CONDITIONS AND TREATMENTS

FREQUENTLY ASKED QUESTIONS

This page covers many common questions we are asked about foot and ankle conditions, as well as podiatry as a specialty in general.  It is updated weekly with new questions and answers.  Be sure to check this page out regularly for new topics and answers.

General Podiatry Questions

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.

How many years of school do podiatrists go through before becoming physicians?
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.

Can podiatrists perform surgery?
Yes, most podiatrists are very well trained and experienced in foot and ankle surgery, and are licensed to perform surgery by the state in which they practice.  Podiatric surgeons are either board certified, or are board qualified (meaning they have passed their written certification exam and are waiting to sit for their oral exams).

What does it mean to be a board certified foot surgeon (American Board of Podiatric Surgery)?
Board certification is an extra process by which a licensed foot surgeon is recognized by his/her peers as meeting a rigorous criteria of surgical knowledge.  For a podiatrist to become board certified, the surgeon must have a specific level of training in a wide variety of foot procedures during their residency years, and then pass a comprehensive written examination to become board qualified, or eligible to sit for his/her final evaluation to become board certified.  This final assessment comes after several years of performing surgery in private practice, in which a specific number of different types of cases must be completed and their results sent to a selection committee.  If the surgeon is accepted, he/she must then pass a rigorous oral and computer simulation exam that tests the surgeon's knowledge and skill on routine and complicated surgical scenarios, as well as surgical complications.  This test is given by other board certified surgeons, and if the surgeon passes, he/she is granted board certification.  This measure is often used by hospitals and insurance panels as a requirement for membership and participation, respectively.

 

General Indiana Podiatry Group Questions

How long has Indiana Podiatry Group been serving patients?
Indiana Podiatry Group has been serving the foot care needs of central Indiana since 1993.

How can I reach my podiatrist after office hours (nights and weekends)?
The doctors can be reached by calling any one of the office numbers, and then listening to the message prompts to reach the individual doctor's voicemail.  Leave a message containing your name, your call back number, and the problem you are calling about.  Please keep in mind this is for urgent medical matters, and all non-urgent issues like scheduling concerns, general non-emergency questions about foot conditions, and non-urgent medication refill requests should be handled through the staff during office hours.

Do you have early morning and late appointments available?
Our doctors have specific days that they see patients as early as 7 am, and as late as 6:30 pm, to accommodate for a variety of patient's personal schedules.  Each office has early and late appointments on different days.  To see the when late and early appointments are available, follow this link.

Do I need a referral to see your doctors?
Unless your insurance requires a referral for specialist visits, you do not have to have a referral to see the doctors at Indiana Podiatry Group.

Do I need to make an appointment to see your doctors?
Indiana Podiatry Group are specialists, and see patients by appointment only.  Exceptions are made on a case by case basis for urgent walk-in visits.  However, we are able to accommodate same-day or next-day appointment scheduling on most days, so patients can generally be seen within 24 hours.

Are all services available at both of your locations?
Both our offices are equally equipped and staffed.  Each office provides digital x-ray, PAD (circulation) testing, wound care, minor surgical procedures, diabetic shoes, foot care products, orthotics, bracing, and is staffed by all three doctors on different days.

Where can I find more information on foot and ankle problems?
Our Learning Library page contains a wealth of information on many foot and ankle conditions, and Dr. Kilberg authors two blogs on general foot pain and diabetic foot problems through Blogger (myachingfoot.blogspot.com and thediabeticfoot.blogspot.com).  Dr. Kilberg also has written dozens of e-articles on various foot and ankle conditions on the following site (http://articles.submityourarticle.com/Scott-Kilberg%20DPM-5336).  Our heel pain site, indyheelpaincenter.com, specifically discusses heel pain and heel pain treatment, and serves as an excellent resource for this common condition.


Skin Conditions

What is athlete's foot?
Athlete's foot is an infection of the skin under the foot and in between the toes by a fungus.  Fungus is a microscopic organism, somewhat similar to bacteria and viruses, that can invade and infect human tissue.  The fungus that causes athlete's foot can also invade the skin under the nail, causing nail fungus infection.  Symptoms of athlete's foot include redness, itching, burning, and peeling under the foot, around the sides, and/or in between the toes.

