Dr. Pribut On Running Injuries


Online Chat With Dr. Pribut





USA Today Foot Hotline: Dr. Stephen Pribut

Thursday, June 7, 2001 noon ET

Washington, D.C. podiatrist Stephen Pribut


Thursday, June 7 noon-2 ET


Comment from Stephen Pribut: Good afternoon, We are about to begin. I'm warming up my fingers. I'm happy to participate in the online chat as a volunteer and member of the American Podiatric Medical Association. Some brief background and sites to visit: I am a Director of the American Academy of Podiatric Sports Medicine and in private clinical practice in Washington DC. Online resources I recommend include the American Podiatric Medical Association at www.apma.org, the American Academy of Podiatric Sports Medicine at www.aapsm.org and you may visit my website and sports medicine information at www.drpribut.com. I participated in the online chat here last year and am glad to be back. Let's begin.


Bismarck North Dakota: I often have pains emanating from the bottom of my heels upward. Sometimes my heels are so tender it is painful to walk or at least the first few steps. Should I be concerned?

Stephen Pribut: This sounds like it might be the beginning of plantar fasciitis. I would recommend that you wear shoes around your home all of the time. Make sure your shoes are supportive and do not bend in the middle of the arch.

You should also begin some gentle calf stretching exercises. The runner's stretch leaning forward against the wall for 10 seconds on each leg and repeating 10 times would be good.

Toe curls or trying to pull a towel towards you by grasping a towel on a smooth floor can also be helpful.


Lakewood, Colorado: I had hammertoe surgery ten weeks ago. The pin was removed two weeks ago. My foot continually swells every day. How long can I expect the swelling to continue, and how long before I am able to wear a closed-toe shoe? I am having additional surgery (bunion and hammertoe) on my left foot in mid-July and I need to be sure my right foot is ready to carry the burden.

Stephen Pribut: It is important to keep your foot elevated after surgery. I tell my patients that the best cure for swelling is prevention. It would be best to address your concerns with your foot surgeon about the swelling and having additional surgery before your other foot has recovered.


Minneapolis, MN: What about patients with Complex Regional Pain Syndrome of the foot? How do you treat them?

Stephen Pribut: Complex regional pain syndrome is a very difficult problem to treat. I usually enlist the assistance of a neurologist and physiatrist to assist in the treatment of this condition.

I would also suggest using a search engine to find an online support group. You may also visit PUBMED and perform a literature search to find out about the latest treatment for this condition.


Boca Raton, Florida: I think I have a ganglion on the top of my left foot that aches and swells every day. I have other health issues related to autoimmune system. Can I safely have it removed?

Stephen Pribut: A Ganglion is a benign foot condition. It can often be treated nonsurgically by making sure that your shoes are not causing excessive pressure over the ganglion. Removing the fluid by needle aspiration is often performed. Occasionally surgery is necessary. Many factors go into deciding whether surgery is safe for the individual patient. The internist or immune specialist who is treating you would be best suited for making the determination of whether or not surgery is of low risk and safe for you to undergo.


Milwaukee, WI: How do you get rid of heel spurs that aren't responding to the stretching exercises prescribed by my doctor?

Stephen Pribut: Orthotics are often used for treatment of plantar fasciitis and heel spurs. But let's look at some background first.

Factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight, or a change of shoes or allowing your current shoes to wear excessively. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Make sure your shoes are not excessively worn and that they do not bend in the "middle of the arch".

Just to emphasize what you can do at home to treat this: Check your shoes to make sure they offer sufficient support and motion control. They should bend only at the ball of the foot, where your toes attach to the foot. This is very important. Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this.

You may also strengthen the muscles in your arch by performing toe curls or "doming". Toe curls may be done by placing a towel on a kitchen floor and then curling your toes to pull the towel towards you. This exercise may also be done without the towel against the resistance of the floor.

