Category: Podiatry

Diagram showing proper footwear, sock selection, foot inspection, and skin moisturizing for diabetic foot care.

Diabetic Foot Care: How to Check and Protect Your Feet

On By Dr. Scott RennieIn Podiatry, Senior & Caregiver Health, Weight Loss & Metabolic Health, Wound care3 Comments

shutterstock_110360354Patients who have diabetes need to pay extra attention to their foot care to help prevent infections.  I’ve had numerous patients with diabetes need foot or toe amputations that could have been prevented with excellent foot hygiene.  Small scrapes in the skin or ingrown nails can become extremely bad very quickly with diabetes because patients who have diabetes often don’t have as much sensation (due to damage to the nerve endings and blood vessels in your feet).  This can make it difficult to detect sores and once an infection is present it can be very difficult to treat.  I thought I’d put together some tips to help you keep your feet healthy and decrease the risk for infections.

  1. Stop smoking:  If you smoke, this can decrease the blood flowing to your feet and make foot problems worse.
  2. Inspect your feet everyday:  Look for blisters, cuts, cracks or sores.  If you cannot see your feet well then use a mirror or have a family member help you.
  3. Wash your feet everyday:  Use warm (not hot) water – be sure to check the temperature with your hands rather than your feet.
  4. Dry your feet well:  Pat them dry and do not rub the skin on your feet too hard.  Dry between each toe.  If the skin on your feet stays moist, bacteria or fungus can grow and that might lead to a foot infection.
  5. Keep your feet soft:  Use a skin moisturizer such as Aveeno, Dove or Cetaphil on your feet to keep your skin soft and prevent calluses and cracks.  Don’t put the cream between your toes unless you are treating athlete’s foot with a fungal cream.  Make sure to wear socks or traction on your feet after applying the cream so you don’t slip and fall.
  6. Clean under your toenails carefully:  Don’t use sharp objects under your toenails.  Instead use the blunt end of a nail file or other rounded tool to decrease the chance of piercing the skin.
  7. Trim and file your toenails straight across:  This helps prevent ingrown nails.  Use a nail clipper instead of scissors.  Then use an emery board to smooth the edges.  If you need help trimming your nails, schedule an appointment with your medical provider.
  8. Change your socks everyday:  Socks should have a thick cushion and fit loosely around your feet.  Socks without seams are best because seams often rub the feet.  Do not wear stockings, socks, or garters that come up to the thigh or knees unless your medical provider advises you to do so because they can decrease the blood flow to your feet.
  9. Look inside your shoes before putting them on:  Check them every day for gravel, torn linings, or thorns that can cause blisters or sores.
  10. Do not go barefoot:  Don’t wear sandals or shoes with thin soles because these types of shoes are easy to puncture.  They also do not protect your feet from hot pavement or cold weather.
  11. Have your medical provider check your feet during each visit:  If you notice a problem with your feet, see your medical provider right away rather than trying to treat it with a home remedy.  Some home remedies or treatments that you can buy without a prescription (such as corn removers) can be harmful.
  12. Keep your blood sugar down:  Watch what and how you eat, monitor your blood sugar, take your medications and get regular exercise.

When to seek medical help:

A)      If you cannot do proper foot care

B)     If you have a foot sore or ulcer that is not healing after 3 days (including corns, calluses or ingrown nails)

C)     If you have black and blue areas in your toes or feet

D)    If you have peeling skin or blisters between your toes

E)     If you have a fever for more than 24 hours and a foot sore

F)     If you have new numbness or tingling in your feet that does not go away after you move your feet or change positions

G)    If you have unexplained or unusual swelling of your foot or ankle

H)    Anytime you have questions about your feet or concerns it is best to contact your medical provider

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sole of foot with dry, peeling skin and calluses