What is a wart?
Warts are bumps or masses in the skin caused by a virus infecting the skin tissue.  In the foot, the most common location is on the bottom of the foot, where it is called a plantar wart, due to its location on the plantar surface, or sole, of the foot.  It is often mistakenly called a planters wart.  They are usually found on the bottom of the foot because that is how the infection is commonly contracted, by stepping on infected human skin tissue in a public place like a shower or locker room.  The virus creates a hard, lumpy mass of skin that can be speckled with black dots composed of dead capillaries (often mistaken as seeds), bumpy with cauliflower-like growth, or hard with callus formation on top.  Many warts cause pain when stepped on, and have the potential to enlarge and spread.

Are warts contagious?
Warts are caused by an infection, and can certainly be passed from one person to another.  This is why many people develop warts after going barefoot in a public shower, locker room, or in a bathroom shared with a family member or roommate who has foot warts.  The virus rides along on shed skin tissue, and can enter the skin of another who steps on the skin tissue if there is a small crack or break in that foot.  It is not easy to contract this virus, as it is hardly as contagious as a cold virus, for example, and essentially boils down to stepping in the wrong place at the wrong time.
 

Do warts have roots?
Warts actually do not have 'roots', because the deepest that wart tissue extends in the skin is to something called the basement membrane.  This tissue is the bottom layer of the most superficial half of the skin layers, between the epidermis and the dermis.  The wart does not extend any further into the skin or the body overall, and therefore does have a 'root' or a 'stalk'.  The bottom of the wart is actually shallow and rounded.

Do warts have seeds?
Warts appear to have small black dots within their ridges, that at first glance may appear seed-like.  In actuality, these are the ends of choked-off small blood vessels called capillaries that have been constricted by the wart growth, died, and turned black.

Can I get skin cancer on my feet?
Many types of skin cancer, both benign and malignant, can appear on the foot.  Common benign lesions include nevi (pigmented, darker color moles) and dermatofibromas (hard, scar tissue-like lumps).  Malignant cancers include basal cell carcinoma and squamous cell carcinomas, as well as dangerous spreading cancers like melanoma (cancer of cells that produce skin color), which can be fatal if not treated in a timely manner.  All new skin masses, or ones that have changed appearance, need medical attention and perhaps a biopsy to ensure cancer is not present.  Unfortunately, many cases of foot skin cancer are overlooked given their location, and, especially in the case of melanoma, this can be fatal.

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.


Nail Conditions

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.

Is nail fungus contagious?
Nail fungus can be passed from person to person.  This typically takes place when the fungus infects the skin of a second person, usually through contact in a shower, bathroom, locker room, or wherever there is a somewhat moist environment and people walk barefoot.  This fungus then passes along the skin as an Athlete's foot infection, and then eventually enters the skin under the nail.  Overall, the contagious risk of this infection to another person is not very high, but it can be passed along.  Some people are even more likely to develop toenail fungus than others, and some individual nails may also be more likely to become infected.
 
How can I prevent toenail fungus?
Prevention may be difficult, as some people genetically seem to be more likely to develop toenail fungus infections, and some individual nails may also be at greater risk for becoming infected over others on the same foot.  Keeping the feet clean, dry, and well moisturized (without actually being too physically moist) can limit the potential for fungus to infect the skin.  All Athlete's foot infections should be treated right away to prevent the infection from spreading off the skin into the nail, and chipped or otherwise damaged nails can be treated with an anti-fungal cream to protect them as they grow outward.  One should use shower sandals in public locker rooms and showers, and if a family member or roommate has a fungal infection, regular cleaning of the shower/tub and floor is advised, along with ensuring that family member or roommate obtains anti-fungal treatment.  If nail discoloration does develop, prompt evaluation and treatment by a podiatrist may make a difference in the effectiveness of the treatment course.

