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Dr. Karpati on Foot Care
Dr. Karpati on Foot Care:
My sister in law has problems with her feet. We can be walking in the mall
less than 1 hour and her feet start to arch with instant pain, plus drenched
socks. What can she do to prevent this from happening? The pain has her
in tears every day and night.
Dr. Karpati's Answer:
This does sound very distressful for your sister-in-law. Unfortunately,
without a proper examination, I do not feel it is appropriate to try and
guess as to what this could be. Is there some neurological component that
causes her "feet to arch" or is this purely biomechanically induced? Is
the sweating more of a direct response to the pain or independent of it?
There are many questions to be asked by a professional to get to the root
of her problem. Please refer to the "Find a Podiatrist" tab on the www.apma.org
website to find a podiatrist in your area who can help.
What causes and how do you treat a stinging sensation in your feet? My husband
is 52, he complains daily of a severe burning or stinging in both feet.
Mostly in areas that are calloused i.e. the ball, heel, bottoms of toes
and across the top of the foot, near the toes. We have used everything that
we can imagine to comfort him. It seems to worsen at night, although he
does have the sensation during the day.
Dr. Karpati's Answer:
My first question would be whether or not he or a relative is diabetic.
Many diabetics experience the sensations you are describing. If he has been
tested for this and is not diabetic then he does seem to have similar nerve
type pain. He may have compression of the nerves in the lower extremity.
This may be due to binding of a certain nerve from, let’s say, a flat foot
type, or if he is athletic, this could be due to the chronic jamming of
the foot forward in a shoe with exercise. In either case, the next best
course of action is to seek a neurologist who can perform nerve conduction
velocities (NCV) and Pressure Specified Sensory Devise (PSSD) testing to
help narrow the cause down. A podiatrist will help eliminate abnormal biomechanics
as a cause. There are medications that can help reduce these sensations.
Your neurologist and podiatrist will help you find the right medication
combination if need be.
I have very narrow feet and often feel like I am walking on my bones, my
feet hurt most of the time, is there anything I can do?
Dr. Karpati's Answer:
It sounds like you need a good pair of functional orthotics. These devices
are custom-made for your foot and their job is to help realign the osseous
and soft tissue structures, providing optimal alignment and function during
stance and ambulation to help alleviate discomfort. You will need to see
a podiatrist to have these made and to find out insurance coverage for these
and there will more then likely be a waiting period to have these made.
These are truly the ones that our custom to your foot (rather than shoe
size) You may find a podiatrist in your area by visiting www.APMA.org.
In the meantime, you can visit www.faant.com,
go to our online store and then click under the heading on the left called
“Pronation”. Product # 67 is the “Orthofeet BioSole-Gel Self Forming Orthotics
Soft” which adds a lot of extra cushioning on top of the support. These
will definitely tide you over until you can get some custom ones made!
I've lived in cheap rubber flip-flops for at least seven summers and generally
wear cheap shoes year-round. I have pretty flat feet and am relatively sure
I over-pronate. But I have been blessed to avoid foot pain, so I generally
never thought about the importance of "good shoes." I have had just a little
occasional arch pain lately, though, and as I prepare to have a baby and
anticipate carrying a little one a lot, I thought I would invest in a good
pair of shoes. I bought a pair of Chacos after hearing them so highly recommended
as healthy for your feet, but when I tried them on, I found them pretty
uncomfortable. The arches were so high that my feet were hurting after standing
and walking in the Chacos for just half an hour. I was relieved to put the
flip-flops back on! What I'm wondering is, do my feet NEED this kind of
support and they'll just get used to it and stop hurting in the Chacos if
I keep wearing them? Or will they always hurt, and I just need a different
kind of shoe for my flat feet? I don't want to keep and wear such an expensive
shoe if it's just going to be painful all the time, but I'm willing to pay
the money and undergo temporary pain if this is really so much better for
my feet (and back, shoulders, etc) long term.
Dr. Karpati's Answer:
There is no question that podiatrists see an increase in foot pathology,
including heel/arch pain, during the summer months since it is during these
times when people are wearing flip-flops/sandals the most. Increased weight
from your pregnancy is putting increased pressure on your arches. This,
combined with a flatfoot type, is what I believe is giving you arch pain.
