Erythrasma is a condition in which the skin between the toes becomes red and itchy. The skin may turn brown or become scaly. Creams, anti-fungal ointments, and powders will not resolve the skin infection. Those with erythrasma may notice the same patches of skin in skin fold regions: armpit, the groin, the belly button, and may be worsened by dermatitis or infection by other bacteria. The main culprit is Corynebacterium minutissimum, however other fungi or bacteria can co-infect the area. Very rarely, the infection can become deeper and an abscess may develop; thus, treatment is recommended.

Your podiatrist and/or dermatologist may recommend:

• Erythrasma requires certain tests to diagnose: under a Wood’s lamp, the skin may fluoresce coral red or a swab or skin scrapings may be collected and viewed under a microscope
• Controlling for moisture between the toes as moist environments can harbor bacteria
• Treatment with topical gentamicin, an antibiotic
• Maintaining proper hygiene
• If ointment does not resolved the infection, oral antibiotics may be used

Erythrasma resolves within a few weeks in most patients treated with antibiotics. Co-infections may have to be treated as well. The sooner you see your physician, the sooner the infection can be treated.

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Hallux limitus is a condition in which the joint that moves the big toe becomes stiff and possibly painful from arthritic changes. The pain usually is with lifting the toe or stretching the toe toward the leg. The pain may occur with walking, with jumping or over time if the joint is damaged, at rest. The pain may also center under the ball of the foot. Often a callus will form under the toe and may become painful or create a wound. Sometimes, there is a bony painful protrusion on the top of the joint.

To treat hallux limitus, your podiatrist may recommend:

• Wearing different shoes: high heels can place more pressure on the joint and cause two bones to grind on one another
• Shoe inserts or orthotics with modifications to either increase or decrease the motion at that joint
• Steroid injections which tend to be temporary pain relievers but can reduce inflammation
• Solid sole shoes, possibly with a curved sole to reduce bending of that joint
• Topical or oral pain medication
• Surgery to remove bony outgrowths
• Surgery to fuse the joint

Hallux limitus is a condition that is often treated successfully with conservative care. Your doctor may want to test your joints and muscles to determine the best supportive orthotics for you so plan for a bit of a longer visit. Sometimes excellent shoes may be enough to prevent most pain associated with the joint.

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Hyperhidrosis is excessive sweating often associated with white, soft skin that is prone to breakdown and infection. The feet of patients with increased sweating often demonstrate the skin breakdown or infection between the toes. Often the inter-web spaces smell strongly and develop fissures and ulcers. The excess sweating may be localized to the feet or may affect the entire skin surface. Hyperhidrosis affects an estimated 3% of Americans and is often difficult to treat. They may sweat profusely because of a hereditary disease, a medical condition (diabetes, tumor, injury, or gout), or food or medicine the patient is taking.

Your podiatrist and/or dermatologist may suggest:

• Identifying medications that are causing hyperhidrosis and changing medications
• Iontophoresis (electrical current)
• Alcohol or betadine applications
• Antiperspirants
• Botox injections
• Prescription medications such as antibiotics or antifungals
• Surgery
• Hygiene such as dry socks, powder, creams, proper drying, etc.

This disorder is not easy to treat and it may require multiple attempts at treatment before some relief is obtained. It is important to seek treatment as infections of the skin can deepen and threaten limb or life if there are openings in the skin.

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The peripheral nervous system found throughout the body works closely with the brain and spinal cord to send and receive messages. The system is responsible for telling the brain that ice is cold or a knife is sharp and the brain in return sends signals to tell the peripheral nervous system to activate muscles. When this connection is failing or there is damage to the peripheral nerves, these signals are often increased or decreased, causing anything from pain to paralysis. Common symptoms include odd sensations such as pain with regular touch, numbness, tingling, cold, poor muscle control, loss of gland production of oil or sweat and gastrointestinal problems (autonomic nerve damage), and may even cause kidney disease or loss of sight. 20 million Americans are affected by peripheral neuropathy and early signs such as changes in sensation or vision should be taken seriously and a doctor’s appointment should be made.

How is peripheral neuropathy addressed:

• Many causes of peripheral neuropathy exist including diabetes, alcohol use, bacterial or viral illness, toxin exposure, genetics, injury and more
• The first step is to identify the cause and try to correct the underlying culprit. An example would be improving diet and increasing exercise in diabetes to lower glucose and prevent progression of symptoms.
• More extensive testing such as electromyography or nerve conduction studies may reveal a more central or more peripheral cause
• Creams or topical medications can calm the nerves by overwhelming them
• Oral medications can improve symptoms and may also include supplements such as alpha lipoic acid
• Bracing to keep the foot from dropping when the muscles are involved
• With loss of fine touch, special shoes, daily foot checks, yearly foot exams by a doctor, and the use of shoes around the house can prevent new wounds
• Physical therapy or surgery may help control nerve pain
• Avoidance of the cause of the neuropathy may prevent progression

This disorder is not easy to treat and it may require multiple attempts at treatment before some relief is obtained. They may also refer you to a pain specialist or neurologist for specific therapy. Remember to be patient with yourself, your body and your doctor so that the right treatment can be found for you.

