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Q.

"Often when I wake up my feet are numb…lately it’s been in the balls of my feel, right below the big toe and the one next to it. What could be causing this problem?"



A. The sensation of numbness in your feet is most likely due to a nerve issue. Peripheral Neuropathy affects the long nerves of the body and is one possible cause of this, along with back issues, trauma, injury, infections, vitamin deficiencies, alcoholism, and diabetes. The symptoms may also include pain and burning. External factors are anything that puts pressure on the nerve, such as swelling of soft tissue or bone issue. I recommend that you seek medical treatment for a proper evaluation of your symptoms. Treatment may include rest, ice, decreased activities, tape the foot, injections, antiinflammatories, and/or custom-made orthotics.



Q.

"I have a solid mass on the bottom of my foot, which shifts from side to side. What could this be?"



A. The solid mass on the bottom of your foot may be a plantar fibroma. This is a benign lesion composed of fibrous tissue. The lesion is located within the bands of the of plantar fascial ligament. The ligament starts at the bottom of the heel bone and extends to the toes; it is composed of three major bands to help support the arch of the foot. The lesions are typically firm and may be single or multiple. This may be associated with diabetes, thyroid disease, alcoholism or epilepsy. I would recommend that you are evaluated by a Podiatrist. Treatment consists of padding the area to take pressure off of the lesion, steroid injections and lastly surgical excision if pain is present. Should the lesion rapidly change in size you should contact your doctor.



Q.

"I had surgery in September for Plantar Fasciitis, my foot has increasingly gotten more painful from that time. I noticed that at the surgery sight where there used to be small lumps prior to surgery there are now large lumps surrounded by scar tissue. I have a tingling sensation also. How would this be treated?"



A. The plantar fascial ligament is attached to the heel and extends to the toes, which provides support to the foot. The tension on the ligament can cause the development of a bone spur. When conservative treatment fails, surgery may be considered. Surgical intervention consists of cutting a portion of the band, with or without addressing the bone spur if one is present. It is not uncommon to scar especially in that area. The thickness of the scar may be applying pressure to nerve branches, causing the tingling sensation. Treatment may include topical medications, steroid injections, massaging the scar, physical therapy, and lastly surgery to explore the area. It is possible that the nerve branches surrounding the heel have inflamed causing a neuroma. This may also be alleviated by a steroid injection. I recommend that you follow up with your surgeon.



Q.

"Three days ago my 14 year old daughter woke up with a sore toe. The pain has since localized in her 5th MTP joint on both feet and is accompanied by swelling and redness. She cannot recollect and injury. She can walk, but can’t curl her toes. Do you have any idea what this could be? I am concerned that it is affecting the same joint on both feet. She does not wear tight shoes or high heels and has excellent overall health."



A. The symptoms you describe can most likely exclude infection and trauma since they occur in both feet. I recommend that your daughter be evaluated so a proper diagnosis and treatment can be determined. The pain, swelling, and redness may be due to a variety of things, such as a Tailor’s Bunion, juvenile arthritis, or shoe irritation. A Tailor’s Bunion, also known as a bunionette, is bony prominence off of the fifth metatarsal head. The bone is prominent and can rub in a shoe. Following evaluation and X-rays, if necessary, treatment may include taping, ice, massage, anti-inflammatories, custom made orthotics, or shoe modification.



Q.

"Is there anything I can do for big-toe-bunions, short of surgery, besides the obvious stuff like shoe-comfort, anti-inflam., etc?"



A. A bunion is a deformity that develops when there is an imbalance of the joint and tendons of the big toe. This causes a large bony prominence at the base of the toe, which can be sore. This is a hereditary condition that affects the function of the great toe joint. You are correct that wider shoes and antiinflammatory medications are a form of conservative care. Another option is a custom made orthotics, which would provide support to the foot and slow down the progression of the deformity. A taping can be applied prior to taking a mold of the foot to determine if this an option for you. When surgical correction is warranted, there are numerous procedures that the surgeon may choose from based upon clinical symptoms and x-rays.



Q.

"I had a portion of my nail removed on both of my big toes about 2 years ago. Now my feet are partially numb with pain. My fifth, fourth and third toes are pulling towards the big toe - what could be the cause of this? It has become quite painful."



