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Indiana Podiatry Group
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Questions We Receive Frequently at Our Indianapolis Foot Care Office

Our patients usually come into our office with many different questions. While we are always happen to answer questions, we also wanted to provide answers on our website to some of the questions we receive the most.

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  • DO TIGHT SHOES CAUSE HAMMERTOES?

    https://www.youtube.com/watch?v=aENi-KUczmw

    No, hammertoes are due to complex changes in the relationship between the muscles that pull the toes upward, and those that pull the toe downward. This change occurs typically because of instability in one’s foot structure, from either too low of an arch or too high of an arch. Shoes cannot mold toes into this position, no matter how tight they are. Tight shoes will irritate hammertoes that already exist, however.

  • WHY DOES MY CHILD HAVE HEEL PAIN?

    Heel pain in children can have many causes. Typically, children often develop pain in their heels in late childhood or early adolescence due to inflammation in the heel bone growth plate. This condition usually resolves on its own, but can be sped along with proper treatment. Other causes of heel pain can include sports injuries and bruises to the heel, inflammation of a ligament called the plantar fascia (more common in adults). Tissue strain because of poorly supportive or poorly laced shoes can contribute to heel pain as well. Stress fractures in the heel bone are possible in children but are very uncommon. In very rare cases, some tumors can develop in the heel bone, which may be either benign or malignant cancer. These are quite rare, but should at least be ruled out on exam due to their serious implications.

  • IS INGROWN TOENAIL SURGERY PAINFUL?

    Ingrown toenail procedures are by nature painless, because the toe is completely made numb by a local anesthetic before the procedure is performed.  This numbing injection does sting and burn, usually no longer than 20 seconds.  The toe will feel like it is filling with a hot fluid.  Once the injection is complete, this sensation ends and the numbing begins.  Everyone tolerates injections differently- some people barely feel them, and others have more anxiety about needles and seem to have a little more discomfort during the injection.

     

    After the procedure is completed and the numbness wears off, some light soreness can be felt where the procedure was performed.  In the first couple of days after the procedure, the toe can even throb a little.  This is usually relieved with an over-the-counter anti-inflammatory medication like ibuprofen.  Most people have just a little tenderness with direct pressure on the nail area for a week or two after the procedure, although some people feel no discomfort at all.  For those whose ingrown toenails were very painful, there is nearly always a significant and immediate amount of relief.  A very small number of people, especially those who do not follow the home care instructions, have somewhat more pain during the healing period after the procedure.  This is typically due to an uncommon infection of the nail area after the procedure, or inflammation because of inadequate home care ( such as not soaking, or leaving the area to air dry instead of keeping it covered with antibiotic ointment and a band aid).  Overall, though, most people successfully go through this procedure with little to no discomfort.

  • WHAT CAUSES HEEL CRACKS?

    Heel cracks, also known as fissures, are the result of dry, callused skin on the heel combined with excessive pressure and skin displacement during weight bearing.  The dry heel skin begins to develop a thickening of its top layer as a natural protective measure from pressure, they way all calluses form.  As the callus tissue begins to thicken, lateral pressure from the side and flattening pressure from the top due to the rounded shape of the heel causes the callus to crack in the middle, and a fissure forms.  This crack can be fairly deep, can bleed, and can be very painful to walk on.  Treatment requires a combination of moisturizing the skin, filing down the callus build up, and reducing the excessive pressure on the heel.

  • WHAT IS PERIPHERAL ARTERIAL DISEASE (PAD)?

    PAD is a condition in which arteries, the blood vessels that deliver oxygen and nutrients to all the cells of our body, become clogged or otherwise blocked.  The word peripheral describes the part of the circulatory system away from the heart and brain.  For the foot, it specifically describes disease of arteries in the legs.  In fact, when people are discussing PAD, it is usually referring to leg circulation, as opposed to the arms.  Arteries can develop areas or plaque, or wall blockages, that can restrict flow down the legs further past the blockage.  The process is similar to the one that causes blockages in the heart arteries that lead to heart attacks.  When the leg blockage occurs with enough severity, the tissues in the foot affected will slowly starve, lacking vital oxygen and nutrients.  This can result in tissue damage, wounds, severe pain, gangrene, and even amputation.

