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Advanced Foot & Ankle Center

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Danbury, CT
Advanced Foot & Ankle Center

At Advanced Foot & Ankle Center, we believe that healthy feet are happy feet and we offer the highest quality podiatric care in Danbury, CT.

At Advanced Foot & Ankle Center, we are dedicated to relieving pain and treating your foot and ankle conditions promptly so you can get back on your feet and living a healthy, active life. Our board certified podiatrist, Paul Betschart, D.P.M. has over a decade of experience treating common foot problems, such as warts, bunions, ingrown toenails, calluses, corns, fungal toenails, and athlete’s foot, as well as more serious ailments, like Achilles tendonitis, plantar fasciitis, arthritis, flatfeet, gout, cysts, and neuromas. Advanced Foot & Ankle Center also treats ankle sprains, strains, fractures, and other sports related injuries. We want our patients to be educated about good foot health so they can make informed choices about their care. We believe that the foot doctor is your partner in developing a healthy lifestyle and we promote proactive and preventive care for diabetic patients, children, and seniors. Advanced Foot & Ankle Center has two easily accessible locations, one in Danbury, and offer convenient appointments and digital x-rays in both offices. Healthy feet are the foundation of a healthy body and that’s why our friendly and compassionate staff is committed to meeting all your foot and ankle care needs with the best quality care currently available. If you have questions or concerns about your feet, we urge you to call us today to set up a consultation and take the first step to good foot health.

08/22/2025

Gastroparesis Awareness Month is a valuable opportunity, not just for public education, but also for healthcare providers to reexamine a condition that often goes undiagnosed, particularly in patients with chronic, complex illnesses.

Gastroparesis is defined as delayed stomach emptying without a physical blockage. It sits at the intersection of gastrointestinal dysfunction and neurological impairment. For physicians, recognizing this connection is critical, not only for symptom relief but also for maintaining quality of life and stabilizing blood sugar, especially in people with diabetes.

Not One-Size-Fits-All
Gastroparesis isn’t a uniform disease. It varies widely and often begins with vague symptoms like bloating, early fullness, or occasional nausea, complaints that are easy to dismiss. But in patients with autonomic nerve damage, these symptoms can be severe and ongoing, rooted in deeper neurological problems.

This isn’t just a case of slow digestion, it’s a breakdown in communication between the brain and the gut, particularly in the systems that regulate automatic body functions, the autonomic nervous system.. For patients with diabetes, that breakdown can further destabilize an already delicate balance.

The Nerve Connection: Autonomic Neuropathy
The most common known cause of gastroparesis is diabetic autonomic neuropathy (DAN), which leads to damage of the vagus nerve. This is the nerve responsible for signaling the movement of food through the stomach and intestines. When the vagus nerve is impaired, gastric contractions slow down, causing food to remain in the stomach for an abnormally long time.

This leads to symptoms including:

Nausea
Vomiting
Bloating
Abdominal pain
And it’s a vicious cycle: erratic stomach emptying disrupts insulin timing and blood glucose control. Even well-managed diabetes becomes unpredictable.

It’s Not Just Diabetes
While diabetes is the most familiar cause, many other conditions can lead to vagus nerve dysfunction and gastroparesis. These include:

Amyloidosis
Parkinson’s disease and other neurodegenerative disorders
Autoimmune diseases
Paraneoplastic syndromes
Post-viral autonomic dysfunction (including long COVID)
In some cases, gastroparesis may be one of the first signs of a broader neurological or systemic issue.

What to Look For
Patients with autonomic neuropathy–related gastroparesis tend to have:

More severe and persistent GI symptoms
Symptoms that worsen with blood sugar swings
Other signs of autonomic dysfunction (e.g., orthostatic hypotension which is a rapid blood pressure drop when standing up, resting fast heart rate, erectile dysfunction)
The degree of vagal nerve dysfunction often correlates with how delayed the gastric emptying is. In diabetes, parasympathetic nerve damage (especially involving the vagus nerve) can occur early, sometimes before other autonomic symptoms develop.

Takeaways
Gastroparesis isn’t just a GI disorder, it’s often a warning sign of deeper neurological issues.

In diabetic patients, persistent GI complaints should trigger evaluation for autonomic neuropathy and adjustments in insulin regimens.

In non-diabetic patients, new gastroparesis symptoms may warrant a broader neurological or autoimmune workup.