What is Formula 3?
Formula 3 is a specially formulated antifungal medication that is designed to penetrate nail tissue to deliver an adequate enough dose to kill nail fungus.  It contains tolnaftate, a common and powerful antifungal medication, and is specially formulated to penetrate nail tissue, where other forms of tolnaftate cannot.  It is safe, effective, and applied like a nail polish.  Used every day, this medication has a much greater chance of killing nail fungus than store-bought antifungal medications, which are generally considered ineffective.  Formula 3 is available without a prescription, but is only dispensed by physicians to ensure it is only used for nail fungus infections.  The company that manufactures Formula 3 offers a money back guarantee if it does not work, or if one is dissatisfied with it.

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.

Why does my toenail grow deformed after it was injured?

The cells that grow nails, collectively called the nail matrix, are fairly fragile and can be easily damaged when an object falls on the toe or when the toe kicks something.  Once this damage occurs, a permanent change can occur in the nail growth pattern.  This change can include nail thickening, sideways or angled growth, splitting, chipping, or the development of ingrown nail borders.  Unfortunately, this change is permanent, and if painful the treatment requires routine nail thinning or permanent removal of the entire nail (or only the sides of the nail in the case of an ingrown toenail).

Does discoloration of a nail always mean there is nail fungus?

Nail fungus infections nearly always present with some form of discoloration to the nail itself.  However, the appearance of discoloration in a nail does not necessarily mean an infection is present.  There are many instances in which nails can become discolored due to skin debris and 'callus' build-up under the nail plate without actually becoming infected.  This is seen after chronic nail damage, pressure from shoes, and even after stubbing a toe.  Sometimes, chemicals in polish or nail adhesives can leave a discolored spot.  Certain diseases of skin, such as psoriasis, can also change the appearance of nails over time and be mistaken for a fungus infection.  Since it can be hard to tell the difference between these conditions and an actual fungus infection, medical evaluation by someone experienced in treating nail disease (such as our doctors) is recommended before embarking on a potentially ineffective treatment course.

Diabetic Foot Issues

What is diabetic neuropathy?
Diabetic neuropathy is a form of nerve disease that develops as a complication to either uncontrolled diabetes or long term diabetes.  The excessive glucose found in the blood stream with diabetes prompts a complex chain of chemical events that ultimately leads to sensory nerves in the legs and even arms not functioning properly.  This leads to decreased sensation in the feet and hands, which can worsen to an outright numbness as the condition worsens.  Abnormal, phantom-like sensations can also develop, including burning and tingling sensations.  In later stages,  muscle function can be affected, resulting in weakness and cramping.  There are medications available to treat neuropathy, although control of blood sugar works the best.

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.

Can a person still walk normally after a toe amputation?
Toe amputations do not change the way a person walks to any significant degree.  Despite common perception, the body does not balance on the toes through the walking cycle.  They help make the foot efficiently push off the ground, and the big toe has a role in stabilizing the inner side of the foot during this push-off period.  However, their loss, either solitary or in groups, does not noticeably change the manner in which one walks, nor does it make walking more difficult

Does Medicare cover diabetic shoes?
Medicare provides 80% coverage of diabetic shoes for diabetics who qualify, along with special diabetic inserts to go in the shoes.  These who qualify include diabetics with poor sensation, foot deformity, pre-ulcerative calluses, poor circulation, prior skin wounds, and past amputations of part of one foot or all of the other foot.  Many supplemental insurances cover the remaining 20%, and Medicare all-in-one advantage plans cover varying amounts based on their individual policies.

Do non-Medicare commercial insurance policies cover diabetic shoes and inserts?
Some commercial insurance companies cover diabetic shoes and/or inserts.  Policies vary widely, and one should call their insurer directly to learn what is covered.  Information on specific billing codes can be obtained through our staff prior to making this call.

Are Dr. Comfort shoes available to non-diabetics and the general public?
Dr. Comfort shoes are a fine line of supportive, attractive, and durable shoe, and can be purchased through our office.  While we do not carry them in stock,  all our shoes are custom ordered after an expert measurement and fitting by our staff, and are usually available within 2-3 weeks.

Foot Pain

What usually causes heel pain?