  • ARE INGROWN NAILS CAUSED BY CUTTING THE NAIL TOO CLOSELY?

    Nails grow from an area of tissue called the nail matrix, located at the base of the nail just under the skin. Also known as the nail root, this region grows nails outward. Nails grow inward toward the skin from this area sometimes, either due to a birth malformation or eventual pressure from tight shoes or toe injuries. This is what is referred to as an ingrown toenail, although most people do not notice the ingrown nail until infection develops. By cutting the nail too closely, one does not cause an ingrown nail to form, as it has already formed at the root. However, this can irritate the skin next to the nail, leading to infection or inflammation of the skin which makes a typically painless ingrown nail become painful.

  • WHAT ARE WARTS?

    A wart is a callused mass on the skin that, unlike regular calluses, is actually caused by a virus infecting the skin. Warts can be found all over the body, and in the foot the most common location is on the bottom of the foot or toes. It is typically called a plantar wart, due to it being located on the bottom, or plantar, surface of the foot. Commonly, the wart is mistakenly called a 'planters wart'. Warts typically appear on the bottom if the foot because the infection is usually contracted by stepping in infected human skin tissue left behind from another's bare foot. The infection often occurs in a shower, bathing area, or locker room for this reason. The virus forms a hard, sometimes thick mass of skin that can be bumpy with a cauliflower-like appearance. It can also have speckled black dots that resemble small seeds, although in actuality the dots are dead capillaries. Warts can vary from being non-painful to extremely painful, depending on their size and location. Over time, they can also enlarge and spread to elsewhere in the foot.

  • WHY SEE A PODIATRIST?

    A podiatrist is a doctor who specializes in foot and ankle conditions. Podiatrists begin their training similar to medical doctors and osteopathic doctors, with 4 years of podiatric medical school after college. During this time, podiatrists undergo general medical training, but later on they begin to devote significant time to studying diseases and injuries of the foot and ankle. A typical podiatrist will then train in a residency program after graduation, usually for 2-3 years studying advanced treatment and surgery. A podiatrist is licensed to treat all conditions involving the foot, as well as the ankle in most states. These include skin and nail diseases, nerve entrapment and disease, bone and tendon injuries, and surgical reconstruction of deformities like bunions, hammertoes, flat feet, and arthritis.
     
    No other specialist has more training in foot and ankle disease than a podiatrist, and are generally the preferred specialist that other doctors refer to when they come across foot and ankle conditions in their patients. Podiatrists also play a big role in the comprehensive treatment of diabetics, and are often the first physicians to diagnose serious circulation disease in the legs. In addition to all this, podiatrists integrate the study of biomechanics into their treatment, which is the study of how the body interacts with the ground and itself during motion. Many common foot and ankle conditions outside of accidental injury can have their origins be traced back to a structural problem or abnormality of the shape or functioning of the foot and its bones. Podiatrists often include better structural support and shoe selection in their treatment plans to help reduce the likelihood that a foot condition will return once it is healed.

  • WHY IS NAIL FUNGUS SO HARD TO TREAT?

    Nail fungus infections occur in the skin UNDERNEATH the nail, and not on the top surface of the nail itself. Because the nail is made of material that is generally water-tight, most medications used to treat skin fungus infections are incapable of going through the nail to kill the fungus. In order for nail fungus to be treated, the medication typically has to come to the infection from below the skin via the blood stream, or from above via an oil-based medication applied to the nail that will actually penetrate the nail tissue.

  • WHY DOES MY INGROWN TOENAIL BECOME INFECTED?

    Ingrown toenails often become infected. In fact, this is sometimes the first sign one notices with their ingrown toenail, as many people have ingrown toenails that do not bother them. The signs of an infected ingrown toenail include redness to the skin next to the nail, drainage in the form of a clear fluid or a thick pus, as well as scabbing from dried drainage. The side of the toenail can be painful to even light touch. The pain is worsened with being stepped on, as well as with wearing tighter shoes.
     
