Podiatrists: The primary care physicians of the lower extremity

There is a nationwide shortage of primary care providers (PCP’s), which include family practitioners, internists, pediatricians, among others.  A recent US Department of Health study documented shortage of 17,000 PCP’s.  In many areas, it is often difficult to get an appointment with a PCP.  Many are not accepting new patients, and established patients may experience long waits.

The good news is that, at least when it comes to the lower extremity (foot, leg, and ankle), the specialty of podiatry stands ready to help!  Podiatrists are surgeons, but they are first and foremost PCP’s of the lower extremity.

Podiatrists treat hundreds of lower extremity conditions.  In the lower extremity, podiatrists  are the experts in rheumatology, dermatology, neurology, pediatrics, geriatrics, orthopedics, vascular disease, medicine, wound care, and sports medicine.

Podiatrists are experts in dermatology of the lower extremity. Skin rashes of all types, skin tumors, and toenail conditions are commonly treated. The ingrown toenail is ,in fact, the most common condition that we treat.

Rheumatology, or  arthritic conditions of the lower extremity, is another common  area of podiatric expertise.  Any of the multiple joints of the foot as well as the ankle joint are prone to  arthritic conditions.

Neurology, or nerve  problems, is another common area of podiatric involvement.  Nerve injuries, nerve entrapments, and nerve disease (neuropathy) are common in the lower extremity and are often difficult to diagnose and treat.

Podiatrists also specialize in lower extremity pediatrics, or children’s foot problems.  These include gait abnormalities, flatfoot, and sports injuries. Podiatrists also specialize in geriatrics, or treatment of conditions of the elderly.

Circulation problems, both arterial and venous, commonly affect the lower extremity.  Podiatrists are often the first to diagnose these.  Evaluation of poor arterial circulation and prompt referral for vascular intervention, especially in diabetic patients, can be limb saving or life saving. Vein problems, ranging from venous leg ulcers to unsightly spider veins are all conditions treated in the office by podiatrists.

When it comes to orthopedics (bone problems), of the lower extremity, podiatrists are the experts. We treat all types of fractures, sprains, bone, muscle and tendon conditions. We are especially adept at treating athletic injuries.

Finally, it should be noted that many systemic conditions have manifestations in the lower extremity, and sometimes these are the earliest symptoms. These include diabetes mellitus, kidney disease, congestive heart failure, nutritional deficiencies, among many others. Podiatrists recognize these and make the appropriate referrals.

Most PCP’s understand the value of podiatry and refer conditions of the lower extremity to them. Podiatrists work closely with PCP’s, other specialists, and health care providers as a part of the medical team to provide the best care for every patient.

Most health insurance plans, including Medicare, do not require a referral from a PCP to see a podiatrist. You can make an appointment directly with us without a referral.

Call our offices for any condition of the lower extremity. We will be glad to help you!

Protective shoes for diabetic feet

It is well-known that people with diabetes mellitus can experience numerous foot problems, many of which if untreated can become severe.  Proper foot hygiene and other forms of preventive care can  prevent many of these complications.  One important component of protection and injury prevention in the diabetic foot is the Medicare diabetic shoe program.

Approximately 30 years old, the Medicare diabetic shoe program was designed to provide protective shoes as a covered service for Medicare patients with diabetes who met certain criteria.  To qualify for this program, the patient must meet 3 criteria: Coverage by Medicare or Medicare Advantage Plan, diagnosed diabetes mellitus, and a diagnosis of any of the following 6 conditions: Poor circulation; foot deformity; neuropathy with callus formation; callus; history of previous ulcer; or history of partial or complete amputation of the foot.  Since 60% of diabetic patients have neuropathy, over 10% have poor circulation, and 70% have some type of foot deformity (bunion, hammertoe, etc.), a majority of diabetic patients will meet the criteria for inclusion in the program.

The doctors at the Melbourne Podiatry Associates will examine you and determine if you  meet  the criteria for the program.  If so, they will completely appropriate paperwork which will be co-signed  by the physician treating  the diabetes itself.  Once authorization is obtained,  the patient will return for sizing such that the shoes can be ordered. When the shoes arrive, the patient will return to the office for dispensation.

All of the shoes come with three pairs of removable soft insoles.  The shoes are very durable and comfortable and have no internal seams.  All shoe models have extra depth and width in the forefoot area.  A wide variety of shoe models, colors, and styles are available. All the shoes are attractive looking and are extremely comfortable.

