A Step Ahead - Sole Foot and Ankle Specialists Blog

With how much walking we do, our footwear undergoes wear-and-tear, especially running shoes. All footwear has a limited lifespan and will eventually need to be replaced. When shoes are beginning to wear down, their stability begins to fade, and makes feet susceptible to various injuries. Knowing exactly when to replace shoes can be difficult and as well as knowing what signs to look for on shoes that are wearing down. The following are signs you should consider replacing your current shoes:

  • They no longer fit comfortably: Feet can change sizes, especially when people undergo weight loss or gain, (i.e. dietary or pregnancy) and will need properly fitted shoes to accommodate the changes. People who have suffered foot recent injuries (such as sprains) can have swelling and may need to temporarily have larger shoes to help accommodate swelling if it is not healing.


  • Worn down shoe treads: When the tread begins to wear down, they lose traction, and increase the chance of falling, and increase the risk of suffering other foot and ankle injuries. Treads often wear down at the heel and ball of the foot more so than other areas of the shoe due to increased application of weight in these areas.


  • The shoes become unstable: To test whether your shoes are unstable, bend your shoes at the ball of the foot, twist the shoe (the more it twists, the less stable the shoe has become), and check the firmness of the shoe’s heel counter where your heel sits. Each of these helps test the shank rigidity of the shoe and new shoes should be purchased if the shoes have increased flexing and twisting.


  • How many pairs of shoes you own: Having more than one pair of shoes that you can rotate will help prolong the lifespan of your shoes and prevent rapid wear-and-tear. If you are constantly wear one pair of shoes, the shoes will wear down faster, and need to be replaced. This is important, especially if they are running shoes, or shoes you wear to work every day.


When You Should See a Podiatrist

If you are experiencing foot pain and it is not relieved by new footwear, then it is important to see your podiatrist to identify the cause of your foot pain. Your podiatrist can also help you select shoes appropriately fitted for you and minimize the risk of injuries later.

If you are currently experiencing foot pain, it could be caused by worn out shoes, and need to be replaced. If you have recently replaced your shoes and are still experiencing foot pain, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you to ensure you maintain healthy feet.

When hearing the word “ulcer” the thoughts of open sores comes to mind (i.e. skin or internal organ). Ulcers of the skin expose deeper tissues in the body and can occur when there is trauma to the skin (i.e. excessive pressure application, skin punctures, and cuts). Since the foot is under constant pressure when we are standing or walking, the risk of ulcers occurring increases, especially if a trauma occurs. There are many individuals suffering from conditions such as diabetes and vascular diseases who may not feel the pain caused by ulcerations due to loss of sensation (neuropathy). However, there are distinct ulcers associated with a skin disease called Pyoderma Gangrenosum that are different in nature, and can be painful, misdiagnosed, and difficult to treat.

For more information on ulcers, see our Ulcers/Wound Topic

About Pyoderma Gangrenosum

Pyoderma gangrenosum is a skin disease that results in painful ulcerations commonly seen on the top of the foot and shins. The name of the disease is associated with the appearance of the wounds that occur, which is dead tissue in the center of the wound (necrotic center), and a dusky red color around the edge of the wound. The appearance of the wound starts off as small, tender papulopustule(s), which having a similar appearance of acne on the face, and is often not recognized immediately upon examination by physicians. As the papulopustule breaks down, it starts to form small ulcers in the area, and eventually they progress together into to a full-thickness ulcer in the skin.

Causes and Risk Factors for Pyoderma Gangrenosum

The exact cause of pyoderma gangrenosum is not currently known, but is often associated with other debilitating conditions. These conditions include: inflammatory bowel diseases (Crohn’s disease and ulcerative colitis), arthritis, diverticulitis, hepatitis, myeloma, leukemia, or Behcet’s disease. While it is not understood why pyoderma gangrenosum is linked to these diseases, pyoderma gangrenosum is often seen in up to 50% of patients with one or more of mentioned conditions.

