This post was written based on a recent appearance by Ashley M. Bojrab, DPM, FACFAS, ABPM, CWS, PPG – Podiatry, on the television program PBS HealthLine.
When it comes to our feet, some issues are more common than others. Here is some general advice for a handful of popular podiatry issues, including treatment suggestions, from conservative to more aggressive.
Plantar fasciitis
Plantar fasciitis is essentially heel pain. Patients with this common condition often notice a sharp pain when they first step out of bed in the morning or stand after they’ve been sitting for a while. It is caused by inflammation in the bottom band that runs from the heel bone into the toes. The Achilles tendon gets tight, and the result is discomfort.
Because the tendon is tight, stretching is key to treating and preventing the onset of plantar fasciitis in the future. It’s also an inflammation problem, so the treatment will involve bringing the inflammation down. This can be achieved by using anti-inflammatories, depending on your medical status, as well as icing. I encourage patients to freeze a water bottle and then roll the foot on it. Proper shoe gear is also key to treatment and prevention.
If the patient requires more aggressive treatment, we might take x-rays and develop a treatment plan that could include steroid injections, oral steroid medication, physical therapy or night splints. Surgery is a last resort.
Even after the condition subsides, you will want to continue stretching and ensuring you have proper shoe gear, to prevent the plantar fasciitis from coming back.
Flaky skin and exfoliation
It’s common, particularly in winter, for patients to experience dry, even flaky skin. It really comes down to hydration and delicate exfoliation. I typically recommend exfoliating gently in or just after a warm shower, when the skin is soft. Then, within 1-2 minutes of showering, apply a creamy moisturizer and put socks on. Avoid water-based lotions or ointments, like petroleum jelly. Do this twice a day, if possible.
For exfoliating, a pumice stone is a great tool. But I would say use it with caution. Start with a softer grade and just do 4-5 swipes on the area of concern. I don’t recommend battery-operated tools, as they make it easy to get carried away and over-exfoliate. If there is any loose or flaky skin, I recommend clipping it off, rather than trying to pull it or exfoliate it off. Pulling or tearing can lead to infection or additional issues.
If you continue to be concerned about your dry skin, consult your primary care provider or podiatrist. There are some prescription lotions they can prescribe if they feel it is appropriate for treatment.
Corns and calluses
Corns and calluses are a result of skin buildup, often due to rubbing or friction in the area. They can also occur if a patient has a clogged sweat gland on the bottom of the foot, which causes that buildup and discomfort.
In order to prevent and treat these uncomfortable spots, make sure your shoes are fitted properly. If you want to try treating the area at home, use a pumice stone to exfoliate the area very gently around the corn or callus. If home treatment doesn’t work, your podiatrist can debride the dead skin in the office and offer padding and shoe modifications if needed.
Nail fungus
Foot and nail fungus often makes the toenails become thickened and discolored. It can be hard to pinpoint what causes nails to become fungal. We see patients get athlete’s foot and then the nails become infected. You can also pick it up from walking around in public places without shoe gear.
It’s very hard to get rid of a fungus and can become a permanent problem. Patients can start by trying the topical, over-the-counter medications. If those don’t work, your podiatrist can prescribe prescription topicals or oral medications. The oral medications can be tough on the liver, as that’s where they are metabolized. Your provider should do bloodwork to ensure your body is responding to these medications safely. Another option is to “kill” or remove the toenail to eliminate the issue.
Footwear
Having the proper shoe gear is imperative. You need to make sure your shoes and boots are fitted to your foot, rather than you trying to fit into the shoe. An improperly fitted shoe can cause swelling, pain, blisters and even discoloration. If you need more support, you can try removing the insert that comes with your shoe or boot and insert an orthotic. If this doesn’t work, it is best to return your shoes and get something that’s a better fit for your needs.
People often ask if it’s necessary to get toddlers properly fitted shoes and I absolutely believe it is. Cloth shoes are for fashion, but once a child starts walking, it’s best to go and get them a supportive option that doesn’t bend or fold. If a child has trouble with their gate, your podiatrist can prescribe an orthotic or shoe that can help correct this. If your little one is sending signs, such as saying that their feet hurt or they don’t want to run, it’s best to consult with their provider.
Inserts and orthotics
Inserts and orthotics work best when they’re custom-made for your foot. A professional can use a mold or sensors to identify where you need to offload high pressure areas. If you want to try over-the-counter options, there’s no harm. I wouldn’t recommend spending more than $50 on these options, however, before you consult a professional. A shoe store or your podiatrist’s office can assist with custom inserts or orthotics for your needs. Spending money on your feet is an investment in your livelihood. You have to take care of them; you only get one pair!
Warts
Warts are tricky because they can be hard to identify and treat. These potentially painful spots are caused by a virus that gets into the skin through a little crack and once you have the wart, you will always have it. You can certainly try over-the-counter topical treatments. Ultimately, you might have to visit your podiatrist for further assistance with treatment if the wart is painful.
Neuroma
People often notice a neuroma because it feels like they have a pebble in their shoe or their sock is bunched up. A neuroma is a benign tumor of the nerve, typically found on the metatarsal that runs between the third and fourth toe. Again, a supportive shoe and orthotic can help with the discomfort. A little extra padding often helps offload some of the pressure on that metatarsal. Icing and anti-inflammatories are also beneficial. If the patient is still experiencing pain, steroid therapy and, potentially, surgery, could be beneficial. We always start with conservative options and monitor the situation.
