FREQUENTLY ASKED QUESTIONS ABOUT PODIATRY

Please use the following information to learn more about common medical problems, foot conditions and the amazing treatments doctors of podiatry can offer. If you have any questions, please consider one of "America's Best Podiatrists" for a consultation, examination and care.

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What is a Podiatrist?

What is a Podiatrist?

A podiatrist is a medical specialist involved with the prevention, diagnosis, and treatment of foot disorders and diseases. Specialties within podiatry include podiatric surgery, podiatric sports medicine, pediatric podiatry, and geriatric podiatry. Podiatrists may work in private practice, a clinic or hospital setting.

Educational Requirements

The Doctor of Podiatric Medicine (DPM) degree requires four years of college, followed by an additional four years of intensive post-graduate training at a school of Podiatry. College coursework includes organic and inorganic chemistry, physics and biology; and may also include microbiology, human anatomy, and biochemistry. Podiatric Medicine training involves more advanced study in basic sciences, medicine, surgery and clinical podiatry.

Bunions

Bunions

Excessive pressure placed on the big toe can force it out of alignment and cause the bone or tissue around the base of the joint to enlarge. This is called a bunion. A bunionette, also referred to as a tailor’s bunion, affects the little toe and appears as a bony bump at the toe’s base. With a bunion, the big toe may bend in toward the other toes, causing swelling and discomfort in the joint. With a bunionette, the little toe may bend in, as well, with the same resulting swelling and pain.

Some bunions do not exhibit symptoms. Others may cause:

  • Pain located in the big toe
  • Red, irritated skin at the site of the bunion
  • Swelling
  • A big toe that bends toward the others

The symptoms of a bunionette are similar, but they involve the little toe.

Causes of Bunions

  • Foot shape, which can be hereditary
  • Ill-fitting shoes
  • Excessive pronation, characterized by the foot rolling in during walking
  • Flat feet

Diagnosing Bunions

Following an examination of the toe joint and a range-of-motion evaluation, your doctor may want to know:

  • When the discomfort began
  • What makes the bunion worse
  • Whether you are experiencing pain in other joints

X-rays, lab work, and assessment of joint fluid may also be helpful to diagnose a bunion and/or rule out other conditions that may be causing the symptoms, such as rheumatoid arthritis, gout, or an infection in the joint.

Treating Bunions

There is no sure way to prevent or cure bunions, but you can reduce the risk of developing them. Wear flat or low-heeled shoes with appropriate arch support and a toe box that does not place pressure on toes. Homecare is often considered the best course of treatment for bunions and may include:

  • Taking over-the-counter pain relievers
  • Wearing comfortable shoes/avoiding shoes that are too tight or that have a heel height that places too much pressure on the toe joints
  • Cushioning the bunions with pads
  • Wearing custom-made orthotics
  • Avoiding activities that increase toe/foot pressure and incorporating activities like swimming or cycling
  • Having surgery

Calluses & Corns

Calluses & Corns

A callus is a thickened area of skin. Corns are also thickened areas of skin, but they can have a soft or hard core. People typically experience calluses on the hands or feet. Corns usually appear on the toes. A corn between the toes is called a soft corn. A corn on the top of a toe is called a hard corn. Calluses and corns can cause discomfort when pressure is placed on them.

Callus & Corn Symptoms

A callus can appear as a yellowish or grayish thick, dry, hard lump on the skin with a bumpy consistency. Decreased sensitivity may occur in the area of hardened tissue. A corn can present itself as a firm, thick nodule, often with a yellow-ringed gray center (when it appears on a hand) or an open sore (when it’s a soft corn).

Causes of Calluses & Corns

Excess friction or pressure can cause a calluses or corns to form. If sweat is trapped in the skin cells when a corn is forming, it softens the hard skin cells at the core, and a soft corn develops. Calluses and corns are not caused by a virus and are not contagious. Causes may include going barefoot, wearing ill-fitting shoes, repetitive pressure on the foot, a gait that is abnormal, flat feet, or bone spurs.

Diagnosing Calluses & Corns

An examination by a healthcare provider coupled with questions about hobbies, sporting activities, your type of work, and the shoes you wear can contribute to a diagnosis. X-rays may be required, in some instances.

Tips to alleviate pain include:

  • Wearing shoes that fit properly, which usually involves a toe box that does not irritate or put undue pressure on the toes.
  • Utilizing toe separators, pads, moleskin, toe caps, toe sleeves, or other types of padding to protect toes.
  • Softening the callus or corn by soaking it in water or softening it with salicylic acid (only applied directly to the corn or callus and with a doctor’s advice; then rubbing away the dead skin with a pumice stone.
  • Seeing a podiatrist for a protective orthotic, trim the callus or corn or perform more extensive surgery if necessary.

Diabetes- Special Note:

Never treat a callus or corn by cutting it or by using salicylic acid yourself. This is especially true if you suffer from diabetes or other condition that causes you to experience numbness of the extremities or problems with the circulatory system.

Preventing Calluses & Corns

Tips for prevention include:

  • Wear shoes that fit properly.
  • Visit a podiatrist to determine whether your gait may contribute to calluses and corn.
  • Try to avoid activities that put undue pressure on the skin.

Custom Orthotics

Custom Orthotics

Custom orthotics are prescribed by a podiatrist based on an assessment of your specific needs and an examination of your feet, legs, and ankles. Prescription orthotics provide comfort and support to feet and are designed to fit your unique gait and activities, alleviate foot discomfort and/or issues, and improve function. Orthotics are prescribed for conditions such as ankle pain, heel discomfort, plantar fasciitis, bursitis, foot problems related to diabetes, and other conditions.

