Seeing a new patient is like an athlete getting ready to go onto the field or an actor waiting in the wings preparing to go onstage.  I have to get psyched, this is your first impression of me.  I pick up the paperwork you filled out and see that the reason you came to see me was “foot pain”.  Imagine my reaction.  I start sweating, my heart is beating in my throat, I might pass out.  Foot pain is just about everything and anything.  I need to find out where exactly in your foot the pain is located, what it feels like, and when it hurts.  This is why I write this article.  Help me help you.  Below is a list of common causes of “foot pain”.  There is a brief definition of the problem, where it is located, and in general what the pain feels like.

Bunion:

A lump behind your big toe caused by the big toe going one way, towards the 2nd toe, and the bone that supports the big toe, metatarsal, going the opposite way.  The lump is the metatarsal.  Pain can be divided in two:  on the lump is usually sharp pain with pressure from shoes, redness, and sometimes swelling, while the other pain is deep in the joint described as aching or throbbing that gets worse when you walk.

Bunionette or Tailor’s Bunion:

Similar to a bunion, but at the little toe.  This is where the 5th toe moves toward the 4th and the bone supporting the toe, 5th metatarsal, moves the opposite way making a lump on the outside of your foot.  Pain can be described just like it can for a bunion.

Corns: 

Hard skin on any side of a toe that usually causes sharp pain to pressure or shoes.  You might notice that the toe has changed position or shape.

Calluses:

Hard skin on any surface of the foot other than the toe, usually causing sharp pain while walking.  Why is a corn on the toe and callus on the foot?  I have no idea.

Exostosis:

This is an abnormal growth of bone.  Places where you might be able to see this are on a toe, top of the 1st metatarsal, or on the top of your arch.  These cause sharp pain when pressure is applied, but are caused by arthritis in the nearby joint.  Arthritis pain is deep aching, throbbing and yes it does get worse with the weather.

Hammertoe:

A toe that is buckled, curled, or bent any way other than straight.  Pain from the toe is usually related to a corn, but the joints can cause deep aching pain when walking.

Hallux limitus or hallux rigidus:

The hallux is the big toe and these conditions describe the joint at the base of the big toe.  The motion in this joint can be limited or completely gone, rigid.  These are forms of arthritis commonly described as deep aching, throbbing, or even sharp.  Anything that makes the toe move aggravates the pain such as walking especially in heels or up hill.

Metatarsalgia:

This is a general term for inflammation of a metatarsal.  It has fallen out of favor recently since it is not very descriptive.  Now-a-days this would be inflammation of the joint in the ball of your foot called capsulitis.  This is deep aching or throbbing pain when the joint moves, such as when walking, but usually better in supportive shoes and worse in heels or on stairs.

Metatarsal stress fracture:

A stress fracture is true inflammation of the bone that weakens the structure of the bone and can become a real break.  This is deep aching and throbbing with swelling of the foot in the area of the break.  Usually you have increased your activity or changed shoes before this started.

Neuroma:

A pinched nerve in the ball of the foot.  This causes sharp shooting pains that might travel out the end of your toes, most commonly the 3rd and 4th toes.  Some people can describe a clicking feeling in the ball of their foot when they walk.

Peripheral neuropathy:

The sensations of burning, tingling, or insects crawling on your skin worse when you have no other distractions like when you lay in bed.  These usually follow nerve patterns and can travel up and down the foot or leg.  This can get worse leaving you with loss of feeling.  You would think that loss of feeling has no way to be described, but since you had feeling then lost it patients are able to describe this lack of sensation.

Plantar fasciitis:

Arch pain in the muscles that is often described as cramping, aching, pulling, or even sharp when you walk.  This pain is usually worse with the first steps in the morning or after a period of sitting.  The plantar fascia is a big strong ligament running from the heel to the toes, but it is actually the muscles that sit just beneath the fascia that are inflamed.  The heel is usually involved in the pain as well.

Sesamoiditis:

The sesamoids are like knee caps for your big toe.  They sit in the ball of your foot behind the big toe and help the tendons hold your big toe on the ground.  These can be injured directly or by forceful upward motion of the big toe.  Aching in the ball of the foot at the base of the big toe with or without swelling is usually described by patients.

Tendonitis:

The muscles in your leg travel to your foot by tendons.  Any of these tendons can become irritated, injured, or inflamed.  The pain is usually along the line of the tendon and is commonly described as sharp, stabbing, aching, or throbbing depending on your activity.

Ulcer:

An ulcer is a break in the skin.  Obviously this would hurt, but most patients with ulcerations on their feet are lacking the ability to feel pain.  This can be hidden under callus or develop from a blister next to a callus.