Treatment should go beyond medications that promote motility. A well-rounded approach includes:

Dietary changes
Optimizing blood glucose
Considering neuromodulatory therapies when appropriate, especially where peripheral neuropathy also exists.
Ultimately, recognizing the gut–nerve connection can lead to better care, fewer unnecessary tests, and more precise treatment.

What’s more, peripheral neuropathy, which causes numbness, tingling, or weakness in the hands and feet, can sometimes predict problems with the autonomic nervous system. This is especially common in people with diabetes, where long-term high blood sugar can damage many types of nerves over time. When the same nerve damage that affects the feet and hands starts to impact the nerves that control automatic body functions, it can lead to more serious issues. It’s a red flag that the nerve damage is no longer staying in one place and it’s time to take action before more systems are affected.

06/26/2025

Gout is a specific type of arthritis that causes inflammation and pain in one or multiple joints.

It often begins suddenly without a warning. The pain can bring you to your knees.

It’s common for a gout attack to occur within the foot and ankle. In fact, the big toe joint is the most common place where gout shows up.

Gout happens when crystals of uric acid, a naturally occurring substance in the body, collect in the joint. The joint often becomes red, warm, and swollen.

The average age of onset for gout is between the ages of 30 and 50. Causes of gout include genetics, obesity, certain medications (diuretics), and diets rich in purines (red meat, shellfish, and beer).

We can often diagnose gout simply by the symptoms. X-rays and bloodwork can also aid in the diagnosis.

The good news is that gout is easily treatable with diet modifications and medications that prevent the production and collection of uric acid crystals within the body.

If you have a sudden onset of pain, redness, and swelling — especially if it’s at the big toe joint — don’t wait to have us evaluate it. We can often make the intense pain of gout disappear in a few hours.

06/11/2025

One of best decisions you can make for your feet is to wear shoes or quality slippers or sandals in the house.

Going without shoes on a hard surface over the course of time can cause problems.

It’s especially important to wear shoes at home if you are experiencing a foot or ankle issue. For a common condition like plantar fasciitis, just making this one change can help relieve some of the pain.

As we get older, we gradually lose the fat pad in our feet. It just makes sense to cushion our feet when on a hard surface.

If you like your feet to breathe at home, Birkenstock or Vionic sandals are two of the more supportive options.

Since we plan to live to a ripe old age, we must do whatever we can to preserve these two precious assets: our feet.
If you need specific recommendations for footwear, we are here to help!

05/28/2025

There are many conditions that can show up in the feet as a result of diabetes. Although we can’t diagnose diabetes just by looking at the feet, there are signs and symptoms that indicate the possibility.

Diabetes can affect circulation, skin, bones, muscles, tendons, and nerves. Blocked arteries can lead to pain as well as very extreme circumstances such as amputations. The skin can become darker, thinner and dry. People with diabetes can develop curled toes from the muscles and tendons not working properly.

A more severe consequence of diabetes can be that the bones in the mid-foot cause a collapse of the arch.

Numbness, tingling, burning and sharp pain - especially in the toes - can stem from a condition called diabetic neuropathy.

Those are just a few examples of how diabetes can affect the feet in many unfortunate ways.

One of the main reasons we encourage our patients not to wait on a foot concern is because sometimes the root cause is something bigger.

Waiting to treat a condition that might stem from diabetes could have dire consequences.

We specialize in treating diabetic foot conditions and preventing severe complications.

Please let us know how we can serve you.

05/21/2025

Sport-specific shoes are important because they can help prevent injuries, while enhancing performance and comfort. Material technologies used can provide cushioning, flexibility, fit/snugness/room, and traction to address the distinct biomechanical patterns inherent in the particular sport. Sport-specific shoes have uppers with midfoot support and most importantly, specially designed outsoles created for a given playing surface. In addition, some companies are offering additional widths in court and field shoes.
Midsoles, outsoles, upper materials, and heel and midfoot lockdown differ for each sport due to different containment, cushioning, and traction needs.
Using the wrong type of footwear for a particular activity can predispose you to injury.
An example of this that I have been seeing lately is the use of running shoes while playing the fast growing sport of pickleball, Pickleball is a court sport similar to tennis which demands lateral stability for side to side motion, Many people start playing pickleball in whatever athletic shoes they already have. Running shoes are designed for forward motion having less lateral stability and a thicker heel to cushion heel strike. These features can predispose court sport players to ankle sprains and tendon injuries. Pickleball specific shoes are currently rare but the choices are growing along with the sport. Tennis specific shoes are a great option as they provide the stability and mobility needed. Basketball shoes can be ok but are heavier on the feet.
Whatever the sport shoe needed, getting the correct fit is important. Start with a foot measurement using the Brannock device or similar measuring instrument . This should give a starting point for length and width.
Keep in mind that shoe sizing is not a uniform standard and can vary significantly even within brands. My rule of "thumb" for length is to be able to press the tip of your thumb between the end of the shoe and the longest toe.

