A podiatrist, also called a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of foot, ankle and heel problems. In addition to undergraduate medical school training, podiatrists also attend graduate school for a doctorate degree in podiatry. Podiatrists are required to take state and national exams. Podiatrists must be licensed by the state in which they practice.
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Surgery is not always the best option to resolve foot pain and deformity, but may be the only option available if all else has failed to provide relief. If you are considering foot surgery, then consider all you options before doing so. Ask questions that the foot/ankle surgeon will answer in common terms that you understand before having any procedures with regards to outcomes, benefits, disability, pain involved, type of anesthesia used, and eventual return to normal daily activities. It is always imperative that you also check the credentials, training, and experience of the foot/ankle surgeon. Are they board certified by a credible and national qualified foot surgery board, such as The American Board of Podiatric Surgery? Not all podiatrists have been surgically trained, experienced, or have the prerequisites to perform foot/ankle surgery. If the podiatrist you are currently seeing does not do foot surgery or keeps putting off that kind of treatment for other non-surgical means, then seek a second opinion. Most foot surgery is performed in an outpatient setting at a hospital or surgery center. If the podiatrist suggests doing your reconstructive foot or ankle surgery in their office, then reconsider having it done by another surgeon. Foot surgery is a serious matter, therefore much thought and contemplation must be considered before making a decision to do so.
Foot pain can be caused by a number of biomechanical, metabolic, and/or combination of structural deformities of the foot, ankle, or legs. Therefore, it is important that your podiatrist perform a thorough exam of your feet, ankles, and legs during the visit. This exam should be done standing and sitting. If this is a first time visit or you have not been to the podiatrist in some time, then a complete history of any medical problems, medications being taken, past foot low back, hip or knee problems, surgeries, family history, and do you have you had a history of diabetes, heart disease, circulation problems, or use of tobacco products? The podiatrist may perform certain in-office test, like X-rays to better assess your foot problem. The more information that is obtained at the time of your visit, then the more simple a task of making the proper diagnosis and treatment regimen to resolve your foot pain will be.
A bunion is an enlargement of the great toe joint. This is usually caused by a displacement of the big toe joint because of underlying abnormal structural forces affecting the feet. Over time the great toe joint can be become so displaced that it becomes a non-functional joint and not only causes pain, redness, and swelling around the joint, but can also cause other deformities of the lesser toes throughout the and eventual pain in entire foot. Shoes do not cause bunions to form; that is a misnomer. Tight shoes only aggravate the deformity. The simple treatment for bunion pain reduction may be just wearing wider shoes. But, sometimes surgery is required to correct this deformity. The procedure is performed in an outpatient same-day facility setting with patient under local and IV anesthesia. The procedure performed is dictated by the severity of the bunion deformity and the opinion of the surgeon performing the bunion correction. The disability involved from a bunion surgery is usually 4-6 weeks of non-weight bearing with crutches and a surgical boot. Returning to normal daily activities will occur after the initial disability occurs. A series of follow-up visit may occur for up to year after the surgery.
Inspect your feet every day, and seek care early if you do get a foot injury. Make sure your health care provider checks your feet at least once a year - more often if you have foot problems. Your health care provider should also give you a list and explain the do's and don'ts of foot care. Most people can prevent any serious foot problem by following some simple steps. So let's begin taking care of your feet today.
According to the American Diabetes Association, there are approximately 32 million Americans with diabetes. Unfortunately, this number continues to grow. Of persons with diabetes, 35 percent develop foot problems related to the disease. Recognizing this problem, In 1993, the US Congress approved the "Medicare Therapeutic Shoe Bill", helping thousands of persons with diabetes obtain protective footwear and inserts. Check with your local podiatrist and see if you may qualify to receive this benefit as a Medicare beneficiary.
