What Questions Do You Have?
- Why Do My Feet or Ankles Hurt?
- My Feet Are Numb or Tingling
- Tell Me About My Diabetes
- I Want To Keep Playing Sports
- What About My Child's Feet?
- Do I Have An Ingrown Toenail?
- Do I Have An Infection?
- Do I Have A Bunion?
- Why Do My Heels Hurt?
- Why Are My Toes Curling?
- Am I Walking/Running Correctly?
- What Is This On My Skin?
- Do I Need Orthotics?
- What Shoes Should I Buy?
- Should I See/Call The Doctor?
- Do I Need Surgery?
- Tell Me About My Foot
- What Is Podiatry?
- Who Do You Treat?
- Where Can I Get Registration Forms?
- How Do I Request An Appointment?
- Page 4
Will I Lose My Toenail?
Just because a toenail doesn't look normal, doesn't mean you will lose the nail. There are many reasons the nails may not look normal including injury which can cause blackening of the nail, fungus toenails, ingrown toenails and even some diseases may cause different appearances to the nail. Whatever the cause of the discoloration, the question is always whether you will lose the nail or not.
Black Toe Nail: Usually indicates trauma to the nail (dropping something on it, runner's toenail, or bumping it). Depending on the extent of the injury, you may lose the toenail. Often in this case, the nail will stay intact and be discolored for about 1 year (the amount of time to grow the nail out).
Fungus Toenail: Otherwise called onychomycosis. Although this is a thickening and discoloration of the nail. Unless the nail is pulled off by catching it on something, the nail is usually not lost.
Ingrown Toenail: Unless the nail is severely infected and fluid builds up under the nail, only the portion of the nail treated will be lost. The nail usually is not.
Other: Most other discolorations of the nail will not usually cause the nail to be lost.
Why Do I Need an Explanation of Benefits?
Your insurance is required by federal law to notify both the patient and doctor of decisions they make on your claims. This notification usually arrives by mail and is named differently by each insurance company. Some examples are Remittance Advice, Explanation of Benefits (EOB), or Explanation of Services.
It is important to read these notifications because often they tell patients in advance how much was assigned to patient responsibility by their insurance. It also helps to eliminate clerical errors as the patient is aware of what services they received.
Part of the "Understanding Insurance" series.
What is an "Allowed Amount?"
Allowed amounts are determined by an insurance company. As all doctors determine their own fees, an insurance company takes the average of those fees in a geographic area by that type of provider (i.e. cardiologist, podiatrist, etc.) to determine what amount is fair. This is called ‘Reasonable & Customary.’ Depending on the type of contract your doctor has with your insurance company the allowed amount for a service may be even lower than the Reasonable & Customary amount in that locale.
Part of the "Understanding Insurance" series.
Why Do I Have Foot Pain at Night?
Foot pain at night can be caused by several conditions:
Unusual amount of use
If you have spent a lot more time than usual on your feet (theme park, wedding, double shift at work), they may hurt or be extra sensitive when you try to fall asleep. To relieve them, try elevating feet, taking an anti-inflammatory pain reliever like ibuprofen, and soaking them in an epsom salt bath. This should decrease inflammation and pain.
Neuropathy is the most common reason patients experience night pain. Neuropathy is often characterized by tingling, burning, electrical shocks or shooting pains at night. Neuropathy usually starts in the feet at the tips of the toes and works towards the body.
Ingrown toenails can be very painful at night from rubbing against bedding. If you have an ingrown toenail, make sure to protect it before going to bed. Eventually the toenail will be sensitive even to a bandage used to protect it. Come in at the first symptoms of an ingrown before it gets to this point.
Injury (Strains, Sprains or Fractures)
Strains, sprains and fractures can all hurt worse at night. After moving around all day, injuries are swollen and can throb at night. Remember to RICE: rest, ice, compress and elevate the foot. This can offer some relief. Either try over-the-counter pain killers or prescription medication to manage the pain.