There are two types of custom orthotics: functional and accommodative.

  • Often made from graphite or plastic, functional orthotics are typically prescribed to relieve discomfort caused by irregular motion and can also be used to remedy problems caused by issues such as tendinitis or shin splints.
  • Softer orthotics that support and pad feet are called accommodative orthotics. A podiatrist may prescribe this type of orthotic for someone suffering from uncomfortable calluses on the soles of the feet, foot ulcers related to diabetes, and other causes of foot pain.

Custom orthotics prescribed by a podiatrist usually cost more than the shoe inserts available over the counter, although your insurance company may pay a portion of the cost. Each custom orthotic is a one-of-a-kind device specifically made to fit the foot of an individual and address that individual’s unique situation. Made of high-quality materials, custom orthotics – if treated with proper care – may last for several years.

Shoe Inserts
Shoe inserts can be purchased at retail stores and ordered online. These non-prescription products are placed in shoes to provide arch support, alleviate foot and leg discomfort, or cushion the foot. However, unlike custom orthotics, shoe inserts do not address foot problems caused by biomechanical issues with the feet or legs, nor are they made to remedy foot issues resulting from chronic problems.

Common kinds of shoe inserts include:

  • Heel inserts to cushion the heel area
  • Arch supports to augment the natural arch of a person with low arches or flat feet
  • Foot cushions to prevent shoes from rubbing against feet
  • Insoles to support or cushion feet

When purchasing a shoe insert, consider the following factors:

  • Your purpose: Do you want a product to prevent foot abrasions from a shoe that rubs, or are you looking for something to place in your shoes to provide extra cushioning during exercise?
  • Your health: For example, if you are looking to remedy a foot problem caused by circulation issues or diabetes, consider a custom orthotic prescribed by a podiatrist as opposed to a non-custom shoe insert.
  • Your shoes: Make sure the insert fits into the shoes you will be wearing.
  • Your comfort: If you can, place the insert into your shoe and see how it feels.

See a Podiatrist
If you suffer from a serious foot problem or if over-the-counter shoe inserts do not remedy your problem, visit a podiatrist for a thorough examination and assessment. The doctor will evaluate your gait and examine your feet to determine the source of your discomfort, then prescribe the correct treatment – custom orthotics or shoe inserts – for your individual needs.

To design custom orthotics, the podiatrist will use a 3D image of your feet, along with precise measurements, to ensure that your orthotics fit your individual requirements and provide the comfort and support needed to remedy your foot issue. A podiatrist may make other treatment recommendations, as well, depending on your needs.

Diabetic Foot

Diabetic Foot

Diabetes is at epidemic proportions and is currently the fastest growing chronic disease. It occurs when a person’s body fails to produce the hormone insulin, or uses insulin inefficiently. Insulin helps provide energy to the body by helping move sugar molecules (from the things we eat and drink) into our cells. When one has insufficient insulin, sugar builds-up in the blood stream. Excess blood glucose over extended periods of time can contribute to a variety of health issues, including

  • Inability to heal infections, especially in the feet which can lead to severe infection and amputation
  • Stroke & Heart disease
  • Blindness
  • Kidney disease

Symptoms & Diagnosing Diabetes:
Common symptoms of diabetes include excessive thirst, frequent urination, extreme hunger, fatigue, irritability, unexplained weight loss, blurred vision and slow healing of bruises. If you suspect that you have diabetes, see your doctor. If you’ve been diagnosed with diabetes, follow the advice of your healthcare provider to manage symptoms and minimize damage.

Symptoms & Diagnosing Diabetes:
Common symptoms of diabetes include excessive thirst, frequent urination, extreme hunger, fatigue, irritability, unexplained weight loss, blurred vision and slow healing of bruises. If you suspect that you have diabetes, see your doctor. Podiatrists can help diabetes sufferers prevent and treat foot-related complications of diabetes.

Diabetic Feet:
Over time, diabetes can cause damage your nerves and blood vessels. Damage to the blood vessels interrupts proper blood and oxygen flow to cells so injuries cuts or sores fail to heal. Serious cases may even lead to amputation.
Nerve damage can cause loss of feeling in feet as well. To help avoid foot problems, control your blood sugar levels. Excellent foot hygiene is also essential:

  • Check and wash feet every day to catch infections or sores early.
  • Always wear shoes and socks to protect feet.
  • Avoid cold to keep the blood flowing to your feet
  • Trim toenails regularly, smooth corns and calluses and keep skin soft and smooth. Frequent visits to a podiatrist may be critical to your long term health and well-being.

Warning Signs of Diabetes

  • Changes in the color of skin
  • Numbness that occurs in the toes or other parts of the foot
  • Foot or ankle inflammation
  • Slowly healing or non-healing ulcerations or sores on the foot
  • Swelling of the foot or ankle
  • Leg pain
  • Calluses or corns that bleed
  • Ingrown toenails
  • Cracked skin on the heel or other parts of the foot
  • Toenail fungus

Visit a Podiatrist
Diabetes complications are responsible for over 65,000 amputations in any given year. Regular foot screening can reduce your risk of amputation due to diabetes by as much as 85%; and significantly lessen the need for diabetes-related hospitalizations.

Caring for Feet if you have Diabetes
If you suffer from diabetes:

  • Wear thick socks that are soft and comfortable
  • Avoid seams in socks
  • Check feet for sores, toenail changes, bruises, and other abnormalities every day
  • Lose weight, if necessary
  • Improve circulation by exercising
  • Wear appropriate, properly fitting footwear when exercising
  • Get feet professionally measured when buying new shoes
  • Avoid walking without shoes, even at home
  • Seek professional care for corn, callus, or wart removal

Foot Surgery

Foot Surgery

If a foot problem causes excessive pain, if non-surgical treatment has not remedied a foot problem or injury, or if a foot deformity is present, surgery may be needed to alleviate pain and renew proper function.

