to look like regular sneakers. I wear the orthotics in these sneakers and I have found relief from my pain most of the time. The sneakers have a very wide toe box and are comfortable. I have done a tremendous amount of research in this area to try and help myself. I am even able to walk and listen to my i pod with these sneakers. My question is: Is there anything else that I can do to slow down the progression of this condition? How will I know when I need surgery? Also, what is the best kind of exercise to do without aggravating this condition? Currently I use an elliptical machine frequently. I don't want to have surgery. I am 55 years old. I love to work out and I used to be a tremendous tennis player before my feet started hurting me. I still want to be able to walk long distances. Right now after 1 and a half miles, I have to stop because of foot pain. I would definitely be your patient if I lived closer, but I live in Florida. I would love to find the right surgeon to do this. Do you have any recommendations in South Florida? Again, thank you so much for all that you do with your website. Take good care. I am very grateful too, that you are taking the time to read my long email. Thank you! Linda, Boca Raton, FL
A: Linda: It sounds as if you are currently able to do the activities that you would like to do. Any activity that attempts to bend the big toe may aggravate the condition, but if the shoes are modified appropriately, this may not always be the case. An elliptical machine is a good choice; running may be too demanding on the joint. Regarding when to have surgery, I believe that that time occurs when the symptoms are not controlled by non-surgical means, and you are unable to do the activities you either want to do or need to do on a a daily basis, without pain. As for what surgeon should do this, I would need a better sense of what cities/towns are near you to make that recommendation. Dr. Barry Rosenblum , Podiatry
Q: I have been getting about 7 plantar/mosaic warts treated on the soles of my feet for 5 years. Recently have made some good progress on all but one site. Do you know where I can get it removed by laser, if it continues to be aggressive and non-responsive? (I have tried cyro , bleomyicin injections, formaldehyde, and oral cemetidine!) Jeffrey, New York, NY
A: Plantar warts can be tenacious to treat as they may take several months, even years, to fully resolve. It is important to remember that the majority of wart treatment involves killing the skin the wart resides in. This may involve freezing the skin (cryotherapy) or burning the skin (salicylic acid or laser therapy). It sounds like you have tried various methods with little improvement and are considering laser therapy. This is perfectly appropriate before you proceed to having the wart removed surgically. While I don't have any specific names for you, you may be able to locate a provider who offers laser treatment by doing an Internet search or looking in your local yellow pages. Additionally, your primary care provider may be able to supply you with the name of someone locally. Dr. Thanh Dinh , Podiatry
Q: I am a 39 year old mother of three young children. I had bunion surgery on both feet in 2008 and have been diagnosed with Morton's Neuroma in my right foot between the 2nd and 3rd toe. I walk with a limp now from the discomfort of my right foot and can feel a neuroma starting on my left foot. I tried a series of 3 cortisone injections that were discontinued after no relief. I tried acupuncture with no relief. I am now ready to proceed to alcohol injections but have read that it is wise to have the injections under ultrasound guidance. Do you agree? Do you agree? Do you perform them this way or do you inject without the use of an ultrasound? Jennifer, Duxbury, MA
A: I have provided alcohol injections with and without the use of ultrasound. To date there is no convincing evidence that ultrasound guidance for neuromas provides any additional benefit or accuracy. Ultrasound is also highly operator dependent, that is, upon the person administering it. There are many injections that physicians safely administer throughout the body without the use of ultrasound or imaging. Dr. Emily Cook , Podiatry
Q: Hi, I believe I have planters fasciitis. I have Network Health and this only covers non routine visits. If a doctor can diagnose my condition as Planters would that constitute insurance coverage and do you have experience with Network Health allowing for treatment? Also is there good results in treating this condition of the lower foot ligament as it is hard to find shoes? Thanks. Robert, Needham, MA
A: You will have to check with your benefits manager or the insurance company directly about your coverage. As for plantar fasciitis, it is most commonly treated with a combination of a supportive shoe, an over the counter insert and stretching exercises. A good running shoe, walking shoe or hiking boot is an example of a good supportive shoe. You can find these in most running shoe stores. In more resistant cases it may require a formal course of physical therapy or even a cortisone injection. Most cases of plantar fasciitis will respond to this regimen and few will need more aggressive treatment. For more in depth information, scroll down this web page to read the numerous questions previously answered about plantar fasciitis. Dr. John Giurini , Podiatry
Q: I have had plantar fasciitis for almost 3 years. I recently had x-rays indicating bone spurs as well. Pain has increased significantly and is radiating up the legs with concentration in the ankles. Is a podiatrist the person to see or maybe an orthopedic doctor? Leslie, Hanover, MA