Infections can also throb and hurt at night. If an area is inflamed and painful, there may be an infection. Make sure to get it checked out if it persists. Your podiatrist may prescribe antibiotic, antiviral, or antifungal medications to promote healing.
Bunions, bone spurs and hammertoes can all cause pain in the feet. When these bones are out of place, or growing too large, they can put pressure on the nerves in your feet or cause swelling of joints, which both can cause the pain. There are products you can use to support and align feet to decrease this pressure. If these options don’t help, surgery is a last resort that is effective at relieving this discomfort.
Chronic Inflammation- Plantar fasciitis
Patients with plantar fasciitis may experience pain at night after being on their feet all day. One of the classic signs of plantar fasciitis is foot pain in the morning when you first get out of bed.
Due to decreased blood flow to the legs or feet, poor circulation can cause foot pain too. Increased pain will be more apparent when you walk, but night pain (especially on busy days) is quite common.
Come into our office to get the source of your night pain diagnosed.
What Insurance Plans Do You Accept?
Our goal at Mountain West Foot and Ankle Institute is to make your experience as easy, fun, and efficient as possible. That is why we are a participant in almost every insurance plan out there. We accept most insurance, including Medicare and Medicaid. The only insurance plan we do not accept at this time is Select Value.
Are There Treatment Options For Neuropathy?
Often patients, family members or others suffering with peripheral neuropathy (of any cause) are being told nothing can be done for the symptoms. Others are given medications to decrease the symptoms. But the real question is can neuropathy truly be treated? Although neuropathy will not ever completely resolve (unless the cause is eliminated), and neuropathy is usually progressive throughout life, there are treatments that can keep neuropathy from progressing and keep symptoms in check throughout life. One such treatment would be the use of vitamin supplements to treat neuropathy.
Our recommendation is that this should only be done under direction of your physician and after careful evaluation of your nutrition status.
Can I take anything to heal a fracture more quickly?
Fractures are commonly encountered in our office, and never heal as quickly as you the patient would like. In fact, the pain will resolve before the fracture is fully healed. With this in mind, however, there are several things that can affect the healing speed of any fracture.
- Poor Healing Potential: Poor nutrition, protein deficiency, smoking and even alcohol have been shown to interfere with healing of bone. Smoking, for example, decreases blood flow to bone and will cause significant interference with bone healing (especially in feet and ankles). Alcohol in excess has also been shown to be toxic to bone and may even lead to fractures. Using care to limit these factors will increase your chances of healing.
- Nutrition: Fracture healing causes increased need for the intake of quality calories. Increased caloric intake is often necessary to speed healing -- two to three times increase in calorie count may be required to match the energy needs of fracture healing (especially with multiple fractures). The increased calorie count should be from healthy alternatives (not cookies, cakes, cheese burgers, etc.)
- Protein Intake: Protein is a key to bone healing, both because roughly half of bone volume is protein and many of the building blocks and enzymes the body utilizes in the healing process are formed from proteins. Protein malnutrition or limitations may lead to a less rigid or "rubbery" callus. Proper bone healing requires high protein levels to produce a rigid bony callus.
- Increased Mineral Intake: Many individuals add calcium to their diet for bone healing, but this is insufficient to get necessary healing. 70% of bone weight is from minerals. Fracture healing therefore requires the necessary minerals.
Bone Healing Range/Day
Main mineral of bone (Dependant on vitamin D for absorption) Phosphorus
Main mineral of bone Magnesium
Important role in bone collagen formation. Enhances effects of calcium and vitamin D on new bone formation Zinc
Aids in callus formation, enhances bone protein production, and facilitates bone healing. Manganese
Aids in formation of bone collagen. Boron
- Increased Vitamin Intake: Vitamins play a key role in healing by stimulating the biochemical reactions that build the bone with the proteins and minerals. In fracture healing, some principle vitamins are important.
Bone Healing Range/Day
Important regulator of calcium absorption. Vitamin C
Important antioxidant and anti-inflammatory nutrient. Also essential in bone collagen formation. Vitamin K
K1: 250-1000 mcg
K2: 45-180 mcg
Essential part of the biochemical process that binds calcium to bone. Vitamin B6
Linked to bone healing Folic Acid/Folate
Linked to collagen formation Vitamin B12
Linked to bone healing
- Other: There are also multiple herbal remedies/supplements and alternative techniques that have been found to assist in bone healing.