Before Surgery
Prior to surgery, your podiatrist may require that certain tests or exams be performed. These tests may include EKG, blood analysis, urine analysis, as well as tests to evaluate blood flow. You and the doctor will also discuss your health history, allergies, medications and other health-related issues. If the podiatrist feels that some aspect of your current health requires further evaluation, he may recommend that you see a specialist.

Foot Surgery Types
There are many different types of foot surgery Podiatrists peform, including surgery to:

  • Fuse two or more bones together with plates, pins, screws, or one or more of these items; this type of surgery may be recommended to address foot or ankle arthritis
  • Remove a neuroma
  • Repair a torn tendon, reroute a tendon, or alter tendon length
  • Remedy problems with the metatarsals or the bones in the ball of the foot
  • Correct hammer toe by realigning the toe through fusing the joint of the toe, removing bone, or putting an implant in the toe
  • Alleviate bunions; the type of bunion surgery recommended depends on which joint is involved and how severe the bunion has become
  • Reconstruct the ankle or foot, such as to repair a congenital defect, alleviate a foot condition caused by disease, or as a response to trauma
  • Alleviate heel pain by releasing the plantar fascia or removing a bone spur

After Surgery
Care following surgery depends on the type of surgery the doctor performed. Factors common to surgery aftercare include:

  • Resting the foot
  • Applying ice
  • Utilizing compression on the treated area
  • Elevating the foot
  • Wearing appropriate bandages, shoes, splints, or casts
  • Using a cane or crutches if you must wait delay bearing weight on the foot following surgery

Always adhere to your doctor’s instructions for a safe and successful recovery from foot surgery.

Fractures & Sprains

Fractures & Sprains

A fracture occurs when a bone breaks. A sprain involves injury of soft tissue, notably a stretched or torn ligament. The foot and ankle are common sites for fractures and sprains, with sports-related injuries contributing to the occurrences of the incidents. Even if you do not participate in sports, a trip or stumble while walking can cause a foot-related injury.

Symptoms of Fractures & Sprains

  • Pain
  • Bruising
  • Inflammation
  • Inability to bear weight on the foot
  • Trouble walking

Caring for a Foot or Ankle Injury at Home  
Remember RICE:

  • Rest—Rest your foot and avoid bearing weight on it until you see a doctor.
  • Ice—Apply ice following the injury and for 15 to 20 minutes every 3 to 4 hours for the subsequent 48 hours.
  • Compression—Wrap your foot or ankle snugly, but not tightly, with an elasticized bandage.
  • Elevation—Elevate your foot so that it is above your heart.

See a Podiatrist 
If the pain of your injury gets worse, you notice redness or inflammation, or you have trouble walking following an injury, see a podiatrist for evaluation.

Diagnosing & Treating Fractures & Sprains
Your visit to the podiatrist will involve an examination of your injury and a discussion of your health history. An X-ray can identify a bone fracture, while an MRI or ultrasound may be needed to assess a soft-tissue injury.

The treatment the podiatrist recommends will hinge on the extent and type of injury.

  • Anti-inflammatories can reduce swelling and pain
  • Fractures may be treated with surgery or with the doctor aligning the ends of the bones to promote healing
  • Stress fractures often require immobilization, resting the affected area, and eliminating or minimizing weight bearing on the foot
  • Sprains typically get better following immobilization
  • Torn ligaments may need surgery for reconstruction

Preventing Fractures & Sprains

  • Implement a warm-up into your exercise routine
  • If you walk or run for exercise, do so on smooth, even surfaces
  • Wear the appropriate shoes for the activity you are performing
  • Replace shoes as advised to retain proper cushioning and support

Haglund's Deformity

Haglund's Deformity

A bony bump at the back of the heel, along with heel pain, indicate a condition called Haglund's Deformity. Women frequently experience this condition as a result of wearing pumps. Hence, Haglund’s Deformity may be referred to as pump bump. Blisters may also form on the heel caused by shoe movement along the bump.

Causes of Haglund’s Deformity

  • Foot shape
  • A taut Achilles tendon
  • A gait in which you walk on the outside of the feet
  • A high arch in the foot
  • Shoes that have a stiff back

Caring for Haglund’s Deformity at Home

  • Wear heel pads in shoes
  • Ice your heel after taking off your shoes
  • Wear shoes with an open heel (only if your feet are otherwise normal with no bunions, structural issues, tendinitis, or other conditions)

See a Podiatrist
Visit a podiatrist to address symptoms that don’t subside with home care. The podiatrist will examine your feet, discuss your health history, and may take X-rays for a detailed view of foot structure. Other diagnostic tools that may be of use in diagnosing the source of your discomfort include ultrasound and MRI.

Treating Haglund’s Deformity
Depending on your unique situation, treatment may include:

  • Arch supports
  • Heel lifts or pads
  • Custom orthotics
  • A soft cast or boot to immobilize your foot
  • Medication to relieve discomfort and inflammation
  • Surgery

Preventing Haglund’s Deformity

  • Wear proper footwear, opting for shoes without hard backs
  • Wear shoe inserts, as necessary
  • Stretch your Achilles tendon to relieve tautness

Hammer, Claw & Mallet Toes

Hammer, Claw & Mallet Toes

Oddly bent toes, other than the big toe, are called hammer, claw, and mallet toes.