A: Thank you for your question. The presence of a spur on x-ray does little to change the diagnosis of plantar fasciitis, however, if the pain is radiating to the ankles or higher, there may be an additional cause, such as tendinitis or irritation of a nerve. As for which specialist to see, there are orthopedic surgeons who see foot and ankle problems, although not all do. On the other hand, podiatrists concentrate solely on problems of the foot and ankle. Hope this helps. Dr. Barry Rosenblum , Podiatry
Q: Why do my feet feel stiff and painful when I wake up and first walk in the morning or when I have been sitting for awhile? What can I do and what does this mean for the future? Michelle, Newton, MA
A: Dear Michelle - What a wonderful question! I am so glad you asked this! I get asked this question all the time. It is a very common complaint that I suspect most people have or will experience. During the course of the day, we put a great deal of stress on the various structures of the foot. Overnight, there are likely areas of low grade inflammation in tendons, joints and ligaments that may manifest once the foot remains still when sleeping. As part of this, there may be a slight amount of swelling that is usually not detectable with visual inspection of the foot. When you first step down in the morning after arising, the foot feels stiff until motion of these affected parts and likely your body weight help to "milk out" the swelling. This typically could take a few seconds to several minutes. In most cases, it is of little consequence and probably is a sign of becoming less young.
What can you do? As long as it does not deter you from your normal routine, I would advise not worrying about it. If it is more acute and worsens rapidly, it may be worth having evaluated. Thanks Michelle for that great question! Have a good day. Dr. Thomas Lyons , Podiatry
Q: Do you treat foot problems caused by arthritis? Sylvia, Boston, MA
A: Yes. Arthritic conditions of the foot are very common and seen on a daily basis. These conditions include osteoarthritis, also referred to as "wear and tear" arthritis. This is commonly seen with age though not necessarily with "old age". Osteoarthritis can also occur in patients who have sustained an injury. In this case it is considered traumatic arthritis. Other arthritic conditions include inflammatory arthritic conditions such as rheumatoid arthritis and other forms of arthritis similar to rheumatoid arthritis. As with many foot complaints of pain associated with arthritis, simple measures are often tried first to provide relief. When simple measures fail, surgical considerations may be considered. Dr. Thomas Lyons , Podiatry
Q: The heels on both of my feet hurt quite a bit. I saw a doctor on the south shore and received x-rays, physical therapy and a cortisone injection. I currently wear a night splint at bedtime. Unfortunately nothing has worked. The x-rays indicated a bone spur on each foot on the inside of the heel at the back of the arch. After all that has been done, is the next step surgery? Janise, North Easton, MA
A: Plantar fasciitis, also known as heel spur syndrome, is one of the most common and most frustrating conditions we see. Most patients have suffered with this condition for 6 months or longer by the time they seek medical attention. Therefore, it has become chronic and more resistant to treatment by conventional methods. The typical course of treatment can, and should, include physical therapy, shoe gear modification, orthotic devices and anti-inflammatory medications. The next tier of treatment includes injections, night splints and, in severe cases, immobilization with a brace or cast. Finally, if all conservative measures fail, surgery remains an option. The benefits of surgery should be weighed against the potential risks of infection, delayed wound healing and possible nerve injury. Therefore, patients who go on to surgery typically have difficulty functioning during the day and are limited in their ability to exercise. Dr. John Giurini , Podiatry
Q: I need to find the best reconstructive foot surgeon available. I have had 3 surgeries to correct a broken foot. I am club footed and the second row of bones behind my small 4th and 5th toes have been bridged with steel for support. The plates are cracked. I know I can not do want I once could. I am a 57 year old male and a historic preservation trades person, working with historic masonry,working from platforms ladders. I know I have to stay on the ground. I also know bone is like wood, it can be repaired so many times. I recently had a chest x-ray and they did my foot as a favor, since I told them I had a recent problem. I guess it's legal to copy this CD and send it to you. I am a retiree from Howard County, Maryland with Aetna PPO health insurance. I'm looking for the best surgeon and reconstuctive procedure and am willing to travel. Is someone able to talk to be about my condition. Thank you in advance for your time. Best regards, J. Michael Logan, Waynesboro, PA