Diagnosis and Treatment

Since no specific test exists to detect pyoderma gangrenosum specifically, the diagnosis if often made by exclusion, and ruling out all other possible causes (diabetes, neuropathy, vascular diseases, etc.). Therefore, a detailed patient history is done to determine if the cause is due to trauma of the affected area, venous stasis, increased pressure, or pyoderma gangrenosum. It is also important to note if previous treatments have been done before since these ulcers tend to worsen with ulcer debridement or if the wound dries out. Also, obtaining a wound culture helps make the diagnosis since it helps ensure the patient does not have a wound caused by gangrene (requires surgical treatment).

Treating pyoderma gangrenosum is challenging since no specific treatment for it exists. The main priority will be to avoid trauma to the wound and this includes debridement since these ulcers enlarge with debridement. However, immunosuppression is the primary treatment. The following the most commonly use medications and treatment options:

  • Topical anesthetics for the pain
  • Topical and oral antibiotics while awaiting culture results
  • Corticosteroids
  • Ciclosporin if corticosteroids are not effective

The wound should be inspected every week to ensure treatment is not enlarging the wound, have proper dressing changes, and should be kept dry from bathing to prevent bacterial growth in the wound. It can take a few months to heal pyoderma gangrenosum, but the wound will heal if it is treated correctly.

If you been experiencing pain due to ulcers on your foot and/or leg, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and ensure you and your family maintain healthy feet.

By Gary N. Friedlander DPM, FACFAS and Jay C. Larson DPM
April 16, 2018
Category: Foot Problems

When determining the cause of pain in our toes, it can be difficult to figure out the source; this is often due to misdiagnosed outgrowths on bones or tissue in the toes. An example of such a condition are glomus tumors, which are often associated with throbbing pain of the toes, and fingers.

What is a Glomus Tumor?

A glomus tumor is a benign growth that arises from the glomus body of our fingers and toes. The glomus body is found in the dermis of the skin and plays a role with regulating temperature through changes in blood flow through the digits. Glomus tumors can occur anywhere in the skin, but are commonly found in the digits, especially underneath the nails.

How Do I Know if it is a Glomus Tumor?

Often, a long history of pain and tenderness are reported by patients with glomus tumors, and describe it as being excruciating, and intermittent. Another complaint given by patients is sensitivity to temperature, especially colder temperatures, but it is not always a consistent finding. Part of what makes diagnosing glomus tumors difficult is due to how rare they are when compared to other foot conditions affecting the toes (neuromas, ingrown nails, spurs, etc.). When a physical exam is performed, sometimes tenderness, and thickening is present in the tissues of the toes, as well as a detectable mass underneath the nail. If the glomus tumor is superficial, it might be seen as a reddish/blue nodule underneath the nail or skin, and be affiliated with a nail growth deformity as well.

There are a couple of simple routine tests to help determine if a glomus tumor is causing the pain in the toes: Love test and Hildreth test. The Love test is performed by taking a small, sharp object such as a paperclip, pencil, or toothpick and using it to recreate the pain felt in the toes. The Hildreth test is performed by elevating the affected limb and applying a blood pressure cuff or tourniquet to the ankle. After the tourniquet is applied, the podiatrist will palpate the area where pain was felt, and see if the pain persists once the tourniquet is released.

Are Glomus Tumors Treatable?

Yes. Surgical removal of the glomus tumor has proven to be the most definitive treatment and patients often experience relief of their painful symptoms. Depending on the severity of the glomus tumor and if nail deformities are present, a total nail avulsion may be required in order to remove the glomus tumor.

If you have been experiencing excruciating pain in your toes and have yet to find relief, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have your treatment options presented to you to ensure you continue to maintain healthy feet.

Did you know that in 2015, the U.S. Census Bureau estimated approximately 15% of the US population was over the age of 65, and is expected to increase? This is because aging is a natural biological process that happens to everyone. As our bodies age, they undergo natural wear-and-tear, blood circulation and vision declines, the skin becomes thinner and more fragile, and people are often less mobile. Each of these changes can make people more susceptible to illness and injury, including foot injuries. Since we are only given one pair of feet, it becomes important to take care of them, and can be more difficult as we age. It is also important for individuals being treated for diabetes, heart conditions, gout, and many other conditions that can also affect your feet. When these conditions are not treated properly, foot symptoms can develop quickly, and lead to serious issues such as infections or falling.

