Ask America's Podiatrist: Recent Posts

Susan Phillips on "Metatarsus Adductus Adult"

Susan Phillips — Thu, 22 Jul 2010 18:41:22 +0000

I am a 60 year old female, who discovered I had met adductus two years ago, when consulting a podiatrist for another problem. I also have very high arches. I have been clumsy all my life and wonder if this might be a causative factor. Thank you.

viaaLeqendary on "Toenails"

viaaLeqendary — Thu, 22 Jul 2010 13:18:57 +0000

Okay, so I have a brownish/yellowish toenail on my right big toe and it seems as if it was dying. There is no pain, but I see there is another toenail growing under because of a crack on it when i hit the toenail. How do I remove the dying toenail.

JL on "neuroma and flat feet."

JL — Tue, 20 Jul 2010 13:25:39 +0000

After years of trouble with knee pain, I have been able to get back into running, thanks to my chiropractor who has administered active release technique (ART). I still fight it, but it's kept at bay. I started training for a triathlon a few months ago, and the biggest problem i've had so far is my left foot. I have what i believe to be morton's neuroma. it was suggested by chiropractor and i also went to a podiatrist who said the same. The pain is dull and inconsistent, between my 3rd and 4th metatarsals. I rarely notice it while running, and it's typically worst the day after speed work (sprints), and often accompanied by arch pain/stiffness. I have since switched from a motion control shoe to a neutral shoe(brooks ghost). The symptoms have remained largely unchanged despite continuing my triathlon training. The podiatrist said i have flat feet and was quick to blame it on that. he recommended i get orthotics, but i had orthotics for my knees, which did not work, so i stopped using them. I'm confused by all of this. i agree that my arches are not as high as they should be, but they don't seem "flat" to me. i much prefer the neutral running shoe to the clunky motion control. i've tried throwing in some barefoot running to strengthen my feet, but with the neuroma it quickly becomes unbearable. should i shelve the barefoot running idea until i recover from the neuroma? are orthotics a reasonable approach for this? What steps should I take to recover from this, and prevent it from happening again? Thanks!

jnazarian on "red/brown bumps under skin, die and peel, random, no pain/itch"

jnazarian — Sat, 17 Jul 2010 09:31:09 +0000

Rather, I meant right for bottom and left for top.

jnazarian on "red/brown bumps under skin, die and peel, random, no pain/itch"

jnazarian — Sat, 17 Jul 2010 09:30:22 +0000

Bottom is newer lesions, top is the cluster that is dieing out. Soon it will peel

Dr. Nirenberg on "2 toes are still numb almost 1 week later!!"

Dr. Nirenberg — Sat, 17 Jul 2010 08:19:58 +0000

It sounds like you may have injured a nerve, and now it is probably pinched. You should see a podiatrist, though it usually improves in time. Try soaks in Epsom Saltg four times a day for 10 minutes each time.

Dr. Nirenberg on "Top of foot pain - rehab strategies"

Dr. Nirenberg — Sat, 17 Jul 2010 08:17:56 +0000

Great! Glas you are doing better!

Dr. Nirenberg on "red/brown bumps under skin, die and peel, random, no pain/itch"

Dr. Nirenberg — Sat, 17 Jul 2010 08:16:55 +0000

Please post a photo!

Dr. Nirenberg on "Toe Still Numb 21 hours later"

Dr. Nirenberg — Sat, 17 Jul 2010 08:15:27 +0000

I would not worry. Sometimes the anesthetic can last a while. If it persists, call the doctor.

Anders on "Top of foot pain - rehab strategies"

Anders — Fri, 16 Jul 2010 12:19:26 +0000

I have actually recovered from my top of foot pain now. As soon as I got the problem, I backed off on the extra barefoot activity I had introduced (I did have some light bf activity before though, being shoeless in the house, stepping in and out of the kayak etc and I continued with that). My tofp came into a "steady state", did not get worse, but not better either. It did not feel like a stress fracture, but rather overused tendons. After 3,5 weeks with no difference, I made up this program for myself: 1) wear supportive shoes all day, also inside the house - purpose: simulate total rest. I used regular stability motion control jogging shoes. It was immediately evident how passive the foot gets in such a shoe, since I felt much less aching when moving around in these shoes -- good for rehab, put it probably weakens the foot in the long term... 2) eccentric strengthening exercise for the top of the foot: lift toes all you can, press down toes with hand while resisting. Repeat 20 - 40 times (until reasonably tired), about 5 times a day. Purpose: trigger healing process and supercompensation 3) hot water bath 15 minutes a day, as hot as you can bare - purpose: heat the injured structures to get better blood flow and speed healing 4) stretching of top of foot by pushing down toes with hand, hold for one minute. Purpose: not sure, but it feels good During the first 4 days I noticed no difference, but then the ache started to reduce and after 7 days I had my first pain-free day. Not sure what in the program that was most effective, but it did work...

