General

What does a Podiatrist do for your feet?

Podiatrists are specialists in medicine that diagnose, treat, and prevent foot, ankle, and lower legs injuries and conditions. They treat any and all injuries when it comes to the foot and ankle. They can set broken bones, administer injections to alleviate pain, prescribe orthotics and medications as well as physical therapy. They also can bring a patient to surgery when needed.

When should I see a Podiatrist for foot pain?

You should see a podiatrist if you have foot pain or an injury to the foot and ankle. Seek a podiatrist if you have sports related injuries, sprains, strains or broken bones. If you have arthritis with joint pain, heel pain, bunions, hammerotes, skin conditions, ingrown nails, swelling, and infections. If you are a diabetic you should not only be seen for pain and open wounds but also for regular maintenance so as to prevent further issues down the line. A podiatrist should also be your choice of specialists to go to if you begin a new exercise routine such as running or biking.

Is it better to see a Podiatrist or Orthopedist?

When it comes to the management of bones, joints, and ligaments, both podiatrists and orthopedists are qualified. However, when it comes to an injury or condition affecting the foot and ankle, your best option is to see a podiatrist. From an educational point of view, the podiatrist is highly focused and specifically trained in diagnosing and treating foot and ankle disorders from the very first day of medical school and throughout residency and fellowships. They emphasize their entire medical career on the foot and ankle. An orthopedist is trained in a similar manner but they focus on all the body parts of your musculoskeletal system.

What does a Podiatrist do on a first visit?

When you are seen for your first visit, the podiatrist will have you fill out a thorough medical history including medications taken, medical conditions and past surgeries. You will be asked to describe your foot and ankle conditions to help the doctor better identify and diagnose the area of concern. A physical exam will then take place and depending on the condition, the podiatrist may decide to take in-office x-rays, send you out for other diagnostic testing such as MRI or CT scan and possibly blood work. Treatment will vary according to the diagnosis made. It may include a nutrition program, orthotics, oral medication, injections, application of devices to help you walk better and surgical discussions if needed.

When is foot pain serious?

You should seek immediate attention when you experience pain that is persistent and not going away, swelling, tingling and numbness to the feet, an open wound, signs of infection like oozing and fever above 100F. You should also seek medical attention if you find that you can’t walk or bear weight on your foot. Also, if you fall and injure your foot and ankle and it feels like you may have sprained badly or broken a bone, don’t wait and seek a podiatrist.

What conditions can Podiatrists treat?

There are numerous conditions that can affect the foot and ankle. A podiatrist is equipped to treat any and all conditions of the foot and ankle from skin disorders to structural deformities. Some examples are:

  • Bunions
  • Hammertoes
  • Achilles tendonitis
  • Plantar fasciitis and heel spurs
  • Diabetes
  • Arthritis of the foot and ankle
  • Growing pains in children
  • Morton’s neuroma
  • Ingrown toenails.
  • Athlete’s foot.
  • Warts
  • Toenail fungus
  • Melanomas and skin growths
  • Structural issues such as flatfoot
  • Foot and ankle fractures
  • Foot and ankle sprains
  • Achilles tendon ruptures
  • Gout

Can Podiatrists cut toenails?

Yes, podiatrists can assist patients with toenail cutting. This is a service provided to patients with diabetes, circulatory issues, and those who can’t manage to cut nails themselves. This will prevent patients from cutting themselves and causing further issues such as infections or amputations.

Can walking barefoot cause foot pain?

Walking around without shoes that support your arch and foot structure can put you at risk for injuries such as plantar fasciitis, tendonitis and metatarsalgia (pain under the ball of your foot) due to the fat pad under the foot getting thinner every time you expose your bare feet to the ground.

What causes foot pain on top of the foot?