Plantar fasciitis is usually controlled with conservative treatment. Besides surgery and cortisone injections, physical therapy modalities such as electrical stimulation and ultrasound can be used. Often the foot will be taped to limit pronation. Following control of the pain and inflammation an orthotic (a custom made shoe insert) can be used to control over-pronation.

The orthotic has a very high percentage of long term success. If the orthotic has failed for 6 months (and make sure you have also tried a softer orthotic, if a hard plastic one fails) surgery can be considered. A new treatment called the osteotron, which uses sound vibration, has just been reported to be used. But the protocal also requires 6 months of failed treatment. I believe that the orthotics and physical therapy work quite well and this should not be needed very often.


Austin, TX: Can you please discuss plantar fasciitis? How does it occur? Can it be prevented? What types of shoes can alleviate the pain?

Stephen Pribut: Please see the answer to the previous question for some pertinent information.

Plantar fasciitis and heel spurs are caused by a painful partial tearing of the plantar fascia from its origin on the heel bone. The term plantar fasciitis is derived from plantar which refers to the bottom of the foot and fascia which is a type of dense fibrous connective tissue.

The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation. If your foot flattens or becomes unstable during critical times in the walking or running cycle, the attachment of the plantar fascia into your heel bone may begin to come under significant tension and start to pull away from the heel bone.

Sometimes the area where the plantar fascia is injured bleeds and then calcifies which results in a heel spur. The spur does not have to be present for pain to occur. Without the spur the condition is called plantar fasciitis. The pain is especially noticeable when you push off with your toes while walking, since this movement stretches the already inflamed portion of the fascia. Without treatment the pain will usually spread around the heel. The pain is usually centered at a location just in front of the heel toward the arch.

Other factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight, or a change of shoes or allowing your current shoes to wear excessively. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Make sure your shoes are not excessively worn.

The things you can do at home to treat this are to check your shoes to makes sure they offer sufficient support and motion control. They should bend only at the ball of the foot, where your toes attach to the foot. This is very important. Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this.

Well-designed running shoes are often quite good for walking and can be worn in your house also. Avoid slippers, sandals, barefeet and socks in the house.


Atlanta, GA: I have pain on the bottom of my feet. If I stand for more than 30 minutes or so, the pain will begin. I have to wear low heals or flats and Dr. Scholls pads in my shoes. I do not have bunions and am not flat-footed. My mother has and grandmother had the same problem. My mother tried acupuncture but this did not help the pain. Any solutions?

Stephen Pribut: The bottom of the foot covers a pretty wide and long area. For heel pain see the last two questions. For forefoot pain a shoe with more forefoot cushioning might help. I'd recommend an evaluation from a podiatrist to see what mechanical factors or other factors might be contributing to your pain.


Chicago, IL: I have a re-occurring corn. Is there any way to completely remove the corn for good?

Stephen Pribut: Corns on toes are usually caused by pressure between the bone in the toe and a shoe, with the skin being trapped between the two. This causes the skin to produce more skin very rapidly with a buildup over the point of most pressure. The possibility exists for one of two things to be changed. The first change I recommend would be to wear a shoe with a wider and deeper toe box. If this does not eliminate the problem, surgery on the toe, which would involve eliminating the bump on the bone, is likely to work quite well.

It is important to take good care of your foot after surgery and to keep it elevated during the early healing time, especially during the first month following surgery.

The surgery is usually performed under local anesthesia on an outpatient basis.


Overland Park, KS: What can be done about cracked skin on the heels despite applying creams and lotions?

Stephen Pribut: You have probably applied moisturizers. Often cracked skin on the heels is caused by a type of athlete's foot, or a fungus or yeast infection.

Often wearing open back shoes increases the problem by causing friction and pressure as your foot slides up and down in the shoe.

First, try an over the counter anti-fungal medication. But if this does not work, I'd recommend visiting a podiatrist for an evaluation and a prescription-strength medication.