A: Thank you for your question. It appears you have a very complicated situation and have already had several surgical attempts at correcting this problem. Without the benefit of an x-ray or an examination, it would appear that a complex reconstructive surgery may be needed. Reconstructive surgery is very involved and very high risk. It is also unpredictable in its outcome. To improve the outcome of such surgery, close follow-up and monitoring is extremely important in our experience. Regular office visits or cast changes, often weekly, are needed. Additionally, it is not uncommon that complex surgeries of this type may require additional surgeries. It is rarely a "one and done" scenario. For that reason, the best advice I can provide you is to find a qualified foot and ankle surgeon in your area if at all possible. So, the next question is "What constitutes a qualified foot and ankle surgeon"? The website www.footphysicians.org can provide you with a list of foot and ankle surgeons board certified in reconstructive foot and ankle surgery in your geographic area. The individual you select should have extensive experience in the correction of complex deformities of your type (i.e. residual clubfoot). In many cases, this is more than just a foot deformity and may involve the ankle or even the lower leg. Dr. Philip Basile, Podiatry
Q: Age 47. Last July, I was diagnosed with plantar fasciitis and was sent to physical therapy. After treatment, I was still not much better, so I got a second opinion and was then diagnosed with flexor hallucis longus tendonitis. I was sent to a chiropractor, and again after a few months of treatment, I wasn't much better so my podiatrist sent me to another chiropractor who specializes in ART (Active Release Technique). Again, after a few months of treatment (3 times a week) I am not much better. The problem exists in both feet, more so in my right foot. Arthritis has been ruled out and an MRI was done on my back and there were no problems with my back. After I am on my feet for a couple hours either working, doing housework, or errands, etc., not only do my feet hurt, but my legs, knees, hips and back hurt too. I have spent a few thousand dollars in less than a year, and have had minimal relief. All my blood work has checked out fine too. I don't know what to do anymore or where to go for help. I have 3 children, work and have very busy lifestyle. I have been told that the muscles in my calves and legs are very tight and I have been doing at home exercises and stretching, icing, etc. almost everyday. Can someone please help me.? I don't know what to do anymore. Thank you. Lynne, Lowell, MA
A: Lynne, first, let me apologize for the inordinate delay in responding to your question. You clearly have significant problems with your feet and several differing opinions. In light of that fact, I decided to review your situation with several of my colleagues before responding to your question. Consequently, the delay in my response. From the history that you provided, it appears you have had several tests to try to diagnose your condition and have had a variety of different treatments. I see that you have had blood tests, an MRI of your back and several forms of physical therapy. However, I do not see any mention of specific studies on the feet, for example an MRI or possibly nerve conduction studies to evaluate for a nerve problem. After discussing with my colleagues, I would suggest that a fresh start is needed here. I would need to take a complete history of the problem and perform a complete lower extremity physical examination. I would also need to review records of any past evaluations or treatments, including any test results available, including blood tests and radiologic studies. This is the only way I could provide you with a more in depth response. Unfortunately, a forum such as "Ask the Expert" does not allow for such detailed review and evaluation. Dr. Philip Basile, Podiatry
Q: In 2002 I had podiatric surgery to remove a bunion from the L great toe. After the surgery the doctor told me that due to degeneration of cartilage in the joint, I would need joint replacement of the great toe joint. I am now in considerable pain; and, would like to pursue joint replacement in the very near future. Is this done at the Beth Israel Deaconess and if so, can you comment on the experience of any podiatric surgeon who may do this? Thank you for any info and advice you may provide. Peter, Moultonborough, NH
A: During routine bunion surgery it is not uncommon to discover more joint damage than predicted by preoperative x-rays. X-rays do not always tell the whole story. Osteoarthritis ("wear and tear" type of arthritis) is a progressive condition, that is,it often gets worse with time. When it occurs in the great toe joint, it can be very painful and can limit all types of activity, even normal day to day activities. Joint replacement is one way to treat osteoarthritis. However, there are several considerations that need to be considered to determine if you are the right candidate for this procedure. Age, activity level and condition of the bone accepting the implant are some of the most important considerations. In order to determine if joint replacement is right for you, an evaluation by a foot surgeon knowledgeable in joint replacement is necessary. The foot surgeons in the division of podiatry at the Bi-Deaconess Medical Center are well versed in this procedure, performing it on a regular basis in the appropriate situations. This would be a good place for you to start. Dr. John Giurini , Podiatry
Q: I have been to many physicians for treatment of plantar fasciitis. My treatment has included orthotics, laser, and physical therapy. My final option of surgery to sever the fascii worries me because the last doctor response was that he did not know if it would work and if it doesn't, I could have permanent damage. I have daily, consistent pain and I am now experiencing knee and leg pain/swelling. Do you know of other options/treatments I could pursue? Thank you. Karen, Sharon, MA
A: Thank you for your question. Plantar fasciitis is one of the most common problems we see. It can also be one of the most frustrating conditions to treat. Your story is not unusual.