Proper Senior Foot Care

Learning proper foot care can help maintain foot health and help patients be aware of conditions that need to be addressed by a podiatrist. The following are some tips on how to properly care for your feet:

  • Wash your feet carefully everyday and visually check them for any unusual changes
  • Always wear clean, dry socks and shoes, including when you are indoors
  • Wear shoes that are properly fitted and provide stability
  • Stay active as you are able – this will help increase blood circulation
  • Avoid smoking – smoking decreases blood circulation and affects breathing capacity
  • Keep your toe nails clean and trimmed


When Should I see a Podiatrist?

Whenever foot issues arise, it is always best to treat them early before they become worse. Often, pain and other foot symptoms are an indicator or side effect of more serious conditions (diabetes, gout, arthritis, decreased circulation, etc.). Seniors and care providers should see a podiatrist if they start to notice any of the following:

  • Foot pain – pain can be debilitating and should always be addressed. Tell your podiatrist if the pain prevents you from sleeping
  • Changes in skin color or temperature of the feet (hot or cold) – This is often an indication of decreased blood circulation or inflammation caused by infection or another condition
  • Discoloring or brittle toe nails – If you are having difficulty maintaining proper nail care, see a podiatrist, and they will properly trim them to prevent ingrown toenails
  • Continual tingling, and/or numbness in your feet – Can be related to neuropathy caused by diabetes or another ailment
  • Blisters, calluses, corns, or cracked skin
  • Wounds that do not seem to be healing
  • Difficulty keeping balance or walking – Your podiatrist will perform a Fall Assessment


Aging can take its toll on the body, especially feet. If you are a senior and are concerned about your foot health, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona. We will explain all your treatment options to available to you to help improve your health, function, and overall quality of life.


Our feet are some of the most delicate, dynamic, and under-appreciated parts of our bodies. We take an average of 10,000 steps every day, which amounts to 125,000 miles in a lifetime, or approximately 5 times around the earth. With each step, most people do not consider the unique changes and adaptations that occur and allow us to walk and run properly. April is dedicated to foot health awareness and informs individuals the importance of taking care of their feet, and how changes in foot health can alter their walking abilities, and overall health, especially with diabetes.

Keeping your feet healthy and pain free can help you continue perform daily necessary and leisurely activities such as working, walking, exercising, and anything else you enjoy. The following are tips on maintaining healthy feet, when you should see a podiatrist, and additional foot health recommendations for individuals with diabetes.

  • Inspect your feet daily when showering, putting on and taking off your socks, and shoes. It is possible to have an injury and be unaware of it. Look for any cuts, bumps or bruises, changes in skin or nail color, any changes in skin temperature, or swelling of the foot and ankle. If you notice any of these changes, make an appointment to see a podiatrist.
  • Properly cleanse your feet daily, including between your toes, and underneath the nails. When cleaning between the toes, ensure you properly dry the to avoid developing fungal infections
  • Ensure your shoes are properly fitted and provide adequate stability – Tight shoes provide discomfort and increase friction on the feet and loose-fitting shoes decrease the stability and protection of your feet when standing or walking. They can also lead to the development of foot ailments such as: calluses, corns, blisters, and friction burns
  • Trim your toe nails properly –  trim them straight across, rather than rounding or curving; your podiatrist can show you how to properly trim your nails to avoid developing ingrown nails or damaging the nail bed
  • Avoid walking barefoot as often as you can – this will minimize the risk of developing injuries to your feet such as cuts or stubbing your toes
  • Maintain a certain level of daily activity to increase blood circulation in your legs and feet.
  • Wear dry, clean socks daily, and do not re-wear used socks
  • If you choose to wear sandals or flip-flops, be sure to apply sunscreen when you are outside to avoid burns, and excessive drying of your feet
  • Perform stretches of your legs and feet daily to minimize strain on your muscles and increase flexibility
  • If you have foot pain of any kind, do not ignore it. Pain is your body telling you something is wrong and should be addressed when it occurs.

If you have diabetes, please click the links see our blogs on diabetes, diabetic foot care guidelines, and diabetes complications/amputation prevention.

The month of April is dedicated to helping people take special note on the important of taking care of their feet. We only get one set of feet and it is important to take proper care of them. If you notice any sudden changes in your foot health, experience any pain, or suffer an injury to your foot, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona.

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