by: Melissa Gaffney, DPM 3/16/24
I live and work in a farming community where in the not so distant past, these self-reliant folks would almost never see a doctor for anything. So many times, folks would be suffering for years from a foot condition and/ or the problems became so chronic and resistant to treatment there was little that could be done or the only thing that could be done is a high risk surgery.
To illustrate this, I had a patient who 30 years ago had unknowingly fractured his left ankle. He was working construction and had no insurance so he never went to the doctor when it happened.
Fast forward 30 years and he comes to me complaining about chronic pain and recurrent ulcerations (wounds) on the side of his foot .
His exam showed a rigid deformity of the foot and ankle with the foot turned inward and no longer centered under his leg or what we call varus.
His x-ray showed an old healed shortened fracture of the fibula bone ( the strut bone at side of the ankle which extends from the leg) with severe arthritis. So that strut bone shortened and destabilized his ankle and caused the turning in of the foot as a rigid deformity . The only thing that would fix this was a fusion of the ankle to the foot to put the foot back under the leg instead of off to the side. Also, now 30 years later he had diabetes, kidney, and heart disease and it was difficult to find a surgeon who would take this case. (This is a a surgery I do not do.) Fortunately, he was medically fit enough to have surgery and we found a surgeon. The fusion put his foot back under his leg and his pain and ulcerations stopped.
Although the example of my patient is extreme, delaying care, I think is more frequent nowadays with high deductible insurance plans and inflation. Delay in care leads to more recovery time later on, increase pain and more money to deal with a neglected problem and possibly requiring surgery. It is cost- effective to diagnose and treat early .
So I put together 6 red flags that require evaluation by your podiatrist. This is not an all-inclusive list :
1. Hot Red Swollen area on the Foot
These are mysteries that you do not want as part of your body. An astute podiatrist versed in the complex anatomy and function of the foot can help nail down the problem.
Hot red swollen area is an inflammatory process as a reaction to something like:
*Infection of soft tissue or septic joint. Waiting to see the foot doctor can result in infection going deep to bone requiring surgery or IV antibiotics.
*Metabolic problem such as GOUT. Although a gouty attack is self-limiting meaning it will resolve on its own, unchecked gout over time will lead to joint destruction. This results in lack of mobility and chronic pain among other things.
*Charcot Arthropathy which is a devastating joint destructive process that happens in patients with certain types of neuropathy ( peripheral nerve disorder). Mainly we see this in diabetics.
*Injuries such as a stress fracture. Not seeking treatment will cause possible nonhealing or delayed bone healing or malunion where bone heals in a deformed position.
*Stress and strain problems for biomechanical issues which can affect joints and tendons in the foot causing tendonitis and joint inflammation. Delay in care can lead to partial tendon tears requiring surgery or chronic pain.
* The start of an arthritic process such as good old osteoarthritis that my patients affectionately call , “Arthur”. It could be undiagnosed rheumatoid or psoriatic arthritis.
2. Foot pain getting progressively worse or interfering with life.
This can be related to the inflammation noted above .
*This can be the result of biomechanical issues causing alignment issues leading to stress and strain on tendons and joints.
*Neurological issues such as neuropathy or pinched nerve such as tarsal tunnel syndrome or neuroma or possibly neuropathy.
If it’s on top of the foot, it could be a stress fracture. Many times it is stress on the joints that make up the ball of the foot , the metatarsal phalangeal joints.
3. Smelly draining wound with redness of the skin, pain, and swelling in the area.
This is likely an infected wound in which care and evaluation by a doctor is needed to prevent worsening. In healthy individuals, direction would be needed for proper care, to determine the infectious agent and possibly antibiotic. Most likely, in healthy patients infected wounds will get better with proper care in a timely manner.
However, in patients with chronic disease such as diabetes and / or arterial disease or lack of blood flow to the extremities, this can be disastrous. In which case, I instruct my patients to call as soon as they see something like this or go to an Urgent Care or ER.
Insurances such as Medicare will pay for wound care supplies to be mailed to your home for chronic wound care.
4. Injury
There are a lot of little bones in the foot and tubercles which are protuberances of bone that can be fractured.
Even with ankle sprains or inversion injury of the ankle , it is not uncommon for a bone in the foot ( 5th metatarsal) can also break and this is not seen on an ankle x-ray.
Podiatrists take and evaluate foot x-rays everyday and are very versed in the delicate complex foot anatomy and sometimes pick up on subtle fractures or problems that were not picked up on by the radiologists.
Sometimes a serious injury such as a Lisfranc’s injury can occur which is quite devastating. Lower energy Lisfranc’s injuries have subtle findings on x-ray but if untreated have devastating consequences. The Lisfranc’s joint is a complex midfoot joint area involving multiple bones, joints, and ligaments.
5. Infected ingrown nails
Just say “No” to bathroom surgery. One, it hurts tremendously to remove without anesthesia. Two, it is highly likely a spicule of nail will be left . Three, your tools have not been sterilized and can introduce new bacteria.