  • Hammer toe typically impacts the second toe. The middle joint becomes elevated as the top of the toe is bent downward. Hammer toe sufferers often have corns, as well.

 

  • Claw toes bend at all of the joints. This bending at the joints makes the toe appear curved. Claw toe is typically seen concurrently in all the toes, except the big toe, on a foot.
  • Mallet toe appears most common in the second toe, but it can impact other toes, too. A mallet toe appears bent near the top joint of the toe.

 

Causes of Hammer, Claw & Mallet Toe
The top culprit is wearing shoes that fit too tightly. Over time, the muscles and tendons in toes force the toes into a curved or bent position until ultimately, they become unable to straighten. Women who wear high-heeled shoes and shoes with narrow toes are most likely to experience these toe problems.

Occasionally, hammer, claw, and mallet toes may be associated with other conditions including stroke, foot and ankle injuries, diabetes, or rheumatoid arthritis.

Hammer, Claw & Mallet Toe Symptoms
These strangely positioned toes may or may not hurt. However, if you notice a strange shape to a toe, it is important to see your podiatrist right away.

Diagnosing & Treating Hammer, Claw & Mallet Toes
Diagnosing these toe conditions consists of an examination and a discussion with your podiatrist. Your doctor may ask you about what impacts the discomfort, whether you are experiencing other types of foot pain, when symptoms started, types of activities you perform daily and whether you have had foot issues previously. Your podiatrist will also access your medical history. Diagnostic X-rays, nerve testing, and ultrasound may be required, especially if surgery is being considered.

Non-Surgical Treatment (Homecare)
A joint that retains movement may be treated non-surgically. Early treatment of these toe conditions will often consist of homecare, such as:

  • Wearing low-heeled shoes that support the arch and provide room for the toes.
  • Using cushioning products like moleskin or devices that comfortably reposition the foot, such as orthotics or arch supports.
  • Treating calluses and corns.
  • Using over-the-counter pain medications.
  • Taping a flexible hammer toe or using toe slings, splints, or caps
  • Practicing exercises to encourage joint strength and flexibility. For example, using your toes to scrunch up a towel or pick up marbles and place them in a cup.

Toe discomfort that does not respond to homecare after 2-3 weeks should be addressed by your podiatrist. A sore on a toe should be evaluated to avoid infection. If you suffer from diabetes or peripheral arterial disease, it’s especially important to see your doctor for any foot pain or sores.

Surgical Treatment
Surgery may be required to address an immobile joint. Surgical options include:

  • Removal of part of the bone or joint in the toe
  • Placing an implant in the toe
  • Cutting the tissues or tendons in the toe joint
  • Amputation (which is rare)

Toe problems can recur following surgery, especially if inappropriate footwear continues to be worn.

High Blood Pressure & Podiatry

High Blood Pressure & Podiatry

As your heart beats, blood pushes against artery walls. The force with which this occurs is called blood pressure. High blood pressure, also known as hypertension, is defined as blood pressure that remains elevated beyond normal levels over time.

Atherosclerosis occurs when plaque accumulates in blood vessels. This condition is related to high blood pressure. As a result of atherosclerosis, blood circulation can diminish and peripheral arterial disease (PAD) can occur. Skin ulcerations, some of which may result in amputation, can be a consequence of poor circulation in the feet and legs.

High Blood Pressure Symptoms
High blood pressure can affect the feet and legs in the following ways:

  • Foot and leg cramps, often occurring during exercise
  • Foot color or temperature changes
  • Hair loss on legs and feet
  • Slow-healing foot or leg sores (or sores that do not heal at all)
  • Swelling in the feet and legs – a symptom of heart disease caused by hypertension

See a Podiatrist
Because hypertension and circulatory issues can dramatically impact foot and leg health, it is imperative that you tell your podiatrist if you suffer from these conditions or if you experience any of the symptoms listed above. Additionally, to prevent negative interactions with medicine prescribed for foot or leg conditions, let your podiatrist know if you take medication for hypertension. Medically controlled hypertension is necessary if you are scheduled for surgery on the foot or ankle.

Diagnosing & Treatment Hypertension
At your podiatric office visit, the doctor will evaluate your vital signs, which includes taking a blood pressure reading. Low blood pressure in the feet or legs, skin that is abnormal in color, or a low pulse rate in the foot can signal circulatory issues and may necessitate a referral to your primary care physician. Tell your doctor if you experience swelling in the feet or legs, as this may be a sign of a circulatory issue, as well.

Ingrown Toenails

Ingrown Toenails

When a toenail grows into the skin, usually on the big toe, it is called an ingrown toenail. This condition causes redness, swelling, discomfort, and possibly infection. Ingrown toenails occur more commonly in older adults who may have thick or curved toenails.

Causes of Ingrown Toenails

  • Nails that have been cut too short or with a rounded edge
  • Ill-fitting socks or shoes that press the nail into the skin
  • A single injury or repetitive injuries to a to

Diagnosing & Treating Ingrown Toenails
A physical examination by a doctor can yield an ingrown toenail diagnosis. Home remedies for treating an ingrown toenail include submerging the toe in warm water 2-3 times a day for approximately 15 minutes; then placing a small portion of a wet cotton ball under an edge of the ingrown toenail.

After the nail lifts and grows away from the skin, it can be trimmed. Wearing comfortable shoes following treatment is advised. Never use scissors or a needle to address an ingrown toenail, as infection could occur or worsen.

If homecare does not resolve an ingrown toenail you should see your podiatrist. You should also seek professional care if infection sets in -characterized by redness, swelling, warmth, and possibly red streaks extending from the site of the ingrown toenail.