cad21303 on "2 toes are still numb almost 1 week later!!"

cad21303 — Thu, 15 Jul 2010 15:06:41 +0000

Hi Dr. Nirenberg, I went out dancing with my friends last Saturday. I was wearing 2 inch healed shoes for about 9 hours and for about 3 hours straight we were dancing when I started having intense foot soreness. It was so painful that I had to remove my shoes because I could barely walk and even without the shoes I still could barely walk the rest of the night. Now, it is 5 days later and I still do not have complete feeling back to 2 of my toes, 1 on each foot. It feels like they are almost numb when I am walking on them and they don't feel totally right when I touch them. I am able to move them with no problem though. Will the feeling come back eventually or should I see a podiatrist in my area?? Thank you, Cheryl

jnazarian on "red/brown bumps under skin, die and peel, random, no pain/itch"

jnazarian — Wed, 30 Jun 2010 18:56:10 +0000

I have had off and on bumps on my left foot only. They are randomly placed, sometimes on side, sometimes in arch, sometimes between toes, never on the top (but do sometimes extend to the outside edge. They are sometimes pin-sized bumps under the surface of the skin. Hard. Do not itch or hurt. Sometimes they are bigger, like the size of a beebee. Right now some have formed one large cluster, if I push against it it hurts the tissue underneath. They come in clusters, start out like a redish color, turn dark brown, then skin around them starts peeling, and they peel off eventually with the skin. Like-cycle about 3-4 weeks. Sometimes they disappear for 3-8 months. When they come back they will start in one area, die out in 3 or so weeks but spread to another area before dieing out completely. Any idea what this is? Antifungal didn't work. One dermatologist gave me 3 different ointments/creams. One made worse, two others did nothing.

Poesjenel on "Toe Still Numb 21 hours later"

Poesjenel — Wed, 30 Jun 2010 10:50:22 +0000

I had my ingrown toenails removed yesterday but my big toe is still numb all these hours later. I'm worried since I can't feel the big toe.

Anders on "Top of foot pain - rehab strategies"

Anders — Mon, 28 Jun 2010 15:29:47 +0000

Pain at the top of the foot seems to be a very common injury among people that are beginning with barefoot activity, perhaps especially among those doing barefoot running. The pain is typically located to the extensor hallucis longus tendon around midfoot. It so happens that I've got that exact problem. If this would have been tendinitis on the Achilles, part of the rehab program would probably be eccentric calf strengthening and light excercise, not complete rest (apart from the initial stages). However, for this hallucis longus tendon problem I don't find any other suggestion than rest until completely gone. What do you think?

Dr. Nirenberg on "Same type of children's shoes over and over OK?"

Dr. Nirenberg — Sun, 27 Jun 2010 18:09:09 +0000

Bare feet are generally better and safer than socks. I would suggest TERRA PLANA kids shoes. You can buy direct from their site.

tduong5 on "Same type of children's shoes over and over OK?"

tduong5 — Thu, 24 Jun 2010 21:12:29 +0000

Thanks for the tip doc. Problem is that we live in a home with mostly tile floors. I did put him in socks a while back but after tripping and falling on his face once (blood involved), I stopped. He has a pair of shoe-socks but it's a pain since he'd want to go outside and the shoe-socks would get wet. He's gone barefoot at my in-laws and have come home twice with a splinter on his foot. Do you have any advice as to exactly what the "something flexible that offers protection" item looks like and where I'd go about buying it? Also, what happens to an adult when the foot muscles don't get developed in childhood? Thank you for your time.

Dr. Nirenberg on "Same type of children's shoes over and over OK?"

Dr. Nirenberg — Thu, 24 Jun 2010 19:42:37 +0000

In general, you want to keep him OUT of shoes as much as possible for the muscles to develop. When he needs to wear shoes, have him wear something flexible that still offers protection. (If that style is always the same, it is okay.) The main thing is you want him to work his foot muscles!

tduong5 on "Same type of children's shoes over and over OK?"

tduong5 — Wed, 23 Jun 2010 20:53:42 +0000

Hi Doc, My 3 yr old son has wide, thick, chubby feet. His grandma bought him a pair of shoes called TT Transporter by Stride Rite. When he outgrew them, I bought him a pair in the next size up. Now that he's outgrown his 2nd pair, I've bought him the same type of shoe in the next 2 sizes up. Because the shoes are now discontinued and harder to find, I'm considering stocking up and buying him 3 more pairs. I know it all sounds rather obsessive but it's really hard to find him shoes that are wide and high enough at the toes. I've bought him other pairs but the Transporter ends up being the ones worn on a daily basis. I thought I heard somewhere that you shouldn't wear the same shoes all the time. With my son being so young, am I messing up my son's feet by having him wear the same type of shoes for the next 2 or so years???

