David Krausse DPM LLC

11/19/2025

11/19/2025

10/17/2025

Ingrown Toenail

What Is an Ingrown Toenail?
When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This digging in of the nail irritates the skin, often creating pain, redness, swelling and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe is not painful, red, swollen or warm, a nail that curves downward into the skin can progress to an infection.

Causes of ingrown toenails include:

Heredity. In many people, the tendency for ingrown toenails is inherited.
Trauma. Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
Improper trimming. The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.
Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.
Nail conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

Treatment
Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot or poor circulation.

Home Care
If you do not have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom salt may be recommended by your doctor) and gently massage the side of the nail fold to help reduce the inflammation.

Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it is time to see a foot and ankle surgeon.

Physician Care
After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.

Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.

Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Preventing Ingrown Toenails
Many cases of ingrown toenails may be prevented by:

Proper trimming. Cut toenails in a fairly straight line, and do not cut them too short. You should be able to get your fingernail under the sides and end of the nail.
Well-fitting shoes and socks. Do not wear shoes that are short or tight in the toe area. Avoid shoes that are loose because they too cause pressure on the toes, especially when running or walking briskly.

What You Should Know About Home Treatment
Do not cut a notch in the nail. Contrary to what some people believe, this does not reduce the tendency for the nail to curve downward.
Do not repeatedly trim nail borders. Repeated trimming does not change the way the nail grows and can make the condition worse.
Do not place cotton under the nail. Not only does this not relieve the pain, it provides a place for harmful bacteria to grow, resulting in infection.
Over-the-counter medications are ineffective. Topical medications may mask the pain, but they do not correct the underlying problem.

09/08/2025

Diabetic Peripheral Neuropathy

What Is Diabetic Peripheral Neuropathy?
Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet, it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves.

Three different groups of nerves can be affected by diabetic neuropathy:

Sensory nerves, which enable people to feel pain, temperature and other sensations
Motor nerves, which control the muscles and give them their strength and tone
Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating

Diabetic peripheral neuropathy does not emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy. The loss of sensation and other problems associated with nerve damage make a patient prone to developing skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg or even a life.

Causes
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even patients living with diabetes who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.

As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage development of ulcers. For example:

Deformities (such as bunions or hammertoes) resulting from motor neuropathy may cause shoes to rub against toes, creating a sore. The numbness caused by sensory neuropathy can make the patient unaware that this is happening.
Because of numbness, a patient may not realize that s/he has stepped on a small object and cut the skin.
Cracked skin caused by autonomic neuropathy, combined with sensory neuropathy’s numbness and problems associated with motor neuropathy, can lead to developing a sore.
Motor Neuropathy (Deformity) + Ill-Fitting Shoes + Sensory Neuropathy (numbness) = Ulcers (sores)
Symptoms
Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.

For sensory neuropathy:

Numbness or tingling in the feet
Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

For motor neuropathy:

Muscle weakness and loss of muscle tone in the feet and lower legs
Loss of balance
Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:

Dry feet
Cracked skin

Diagnosis
To diagnose diabetic peripheral neuropathy, the foot and ankle surgeon will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient’s reflexes, ability to feel light touch and ability to feel vibration. In some cases, additional neurologic tests may be ordered.

Treatment
First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.

Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used.

In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.

Prevention
The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:

Keep blood sugar levels under control.
Wear well-fitting shoes to avoid getting sores.
Inspect your feet every day. If you notice any cuts, redness, blisters or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse.
Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes.

08/06/2025

Gout

What Is Gout?
Gout is a disorder that results from the buildup of uric acid in the tissues or a joint. It most often affects the joint of the big toe.

Causes
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid.

Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is farthest from the heart, it is also the coolest part of the body and, thus, the most likely target of gout. However, gout can affect any joint in the body.

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”) and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as in women.

Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer and red meat.

Symptoms
An attack of gout can be miserable, marked by the following symptoms:

Intense pain that comes on suddenly, often in the middle of the night or upon arising
Signs of inflammation, such as redness, swelling and warmth over the joint

Diagnosis
To diagnose gout, the foot and ankle surgeon will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.

Treatment
Initial treatment of an attack of gout typically includes the following:

Medications. Prescription medications or injections are used to treat the pain, swelling and inflammation.
Dietary restrictions. Foods and beverages that are high in purines should be avoided since purines are converted in the body to uric acid.
Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the buildup of uric acid over time can cause arthritic damage to the joint.