Our recommendation (and what Dr Gibson did) is take a combination of vitamins, minerals and herbs along with a balanced, nutritious diet to speed bone healing.
Since I can walk on it, does that mean it isn't broken?
Although a fracture will often limit the ability to walk on a foot or ankle, amount of fracture and levels of pain are individual. In otherwords, some people handle pain easier than others. With this understanding, there is a high risk of fracture if you are unable to walk on a foot, but even this is no guarantee. Here are three keys to remember:
1. X-ray is the only way to confirm or refute a fracture. If the x-ray is high quality (as in digital x-rays in our office for example), no fracture on x-ray is about 99% sure that even a stress fracture doesn't exist.
2. Stress fractures hurt, but can usually be walked on.
3. Severe sprains or strains may also limit your ability to walk, even in the absence of a fracture.
If there is any concern that you may be fractured, (especially if pain is not improving) it is recommended you see a foot or ankle specialist ASAP.
Can I Setup A Payment Plan?
Yes. With the struggling economy, and people losing their jobs, even a simple doctor's visit can be harder to fund. For this reason, we can often work out payment arrangement to alleviate any financial stresses for our patients, often without interest. This is available at our office, we will handle all of the paperwork for you, and you can be instantly approved! You deserve the highest quality care without concerns about your finances....This will make it hassle free if the need arises. This will make it hassle free if the need arises.
Why Do Diabetics Have Foot Problems?
Diabetes has become a common problem in the United States, and the world. This disease has continued to increase and is causing multiple complications throughout the body. These complications are usually a symptom of tissue failing to function as they are designed. This can include poor circulation, decreased ability of the immune system to function, and failure of the nerves to function properly.
In fact, a simple explanation is "sugar coating" the tissues of the body. As the nerves, cells of the immune system or blood vessels are coated, they start to malfunction or may even fail. This can affect many areas of the body, from diabetic neuropathy to heart problems or peripheral vascular disease to non-healing wounds. These are seen throughout the body, but the areas furthest from the body are most affected. For this reason, foot problems become more common in diabetics.
With diabetes, the foot is affected as one of the locations of the body furthest from the body:
- Peripheral Neuropathy - Because the nerves to the feet are furthest from the brain and spinal cord
- Peripheral Vascular Disease - Because the blood vessels are the furthest from the heart
- Immune System/Poor Wound Healing - Because the tissues are furthest from the central area or the body
Why Does My Neuropathy Pain Increase With A Lupus Attack?
Whether or not your neuropathy is related to lupus, there has been some increased symptoms noted by many patients when having a lupus attack. This is due to the inflammation of the blood vessels (vasculitis) that is related to lupus. When the vaculitis is aggrevated by a lupus attack, circulation is decreased to an already compromised or weak nerve and symptoms are increased. So whatever the cause of your neuropathy, lupus can make the symptoms worse.
Is foot pain a normal part of getting older?
In the past, people thought pain was normal. In fact, they figured aches and pains were part of getting "old". The truth is far from this thinking: Pain is NEVER normal.
As you get older, you can develop conditions such as arthritis from wearing down of the joints. You can get injuries that didn't occur at younger ages because of loss of the elasticity of the tissues (such as tendons or ligaments). You can also get associated pain from change in metabolism that leads to increased weight on the feet. Whatever the condition, age doesn't cause the pain but can influence its presentation.
That being said, in most cases things can be done to minimize the pain (or even resolve it) and allow you to continue to be active. Don't let pain stop you.
Is A Heel Spur Causing My Pain?
Heel spurs are commonly seen in two different areas of the foot. Each has a little different presentation and the answer to this question is different for different areas.