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Most people, when they injure their ankle, experience sharp pain on the inside or outside of the ankle that over time turns into duller pain and ultimately goes away as the ligaments heal. However, sometimes the pain doesn’t go away and instead changes. The pain or sensations have been described as burning, numbness, crawling, cold, cut off with a rubber band, electricity, or highly sensitive to touch. These sensations may be accompanied by history of tripping or falls, muscle weakness, or of stubbing the toes when walking. All of these experiences can be associated with common peroneal nerve syndrome or disorder in which the common peroneal nerve, found on the outer part of the leg just below the knee, can be injured in what seems like a minor trauma, causing sensory and motor symptoms downstream in the leg and foot. This injury is more common in women due to their musculoskeletal anatomy. The common peroneal nerve, when stretched or trapped or injured must be allowed to heal if possible and the symptoms must treated if healing is not possible.

What you can expect:

• Your podiatrist may want to try some special tests on you to determine if it is indeed a nerve problem such as hot and cold testing, two point perception and vibratory testing
• If they are trying to rule out radiculopathy or other more proximal injuries, they may suggest imaging studies or refer you to an orthopedist
• They may order more extensive testing such as electromyography or nerve conduction studies
• They may suggest creams or topical medications that can calm the nerves by overwhelming them
• They may suggest oral medications
• Another treatment may be physical therapy to overstimulate the nerve or release an entrapment
• They may prescribe bracing to keep the foot from dropping when you are walking
• They may recommend an ankle brace or boot to keep movement and stretching to a minimum.
• They may recommend resting the injured area by avoiding placing weight on the leg

This disorder is not easy to treat and it may require multiple attempts at treatment before some relief is obtained. They may also refer you to a pain specialist or neurologist for specific therapy. Remember to be patient with yourself, your body and your doctor so that the right treatment can be found for you.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Neuritis is the inflammation of a nerve. Usually the inflammation causes pain in the area surrounding a nerve, such as in the outside of the heel with sural neuritis. However, it can also cause paresthesias, or odd sensations in the same area. Examples include tingling, numbness, the sensation of bugs crawling on you, burning, and electricity. The way to identify nerve pain is that the pain does not always stay in one place and it usually isn’t sharp or dull. Neuritis is most common after some kind of insult to the nerve, whether from surgery or from poorly fitting shoes or from a trauma. The resulting symptoms can be quite variable and can affect daily life.

What you can expect:

• Your podiatrist may want to try some special tests on you to determine if it is indeed a nerve problem such as hot and cold testing, two point perception and vibratory testing
• They may order more extensive testing such as electromyography or nerve conduction studies
• If the neuritis is painful, they may suggest creams or topical medications that can calm the nerves by overwhelming them
• They may suggest oral medications
• Another treatment may be physical therapy to overstimulate the nerve or release an entrapment
• They may suggest a change in shoes or treatment for the problem anatomy (such as removing an extra bone to relieve pressure)
• They may just offload the area with orthotics or pads

This disorder is not easy to treat and it may require multiple attempts at treatment before some relief is obtained. Your podiatrist may also refer you to a pain specialist or neurologist for specific therapy. Remember to be patient with yourself, your body and your doctor so that the right treatment can be found for you.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

“I was walking along the sidewalk, stepped off of a curb too hard and heard a pop.”

“I jumped to make the shot and when I came down, I felt excruciating pain.”

“I don’t remember injuring myself but now I have pain, I’m having trouble lifting my foot and my foot is bruised.”

All of these stories can be tendon injuries, often ruptures where the tendon tears across and the two ends separate due to the pull of the muscle. Although not as common as tendonitis, tendon injuries have become more frequent due to the increase in both frequency and intensity of sports in the US population. The following is a short list of possible signs and symptoms of tendon injury. You need not have experienced all of them to have a tendon injury.

• Moderate to severe pain with dynamic actions/muscle use
• Loss of strength in a particular movement, such as lifting the foot or standing on tiptoes
• Swelling, especially in a linear pattern across the foot or ankle
• A bulge, usually at the end of the tendon further from the toes
• Bruising, usually not at the site of injury but toward the bottom of the foot

To help your podiatrist diagnose and treat you, clearly explain what led to the injury. Explain the timing of the weakness in movement. Inform your doctor if you have been taking any fluoroquinolone antibiotics for an illness or been given steroid injections near the site of injury because they have been associated with tendon ruptures.