A. Based upon your chief complaint I do not feel that removing a portion of the nail on your big toes created the issue. Numbness and pain can be caused be several things: peripheral neuropathy, impinged nerve, such as trasal tunnel, alcoholism, metabolic diseases, such as diabetes, autoimmune diseases, or injury. Symptoms that may be present are numbness, tingling, burning and/or pain. The description of your 4th and 5th toes drifting towards your big toe sounds like a form of a hammertoe. This type of hammertoe is known as a curly, or varus, toe. This deformity may be caused by over pull of a muscle in the foot known as the quadratus plantea. This muscle originates from the heel bone and inserts into a tendon on the bottom of the foot, the fl exor digitorum longus. These muscles help with contracting your toes however, an imbalance may be present. Treatment can be conservative or surgical. Conservative treatments may include wearing a wider shoe, silicone pads to decrease pressure, or splinting the toe in a corrected position. Surgical intervention requires rebalancing of the tendon, with or without addressing the bone, with a well planned skin incision. Your symptoms may be related. I recommend that you seek medical attention for a proper evaluation of your symptoms to determine the best treatment plan for you.



Q.

"I have diabetes and believe to have neuropathy in my feet, but am not sure. About 2 years ago, I broke the outside of my right foot (a dancer’s break), then a few months ago I broke the outside of my left foot in a similar position. Lately, for the last couple of weeks, both my feet have been hurting day and night, not only in the break sites, but also the whole of my soles. They ache and throb and hurt so bad I can hardly walk or stand on them. I also experience shooting pains from out of nowhere and will even wake me up at night unless I wear socks to bed. Is this more neuropathy?"



A. Diabetic patients with secondary nerve damage may develop Diabetic Peripheral Neuropathy. Since this most commonly is found in the hands and feet it is called “stocking and glove distribution.” The symptoms may include pain, numbness, tingling or burning sensations, and loss of sensation. There are many reasons as to why a diabetic patient may develop peripheral neuropathy: prolonged high sugars, infl ammation of the nerves, smoking, and alcohol use. Neuropathy can be diagnosed by exam and, if necessary, you may be sent for further testing. The damage typically does not reverse, however, the symptoms can be controlled. Treatment includes better control of blood sugars, topical or oral medications, and alternative therapies. The medications may help alleviate the symptoms. Diabetic Foot Care (DFC) is important for all diabetics especially those with neuropathy. DFC includes checking feet daily to check for unusual redness or open sores, not walking barefoot, moisturizing feet daily yet not in between toes, checking water temperature with your elbow, and if necessary diabetic shoes. Based upon the history you provided you may have Diabetic Neuropathy, and I advise that you speak to your Primary Care Physician, as well as a Podiatrist.



Q.

"I had a chemical Permanent Nail Removal on my big toe only partial is removed. Its been almost 2 weeks I still have pain, and just today have yellow puss coming out is this normal?"



A. An ingrown nail toenail occurs when the border of the nail digs into an adjacent border of skin, causing pressure on the nail fold. Tenderess on palpation or a throbbing sensation are common complaints. Initial treatment may include Epsom salt soaks and massaging the skin away from the nail for temporary relief, however, the ideal treatment would include removal of the nail border. Removal of the nail border may be permanent or non-permanent. The permanent procedure involves a brief application of a chemical to prevent the return of the nail border. The chemical may cause the border to be red and drain for 4-6 weeks. Initially, there may be some discomfort yet should subside within 2 weeks. If the toe is warm with increased redness, discomfort and pus is present then an infection must be considered. I recommend that you contact your doctor to be evaluated to determine if you need to be placed on an antibiotic or explore the area.



Q.

"I had foot surgery on my left foot and now I have scar tissue building in my foot. What is scar tissue? I may need to have therapy with ultrasound to help loosen the scar tissue up, and I am not sure if that will help me or not."



A. When surgery is performed on the foot, dissection is made through layers of tissue. Once the surgery is completed the tissue layers need to be to put back together with sutures. As the surgical site heals the tissue may become dense, forming scar tissue. Every individual scars differently, therefore it is difficult to determine beforehand how you will scar. Scar tissue is dense connective tissue. This can cause thickening at the level of the incision, decrease range of motion of a joint, and discomfort. Treatment may include physical therapy, topical medications, steroid injections, and if severe surgery. Physical therapy will consist of massaging, range of motion exercises, and ultrasound to loosen the dense scar tissue. The physical therapy should prove to be beneficial improve the surgical site, however, may not resolve the issue 100%.



Q.

"I was diagnosed with micro trauma to my big toe bone by an MRI, what can I do?"



A. Microtrauma is a microscopic injury to bone or soft tissue. The trauma may be caused by an overuse injury. If the area is not treated it may lead to a major issue, such as a fracture. Treatment may include decreased activities, ice, antiinflammatory medications, or a surgical shoe, which restricts motion to decrease stress and strain on the bone. I would discuss treatment with the doctor who sent you for the MRI.



Q.