05/07/2025

You may have a custom of not wearing shoes at home for cleanliness, comfort, or cultural reasons.

If you are working outside the home or tracking in the rain, slush, or dirt, you probably shed your shoes the moment you walk in the door. And of course, a change of shoes makes sense for these reasons.

But here’s the thing…

Consistently being barefoot, or just wearing socks or slippers at home, can cause or exacerbate foot conditions.

This is especially true if you have flat feet or high arches. Flat feet that don’t have support are prone to strains like plantar fasciitis and achilles tendinitis. High-arched feet need cushion, especially on hardwood floors.

If you are experiencing foot pain of almost any kind, wearing shoes at home can help prevent the condition from worsening.

If you can’t stand having shoes on at home, the next best thing is a quality pair of sandals. Some of the better brands for foot health are Birckenstock, Vionic, Keen, Chaco and Propet.

We have helped hundreds of plantar fasciitis sufferers get relief simply by recommending quality shoes or sandals for home use.

If you are doing a fair amount of standing at home, wear proper footwear. Your feet will thank you for giving them the support they need.

Com in and check out our new summer collection of quality foot wear from Propet. Your feet will be happy!

04/30/2025

Imagine a pain that just won't quit. It might start after an injury, even a minor one, but instead of fading away, it intensifies, spreads, and becomes a relentless, burning torment. This is a glimpse into the world of Complex Regional Pain Syndrome (CRPS), a chronic pain condition that can be both debilitating and perplexing.

CRPS, also known as Reflex Sympathetic Dystrophy (RSD), is a neurological condition characterized by persistent, often severe pain that is out of proportion to the initial injury. It typically affects one limb (arm, leg, hand, or foot) but can sometimes spread to other parts of the body.

What are the hallmarks of CRPS?

The symptoms of CRPS are varied and can change over time, making diagnosis challenging. However, some common signs and symptoms include:

Intense Pain: This is the defining feature, often described as burning, throbbing, shooting, or stabbing. The pain is usually far more severe than what would be expected from the initial injury.
Sensitivity to Touch (Allodynia): Even a light touch, like clothing brushing against the skin, can trigger excruciating pain.
Increased Pain Sensitivity (Hyperalgesia): Painful stimuli, like a pinprick, elicit an exaggerated and prolonged painful response.
Swelling: The affected limb may swell, sometimes significantly.
Skin Changes: These can include changes in temperature (feeling hot or cold), color (red, blue, pale, or mottled), texture (shiny, thin), and sweating patterns (increased or decreased).
Joint Stiffness and Movement Problems: Difficulty moving the affected limb, stiffness, and decreased range of motion are common.
Hair and Nail Changes: Hair growth may become faster or slower, and nails can become brittle or grooved.
Muscle Weakness and Tremors: Weakness in the affected limb and involuntary muscle twitching or tremors can occur.
What causes this intricate pain puzzle?

The exact cause of CRPS isn't fully understood, but it's believed to involve a malfunction in the peripheral and central nervous systems. Often, it's triggered by an injury, surgery, stroke, or heart attack. However, in some cases, there is no identifiable trigger.

Researchers are exploring several potential contributing factors, including:

Nerve Damage: Injury to nerves may lead to abnormal pain signals.
Inflammatory Response: An exaggerated inflammatory response to the initial injury might play a role.
Autonomic Nervous System Dysfunction: This system controls involuntary functions like heart rate, blood pressure, and sweating. In CRPS, it may become overactive, contributing to pain and other symptoms.
Genetics: There might be a genetic predisposition in some individuals.
Navigating the complexities: Diagnosis and Treatment

Diagnosing CRPS can be a journey, as there isn't one definitive test. Doctors rely on a thorough medical history, physical examination, and evaluation of the patient's symptoms. Imaging studies like X-rays, bone scans, and nerve conduction studies may be used to rule out other conditions.