There is no question that you need more support. Just because a shoe is
expensive does not mean that your foot will accommodate to the arch in the
shoe. I recommended you keep trying to find shoes with good support that
are comfortable. It will take six months for your feet to return to their
prepregnancy state and it is at this time that I recommend you see a podiatrist
to get casted for functional orthotics. These are custom-made inserts which
replace the factory inserts in your shoes. Their job is to help realign
the osseous and soft tissue structures, providing optimal function of your
feet which will help alleviate discomfort and help prevent future pathology.
Please go to www.APMA.org to find a podiatrist in your area.
Here is my story/problem: First of all, this is who I am...
Height: 6 feet, 2 inches
Sports: Swimming in the winter, Track (distance) in the Spring, Swimming
again in the Summer, and Cross Country in the Fall.
So basically, when I run, the 1st mile in I'm fine. But then gradually a
pain that wraps around both my ankles develops, and it gets worse and worse
until I can't tolerate it and I start to walk. The pain continues when I
begin to walk, although 30-60 seconds later it usually wears off to a point
where I have no pain. Then when I try to run again, the pain develops within
a minute and I have to walk again. But the weird thing is, it happens on
some days, and not others. I can go through a whole week of running with
my track team with no ankle pain, and then that Saturday when I go out for
a run, my ankles kill me as I just described. The running conditions are
equal, same surfaces, etc.
I went to the podiatrist and they at first thought it was shin splints (which
I knew it was not, because I've had them before), but then when I said that
pain is on my WHOLE ankle, including the back of the foot and all the way
around, they concluded that it was pain from my growth plate that has not
completed fusing. On both feet, he took a total of 6 x-rays. But I don't
know how much I believe him.
I've had the pain before. I had it during the Fall, during Cross country.
But in the Fall, I had the problem where my ankles would hurt so bad, only
if I didn't run the day before. But it was the same pain I have been feeling
recently, except recently it has been worse than ever.
The doctor pressed around my whole leg/ankle/foot area, and could not reproduce
the pain, as I expected. The pain ONLY occurs after running for more than
10 minutes without stopping. Usually I go for 40+ minute runs, which I have
not been able to do recently because of this problem.
The first day of track and field in the Spring, my distance coach made everyone
run way too much, and the same went for the first week of practice. Instead
of gradually working our way up to our target workout and running time,
he jumped right in, more or less, with us running 4-6 miles the first week
of practice. I had to skip a few days because I almost couldn't walk after
the workouts he gave us, because I hadn't ran since the Fall. Maybe because
he started me off to rough, it caused this problem? I thought it could be
a stress fracture, although the doctor said it probably wasn't.
Now let me describe the pain. It doesn't feel like muscle pain or bone pain.
It's just really hard to explain. It seems like the pain (same in both ankles)
radiates from the center of my ankle until it becomes so intense where I
can't run anymore. It almost feels like what sore muscle would feel like,
except it is condensed in a smaller area (around my ankle) and is much more
intense and intolerable.
The doctor told me not to run (ugh...) for 7-10 days, and after that, go
back out and run and see if it still hurts. If so, come back and I'll see
a foot doctor who is a runner, so knows more about running than he did.
Overall, I spent over an hour in the exam room between getting the x-rays,
and the doctor and his intern discussing what it might be. They looked pretty
clueless to me. Does do you have any ideas?
Dr. Karpati's Answer:
Wow! You have really had time to think this through and I am impressed by
your eloquence! I am curious as to what foot type you have. Most people
I see (and I see a lot of runners and use to run myself!) with ankle pathology
have a flat foot type. Now let me tell you, not all flat feet look flat
when you look at them and people will swear to me they don’t have one when
they do. It is not necessarily how the foot looks when you look at it, rather
it is more what the foot does to compensate for how the foot functions that
matters. It is key that your physician watch you walk and run. It is key
that she or he evaluates the forefoot to rearfoot to leg relationship when
your foot is placed in neutral. It is key that she or he looks at the bones
and joint structure and alignment on X-ray. Only then can the best course
of conservative treatment be made. With out having done so myself, I can
only guide you so far.
First and foremost, most of my athletes do better with their respective
problems in a functional orthotic. A functional orthotic is a device that
replaces the factory insert in your athletic shoes and works by realigning
the boney and soft tissue structures, thereby improving foot function. Placing
your foot in proper alignment removes much of the excessive strain that
leads to various pathologies. Mind you, I am not talking about an orthotic
that is made off of a mold of you stepping into a foam box (impression type
mold) or walking across a plate. A true functional orthotic is one that
is made by molding a fiberglass type slipper or plaster type slipper onto
your foot while the foot is PLACED in neutral position by a trained podiatrist.