Thickened discolored toenails may be a sign of a fungal nail problem known as “onychomycosis”. This fungal nail condition actually starts in the skin and can be generated by multiple bouts of athlete’s foot. The fungal elements from the Athlete’s foot infection find their way into the toenail beds and eventually they invade the nail plates. Once this happens, the nails become yellow, crumbly, discolored and thickened in appearance. This condition if left untreated can spread to all the toenails. Other skin diseases, like psoriasis can mimic onychomycosis. So, a toenail sample may be taken during the visit by the podiatrist for a pathological evaluation and identification. Once the fungal nail condition is verified, then a proper treatment plan can be formulated. First, regular toenail trim and/or debridement (surgical removal of foreign matter and dead tissue from a wound) will need to occur. Along with this treatment, patient education on prevention must be provided by the podiatrist. Preventive measures include proper hygiene, changing socks daily, wearing odor free and dry shoes, applying low pH skins creams to protect the “acid mantle” on the skin, and using antifungal sprays, creams, or foot powders. Prescription remedies include oral antifungals which may require a three month dosing regimen. Most oral antifungal require pre-dose lab work to evaluate liver and kidney function. Therefore, it is imperative that these labs are taken and the results reviewed by your podiatrist prior to taking this medicine. The oral antifungal has a long term effect on eliminating fungal nail problem, but preventative measures must be utilized for a sustained period of time to allow for the success of treatment. Sometime fungal nails may need to be removed if they have become so deformed and painful in shoes. This should be a last resort.
Depending on much and what type of surface or where you run (treadmill or outdoors). Running shoes should be replaced every 300 miles or so.
If the orthotic is an over-the-counter device, then replace it about every six months. However, if the devices are prescription, then a 3-5 year period should be the norm.
Prescription orthotic devices can be made from a plethora of materials which can be rigid, semi-rigid, flexible, and semi-flexible to soft. Therefore, when getting devices prescribed by a podiatrist, tell them what type of activities you will be doing while wearing them. The activity truly dictates what type of device you will need and what type of material of which they will be made.
Traditional heel pain is usually caused by a condition known as “plantar fasciitis”. The symptoms are as follows: pain in the heel(s) with getting up in the morning, getting up from a rest position, decreased pain with activity, and pain at the end of the day. Other foot and/or back problems must be ruled out before the plantar fasciitis diagnosis can be definitive. Once a diagnosis is made, then further diagnostic teasing may include but not be limited to: foot X-ray, diagnostic ultrasound of the plantar fascia, bone scan, EMG-NCS, and even and MRI. Certain labs may be performed to identify if the heel pain is related to some underlying arthritis like gout or rheumatoid arthritis (RA). A foot X-ray may reveal the illustrious “heel spur”, but not to worry…it is not the cause of your heel pain. He pain is principally caused by the swelling and irritation of the soft tissues (fascia) attached to the bottom of the heel. Plantar fasciitis is caused by abnormal structural deformities in the foot which cause the foot to be out of balance during its function. Therefore, any overuse of the foot like running, standing on hard surfaces, or even walking long distances throughout the day can propagate this condition. The treatment can be as simple as an over-the-counter oral NSAID medication like Ibuprofen or even curtailing or eliminating the overuse activity. If this does not work, then a cortisone injection on the side of heel may resolve the problem followed by an at-home stretching or a physical therapy program prescribed by your podiatrist. Sometimes the foot can be wrapped with tape or a Velcro band to take pressure off the plantar fascia. This may be temporary measure and can be further remedied with a prescription pair of orthotics to help balance and re-align the foot, thereby taking stress off the plantar fascia. When all else fails and nothing has resolved the heel pain over a six month (or greater period…and if you have had heel pain greater than six months). Then you may want to consider surgery to resolve the heel pain. This should be the last resort since research and medical literature shows that 90% of heel pain sufferers get relief without surgery. The techniques utilized to resolve plantar fasciitis have improved greatly over the years and now implore a number of highly technically advanced techniques to eliminate plantar fasciitis with very little disability.
As the discussion already revealed about fungal nails problems above, Athlete’s foot is caused by a micro-organism which a plant that grows on your skin. The foot and in between the toes are commonplace for this type of fungus to grow. Fungus generally likes to grow in dark, moist, warm environments. What better place than to grow than on your feet? Most Athlete’s foot problems can be eliminated by store bought creams, sprays, or powders. Changing socks 2-3 times a day may help. Keeping the feet dry is important to prevent a return of or healing the infection, therefore drying sprays or powders must be used judiciously on a daily basis. Prescription remedies are very beneficial in the successful eradication of the disease. But the best way to resolve an Athlete’s foot problem is just by following common sense preventative measure mentioned above.
