David Krausse DPM LLC

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.

07/16/2025

Pickleball Injuries on the Rise

Pickleball – the highly competitive sport with a funny name – combines elements of tennis, badminton and ping pong and has recently become popular among people of all ages. But, while everyone’s having a lot of fun and getting some great exercise, foot and ankle surgeons caution players also need to be aware of injury risks and take precautions to avoid them.

Pickleball, like tennis, can put players at risk for many toe, foot and/or ankle injuries. Foot and ankle surgeons have seen an increase in injuries from their patients who play the active sport, including:

Ankle sprains, strains and fractures,
Achilles tendonitis, tears and strains,
Toenail injuries
Metatarsal fractures (bones of the foot)
Broken toes
Onychomycosis (a fungal infection of the toenail)

To protect against injury on the court, players of any age or fitness level should always warm up and stretch before a practice or a game, and cool down afterward. They should also be sure to wear proper athletic shoes that are well-fitting, supportive and broken-in, as well as appropriate orthotics as needed for things like additional arch support.
Everyone – from little kids to their grandparents - need to be smart and immediately address any injuries that happen on the court. As a first step, players can use the RICE approach - rest, ice, compression, and elevation - for less serious injuries and allow time for recovery before hitting the court again.
If the pain persists, it may be signaling something more serious that requires a professional diagnosis and treatment plan from a foot and ankle surgeon. For players who find themselves in a “pickle,” early intervention is the key to proper healing.

06/23/2025

Malignant Melanoma of the Foot

What Is Malignant Melanoma?
Melanoma is a cancer that begins in the cells of the skin that produce pigmentation (coloration). It is also called malignant melanoma because it spreads to other areas of the body as it grows beneath the surface of the skin. Unlike many other types of cancer, melanoma strikes people of all age groups, even the young.

Melanoma in the Foot
Melanoma that occurs in the foot or ankle often goes unnoticed during its earliest stage, when it would be more easily treated. By the time melanoma of the foot or ankle is diagnosed, it frequently has progressed to an advanced stage, accounting for a higher mortality rate. This makes it extremely important to follow prevention and early detection measures involving the feet as well as other parts of the body.

Causes
Most cases of melanoma are caused by too much exposure to ultraviolet (UV) rays from the sun or tanning beds. This exposure can include intense UV radiation obtained during short periods or lower amounts of radiation obtained over longer periods.

Anyone can get melanoma, but some factors put a person at greater risk for developing this type of cancer. These include:

Fair skin; skin that freckles; blond or red hair
Blistering sunburns before the age of 18
Numerous moles, especially if they appeared at a young age
What Should You Look For?
Melanoma can occur anywhere on the skin, even in areas of the body not exposed to the sun. Melanoma usually looks like a spot on the skin that is predominantly brown, black, or blue, although in some cases, it can be mostly red or even white. However, not all areas of discoloration on the skin are melanoma.

There are four signs—known as the ABCDs of melanoma—to look for when self-inspecting moles and other spots on the body:

AssymetryAsymmetry -- Melanoma is usually asymmetric, which means one half is different in shape from the other half.

Irregular borderBorder -- Border irregularity often indicates melanoma. The border, or edge, is typically ragged, notched or blurred.

Mix of colors or huesColor -- Melanoma is typically a mix of colors or hues, rather than a single, solid color.

Melanoma grows in diameterDiameter -- Melanoma grows in diameter, whereas moles remain small. A spot that is larger than 5 millimeters (the size of a pencil eraser) is cause for concern.

If any of these signs are present on the foot, it is important to see a foot and ankle surgeon right away. It is also essential to see a surgeon if there is discoloration of any size underneath a toenail (unless the discoloration was caused by trauma, such as stubbing a toe or having something fall on it).

Diagnosis
To diagnose melanoma, the foot and ankle surgeon will ask the patient a few questions. For example: Is the spot old or new? Have you noticed any changes in size or color? If so, how rapidly has this change occurred?

The surgeon will also examine the spot to determine whether a biopsy is necessary. If a biopsy is performed and it reveals melanoma, the surgeon will discuss a treatment plan.

Prevention & Early Detection
Everyone should practice strategies that can help prevent melanoma, or at least aid in early detection, so that early treatment can be undertaken.

Precautions to avoid getting melanoma of the foot and ankle, as well as general precautions, include:

Wear water shoes or shoes and socks—flip flops do not provide protection!
Use adequate sunscreen in areas that are unprotected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of feet.
Inspect all areas of the feet daily, including the soles, underneath toenails and between the toes.
If you wear nail polish, remove it occasionally so that you can inspect the skin underneath the toenails.
Avoid UV radiation during the sun’s peak hours (10:00am to 4:00pm) beginning at birth. While sun exposure is harmful at any age, it is especially damaging to children and adolescents.
Wear sunglasses that block 100 percent of all UV rays—both UVA and UVB.
Wear a wide-brimmed hat.

Remember: Early detection is crucial with malignant melanoma. If you see any of the ABCD signs—or if you have discoloration beneath a toenail that is unrelated to trauma—be sure to visit a foot and ankle surgeon as soon as possible.

