1. Question:
What over the counter powder or meds can I take so my feet can stop sweating?

Dr. Karpati’s Answer:
The easiest way to control your feet from sweating is by using any underarm antiperspirant. This will not stop all of the sweating, but it will help. Your feet will feel even drier by having Summer Soles in your shoes and sandals to wick away any remaining moisture you may have. And with summer just around the corner, now is the time to prepare and start “Summer Soleing” your footwear!

2. Question:
In addition to summer soles what would you recommend as a foot antiperspirant??

Dr. Karpati’s Answer:
Actually, any under arm spray antiperspirant works to a certain degree! It is the main ingredient aluminum chloride that helps to reduce sweating.

3. Question:
I have hyperhidrosis. Are there any effective over the counter foot sprays or should I just go straight to the prescription strength products from my dermatologist.

Dr. Karpati’s Answer:
Try Summer Soles first! You will love the way it absorbs and wicks the sweat away and the way it makes your feet feel! Best of all, it is not medicated which is always a bonus in my book! As an adjunct to Summer Soles, try any underarm antiperspirant (not deodorant) spray in the mornings. It may save you a trip to the doctor!

4. Question:
I use Powder and still have foot odor

Dr. Karpati’s Answer:
My first suggestion is to start absorbing some of the sweat which causes that odor. Summer Soles is great for this since it literally absorbs the sweat off your feet and this will help to reduce the amount of sweat that can cause the odor! Another suggestion is to wear the socks that wick away the moisture. These socks can be found in most athletic stores. Cool Max is a favorite. Also, try changing your sock more several times a day so you have a fresh pair to continue to remove the sweat off your feet. Keep using the powder and Summer Soles will do the rest!
Also, to help cut down on the odor, Dr. Smith’s brand makes a product called “Deodorizing Foot Wash” which you can apply directly to your feet.

1. Question:
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.

2. Question:
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.

3. Question:
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!

4. Question:
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.

5. Question:
Here is my story/problem: First of all, this is who I am…
Age: 15
Gender: Male
Weight: 165
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!

6.Question:
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!

7. Question:
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!

8. Question:
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 luck!

9. Question:
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 do?

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.

10. Question:
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!

1. Question:
My daughter has a small hard blister-like growth on the bottom of her foot. It is transparent and painful if squeezed or pushed on. Thought it might be a wart, but it doesn’t look like any pictures that I have seen. Any ideas?

Dr. Karpati’s Answer:
Every so often I come across a question that I wish I could answer sight unseen. This is one of them! There are so many different types of lumps and bumps that present on the feet that, without a visual, diagnosis is very difficult. I have seen some warts that appear more “transparent” than others, so it is not out of the question. There are also other lesions such as Porokeratosis that present similarly. Your daughter may have also stepped on something and could have a retained foreign body. Please refer to www.APMA.org and click on the “Find a Podiatrist” icon. Your daughter really should have this lesion evaluated.

2. Question:
I have a 5 yr old daughter and she has been suffering severly with dry cracked feet that hurt her so bad she is miserable .I have tried putting neosporin and clean dry socks on 2 times a day, I have tried covering her feet before bed with vaseline, then putting clean white socks on her…… I have tried epsom salt, peroxide, that stuff you put on that is a clear coat that is suppose to seal them and also almost everything, please, please help us, my little girl is miserable and I dont know what else to do!!!! I have also tried special expensive creams but her feet especially her big toes and her heels, actually almost her whole foot(feet) have major deep cracks…thank you

Dr. Karpati’s Answer:
I am sorry to hear your little girl is suffering from this problem! Do not delay in seeing a podiatrist in your area for proper evaluation as dry, cracked feet may be a hereditary condition verses something of a fungal nature resulting in different treatments. A biopsy of the skin may be necessary for proper diagnosis. Please stop the use of peroxide and Epsom salt as both are VERY drying to the skin and may be exacerbating her condition.