Glassboro, NJ: I am planning on a bunion operation. My left foot will be in a cast. What kind of things can I do after operation without being hurt? What safe exercises can I do, etc.?

Stephen Pribut: It is best to ask your surgeon all questions about pre- and post- operative care and treatment.

I recommend a brief hiatus from moving around very much. I do not want my patients to fall and injure their foot. Upper body strength training at a low level should be safe.

A cycling unit that you can use your hands on is also acceptable, but hard to track down.


Woodbridge, VA: Is it better to go barefoot or to wear shoes/slippers around the house. Should babies wear shoes before they are actually walking?

Stephen Pribut: Babies don't need to wear shoes, except when they start walking. A somewhat flexible running shoe is fine for early walkers. Of course if the baby is attending a formal occasion, a suitable shoe that would match the outfit (black tie - white shoes) would probably be just fine.

For adults: If you have no foot problems going barefoot is okay. For people who have foot problems, I recommend running shoes around the house.


Lancaster, PA: I am concerned that a pair of golf shoes I have are too wide. I have no problems with blisters but I sometimes have pain in the middle of my front arch (from little toe to the big toe). Would a more narrow shoe help eliminate this problem?

Stephen Pribut: It is possible, but it could be a mechanical problem that might require balancing the weight in your forefoot, but using an in-shoe foot support or orthotic.


Seattle WA: What does one do about toenail fungus. I've heard that medicine is sometimes ineffective and tedious. Isn't there something else that they've discovered works great on this problem?

Stephen Pribut: There are a few oral medications that have somewhere between 50-80% effectiveness.

There is a new topical medication that studies seem to indicate somewhere between 12%-50% or effectiveness.

The ideal cure has not yet been found. And your body chemistry, skin flora (normal bacteria living on your skin), and genetics are all contributing factors to recurrence of this problem.


Takoma, Washington: In both feet, I have numbness and hyper-sensitivity. If I step on anything without shoes on, I have extreme pain! It feels like it is coming from the balls of my feet. It never goes away even when when I sleep. They feel like they are burning at times and sweating. Do you know what might be wrong? I have had this condition for around two years now.

Stephen Pribut: I think a live evaluation would be needed to determine a possible diagnosis for your problem. Circulatory problems and neurological problems are both possible with your symptoms.


Old Tappan, NJ: I am a 35 year old triathlete/runner who has had problems with pain on the front part of my feet(by the front ball of the foot). For the past two years, I have seemed to injure both of my feet. I can still run but it is painful after I run. I ice it when I am done but it can be painful and frustrating. Do you have any recommendations on how to prevent this and how to reduce the pain?

Stephen Pribut: Without an examination, I cannot determine what precise part of your foot is hurt. It sounds like it might possibly be behind your big toe. This could indicate a sesamoid bone problem, which is located beneath your first metatarsal.

For my patients with this condition, I often use orthotics with an accommodation to take pressure off of the two sesamoid bones.


Eastchester, New York: Who is better qualifed to perform bunion surgury, an orthopedic surgeon or a podiatrist? Who will do a better job?

Stephen Pribut: The qualifications of individual doctors in both disciplines may vary. Both podiatrists and orthopedists perform this surgery.

The podiatrist has studied podiatric medicine and surgery for 4 years and then attended a 1 to 3 year residency program specializing in foot or foot and ankle surgery. This residency program usually entails rotating through various disciplines and having a broad exposure to different types of surgery and the different skills needed for the overall care of the patient. This often includes exposure to general surgery, orthopedic surgery, vascular surgery and other related fields which intersect at the foot. The specialization, however, is foot and ankle surgery. Interaction with residents from other disciplines also takes place within the hospital.

The orthopedist has attended medical school for 4 years and then undertaken a 5 year residency program that includes general surgery, general orthopedic surgery, the other disciplines mentioned above and a very limited amount of foot surgery. If an orthopedist is interested in foot surgery, then they will have to perform an additional fellowship in foot, ankle and lower leg surgery following the completion of their 5 year program. Very few of these programs exist and orthopedists specializing in the foot are in short supply.