"I have a very thick and soft white substance under my toenail beds (3 of my toes) for about 9 months. I’ve tried medications but nothing seems to help. How is this treated?"



A. Discoloration or thickening of the nail can have a number of causes. The common misconception is that all discolored nails are thickened due to fungus, when, in fact, there are several factors that can contribute to the appearance of your nail. Other factors include trauma, repetitive trauma from activity or ill fitting shoes, an over production of nail material, or a combination of these. Toenail fungus may be caused by injury or micro-trauma to the nail. The nail plate may appear to be white, various shades of yellow, black, or green. A thick substance is usually present beneath the nail and may be soft or brittle; this is known as subungual debris. This develops when dermatophytes, mold, yeast, and some bacteria feed off of the nail causing it to become brittle, and sometimes thick and painful. A biopsy of a nail clipping can confirm if fungus is present. Treatment can be timely and difficult because toenails are very slow to grow. It can take anywhere from 6-12 months for a toenail to grow its entire length. Treatment may include topical or oral medication, removal of fungal nails with application of topical medications, and laser. There are risks and benefits associated with each treatment option that you should discuss with your doctor. Keep in mind that not all treatment options are covered by insurance companies as this is considered as a cosmetic condition.



Q.

"I have been diagnosed with a spur under my left heel- I have had 3 cortisone injections which helped for a couple of months. My doctor will not give any more cortisone shots. What else can be done for this condition?"



A. Heel spurs are a result of instability in gait, causing stress on the heel bone and the attached soft tissue. A strain is placed on the muscles and ligaments beyond the normal extension, causing inflammation and possible growth of a bone spur. The effected ligament is known as the plantar fascia, which connects the heel to the ball of the foot. The condition is worse after being sedentary for a prolonged period of time and once the individual begins to walk it resolves. This may also be caused by injury, bruising, shoegear that is not supportive, or inflammation of a nerve or Achilles Tendon. Your doctor is correct in not administrating further cortisone injections, this could cause a break down of soft tissue including tendon and ligaments. Other treatment options include taping, anti-inflammatory medication, icing, stretching exercises, physical therapy, and most importantly custom molded orthotics. The vast majority of patients respond to conservative treatment, however, when exhausted, surgical intervention may be necessary.



Q.

“I’m an average 61 year old male in good health. About ten years ago, I accidentally kicked the leg of the couch with my right foot. These days, I sometimes feel like I have a lump under my foot when walking. No pain or other problems. The second and third toes are slightly bent, but otherwise OK. My question is whether further examination at this late date would provide any course of action. I don’t know the extent of the damage, if any, and what could be done anyway?”



A. It is difficult to say whether or not your incident with the couch is playing a role with the sensation of a lump under your foot.  Depending on the direction the toes are bending it could be caused by a hammertoe, a neuroma, or an old fracture.  If a fracture occurred at that time it would have healed by now.  I would recommend an evaluation and based upon that, treatment can be determined if necessary.  



Q.

"Hammertoe Treatment & Surgery - Why use a crest when toes already want to bend over? Why not cut a ligament/tendon to straighten instead of shortening?"



A. A hammertoe is a contraction of one of the joints in toes two, three, four, or five. In this condition the toe is bent at the middle of the joint, which is called the proximal interphalangeal joint or PIPJ. A toe crest is a conservative form of treatment used help support the toe. This will help straighten the toe by decreasing the contraction of the toe and therefore lessen pain and/or a callus at the level of the joint. Surgical intervention is determined by the severity and location of the hammertoe. Treatments may consist of cutting the tendon located on the bottom of the toe, removal of a piece of bone at the level of the deformed joint and repair the tendon, or tendon transfer. Removal of bone at the level of the joint is also an option; the bone is then fused using a wire or absorbable material. This method may produce more shortening than the above procedures. The goal of the surgery is to decrease pain at the joint and to straighten the toe.



Q.

"I have been battling a foot fungus problem for a while. I’m allergic to Lamisil and have tried numerous over the counter treatments, none of which have helped. What else can I do?"



A. It is possible for fungus to affect the skin and nails of the feet. Fungus likes a dark, moist environment that feet can provide. If the skin shows signs of dryness, itching, scaling, inflammation, or small blisters a fungus/Athlete’s foot may be present. It is possible to catch this from pool decks, locker rooms, and showers. Nail fungus (onychomycosis) may be caused due to microtrauma of the nail. Dermatophytes, molds, yeast, and some bacteria feed off of the nail causing thickening and discoloring. Drying well and not moisturizing between your toes can prevent fungus. Also changing sock if feet sweat excessively will help deter fungus as well as using talcum powder and shower shoes. Since your have exhausted the over the counter treatments, you should consider being seen by a podiatrist. They can determine if fungus is the cause of your problem and, if necessary, prescribe a topical medication. This may take weeks to resolve since toenail fungus is more difficult to treat compared to skin fungus.