3. Question:
I suffer from Morton’s Neuroma. What is the best solution for the burning sensation I get. Thank you.

Dr. Karpati’s Answer:
Supporting the foot to control the abnormal biomechanics causing your Morton’s neuroma and offloading the forefoot is the easiest conservative treatment for a true Morton’s neuroma. Please refer to www.faant.com online store to order the “Power Step metatarsal relief pads” (I believe it is #215 in our product line). This is a pad that helps to offload the forefoot to relieve the pressure under the ball of the foot. Please try this alone as well as in conjunction with an arch support (we have many available online as well.) Your choice of arch support would depend on what types of shoes you wear/activities you participate in. If this does not help, please appoint back to your podiatrist where further evaluation can be performed.

4. Question:
I am a 35 year old woman. I work everyday and my job involves standing for 8 hrs. a day. My feet are very dry and brittle. I use different foot creams. Also my feet are very dark at the bottom, sometimes it looks as though I have leopard feet they have little dark circles on the bottom. What can I do?

Dr. Karpati’s Answer:
There are a few products on my website that specifically address your problem with your feet. Please visit www.faant.com and go to the on-line store. On the left side you will see various conditions to choose from. Go to “dry and cracked skin”. I really like the Hydrostat cream as I have used the product before. It does not feel greasy. Depending on the amount of dryness of your skin, you might also want to consider the Callex ointment which may be greasier but even more hydrating. Heel sleeves are also available to wear over night. A combination approach of lotion or ointment during the day and the heel sleeve at night might be best! As far as the little spots are concerned, you did not mention them itching, which could indicate an athlete’s foot problem, or growing, which could be a more serious dermatological condition. They are probably nothing to worry about. If they change in their appearance or become painful, however, I would most definitely have them checked out.

5. Question:
I had a corn on my fifth toe. I used keralyt gel and the corn is now gone, but the skin in my toe where the corn was located has become discolored. Is there something I can use to bring the natural color back to the skin on my toe. I don’t want to lighten the skin. I just want the natural color to return.

Dr. Karpati’s Answer:
I think the best thing you can do is to wait it out. You did not mention how long ago you stopped using it. It may take a long time for your natural color to return. Mind you, skin color is rarely normal from the corn having been there so long, so you may never get the normal coloration back and there is no product that could “bring it back”.

6. Question:
I have always had the problem of developing blisters on my feet. Especially on my little toe and around my other toes. But really, I have blistered almost everywhere on the top of and on the sole of my feet at one time or another. What causes this, and What can I do about it?

Dr. Karpati’s Answer:
If there is itching or dryness, flaking, and redness associated with the blisters, this could represent a chronic athlete’s foot infection. Try using over-the-counter Lamisil cream which needs to be used twice daily for one month. Any less than one month and you may continue to have recurrences. If you have already done this, please go to www.APMA.org to find a podiatrist in your area to have this properly evaluated.

7. Question:
I have a blister-like growth on the top of my 2nd toe (right at the cuticle-line of the nail). It’s a gelatinous bump that’s been there for quite awhile (several months). It’s definitely not a blister, but that’s what it looks like. If I push on it, it flattens for a minute or so, then puffs back up. I finally got the nerve to stick a pin in it (I know….not the smartest thing…). Clear gel-like stuff came out. A little blood too, but VERY little. I squeezed it fairly flat, but after about 10-15 minutes, it was puffed up again like before. It looks like another one might be popping up on the next toe, but is extremely small. I had a medical doctor look at it, and suggested I got to a podiatrist. But I’ve just been really curious about what it might be. Any ideas…?

Dr. Karpati’s Answer:
This sound like a mucoid/mucous cyst to me. I know, the name sounds ugly, but this is simply a cyst formed from some fluid that has “herniated” from the toe joint that lies under the cuticle. Some times a cortisone injection zaps it and sometimes you need surgery to have it removed since they do like to recur.

8. Question:
Hi. I have a large blister on the BOTTOM of my heal. I’m not sure of the cause–I run and have been playing pick-up basketball the past couple months. How do I heal this blister and how can I prevent one from coming back? Thank you!