Calluses and Corns: Causes, Prevention, and Treatment

On By Dr. Scott RennieIn Other Diseases and Conditions, Podiatry, Wound careLeave a comment
shutterstock_113610118shutterstock_93910513I can’t tell you how many patients come in to the clinic because of a callus or corn that’s bothering them – too many to count!  Corns and calluses can cause significant pain, especially when they’re on the feet because we often get them in areas over pressure areas.  When they get thickened they can re-distribute your weight onto other areas of your feet and that may lead to foot instability or worsening pain. Calluses are usually on the hands and feet and basically just thickened areas of skin that form when something rubs or presses on these areas over prolonged periods of time. Corns are thickened areas of skin that are often on the soles of the feet or sides of the toes and look like a small nodule that has a hard center.  Corns are usually more painful because they are often over a smaller area and press harder on a more specific area of the foot. Causes:  Possible reasons that calluses or corns develop include: 1)   Wearing shoes that don’t fit properly for your feet – either too loose or too tight 2)   Walking barefoot 3)   Wearing shoes without socks 4)   Calluses on the hands can be caused by repetitive sports such as rowing, golfing, tennis or biking without gloves Prevention: 1)   Get shoes that fit properly!  It’s important to be proactive and to prevent calluses or corns if they bother you.  There are special shoe stores that work with foot doctors to help you select shoes that fit your feet properly.  Some people are born with narrow or wide feet and that makes it more difficult to find shoes that fit properly.  If you are getting painful corns or calluses, take time and visit a store where someone can help you to pick out shoes that fit you well 2)   Avoid going barefoot or wearing shoes without socks 3)   If you have spots on your feet that rub inside your shoes, you can get special pads that prevent rubbing Treatment:  I often work with patients who come into the clinic to trim the corn or callus down so that it reduces the pressure in the affected area.  I use a scalpel to carefully trim away the thickened skin.  A foot doctor (podiatrist or orthopedic surgeon who specializes in treating conditions of the foot/ankle) can make special orthotic devices that can help reduce the pain and help prevent recurrence of corns/calluses.  Some people treat calluses themselves by purchasing special pads that contain medications to burn or dissolve the thick skin.  I highly recommend that patients with diabetes be seen and treated by a medical provider to reduce the risk of infection.  Diabetic patients are at increased risk of foot infections and should be seen for yearly foot examinations even if they don’t have calluses or corns.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Person sitting on bed and holding their lower leg

Plantar Fasciitis Explained: A Real Pain in the Foot

On By Dr. Scott RennieIn Other Diseases and Conditions, PodiatryLeave a comment
shutterstock_90181162One of the more common reasons that I see patients in the urgent care for is plantar fasciitis.  It causes foot pain, mostly in adults.  Patients are more prone to this kind of foot problem if they jump or stand for prolonged periods of time.  These motions stretch the plantar fascia.  Most people who have an episode of plantar fasciitis have no pain within one year. Causes:  A strain in the ligaments in the fascia which is a thick, white pearly tissue with long fibers that starts at the heal bone and fans out along the under surface of the foot and extends to the toes.  The plantar fascia provides support as the toes bear the weight of the body when the heal rises while walking. Symptoms:  pain beneath the heel and sole of the foot.  The pain is often worst when stepping out of bed early in the morning or getting up after being seated for a period of time. Risk factors: 1)   Long distance running 2)   Standing for long periods of time (grocery store cashiers for example) 3)   Dancing 4)   Repeated squatting or standing on the toes 5)   Poor fitting shoes 6)   Obesity Diagnosis:  The diagnosis is usually made by a healthcare provider who takes the history of the patient and performs a physical examination. Treatment:  Several treatment options are used to help with plantar fasciitis.  They may include: 1)   Rest – Limit jumping or standing for extended periods of time.  A complete lack of physical activity is not recommended however 2)   Ice – Putting ice on the area 4x/day for 20 minutes at a time may reduce pain 3)   Exercise – Home exercises including calf-plantar stretches, foot and ankle circles, toe curls, and toe towels often help reduce pain.  Careful attention not to overdo the stretches is important 4)   Pain medication – Ibuprofen or Naproxen may be helpful to reduce the swelling and pain 5)   Shoes with good arch support or metal shanks take the pressure off the plantar fascia and are one of the most important parts of treatment. 6)   Steroid Injection – a steroid shot may be given in the foot to relieve pain but usually the effect wears off after a few weeks.  There is also a risk of worsening the foot pain due to small crystals of the steroid forming in the plantar fascia 7)   Casting – a short walking cast that has a rocker-shaped bottom decreases the flexibility of the sole of the foot and can provide relief from pain. 8)   Surgery  – this is rarely recommended for plantar fasciitis.  If symptoms persist for at least 6-12 months and all other treatments have failed, it may be an option for some people   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Feet soaking in wooden bowl with steaming water, lavender, and Epsom salts