06/05/2025

Black Toenails

A black, purple or brownish discoloration under or involving a toenail is frequently due to trauma to the toenail, such as when something is dropped on the toe. The color results from a blood clot or bleeding under the nail and may involve the entire nail or just a small portion of it. This can be very painful when the entire nail is involved and may need medical attention to relieve the pressure caused by bleeding under the toenail.

When the second or third toenails are involved, it is commonly referred to as "runner's toe." This can be the result of the nail being slightly too long and the shoe being either too big or too tight. If the shoe is too big, when running down hill, the foot slips and the nail can get caught where the toe cap meets the toebox. If the shoes are too tight, the nail can get pinched and jammed, resulting in bleeding between the nail plate and nail bed.

Although it is very rare, a more serious cause of black toenails is malignant melanoma. Since early diagnosis and treatment of melanoma improves the chances for a good outcome, it is important that all black toenails be evaluated by a qualified foot and ankle surgeon to rule out this cause.

Other rare causes of black toenails include fungal infections, chronic ingrown nails or health problems affecting the rest of the body.

05/26/2025

05/13/2025

Prevent Trips, Slips & Falls

Among older Americans, falls are the number one cause of injuries and death from
injury. To help reduce the risk of falls, foot and ankle surgeons recommend keeping
your feet and ankles healthy by following these helpful tips.

DON’T IGNORE PAIN
Foot pain is not a normal consequence of growing
older, so don’t resign yourself to aching and
suffering. Pay attention to what your feet are
telling you, and see a foot and ankle surgeon for
an accurate diagnosis when you experience pain.

EXAMINE YOUR FEET
Make regular foot self-examinations
a routine at home. At the first sign of
bumps, lumps or other changes in your
feet, make an appointment with
your foot and ankle surgeon for
further examination.

EXERCISE
Simple stretching exercises can help you
maintain strength and mobility in your feet
and ankles, as well as provide pain relief.
Talk to your foot and ankle surgeon about
appropriate exercises to fit you.

PROTECT
Use padding, insoles or whatever special
footwear you are prescribed and wear them
every day with comfortable, sensible shoes.
For more foot and ankle health information,
visit FootHealthFacts.org, the patient
education website of the American College
of Foot and Ankle Surgeons.

BE FLEXIBLE
Remember, some foot and ankle conditions are treatable
with conservative methods, but sometimes the best
treatment option to help you stay on your feet is surgery.
Many simple surgical techniques allow foot surgery to
be performed on an outpatient basis. Talk to your foot
and ankle surgeon for all your treatment options and
keep an open mind

04/28/2025

Tips for Parents: How to Spot Kids' Foot Problems

Advice to help parents recognize conditions early.


Just part of growing up vs. the sign of a problem—managing children's health and wellness is complicated for parents, who often struggle to know which signs and symptoms are temporary and which point to more serious concerns. As parents transition back to the regular routines of fall with school and sports, the American College of Foot and Ankle Surgeons offers practical tips to help parents know what their children's feet are telling them.

Common pediatric foot problems can range from pediatric flat foot, toe walking, in-toeing and flat or high arches to tarsal coalitions and extra bone growth. While these conditions and their treatments are different, they share some common signs that show parents there is a problem that needs addressing by a foot and ankle surgeon:

Pain, swelling and redness that does not subside
Development of thick calluses in one area of the foot
Problems with the way your child walks (gait)
Shins or thighbones that appear to turn inward
Ankles that are weak or easily give out

A variety of treatment options for these conditions is available that parents can evaluate in partnership with their healthcare team. Whether a less invasive approach, such as shoe modifications, orthotic devices and physical therapy, or more intensive interventions, such as bracing, steroid injections or surgery, a foot and ankle surgeon can advise parents on which treatment offers the best long-term prognosis for their children.

04/06/2025

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
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.

03/03/2025

Baseball Injuries to the Foot and Ankle

Your feet and ankles take a beating when you’re playing baseball. Baseball players should be aware of the following risks.

Ankle sprains may occur while running, fielding balls, stepping on or sliding into bases. Sprains should be evaluated by a foot and ankle surgeon to determine the extent of injury, including possible peroneal tendon injuries or fractures. The foot and ankle surgeon will develop a treatment plan: failure to fully treat and rehabilitate a sprain may lead to chronic ankle instability and recurrent sprains.
Overuse or excessive training may sideline some athletes with Achilles tendinopathy or heel pain (often plantar fasiciitis, or calcaneal apophysitis in children and adolescents).
Contusions may occur from impact with the ball or contact with other players.
Cleats may pose challenges in the forefoot and aggravation of neuromas, sesamoids, bunions and hammertoes. To stay at the top of your game, ensure that cleats are fitted properly and have injuries evaluated by a foot and ankle surgeon.
One of the most common injuries seen in pitchers and catchers is ingrown toenails. If the nails are cut too short or at an angle, the torque and demand on the toes as they help balance the foot can lead to ingrowing. If ignored, this can lead to a nail infection (paronychia) and cellulitis (a potentially serious bacterial skin infection).