Dr. Karpati’s Answer:
Dear Lindsey, Try to avoid popping the blister if it’s not hurting. It should resorb in less than a week. If it is uncomfortable, the safest way to pop a blister is to soak a needle in rubbing alcohol for a few minutes then let it dry, or heat the tip of the needle until it glows red then allow it to cool. Swab your blister with betadine (you can get this at any drug store), then puncture the blister at the base in several areas and slowly drain out the fluid. Do not remove the excess skin. Apply a thin layer of antibiotic ointment (preferably Bacitracin which is also over- the- counter) then a large non-stick bandaid. Keep it covered and change regularly until the area has dried out and no more fluid accumulates. Watch for signs of redness, swelling or pus which indicates infection. If this occurs, please see a podiatrist who may place you on antibiotics. There are many sites on the web about blister prevention. A favorite site has tips from marathon runner themselves at http://www.ultrunr.com/footcare.html

9. Question:
I have always had clean/soft feet with no cracking anywhere. I noticed over the past few months some itching that comes and goes but mostly cracking in between my toes with peeling skin. Its fleshy pink there. Also I noticed some dark brown spots in the toes area but mostly on the bottom of my feet. They are in clusters. I can feel them as bumps under my skin. Some of them I can actually squeeze out of my skin! Help!

Dr. Karpati’s Answer:
Sound like athlete’s foot! This stuff is a pesky condition that is rampant during the summer months. Buy some over-the -counter Lamisil and use it twice a day for a month even if your symptoms improve before that. If you see no improvement or your symptoms worsen in two weeks, please follow up with a podiatrist in your area. Do not forget your Summer Soles in your shoes to absorb the sweat, which is a huge culprit in recurrent athlete’s foot. Less sweat means less moisture and less chance for the fungus to get out of control!

10. Question:
I have hiv and have been getting black spots under the skin on my feet, along with clear fluid in them. I also have some itching and flaking of the skin. What should I do?

Dr. Karpati’s Answer:
I must tell you I am by no means an expert in the various dermatological conditions associated with HIV, however, your symptoms sound very much like Athlete’s foot. The simplest thing you can do is to try some over the counter Lamisil cream applying it twice daily for one month. You should see a significant improvement in two weeks, but keep using the cream for the whole month. If you see no improvement in two weeks or you resolve this but have chronic recurrences, you should see a podiatrist in your area. You may find one in your area via www.APMA.org

11. Question:
I have been struggling with some little red watery blisters on my feet for about 2 yrs now. They come out and then dry out and go away after a few weeks. They don’t itch or smell or anything. I get like 5-6 blisters at once. They look like chicken pox but very tiny. I have been given steroid cream at the doctor’s but it has not helped. My spouse has gotten them from me too. Can you give me any advice on what it is?

Dr. Karpati’s Answer:
Could be athlete’s foot. Try using Lamisil Cream (this is over-the-counter) twice a day for a month to try and get rid of it. Use “Lysol Tub and Tile” in your shower weekly to disinfect and help keep your spouse “blister” free! If this does not work, have your dermatologist or podiatrist do a skin scraping on it to have it evaluated. Good Luck!

1. Question:
My question is about nail fungus. I have a minor case on three toes. I have been prescribed a cream called Nizoral 2% cream. I am choosing not to take the oral medications since I do not have the time/access to taking the blood tests. I was told I could have developed the nail fungus when wearing my leather Topsider boat shoes without socks. Have you seen cases of nail fungus from wearing boat shoes without socks? Also, is their a better way, other oral, to rid the fungus?

Dr. Karpati’s Answer:
Thank you for your e-mail. To get to the point, yes there is a better topical way to attempt to eradicate the nail fungus. Onychomycosis, which is the fungus that you see on your nail, has its roots in the nail bed. There is a prescription called Penlac whose mechanism is to penetrate the nail plate over time, eventually reaching the nail bed and killing the fungus where it grows. This is the only FDA approved topical medication that can actually eliminate the fungus on the nail bed. Improvement is seen as the new nail grows out, which typically takes six to nine months. Recommended use for this product is one year or more. I would probably give it a success rate of about 70% in its ability to completely eliminate the fungus on the nail bed (this is called a mycological cure). Most people however do relate a significant improvement in their nail appearance even though they might not have a mycological cure. Unfortunately, the saying “fungus amongus” is true! The fungus is everywhere and one can inoculate themselves at any point in time. Typically, a moist, warm environment is ideal and that is why many people inoculate themselves in locker rooms, showers, by the pools, or on the lake. I have seen many people who have fungus who do not usually wear socks with their shoes. Repetitive trauma to the nail is also a good way for fungus to inoculate itself. This is typically seen with people that exercise. I do recommend you visit with a podiatrist in your area to make sure that what you are describing is in fact onychomycosis so that the appropriate prescription can be written.