If you are compensating for the foot pain by altering the way you walk, you may in fact experience knee and leg pain. However, it could also be something totally unrelated. An evaluation by an orthopedist could be warranted. As for the chronicity and lack of response to treatment for the plantar fasciitis, additional opinions and tests prior to surgery may be needed. You mention that you had orthoses and physical therapy. But you do not mention if you had injections or night splints or an MRI.
In the end, if all conservative measures fail to relieve the pain of plantar fasciitis, surgery is an option. It should be performed by a surgeon board certified in foot surgery and who has performed this procedure a number of times. While there can always be complications to any surgical procedure, it can be helpful in alleviating your pain. Dr. Philip Basile, Podiatry
Q: On my large right toe, I have had a ganglion cyst surgically removed in April 2009, and another one on the same toe removed in January 2010. I now have another ganglion cyst on the same toe. It has been drained, but it is growing again. Is this a diabetes issue? Also how can these be prevented? I am concerned about the number of surgeries that the toe can handle and would like to see an other doctor for a second opinion. I am willing to travel to Boston. Please indicate in your e-mail either in your name or the subject area identifying the medical center, since I do not open e-mails that I am not familiar with. Thank you for your time. Susan, Granby, CT
A: A ganglion cyst is a tumor or swelling on top of a joint or the covering of a tendon. It looks like a sac of liquid containing a thick, sticky, clear, colorless, jellylike material. Depending on the size, ganglionic cysts may feel firm or spongy. They may or may not cause symptoms.
As with many problems of the foot, conservative measures are typically tried first. In some cases, observation may be considered as ganglions have been known to spontaneously resolve. Other measures include aspiration or removing the fluid with a needle under local anesthesia. Sometimes this simple maneuver may effectively treat the ganglionic cyst. Aspiration may be followed by a compression wrap to keep pressure on the area after the fluid is removed. In some cases, medication is injected into the ganglionic cyst after the fluid is removed.
Beyond this, surgical intervention may be considered where the cyst is excised and the connection to an adjacent joint or tendon structure is identified and tied off. Recurrence is a possibility after surgical excision. If after surgical excision the ganglion recurs, an attempt at identifying the site or origin of the ganglion may be considered. This may involve the use of an MRI or ultrasound. The goal at this point would be to obtain as much information about the ganglion and its origin to effectively excise and minimize the chance for recurrence. Dr. Thomas Lyons , Podiatry
Q: My right foot "feels" different: there is some discomfort if I point my toes. Sometimes at night I have a painful "cramp" in this foot. Sometimes there's a little tingling. I'm getting more calluses. Do I need to see a doctor? Do I need stretching? I don't wear high heels. Thanks. Evelyn, Boston, MA
A: Painful nighttime cramps are a common problem and almost everyone experiences some type of cramp in their lifetime. There are many causes of cramps with the most common causes including malalignment or structural problems ( flat foot, high arches, toe or bunion deformities, knock knees, etc), foot/leg positioning (type of shoes and activities), dehydration, or electrolyte imbalances. There are many other causes as well which may include medication causes, neurologic disorders, and several other medical conditions. There are also multiple causes for tingling of feet which can range from wearing shoes that are too tight to more serious back and neurologic disorders.
If this continues to be problematic, a medical evaluation would be necessary to determine the source of your cramping and tingling. Developing more calluses on your feet suggest that you may have a structural or malalignment problem. A podiatric physician would be able to review your medical history and provide a full lower extremity biomechanic examination. If structural or malalignment problems are found, this physician would be able to recommend treatment options based on the specific problems identified. Dr. Emily Cook, Podiatry
Q: Am considering corrective foot surgery. I live on Cape Cod and would find going off-Cape a problem. Can you recommend a well-qualified podiatric surgeon here on the Cape? Thank you. Avis, Hyannis, MA
A: Thank you for your question. It is perfectly understandable that you would like to have your foot surgery and after care close to home. This is not uncommon. While there are many qualified podiatric surgeons in Massachusetts, choosing the one that is right for you will depend on what type of surgery you are in need of having. Therefore, it is more appropriate to provide you with a list of questions and qualifications to ask about than an actual name.
