What to ask a podiatrist?

Hi Ray, I was on a similar quest the week before last when I met with orthopedic doctor for suggestions on what might help me with my balance since I have a bad case of hammertoes on both feet. I had been wondering about surgery vs alternative treatments or physical therapy. After examining my ugly toes and not finding any sores or infections he told me surgery is mostly reserved for infections from sores on top of the toes due to rubbing, etc. He told me to keep wearing shoes with large/wide toe box and loose fitting at the top which mine are. He suggested I talk to my PCP about physical therapy for balance which I haven't done yet but I have been trying different balance exercises I've found.

One interesting thing I've done the past 7 months is to change the type of shoes I wear. I used to exclusively wear the spongy foam soled Sketchers because they are comfortable but I have been noticing that they seem to contribute to my wobbly feeling when I'm standing or just get up from sitting. I found some shoes with thin zero drop soles (flat, no heels) and I kind of like that I can feel the ground better and seem to be a little more stable. The downside has been no cushion but for most walking it hasn't been a problem. The ortho doc thought they were good for the hammertoes since they didn't rub on them. I'm still planning on discussing PT for balance and possible gait training. I did have to walk for the ortho doc and he looked at the gait but didn't say anything so I'm not sure if that's also part of my problem.

Hi, John. It seems we're trying to get an answer to the question, "What works best?" I had meant to include in my original post the mystery of shoes (with orthotics) vs. barefoot. Usually, around home, I go barefoot––or sock-foot, no shoes, and my balance, while not great, isn't too bad; it's certainly better than when I'm wearing my shoes. (I'm wearing Nunbush shoes.) When I put on my shoes, my balance goes all crazy, like my gyroscope is broken. That makes me wonder: Which is better? Barefoot? Or shoes? Of course, when I go anywhere, I've got my shoes on, and boy, oh boy, do I have to be on guard! I haven't fallen, but I feel it's only a matter of time. As far as balance exercises go, I've been doing my own at-home exercises, following a program called Better Balance for Life. There are several enterprises using that name. The one I follow is led by a teacher in Perth, Australia. I believe it's helped me, or at least it's helping me keep apace with my balance deterioration. I try doing an hour's session three times a week. Only the other day, however, I sent a message to my neurologist asking if he had any recommendations for physical therapists with a special knowledge of what folks like us with PN are experiencing. I haven't heard back from him yet. ––Ray

Same here, I put my old Sketchers back on and it's like stepping on a balance board. I have bought a couple of pairs of Xero shoes which are pretty good quality but I wish they were made in the US and were a little cheaper.

Good morning, John–– It seems every day, I hear of something I'd not heard of before. You'll laugh––as my partner did–– when I admit to never having heard of Sketchers. "What were you." she said, "raised by wolves and only recently returned to civilization?" I'd also never heard of Xero shoes. But the timing of all this is perfect. I've arranged a sit-down with my podiatrist next Tuesday. He needs to know about my PN. I plan to ask him if there's anything in a podiatrist's toolbox that can help a guy with PN. I can also ask him about shoes: What might be the best for a fellow with foot numbness, either because he has a sensory PN, a motor PN, or a mixed bag? At times, I feel like I'm grasping at straws. But, of course, that's exactly what I'm doing, hoping not to find a "cure," only a little relief; when it comes to shoes, hoping I'll find a pair that will make everyday walking a little easier. ––Ray

For balance problems, Id see a physiotherapist first. Your loss of proprioception may be multifaceted.
Neuropathy could be from somewhere in the spine.

@ray666 Having numbness and poor balance, I'd be interested in hearing what your podiatrist has to say as far as any help is concerned. I wear orthotics due to drop foot which also gives me an improved balance. My podiatrist is a foot surgeon and he asked me if I wanted a nerve biopsy.
Well, do I need it was the question that popped into my head. So far, I've elected not to have this done. Mayo presented me with convincing evidence as to my PN based on a variety of test results which is why I hesitate on a nerve biopsy. My podiatrist plays an important role in my health care, he does a full exam about every 10 - 12 weeks. We're now on a first name basis!!