Treatment for CRPS is typically multidisciplinary, aiming to manage pain and improve function. It often involves a combination of therapies, including:

Pain Medications: Over-the-counter and prescription pain relievers, nerve pain medications, and sometimes opioids may be used.
Physical and Occupational Therapy: Exercises to improve strength, flexibility, and range of motion are crucial.
Nerve Blocks: Injections of local anesthetics near affected nerves can provide temporary pain relief.
Spinal Cord Stimulation: Implanting a device that sends mild electrical impulses to the spinal cord can help block pain signals.
Psychological Support: Coping with chronic pain can be emotionally challenging. Therapy and support groups can provide valuable tools and understanding.
Other Therapies: Depending on the individual's needs, treatments like transcutaneous electrical nerve stimulation (TENS), biofeedback, and acupuncture may be considered.
Living with CRPS:

Living with CRPS can be incredibly challenging, impacting not only physical well-being but also mental and emotional health. It's essential for individuals with CRPS to have a strong support system, including family, friends, and healthcare professionals. Patient advocacy groups can also provide valuable resources and connections.

While there's currently no cure for CRPS, early diagnosis and a comprehensive treatment plan can significantly improve outcomes and quality of life. By understanding the complexities of this condition, we can foster greater awareness, encourage timely intervention, and ultimately help those affected navigate their journey with more hope and support.

If you or someone you know is experiencing persistent and unexplained pain, it's crucial to seek medical attention to explore the possibilities and receive appropriate care.

04/23/2025

Dislocations often occur because of an injury. The pain can be quite intense. Most of the time, the joint can be re-located back to its original position without the need for surgery.

An injury of the foot or ankle can lead to a dislocation. However, there is a unique syndrome involving the second toe that can become a dislocation without any injury.

It’s called Pre-Dislocation Syndrome.

This condition occurs where the second toe meets the foot. Most people will complain of pain in the ball of the foot, near that second toe.

Sometimes the second toe can become curled, raised, or significantly deformed. It can even overlap the big toe.

Other times, a person will present with pain but the toes will look perfectly normal.

The most common symptom is feeling like you are stepping on something under the ball of the foot. It can feel like a marble; or like the sock is bunched up, but it isn’t. The pain is most pronounced when walking around barefoot.

For reasons unbeknownst to us, women over 40 years of age are most prone to this condition. Certain women’s shoes can worsen the pain, but they do not cause the problem.

If you think you might have this condition, it is critical to get it diagnosed and treated as early as possible. That way we can prevent a full dislocation and the potential need for surgery.

If you are experiencing pain on the ball of the foot, feel like you are stepping on something in this area but nothing is there, or your second toe alignment looks out of the ordinary, don’t wait to have it assessed.

04/16/2025

We are always looking for the easiest and least invasive methods for treating foot conditions. We pride ourselves on being able to help someone avoid surgery.

Surgery is a common treatment for a painful bunion, but not the only one. Some people aren’t in the position to take the time off needed to heal from bunion surgery.

Some of the methods we’ve used to help our patients avoid surgery are new and innovative, and some are old and long-reliable.

One of the most reliable traditional treatments for alleviating pain from a bunion is the use of custom orthotics.

Custom orthotics are made from a mold of your feet. They are effective at reducing or stopping the pain from a bunion because they prevent the foot from turning inward. By stabilizing the foot, there’s less irritation on the bunion as it no longer rubs against the shoe..
Not only can orthotics stop bunion pain; they can slow down how fast a bunion grows. They slow down the progression of the deformity by stabilizing the first ray(the big toe and the bones behind it). Many bunions get bigger with time unless something changes about how the foot moves.

We’ve had teenagers and adults walk in with consistent pain from a bunion, and walk out of our office pain-free thanks to custom orthotics.
Orthotics are also helpful at avoiding surgery for many other foot conditions including neuromas, hammer toes, metatarsalgia, plantar fasciitis and flat feet.

If you are experiencing pain from a bunion and would like to avoid surgery, orthotics are an easy and painless solution

04/09/2025

The tip of the toe is a place where some unhappy things can happen. A callous can form here - especially if the toe bends downward even just a little bit, or if the second toe is longer than the big toe.

The tip of the toe can also develop an open sore called an ulcer. People who have diabetes or neuropathy are most prone to ulcers. However, you don’t have to have diabetes, neuropathy or poor circulation to have a problem at the tip of one of your toes.

If left untreated, an ulcer at the tip of the toe can lead to an infection - and even result in loss of the toe.

