PPMA Members Answer Questions You May Have Wondered About
But Reluctant to Ask
Have a question you’ve always wanted to ask a podiatrist? Now is your chance, send questions to info@ppma.org and PPMA staff will make sure your general question is answered by a PPMA member podiatrist.
Is it ever too late to get my severe fungal toenails treated? What are my options?
That's a good question. It might seem like an easy question to answer, but is not always so. There can be several options including oral and topical medication, as well as serial debridement (scraping off dead skin) and palliative care. The choice of which one to choose can depend on many factors such as the extent of infection, co-mobidities, other medications the patient is on, insurance coverage, and patient preference. I find that oral antifungal medication is by far the most effective. It is slow to resolve, but all treatments are. Patients who have underlying liver problems or who are on medications that also affect the liver may not be candidates for this. Topical medication in my opinion is extremely slow, 14+ months, and has a low cure rate. It does, however, have a low side effect profile and may be the treatment of choice if the infection is mild. Serial debridement can be helpful as an adjunct to either method. Gerald Gronborg, DPM, is a PPMA Board Member and practices in Altoona, PA, Central PA Podiatry Associates, PC.
I’m a diabetic for 4 years now, and never have been to a podiatrist because I haven’t had any noticeable foot problems, why should I go?
Diabetes is a disease that can affect your circulation (blood flow) and your sensation (ability to feel). In early diabetes, you may not be aware of any problems forming, but warning signs could exist that a podiatrist can more readily detect.
Early detection is the best way to prevent some of the more serious long-term consequences such as neuropathy (nerve damage) and ulcerations (open wounds or sores). In general, it is recommended for all diabetic patients to have regular evaluations by a Podiatric Doctor to test their circulation and sensation. Christine Miller, DPM, is Assistant Professor at Temple University School of Podiatric Medicine, Philadelphia, and an editor of the Goldfarb Foundation Board Review Study Guide.
I have a son with special needs in his mid-30s, his ankles and feet are acutely swelled and his right foot turns outward at a noticeable angle when he walks compared to his left foot. Should I have his PCP treat him or a podiatrist?
First of all, it is always a good idea to first check with your son's medical insurance to verify that there are not requirements from the insurance plan to first contact your son's primary care physician (if not actually required to be seen or not in that office) before his insurance would cover services by a specialist. A referral might be necessary.
Otherwise, Podiatric Doctors are uniquely trained foot and ankle care specialty providers, because they can provide medical and mechanical diagnoses for foot and ankle issues. They can offer a variety of non-surgical and surgical treatment plans for all types of foot and ankle issues. Often, podiatrists will have X-ray equipment and other diagnostic equipment right in their offices. Many times the type of care required for the circumstances you describe for your son are beyond the comfort level and training of your PCP. When you think about it, your primary care physician will refer an eye problem to an eye specialist, or a tooth problem to an oral surgeon or dentist, so referring a foot issue to a Podiatrist makes sense. It would be recommended that you bring along a general medical health summary from your PCP office.
In the circumstances described, your son may have a chronic problem—i.e., one that has been developing for a long time, such as a collapsing or weakened foot and ankle mechanical change on the right; and the acute swelling, more recently developing. The latter could be tendinitis (swelling from overuse or injury of one of the tendons that normally works to maintain the arch structure), or another sudden soft tissue injury. Treatment might include an evaluation of shoes, determining whether a Foot-Arch-Support versus an Ankle-Foot-Bracing is needed (either temporarily or permanently) as well as accurately diagnosing the problem.
The most important thing is that you are taking the first step for your son. A problem that sounds this significant in the mid-30s age group will not take care of itself, and may also have impact on his knees, back, and his ability to be active and remain independent. Larry Assalita, DPM, solo practitioner in State College, PA, and ‘Fit Feet’ volunteer at Summer Special Olympics in State College.
How is limb-length discrepancy treated?