If an infected ingrown nail becomes chronic, it can result in the bone, which is very close the nail, becoming infected. This can require long term antibiotics and possibly a surgery to take the infected bone out. I always get an x-ray if a patient has had a infected ingrown nail for more than a month to check for a bone infection.
A podiatrist removes ingrown nails on a routine basis and can do so quickly and easily. They completely numb the toe with a lidocaine injection at the base. If you have fear of needles, see my post or you tube episode about how to overcome the fear of needles. Fear of Needles! 12 Tips to Overcome Needle Anxiety and
Chronic ingrown nails in addition to being at risk for bone infection also cause a toe deformity with severe hypertrophy of the skin surrounding the nail.
6. Chronic off and on foot pain
I understand time flies and people get in the mindset that the pain will go away. Off and on pain for more than 3 to 6 months in the foot, is a pain that’s not going away. This can morph into the whole foot hurting making the root cause hard to diagnose or pain moves also into hip knee or back.
Here is what I commonly see:
- Unknown alignment issues causing stress and strain on the foot . This leads to joint inflammation, tendonitis and bursiitis. Letting this go could eventually cause a partial tear in the tendon.
- Bad shoes causing stress and strain on the foot.
- Arthritis. Although arthritis is not curative, a podiatrist alleviates pain from arthritis with shoe gear modifications and orthotics to offload this area as well as medications. Fish oil supplement and an anti-inflammatory diet can decrease inflammation associated with arthritis. Also a podiatrist can do joint fusions or big toe joint replacements to alleviate pain in end stage arthritis.
- Neurological Problems such as peripheral neuropathy, pinched or entrapped nerves. These all get worse in time.
You may have noticed that I didn’t include the patients that need to come on a regular basis. I think this is more well known that these folks know they need to see their foot doctor.
These include :
*Diabetics at least once a year.
*Diabetics who have had foot ulcers that are now healed should see their podiatrist every 2-3 months.
*Diabetics with a foot ulcer should see their podiatrist every 1-2 weeks.
*Patients with a history of recurrent foot problems should check in with their podiatrist at least once a year.
In conclusion, the high cost of healthcare is a huge hindrance to seeking timely care. However, as you can see above, it would be cost-effective in the 6 red flag examples above to be treated as early as possible to save time, money, aggravation and most importantly less suffering . Remember this is not an all-inclusive list so, in general, if you feel something is not right, then see your doctor. .
Thanks for reading. I hope this helps you. Leave me feedback and any comments that you may have or topics that you would like me to discuss.
Please check out my you tube channel: https://youtube.com/@drgaffneybestfoot/?sub_confirmation=1
Disclaimer: This blog is not Intended to diagnose treat or prevent any disease disorder or condition. It is for informational purposes only and does not constitute medical advice nor is it intended to replace medical advice. This blog does not constitute a doctor patient relationship. We disclaim liability for incidental or consequential damages and assume no responsibility or liability for any loss or damage suffered by any person as a result of the information provided. The information is provided “as is” without any representations or warranties, express or implied. One should always consult their doctor before starting any treatment or concerning any condition.
It is NOT the intention of drgaffneybestfoot.com/ youtubechannel to provide specific medical advice (e.g.: diagnosis and treatment related to individual and/or specific medical cases, second opinion for medical diagnosis and/or treatment or recommendations regarding therapy), but rather the material contained on this site is for informational purposes only . Specific medical advice will not be provided, and drgaffneybestfoot.com/ Dr. Melissa Gaffney urges you to consult with a qualified podiatrist or physician for diagnosis and for answers to your personal foot related questions.
The information and contents of this site is provided “as is,” and drgaffneybestfoot.com, Dr. Melissa Gaffney, it’s affiliates, contractors, and editorial review board members make no representations, express or implied warranties as to the accuracy or completeness of such information. Nothing contained in the site is intended to be instructional for medical diagnosis or treatment. The information should not be considered complete or up to date, nor should it be relied on to suggest a course of treatment for a particular individual. It should not be used in place of a visit, call, consultation or the advice of your podiatrist, physican or other qualified health care provider.
drgaffneybestfoot.com/ Dr. Melissa Gaffney , affiliates, contractors, editorial review board members and sponsors are neither responsible nor liable for any direct, indirect, incidental, consequential, special, exemplary, punitive, or other damages arising out of or relating in any way to this site, site-related services, content or information contained herein, or any hyperlinked web site.
External Links:
Some web pages on drgaffneybestfoot.com may provide links to other Internet sites for the convenience of users. drgaffneybestfoot.com/ Dr. Melissa Gaffney is not responsible for the availability or content of these external sites, nor does drgaffneybestfoot.com / Dr. Melissa Gaffney endorse, warrant, or guarantee the products, services, or information described or offered at these other Internet sites. Users cannot assume that the external sites will abide by the same Privacy Policy to which drgaffneybestfoot.com adheres. It is the responsibility of the user to examine the copyright and licensing restrictions of linked pages and to secure all necessary permissions.