Heel pain is caused by many different conditions.  By far and away the most common cause of heel pain is inflammation of a band of tissue called the plantar fascia.  Found on the bottom of the foot in the heel and arch, the plantar fascia is often injured simply by poor foot structure (too high or low of an arch) and daily activity.  It can be directly injured by stepping on a blunt object or jumping down hard on the heel, but most cases involve a gradual weakening and straining of the fascia tissue by poor foot mechanics, often in combination with poorly supportive shoes and excessive activity.


Foot Deformities

What is a bunion?
A bunion is a deformity of the big toe in which the big toe swings over towards the second toe, and the head of the long bone behind the big toe protrudes outward towards the skin.  This deformity is due to a complex change in the foot related to instability in the foot structure.  Some children are born with this, but most people develop it over time.  The typical symptoms of this condition involve pain along the side of the big toe joint in shoes, or pain in this joint with walking or prolonged standing.  It is typically corrected by surgery.

Do tight shoes cause hammertoes?
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.

What is a Tailor's bunion?
A Tailor’s bunion is an outward prominence of the head of the long bone 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.

How do I know if I have flat feet?
This question is not as easy to answer, as flat feet may not be immediately visible upon looking at one's own feet while standing.  Simply looking at the arch while one is seated will give little clue, as most people have some form of an arch then since the foot is in what is called a supinated position.  Severe flexible and rigid flat feet are easy to see, as the inner part of the foot is driven into the ground as the foot flattens.  However, some people have a more functional kind of flat foot where the arch looks more normal when standing still, but when moving the bones become more hyperflexible and a flattening occurs.  This is harder to observe on oneself, and typically needs someone trained in foot biomechanics to observe it in others.

Can flat feet cause back pain?
Flat feet contribute to excessive mobility of the foot below the ankle, and this hypermobility can lead to a inner rotation of the lower leg.  The rotation in turn may cause strain to transfer up the leg, and can affect the knee, hip, and lower back.  In some cases, lower back pain is directly attributable to flat feet.  However, many cases of lower back pain are due to direct disease or injury involving the back itself, and while foot support can help ease some of this, the primary treatment should concentrate on the back itself.

Can you have extra bones in your feet?
The human foot has the capacity to form extra bones called accessory ossicles.  There are about a dozen common places that small, egg shaped bones can form in the foot.  These bones are usually benign, however there are times in which these bones can be a source of pain, especially if they are integrated into tendons or prominent under the skin.

Why do ganglion cysts return after being drained?

Ganglion cysts form as a result of an extension or herniation of joint or tendon tissue, and have the capability to create a thick, jelly-like fluid.  When the cyst is drained, it loses its fluid volume.  However, as the puncture site repairs itself, the cyst can fill up again with the fluid it creates (much like a self-filling water balloon).  By adding a steroid medication injection with the initial drainage, the cyst wall may be scarred enough to cease fluid production.  However, many ganglion cysts do require surgical excision for permanent removal.
 
Foot Problems In Children
 
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.
 
How long do orthotics last in children?
Orthotics are meant to be used for a very long period of time, but in children they must be periodically replaced due to the fact that a child's foot grows, becoming longer and wider.  The orthotic subsequently become too short and narrow as the foot grows.  A good rule of thumb for orthotic replacement in children is once a child has grown two to three shoe sizes, the orthotic needs to be replaced with a new one from a new cast molding of the bigger feet.  If the orthotic becomes uncomfortable before this time, when it had been comfortable all along, this may also indicate a need to replace the orthotic.
 
Why does my child's foot turn inward when walking?
Intoeing gait, as this condition is called, can be due to a number of reasons.  Most commonly, this condition is due to a tightening, or imbalance, of muscles in the leg and thigh that cause the leg to rotate inward too far.  In most cases, this goes away as the child grows, or can be corrected with simple physical therapy.  Abnormalities of either the thigh bone (femur), or the shin bone (tibia), can also cause a rotation of the foot and leg inward.  These abnormal bone rotations are less common, but may require surgery to correct.
 
My child seems to get ingrown toenails frequently.  Is this normal?
Ingrown toenails are very common, and children do suffer f