Very often limb-length discrepancy can cause ankle, knee, hip, or lower back pain. This can usually be addressed through a simple heel lift or an orthotic inside the shoe, if there is a subtle discrepancy. If there is a large discrepancy, such as 1/2" or greater, then an external heel lift can be placed on the shoe of the shorter side. Usually the body attempts to adjust for the limb-length discrepancy. Therefore, a gradual incremental increasing heel lift is advised until reaching the optimal length. Extreme congenital limb-length can be corrected by surgical limb-lengthening procedures. Kevin Naugle, DPM, is a Past-President of PPMA (2008-2009) and practices in Shillington, PA, Berks Foot & Ankle Surgical Associates.
Is surgery my only option for my Bunions? What’s the difference between a bunion and bunionette?
The difference between a bunion and a bunionette is the location on the foot. A bunion is a deformity of the great toe while a bunionette is located on the fifth or baby toe. While surgery can sometimes be the best option for treatment of your bunions, it is not the only choice. Shoes with plenty of room in the toe-box as well as padding can sometimes relieve the pain associated with a bunion. Arch supports can help prevent the progression of a bunion deformity. When the pain and discomfort gets to the point where it begins interfering with activities of daily living, then surgical correction of a bunion should be considered. Jason Sweeley, DPM, PPMA Member, practices in Mechanicsburg, PA, an associate with Jeffrey Marks, DPM.
I’ve always picked up shoe inserts from my local drugstore to place in my shoes for comfort while I play sports. Recently they don’t seem to be helping and a friend of mine was telling me he went to a podiatrist to get his orthotics custom-made. What’s the difference?
The inserts that are purchased from a drugstore are designed to fit the average individual. They are made in a cookie-cutter fashion and partially give some additional support while not being uncomfortable. Therefore, these devices do not satisfy the actual contour of your foot because each individual has a unique footprint. In addition to matching the contour of the foot, a device that is customized will actually position the foot in the manner necessary for ideal foot function and proper mechanics. This can only be achieved by a cast mold or computer analysis of each individual foot by a trained clinician. While some individuals can gain comfort from an over-the-counter insert, others will require the more specific and precise correction provided by custom- orthotics. Todd Zeno, DPM, is a PPMA Board Member and practices in East Berlin, PA, East Berlin Foot & Ankle Center, PC.
My father is 80 + years old, his mobility has decreased and he has painful hammertoes/overlapping toes, what other options are there for him without having surgery?
The best non-surgical options for something like this would be high toe-boxed shoegear that allow plenty of space for the toes. There are also toe-spacers that can help prevent the rubbing between toes, and the pain that is often associated with it. Silicone toe sleeves are also available to help prevent the friction and pain that is associated with overlapping and rubbing of the lesser digits. Jason Sweeley, DPM, PPMA Member, practices in Mechanicsburg, PA, an associate with Jeffrey Marks, DPM.
I think I have heel spur syndrome but don’t want to even think about having surgery. Is surgery my only option?
Surgery for heel spur syndrome is only considered after a patient typically fails conservative options. In fact most patients undergoing conservative therapy completely resolve their heel pain. Patients will work with their podiatrist to develop a cohesive and extensive pain reduction/treatment program, which can include but not limited to anti-inflammatory medications, stretching, physical therapy, custom-molded arch support, and sometimes steroid injection therapy. If the patient fails all of these conservative options your podiatrist may choose to perform an MRI to look for additional causes of the chronic heel pain. Ultimately if conservative options fail, surgical intervention may be suggested. This is usually taken care of by an endoscopic "camera" approach to releasing/cutting of the plantar fascia to remove the abnormal strain on the plantar fascia tissue. The spur is not typically removed as it is not the cause of the symptoms. Jeffrey Dunkerley, DPM, is a Goldfarb Foundation Board Member and practices in York, PA, Martin Foot & Ankle.
What’s the difference if I buy wart treatment over-the-counter or go to a podiatrist to pay him to treat my warts the same way?
For stubborn warts, your podiatrist will first be able to debride (scrape off the dead skin) them properly and will have stronger versions of the over-the-counter products and/or other treatment options that would never be available to the general public—such as laser, prescription topical medications, immunotherapy injections, and surgical excision. Also, it is important to make sure it is a wart, as there are other conditions that may be confused with a wart; so your podiatrist would be the expert in that area. Tracey Vlahovic, DPM, Instructor of Dermatology, Temple University School of Podiatric Medicine, Philadelphia; Frequent Goldfarb Foundation Faculty
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