Compared to a general orthopedist who also works on knees, shoulders, hips, and elbows, the podiatrist has a special interest and expertise in the foot.

Additional qualifications to consider in your choice of podiatrist would be Board Certification by the American Board of Podiatric Surgery. This board has very high standards and the applicants undergo a rigorous testing process. For orthopedists, I would usually recommend one with a specialization in the foot, although as Dr. Carol Frey has mentioned in today's print and online edition of USA TODAY, most of the foot orthopedists prefer to do complex ankle and rear foot surgery. Podiatrist are pleased to work on your foot and ankle, period.

Make sure that you check with others about your potential surgeon's reputation, results, and the quality of their aftercare.


Comment from Stephen Pribut: For more information on podiatric medical education and foot surgery qualifications visit the web sites of the: American Podiatric Medical Association at: http://www.apma.org/ The American Board of Podiatric Surgery at: http://www.abps.org The American College of Foot and Ankle Surgeons: http://www.acfas.org/


Trumbull, CT: I have Morton's toe. I also have been having pain in what appears to be my middle front of my foot at a point about 1 1/2-2" from the front of the toe. (about 3/4" further in from second joint). In the same foot I my arch has been falling and it is affecting my inner knee. Are they related? I put corn pads where the pain is and it helps alot. I think my pain my be due to a bone spur. If so is the treatment surgery or do I keep using pads. What do you think of my diagnosis. What does one do for falling arches? Should I see an Orthopedist or DPM and if surgery is required is it major or minor and how long is the recovery period. I am a 58 yr old male in good health who used to run marathons but now only bike and swim.

Stephen Pribut: I recommend a visit to a sports podiatrist. I would first recommend conservative treatment. The two problems may be a result of over-pronation and the biomechanical function of your foot and leg should be assessed and a custom orthotic should be considered (long before surgery).


Basking Ridge, NJ: After many years of injuring my ankle I have been diagnosed with soccer ankle, ie.. arthritis of the ankle with loss of cartilage. I have been taking vitamins (Cosimin DS) to help promote the growth of the lost cartilage. The question is, would ankle arthrosocpic surgery be useful in eliminating the arthritis? I have heard conflicting statements about ankle arthroscopy ranging from it being helpful to it being a waste. What is your opinion.

Stephen Pribut: Ankle arthroscopy might be helpful. Ankle arthritis is difficult to deal with. There have been some unsubstantiated reports of glucosamine/chondroitin sulfate being used. This would be low risk.

If specific loose bodies have been found the arthroscopic surgery should be a strong consideration.


Brandenburg, KY: I walk 6-9 miles a week. I wear New Balance Walking Shoes. I have pain in my inside left ankle. Sometimes the pain travels up the inside of my leg to my knee. What could be causing this pain?

Stephen Pribut: The inside of your ankle might be hurting from a problem with your posterior tibial tendon or the medial ankle ligaments. With the pain going a little higher it sounds like it might be a form of shin splints called "medial tibial stress syndrome".

I often find a motion control shoe is helpful. Sometimes custom orthotics are used. Make sure that you change your walking shoes regularly. Consider new ones every 6 to 9 months.

I have some more information on medial shin splints on my web site (a past pick for USA Today Hot Site of the day).


Atlanta, GA: I have ongoing problems with ingrown toe nails. I've had the pediotrist treat them, but it's still an ongoing battle. Now, I just lift the side of the nails, which is somewhat painful and trim it back. Then the toe is inflammed for a couple of days. Is there any way for me to treat this more effectively and easily? Thanks!

Stephen Pribut: Be careful that you don't tear the skin when you trim the toenail. If this is a recurring problem a minor surgical procedure under local anesthesia can be performed in the podiatrist's office to remove the curved part of the toenail and medicine that cauterizes the adjacent part of the toenail root can be used to prevent the ingrown part from returning. This works well more than 90% of the time.