(I do not know of an orthopedic specialist that do what podiatrists do in
this respect.) We are trained to be able to do this in medical school and
residency. If the skill is not kept up with (a podiatrist who won’t take
the time to do this method), however, the technique will be lost. Now there
are many podiatrists who will disagree with this “orthotic casting” view
point, but there are many more who swear by it, and if you think about it,
it just makes more sense.
Once your foot is placed in proper alignment, and the running is resumed,
we can have a better idea of where we can go with you. Unfortunately, having
a custom orthotic made will take time as the mold is sent to a lab where
the orthotic is made according to your specifications based on your symptoms
and foot/ankle type. In the mean time, it is important to have something
better that what you have in your shoes, and the arch supports you find
in stores will not cut it. Not as good as custom, but better than store
bought, are inserts sold to professionals. I carry a few in my on-line doctor
store (go to www.faant.com and at the bottom you will see the “visit our
on-line store” icon. Once there, go down the pathology list on the right
to “pronation”). While I can not have all the inserts I would prefer to
have on this site, the closest insert I would put you in whilst on your
search for an “orthotic casting podiatrist” is the Orthofeet BioSole-Gel
Self Forming Orthotics Sport. Work your way into them. Do not run in them
until you are 100% comfortable in them. (if your feet or ankles get sore
wearing them, take them out and let them rest, putting them back in when
you feel better) When they are comfortable,work your way up in mileage with
them in your shoes. Yes, this does absolutely mean cutting back on your
running. It is hard to heal a hurt ankle when you are pounding on it. I
say run for ¼ to ½ the time you normally run and stop. Work up adding another
¼ to ½ every 3 days depending on your symptoms. You may also want to wear
a lace up ankle brace if the insert alone does not cut it. Under the “ankle
pain/strain” section is the Royce - Exoform Ankle Brace. Try this in conjunction
with the insert, not to replace the insert.
Also while you wait for your orthotics to come in, please get some physical
therapy, not from your high school, but by a physical therapist. This can
help in many ways.
Last but not least, consider getting an MRI if these simple things don’t
work. There are things that can show up on MRI that are not seen on X-ray.
Remember, having not seen your ankle, this is about the best advice I can
give you unseen. Any further advice or treatment must come from a podiatrist
who has evaluated you and whose advice you trust enough to follow. You can
go www.APMA.org to find podiatrists in your area. Very best of luck to you!
My feet feel like they are sweating but there is no moisture on my feet.
My toes hurt and cramp spratically. I have been researching tarsal tunnel
because until January of this year I transcribed information using a dictaphone
using my right foot constantly. I have orthotics, they have helped some
but have not cured the hot feeling feet nor sore toes and now my left foot
has started hurting in the same manner. My sister was diagnoised with diabetics
last year, but according to my recent test results 6 months ago there were
no signs of diabetics. I have no idea why this starting two months after
I no longer used a dictaphone.
Dr. Karpati's Answer:
You may be right on with this one as your symptoms are in sync with Tarsal
Tunnel. You may have quit what caused it but now you sound chronic. Please
gather a "team" (podiatrist and neurologist) and get a good work up done
which should include nerve conduction velocities and EMG. If theses are
negative, get an MRI. Ask about Lyrica to help with your symptoms in the
mean time. Good Luck!
I am otherwise a healthy woman, except on the soles of my feet I constantly
experience burning sensation. I am not in the pain. I am able to exercise,
do cross country skiing, hiking, etc. I do not have a problem sleeping.
It is just this constant burning sensation or like ants walking on the soles
of my feet when I walk or sit. I try exercising my feet to get the blood
moving, put ice pack on my feet whenever I can, I am massaging bottom of
my feet but nothing seems to help. Can you recommend something else I can
try? Do you have an experience with the leg and foot massaging equipment
for around $400? Are they any good? My calves get sometimes very heavy and
tired. I can't sit for a very long time. Flying in an airplane or going
to a theater makes my legs very restless. Is this a circulation problem?
Any recommendation what could I try to relieve these problems? I forgot
to mention that I have flat feet and I use inserts all the time.
Dr. Karpati's Answer:
If you have a history of diabetes in the family, I would get checked yearly.
