Ask Dr. Zaiff

What causes numbness and sometimes shooting pains into my toes when I walk?

The most frequent cause of this is a Neuroma or an enlargement of one or several sensory nerves of the foot. The patient often experiences a variety of symptoms, which may include; burning, tingling, cramping, shooting pains, or numbness. This is usually caused by faulty foot function allowing the metatarsal bones of the foot to be excessively mobile and cause pinching to the nerve or nerves. Treatment usually consists of splinting, injection therapy, orthotics, therapy and sometimes removal of the enlarged nerve.

Why should a patient with Diabetes see a podiatrist regularly?

Patients with Diabetes usually will have circulation problems with their feet caused by elevated sugar levels. Also most diabetics possess a decrease in the sensation of their feet causing a greater chance for infection and in many cases ulcers and gangrene. Even faulty trimming of the toenails could result in amputation in a diabetic patient.

I think I have a Plantar Wart. How do I get rid of it?

Plantar warts are viral skin infections caused by the Humai Papilloma Virus (HPV). These are contagious and can be spread quite easily from person to person. These warts are benign in that they do not cause cancer like some of the other warts from this group are know to do. Generally they result from an area of trauma or site of pressure to the bottom (plantar surface) of the foot. Theses warts may remain solitary or may spread to develop into large aggregates. They are exquisitely painful. Treatment options consist of many topical preparations most of which are acids or chemotherapeutic agents. Laser surgery, cryosurgery, electrosurgery and excision are most effective. Both Fungus Nails and Plantar Warts are picked up by making contact with an area that the person infected with them previously stepped at. This can be a shower, healthclub, pool, etc. Treatment will vary but success for fungus nails can be achieved by use of topical medication or newer oral medications. Plantar warts have been successfully treated by prescription medication or in many cases removal by means of Laser.

What is a heel spur or plantar fascitis?

A heel spur is caused by irritation to the heel bone when the plantar fascia tears from it’s insertion. Calcification over time results in the development of a spur. In many cases the plantar fascia will become inflamed prior to a spur developing. In many cases the pain is worse upon waking or taking initial steps after sitting. Successful treatment consists of stretching exercises, ant-inflammatory medications, therapy, orthotics and in some cases surgical treatment.

Why are my toenails becoming thick and discolored?

Toenail problems are common complaints in the podiatrist’s office. They include thickening, brittleness, discolouration, and ingrown toenails. Nails, like hair, are an appendage of the skin. They are formed by layered sheets of protein with traces of other substances. Contrary to popular belief, there is very little calcium in nails. The normal toenail may be from 0.05 to 1.0 mm thick,. and grows its full length in about six to twelve months. Nails are harder than skin, due to their high sulfur content and lack to water. The normal nail is translucent, and one can see the underlying pink nail bed.
Thickening and discolouration are often the sign of a diseased nail. With aging, the toenails thicken, grow more slowly, and become more susceptible to disease. Injury, infection, and disease may affect the toenails. The toenails and surrounding tissues are are susceptible to day to day small repetitive injuries, for example in confining shoes. Changes in the underlying bone can cause deforming forces on the nail plate. A common affliction of the nails is fungus infection. This may cause a thickening and degeneration of the nail plate. A microscopic examination and culture of a nail sample may help confirm the diagnosis. This is a difficult problem to treat. You podiatrist may prescribe therapy with oral anti-fungal medication. The ingrown toenail is another common problem which presents to the podiatrist’s office. Infection mat result from improper cutting of the toenails, or injury to the surrounding skin from an incurvated or deformed nail plate. Your podiatrist may simply trim the offending nail border. Some patients require regular expert nail care by the podiatrist. In many cases a simple nail surgery can permanently correct the problem.

What are orthotics?

Podiatrists prescribe and construct foot orthotics. These are specially designed devices that are worn inside the shoe to control abnormal foot function and/or accommodate painful areas of the foot. Properly designed foot orthotics may compensate for impaired foot function, by controlling abnormal motion across the joints of the foot. This may result in result in dramatic improvement in foot symptoms. Functional foot orthotics are usually made from rigid materials, especially plastics and carbon-fiber composites. They are constructed upon a plaster impression of the feet, and modified based on the podiatrist’s evaluation of your problem. They are normally quite comfortable, and do not feel hard or uncomfortable in the shoe. Rigid orthotics normally last for years, additions such as top covers and extensions may require periodic replacement. Some patients, for example the very elderly, may not tolerate rigid functional orthotics. Under these circumstances, the podiatrist will prescribe an orthotic made from softer materials with special accommodations for painful areas. Many different materials can be utilized, such as rubber, cork, leather, and soft synthetic plastics. The podiatrist is in the unique position of being able to evaluate, diagnose, and treat your foot or leg problems. If orthotics are indicated, he or she can utilize the most advanced methods of construction. Orthotics that are prescribed by the podiatrist and custom made for your feet, should not be confused with over the counter arch supports. These may help the occasional patient with minor arch discomfort, but they frequently fail because they do not properly control foot function and/or do not properly fit the patient’s feet. The consumer should beware of individuals with no or inadequate training, who hold themselves out as experts on foot problems and orthotics. Only the podiatrist, chiropodist, or medical doctor can diagnose foot problems and offer alternative treatment plans. If complications develop, the podiatrist is there to evaluate and treat those. He or she can offer the patient alternative treatments, be they medical, orthopedic, or surgical.

I have a single discolored toenail. What could this be?

There are many causes of discolored or thickened nails. A frequent cause of nail discoloration, thickening and pain is fungus (onychomycosis). Nail fungus may initially begin beneath the edge of the nail, spread to the entire nail plate other toenails and to the skin as athlete’s foot. Oral antifungals are currently the treatment of choice for fungal nail infections, Other causes of painful, thickened or discolored toenails could include nail dystrophy, psoriasis, glomus turners, subungual hematomas and even melanoma.

Is there a permanent remedy to my ingrown toenails?

Yes there is and it’s a simple one. Most ingrown nails result from an incurvatlon of the nail into the surrounding skin as it grows out from the root. As the nail digs into the skin it develops into a localized infection. These infections can become quite intense and must be treated promptly. Provided the patient’s general health is good, a simple in-office procedure can rid you of this chronic condition. Under local anesthetic the nail border is removed and the matrix or nail root is destroyed. Most patients experience little discomfort with this procedure and the toe will go on to heal in a week or two.

What is Plantar Fasciitis?

Plantar fasciitis (commonly referred to as “heel spur”) is a common cause of heel pain and affects millions of individuals in the U.S. each year. The plantar fascia is a broad ligament that spans the entire bottom (plantar) of the foot just beneath the skin. When this ligament is stressed, the small collagen fibers begin to fray which results in inflammation and pain. This is caused by a number of factors including sports injury, obesity, jobs that require lots of standing and walking, high arched feet and flat feet. Treatments consist of shoe gear changes, anti-inflammatories, orthotics, physical therapy, extracorporal shockwave therapy and surgery.

What is a Neuroma?

A neuroma is a benign thickening of a nerve between the toes that usually results in radiating pain toward the ends of the toes or even up the foot and leg. Though neuromas can be found along any nerve they tend to have a predilection for the area between the third and fourth toes. This is known as a Morton’s neuroma. The most common causes of neuromas are inappropriate or tight shoe gear and trauma. Treatment options consist of simply changing shoe gear, orthotic devices, anti-inflammatories, sclerosing therapy and surgical excision.

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