Foot pain on the top of the foot may be caused by different conditions. Common conditions are from overuse when exercising such as running, kicking, and jumping or tight shoes. Pain may also be caused by an injury such as dropping a heavy object on the foot causing a tendon sprain or a broken bone, a ganglion cyst (a lump that forms below the skin surface), arthritis, diabetes, or gout.

What part of the foot hurts with diabetes?

Diabetic patients experience foot pain with nerve damage called neuropathy. They experience numbness, tingling, burning, and sharp aching pain. They also can experience pain from open wounds that are slow to heal and drain. Diabetics also get pain from something called charcot arthropathy. Charcot foot happens when the nerves are not functioning properly and it leads to changes in the bone structure of the feet. When this happens, diabetics experience severe pain with redness, warmth, and swelling.

Neuropathy

Do podiatrists treat neuropathy?

Podiatrists will treat neuropathy of the foot and ankle and refer out to a neurologist if the neuropathy involves other aspects of the body. Together, the podiatrist and neurologist, as a team treat neuropathy in patients.

Do podiatrists deal with nerve damage?

Your podiatrist can offer oral or topical medications that can reduce the symptoms of neuropathy. They can also offer home therapy programs that would help improve balance. TENS (transcutaneous electrical nerve stimulation) can also be of value in relieving neuropathy symptoms. This system uses electrical stimulation to stop pain signals from traveling to the brain. Orthotics can also help reduce movement of the muscles and tendons preventing blistering. Surgery is indicated in more severe cases to release compressed nerves.

Can you get rid of neuropathy in your feet?

If in the early stages of nerve damage, neuropathy can be reversed. Exercises, controlling your blood sugar, quitting to smoke, and using topical and oral antineuropathy medications can all help.

What does nerve damage in your feet feel like?

The most common described feelings by patients who have neuropathy are tingling, pins and needles, weakness, fatigue, sharp stabbing like sensation, burning and throbbing.

How long does nerve damage in feet take to heal?

When a nerve is hit or bruised it could take from 6 to 12 weeks to heal and recover. If a nerve has been cut it can have the potential of recuperating. A nerve can grow 1 mm per day.

Can you stop the progression of neuropathy?

Stopping or slowing down the progression of neuropathy depends on the underlying cause as well as the severity of the nerve damage. Many times lifestyle changes can be successful in slowing or stopping progression.

It is important to see your doctor and together decide on a management plan that will also include medications and vitamin supplements.

What is the difference between neuropathy and peripheral neuropathy?

Peripheral neuropathy is damage to the nerves that affect the extremities. The feet, legs, hands, and arms. Neuropathy is nerve damage to the entire body.

How can I reverse neuropathy naturally?

Natural treatments include:

  • Monitoring your blood sugar levels
  • Losing weight and a healthy diet
  • Exercising and physical therapy
  • Stop smoking
  • Limit alcohol drinking
  • Vitamins
  • Essential oils

What can be mistaken for neuropathy?

Diseases such as:

  • Sjögren’s syndrome
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Guillain-Barré syndrome
  • Infections

What causes neuropathy to flare up?

There are several triggers that can flare up neuropathy.

These include:

  • Diabetes
  • Alcohol
  • Poor diet
  • Infections
  • Chemicals
  • Medication

Custom Orthotics

How much do custom orthotic inserts cost?

The cost of custom made orthotics depends on what orthotic laboratory the doctor chooses. It also depends on the materials used, as well as the deformity that is being addressed. The more complex the deformity, the more adjustments the lab has to make. They can run from 200$ to 600$.

Are custom orthotics worth the cost?

Yes they definitely are. There is so much that goes into the making of an orthotic. It includes a thorough physical examination from your doctor, followed by x-rays, then taking a cast or 3-D scan of your non weight bearing foot in a neutral position, manufacturing and fitting the device.

What are custom molded orthotics?