Sometimes a callous or ulcer at the tip of the toe can also involve the nail, which usually produces more pain. The nail can become thicker, discolored, and sometimes loose enough to fall off.

If you are experiencing pain in one of your toes, it may be coming from one of these conditions.

There aren’t home remedies for any of the conditions mentioned above, but we would be happy to treat any of these problems for you.

We specialize in solving all foot problems - none too big or too small, not even a tip of the toe

03/26/2025

You probably have heard of the term “bone spur."

Although commonly found in the heel, bones spurs can form in several different places in the foot.

One of the places we see is them under a toenail. This can be quite painful.

Sometimes the toe looks perfectly normal, and other times there is a noticeable deformity of the nail.

If a toenail is raised, discolored, deformed or painful, it could be caused by a bone spur.

A bone spur under the nail that isn’t causing any problems can usually be left alone. But if the spur is causing pain, the only option is removal.

Removal of a bone spur under the nail is a straight forward procedure that can be performed in the office under local anesthetic. We’ve helped many patients get rid of toe pain by removing a bone spur.

The only way you would know if a bone spur is present is by getting an X-ray. So if you’re experiencing pain and would like to address the source, schedule an appointment and we’ll get to the bottom of it.

03/19/2025

Spring is a great time to begin an exercise program. As the weather warms many of us are eager to get out and "hit the bricks" to start our running programs. Many people are training with a goal of competing, others to stay in shape. Whatever the goal, training places demands on the body, including micro trauma to the muscles. It is the recovery from this trauma that allows the body to become stronger and increase exercises tolerance.
Most of us focus on the training effort, but rest and recovery is equally important in developing strength and stamina. Rest and recovery days with reduced or no training are needed periodically throughout the training cycle. Cross training by performing a different movement than the primary exercise(for example biking instead of running) is an way to achieve relative rest while still training.
An important but often overlooked part of recovery is sleep. Quality sleep of adequate duration is essential to allow the body to repair tissues for recovery and improvement. Most people should aim for 7-9 hours of sleep in a cool, dark room.
How do you know if you are overtraining? Some of the signs include fatigue and poorer performance. Other symptoms include loss of appetite, headaches, sleep disturbance and irritability.
A more accurate assessment of recovery is Heart Rate Variability. This is the variation of heart rate during rest and sleep. This can be measured manually, which can be time consuming and complicated but can be measured with certain fitness watches and trackers if worn during rest and sleep. A quick estimate of heart rate variability can be made by simply tracking resting pulse rate upon rising each morning before getting out of bed. A resting pulse rate more than 10 beats above average is a good indication that you are not adequately recovered.
Injuries related to overtraining and under recovery bring a lot of people into the office in the spring. If you have a lower extremity pain that is not responding to rest, make sure you get in to the office for an evaluation and treatment so we can get you back to training as soon as possible.

Address

57 North Street, Ste 108
Danbury, CT
06810

Opening Hours

Monday	9am - 7pm
Tuesday	8am - 5pm
Wednesday	8am - 5pm
Thursday	8am - 5pm
Friday	8am - 5pm
Saturday	8am - 12pm

Telephone

+12037910466

Website

http://www.danburypodiatrist.com/

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Our Story

At Advanced Foot & Ankle Center, we are dedicated to relieving pain and treating your foot and ankle conditions promptly so you can get back on your feet and living a healthy, active life. Our board certified podiatrist, Paul Betschart, D.P.M. has over two decades of experience treating common foot problems, such as warts, bunions, ingrown toenails, calluses, corns, fungal toenails, and athlete’s foot, as well as more serious ailments, like Achilles tendonitis, plantar fasciitis, arthritis, flatfeet, gout, cysts, and neuromas. Advanced Foot & Ankle Center also treats foot and ankle sprains, strains, fractures, and other sports related injuries. We want our patients to be educated about good foot health so they can make informed choices about their care. We believe that the foot doctor is your partner in developing a healthy lifestyle and we promote proactive and preventive care for diabetic patients, children, and seniors. Advanced Foot & Ankle Center has two easily accessible locations, one in Danbury and one in Middlebury, and offer convenient appointments and digital x-rays in both offices. Healthy feet are the foundation of a healthy body and that’s why our friendly and compassionate staff is committed to meeting all your foot and ankle care needs with the best quality care currently available. If you have questions or concerns about your feet, we urge you to call us today to set up a consultation and take the first step to good foot health.