Dr. Rodney Louis Tomczak, DPM

Bunion correctors cannot change the structural deformity that accompanies these bunions. Only surgery can correct the deformity.

Rod Tomczak, MD, EdD

Letting a true ingrown toenail, usually involving the big toe, is a dangerous decision to make. Most ingrown nails are or quickly become infected. The nail causes the infection manifested by all the classic signs of infection, pain, swelling, red and inflamed with drainage. If the infection spreads to the bone, months of antibiotics or amputation are needed to achieve a cure. I have seen a patient who tried to cut out the ingrown portion, but missed part of the ingrowing nail. A sharp point of the nail had grown out of the end of the toe. If the patient is diabetic, the chances for amputation are great.

Rod Tomczak, MD, EdD

Some years ago I published a paper on the treatment of neuromas. Conservative treatments with orthotics didn't seems to work at all. From a pharmaceutical treatment aspect, there was some success with injecting a corticosteroid or a sclerosis agent, usually alcohol.

The best treatment was to surgically excise the neuroma. It is a simple and easy procedure taking only a matter of minutes. I used an approach through the top of the foot allowing for immediate weight bearing,

Yes, a bunion is new bone growth at the head of the 1st metatarsal caused by rubbing at that area by shoe gear. The tighter the shoe (pointed high heels) cause more bone to grow and faster,

If the correct procedure was performed your chances of a second bunion are minimal. If only a bump was removed then the chances of a secondary bunion increase. Aside from choosing better parents because this is a hereditary malady The only thing that might help prevent the second bunion would be very loose shoes.

There is a chance this is not a corn at all. It may in fact be some kind of tumor and should be seen by a surgeon who will remove the nail and then determine what the growth is, either by biopsy or total resection of the growth. "Corns" are usually caused by friction, which cannot exist under a nail.

Rod Tomczak, MD, DPM, EdD

Unfortunately, your diabetes is a real problem and potentiates a lot of post-op problems. Since your problem is not emergent, I would want your sugar under control and your Hemoglobin A1c as low as possible. Your chance of infection is also increased and I would prefer you stay in the hospital long enough to give you IV prophylactic antibiotics. If you smoke, I would not do this surgery until you have quit smoking for a month. Type 2 diabetics tend to have an elevated BMI. If you do, I would ask you to diet. Again, these factors increase your infection possibility. And post-op, diabetics heal slower if your blood sugar is elevated.

Rod Tomczak, MD, EdD

At least once a week clean your feet in someone else’s tub so they may be able to inspect the bottoms of your feet and in between your toes. Clean them with a mild soap and moisturize the skin when done.
If this is not possible make sure someone purchases a mirror and a long handle which will allow you to see the bottoms of your feet. You are checking for cracks or fishers and sores.
Don’t think that getting a pedicure every now and then is the answer. Utensils are not always sterile and the untrained can cause Asians that don’t heal. It’s important to have your nails cut by a professional and very professional I mean nurse or podiatrist

There is no question to your question. It is an absolute necessity. If I developed DM, I would see a podiatrist.

Rod Tomczak, MD, EdD

In the last year, I've had a spinal fusion from L2-S2 and both hips replaced. I can't get near my toes to cut my nails, so I go for a pedicure. I make sure the foot tub has been cleaned with a good disinfectant. The other thing is making sure all the instruments are sterilized and the indicator has turned colors in the autoclave. When all these things align to my satisfaction, I relax and enjoy the pedicure.

Rod Tomczak, MD, EdD

The major problem here is whether or not this growth is really a wart and not something else. I testified in a case where a patient saw 4 different healthcare providers because the last provider performed a treatment that didn't remove the wart. It turned out the "wart" was really a melanotic melanoma, a very aggressive form of skin cancer. Ultimately, the patient lost his leg all the way up to his pelvis.

Aside from cutting out the wart, there are various methods to remove a wart. Duct tape covering the wart for 6 days, remove the tape, wash the wart, and file it down with an emery board. Repeat until the wart is gone. Or ask your pharmacist for the various OTC modalities including freezing, acid, and tapes.