Custom made orthotics are specific inserts made specifically for the person wearing them. They are not just a regular shoe insert you can buy online or at a sports store. They are customized and made for your unique feet. In order to make the orthotics, the doctor evaluates your deformities and asks you about your symptoms. The doctor then places you in the proper alignment to reduce your deformities. The orthotics are then built in such a manner that when you place them in your shoes your deformities and symptoms are reduced and even gone.

Do you need a prescription for custom orthotics?

After a doctor evaluates a patient’s needs, they send the information to a lab via the form of a prescription to create the actual orthotic. Making a custom molded orthotics cannot be done without a face-to-face visit. The appropriate measurements must be taken by placing the patient in a neutral non-weightbearing position and then using casting material or a 3-D scanner to take an image of the foot. The correct prescription is then sent to the laboratory responsible for making the orthotics.

Do custom orthotics really work?

Yes, orthotics really work. They are part of a comprehensive treatment plan used to treat pain, misalignment and discomfort of the feet, legs and even back. They help correct foot deformities, help support the arches and reduce inflammation. They help distress the tendons of the feet and muscles of the legs reducing the risks of future injuries. They also reduce pain to the knees, hips, and back.

Are orthotics really necessary?

Orthotics are necessary for several deformities and medical conditions. Conditions such as but not limited to;

  • Plantar fasciitis – Orthotics will reduce inflammation and support the arch.
  • Arthritis – Orthotics will reduce the discomfort and correct poor positioning.
  • Bunions and Hammertoes – These are deformities caused by the foot type of an individual. The unbalancing of the tendons cause the bones to shift and create deformity. Orthotics will position the foot correctly and reduce the progression of the deformity.
  • Back pain – Poor positioning of the feet can misalign the back and orthotics will lessen the pain with proper alignment.
  • Diabetes – Some people get neuropathy, loss of sensation in their feet. Orthotics can help reduce the stress and pressure that is created and help prevent ulcers and amputations.
  • Flat feet – Flat feet can cause foot, ankle, and back pain. Orthotics can help to support the feet and promote proper foot positioning.
  • High arches – A high arch creates lots of stress on the tendons of the feet. Orthotics will support these high arches.
  • Injuries – People who’ve experienced trauma to their feet and ankles that may cause excessive rolling of their ankle in an inward or outward way may require extra support which is provided by orthotics.

Do you need bigger shoes for orthotics?

You do not need bigger shoes for your new orthotics. All you have to do is remove the inserts that come with your shoes and replace it with the custom orthotic.

What are the best custom orthotics?

The best type of orthotics is one that achieves the proper support and corrects the condition and symptoms a person has. The orthotic is based on each individual’s need. Materials range from rigid to accommodative. They can be full length or semi length. The importance is in the experience the doctor has in taking the appropriate mold of your feet and on writing the prescription.

Does insurance cover custom orthotics?

All insurances are different. Some cover at 100%. Others may only cover partially and some insurances don’t cover at all. It is best to discuss your options with your doctor and have the staff check with your insurance company.

Should orthotics hurt at first?

New orthotics will feel uncomfortable and may hurt at first. It is important to ease your feet into wearing them. This is done slowly and is called the breaking in period. The orthotics are changing the way the muscles and tendons of your entire body work and the way you have been walking all your life. It will take some time to get used to them.

Why do my orthotics hurt?

Your orthotics should not hurt after the breaking in period. If they were made properly and custom for you they should not even be felt in your shoes. It is important that you discuss it with your doctor if any pain or discomfort is felt so that the orthotics can be either adjusted or remade.

Which insoles do podiatrists recommend?

Every podiatrist will choose a laboratory that they believe will create the best custom orthotic for their patient. Here at Cella Foot & Ankle Specialty we have looked long and hard and have gone to several labs to witness the manufacturing of orthotics. We have chosen a laboratory named Performance Laboratory.

Wound Care

Do podiatrists do wound care and treat ulcers?

Podiatrists are the key doctors to wound care. They are the ones to see first if you have a wound on your foot, ankle, or leg. They are the ones to manage the wound and build the team necessary for wound care.