Ingrown toenails and paronychia

On By Dr. Scott RennieIn Infectious Disease, Other Diseases and Conditions, Podiatry1 Comment
shutterstock_149255009I see patients who come into the clinic for ingrown nails, most often toenails but even ingrown fingernails can bring people to the doctor. Paronychia: an inflammation involving the lateral and proximal fingernail folds.  It can be acute (rapid onset) or chronic (long-standing). Causes:  occupations where the hands are in the water frequently, nail biting, thumb sucking, overzealous manicuring and even diabetes can lead to fingernail infections. Ingrown toenail:  The big toe is most commonly affected.  Signs and symptoms can include pain, swelling, drainage and granulation tissue.  It’s more common to get ingrown toenails from poor fitting shoes, toe trauma, excessive trimming of the lateral nail plate, or in patients who have a over-curvature of the nail which can be hereditary or acquired. Acute nail infections are usually accompanied by redness, and pain at the sides of the nail, sometimes with a blister that can be filled with purulent material If the patient hasn’t been biting their nails, the infection is most often caused by Staphylococcus aureus or Steptococcus pyogenes or a combination of both.  Different bacteria are often present if the patient is a nail biter. Chronic nail infections are often associated with eczema, however it can also be complicated by a Candida or yeast infection of the nails. Diagnosis:  In the clinic we can usually tell that there is a nail infection by the appearance of the nail folds on examination.  If a purulent fluid collection is present, the diagnosis is even easier to make. Treatment:  If the infection has come on rapidly (acute onset), the treatment usually involves warm compresses or soaks to the affected finger or toe for 20 minutes three times/day.  Antibiotics that are taken orally may be helpful in severe causes.  Topical antibiotics such as triple antibiotic ointment might be helpful after soaking the digit, but there isn’t a lot of research to support it. If there is an abscess present, incision and drainage is usually helpful in addition to the above treatments.  We usually perform a digital block to numb the finger or toe for comfort before the surgery is performed.  Treatment with antibiotics is common and we usually use them for 5 days after a surgical drainage and for 7-10 days if there is no drainage.  The choice of the antibiotic depend on whether the patient has been biting the nails, and the patient’s history of drug allergies.  Possible treatment options include dicloxacillin, Keflex (no no MRSA in suspected) or Bactrim.  We may also add metronidazole or clindamycin to the regimen if the patient has been biting their nails. For ingrown toenails that are mild, we may place a cotton wedge or dental floss underneath the lateral nail plate to relieve the pressure and doing the soaks in warm soapy water for 10-20 minutes 3x/day.  If the ingrown nail is severe however, we usually perform a partial nail removal after doing a digital block to relieve the discomfort.  Antibiotics may be prescribed after partial nail removal may be helpful, however evidence has not shown that antibiotics decrease the healing time. Follow-up after 3-4 days to assess treatment. Recurrent ingrown toenails:  May require treatment with permanent nail ablation surgery using both surgical excision plus phenol ablation (chemical matricectomy).  The keeps the toenail from returning. Post-op care after toenail removal:  You should be able to put weight on both feet immediately after surgery, but walking will be uncomfortable.  Some mild bruising and bleeding is normal after foot surgery. We usually apply some antibiotic ointment and 4×4” gauze, tube gauze and paper tape.  After 24-48 hours, soak the affected toe in warm, soapy water and reapply antibiotic ointment and a clean bandage.  This should be done 3-4x/day for 1-2 weeks after the procedure.   Keep your foot and leg elevated while sitting or lying down and make sure your bandages are clean and dry at all times.  We ask patients not to wear shoes for 3 days and recommend antibiotics and anti-inflammatory medications for 10 days.   I hope that you have found this information useful.  Wishing you the best of health,