Pain in the balls of the feet are usually stemming from a mechanical disturbance in foot function. Whether it is a toe joint that is injured in the ball of the foot or just a pinched nerve, pain of this type must be identified one way or another. Diagnostic tools like X-rays and ultrasound can help determine if there is any bony or soft tissue pathology, but most of the time a proper diagnosis is mad mostly by the podiatrist’s physical exam and patient history. A Morton’s neuroma is the most common reason for pain in the ball of the foot. This condition is a pinched nerve usually occurring between the third and fourth toes. The pain can be a burning sensation, cramping, or fatigue type feeling in the ball of the foot. Sometimes even numbness can occur. The pain and/or numbness does not necessary need to be between the toes, but can be referred to the whole ball of the foot. Some patients even complain like they are walking on something wadded up under their foot. Treatment for this condition may include but not be limited to the following: Oral medication, cortisone injections, padding, orthotics, and physical therapy modalities (TENS, ultrasound, iontophoresis). If there is no relief after all these treatments have been tried and failed, then a simple decompression of the pinched nerve can be performed in outpatient setting with a very short term recovery.
Flat feet can be treated by just wearing the proper fitting shoes with added arch support. If that does not provide relief, then your local podiatrist may help by prescribing orthotics to wear in your shoes to help re-align the arches into more normal position. This is the only non-surgical remedy to resolve flat feet. However, with today’s advancing technology in foot surgery there is a more permanent way to resolve flat feet. A simple outpatient procedure may be performed on a patient (after a thorough exam and history is performed to see if they qualify) to permanently resolve a flat foot condition. A small implant can be placed just under the ankle bone through a tiny skin opening which will align the foot by preventing abnormal flattening of the foot. This procedure is mostly done on children and young adults, but can be performed on older adults (if warranted) along with other ancillary tendon and bone procedures. The recovery from any flatfoot procedure is inherently related to the type of surgery performed along with medical background and age of the patient.
Ingrown nails can be simply resolved by trimming your toenails straight across and do not round off the corners. A podiatrist is skilled and specifically trained in treating toenail ailments. An ingrown nail is one of the most common in-office procedures performed by a podiatrist. Therefore, when an ingrown toenail becomes unmanageable and/or infected then it is time to see your local podiatrist. They can perform a simple procedure on the affected to toenail border(s). Most of the time, the cause of an ingrown nail is from trimming toenails incorrectly or trying to perform a “bathroom surgery” on a toenail that is ingrown. Diabetics should not ever trim their own toenails just for this reason alone. The ingrown nail procedure is done in a few minutes under an aseptic technique with the affected toe(s) numbed with local anesthetic. Once the offending nail border is removed, them a small amount of a chemical agent is placed on cotton tip applicator and placed in the nail grove for 30 seconds to a minute time frame. Then a light dressing is applied to the toe(s) and the patient is able to go home in a regular shoe with very minimal disability. Home care instructions are provided to the patient afterward.
Repetitive trauma to the toenail is the principle reason for this to happen. Runners are usually the most patients who present with this condition. Losing toenails is from the shoe being too tight and the toes hitting the end of the shoe while running. This causes the trauma and hence the loss of the toenail. Runners should always make sure they have a good thumb’s width between the longest toe and the front of the shoe.
Most who have an ankle sprain never seek treatment, but if an ankle sprain does occur and you do not want to seek medical care, then just follow this anagram: RICE, which stands for: Rest, Ice, Compression, and Elevation. Stay off the foot to prevent any further damage. If you are not at home and you get an ankle sprain, then leave your shoe on the affected foot, because it will limit the amount of swelling that will occur after the injury occurs. You should also try and wrap the foot in an ACE wrap to reduce swelling. Immobilization of the foot in a walker boot for short period of time may be necessary to also limit pain and swelling. If after a few days you still have tremendous amount of swelling and pain, then seek medical attention from a local podiatrist. They will exam the foot for any fractures or ligamentous injury with diagnostic tools like X-ray, ultrasound, and possibly an MRI. Fracture of the fifth metatarsal base is quite common with an ankle sprain and should be ruled out by the podiatrist before continuing treatment on the ankle sprain. If there is presence of this foot fracture, then surgery may be indicated to repair this fracture. A lateral ankle stabilization procedure may also be indicated if ligamentous and/or soft tissue disruption has occurred.