Do wounds heal faster, covered or uncovered?

It is best to keep a wound covered and closed so it remains moist. The blood vessels and cells necessary to decrease inflammation and bring more blood flow to the wound increases when a wound is covered causing the wound to heal faster.

Can foot ulcers be cured?

When caught early, foot ulcers can be cured. It is pertinent that you see your podiatrist when you notice a sore. Healing an ulcer requires many steps.

  • If the arterial circulation is compromised, decreased blood flow to the ulcer, then a vascular consultation is required to evaluate the patient and determine if any intervention is necessary.
  • Keep blood sugar under control
  • Debridement of the ulcer is necessary if the tissue overlying the wound is fibrotic (non healing tissue).
  • Antibiotics are needed if there is an infection
  • Compression garments/ lymphedema pumps are required when edema is out of control
  • Collagen/ debridement/ antimicrobial dressings
  • Skin substitute grafts
  • Live tissue/ amniotic membrane grafts
  • Total contact cast
  • Unna boots

What are the 5 rules of wound care?

  • Controlling the amount of blood in a wound. Known as hemostasis.
  • Cleaning and debriding the wound.
  • Preventing pain with analgesic medications and preventing infection with antibiotics.
  • Skin Closure through suturing if the wound is small. Skin substitute grafts or autogenous graft ( skin taken from another part of the patient’s body) if the ulcer is larger.
  • Dressing the Wound and follow-up for evaluation.

What are the types of leg and foot ulcers?

Venous stasis ulcers – Are seen in patients who have leg swelling, varicose veins and a history of superficial or deep vein blood clots. These ulcers are usually found below the knee and on the inner aspect of the ankle.

Neurotrophic (diabetic) – These types of ulcers are mostly seen in patients with diabetes, although they can occur and affect anyone who has a decrease in sensation of the feet. They are usually seen on pressure points of the feet.

Arterial (ischemic ulcers) – These ulcers are seen in patients who have poor circulation and have other underlying conditions such as, diabetes, thin skin, renal issues or simply had trauma that initiated the process and poor blood flow did not allow healing of the wound. They can be located anywhere but mostly seen in areas where there is decreased blood flow such as the heels and the toes.

Is hydrogen peroxide good for diabetic wounds?

It is best to keep wounds moist and covered to prevent infections and allow faster healing. Hydrogen peroxide will only dry the wound and is not recommended as it could lead to further complications.

When is a diabetic patient at high risk for an ulcer?

A patient is at high risk for an ulcer if they have or do the following:

  • Neuropathy
  • Poor circulation
  • A foot deformity (e.g., bunion, hammer toe, flat feet with a prominent medial column)
  • Wear inappropriate shoes
  • Poor and uncontrolled blood sugar
  • History of foot ulcers
  • Smoking
  • Consuming large quantities of alcohol
  • High cholesterol

Why don’t diabetic wounds heal?

  • Patients who have diabetes also have problems with their immune system. They do not have enough immune fighting cells to heal the wound and therefore the wound heals slower.
  • If the diabetes is uncontrolled it will lead to poor circulation. With a slow down of blood flow, the body has a difficult time delivering nutrients to the wound. The wounds are again slow to heal.
  • If a diabetic has a blood sugar that is higher than normal it will prevent oxygen from being delivered to the wound and it will not allow proper healing.
  • High levels of blood sugar also increase the risk of infections to the wound. Bacteria loves sugar and thrives on it and with the immune system being down, infections grow causing a slowing down in healing and even possible complications such as amputations.

What are the 4 stages of wound healing?

  • Hemostasis – This phase happens when the blood in the wound clots.
  • Inflammatory phase – This phase begins at the time of injury and lasts up to four days.
  • Proliferative phase – This phase begins about three days after injury and overlaps with the inflammatory phase.
  • Remodeling phase – This phase can continue for six months to one year after injury.

What does a wound care specialist do?