Your podiatrist may recommend antibiotics and/or removal of part of the toenail or the entire toenail to resolve the issue. Depending on the method of surgery used and whether the toenail root is removed, the toenail may or may not grow back following surgery.

Preventing Ingrown Toenails

  • Wear comfortable shoes with roomy toe boxes and consider wearing steel-toed boots, if necessary, in the workplace
  • Keep toenails properly trimmed
  • Visit a foot care clinic for assistance with trimming toenails

Note: Always confer with your doctor regarding the proper way to trim your toenails if you suffer from diabetes or peripheral arterial disease.

Neuromas

Neuromas

A neuroma occurs as a result of a growth of nerve tissue. Sometimes called nerve tumors or pinched nerves, neuromas are painful but benign. They most often occur between the third and fourth toes of the foot, although the discomfort caused by a neuroma can radiate to the ball of the foot, as well. Swelling between the toes may occur. A neuroma can feel like you have a rock in your shoe pressing on your foot. More women than men develop neuromas.

Symptoms can include numbness, burning, tingling, and pain when walking. When pain occurs, sufferers are advised to remove their shoe and massage the area that hurts.

Causes of Neuromas
A definitive cause is unknown, but the following factors may play a role in the development of this condition:

  • Being flat footed or having a high arch
  • Wearing ill-fitting shoes and/or heels taller than 2 inches
  • Sustaining an injury to the foot
  • Repetitive stress on the foot, as with particular occupations

Home Care for Neuromas

  • Wear shoes that fit properly
  • Wear thick socks that absorb shock well
  • Avoid heels higher than 2 inches
  • Rest your foot
  • Massage the area of discomfort
  • Apply ice
  • Utilize inserts or pads to minimize pressure on the foot

See a Podiatrist
Neuromas can worsen if not treated. A podiatrist will examine your foot and may take an X-ray. Treatment for simple neuromas may include wearing thick socks with properly fitted shoes. This relieves pressure on the neuroma and lets it heal on its own. Surgery may be an option for severe cases of neuroma.

Other treatments may include:

  • Taping and padding the ball of the foot
  • Anti-inflammatories
  • Custom orthotics
  • Cortisone injections

Preventing Neuromas
It is not known for sure what causes neuromas. The following practices may help prevent them, however.

  • Wear properly fitting shoes to exercise
  • Ensure excess pressure is not placed on toes in shoes
  • Find shoes with good padding under the ball of the foot
  • Minimize time spent in heels higher than 2 inches
  • Avoid shoes that have a narrow toe box

Osteoarthritis

Osteoarthritis

When the cartilage surrounding a joint begins to break down, the joint loses the cushioning that enables smooth, pain-free motion and becomes damaged. Osteoarthritis can affect any joint in the body, but it primarily impacts the spine, feet, knees, hips, and hands. Sufferers experience joint pain that makes using the affected joint difficult. Osteoarthritis is more common in older people.

Osteoarthritis Causes
It is currently unclear what causes cartilage around joints to break down, but the following factors may contribute:

  • Injury to a joint
  • Carrying excess weight
  • The natural gaining process
  • Genetic factors

Osteoarthritis Symptoms

  • An achy, burning, or sharp pain in a joint
  • Stiff creaky, joints – especially when first getting out of bed in the morning
  • Joint swelling
  • Joints that creak when moved
  • Diminishment in the range of motion of a joint
  • Weakening of the muscles surrounding a joint
  • Abnormal appearance to the joint

Diagnosing Osteoarthritis
After discussing your symptoms, the doctor will examine your sore joints and the muscles surrounding them. X-rays may be ordered to help identify joint damage. Blood tests and other diagnostic evaluations can help rule out other conditions that may be causing joint pain.

Treating Osteoarthritis
There is no cure for osteoarthritis, although treatments exist to ease discomfort and increase joint movement. The appropriate treatment depends on many factors and may include:

  • Medications: over-the-counter pain medications, non-steroidal anti-inflammatory prescription medication, or medicine injected directly into a joint.
  • Creams to rub on a sore joint
  • Shedding extra weight
  • A doctor-recommended exercise program
  • Physical therapy
  • Ice or heat applied to a joint
  • Joint-replacement surgery

Osteoarthritis sufferers can also help themselves by using devices at home that minimize joint stress, such as using canes, special doorknob covers, splints, and tools to reach for and hold items. Lifestyle changes may help, too. Try swimming; or walking instead of jogging, for instance.

Peripheral Arterial Disease

Peripheral Arterial Disease

Peripheral Arterial Disease, or PAD, is a condition that impacts up to 12 million Americans. Twenty percent of the population over age 70 suffers from PAD. The condition occurs when plaque builds up in the arteries and causes narrowing and hardening, called atherosclerosis, which contributes to reduced circulation. In some cases, this accumulation of plaque can completely block an artery. Typically, PAD affects the leg arteries, although other arteries can be affected as well, including the ones that transport blood to the brain, arms, kidneys, stomach, and aorta. Hardening of the arteries in the heart is known as coronary artery disease. It is also called cardiovascular disease.

PAD increase the risk of death from stroke or heart attack. Along with diabetes, PAD is a primary contributor to amputation of the foot or leg.

PAD Risk Factors

  • Carrying excess weight
  • Smoking
  • Diabetes
  • High cholesterol levels
  • Lack of physical activity
  • Hypertension

PAD Symptoms

  • Cramping or fatigue that occurs in the buttocks, thighs, or elsewhere in the legs when walking; this pain disappears upon resting

Note: Many PAD sufferers do not experience this type of discomfort.