2. Question:
Why does my toddler have yellow toenails? What could be some reasons for this?

Dr. Karpati’s Answer:
Hard to know without taking a look at them. Young children typically do not have nail fungus. Are his//her finger nails the same color? Did his/her nails use to be whiter? I would find a podiatrist in your area (at www.APMA.org) if you are concerned for a quick look. This may give you piece of mind!

3. Question:
I have a question regarding toenail fungus and permanent toenail removal and would be grateful if you could provide me an answer to my questions I have about it. My boyfriend who is 46 yrs old has had toenail fungus for quite some time now. His toenails quite frankly look very gross!!! I don’t mean to be rude but they area HUGE turn off… they just look very appalling.

All of his toenails are affected by it. I take great care of my own feet with weekly pedicures and I expect my partner to as well but he refuses to get treatment for his toenail fungus because he has crohn’s disease (takes medication for the crohn’s) and cannot take the oral medications to attempt to eradicate the toenail fungus because those medications would put his already at high risk liver into too much jeopardy.

Therefore he cannot take the oral medications to eradicate the toenail fungus. Also I feel even if he did take the oral medications and managed to eradicate his toenail fungus it would be entirely pointless because the fungus would come back eventually for certain. I say this because he is a stubborn man and refuses to wear sandals and insists on walking around the entire day in these sweaty boat shoes with no socks! When he takes these shows off you can tell that they are a breeding oasis for bacteria just by the way it smells! Why anybody would do that who is prone to toenail fungus is beyond me. It just boggles my mind and I am reaching my wits end. And of course those ointments you can put on the actual nails are not effective.

Therefore I brought up the subject of PERMANENT toenail removal to him. Not temporary removal because that does not get rid of the fungus of course (but permanent toenail removal) for ALL of his toenails since he is unable to or refuses to take care of them whatsoever and the fungus has been there for a long time and is slowly getting worse. So my main question is… is this a GOOD solution do you think… to have permanent toenail removal done on all of his toenail? Basically I want him to be de-clawed like a cat!

But what I’m mostly concerned about is will the skin be perfectly normal after the toenails have been removed and it has healed? Or will the skin be very strange in that area where the nails used to be? And what about the cuticle… when you do permanent nail removal how do you ensure that the cuticle NEVER grows back? Because that would be very strange to not have any nails but have cuticles still growing on your toes when you don’t have any nails on them. Or am I incorrect in thinking this and the cuticles would also be prevented from growing back along with the nail??? When you remove the nail bed I suppose the cuticle is also permanently stopped from returning, am I correct? And my other main question was… in general how much does it cost to have 10 toenails removed?
Thanks for your time,
Disgusted 🙂

Dr. Karpati’s Answer:
Dear Disgusted,
Wow! You have definitely thought this one through!

I agree that oral medication is out of the question given his medical history. The only other option for treatment is prescribed topical Penlac which takes about a year of use for any true result to be determined. If he is non-compliant with this medication, he may never get rid of it. You are also right about the increased probability of getting it back wearing those shoes!

Removal of all of his toenails is a pretty radical solution for this problem, especially if they do not cause him pain, because of the potential risk for infection (as is the case for any procedure). If his case is as extensive as you say involving all of his nails, then there is potential for transmittal to his foot resulting in Athletes foot. If this is a chronic problem, then permanent removal is a very good option for him. Permanent removal (called a Matrixectomy) is usually accomplished under local anesthesia using chemical called “Phenol” at the nail root, which sits underneath the cuticle, to keep the nail root from producing nail. It is about 90% effective in preventing the nail from coming back. The cuticle does not “grow”, and stays as is. The nail bed may be sensitive for some time after that, but that usually resolves and most people are happy with the appearance of the nail bed. I suggest you consult with your podiatrist for their experiences with matrixectomies as I am only speaking of my own. As far as cost is concerned, that would be better answered by your podiatrist should your boyfriend decide to proceed!