For most people an ingrown toenail is a nuisance. With diabetes or neuropathy it is a different problem, because an infected nail edge on a foot you cannot feel well is how some ulcers start, which is why I wrote about protecting your feet if you have diabetes.

Updated for 2026: Mostly Confirmed, With One Number Worth Having

I went looking for what had changed here since 2012 and the honest answer is: not much. No major society has rewritten this in the last few years. The approach I described holds up. So rather than manufacture a revolution, here is what has been sharpened. For an ingrown toenail bad enough to need a procedure, the thing that matters is whether the nail matrix gets treated, not just the nail edge removed. Partial nail avulsion combined with chemical destruction of the matrix using phenol gets cure rates above 95 percent. Avulsion alone does not. A 2025 trial of 140 patients put recurrence at 1.43 percent with phenol against 10 percent without (1). So if you are offered a procedure for a recurring ingrown nail, the question worth asking out loud is whether the matrix is being treated. That single detail is the difference between fixing it and doing it again next year.

Chronic Paronychia Is Not an Infection

This is the part I most want to correct, because it is treated wrongly all the time. Acute paronychia, the hot painful swelling beside a nail that comes on over a day or two, is an infection. Warm soaks, and if there is a pocket of pus it needs draining. Once it is drained, oral antibiotics usually are not necessary. They get reserved for spreading cellulitis, a suppressed immune system, or someone who is genuinely unwell (2). Chronic paronychia, meaning six weeks or longer, is a different animal. It is an irritant dermatitis, driven by repeated wet work and exposure, and treating it with antifungals or antibiotics does not work because it is not an infection. The treatment is getting the hands out of the water, barrier protection, and a topical steroid or calcineurin inhibitor. It takes weeks to months to settle, and people abandon treatment long before that (2). If you have had a swollen nail fold for two months and have been through three courses of antibiotics, that is the pattern.

What This Looks Like Over Video

A photograph does most of the work here, and this is one where I want more than one angle. From directly above and from the side, so I can see whether the nail fold is simply inflamed or whether there is a pocket of pus lifting it. What I need from you beyond that is duration, which is the single most useful question, along with what your hands or feet are exposed to during the day, whether you are diabetic, and what has already been tried. I can settle the chronic cases from here, and those are the ones most often mismanaged. What I cannot do is drain anything or take a nail off, so if there is pus, or if the nail needs a procedure, my job becomes telling you that clearly and getting you to someone who can do it.

When To Be Seen, Sometimes Urgently

Spreading redness, red streaking, or fever. Any toe infection at all if you have diabetes or poor circulation, where the threshold to be seen should be much lower than you think. Severe pain in the finger pulp, which can mean a felon. And pain on straightening the finger with a sausage shaped swelling, which suggests flexor tenosynovitis and is a same day surgical problem, not something to sleep on.

The Bottom Line

For a nail that keeps growing in, ask whether the matrix is being treated. For a nail fold that has been swollen for months, stop taking antibiotics for it and start treating the skin.

Sources

1. Comparison of Partial Nail Avulsion With or Without Phenolization in the Management of Ingrown Toenails. Cureus. May 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12147675/ 2. Acute and Chronic Paronychia. American Family Physician. 2017;96(1):44-51. https://www.aafp.org/pubs/afp/issues/2017/0701/p44.html 3. Ingrown Toenail Management. American Family Physician. 2019;100(3):158-164. https://www.aafp.org/pubs/afp/issues/2019/0801/p158.html

Related Reading

Abscesses and MRSA: What To Do About a Skin Infection When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.