  • Pain in the toe or foot that disrupts sleep
  • Slow- or non-healing ulcerations on the skin of the toes or feet

See a Podiatrist
If you experience leg pain, see a podiatrist to determine if it is a symptom of PAD. Detecting PAD in the early stage decelerates its progression and minimize stroke/heart attack risk.

Diagnosing & Treating PAD
An ankle-brachial index, or ABI, blood test can determine the occurrence of PAD. This test compares arm/ankle blood pressure. A normal reading on the ABI test may necessitate additional tests to determine PAD.

Treatment for PAD includes:

  • Stopping smoking
  • Getting cholesterol to goal
  • Controlling blood pressure
  • Taking medications to prevent blood clotting
  • Managing diabetes
  • Maintaining a healthy diet
  • Exercising
  • Surgery

Peripheral Neuropathy

Peripheral Neuropathy

When the nerves in the fingertips and toes, called peripheral nerves, become damaged, a burning or tingling sensation, sharp pain, or numbness can occur. This is called peripheral neuropathy. Nerves do not function as they should, resulting in the sensations described above. Peripheral neuropathy can also negatively impact the ability to move the fingers and toes.

Causes of Peripheral Neuropathy
Diabetes is the leading cause of this condition in the United States. It is estimated that up to 70% of people who suffer from diabetes will also experience peripheral neuropathy at some point in their lives. Age plays a role as well, as the risk of neuropathy increases with age.

Other causes are:

  • Chemotherapy drugs and other medications
  • Arthritis
  • Family history of the condition
  • Spina bifida, fibromyalgia, and other neurological disorders
  • Damage sustained by the peripheral nerves as a result of injury
  • Alcohol abuse

Preventing Peripheral Neuropathy
Maintaining proper blood sugar level is the most important action you can undertake to avoid peripheral neuropathy. The degree to which peripheral neuropathy occurs often hinges upon how well blood sugar is controlled.

See a Podiatrist
It is important to tell your doctor if you experience any of the signs of peripheral neuropathy, as they could indicate diabetes complications or undiagnosed diabetes.

Diagnosing & Treating Peripheral Neuropathy
To diagnose peripheral neuropathy, the doctor will conduct a physical exam, discuss your health history, talk about the symptoms you are experiencing, and may schedule a blood test.

No cure currently exists for peripheral neuropathy, although proper treatment can minimize discomfort, help maintain the health of the feet, and impede the advancement of peripheral neuropathy.

Treatment may consist of:

  • Oral pain medications
  • Instruction on how to check your feet for damage and how to care for them at home
  • Maintaining proper blood sugar levels, often through lifestyle changes and medication, if necessary
  • The podiatrist working in tandem with other healthcare providers to provide a complete spectrum of care

If you suffer from peripheral neuropathy, it is recommended that you see a podiatrist at least once each year for a thorough examination of your feet.

Home Care for Peripheral Neuropathy

  • Evaluate the condition of your feet on a regular basis to identify infection or injury; have someone else examine your feet if you are unable to do so
  • Wear shoes that fit properly
  • Do not go barefoot
  • Control your blood sugar if you suffer from diabetes

Plantar Fasciitis

Plantar Fasciitis

A flat ligament called the plantar fascia is located at the bottom of the foot. It connects the heel bone to the toes and supports the arch. When this ligament becomes strained, tiny tears in the ligament can cause swelling and discomfort, resulting in heel pain known as plantar fasciitis.

Plantar Fasciitis Risk Factors
This common cause of heel pain occurs commonly in middle-age. Risk factors for developing plantar fasciitis include:

  • Feet that roll in excessively while walking
  • Flat feet
  • High arches
  • Obesity
  • Improperly fitting shoes
  • Tight muscles in the calf
  • A tight Achilles tendon
  • Being on your feet, especially on hard surfaces for extended periods of time

Plantar Fasciitis Symptoms

  • Heel pain when first stepping on the floor after waking or after sitting for a long period. A lessening of pain after walking a few steps.
  • Increased foot pain throughout the day
  • Pain that is intensified by activities such as standing or climbing stairs

Note: Foot pain that occurs at night may indicate a nerve problem, arthritis, or another condition other than plantar fasciitis.

Diagnosing & Treating Plantar Fasciitis
An examination may include:

  • An evaluation of your feet and gait
  • Questions about your health history and your current symptoms
  • Discussion about your activity level
  • X-rays of your foot

Treatment
Treatment for plantar fasciitis depends on individual. The doctor may recommend:

  • Curtailing activities that cause foot pain
  • Performing toe and calf stretches
  • Resting the feet
  • Icing the heel
  • Taking over-the-counter pain medications
  • Wearing shoes that proper arch support
  • Using heel cups or orthotics
  • Wearing a splint at night
  • Receiving steroid injections in the heel
  • Surgery for pain that doesn’t respond to other types of treatment after 6 to 12 months

Following treatment, plantar fasciitis pain may dissipate after a few weeks. However, it may take many months – even up to a year – for pain to fully subside.

Psoriasis

Psoriasis

We are constantly sloughing off dead skin cells and creating new ones. The skin condition known as psoriasis occurs when this renewal process occurs too quickly. The rapid creation of new skin cells does not let old ones slough off as they should. Instead, the dead skin cells remain on the skin, causing dry, thick, reddish skin with patches (called psoriatic plaques) that are silvery white in color. Psoriasis can affect small or large areas of the body. These patches may cause the skin to itch. Typically, psoriasis sufferers experience psoriatic plaques on the soles of the feet, elbows, and knees, although other parts of the body – joints, fingernails, toenails – may be affected.