It sounds like we’re all having similar issues, with or without hammer toe activity. For me, just alternating between wearing thick socks in the house to having to wear shoes to go out is a major activity change. And I CANNOT have 2 different styles of shoes in my life or that’s another Olympic event with consequences. Just removing socks in the house to walk completely barefoot into the shower is yet another obstacle course.
When I was a very active runner and would need competitive feet, gait, and stride, there were (are) athletic shoe stores that would test you, measure & analyze your feet in action, and could connect you to the best engineered shoe for your foot health and performance. Now, while my end goal has changed, I’m still looking for the optimally engineered shoe for MY foot health and performance, but have been unsuccessful in finding the medical discipline or whatever who can do the same analysis as the athletic shoe people who regularly enabled me (and other athletes with all kinds of different feet) to run 26.2 miles!!
Our needs are so much more necessary today, and I would love to continue hearing your stories and experiences that might help me in my quest for more direction. I do PT and home exercises regularly. I’ve had a couple of Podiatrists but their focus wasn’t on footwear or gait solutions, just general advice and hammer toe surgery options. I haven’t found a go-to for a Total Foot function analysis and solution. Please continue sharing successes or watch-outs!

Hello, @kd59

I agree with what you say about the help a physiotherapist can offer. Fortunately, my neurologist is a physiatrist working out of a clinic with several good physiotherapists on staff.

I've had several central nervous system MRIs––brain, cervical, thoracic, and lumbar––since I've been working with these people. Nothing was revealed indicating my present PN besides my being a rather heavy drinker 30 years ago (that showed in my brain MRI). Sitting down with my podiatrist and later my orthopedic doc to discuss my PN is an attempt to "leave no stone unturned."

That's been one of my mottos since dealing with PN: "Leave no stone unturned."

Thanks for your message!

Ray (@ray666)

Ed - Oddly enough, I was able to get a nerve biopsy referral from my Neurologist to a Neurosurgeon who did it 2 years ago. His first question was “Why wouldn’t he do an MRI first, it’s less invasive?” But he did the biopsy - sent results to my Neurologist who always lost or misfiled things. After 2 weeks of not getting results from my Neuro, I had a wound follow up with the surgeon, the surgeon handed me a copy of the results, saying he couldn’t “review” it with me, but my Neurologist should follow up on the “inflammation” noted. A month later my Neurologist finally reviewed the biopsy with me and said it confirmed axonal PN no evidence of further degenerative something or other, and he said the “inflammation” found was insignificant.
So the biopsy confirmed axonal PN like nerve conduction tests, but left me with 2 pestering wonders.. (a) Why did neurosurgeon hint significance re: inflammation of something and my scattered Neurologist dismiss it? and (b) Why won’t they do a Neurological MRI on me?
Anyone who has followed me on here knows I’ve been at awe that I seem to be the only one on here that has not had an MRI, despite asking for it. My doctors have absolutely no clue as to what exactly I have or how I got it, but are absolutely 100% certain an MRI will tell us nothing!!! I think it’s become a conspiracy with doctors as I moved to different states that if the first doctor said No to MRI, they’re not going to disrespect his opinion. To me, it can’t be 100% deemed useless unless they had all or most of the medical questions answered about my PN.
Oh well, as much as I have focused on symptom management and quality of life maintenance and improvement, and try to accept the end of efforts in trying to diagnose me, can you still tell I’d like an MRI to help prove to me one way or another and help provide closure for me?? 😊

Good morning, Ed (@njed)

I envy you being on a first-name basis with your podiatrist! That suggests a kind of rapport I'd like to have with all of my docs. I may have my best chance with my podiatrist. His outside-podiatry passion is long-distance running, like ultra-marathons (phew!), as mine used to be (not ultra-marathons, though). His learning that I have a knee prosthesis that ended my running days made him extra-sympathetic. I know he'll feel even more that way when I tell him I now have PN.

I too would shy away from a foot nerve biopsy. I'll listen to what my podiatrist has to say, of course, but I'm hoping that instead of a biopsy, he'll suggest an improved pair of orthotics and a better brand of shoes. I used to think my present Nunbush shoes were about as comfortable as I could buy, but as my PN has progressed, I'm no longer so sure. (I've never gotten used to the cost of good shoes. In my earliest running days, they were Asics Tigers, then Nikes (can't recall the model), then Brooks Chariots, and others also––always pricey!) I trust that last August's EMG told me all I need to know (for now) about the state of my feet.

I plan to lobby my neurologist for another EMG this August (a year apart).

I like the idea of a regular get-together with your podiatrist. I'd like to ask mine if he'd be up for that. (If nothing else, we can waste each other's time talking about running. LOL)

And yes, of course, I'll tell you how this Tuesday's meeting goes.

Have a great weekend!
Ray (@ray666)