First, you should make sure that whichever podiatric surgeon you choose is affiliated with a hospital, both from the standpoint of where the surgery will be performed but also in the event that a postoperative complication should occur. Also, surgeons with hospital privileges have undergone an extra level of scrutiny and review. Next, find out if that podiatric surgeon is certified by the American Board of Podiatric Surgery (ABPS). This is the only certifying board for foot surgery. Board certified individuals have undergone a rigorous process of written and oral examinations. Additionally, they are required to have been in practice for a minimum of 5 years and to have submitted for review a predetermined number of surgical cases of varying degrees of complexity. A list of board certified podiatric surgeons in your community is available from the American College of Foot & Ankle Surgeons website, (www.acfas.org). They will be identified as Fellows of the College. Finally, it is not unreasonable to ask your chosen surgeon if they are board certified, how many years they have been in practice and how many of a certain procedure they have performed in a given year.
While these complications can always occur even amongst the best of surgeons, having the answers to the above questions will give you the confidence that you are in the best hands for a successful outcome and management of whatever complications may come along. Best of luck to you. Dr. John Giurini, Podiatry
Q: I have a bunion on one foot, which seems to be growing, & is becoming more painful. What advantage, if any, is there to seeing a podiatrist (probably not covered by insurance) versus seeing an orthopedist with a specialty in feet (probably covered)? Audley, Cambridge, MA
A: First allow me to address the question of insurance coverage. I'm unaware of any insurance providers that would allow for treatment by an orthopedic surgeon but not a podiatric specialist. Both specialties require four years of post-college education followed by an approved residency. Both specialties utilize the same billing system submitted to insurance that are used throughout the medical profession. For example, if a podiatric surgeon or an orthopedic surgeon were to correct a bunion surgically, both procedures will be covered or not covered depending on the specifics of your insurance package regardless of the surgical specialty.
Next, what are the benefits of seeing a podiatrist/podiatric surgeon versus an orthopedic surgeon with sub-specialization in foot care? In recent decades there seems to be more similarities than differences. A podiatric surgeon/podiatrist will have completed several years of residency with the large proportion of surgeries being related to foot or ankle. Most orthopedic surgeons with a specialty in foot care have completed a general orthopedic residency followed by a year-long fellowship in foot and ankle care. The difference comes down to emphasis.
Finally, I'll address your bunion problem. Bunions generally become more painful as the deformity increases because of prominence of the bone or worsening of the arthritis from the mal-aligned joint. Treatment is largely dependent on your specific deformity. Conservative care like anti-inflammatory medications or shoe modifications may reduce your symptoms. Other individuals may require surgical correction. I'd suggest contacting a care provider for an evaluation to see what your specific needs may be. Dr. Jeremy Cook , Podiatry
Q: I injured my foot last August and have had pain in the foot and ankle area since then. Two MRI's have diagnosed me with Posterior Tibial Tendon Dysfunction and Arthritis in my big toe. A tingling feeling in my foot started in January. My doctor wanted a Nerve Test performed which is scheduled for 4/28. Will the nerve test determine if surgery is necessary? Staying off my feet completely is not an option. I've been wearing an ankle cast since January without any improvement. I'm getting tired of tests without anything being done to stop the pain or tingling. Betty-Jo, Eastham, MA
A: The test that is being ordered is only part of the information needed to determine if surgery is necessary. First, it is necessary to determine where the tingling is. If it is in the toes, it may be a local nerve problem. If it involves more of the foot, it may involve a larger nerve near the ankle or even further up the leg or in the lower back. The test may help to sort that out. Having posterior tibial tendon dysfunction, if that is what you have, suggests in many cases that a foot flattens or pronates. This may stress the nerve and cause irritation of the nerve based on abnormal foot mechanics, that is how your foot functions when you walk. Controlling the abnormal mechanics may solve the problem. The key is to determine the source of the pain and the source of the tingling. Treatment is usually initiated in a nonoperative fashion to determine what works and how the symptoms resolve. If conservative measures are unsuccessful, surgical options may need to be considered if necessary. Dr. Thomas Lyons, Podiatry