Wound specialists are physicians who have been trained in the treatment of wounds. Podiatric doctors are trained to treat all types of wounds involving the lower extremity, acute and chronic.

Wound care specialists utilize wound care treatments that other doctors are not trained to perform. Seeing a wound care specialist gives you the best chance at healing. They use different forms of treatment to accomplish a successful healing. These include but are not limited to debridement, bioengineered skins, surgical incision and drainage, skin grafts, unna boots, total contact casts.

Wounds, if but treated properly can lead to amputations. It’s is extremely important to find the best wound care specialist. Dr. Cella had been treating wounds for over 20 years. Your physical health and quality of life depend on the doctor you choose to treat your wounds.

Bunions

What problems are caused by bunions?

One of the biggest problems that can happen from a bunion is the formation of hammertoes and the crossing of the second digit over the big toe. Other problems caused by bunions are metatarsalgia (pain under the ball of the foot), tailor’s bunion (bunion found on the outside part of the foot), ingrowns, and flatfeet.

How do you stop a bunion from progressing?

  • Wear proper shoes with an arch that supports your foot.
  • Cushions your bunions.
  • Most importantly wear custom made orthotics. They are fabricated so as to realign your feet into the proper position.

Do bunions grow back?

Bunions can come back for several reasons.

  • It could be due to poor procedure selection. It is extremely important for the correct procedure to be chosen and this can be done after a proper and thorough evaluation prior to surgery.
  • Bunions can return simply because of the structure of the foot and the abnormal movement of joints found from the ankle down.

What is the root cause of a bunion?

  • Overpronating, the lowering of the arch which causes an abnormal pull on the tendon that makes the toe joint unstable.
  • Hypermobility, the big toe bone moves more excessively than usual.
  • Injuries to the foot.
  • Arthritis, such as rheumatoid arthritis.

Is bunion surgery worth having?

Bunion surgery is important if a person is in pain every day and it keeps them from doing daily activities. Bunion surgery is very successful and people experience significant pain relief once they recover. It improves the toe alignment so that walking is facilitated. Bunion surgery is not for people who just want a cosmetic fix.

How can I shrink my bunions naturally?

Bunions can not be shrunk naturally. There are things that one can do to help reduce pain and swelling though. Such as wear wider shoes, avoid flip flops, ice the area of pain, home exercises, NSAIDS for inflammation, and bunion cushions.

Do bunions hurt all the time?

When a bunion forms it is usually mild and causes slight discomfort. Unfortunately, bunions are progressive and as the years go by and the big joint moves out of alignment and the bone, called the metatarsal, starts to grow the pain becomes severe and constant.

How can you tell the difference between gout and a bunion?

Some people mistake gout for a bunion but the diagnosis is completely different. With gout there will be redness and swelling within the joint that one feels with motion and when an acute episode occurs it is extremely painful. Bunions demonstrate a lump on the outside of the foot and the redness and swelling is around the joint. Gout occurs due to an increase in uric acid levels and a blood test can demonstrate this.

What happens if a bunion is left untreated?

If left untreated, a bunion can progress and cause worse discomfort that can travel up the leg and the back. Eventually the second toe will sit on the top of the big toe causing irritation and callus formation to the toe. Ignoring a bunion will also cause the other four bones to dive down and create callus and pain to the ball of the foot. There will also be a loss of balance and an increase in falls as one grows older. Osteoarthritis also sets in and there is extensive damage to the joint. The cartilage deteriorates due to the misalignment of the joint and causes pain and inflammation as well as decreased motion of the big toe. Bunions are serious issues and patients should fix them as soon as possible.

Do bunions get worse with age?

The foot type you were born with is inherited. A bunion forms due to specific foot types that create tension and pull on the ligaments and tendons in the feet. As we age, the ligaments and tendons weaken and fray causing further misalignment and with this comes shifting of the bones creating a bunion formation to progress and worsen.