The major cause of shin pain is a “shin splint” or can be a stress fracture of the shin bone. This may occur when the foot is unable decelerate when it is hitting the ground. Shin splints are usually seen more in runners who “pronate” or flatten their feet more when they run. Pronation puts an excessive strain on the leg muscles that attach to the shin bone which are responsible for increasing the arch of the foot when the foot hits the ground. Repetitive strain on these muscle fibers along the shin bone can cause tearing of these fibers and bleeding. The classic physical finding of shin splints is not only pain along the “tibial crest” or shin, but one may also feel a “string of pearls” along the shin which is caused by the tearing away of the muscle fibers and the aftermath of scar tissue. If shin splints are not allowed to heal properly through sustained periods of rest and icing, then a stress fracture of the shin bone may occur. Pronation of the foot can be limited by prescription orthotics as well as combing them with running shoes that increase “supination” (increase the arch of the foot or opposite pronation).
If you engage in excessive amounts of exercise, your legs will hurt. That's normal. But if you regularly have leg pain after moderate or small amounts of exercise, or feel it lying down or sitting in a chair, that's not normal. That's when leg pain can be a problem.
The symptoms of leg pain are more common than you think. Particularly for people over age 50, and especially for those who smoke or have diabetes. About 30% of adults in this category have some form of peripheral arterial disease, which is often the underlying cause of leg pain.
Leg pain feels different to different people. Some people feel it as a sharp, crampy, or "Charlie-horse" type pain they get after walking, climbing stairs or some other kind of leg exercise. This type is called "intermittent claudication." In more severe cases, people will complain of pain in their toes or feet when lying down, and this pain can even disturb sleep. This type of leg pain is called "rest pain."
Peripheral arterial disease (PAD) is caused by a narrowing or blockage of arteries that results in restricted blood flow to your arms and legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps.
Leg arteries get clogged with fatty deposits, or plaque (pronounced as 'plak'). Plaque is made of extra cholesterol, calcium, and other material in your blood. Over time, plaque builds up along the inner walls of the arteries, including those that supply blood to your legs. When plaque builds up, there is less room for blood to flow. Every part of your body needs blood that is rich in oxygen. But plaque buildup prevents that blood from flowing freely and starves the muscles and other tissues in the lower body.
This process of plaque buildup usually happens at the same time throughout the body. It is called atherosclerosis or hardening of the arteries.
P.A.D. affects millions of Americans over age 50. The hardened arteries found in people with P.A.D. are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. That is why people with P.A.D. have a two to six time's greater chance of death from a heart attack or a stroke.
Your doctor will ask lots of questions. What does your leg pain feel like? Where is it isolated? How did it start? How bad does it get? Is it constant or does it come in attacks? What seems to bring it on? What makes it better? What makes it worse? What other symptoms go along with it?
If you are seeing a doctor for the first time, you will also be asked about other or current health problems, about health problems in your immediate family, and about your lifestyle.
Some doctors prefer to ask these questions face-to-face. Others prefer to have you fill out a questionnaire in the waiting room and then go over the answers with you. You should be aware that certain information is helpful and other information is not. Your doctor knows what information is helpful, so it's best to let him (or her) ask the questions.
You will be examined. Your height, weight, heart rate, and blood pressure will be taken. The doctor will listen to your heart and lungs and examine various parts of your body, especially looking for evidence of sores or ulcers on your feet, legs and toes. He will feel your pulses, particularly in the legs to feel for the strength of blood flow to these areas.
Some disorders that cause leg pain don't require treatment. They go away by themselves. Fortunately, most arterial disorders can be treated with medication, surgery, diet, a change in lifestyle, or some combination of these.
After his examination, if your doctor thinks you may have P.A.D., he (or she) may order a test called PADnet. PADnet is a 15-20 minute test of segmental blood pressures in your arms and legs, called the ABI, or ankle brachial index (pronounced as 'an´ kel-bra´ ke-el in´dex'). It also measures blood volume in the legs using pressure cuffs (Pulse Volume Recordings or PVR's) and blood pressures in the toe (toe brachial index or TBI). For more information on PADnet and BioMedix go on the web at www.biomedix.com or click here to contact Dr. Joseph Borreggine.