Beware of the one in a million "warts" that's malignant.

Rod Tomczak, MD, DPM, EdD

At one point, I think 1/2 of my new patients complained of excruciating heel pain. Usually, the patients told me their first few steps to the bathroom in the morning were incredibly painful and if they were seated for a half hour or so, then got up, they suffered the same terrible pain.

Early on, we were confused about the presence of a bone spur. Some patients had terrible pain and no spur while other patients complaining of a different problem and no heal pain had huge, asymptomatic spurs. It turns out, the spur doesn't cause the pain. Most spurs point upward, so the spur never comes in contact with the ground when standing. The plantar fascia that runs from just below the spur to the metatarsals supports the arch of the foot. I could reproduce the pain by pushing on the fascia at the heel.

Most patients got relief with an arch support in their shoe; some needed a shot of cortisone in addition. A few did not respond to this regimen and needed to have a surgical release of the inner part of the fascia. I developed an arthroscopic procedure requiring two small incisions. Patients could walk almost immediately and could return to work symptom-free much sooner than with a spur removal.

It's important to see a foot and ankle surgeon who performs this arthroscopic procedure if surgery is needed, and will not bother with the spur. Spur removal is incredibly painful post-operatively, and removal can result in a fracture to the heel bone.

Good luck with your problem,

Rod Tomczak, MD, DPM, EdD

Bath salts don't have an effect on the pathology in heel pain unless the discomfort is caused by some type of skin lesion. The bath salts do not penetrate through the skin. The skin is a great barrier that acts to keep harmful solutions and toxins from penetrating the skin where they could be dangerous to the individual.

Soaking the foot in warm water that is not too hot will increase blood flow to the area bringing more of the body's own healing elements to the area being soaked. So, the increase in local temperature is what helps heal any damage, not the bath salts.

A word of warning. Individuals with compromised circulation, especially patients with diabetes, must be vigilant about water temperature. Individuals with decreased circulation will burn at a lower temperature than patients with normal circulation.

Rod Tomczak, MD, DPM, EdD

Without pictures, this is very difficult to diagnose. It could be a yeast infection, but then again, it might be psoriasis. My suggestion would be to find a podiatrist or dermatologist to give you an accurate diagnosis and treatment plan.

Rod Tomczak, MD, DPM, EdD

Usually an infection cannot occur unless there is a break in the skin. Diabetic ulcers are almost universally infected as are ulcers caused by poor circulation.

Foot odor can occur without an infection and is usually called Bromhydrosis. This can be treated with a medication. In any case you should be seeing someone who is well-versed in foot path allergy.

Blisters are caused by friction. Either your heels are too narrow and rub, or the heel cup of your shoes are too wide, or both. Simple blisters are a mechanical problem. The easiest way to fix this is to make your shoes narrower because it's difficult to make your heels wider. I would suggest making your shoes narrower in the heel by lining the heels all the way around the heel cup with moleskin. Be careful not to have any ridges in the moleskin. A cobbler may do this the best. This procedure is better than applying moleskin to your heels.

Rod Tomczak, MD, EdD

Flat feet are inherited or a result of torn posterior tibial tendons. Torn tendons are rare, so you were probably born with them, depending.

I have used DrySol in my practice with great success. DrySol is by prescription only. CertainDry contains DrySol in a lower strength. You can try that first before visiting a podiatrist for a prescription for DrySol.
Some healthcare providers have never used or heard of DrySol, so make sure you bring your request to them. A package insert or internet information will guarantee your podiatrist can prescribe it for you.

Rod Tomczak, MD, DPM, EdD

There are a couple ways to treat this successfully. You should ask your podiatrist when he can do a permanent correction. He will use a substance like Fino to treat the Nail route so that that portion that being ingrown does not come back. There is also a small surgical procedure where the podiatrist will exercise a small portion of the Nail root so that the nail grows back flat. Both of these procedures have a very high success rate. There is no reason to just remove the offending Nail portion when a permanent correction can easily be done

You need to see a surgeon or an emergency room doctor as quickly as possible. The area is infected and the infection could spread up your leg. This could happen sooner if you are a diabetic.