These are the most common causes of “foot pain”.  I hope this will help when you need to explain the pain.  My heart can only handle so many complaints of “foot pain” in a day.

You probably don’t even think about them unless you lose one in the wash.  They are left balled up in a drawer.  Half asleep, you reach in blindly and grab the first pair you make contact with.  You give more consideration to them when you use them for dusting rather than when you wear them.

Socks!  What other particle of clothing has so many uses?  They help to keep your feet clean, warm, and dry, fight dry skin, cushion and protect your soles.  Some people use them as a form of expression and others just an accessory.  Even when they are worn out and no longer suitable for your feet you can use them to polish furniture, shine shoes, wash your car, cover your golf clubs, or make a puppet.

At Desert Foot Surgeons, our talk about socks is not limited to just patients with diabetes.  Socks can make a difference and help in your treatment.  Dr. Geller talks about the fibers used to make the sock, thickness of the material and padding.

The fibers used to make socks are either natural fibers or man-made (acrylic).  Natural fibers are cotton and wool.  You didn’t have to grow up in New Jersey, like Dr. Geller, to know that wool is itchy.  Socks made of cotton and wool are criticized for being too tight and the seams too rough, in other words uncomfortable.  When it comes to keeping your feet dry, natural fibers are not as good as man-made materials.

Acrylic materials are combinations of polyester, nylon, and elastic fibers.  When these types of socks are made with increased cushioning, they are better at keeping moisture away from your skin compared to natural fibers.  The material is softer and the seams easily hidden.  Padded socks made of man-made materials have been shown to lower the pressure on your feet.  Elastic can be increased so that the socks can be used to help prevent swelling.

No matter what material they are made from socks cannot replace shoes.  Walking in socks does not provide the support or protection that a shoe does.  Especially for those of you who have diabetes with loss of feeling in your feet, you cannot walk inside or outside in socks alone.

At Desert Foot Surgeons, Dr. Geller does the shopping for you.  We carry special diabetic socks.  These are high quality, padded acrylic socks especially good for our patients with diabetes.  Even if you don’t have diabetes, these socks are good for people who are athletic or work in areas where your feet are exposed to moisture.  Please give your socks the consideration they deserve and dress your feet.

“I take longer to heal because I have Diabetes”.

This is a statement many patients coming to see Dr. Geller at Desert Foot Surgeons say their first visit. Unfortunately this is a rumor that makes a convenient excuse. When diabetes is controlled you not only reduce your risk of complications such as heart disease, blindness, and kidney failure, but you heal like anyone else.

One out of ten people you meet in the United States has diabetes. Out of the people you know with diabetes, at least one has developed a hole in their skin known as a foot ulcer. The feet are most affected by loss of feeling and circulation. Diabetic foot ulcers are caused by one or both of these complications. What prolongs healing is poor circulation to your legs and feet or walking on an open sore because there is no pain.

Dr. Geller has a special interest in wound healing. At Desert Foot Surgeons we don’t wait for wounds to heal. Wounds are made to heal by fixing poor circulation, getting your weight off of the wound using total contact casting, and even surgery to correct buckled toes, lumps on feet, or skin grafts to cover the defect. Control of your diabetes and compliance with the plan of care is the patient’s role. Healing diabetic foot ulcerations takes a team and the patient is the major player.

If you have a diabetic foot ulcer and have been told you can’t heal because you have diabetes, come and see Dr. Geller at Desert Foot Surgeons.

Before And After Pictures,

(After)

Before Pictures :
WARNING – Click Here for Graphic Images – WARNING

When I was in college I ran 12 miles a day. This was Boulder, Colorado so summer days always had about an hour of rain at 4pm and then everything would cool off. I enjoy running in the rain so scheduled my runs during this little drizzle. After a month of wonderful, calming runs I developed itching between my toes and a red rash with cracking skin in the crease under my little toes. The burning from the cracked skin was intense at times and the itching nearly drove me insane. Have you ever seen this before?

Athlete’s foot is an infection of the skin caused by fungus. Besides redness, itching, burning, and cracking skin, as I experienced, there can be blisters and oozing. If left untreated the infection worsens. The toenails can become infected causing thick and discolored toenails, but that’s a topic for another day. The fungus can decrease your skin’s defenses leading to infection with bacteria noticed by swelling, redness, and more severe pain.

Treatment of fungus begins by removing the source of the infection. Fungus grows in dark, moist places. Can you figure out what I was doing wrong? In my case I was wearing wet shoes everyday to run. Shoes take 24 hours to dry so alternate your shoes everyday. That means don’t wear the same pair of shoes two days in a row. Always wear clean and dry socks, wash your feet thoroughly and make sure you dry between your toes.