Patients who qualify for this Medicare program are entitled to a new pair of shoes annually for life.  This program has been documented to prevent millions of diabetic complications each year.

If you are diabetic or know someone who is , make an appointment with our doctors determine qualification for coverage.

Topically applied compounded medications

There are three basics routes of administration for medications to get into the body. These are oral (pills), injectable, and topical (applied to the skin). While oral and injectable routes are the most effective and the most commonly used, new advances in the production of compounded topical medications has led to increased use of these. They can be used in conjunction with other treatments , or, sometimes as the primary treatment.

The word “compounding” refers to the process of a pharmacist actually mixing up the medication. These are not something that one can get at the local pharmacy, rather they are specially ordered from a company that compounds them.

The most common conditions treated with compounded topical medications are arthritis, plantar fasciitis, neuropathy, warts, and fungus infections.

One common condition that affects the foot is plantar fasciitis, which causes inflammation and pain in the plantar fascia, which is the tendon that begins on the bottom of the heel and runs along the bottom of the arch. Compounded medications for plantar fasciitis can include anti-inflammatory agents such as ketoprofen or diclofenac, pain relieving agents such as lidocaine, capsaicin, or CBD. Thes medications are also very effective for various types of arthritis, tendinitis, and muscle pains.

Another foot problem that can benefit from compounded topical medications is neuropathy, which is characterized by tingling, burning, pain, and/or numbness. Compounded medications for neuropathy may contain medications such as gabapentin or amitriptyline, which relieve symptoms.

Compounded topical medications have the advantage of safety, as very little to none of the medications are absorbed into the body. Rather, the medications are just absorbed through the skin and act locally. Adverse effects are extremely rare and minor. They also have the advantage of versatility, as the doctor can individualize the compound for each patient as necessary.

The doctors of Melbourne Podiatry Associates use these medications when appropriate for their patients. These medications provide additional treatment options for many patients. Ask your doctor if one of these medications may be helpful for you.



Many devices known as orthopedic braces and splints are used in treatment of various conditions of the foot and ankle.  These products are removal devices that are useful in the treatment of some acute injuries, treatment of some chronic conditions, and sometimes as preventative therapy (i.e., ankle sprain prevention).

Splints and braces are useful as primary treatment in some cases and as an adjunct to other treatment in others.  They can improve physical function; reduce pain; reduce edema; immobilize a fracture or sprain; reduce excessive range of motion; and facilitate healing of injuries.

Braces and splints are known as durable medical equipment (DME).  They are usually covered by insurance. Examples of some commonly used DMEs include the night splint for heel pain and plantar fasciitis, pneumatic walking boot for sprains and fractures, and the ankle brace for treatment and prevention of ankle sprains.

The doctors of Melbourne Podiatry Associates utilize a variety of splints and braces for the treatment of many conditions.  We have the best DME products available in stock and ready for dispensation.  Call for an appointment if you suffer any type of problem of the foot, leg or ankle.

Spring Walking Checklist

Spring is a great time to get yourself up off the couch and get on your way to better health. Don’t let foot pain slow you down. Follow these helpful tips for your springtime walks and enjoy the weather!

— Wear supportive shoes.
— Wear “moisture wicking” socks.
— If you have being inactive over the winter, don’t overdo it. Gradually work into a walking program.
— Walkers can frequently experience heel pain, especially if you have been inactive during winter months. Often, ibuprofen and daily stretching exercises can provide relief.
— If you experience pain in the heels or ankles that does not disappear within 2 weeks, schedule a visit with our office.

Don’t ignore big toe pain

The joint at the base of the big toe takes a beating each day. It has to bend with each step you take, gets jammed when you make quick stops or twisting motions, and deals with added stress when placed in high -heeled shoes.

While occasional pain in the big toe joint may occur from the daily grind, constant pain in the big toe joint could be a warning sign of a progressive, arthritic condition known as “hallux rigidus”. “Hallux refers to the big toe, and “rigidus “ indicates that the toe is rigid and cannot move. In the early states, when movement is only somewhat restricted, it is sometimes called “hallux limitus”. This joint stiffness gets worse over time, making it difficult for you to walk or stand for long periods of time.

Hallux rigidus may run in the family but can also be caused by repetitive stress from workplace or sports activities. Tradesmen who crouch and stoop a lot and avid golfers and tennis players are prone to developing hallux rigidus. An injury, such as a severe stubbing of the big toe, can also be a culprit for the condition.

