Jan David Tepper, DPM

You have what appears to be Verrucae multiformis also known as warts.

Jan David Tepper, DPM, FACFAS
CEO Family Foot & Ankle Center
984 West Foothill Boulevard, Suite B
Upland, California 91786
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WWW.drtepper.com
JDTDPM@aol.com

Anything including a stress fracture is possible. If rest ice compression and elevation are not helpful you need to see a doctor who can perform a physical exam and take X-rays to determine an appropriate treatment plan.

If you have symptoms that include peeling and scaling of the skin or discolored nails, you can consider a skin and nail biopsy to rule out fungus or a punch biopsy of the area to go full thickness of the skin to identify what the disease process is. If it is fungus, topical or oral anti fungal treatments may be necessary depending on other medical conditions. If it is an allergy or a disease process where the body is triggering the immune system to attack yourself, oral or topical steroids may be necessary depending on other medical conditions. If it is an allergy to something in you environment like a chemical in material in your shoes socks or bedding soap or something else you can see a dermatologist who performs contact dermatitis, testing of common allergens that they put on your body and track which one is causing your skin changes and discomfort. Then you will know which one or what to avoid contact with or ingestion of.

Jan David Tepper, DPM, FACFAS


From the picture it looks like an ingrown toenail. However from the description you describe infection that could be from other causes that would need proper diagnostic tests to determine. So if the problem resolves with the nail removed in that area you may need an ingrown toenail repair and advise on how to prevent this from recuring in the future.

It depends on the length and complexity of the procedure, medical health of the patient, location of the surgery, and the availability and skill of the anesthesiologist. That being said, most cases that are done in hospital would be a general anesthetic. However, all ankle procedures can be done under local anesthetic with or without IV sedation or a spinal anesthetic.

Jan David Tepper, DPM, FACFAS

Rest, ice, immobilize with ace bandage, and if that isn’t enough to provide relief, use an ankle brace or a boot cast with the ace bandage. If that isn’t enough to help you walk without pain, then go to a doctor for an X-ray. If painful to walk with boot, may need a cast or crutches for non-weight bearing and get another diagnostic test. If it doesn’t show on X-ray, may need MRI to find out what the problem is.

Jan David Tepper, DPM, FACFAS
@aol.com

From the picture, this looks like an ingrown toenail. You should see a foot specialist to explain the pathology and give you treatment options as there are many causes and that would help guide you to determine your best options.

Jan David Tepper, DPM, FACFAS

It may not be a bruise. If something is not responding the way you would expect it to, a diagnostic test would be indicated or a second opinion. You should see a doctor ASAP and give an accurate history as many skin diseases look alike.

Jan David Tepper, DPM,FACFAS

There are many reasons why your feet and legs would swell and burn. If the swelling is in both feet and lags it is more likely the problem is coming from the body higher up and gravity is bringing the fluid to the feet. Therefore, you need to see your health professionals to check heart and lungs as well as the circulation of your legs. Blood tests may be. Necessary to determine if liver or kidneys or other internal organs. Other diagnostic tests can identify infection, arthritis or other medical conditions that could present itself with these symptoms. In any event, if there isn’t a history of trauma or an open wound the problem is less likely to be a foot and ankle primary problem.

Jan David Tepper, DPM, FACFAS

Although the only thing you know for sure is that the nail is lifted away from the skin, this looks like there was a traumatic event that most likely occurred. Depending on the amount of force which appears significant this could grow out normal or it may permanently deform the nail to some extent. Other less likely causes could be poor circulation, or any of the diseases that effect the skin could have this appearance in the nail, however looking at the rest of the foot circulation looks good and without any other rash or skin changes or history of skin disease like psoriasis, fungus or Lichen Planus other causes of this nail dystrophy seem unlikely.

Jan David Tepper, DPM,FACFAS

Yes, you could still have a significant injury. Urgent care doctors are for life and death issues. A Foot and Ankle specialist would be better to evaluate the foot and diagnostic tests like X-rays and when to consider more diagnostic tests like an MRI to determine best treatment options and expectations of success

Jan David Tepper, DPM,FACFAS

You should see a doctor as this could be very serious. If the pain goes away with rest and returns again after walking a short distant again, this could be intermittent Claudication, a sign of Peripheral Vascular Disease. This is easily diagnosed and covered by Medicare with non invasive study in the office. If this is not the problem, during the exam, the doctor can see if this is a musculoskeletal issue like a damaged muscle or tendon or a neurological issue like a pinched nerve local in the leg or occurring higher up. In any event, neglect may result in a simple problem becoming more complex and even life threatening.