Dr. Nirenberg on "5th toe injury, slow recovery."

Dr. Nirenberg — Wed, 23 Jun 2010 17:31:25 +0000

Warm water and Epsom Salts 10 min twice a day.

andrewp on "5th toe injury, slow recovery."

andrewp — Wed, 23 Jun 2010 12:24:18 +0000

Ah, that makes sense! I haven't been soaking, just an ice pack and elevation. Should I be soaking too? What temp? Thanks!

Dr. Nirenberg on "5th toe injury, slow recovery."

Dr. Nirenberg — Wed, 23 Jun 2010 12:14:45 +0000

Just because there was no fracture, you could have a bone bruise, and these can take a long time to heal. Keep soaking and keep the pressure off the toe. In time, it should ease up and go away.

Dr. Nirenberg on "daughter's feet"

Dr. Nirenberg — Wed, 23 Jun 2010 11:07:49 +0000

In toeing usually starts younger than 10 and by 10 there is not a lot that can be done. I would try orthotics, and have her see a podiatrist immediately.

Dr. Nirenberg on "pain after mini tightrope bunion procedure"

Dr. Nirenberg — Wed, 23 Jun 2010 11:05:52 +0000

Certainly, a contusion to a surgical site can cause injury, and you should get an x rays. However, bunion surgery can take a long time to heal, dependent on various factors - smoking, activity etc. You should notice a gradual improving of the pain as time goes by. I hope this helps!

andrewp on "5th toe injury, slow recovery."

andrewp — Wed, 23 Jun 2010 11:00:15 +0000

Greetings Dr. Nirenberg. I enjoyed your interview on Living Barefoot and hope you can help me. In the first week of April I struck my left 5th toe walking in the dark. The pain was enough to cause me to become light headed. I was unable to put weight on it, flex, or extend it without causing significant pain. There was noticeable swelling with bruising in the webbing between the 4th and 5th toes and a small impact bruise at the last 5th toe joint (DIP). I began taping it to its neighbor and icing it. I had an xray taken the following week but was told there were no fractures seen. I continued taping and occasional icing my little toe for two more weeks with no improvement. Pain was spreading up the outer edge of my foot and it still could not bear weight. I finally saw a podiatrist who advised a cortisone injection into the MTP joint. This brought relief to the pain spreading up the foot. Two weeks later the pain in the toe itself persisted and I was given another cortisone injection, this one in the toe. This brought immediate relief however the pain returned after a few days. I received a third injection two weeks later which resulted in the same. I discovered I have been wearing shoes a full size too small for many years (I'm 27). This has resulted in some mild claw-toe in my 4th and 5th toes on both feet, and on my left foot the injured 5th toe is also slightly rotated so the nail faces out. I suspect this may be a factor in this being so hard to heal. I have included photos to show this. I realized I can not bend the toe at the last joint, but I'm not sure if this is new. I am now able to walk without limping. Despite moving up a size, shoes still cause me pain so I go barefoot as often as possible. I believe there is still some mild swelling. I can flex the toe without pain, however stretching it back towards me or putting weight directly on the toe is still painful. I think the pain is coming from the DIP joint. If I rub it there is some tenderness. I have begun stretching and exercises. Moving small rocks back and forth using just my little toe and doing foot curls in an elastic strap. It is too soon to know for sure but I think this may be helping. Can you recommend any additional action or treatment? Any special stretches or exercises? Your advice is greatly appreciated.

Evan on "Does your arch fall or rise as the foot adjusts to going barefoot?"

Evan — Tue, 22 Jun 2010 19:33:37 +0000

Interesting! I just assumed the answer was probably common knowledge among podiatrists. We all have a lot to learn, huh? Unfortunately, I don't have anything that might be a reliable record. Some barefoot newbie with an itch for research will have to be found to contribute. Thanks for replying.

kat83 on "daughter's feet"

kat83 — Mon, 21 Jun 2010 21:31:47 +0000

I need shoes for my 10 year old daughter. She severely toes in and wears her shoes on the inside of the heel. any brand of shoe is shot in 2 weeks. I've had an orthopedic surgeon and her primary physician say that she is normal. She has lately been complaining that her feet hurt. HELP!

bird on "pain after mini tightrope bunion procedure"

bird — Fri, 18 Jun 2010 20:00:03 +0000

Hi again - I forgot to mention that prior to surgery, my bunions were moderate, not severe, although the right foot was worse than the left. The side incision is about 1/4" longer on the right, and I assumed that was because it was the worse foot.