I also want to caution you about the potential for getting nail fungus from your weekly pedicures if you go to a salon. Be sure your salon/spa is reputable and that they have enough time between clients to clean their instruments/ whirlpools. Better yet, bring your own files, nail sticks etc. to minimize the risk!

Finally, the very least your boyfriend should do is get some Summer Soles into those shoes to help wick away that sweat (and hopefully some of that smell!)

4. Question:
My two big toenails are yellowing in color. One big toe is also curving in on each side and the nail seems to be lifting from the nailbed. I have another smaller toenail that is growing upward and has completely left the nailbed. I was to my family doctor this morning and they tested me for toenail fungus. The results were negative, so they are suggesting I see a podiatrist to look for answers. Do you have any insight or suggestions for me. I really can’t afford to see a specialist.

Dr. Karparti’s Answer:
Many times a fungal culture comes back negative even though it is obvious that a fungus is present. If you really are seeking treatment, you really should see a podiatrist. In the meantime you can try something over the counter. Mind you, topical medications will take one year of continued use to see results. If you go to http://www.ourdoctorstore.com/crane/ and to the ‘nail fungus’ section, you can start using “Tripod NailStat”. This will at least suppress the fungus while you get to a specialist.

5. Question:
My big toe…just one has no cuticle. It is possible that I may have a fungus starting. I have been using a topical on the nail for awhile. My nail is not thickened or yellow, but has got white spots. I wanted to try right away to stop it if it was a fungus. The rest of all my nails look fine. I have however been spooked and have been treating all of them ….just in case. I have also tried tea tree oil. This one nail seems to be very stubborn. Since this toe was the only one that I noticed had no cuticle, I know something must be “lingering” there. Does a cuticle ever grow back? That would mean that maybe it was healing, but I see no signs of a cuticle even trying to form. Is this weird?

Dr. Karpati’s Answer:
The cuticle is basically the skin at the base of the nail, so you definitely have one. I think you may be speaking of the lunula, which is the semi-circular lighter area at the base. This may be occluded by the fungus. It also sounds like you have only tried the over-the-counter remedies for the fungus. If it hasn’t cleared, you should try something prescriptive. A prescription will give you the best chance of getting rid of it at this point and getting back a more normal appearing nail. Good Luck!

6. Question:
I would like to know what causes your toe nail at the cuticle to turn black. Would I need some type of cream to restore the color to my toe?

Dr. Karpati’s Answer:
Darkening of the cuticle region could be secondary to trauma to the toe or possibly a fungal infection. It is difficult to tell without proper evaluation. I do recommend that you visit with the podiatrist for evaluation. You can find one in your area by visiting: www.ACFAS.org

7. Question:
I have a nail fungus on my two big toenails. I am currently taking lamisil for it. One of my nails is about to fall off and it looks kind of gross. I was wondering if it would hurt anything if I got a press on nail when my nail fell off. Would that cause any problems with the healing process?

Dr. Karpati’s Answer:
I am not too thrilled about the idea of a fake nail on top of the nail bed that is trying to heal from fungus. The warm and moist environment that you will be creating with a press-on nail is very inviting for re-inoculation of fungus. For this one, I say let Mother nature take its course and allow a fresh new nail to grow unimpeded. Good luck!

8. Question:
I am in desperate need of an answer to this question. I used to get pedicures all the time, but ever since my big toes on both feet have this ugly look to where I have to keep them polished. Its not nail fungus according to my ARNP that I see (she couldn’t give me an answer), but they look like they have been “scraped” maybe with a nail file or something. It just has a white,scraped look to it. Do you have any idea what it is and what could I do to fix it? I haven’t had my nails done in a long time, I just polish them myself since I think the cause is because of the salon. A response would be appreciated!