Q.

"How are bone spurs treated-is surgery always necessary?"



A. A bone spur can be the result of instability in gait causing stress on the bone. Also, strain placed on the muscles and ligaments beyond normal extension can cause inflammation and the possible growth of a bone spur or osteoarthritis. Osteoarthritis affects the cartilage of the joint, it is slowly worn away and therefore the bones no longer glide smoothly which may cause pain. The joint shape may change and a bone spur may grow on the edge of the bone. Bones spurs may be located in various locations of the foot: heel, toes, and the top of the foot. Treatment will depend on the location and cause of the spur, however, conservative treatment is recommended first. This may consist of taping, anti-inflammatory medication, ice/heat, stretching exercises, possible steroid injection, physical therapy and custom molded orthotics.  Surgery may be necessary and again the procedure will depend upon the severity and location of the spur.



Q.

"When I first arise in the morning I have a terrible tingling sensation on the bottom of my feet. It goes away after a few minutes. What would cause this – I am on my feet a lot during the course of the day.



A. Peripheral neuropathy affects the long nerves of the body and is one possible cause of your tingling sensation. The symptoms may include pain, numbness, or tingling or burning sensations. There are various causes that lead to these symptoms, some of which are external while others are internal. External factors include anything that puts pressure on the nerve such as compression of it due to swelling of soft tissue, difference in anatomy where the nerve maybe impinged, or a tumor. Other common causes of neuropathy can include traumatic injuries, infections, exposure to toxins, vitamin deficiencies, alcoholism, metabolic diseases such as diabetes, and autoimmune diseases like Lupus. Preventative measures range from maintaining blood sugar levels and diet, the proper consumption of vitamins, to avoid repetitive motions and cramped positions. I would recommend that you seek medical treatment for a proper evaluation of your symptoms. A full work up may include muscle testing, blood work, and if necessary a nerve biopsy. The actual cause may not be identified, however, a proper check-up can exclude certain factors, allowing the nerve to recover and symptoms to subside.  Medications are available to assist with the symptoms.  



Q.

"What causes flat feet and how is this condition treated?"



A. A flat foot deformity, also known as pes planus, denotes a flexible or rigid decrease in the arch of the foot. The deformity occurs due to over pronation, which is inward rolling of the foot. Pes Planus can also be categorized as congenital or acquired. Congenital flat feet, in which the deformity has been present since birth, are typically flexible. A non-weight bearing arch is present, however, when weight is applied, the arch collapses. Acquired flat feet develop over time. The condition can be the result of a number of other foot related issues: improper shoe gear, faulty biomechanics of the foot, compensation for abnormalities of the foot, rupture of tendon/ligament, and most commonly a tight Achilles tendon. Treatment of flat foot deformity depends on the presence of pain. If no pain is present, then no treatment needs to be rendered aside from wearing proper shoe gear. Treatment for painful flat feet can vary from taping the foot for additional support, custom molded orthotics, stretching and range of motion exercises, and lastly surgical intervention.



Q.

"What is done for ingrown toenails and can they reoccur?"



A. Ingrown toenails occur when the border of a nail digs into the adjacent skin causing pressure on the nail fold. Common causes for ingrown toenails include the shape of the nail, genetics, trauma, or improper cutting of the nail. Ingrown toenails can cause discomfort with or without pressure from shoe gear. Recurrence may occur depending on the cause. Tenderness on palpation or a throbbing sensation are common complaints. If untreated, pressure on the nail fold can cause an infection. Signs of infection would include redness surrounding the nail border, increase in skin temperature, and/or pus drainage. Antibiotics may be warranted if such symptoms are present, however, the offending border would need to be addressed to avoid the pressure. Initial home remedies may include Epsom salt soaks and massaging of the skin fold away from the nail for temporary relief; however, the ideal treatment would include removal of the nail border. This procedure, which is also known as a partial nail avulsion, can be performed in the office with a local anesthetic. Depending on the frequency of reoccurrence, one can determine whether to perform a temporary or permanent nail avulsion. Patients who have had an ingrown for the first time may consider a temporary procedure in which the nail border would be removed, however, over six to nine months as the nail grows, the border would grow back. For patients who get recurrent ingrown toenails, a permanent nail avulsion may be warranted. A chemical is used to prevent the return of the nail. Regardless of the type of procedure performed, the patient remains weight bearing and can return to full activity immediately.



Q.

