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

Another common foot problem is plantar warts. Plantar warts are a virus that specifically infects the superficial layer of skin. When the virus is given the opportunity through some type of mechanical breakdown of the skin, it will infect the skin and grow there. When one gets a wart on their hand, that virus will grow above the level of skin, but when it occurs on the bottom of the foot, because you walk on it, the virus will grow within the layer of skin. It won't grow deep into the deep layers. Because this is a virus, there's no medication that can be given orally to eradicate the virus. The virus would have to be treated locally at the site of infection. This is done with topical acid preparations, freezing, injectable medications, and removal. Removal of the wart can be done in several different ways, utilizing cautery agents, and/or laser techniques. Keep in mind whichever way your wart is removed, they can reoccur, they can spread, they can reinfect. Warts are usually found in the younger population, and not in the elderly. Important things to do to prevent this problem is generally good foot hygiene, and disinfecting areas of the home, such as the bathroom and shower. It is not possible to totally eradicate the virus, and usually most people who are susceptible to the virus will contract it.

Moderator: mgonzales asks: "The arch on my right foot has been hurting for the past week. It has become so bad, that I can't walk. It feels like the arch in my foot is falling. What should I do to get rid of the pain?"

Dr. Mauser: It is difficult to determine whether the problem is truly in the arch, or the heel. A lot of times, pain from arches are deferred from the heel, but there are things you need to be aware of in the arch that could be a problem. If you are active, one would have to consider the possibility of a stress fracture. There is also the possibility that a tendon can rupture in the arch, causing pain and problems. There are also accessory bones that can occur that may become symptomatic over time, specifically, the best option would be to be evaluated, take some X-rays, and other diagnostic testing to determine the exact cause of the arch pain.

Moderator: Let's talk about shoes. What should we be looking for besides style?

Dr. Mauser: I will give my view on shoes, and this is what I tell my patients. Shoes are a shell that go around your foot. The shoe is only as good as the foot that goes into it. Shoes can make your feet feel better, but won't correct problems. There are things you should look for. I don't recommend a particular brand of shoe, because no sooner than I recommend it, the patient can't wear it. People need to be consumers of shoes, meaning they need to try many types and brands on, and walk around the shoe store walking around, and should go at the end of the day when their feet are tired and swollen. They should look for shoes geared towards specific activities. If the shoe doesn't feel good in the store, it won't feel good at home. A good sensible walking shoe is usually best, and there are many different brands. Women's dress shoes are not necessarily the best thing for your feet, and I certainly do not recommend four-inch heels. Again, when purchasing dress shoes, you need to be a careful consumer. In terms of the specific attributes of the shoe, they should have a good sturdy soul, wide base, the toe box should be deep enough to accommodate any deformities, the heel counter should be fairly stiff, lace up or slip-ons are your preference. A lot of shoes come with a removal insole. That is what they consider the arch support, when in reality it is nothing more than a little pad in the shoe. Often times the insole can be removed and replaced with something more supportive that you can buy over the counter in a running store, or this is an excellent place for the custom orthotic devices. Again, shoes are activity specific. You should not run ten miles in your basketball shoes, nor should you play a day of basketball in your running shoes.

fcrockow_lycos: My toes and the balls of my feet have hurt, increasingly so, for years. My primary care doc seems to have ruled out all ideas he is aware of. When I stand or jump they are particularly painful, and when I lay down they are excruciating. Walking around actually seems to help. Please help.

Dr. Mauser: It is certainly difficult to get the complete idea of your situation over the Internet. I encourage you to obtain a copy of the book I mentioned earlier. Entrapment of nerves are possible in the front of the foot, and we call those neuromas. It sounds like you've been evaluated fairly extensively, and in some cases, as mentioned before, there is no known ideology as to why people have some conditions. It does sound like you have a generalized neuropathy in which there is no specific cause. Perhaps the book can give you some good information.

Moderator: Jeanhoney says: "Dr. Mauser, my daughter has been diagnosed with plantar fibromatosis. Her doctors told her there is nothing they can do for her. She has too many nodes to be operated on. Do you have any experience treating this condition? I am in a discouraging and bewildering situation. Thank You."

Dr. Mauser: In this situation, if plantar fibromatosis is a single isolated nodule, or several small nodules, they could be removed. If the problem is related to a more systemic problem, such as neurofibromatosis, there is probably not much that can be done in terms of removing the lesion. I would encourage you to seek out a podiatrist or an orthopedist as someone who can make an accommodative orthotic or an accommodative custom made shoe.

Moderator: Colleen asks: "My mother is 70-years  old, and insulin dependent. No heart problems. She suffers from arthritis. Her feet have started swelling and her ankles hurt when she walks. The doctor has given her water pills and she takes Naprosyn (naproxen sodium). We are not sure what line of treatment she should pursue. Can you help?"

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