Causes of Psoriasis
This autoimmune disease has a genetic component and can be hereditary. People with weakened immune symptoms and those undergoing stressful situations can experience severe psoriasis.

Home Care for Psoriasis

  • Moisturize the skin regularly; a hypoallergenic moisturize can be beneficial
  • Participate in light therapy with a UV-B light or natural sunlight
  • Take oatmeal baths

See a Podiatrist
If you think you have psoriasis on your feet and home care does not improve the condition, a podiatrist can evaluate the situation. An examination will tell the doctor if the condition is psoriasis or another condition such as contact dermatitis or athlete’s foot.

Diagnosing & Treating Psoriasis
A visit to the podiatrist will include a discussion of your health history and a thorough examination. A skin biopsy in which the doctor removes some cells from the area of skin being examined can aid in diagnosing psoriasis.

The severity of the psoriasis will dictate the recommended treatment. Treatment may include:

  • Topical steroid creams for mild psoriasis
  • Immune-system-suppressing or biologic drugs for severe psoriasis

Your podiatrist may work in tandem with your other healthcare providers to administer treatment for your psoriasis if your case is severe.

Preventing Psoriasis
Psoriasis cannot be prevented. It can, however, be managed by identifying and avoiding things that aggravate your psoriasis. For example, learning stress management techniques, avoiding alcohol, and monitoring your sunlight exposure may minimize psoriasis occurrences if these things are triggers for your psoriasis.

Skin Cancers of the Feet

Skin Cancers of the Feet

Skin cancer that occurs on the feet is often painless. It is typically found when unrelated issues of the feet are noticed. Skin cancer of the foot often follows repetitive occurrences of skin ulceration, bleeding, or cracking of the skin on the feet. Frequently, individuals discover their skin cancer after unrelated ailments occur near the affected site.

Skin cancers that affect the feet are usually linked to:

  • Viruses
  • Continual irritation or inflammation
  • Exposure to certain chemicals
  • Inherited characteristics

Common Types of Skin Cancers of the Feet
Basal cell carcinoma usually occurs on skin that has undergone frequent exposure to the sun, but it can occur on the feet.

  • Least aggressive of the skin cancers
  • Damages a specific area
  • Rarely spreads
  • Looks like pearly, white patches or bumps on the skin and may appear to be benign tumors; crusting and oozing may occur, as well as an open sore

Squamous cell carcinoma is the most frequently occurring skin cancer of the feet.

  • Typically affects only the skin and does not spread to other areas of the body; however, advanced cases can spread
  • Painless but can be itchy
  • May occur following continual bleeding or cracking of the skin
  • Looks like a small, scaly bump or plaque on the skin; can appear to be inflamed or can look like a plantar wart, ulcer, eczema, callus, or other benign foot condition

Malignant melanoma is one of the most lethal types of skin cancer.

  • Rarely made better by non-surgical treatments
  • Early detection is crucial for survival
  • Can occur on the top or bottom of the feet; can sometimes develop under a toenail
  • May spread throughout the body
  • Can have many appearances:
    • Typically starts a bump or spot that is brownish-black in color, although many melanomas look red or pink
    • May look like benign moles, ingrown toenails, blood blisters, plantar warts, ulcers, and other benign foot conditions; looking closely, though, you will likely see a size greater than 6mm, differences in color, an asymmetrical shape, and borders that are irregularly shaped

See a Podiatrist
Always inspect your feet for skin abnormalities. See a podiatrist right away if you notice a bump or patch that fits meets the ABCD criteria:

  • Asymmetry – The sides of the lesion do not match
  • Borders – The outside edge of the lesion is ragged looking, uneven, or irregularly shaped
  • Color – More than one color is present and/or the colors are uneven in their appearance
  • Diameter – The lesion is wider than 6 mm, which is about the size of a pencil eraser

In addition, if you have an ulcer or sore that does not heal; bleeding or cracked bumps on the skin; raised areas, scaly patches; or raised areas with an edge that is shaped like a donut, contact a doctor immediately.

Diagnosing & Treating Skin Cancers of the Feet
A thorough examination of your foot and the suspicious lesion, along with a skin biopsy, will help your podiatrist determine the appropriate diagnosis and correct treatment.

Preventing Skin Cancers of the Feet

Minimize exposure to the sun and apply sunscreen with an appropriate SPF to lessen the risk of developing skin cancers of the feet.

Sweaty Feet

Sweaty Feet

Hyperhidrosis is the medical term describing excessive sweating of the feet and/or hands. This condition impacts more younger than older people and more men than women. The cause of hyperhidrosis is not known, but it seems to have a hereditary component. Current thinking is that the point at which sweating is typically triggered is different for people with hyperhidrosis than for those who do not suffer from this condition.

Symptoms of Hyperhidrosis
Excess sweat is the primary symptom of this condition. Additionally, feet may look wet and white in color and have an odor. Infections can occur with hyperhidrosis, as the constant wetness makes the skin susceptible to infection.

Home Care for Hyperhidrosis

  • Wash the entire foot, including between the toes, daily using antibacterial soap and then dry thoroughly
  • Apply foot powder, cornstarch, or antifungal powder after washing and drying feet
  • Change socks as needed throughout the day
  • Wear socks that wick moisture away from the skin – socks made of synthetic material draw moisture away from the feet; socks made from 100% cotton absorb moisture and can cause blisters
  • Consider an iontophoresis machine; this device transmits a non-harmful electrical current through skin, utilizing water as a conduction method

Proper home care can prevent infection and odor to keep feet healthy.

