When Should I Call My Podiatrist?

Over the years, I have noticed that many of my patients hesitate to call my office for an appointment, wondering if the problem they have will just get better by itself.  Sometimes, that is the correct thing to do – wait a few days to see if it gets better.  If it does get better, then you’ve saved yourself from having to come in to see the doctor.  However, there are some instances when waiting a few days (or weeks) can be dangerous, and you can end up with a very serious problem that could have been treated without too much difficulty had it been addressed sooner.  I would like to discuss a few instances where waiting to see the doctor is a poor choice.

If you have diabetes, and notice any redness, blistering, warmth or open sores on your feet, I personally want to see you ASAP.  We will make room for you on the schedule.  We will stay late.  If for some reason, we can’t see you, we may even recommend you go to the emergency room at the hospital.  It is shocking how fast a little blister on the foot can progress to a large, infected ulcer (sore), leading to possibly loss of the leg itself.  If you have had a past history of a foot ulcer, or have poor circulation, you are at even greater risk.  Please don’t wait to call!

Any injury that causes significant pain, you really should have it looked at.  Often, patients will say that they didn’t think they needed to be seen after an injury because they could still walk.  The ability to walk or move the injured part of the foot, they reason, means it is not broken.  While this may sound reasonable, it is in many cases not so.  I have seen many fractures over the years that were dismissed as a simple sprain just because they could still walk.  Your suspicion for a fracture should be higher if you see significant swelling, pain that persists beyond a few days, or see bruising around the injured site.  And, when you come to my office, I may believe there is a fracture based on my exam of you, but even I won’t know for sure in most cases until an x-ray is taken.  Fractures that are not addressed can lead to poor healing, or in some cases, lack of healing at all.

Ingrown toenails are something that patients will put up with for weeks, and in some cases, months before coming in to see me.  And it is true that mildly ingrown toenails will sometimes work themselves out.  However, I have found that a lot of patients delay coming in to have the ingrown toenail treated because of fear of the minor surgery to remove the ingrown nail.  Let me put that fear to rest.  The vast majority of patients who have ingrown toenails removed say to me afterwards that the procedure was not anywhere near as painful as they had feared, and they express relief at how much better the toe feels afterwards.  Contrast that to the patient I am currently treating.  He has a severely ingrown, infected toenail that has been literally festering for years.  In his case, the infection has gone into the bone, and he now is scheduled to have his toe amputated to remove the infected bone.  This is not something that happens frequently, but had I been able to address his ingrown toenail when it first became an issue, he would have been relieved of years of pain, and he would not be losing his toe.

Finally, heel pain is a problem that patients tend to procrastinate treating.  If a patient were to begin to feel the symptoms of heel pain (also known as plantar fasciitis), I would recommend first using over the counter arch supports.  If the symptoms are not improving in a week or so, I would recommend having the patient into the office to see me to verify the diagnosis, and begin more aggressive treatment of the condition.  Plantar fasciitis is a condition that can almost always be treated successfully using conservative measures.  I have found that those patients who do go on to require surgery, their symptoms have been present for longer periods of time, often without any treatment being received at all.

The list I have provided in this blog is certainly not conclusive.  In short, if a patient feels any concern at all about their feet, I recommend having them come in for an evaluation.  It may be that nothing is wrong.  If that’s the case, you’ll have peace of mind.  However, if something more serious is amiss, we can get you on the road to a full recovery.

Tobacco and Your.... Feet?

Everyone is aware of the dangers of smoking to your lungs and heart. But the effects of smoking go far beyond your heart and lungs. Are you aware of what smoking can do to your feet? When I tell patients that smoking cigarettes can affect their feet, many are surprised. But the fact is that smoking can lead to serious problems with your feet.

First, when you smoke, levels of carbon monoxide become elevated in the bloodstream. Carbon monoxide displaces oxygen in red blood cells, and the result is that the blood is not able to carry as much oxygen. Since the tissues in your body (and feet) need oxygen, this is serious. Once oxygen is displaced from the blood cell by carbon monoxide, that blood cell can no longer carry oxygen for the rest of its lifespan (about 3 months).
Secondly, nicotine, which is found in cigarettes, causes the blood vessels to constrict and become narrower. This decreases the amount of blood (that’s the blood that already is carrying less oxygen) that can get to the tissues. The effects of nicotine diminish after two weeks, so quitting can improve circulation in a relatively short period of time.

Thirdly, smoking greatly increases the risk of PAD (peripheral arterial disease). This occurs when the arteries become clogged with plaques, further decreasing blood flow. Of the three main effects of tobacco smoking on circulation, this is the slowest to reverse itself after smoking is stopped (see www.padcoalition.org).

Why should you care if your feet are receiving adequate blood flow? Patients with poor circulation often will develop a condition called claudication, which manifests itself by causing severe pain in the legs when a person walks for short distances. In essense, the pain is a result of the muscles being starved of oxygen. When blood flow is poor, your body’s ability to heal itself (such as if you have an ulcer) is greatly diminished. Bones are also slower and more difficult to heal with a smoker who has poor circulation. In fact, when the circulation is bad enough, healing will not occur at all. This leads to tissue death (gangrene), and ultimately, amputation of a portion of the foot, or even the leg. This is very serious, because studies have shown that the 5-year mortality rate following a major amputation was 68%! This is higher than those diagnosed with colorectal cancer (39%), breast cancer (23%), Hodgkin’s disease (18%), and prostate cancer (8%). Losing a leg is not something to be taken lightly. Lung cancer, as it turns out, has a higher mortality rate (86%), but then again, tobacco is the major cause of that cancer too.

So what can be done? First, if you don’t smoke, please don’t start. I know very few people who are happy about the fact that they’re addicted to cigarettes. Secondly, if you do smoke, talk to your doctor about ways to quit. It probably will not be easy, but will most definitely be worth not only saving a foot, but saving your life!