Jan David Tepper, DPM,FACFAS

Yes, they do. They can get rid of the infection, diagnose the cause of the symptoms, and make recommendations for permanent corrections of the problem, whatever that is. Sometimes there is a medical condition that needs to be addressed before the local problem can be resolved and your podiatrist can help identify that as well.

Jan David Tepper, DPM,FACFAS

I would recommend a non invasive peripheral vascular exam that would include an ultrasound, Doppler study, ankle brachial pressure ratios, and plethysmography to screen for arterial or venous blockage or insufficiency before recommending any further treatments. At this point, you need an accurate diagnosis to guide any treatment.

Jan David Tepper, DPM, FACFAS

Take an X-ray, you could have a fracture or dislocation.

Jan David Tepper, DPM, FACFAS

Fungus likes to live in areas that are warm dark and moist so skin rash cracking and dryness could result in a breakdown of the skin, which could allow access of bacteria and you could develop an acute bacterial infection as well. So, any signs of pain swelling or discoloration should be addressed, especially if there is an underlying medical condition that could interfere with the ability to fight infections.

Jan David Tepper, DPM FACFAS

The only way to get rid of a bone spur is surgery. However, there are different causes of bone spurs and many are not the cause of pain. What is usually observed on a routine X-ray is an enthesopathy, which is a bone spur in the area of tight soft tissue attachments. This can occur on the bottom of heel from tight plantar fascia commonly referred to as a heel spur or in the back of the heel from tight pull from the Achilles’ tendon, frequently referred to as calcification tendinitis if painful. These are not always painful and when they are painful, conservative treatments are 90% successful, if the musculoskeletal abnormality is treated with attention directed to relaxing the soft tissue pull on the bone and modification of foot gear, especially if the tight shoe is mechanically putting pressure on that bone and the pain goes away. This can be done with non surgical treatments, however, if they fail, surgery may be indicated. Other spurs can be caused by any of the arthritic diseases and treatment should be directed at identifying the disease and treating that disease. Other less common causes of bone spurs could be trauma or a bone cyst, most of which are benign, however, some could be malignant. The very rare malignant bone tumors that show up on the foot can be from a tumor that traveled from another area and seeded in the foot or from the foot itself. If from another location, it has the characteristics of the tissue from that other location. The tumor originating in the foot usually results in loss of limb or life and needs to be addressed with urgency.

Jan David Tepper, DPM, FACFAS

Yo would want to see a doctor that either does non invasive peripheral vascular disease tests like diagnostic ultrasound, Dopler, ankle brachial Pressure Indicies, plethysmography studies to see if you have a thrombophlebitis or increased pressures or blockage in the venous system, which is a complication of Venous Reflux.

Dear I Have Throbbing Pain On the Sides of My Feet,

Are you wearing proper style and fitting running shoes? Every foot and shoe is narrow in the arch getting to the widest just behind the toes. The widest part of the foot ( the big toe joint) should be adjacent to the widest part of the shoe. If this is the case, there should be a space between the longest toe and the end of the shoe, about the width of your thumb. No part of the upper shoe should touch your toes. The shoe should be snug in the area of the laces and the heel to avoid slipping out of the she not by hugging the toes. The sole of the shoe should be firm and rigid, not loose like a slipper. The sole should resist twisting and only bend upward at the base of the toes not in the arch area. There should be a rigid heel cup made of plastic that you can’t crouch with your fingers if you attempt to squeeze it from side to side. If you still have pain, you can try an over-the-counter arch support while waiting to get an appointment with your sports medicine Foot and Ankle specialist in your area.

Jan David Tepper, DPM, FACFAS

You need a hands-on, face-to-face examination of your foot. After a full medical history of the injury, physical examination, and any necessary diagnostic tests, it can be determined what is going on depending on the anatomy in the area and how it reacts to the specific testings.