Diagnosing & Treating Hyperhidrosis
A podiatrist will examine your feet and discuss your symptoms. A starch-iodine test is a diagnostic tool that aids in the diagnosis of hyperhidrosis. Your doctor will recommend treatment based on your unique situation. Treatment may include:

  • Prescription antiperspirant to use on your feet
  • Botox injections
  • Surgery for extreme cases

Tendon Injuries

Tendon Injuries

Tendons are the structures in the body that connect muscles to bones. Tendon injuries typically occur near joints, with the elbow and heel joints sustaining most of those injuries. The onset of a tendon injury may seem sudden, but it is more commonly the result of tiny tears occurring over time and weakening the tendon, making it susceptible to injury.

Common terms for tendon problems:

  • Tendinitis refers specifically to tendon inflammation, although the term is often used to describe any type of tendon injury
  • Tendinosis is an overuse injury characterized by tears in a tendon.
  • Tendinopathy is a term to describe tiny tears that occur in a tendon and inflammation

Causes of Tendon Injuries
The aging process, overuse of a tendon, and wear and tear over time are the typical causes of tendon injuries. People of any age can experience a tendon injury suddenly during sports or falls, although those who perform repetitive motions day-to-day, or in the workplace are most at risk.

Symptoms of Tendon Injuries

  • Pain that worsens when the impacted tendon is used
  • An area that feels warm, appears red, swells, or feels tender to touch
  • Diminished strength, stiffness, and discomfort in a tendon
  • A joint that feels or sounds “crunchy”
  • Stiffness and pain that is present at night or upon waking

Diagnosing & Treating Tendon Injuries
A physical exam and health history can help your podiatrist diagnose a tendon injury. You may be asked to demonstrate the movement that causes the discomfort. Diagnostic tests that include ultrasound, MRI, or X-rays may be required.

Home care for tendon injuries includes:

  • Resting the tendon that’s causing discomfort
  • Avoiding activities that worsen the pain
  • Using over-the-counter medications to relieve pain and/or swelling
  • Performing exercises to help range of motion
  • Stretching
  • Applying cold packs or ice

If tendon injuries do not improve with home care, your doctor may recommend physical therapy or a device to immobilize the tendon.

Tendon injuries may take several week or months to heal. After your injury improves, slowly return to normal activities, taking care not to overuse the impacted tendon. Lifestyle, activity, and workplace changes may be required to prevent re-injury.

Tinea Pedis - Athlete's Foot

Tinea Pedis - Athlete's Foot

The skin infection known as athlete’s foot (also called tinea pedis) typically occurs between the fourth and fifth toes. Athlete’s foot can affect the nails and the bottom of feet, as well. Early treatment is advised if the nails are impacted.

Athlete’s Foot Symptoms
Itching is the primary symptom of athlete’s foot. Other symptoms include:

  • Burning
  • Redness
  • A stinging sensation
  • A foul odor
  • Peeling and scaling skin
  • Blistering

Causes of Athletes Foot
Athlete’s foot occurs when fungi called dermatophytes respond to moist, warm conditions or a lowering of the body’s natural resistance by reproducing in large quantities on the skin, causing the infection known as tinea pedis.  

Treating Athlete's Foot
Your doctor may advise you to:

  • Keep feet clean and dry
  • Use methylated spirits on feet
  • Apply an antiseptic liquid to cracked areas to treat bacterial infection
  • Wear shoes with leather uppers
  • Wear socks or hosiery make of natural fibers
  • Treat feet, shoes, and socks with a fungicide
  • Take oral medications to treat a persistent infection

Toenail Fungus

Toenail Fungus

Toenail fungus (onychomycosis) feeds on dead skin cells in order to multiply. The fungus spreads from the end of the toenail growth plate extending under the surface of the nail. Toenail fungus sometimes occurs in conjunction with athlete’s foot.  Symptoms include white, chalk-like areas on a toenail. These white patches eventually become yellow or brown in tone. The nail may thicken and become misshapen due to cell damage.

Toenail Fungus Treatments
Toenail fungus is often hard to eliminate. Typical treatments include:

  • Antifungal medications
  • A professional toenail cutting and nail thinning by a podiatrist
  • Oral medicines prescribed by the doctor
  • Laser treatment
  • Surgery (if conservative options do not produce positive results)

To prevent re-infection, it is important to treat shoes with an antifungal spray, in conjunction with these other treatments.

Warts of the Feet

Warts of the Feet

Warts result from excessive growth of the cells on the top layer of skin. A wart can occur on any part of the body. Contact with the virus known as human papilloma virus (HPV) is responsible for warts. Types of warts include common warts and plantar warts. People typically experience common warts on the hands; plantar warts occur on the bottom of the feet.

Warts spread through contact with the wart itself or by using a towel or other personal item of a person with a wart. Warts are slow growing, and most warts resolve without treatment, although it can take months or even years for a wart to go away.

Wart Symptoms
There are smooth, flat warts, as well as rough, bumpy ones. Some warts display a dark spot in the center, which is caused by blood vessels growing into the wart core. Warts typically don’t cause pain, unless they occur in a place that receives pressure.

Diagnosing Warts
Usually, a visual examination is all that’s required to diagnose a wart. A skin biopsy may be taken to confirm a diagnosis and rule out other conditions.

Treating Warts
Unless a wart causes pain, is spreading, or is unsightly, no treatment is required. Treatments for warts include:

  • Home remedies such as duct tape or salicylic acid
  • Cryotherapy to freeze a wart
  • An injection by a doctor
  • Surgical removal

Most treatments don’t kill the virus that caused the wart, meaning that even a treated wart can return or spread.

Illustrated Anatomy of the Leg & Foot

Illustrated Anatomy of the Leg & Foot