Feet Pain: Why Do My Feet Hurt? (cont.)

rosie2000_webmd: I have problems with ingrown toenails on my big toe. I've been told to cut them straight across, but when I do, they go into my toe. If I cut the edges down, it relieves the pain in my toes. What do you suggest I do?

Dr. Mauser: Ingrown toenails are a common problem. Certainly, you should cut them straight across. But when the toe is curled such that it continues to dig into skin, something more definitive needs to be done. There is a relatively simple surgical procedure that can be done in a podiatrist's office, which is that the side of the toenail is removed, the growth center is treated with a chemical, and this should eliminate the recurrent ingrown toenail. This can be done on any of the toes, or any of the sides of the toes, or entire nails can be removed, utilizing this procedure. It is a simple, easy, relatively painless procedure.

Moderator: imilton asks: "I need to walk to get weight off. But my feet hurt. It's not my shoes. I wear only soft leather with thick soles (or air) and thick socks. I take no medicine of any kind, sugar, blood pressure and cholesterol is normal. I have great circulation. First the doctors said I was too young, now I am told it is because I am old. Can one's bones hurt just for the heck of it?"

Dr. Mauser: Certainly, walking is the best exercise for anyone, and I encourage people to walk. It's a Catch-22 if you need to walk to lose weight, yet the weight is contributing to pain in your feet. I would advise you to find a good running store, and check out the different brands of running shoes. The people in the stores are knowledgeable about the shoes. A custom made pair of orthotic devices may alleviate discomfort. Additionally, one with this problem should seek medical advice, as there may be a specific cause for the pain rather than just a general type of pain.

Moderator: Can you please tell us more about orthotic devices? What are they, and what are they designed to do?

Dr. Mauser: Orthotic devices are usually a custom made device inserted into the shoe that is made from a mold of a patient's foot, that will control abnormal motion, provide support, and accommodate specific problems. There are various different devices that could be made, and there are devices for different activities. The specific device would be at the discretion of your physician. In my office I use a computer, and a force plate which a patient walks over and it records the force of the foot, and them I'm able to generate a fabricated device from the computer generated image.

Moderator: David_Cheri asks: "What is the best way to keep feet from getting the hard, dry skin on them - especially the heels?"

Dr. Mauser: I'd like to talk about calluses in general. A callous is the build up of superficial layers of skin. This occurs in areas with increased pressure, or frictional forces. Commonly these form on the front of the foot, underneath a metatarsal head that has dropped down or is too large. This results in increased pressure, increasing callous formation. Calluses that occur around the back of the heels are generally due to the lack of elasticity of the skin, and moisture content in the skin, and when one puts pressure on the heel, the fat pad of the heel displaces outward causing increased pressure around the periphery of the heel, resulting in increased calluses and perhaps cracking of the skin. For those heel calluses, one needs to moisturize their skin really well. There are some very good prescription moisturizers out there. Additionally, shoes that have a good sturdy heel counter, that can hold the heel in place will help. Calluses on the front part of the foot are often treated by trimming them down and reducing the thickness of the skin, but the continued pressure will result in the recurrence of the callous. Sometimes it's necessary to look at the cause of the callous, and if a specific metatarsal bone is the problem, perhaps surgery is performed to alleviate the pressure in that area.

Moderator: bmaxwell asks: "What causes feet to feel like they are burning?"

Dr. Mauser: There are many different causes for burning feet. Usually they are of a neuropathic ideology. This means that there is a problem with the nerves, and the signal sense of the brains. This can be a symptom of long-standing diabetes, vascular problems, MS (multiple sclerosis), and other diseases. There is also what we call idiopathic neuropathy, in where there is no obvious cause of the burning. There is a good book on the subject called Aching Souls and Painful Toes, and the author is a layperson who has peripheral neuropathy, and does a great job of talking about the different causes and treatment options available for this condition. Some of the treatment options for this consist of oral medications, such as Tricyclic antidepressants and Neurontin (gabapentin). There are also topical medications that can be applied to the soles of the feet. Keep in mind that each and every case of burning feet, or neuropathy, is different, and responds to different treatment in different ways. One should consult their podiatrist, family physician, or a neurologist for a complete treatment plan. 

I would like to talk about some common foot problems. We have already talked about ingrown toenails, I'd like to talk about fungal toenails. Fungal toenails are thick, dystrophic, discolored nails that can be an isolated nail, or all ten toenails. Usually they are painful, and cause problems with shoes. The toenail has become infected with a fungus. The fungus is in our environment, is opportunistic, and when given the opportunity to get up into the nail, does so quite readily. Usually there is a trauma associated with the fungus getting under the toenail. The trauma doesn't have to be anything more than your shoes rubbing your nail. Once fungus is under the toenail, it's in a nice dark, warm, moist environment, and continues to grow. It can spread to the other nails easily. The fungus is essentially a disease of the nail, and should be treated as a disease. There are medications that can be taken orally that will be incorporated into the nail and kill the fungus as the nail grows out. Topical medication can be useful by helping this process and reducing the amount of fungus around the nail plate. Occasionally it is necessary, when the nails are nonresponsive to medication or severely deformed, to remove them permanently. This is a fairly simple process done in an office under local anesthesia. The important thing to remember is that this is a disease process; it can be cured by oral medication. But it is not effective in every instance. medications need to be taken for a period of about three months. The effectiveness of medication will need to be evaluated over the next six to 12 months. Medicare, in our elderly population, will pay for these nails to be reduced in size and trimmed, if they are painful. 

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