- Plantar Heel Spur: This is a spur to the bottom of the foot. This is the most common spur and has been show in current research to not cause pain. Often an x-ray will show a "heel spur" in an individual with no pain. It may also be associated with a condition called Plantar Fasciitis that causes pain with or without a heel spur. In this case the spur is a symptom of the problem and not the problem itself. It often doesn't need to be treated to solve the heel pain, instead treating the Plantar Fasciitis will solve the problem.
- Retrocalcaneal Heel Spur: This is a spur in the back of the foot, in the area of the Achilles tendon attachment. It often causes significant pain and inflammation to the area. The condition is called Calcific Achilles Tendinosis and may require surgery to resolve the problem. In this case, the spur is the reason for the pain and needs to be treated.
Do I Have Warts or Plantar Warts?
The diagnosis of plantar warts (on the bottom of the foot) or warts elsewhere is often not too difficult. The most common signs and symptoms of warts include:
- Thickening of the Skin: Warts, especially plantar warts due to the repetitive stress of walking, often resemble calluses and have thick, hard skin.
- Pain: Warts are often painful, especially with pressure or when sides of warts are squeezed. This is especially problematic with plantar warts, as they cause pain during walking or standing.
- Black Dots: Often you will hear people say "seed warts" or "my wart has seeds". These small black dots seen in the thick tissue making up a wart are the most important feature to diagnosis a wart. These black dots are capillaries (small blood vessels) in the skin that supply the wart. When the top of the wart is removed, little areas bleed (often called "pin-point bleeding") and confirms the diagnosis.
The answer to this question is two fold:
- Warts on the feet are caused by a virus, the human papiloma virus (HPV), that commonly causes warts throughout the body. This virus becomes infective only through direct contact. This contact can occur in public places (when walking barefoot) such as public swimming pools, showers, locker rooms, gymnastic classes or karate classes. It may also be encountered with poorly cleaned equipment during a pedicure.
- Warts have a genetic component. Although warts are caused by a virus (and thus can not be inherited), the infection runs in families. This is both because exposure can happen at home and also that certain individuals inherit the tendency for the virus to present as a wart. The genetic or familial tendency + viral infection = wart.
Who Gets Warts?
Warts, especially plantar warts, are a common problem encountered primarily in children, adolescents and the elderly. This does not preclude adults from also having warts, although it is less common. There also seems to be a genetic component, as warts are more common in families with some individuals having a higher prevelance of warts among family members.
Can Neuropathy Cause Me To Fall More?
The simple answer is yes. In fact, many people see a decreased balance with progression of neuropathy. Although age can also cause some increased instability, peripheral neuropathy can lead to faster progression and poorer balance. Neuropathy does cause falls and poor balance.
Is Proper Shoe Sizing Important?
On a regular basis, we are asked if tight shoes or wearing shoes too small can cause foot problems.
Dr Gibson has always said that shoe size will not cause foot problems, but will make problems you have a tendency for worse. In saying that, however, significant shoe size will cause problems. The best example of this is strapping of the feet in China to make the feet smaller. Severe problems exist in the feet in these cases.
Shoe size, therefore, can cause similar problems if not correctly fitted to the feet. Even slightly tighter shoes can predispose a foot to bunion, neuromas, hammertoes, injury to nails, corns and calluses and other foor or ankle problems.
Our recommendation is to have a properly fitted shoe that is appropriate for whatever activity you will be participating in.
Can Gastric Bypass Surgery Cause Neuropathy?
Yes. Malnutrition has been shown to cause peripheral neuropathy and has been associated with alcoholism, gastric bypass surgery, intestinal disease, improper diet and will often present with a painful neuropathy. Symptoms will present as "burning feet" and is often very painful. In the case of Gastric Bypass Surgery, it is a problem of poor absorption of nutrients necessary for normal nerve function including B vitamins (specially thiamin, B12, folic acid and B6), copper and other important nutrients. Since gastric bypass surgery is also associated with decreased caloric intake, it increases the probability of malnutrition.
If you will be undergoing (or have undergone) gastric bypass surgery, discuss this possibility with your surgeon. There may be supplements you can add to your daily intake to decrease the chances of peripheral neuropathy.