Venetia, PA: What is the best way to treat warts on the bottom of the feet that do not respond to topical treatment & "freezing"?

Stephen Pribut: There are many types of treatment for warts. Immune therapy may be used, electrical cauterization, and burning with a laser are all possible therapeutic options.


phila pa: i've been wearing orthodics for 6 months and my right foot is worse now than it was before -- pain all day instead of just in the morning when getting out of bed. what other treatment is available for flat feet?

Stephen Pribut: Occasionally surgery is performed, but this would be very rarely done. You should have further evaluation to see if you have any other associated problems such as arthritis or a tendon injury. Posterior tendon injuries can cause significant problems and may require surgery or a brace that goes higher than an in shoe orthotic does. Make sure you return to your doctor or see another doctor for an evaluation.


Buford Georgia: I am 47 years old, female, not overweight. I do step aerobics 5 times a week. I have been doing this for 2 years. All of a sudden my right foot developed a pain in the heel radiating through the arch. ( I have high arches) I looked up material which said that I probably pulled the plantar fasc. ligament. It has been 3 weeks that I have rested from the exercise routine. I bought new exercise shoes with an additional arch support. How can I tell if I have bought enough support for my foot? I thought I was using an excellent shoe when the pain developed. Should I "walk through" the pain and walk in the new shoes even though afterward my foot tends to hurt? Are there exercises I can do to prevent or treat this?

Stephen Pribut: You should not walk through the pain. Many professional athletes and amateur athletes tear their plantar fascia when doing high speed or impact sports. They are often casted for up to 6 weeks or more. If you are still in pain after 3 weeks, you should visit a sports podiatrist. The American Academy of Podiatric Sports Medicine has a list of their members at http://www.aapsm.org/

As far as shoes go, it is important that they not bend in the middle. I recommend testing for flexion stability by doing a "push up test". Hold the heel of the shoe in your right hand. Press underneath the ball of the shoe with your left hand. I should not bend. It should only bend when you press towards the toes. The shoe should bend where you toes do, not before that point. The foot was not designed to bend in the middle and your shoes should not be designed to bend there either.


Hagerstown, Maryland : Doctor, I have some dead skin on the bottom of my Right foot that has develop three areas of growth that my friends have described as warts. They happen to be in sensitive areas that my body weight alone(and the wrong shoes) causes pain. Is there a simple fix , an OTC remedy, or should I schedule an appt. with Dr. Harrison, my podiatrist in town?

Stephen Pribut: You may try an over the counter wart medicine, but sometimes the guess that it is a wart is wrong. It is probably best to see your podiatrist for a quick visit before beginning self treatment and the podiatrist may be able to help relieve the pain so that you can continue walking in comfort.


Plymouth PA: My feet smell awful after work, is it my diet, shoes, or socks?

Stephen Pribut: It is not likely to be your diet, that would have a larger impact on your breath and bodily gases. Sometimes athlete's foot infections or a bacterial infection by a bacteria called Cornybacteria may cause an odor. The treatments are different.

Moisture can be a factor in problems of malodor. I'd recommend wearing socks that wick the moisture off of your foot. Runner's wear socks made with Coolmax or a similar material. Avoid cotton socks which hold the moisture against your skin.

You may also consider using a topical anti-fungal medicine. And see your podiatrist or dermatologist if the problem continues.


Kirkland, Washington: Recently, I've had a nerve that runs along the top of the foot to the big toe feel like it's stretched or exposed. At times, I get an intense electric shock from it; at other times I can feel it as kind of a dull sensation, or even numbness in the toe. It seems to be getting worse. What can I do?

Stephen Pribut: It is possible that it might be a bump and irritation with your shoe that is contributing to this condition. If I see that that is present in a patient, I skip a shoe lace (going vertically) over that spot. The American Academy of Podiatric Sports Medicine has a diagram of shoe lacing techniques. It is not yet on their web site, but you can request by visiting their website (www.aapsm.org)and sending email to them.

