Is Dr. Nirenberg a real doctor? Hear what Seinfeld has to say:

Podiatrists, or Doctors of Podiatric Medicine (DPM), are, in fact, real physicians.

Podiatrists specialize in treating foot and ankle problems. Podiatrists treat all problems related to the foot or ankle, and the variety of cases is endless. However, the most common problems I see are:

• Heel and/or arch pain

• Ingrown toe nails

• Bunions (bumps on the inside of the big toe)

• Hammertoes (bent toes)

• Flat feet

• Foot or ankle arthritis

• Fungal toenails

• Sores (ulcers)

• Infections

• Sprains and fractures

• Ankle pain or weakness

• Nerve problems and neuropathy (numbness, burning, or tingling)

• Shin splints

• Gout

• Athlete’s foot

• Sports medicine and diabetics foot problems

• Children’s foot problems

• Swelling or discoloration

• Plantar warts

• Arthritis of foot and ankle

• Heel spurs

• Arthritis

• Tendonitis

• Blisters

• Corns and Callouses

• Moles, cysts, tumors or lesions

When to Call a Podiatrist:

1. You Have Foot or Ankle Pain

Some aches and pains in our feet or ankles may go away in a day in a two; others do not, and that is when you need to go to a podiatrist.

Many people who see me for a painful foot or ankle have had pain for several days or weeks, but some have been limping around for several months or even over a year!

Pain is the body’s way of telling us something is wrong. Don’t ignore it.

However, not all people with foot or ankle problems have pain. For example, diabetics who have neuropathy (a deterioration of the nerves of their feet) may fracture a bone or develop an infection or sore on their foot and not have any pain.

Recently, I had a patient with diabetes come to see me complaining of a small sore on the bottom of their foot; an x-ray revealed a needle inside the foot.

Because the patient had very little feeling in her feet she didn’t know she had stepped on anything sharp.

In all patients, foot and ankle problems can quickly become serious, but diabetics are especially at risk.

Diabetics who don’t seek podiatric care promptly often develop gangrene and need a toe or the whole foot amputated.

Prompt treatment is essential. All diabetics or anyone else with decreased feeling in their feet need to have any foot or ankle problems checked by a podiatrist immediately.

2. You Notice Changes in Your Feet

Some people may notice one foot swelling or flattening.

Diabetics and others with neuropathy may not have pain, however these are the people most at risk for a particularly serious problem called charcot arthropathy.

In charcot arthropathy, the bones of the foot weaken and slide out of position, and may actually break through the bottom of the foot, leading to infection and even amputation.

For other patients, a rapid flattening of one foot may mean the main tendon holding up their foot has torn.

It is a good guideline for anyone who notices swelling, redness, increased warmth, or a change in the shape of his or her foot or ankle to see a podiatrist promptly.

3. You Find Something Abnormal On Your Foot or Ankle

A podiatrist should check any lumps, bumps, cysts, tumors, or moles on your foot or ankles. These problems are usually harmless, but occasionally they can be cancer and life threatening.

Final Thoughts on Foot and Ankle Problems

If you have a foot or ankle problem or pain, the best advice I can give you is: Don’t wait for it to go away—it may not.  

If you experience persistent pain, notice changes in the shape or color of your feet, or find an abnormality, then see your podiatrist right away. To learn more about podiatry, podiatrists, and podiatric medicine, visit the website of the American Podiatric Medical Association

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Blisters are a common, annoying, and painful foot problem. At some point, nearly everyone gets at least one on their foot.

A blister is a pocket of fluid that forms between the outer and inner skin of our feet usually in response to friction. They can also form in response to heat, moisture, an allergic reaction, or an infection.

Sometimes blisters are due to a bony problem under the skin. Blisters are our body’s way of preventing the skin on our feet from breaking open.

Unfortunately, blisters can be very painful and they can lead to serious infections or even in some cases gangrene.

Preventing Blisters

The best way to prevent a blister is to remove the source of the friction. This may mean simply wearing a good pair of socks, padding your foot with moleskin, or perhaps, buying a new pair of shoes or wearing a different shoe brand or style.

I also recommend keeping your feet dry, wearing shoes that fit well and using a sprinkle of good foot powder.

The very interesting thing about blisters is that what works to prevent a blister today may not work tomorrow.

Here is why: our feet change shape in response to temperature, humidity, the time of day, amount and type of activity, and other factors. An area of your foot that does not rub against your shoe today, may be a problem tomorrow.

Treatment of Blisters

People in good health can treat small blisters by puncturing them with a sterile instrument and socking their foot in diluted betadine solution repeatedly.

If blisters recur, they may be due to bone problem or spur in your foot, or in some cases may not be a blister. In any event, you should have the problem checked by a podiatrist.

Further, if larger blisters develop or if you have an underlying medical problem, such as diabetes, neuropathy, arthritis, or poor circulation, don’t treat the blister yourself; promptly see a podiatrist.

To learn more about podiatry, podiatrists, and podiatric medicine, visit the website of the American Podiatric Medical Association

– Dr. Nirenberg

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Published in the Fixing Your Feet Ezine – http://vonhof.typepad.com/fixingyourfeet/
By Michael Nirenberg, DPM

Having treated thousands of feet, I often see patients complaining of a blister that is actually a type of cyst called a mucoid cyst. Recognizing you have a mucoid cyst and not a blister is important because mucoid cysts are treated differently. The key differences between blisters and mucoid cysts are:

•    Blisters can occur anywhere on the foot. Common places for blisters are the ball of the foot, the back of the heel, or on or between the toes. Mucoid cysts only occur on the top of the toes or fingers beside the nail or about a centimeter from the nail.
•    Blisters often develop from friction. We don’t know why mucoid cysts develop, however, scientists believe they are the result of minor trauma to the toe or finger. In runners, this could be due to the repetitive jamming of the toe against the shoe. 
•    Blisters contain a clear watery-like fluid sometimes tinged with blood, whereas mucoid cysts have a thick, jelly-like substance.
•    Blisters come in various shapes and sizes; mucoid cysts are dome shaped and round.

There are two types of mucoid cysts: those connected to a joint inside the finger or toe and those that are isolated or not connected to a joint. Most mucoid cysts are painless, though tight-fitting shoes can cause them to become painful. 
     Mucoid cysts tend to occur more often in females and usually during the fifth to seventh decades of life, but I have seen them occur in people of all ages, including teenagers.

The treatment for a blister is usually to drain it. Mucoid cysts will usually recur if simply drained; they require surgery. The doctor will need to excise the entire cyst, often dissecting down to the bone. However, if the mucoid cyst is not painful, you can ignore it or if it only causes minimal discomfort, your doctor may recommend padding it with moleskin or felt.
     Whenever any mass or lesion occurs on your foot, have it checked by a podiatrist; for lesions or masses elsewhere on your body, see a dermatologist. Even though you may believe it’s nothing serious, in some cases, an abnormal lesion or mass could be cancer.

Dr. Michael Nirenberg, “America’s PodiatristSM,” is a podiatric physician, surgeon and forensic podiatrist. 

Photos are used with permission: Dockery GL: Cutaneous Disorders of the Lower Extremity, WB Saunders, 1997.

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