Your podiatrist may suggest that you spend time in a walking boot or you may need surgery, depending on the level of injury. Either way, you will be in good hands. Tendon injuries are not the end of activity but the beginning of a road to recovery.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

We have been told since childhood that strong bones were essential to our health. We were told to drink milk and workout and eat our vegetables. However, today Americans still have high rates of Vitamin D deficiency, as high as 20% in healthy individuals and over 80% in obese, African American individuals. Vitamin D deficiency increases with age and with chronic medical conditions and can lead to the weakening of bones. In more than 20 studies it was shown that adequate Vitamin D was associated with a reduction in falls and ultimately prevention of osteoporotic fractures. Diet is partially to blame for this as most of our Vitamin D is sourced from dairy and orange juice and fortified cereals but other important sources such as fish are not eaten as frequently. It is commonly known that osteoporotic bone leaves an individual susceptible to hip fractures, but other complications can include ankle fractures, muscle weakness and healing complications involving surgical fixation of bone. Women are affected at nearly double the rate of men and increased age plays a role in the development.

Protecting your bones is possible and the following recommendations will help you save your feet and ankles from a future of instability and fragility.

• Eat fish (cod, tuna, salmon, swordfish), fortified orange juice, dairy, and eggs as part of a healthy diet
• Maintain a body weight as close as possible to the healthy range for your height
• Spend 15-20 minutes outside in the sun daily
• Talk to your doctor about Vitamin D supplementation, which improves levels in nearly 65% of individuals
• If there is a risk of Vitamin D deficiency (former/current smokers, those with malabsorption such as celiac patients, those with liver disease, and those on anticonvulsants), see your doctor for Vitamin D screening
• Perform daily strength, resistance and weight bearing exercises to maintain strong bone architecture

Your bones have to last as long as you do. The more you can do to improve Vitamin D levels and bone structure, the stronger your hips, ankles, and the bones in your feet will be as you age.

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Up to 25% of Americans have an allergy to nickel resulting in rashes, itching, pain, swelling and flaky skin. But often people do not associate their symptoms with nickel because they find the rash in odd places, without recognizing the nickel because it is hidden as part of an alloy. An alloy is a metal combination such as stainless steel which can have nickel, carbon, iron, and other metals. Often these allergies are first identified when women wear jewelry, which may also explain why women are more susceptible to nickel allergies, also called contact dermatitis. But the allergy may manifest as a rash near the belly button from belt buckles, a rash on the legs from metal studs in pants, or even swelling, redness and patches across the feet from buckles on shoes. Identifying contact dermatitis from metals is important because should a person need surgery to fix a fracture, they may need screws and plates, most of which are made from stainless steel. 60% of failed plates and screws were placed in patients with metal allergies.

What can you do to prevent complications from metal allergies?

• Pay attention to your body; if jewelry or other metal exposure causes swelling, redness, itching, pain or other discomfort, do not wear it and share that information with your primary physician
• If you are unable to wear stainless steel or handle money without breaking out, you can use other metals such as titanium, silver or gold and protect your hands with gloves when touching coins
• If you avoid contact with the offending metal but still have dermatitis, you can get patch testing to determine the true cause of the allergy
• If dermal rashes develop after placement of screws and plates, the doctor can prescribe steroids and remove the plate and screws

As long as the metal is avoided, the symptoms usually remain local to the contact point of the allergenic source but if you also notice chest pain, difficulty breathing and nausea and vomiting, you may be suffering from a systemic allergy to metal. Immediately call 911 and get help as soon as possible.

Contact dermatitis can be dangerous if not properly managed. If you talk to your doctor, you may be able to avoid placement of high nickel hardware to stabilize a fracture. Instead your doctor may recommend hardware made from other types of metals such as titanium alloys, preventing a second surgery to remove the hardware.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Fourth of July brought with it flags, parades, family and fun. It also brought barbeques and fireworks. Over 9,000 people each year are burned by fireworks, a third of which are children. Most are burned on the face and upper limbs, but occasionally small children step on lit fireworks or the fire spreads down a person’s clothes. Barbequing brings its own set of dangers. Too much fuel or malfunctioning equipment can cause similar burn patterns as fireworks and burns on the feet can come from spilling coals from traditional charcoal grills. The National Health Service and the New York Department of Health have tips to avoid and treat burns this summer:

• Do not let children use fireworks and keep them at least six feet away
• If the fireworks do not ignite or explode, do not go investigate
• Even sparklers reach over 1,800 degrees Fahrenheit
• Add fuel to the barbeque and ignite as soon as possible to avoid pooling of the fuel
• Do not add more fuel to a burning grill
• Do not leave a grill unattended
• When disposing of coals, allow them to cool first
• If someone is burned or injured, call 911 immediately and follow these treatment strategies
  • Stop the burning process immediately – cover flames with blanket, douse with water, etc.
  • Remove any clothing or jewelry that is not stuck to the skin
  • Cool the burn with lukewarm water for 20 minutes
  • Keep the affected person warm but do not cover the actual burns
  • Cover the burn with cling film
  • Treat the pain with ibuprofen
  • Avoid making the affected body part dependent. Elevation reduces swelling.

Although less common this time of year, burns to the feet and legs can be just as devastating. Timely prevention of burns, treatment, and help from medical professionals can make the difference this summer. Enjoy your friends and family, salute your country, and stay safe!

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office