    As the skin along the side of the toenail becomes swollen from inflammation, it expands into the nail plate. This causes the skin to trap any debris and bacteria underneath. This enclosed environment is ideal for the growth of bacteria, and an infection can soon develop as the bacteria multiply. Antibiotics can easily treat this infection, but unless the part of the nail enclosing the bacteria inside this 'pocket' of skin is removed permanently, the infection is likely to retune at some point.
     
    Ingrown toenail infections are usually not serious, but can pose a greater danger to diabetics, people with poor blood flow to the foot or in the foot, as well as those who have poor immune systems. If an ingrown toenail infections is allowed to persist for a long time untreated, the infection can possibly pass into the bone below the skin, and create a more serious infection that requires aggressive treatment.

  • WHY DO DIABETICS GET FOOT AND LEG AMPUTATIONS?

    Diabetes causes numerous complications. Among these include poor sensation and decreased microcirculation in the feet, which can ultimately lead to pressure sores. Diabetes also affects the body's ability to heal wounds and fight off bacteria. When these two complications are combined, that puts diabetics at a greater risk for developing pressure sores that do not heal and become infected. When the infection is not promptly treated, or is bad enough, it can spread to the bone or even up the leg. If this cannot be cured by other measures, then an amputation must be performed of the infected part to preserve the health of the rest of the leg or the body itself.

     

  • WHAT IS PERIPHERAL ARTERIAL DISEASE (PAD)?

    PAD is a condition in which arteries, the blood vessels that deliver oxygen and nutrients to all the cells of our body, become clogged or otherwise blocked. The word peripheral describes the part of the circulatory system away from the heart and brain. For the foot, it specifically describes disease of arteries in the legs. In fact, when people are discussing PAD, it is usually referring to leg circulation, as opposed to the arms. Arteries can develop areas or plaque, or wall blockages, that can restrict flow down the legs further past the blockage. The process is similar to the one that causes blockages in the heart arteries that lead to heart attacks. When the leg blockage occurs with enough severity, the tissues in the foot affected will slowly starve, lacking vital oxygen and nutrients. This can result in tissue damage, wounds, severe pain, gangrene, and even amputation.

  • WHAT IS A TAILOR'S BUNION?

    A Tailor’s bunion, also known as a bunionette, is an outward prominence of the head of the long bone (5th metatarsal) that sits at the base of the little toe. Due to instability in the foot, this long bone eventually swings too far outward, or develops an enlarged prominence on its outer side. This can lead to pain in tighter shoes, and swelling and inflammation along the base of the little toe.

  • WHAT IS A PODIATRIST?

    A podiatrist is a physician who specializes in the medical and surgical care of the foot and ankle. Podiatrists treat all conditions involving the foot, ankle, and sometimes lower leg, including bone deformities, skin and nail conditions, nerve diseases, fractures, sports injuries, and diabetic foot problems. Podiatrists are generally recognized as the experts on foot and ankle conditions and treatment, and also have extensive training in biomechanics, the study of how foot structure and function leads to injury.

  • WHAT IS A NEUROMA, AND IS IT THE SAME THING AS A PINCHED NERVE?

    A neuroma is a condition in which the outer layer of a foot nerve, usually one found in between the long bones of the foot along the bottom, becomes inflamed and swollen due to mechanical irritation from pressure under the foot. It is often called a pinched nerve, but this is a somewhat inaccurate description of the actual process. As the nerve is mechanically irritated by excessive pressure from below (the ground) as seen in cases of flat feet and high arches, and pressure from above (a ligament binding two adjacent long bones together), a reaction develops in the outer layer of the tissue covering the nerve. This leads to thickening, scar formation, and the eventual irritation of the underlying nerve fibers. As a result, pain develops in the ball of the foot that can feel hot, numbing, tingling, or simply like a lump, and often involves the two toes the specific nerve supplies sensation to.

  • WHAT CAUSES HEEL PAIN?