This presents very much like diabetic neuropathy. Assuming you have recently
been checked for diabetes and you do not have this, and the fact that you
have flat feet, you may be experiencing Tarsal Tunnel Syndrome. Flat feet
put excessive strain on the nerve that supplies sensation to the bottom
of your feet. When this nerve gets compressed, it results in the symptoms
you are describing. Over the counter inserts may not support your arches
enough. The best thing you can do immediately is get functional orthotics
to reduce the biomechanical strain. Please get these from a podiatrist who
will actually get a cast molding of your foot (not handed to you by shoe
size, not by scanning your feet and not getting a mold of your foot by stepping
in a foam box.) Your podiatrist can also evaluate your condition. You may
also need to see a neurologist who can do tests to check for nerve entrapment.
There is medication that can help in your symptoms. I do not like medicating,
but if an orthotic doesn't cover it, sometimes meds are necessary to alleviate
these symptoms. Do not waste your money on foot massaging equipment (put
it towards the orthotics instead). Good luck!
My almost 15 year old daughter has "bunyons??" on both large toes...we've
read in a medical book about this and know it can be hereditary; what can
be done for such a young one (I always thought this came as are result of
wearing heels a lot and being on our feet, etc.)
Dr. Karpati's Answer:
Bunions are very much a hereditary condition in a juvenile patient. She
may also have flat feet. Orthotics can to slow down the progression of her
condition, but if she is already having pain and the orthotics do not work,
then surgery is the most likely answer. Please fill free to visit my web
site at www.faant.com and go to the "patient information" section. Here
you will find more information on bunions, flat feet and orthotics. Good
I am a 42 year old woman who jogs about 5 miles a day. I just
noticed a soft bump on top of my left foot. It is the size of a golf ball
and it is painless. How can I get the swelling to go down or what can I
Dr. Karpati's Answer:
Sounds like you have developed a cyst. If it is soft, they you can inject
it with cortisone and sometimes get it to shrink. Yours is quite large and
definitely worthy of a visit to your podiatrist to have it checked out.
OK, I have a foot question and I know you might not be able to answer without
an exam but any suggestions/thoughts would be very helpful!! I've tried
to be as descriptive as possible....
My left foot: To start, the inside of the heel is painful if you put pressure
on it. Not at the base but starting right above the bone and continueing
for about an inch up from that point. I'm not sure if this is related or
not to what I'm actual asking about so I thought I'd mention that. It's
been about, 3 months with that heel pain.
My real problem: I have been having pain in my toes with certain foot movements
for about a month or so now. If I try to curl my toes they can only get
about halfway before it starts to hurt, if I try to go all the way it's
extremely painful! I have a bump on the top of my foot, not noticeble unless
you touch it. If you look at the top of both my feet the left one is noticeable
a bit higher as a whole, not just the bump area. If I press down on the
small knot it sends a tingle from that place all the way down to my toes,
kind of like an electrical current is the best I can describe it. No pain.
Pushing harder this sensation turns to pain running down my foot. Basically
the same feeling as when I curl my toes hard only starting from the middle
and going down. Do you have any idea of what this might be or anything I
can do to aleve this?? A lot of times after I have been walking/running
it just has a dull pain to it which is quite annoying. I've taken to putting
a bag of ice on the top of my foot just to numb it and make it feel normal
briefly. Anything is helpful! Thank you so much in advance!!!
Dr. Karpati's Answer:
The bump you are describing seems to be putting pressure on the nerve that
provides sensation to the top of the foot and when you compress it, you
get tingling and pain. This is called "neuritis". If the bump is from a
cyst, then sometimes we can inject it with cortisone and shrink it. If it
is caused by bone, then things get more complicated. You can try skipping
the laces in your shoes over the area or wearing orthotics to try and change
the position of your foot in your shoe. If neither helps, you may have to
resort to having your podiatrist shave down the bump surgically. The other
pain to the heel, called "plantar fasciitis" can extend up the inside of
the heel because there is a nerve that innervates the inside of the heel
in that area which can worsen the condition. If the pain is more along the
ankle bone, then that could be tendonitis or another nerve problem known
as "tarsal tunnel syndrome". Hope that helps! Now get to your podiatrist
and get better already!
- - -
Medical conditions are fact-dependent, so in addition to Dr. Karpati's insights,
it is important you consult with your personal physician before undergoing
any footcare treatment.
Dr. Adriana Karpati is a trusted Summer Soles Advisor and frequently tests
Summer Soles products before they are brought to the public. Her practice
is located in Grapevine, Texas. For more information, visit: www.faant.com
Summer Soles Ultra Absorbent insoles for sandals are wool insoles that help remedy feet sweat when wearing open shoes and sandals. These open shoe insoles are ideal for stopping feet sweat from ruining shoes and making sandals uncomfortable.