Q: I have a bunion on my left foot. I bought wide sneakers to help with this pain. So far it seems to be working. The problem is with the toe next to my big toe and the ball of my foot. I have a constant pain in my toe and the ball of my foot is very tender. This is causing pain when walking. Also the constant pain in my toe wakes me up at night. Do you have any suggestions that I can try to cure the pain and swelling in the ball of my foot? Also how to get the toe to stop throbbing? Diane, Merrimack, New Hampshire
A: Pain associated with bunions is fairly common, and the fact that you've had improvement with that pain after a simple shoe change is encouraging. The underlying structure that results in your bunion is referred to as the first metatarsal. It is important for normal walking, as it carries a significant amount of your body weight. In some individuals, the pressure of walking causes instability in this bone relative to the rest of the foot. As a result other bones are forced to carry more of your weight. Over time these compensating structures can fatigue and wear down predisposing you to additional functional limitations. Based on the symptoms you have described there are several possible diagnoses. These range from conditions as mild as metatarsalgia (an inflammation of structures adjacent to the ball of the foot) to more concerning diagnosis like a stress fracture. Various methods such as padding and rest may be adequate to treat the former condition, but rest and clinical examination are critical to the latter diagnosis. The toe throbbing you experience at night could also be symptomatic of a nerve entrapment. For now, I would suggest rest (avoid strenuous exercise) and daily ice pack applications for 10-15 minutes to the area. If icing increases your discomfort then discontinue this therapy. If you do not notice improvement or if you experience progression of your symptoms then contact a professional for a clinical exam. Dr. Jeremy Cook , Podiatry
Q: I want to know what the deal is with those new "shape up" sneakers. Do they REALLY work? They claim to tone your legs and butt. But they are sorta expensive. Thanks. Rhonda, Natick, MA
A: Shoe manufacturers are free to make claims within reasonable limits. Most athletic shoes can accurately claim to improve physical fitness and appearance but it is not the shoes themselves that provide these benefits, but rather the exercise performed while using them that enhance these outcomes. The most important elements in selecting the proper shoes are appropriate support and appropriate fit. Any shoes that fail to meet these simple criteria are less likely to aid you in your fitness goals. Regardless of the shoes you select, be sure to gradually break them in before attempting high intensity exercises. Dr. Jeremy Cook , Podiatry
Q: Do the shoe inserts for arch support that can be purchased at a local drug store work just as good as the professionally made orthotics? I'd like to save money by using the ones at the local drug store, but not if they aren't going to make a difference or maybe cause more problems. Laurie, Boston, MA
A: That's an excellent question which I frequently encounter within my practice. The truth is that the best orthotic depends largely on the condition being treated. Orthotics can be broken down into two simple categories, accommodative and functional. Accommodative orthotics are what most people think of when they are describing orthotics. These are the cushiony insoles that you can buy at the local drug store. They are an excellent choice if the problem is a simple padding issue, such as when the fat pad on the ball of the foot becomes thinner as we age. Where these fall short is in the setting of a biomechanical fault such as in individuals with excessive pronation. In these cases the accommodative insoles can mask the problem by augmenting padding and delaying more appropriate treatment. Functional orthotics are typically more rigid and help place the foot into a more optimal position. These are more classically the "arch supports" people think of. These should be broken in gradually because they do alter the way you walk. Skipping this break in period increases the likelihood of pain and injury. Finally, pre-fabricated versus custom orthotics, which is better? That's a question that is still being decided by the medical community. Pre-fabricated orthotics are usually less expensive and can be effective for many people. If they are lost, stolen, or even if your foot health needs change, your investment is minimal. When these fail or do not meet your goals custom orthotics should be considered. They are more expensive and take several weeks to months to manufacture, but are made specifically with the characteristics of your feet in mind. Usually it requires a 30 minute appointment to properly capture a plaster impression of your foot. Afterwards these are made into molds of your feet which the orthotics are based upon. Based on your characteristics and needs, the prescribing physician will select several features to optimize your orthotics. Once they have arrived, additional modifications are made as needed until your orthotics provide the maximum benefit. Regardless of your choice, I suggest that you see a health care professional to assess your needs and goals. Dr. Jeremy Cook , Podiatry