If this problem persists a live examination would be a good idea.


Prattville, Alabama: About a year ago, I assumed a position at work requiring a great deal of walking in dress shoes. The pain started with a sharp heel pain causing me to nearly collapse. Heel pads help somewhat, but over time the pain has progressed to the achilles tendon and the bottom of my foot. My ankle and foot will swell after the end of the day and my arch is non-existent. What should I expect if I seek treatment, and to whom should I go?

Stephen Pribut: I would recommend visiting a podiatrist who treats biomechanical problems. A podiatrist with an interest and experience in sports medicine would likely be the best professional to visit.


Washington, D.C.: I have been diagnosed with "tarsal tunnel" syndrome because of pain now focused on the bottom of my feet (both) just behind the ball of the feet. Its usually much worse in winter and is going away now. I have new orthotics and have been told to wrap my ankles to reduce movement. A cortisone shot has not seemed to do much good. Are there any other remedies that are useful?

Stephen Pribut: Sometimes a surgical "release" of the tarsal tunnel is done.


Kansas City, MO: My fiancée has a bunion on her big toe and also on her little toe. It appears they got started while doing competitive dancing. She's 25 yrs old. The article on USAToday mentioned early treatment to stop bunion progress. Could you give examples of these, and what the price ranges might be?

Stephen Pribut: Sometimes custom orthotics are used to limit over pronation of the foot. I'd also recommend lower heeled shoes - only going up to 1 1/2" and gentle calf stretching exercises. Toe curls or "domeing" is also a good idea.

The exercises are free, the shoes vary in cost, as do the orthotics.


Santa Barbara, Ca: What causes my feet to always feel annoyingly hot, even though they are not hot to the touch?

Stephen Pribut: It may be a "nerve" problem or a condition called erythromelalgia. A quick search on the web turns up a site called "the EM support group" which has information on this condition at. (addendum: see online article by Dr. Pribut on erythromelalgia.)

I'd recommend reading about this condition, and then visiting your doctor to see what they think and verify the diagnosis. Self diagnosis and diagnosis over the internet is fraught with risk and inaccuracy.


Newport News, VA: I am 36 years old, and have flat feet and moderate bunions. My podiatrist prescribed orthotics a couple of years ago, but I stopped wearing them after a few months because I had difficulty finding shoes (particularly dress shoes)that would accomodate them. I would like to try the orthotics again because I continue to have foot problems. Any suggestions as to where I can find shoes that fit?

Stephen Pribut: Ask your podiatrist about an orthotic called the slimthotic which has the heel cut-out. It fits into more dress shoes, since your heel is not lifted up and out of the shoe as with a full width orthotic.


Dallas, Tx: I am 51 and all of a sudden my feet hurt! Last year I was walking for about an hour 5 days a week, but the next day my feet were so tender that I could barely walk. Now I ride a bike 5 days a week and although the pain is less, they still hurt! Now, if I walk for even 10 minutes, they hurt. What in the world is going on. (Growing old is for the birds!!!)

Stephen Pribut: Hey, us boomers are finding out that we can age also. Exercise is important so you should try to find out what the problem is so that you can continue to exercise. I was thinking that perhaps a new organization might be founded called B.A.R.F. which might continue fighting for that old boomer spirit. That acronym might stand for Boomers Against Retiring Feet. We don't want our feet to give out on us first.

More seriously, it would be a good idea to visit a podiatrist to find out why your feet hurt and what should be done about it.


Worcester, MA: I have burning pain in both feet and have been diagnosed with neuropathy. The cause is unknown. I have tried many medications with no improvement. Can you recommend any new medication? Meds tried in the past: amytriptoline, mexatil, imipramine, zostrix, and a few others I can't remember at the moment. Thank you for any help you can provide.My email is: Lawrence_Claire@emc.com

Stephen Pribut: Neuropathy is a very difficult condition to treatment. I would recommend discussing the problem with your neurologist and looking for an online support group.