bird on "pain after mini tightrope bunion procedure"

bird — Fri, 18 Jun 2010 19:52:13 +0000

Hi Dr. Nirenberg, I had a bilateral mini tightrope bunion procedure on May 14, 2010. My recovery up to this last week has been fairly unremarkable. There has been some pain and swelling, mostly stiffness in the big toes, but I could tell that I was walking better as time went on. My main issue up to this point was the big toe stiffness. I was in surgical shoes with bandages for about a week and a half, and then continued with bandages but was able to transfer to a shoe big enough to accommodate my bandaged feet. By June 3rd, I was switched to removable bandages with toe spacers. I was told to keep both on for one week, and then the just the toe spacers without the bandages for an additional week. Once I took off the removable bandages on June 10th, I noticed increased pain, mostly on the tops of my feet. Since then, the left foot pain has subsided some (pain is about 3 out of 10, weight bearing), but the right foot is still really bothering me (pain about 5.5 out of 10, weight bearing) and does not seem to be subsiding. It's causing me to limp. In addition, a couple of days ago I stubbed my toes on the right foot, although at the time it didn't seem like I stubbed them that bad. I saw my doctor yesterday, and he said my pain is perfectly normal and that I shouldn't worry (although I forgot to mention that I stubbed my toes). He hasn't taken any x-rays since my my first post-op visit which was three days after my surgery. What is your opinion? Is it possible I did some damage when I stubbed my toes? I had the same kind of pain on prior to to the stubbing, but as I said, the left seems to be getting a little better but not the right. Any insights would be greatly appreciated! Thanks so much!

Dr. Nirenberg on "Does your arch fall or rise as the foot adjusts to going barefoot?"

Dr. Nirenberg — Fri, 18 Jun 2010 18:33:26 +0000

I have thought about this... and I just do not have an answer. If you have some before and after photos, or x rays, it would be great.

Dr. Nirenberg on "Hurting Toes"

Dr. Nirenberg — Thu, 17 Jun 2010 19:35:06 +0000

BTW, I would try soaking in warm water and Epsom salts - a lot!

Dr. Nirenberg on "Hurting Toes"

Dr. Nirenberg — Thu, 17 Jun 2010 19:29:51 +0000

The video is great! Thanks! It sounds like a nerve entrapment or neuroma. I would see a podiatrist. (Also, I am glad to hear about your barefoot success with Huraches!)

gerry957 on "Hurting Toes"

gerry957 — Thu, 17 Jun 2010 12:29:51 +0000

Dr. Nirenberg, I have responded to a couple of posts of yours over at the barefoot forum on Runners World and I am hoping you might be able to assist me this time. About a month ago I was running in huaraches on a very slippery trail. The shoes moved around quite a bit, by the end of the run I was in quite a bit of pain. The pain started on the top of my second toe and top of the third toe, and then worked up the front of my foot to the ankle. Every time I have tried to run after that I have experienced the same pain. I have seen a doctor and he had me quit running for awhile then tried a cortisone shot, then on the last appointment he said just don't run on it if it hurts. Since the cortisone shot there has been some additional numbness on the toes and my doctor has decided that it is now a nerve entrapment. I know you are very busy so I am not really asking for a diagnosis, just an opinion as to what you would do next since it appears as though my sports medicine doctor is not really interested in moving forward. Would you see a neurologist, a podiatrist (which is tough to find one that doesn’t frown on barefoot running) or maybe even an ART practitioner? I have a link to my YouTube video about my injury if you have the time and it would help, otherwise any advice as to who to see would be appreciated. Link: <a href="http://www.youtube.com/watch?v=iHj73zbMSlg" rel="nofollow">http://www.youtube.com/watch?v=iHj73zbMSlg</a> By the way thanks for what you do to support the barefoot community. Gerry

Dr. Nirenberg on "bunion"

Dr. Nirenberg — Wed, 16 Jun 2010 18:53:36 +0000

Great!

Evan on "Does your arch fall or rise as the foot adjusts to going barefoot?"

Evan — Wed, 16 Jun 2010 15:29:37 +0000

This question has been discussed a bit on the Minimalist Runner Google group with no consensus. My own experience suggests that my arches have 'fallen' (if indeed that is what structurally has happened) because after about a year of barefoot and minimalist running, I can no longer wear shoes with any kind of contoured footbed or insole because of the pain that brings to my arches; as if the arch of those structured shoes is too high for my foot.

Barefoot@56 on "bunion"

Barefoot@56 — Wed, 16 Jun 2010 10:11:59 +0000

Here's the picture. I have not had an x ray. I'll keep you posted on any progress. Thank you.