    Heel pain can be caused by a number of different causes. Most commonly, heel pain on the bottom is caused by a chronic injury to a tissue on the bottom of the arch called the plantar fascia. This condition is commonly called plantar fasciitis, and is often mistakenly known as a heel spur (which may be present on the bottom but is not a source of pain). Other causes of heel pain on the bottom include nerve entrapment or disease, swelling of a bursal pad, bruises, body-wide arthritic diseases, stress fractures of the heel bone, and rare tumors. Pain on the back of the heel can be caused by bone spurs, Achilles tendon disease, or growth plate inflammation in children.

  • WHAT CAUSES HEEL CRACKS?

    Heel cracks, also known as fissures, are the result of dry, callused skin on the heel combined with excessive pressure and skin displacement during weight bearing. The dry heel skin begins to develop a thickening of its top layer as a natural protective measure from pressure, they way all calluses form. As the callus tissue begins to thicken, lateral pressure from the side and flattening pressure from the top due to the rounded shape of the heel causes the callus to crack in the middle, and a fissure forms. This crack can be fairly deep, can bleed, and can be very painful to walk on. Treatment requires a combination of moisturizing the skin, filing down the callus build up, and reducing the excessive pressure on the heel.

  • WHAT CAUSES ATHLETE'S FOOT?

    Athlete’s foot is caused by an infection of a fungus, which is a type of microscopic organism similar to bacteria and viruses. This infection enters the body through small cracks and defects in the skin, and often occurs in environments where fungus thrives the most, including the moist surfaces of bathrooms, showers, and locker rooms. The fungus irritates the skin as it multiplies during the infection, and creates peeling of skin, redness, itching, and burning pain. The fungus often invades the tissue on the bottom of the foot and an between the toes, but sometimes it can invade the top of the foot, where the infection is known as ringworm. Fungus can also invade the skin under the toenails, leading to a toenail fungus infection.

  • HOW TO PREPARE DIABETIC INSERTS FOR USE

    Your diabetic inserts are a cornerstone part of a system designed to protect your feet from skin damage due to irritation from shoe contact and excessive pressure from the ground in combination with your foot structure. They are composed of several different materials that are designed to reduce direct pressure to the foot skin, as well as reduce shear forces to the skin which can lead to friction injuries. The top layer of the diabetic insert, called plastizote, can be heat molded to match the foot shape, and needs to be prepared properly to maximize its benefit.
    Some diabetics have received custom made inserts due to an amputation or severe foot deformity, and had a foam impression taken of the foot during the diabetic shoe fitting appointment. If you have received inserts like these, you do not have to heat mold the inserts to your foot as they are already custom made.
     
    If you are amongst the majority of people without amputation or severe deformity who have not had to receive custom diabetic inserts, then a brief heat molding procedure needs to be performed prior to wearing your inserts. If you have just received your shoes and inserts from our office, the first pair was already heat molded in our office at the time of dispensing. Your other two pair will need to be molded before use. Your diabetic inserts should be exchanged every four months, assuming they are not damaged.
     
    To begin the heat molding process, remove your inserts from their packaging and apply a hair dryer to their top surface for approximately one minute, moving the hot air across the entire surface of the insert.
    Next, place the inserts quickly in your diabetic shoes before they have a chance to cool down, and place your feet in the shoes while wearing a pair of socks to insulate your skin from the warmth of the heated insert. Stand in your shoes for approximately thirty seconds, and then remove the shoes, allowing for a cool down period.
     
    Your diabetic inserts are now ready for use!

  • HOW MANY YEARS OF SCHOOL DO PODIATRISTS GO THROUGH?

    Podiatry training is similar to medical doctor (MD) or doctor of osteopathy (DO) training. After graduating from a four year college with a bachelors degree, a podiatry student then undergoes four years of podiatry school. Podiatry school is similar to MD and DO school, in that the first two years of education cover the most of the same basic medical science courses and core clinical skills. The last two years of school podiatry students concentrate more on the clinical care of the foot and ankle, while MD and DO students have a much broader clinical education. After graduation, podiatrists then undergo another two or three years of residency training at a teaching hospital, learning advanced surgical skills and medical treatment protocols before entering private or hospital-based practice.