Cleveland, OH: My question is about stress fractures. I've just been diagnosed with one in 5th metatarsal, apparently from exercise walking a bit to strenuously. I'm 55, in good shape, walk to play golf, and had a normal bone density scan last year. Spent last year in therapy changing how I walk to take stress of osteoarthritis in knees - now walking straighter on my feet. Why would this happen?

Stephen Pribut: I'd make sure that the fracture in your fifth metatarsal was not form an "inversion" injury of your foot. The base of the metatarsal is often hurt in this manner rather than from a stress fracture.

Stress fractures often come from suddenly increasing your exercise level too quickly.

This is part of the terrible two's. 2 much, 2 soon, 2 quick, 2 often.

Build up your walking or running slowly. No more than 10% per week should be added to your exercise program. Every 3 weeks drop back a bit.

Slower is better when it comes to building up your exercise program.


Slower is better when it comes to building up your exercise program.

Orlando, Florida: I had surgery for Morton's Neuroma on both feet, one 4 yrs ago and the other 6 yrs ago. Since then I suffer from cramps and pain in the balls of my feet right behind the toes and it always feels like sand in my shoes or hose and also when I am in my bare feet the skin is very sensitive like "new skin" just healed over from a burn.....also burning sensation if I have been on my feet for awhile...I could go on and on and just want to know what to do to get some relief so I can take a walk without pain and ache. The only thing I can thin of is cordisone shots which I am not certain would be covered with my insurance. I am really desperate because I am limited as to how much time I can stand up, and want to at least be able to take a walk

Stephen Pribut: I will often use orthotics to correct improper foot mechanics to lessen stress and strain on the foot following many types of surgery. Neuroma surgery and forefoot pain may response to this treatment.

It is also possible that you have a "stump" neuroma or a recurrence of the original problem. Please visit your foot doctor to see what can be done, so that you can return to comfortable activity.


Arnold, MD: I have a chronically swollen foot. Pain is not always present, however when it is it is not confined to a specific area of the foot and ankle. I have had many tests but no specific answers. Any ideas?

Stephen Pribut: Your doctor might consider "lymphedema" which is difficult to treat.

Idiopathic edema may be a possibility and is of uncertain origin.

Since there are many possible causes it is important to consider many different possibilities.

Unilateral edema - one foot or leg - has a greater chance of being from lymphedema than from being caused by heart disease, kidney disease, liver disease or other systemic causes.

Complete examination though is important including gynecological examination to rule out other possibilities.


Zephyrhills Florida: Hello my daughter is 13 and has terrible bunions - hereditary because my mother had them Do I wait until she is grown before we operate?

Stephen Pribut: Surgery on the "juvenile" bunion is still controversial. I would recommend more than one opinion.

Personally, I have found that the compliance of 13 - 17 year olds is not the best and that the foot will continue to grow. The results on many previous studies are not great.

I would recommend orthotics until the child is older. But there are other opinions on this and I'd recommend a few live evaluations.


St. Paul, MN: I have hammer toes and high arches, and am a former marathon runner. while I have (it seems) always had some foot pain, now, the pain keeps me from running very far or fast. There is a splitting of two toes on my right foor, and I get quite a bit of pain from both the ball of the foot and on the top, near the toes. My podiatrist says surgery may not be successful because of the severity of the hammer toes, and shape of the bones. Any recommendations?

Stephen Pribut: It is hard to tell exactly what is going on without an examination. I'd recommend another opinion from one more podiatrist.


Comment from Stephen Pribut: Thanks, everyone for visiting today. That is all we have time for. I hope that your questions were answered and that those of you with problems recover quickly and are able to resume exercise.

Foot health is important to overall health. So please take care of your feet, eat right, and get regular aerobic exercise.

Thanks to USA Today and the American Podiatric Medical Association for inviting me here to participate in this online chat.



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