Other treatments for fungus are readily available at your store. Medications are usually creams, powders, sprays, gels, or solutions. The antifungal medicine needs to be applied twice each day for about one week. Beware of using creams. If the infection is mostly between your toes creams might keep the area too moist and fail to kill the fungus. Try powders, sprays, or solution between the toes. If you don’t improve after a week you need to see a physician.

Do you have young boys with stinky feet? Look more closely at their feet. Many times a parent brings in a young teen with redness, blisters, scaling and cracking skin, and the overall complaint of “stinky feet”. Dr. Geller has treated many children with pills to kill the fungus infection besides using creams or powders, clean dry socks, and changing shoes. Some people think treating fungus with oral medicine causes liver damage. They are referring to older medicines not used today. The newer pills to treat fungus are safe if prescribed by an experienced physician. Dr. Geller used pills to treat a fungus infection in his son.

Do not delay treatment of athlete’s foot. Bacterial infections are much more painful and challenging to treat. The earlier you are seen the easier the treatment.

Dr. Stephen Geller, AZ Podiatrist

Of adults over 40 years of age in the United States, about 4.5% have peripheral arterial disease (PAD). This is a lack of circulation to your legs and feet.  Healing an ulceration where there is a lack of circulation is very challenging for you and your doctor.  The most important part of healing these open sores is bringing blood into the foot.  Dr. Geller works with vascular surgeons, interventional cardiologists and radiologists who can help with this part of your care.  The actual care of the open wound is determined by Dr. Geller.  This will involve something to keep pressure off the sore and medication applied to the wound.  At Desert Foot Surgeons you will find a physician with the expertise and experience needed to develop a program that best suits your needs.

Those of you who have healed an arterial ulceration have suffered a great deal of pain and possibly even undergone surgical correction of the poor artery circulation.  If this is not enough reason to quit smoking I don’t know what is. Part of your recovery will be walking for exercise to increase circulation even if you had surgery. Since most arterial ulcerations are on the feet you will need protection of the scar by shoes and possibly inserts. Your heels may need to be protected while lying in bed. Moisturizing dry skin using specific foot creams is also recommended to help prevent new or recurrent ulcerations.

Dr. Stephen Geller, AZ Podiatrist

Swelling in the legs can be caused by bad veins with valves that no longer work, injury from prior blood clot or phlebitis, weak muscles that pump the blood up the leg, or increased pressure in other organs such as your heart.

In order to heal your wound you were placed in some form of compression wrap. Once your scar was mature enough to handle pressure from socks you were prescribed support hose. Even though we live in Phoenix where temperatures often exceed 100ºF the compression is needed to fight the swelling. Surgery is often used for bad veins, but even so support hose are a required part of this treatment. There is no way around it, you will have to wear some form of compression garment.

Dr. Stephen Geller, AZ Podiatrist

Between 30-50% of patients with diabetes have peripheral neuropathy. This is a nerve injury that prevents you from protecting your own skin by losing feeling. In addition, the nerve damage interferes with your muscles leading to deformities and difficulty walking. Pressure increases over these prominent areas leading to callus formation from repeated injury. Damage from the callus or injury leads to open sores or ulceration.

Your wound care treatment has included some form of “off-loading” by padding or casting. This is how we remove pressure from the open sore to allow the body to heal. Under the care of Dr. Geller you also had to remain in this cast or padding 4 weeks after healing to allow the scar to mature. To prevent return of the ulceration you will need protection from pressure on prominent areas.

You should be very proud of yourself. You have accomplished what more than 90,000 Americans failed to do this year. You saved your leg from amputation due from diabetic ulcer.

More than 90,000 people lost a major part of their foot or the entire leg to complications beginning as a wound on their foot. Some of these were not avoidable, but it is estimated that 64% of these could have been prevented with advanced wound care such as you have done.

Now our focus switches to prevention. You and your physician do not want you to experience anything like this ever again. You have most likely been treated using some form of cast or padding to keep the pressure off your foot and swelling down. Since this was necessary to heal the wound it should be no surprise that something will be needed to keep the wound healed.

Prescription shoes with custom-made inserts are used to cushion and protect the feet. You will have to wear these shoes with inserts everyday for quite some time. Every year your insurance will pay for new shoes. You should receive three pairs of inserts for these shoes to be changed every four months. The longer you stay healed and the better you control the callus formation the more flexible your shoe selection will become.

In some patients surgery was performed to correct deformity and decrease pressure. Even these patients have to wear the prescription shoes with insoles.

Dr. Stephen Geller, AZ Podiatrist