It’s best to have your toe joint examined when you first notice pain while walking, standing, squatting, or bending over. If recognized and addressed early, the condition can be improved with conservative treatments such as shoe modifications, orthotic devices, medications, injection therapy, and physical therapy. But when the condition progresses and conservative attempts fail, surgery may be required to repair the damage from this painful condition.

Tasty holiday meals can trigger painful toes

With the most festive season of the year here, be aware that sudden changes in your diet can trigger painful gout attacks, especially in the feet.

Gout attacks are caused by the accumulation and crystallization of uric acid in joint tissues in susceptible individuals. Because the big toe joint is the coolest part of the body and uric acid is sensitive to temperature change, the big toe is most commonly affected area. However, other joints can also be involved.

Foods high in a chemical called purine contribute to uric acid buildup and we recommend patients who are prone to gout to avoid purine-rich items such as shellfish (shrimp, crab, etc.), organ meats (kidney, liver), red meat, red wine, and beer.

Gout can be treated with medications, diet changes, increasing consumption of appropriate fluids, and elevating and immobilizing the foot. It you are suffering from pain in your feet or ankles during this holiday season, call our office and make an appointment.

Assistant your diabetic loved one this autumn

November is National Diabetes Month, and an excellent reminder that the entire family should be involved with making sure that our diabetic loved ones stay healthy.

Here are some ways you can participate in healthy choices and actions with the whole family:

Plan meals carefully. Everyone can benefit from healthy   eating guidelines that your diabetic family member needs to follow.

Make fitness a part of your day.  Taking a walk together is a great way to help the entire family stay in shape, and to help your diabetic family member control blood sugars.

Feet can get cold on chilly autumn nights, so anyone with diabetes should wear socks to bed if their feet are cold.  They should never use a heating pad or hot water bottle.

Helped your family member check his or her.  Cuts, scratches, blisters, redness, and swelling can be detected early before they become a big problem.  So, inspect feet daily, and call our office of the first side of trouble.

Enjoying the fall colors and keep your feet safe

Autumn foliage is best enjoyed while hiking. Hiking, however, can often lead to injuries of the foot and ankle. Steep hills, slippery surfaces, and loose rocks can cause falls as well as stress to the muscles and tendons of the foot and ankle. Avoid problems such as heel pain, ankle sprains, and Achilles tendon injuries with these tips:

Use the right shoes:

Cross training athletic shoes don’t offer the support needed for hiking on uneven, steep, or slippery terrain. An investment in strong, well-insulated and moisture -proof hiking boots will lessen the stress on muscles and tendons and reduce the risk of injury. Look for shoes with a supportive shank: if the shoe bends in the middle, don’t buy it. Many hikers prefer high top hiking boots for more ankle support.

Easy does it:

Beginners should take on less difficult trails until they have mastered them , then move on to more difficult ones. Feet need to be in good physical condition to function properly, or else injuries may easily occur. Be sure to stretch the foot and ankle muscles, strengthen them, and do exercises to improve the sense of balance. This will improve your ability to deal with challenging terrain. Don’t attempt to take on more than your body is ready for; ease into your hiking routine before planning a long, strenuous trip. If you are injured , use  the RICE protocol: Rest, Ice, Compression, and Elevation. Then seek treatment at the nearest emergency facility or in our offices.

Hit the trails safely

Hiking is a great way to get exercise and fresh air while experiencing the beauty of changing seasons. Hiking-related injuries can range from relatively minor ailments such as blisters and bruises to more serious conditions, like stress fractures or ankle sprains.  These injuries may actually be seen as minor overuse injuries that will fix themselves.  Hikers may even attempt to treat the injuries by modifying their pace or by trying different shoes, but if left untreated, they can lead to  complications later.

Proper preparation before hikes can decrease the risk of injury.  Here are some easy ways to keep hikes safe:

–Wear properly fitting shoes or boots to protect toes from blisters and toenails from bruises.

–Condition and break in footwear  before your hike.

–Wear moisture- wicking socks to protect feet from the cold, and  excessive sweating.

–Be familiar with the hiking route and know your options for assessing medical assistance.

–Carry first aid supplies, such as bandages and wraps to help protect and stabilize injured feet ankles.

If you suffer a severe injury while on a hike, go to the nearest emergency room for treatment.  For less than emergent injuries or for follow-up care, call our office for appointment.