Dr. Karpati’s Answer:
It does sound like your nails have contracted some fungus (known as “onychomycosis”). I have no idea without looking at it myself how involved your nails are, but if it is only a minimal superficial portion of the nail, you may be able to get away with using something like “Nailstat” which you can purchase over the internet. I also carry this in my on-line store for your and my patients’ convenience: http://www.ourdoctorstore.com/crane/store/item_id=58. If this does not work or your nails are much more involved, you will probably need a prescription. More information about fungal nails: http://www.faant.com/news_detail.aspx?footer=1&news_id-47

9. Question:
How is the temporary toenail removal process done? I have toenail fungus on my big toe on my right foot. The podiatrist stated that if the topical cream doesn’t work, that I could think about temporary removal of the toenail. Thank you for your time.

Dr. Karpati’s Answer:
First of all, an anti-fungal cream will not work on toenail fungus. I am hoping your podiatrist was recommending topical Penlac (ciclopirox), that you paint onto your nails, rather than a cream. This is the only FDA approved topical medication for your nails. It needs to be used for at least a year consistently to see results. Oral medication is more effective and is only a 3 months treatment. The downside to this one is that you need to get blood work done first to check your liver function, which is no big deal to most people. If your nail is not painful, then there really is no need to remove it. If it is painful, then the process involves numbing the toe with a local anesthetic (yes this is a shot). The nail is removed and healing takes several weeks. Good Luck!

10. Question:
I have a corn on my toe. I have shave the skin all the way down. Does it mean my natural skin will grow back. How do I keep the corn from coming back?

Dr. Karpati’s Answer:
A corn on the toe is usually a result of a boney prominence (such as a hammertoe) or a bone spur in the toe bone. Unfortunately, because the cause is from the bone in the toe, the corn will continue to grow back if you do not change the anatomy of the toe through surgery. To avoid surgery, you can conservatively use a pumice stone in the shower or after a foot soak when your corn is softer to work off the build up. I do not recommend shaving it because if you even nick yourself, scar tissue will form and your corn can get larger!

11. Question:
I have 2 corns on my third and forth toes on the right foot. I’ts been over a month now,I tried Dr scholl corn remover bandage and liquid remover and nothing works. After 3 days the skin will peel off but it still is hard and looks like high bumps and very unattractive on my toes. Please help, because I can’t wear any flip flop or sandals and it’s summer. Thank You.

Dr. Karpati’s Answer:
You have what are called “hammertoes” and there is no patch, cream or pad that will make them go away. It is a skeletal condition which may require surgery if it is painful. Please follow this link to read more about this condition: http://www.faant.com/Hammertoes.aspx

12. Question:
My big toe is infected. It is swollen with pus and red just below the nail. My podiatrist gave me an antibiotic and suggested removing the nail so the pus can drain. Then he said the nail may grow back healthy and pretty, or thick, yellow and ugly or never grow back at all. He did not tell me what type of infection it is – bacterial, fungal, etc. and did not give any reason as to why it happened. Removing the nail seems so radical. Is this a good idea? Is there another alternative? -Thanks!

Dr. Karpati’s Answer:
At this point, there does not seem to be an alternative. If you do not remove the nail, it will continue to in grow and will continue to have pain fan your infection could get worse. These infections are typically bacterial and usually happens when the nail grows into the surrounding nail fold. When you go back to see your podiatrist, please discuss your concerns. Your podiatrist will be able to give you more information than I can because she/he has the added benefit of having seen your toe! Good luck!

13. Question:
I am 19 years old and have been dealing with hereditary ingrown toe nail problems for years. About a year ago I lost one of my toe nails after accidentally kicking it into a door. The nail fell off and it healed over in no time with no problems. The nail has mostly grown back by now but I’m finding that I’m having even more problems with the nail than I had before. I try different ways of trimming it and everything but nothing seems to work. Half of the time I can’t wear a shoe because of swelling and the pain the rubbing of the shoe causes. I’ve been considering permanently removing the nail for a long time now but the only issue is cost. Would you be able to give me any idea of how much it would cost to permanently remove this annoying nail before I contact a doctor. Just so I can have a basic idea before hand of what I’d be in for.Thank you so much!

Dr. Karpati’s Answer:
Every doctor’s office is too variable to give you cost. I have been asked cost questions before and I can never give an answer. Your best option is to call several doctors offices in your area and get a rough estimate. It would only take you a few minutes. Best of luck!