"I had a surgery done on the 1st metatarsal and now I have a screw holding where a wedge was cut out. I tripped on my crutch the other day and fell hard on my heel and may have pushed forward onto my foot, if the screw came apart from the bone would I have felt pain. I just felt the pain from the stitches, the nerves, my foot never swelled or bruised and I haven’t been having any pain since then. Do you think I should call my doctor and maybe have an xray done to make sure I didn’t mess anything up in there?"



A. There are four main goals when dealing with internal fixation, such as a screw: anatomic reduction/alignment of the bone, stable internal fixation, atraumatic surgery (maintaining vascular supply to tissue), and early actiive mobilization as directed by your surgeon. In the early stages of bone healing, the fixation holds the bone ends in place. When a force is applied to this area, the osteotomy, or bone cut, site absorbs the force, since the fixation is rigid. As the bone heals, it becomes as strong, if not stronger, than the screw; therefore, at that stage it is more likely to cause damage to the fixation. Internal fixation can withstand a great amount of force. However, it is possible for the fixation to become unstable or for the screw to break or back out if enough force is applied to the bone early on in the healing process. A deforming force may also cause the osteotomy site to shift from the desired position that your surgeon chose during surgery. You may experience pain if the screw were to break or cause bone to shift; however, the level of pain varies among individuals. Post-operative restrictions are placed to allow the bone to heal with the support of fixation. Any variations in the post-operative care such as a fall should be taken seriously. Since it is diffucult to say with certainty how extensive your fall was, I would strongly advise that you make an appointment with your surgeon as soon as possible for a proper evaluation and x-ray.



Q.

"I am having surgery for a bone spur under by big toe nail. My doctor said he will go through the tip of my toe to get to it and remove. How long is recovery for this kind of surgery? Will I have to wear a boot? How long until I can walk on it? Is this very painful?"



A. I would recommend that you address your question with your surgeon, as we all have our own protocol. Typically, following the surgery you will be placed in a compressive dressing and surgical shoe with partial weight bearing. Each patient has factors which may affect recovery. Generally, healing time is 2-3 weeks, until the incision is healed and swelling is down. Pain varies from individual to individual and therefore difficult to predict, however, most do not have excessive pain with this procedure.



Q.

"How soon can I be active (specifically dance) after permanent removal of an ingrown toenail. I’m hoping they won’t remove the whole toenail. Maybe just the portion that continues to grown into my toe (left big toe)."



A. An ingrown nail is caused by a border of the nail that digs into the adjacent skin causing pressure on the nail fold. Common causes of an ingrown nail may include the shape of the nail, genetics, trauma or improper cutting of the nail. The nail border that is causing the pain is the one that will be removed sparing the remainder of the nail unless there is an issue with the nail plate. Permanent removal of the ingrown toenail will cause some discomfort following the procedure however everyone is different. You will be the judge of your discomfort level yet should be able to return to activity in 3-5 days. Drainage can be present for 4-6 weeks following the procedure yet should not interfere much with your activity.


Dr. Robert Califano and Dr. Brighid Lodge: Role in Wellness

Dr. Robert Califano and Dr. Brighid Lodge provide a full range of services for the treatment of foot disorders for both children and adults. Some of the more common conditions seen include heel and arch pain, bunions, arthritis, ganglions, hammertoes, sprains, fractures, ingrown nails, nerve entrapments, tendonitis and warts. Diabetic foot care is also available. The doctors will always pursue conservative therapy initially for these conditions. Treatment modalities may include supportive tape strappings, oral medications, injections, casting or custom orthotics. However if these approaches are unsuccessful, surgery may be indicated. Surgery is commonly performed on an outpatient basis. The doctors are on staff at Ellis Hospital including their affiliate The Bellevue Campus and the New England Surgery Center.

Dr. Califano has been in practice in the Capital Region since 1985. Prior to that time, he was in practice in San Diego where he served as president of the San Diego County Podiatry Association as well as Director of Podiatric Residency Program at Villa View Hospital. He is a graduate of the University of Hartford and the California College of Podiatric Medicine. He completed his residency in foot surgery at the Kaiser Foundation Hospital in San Francisco. He is board certified by the American Board of Podiatric Surgery. He has served as president of the Northeast division of the New York State Podiatric Medical Association and acts as a consultant to the New York State Education Department. He is chief of podiatry at the Century Same Day Surgery Center and The New England Surgery Center.

Dr. Lodge is a graduate of Kings College and the Temple University School of Podiatric Medicine. She served her residency in foot surgery at Our Lady of Lourdes Hospital in Binghamton where she was named resident of the year in 2004 and 2006.

Dr. Califano and Dr. Lodge are available to see patients both in Rotterdam and Latham.

This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

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