What You Need to Know Before You Have a Pedicure

June 4, 2009


Nothing beats rewarding our tired, aching feet with a relaxing pedicure. It eases tension, and makes our feet feel and look better.

However, like so many other pleasures in life, pedicures can be dangerous. The main culprit is germs.

In one salon over 100 customers developed an infection from a dirty whirlpool.

Over the years I’ve treated several people who developed infections after pedicures and in one tragic case, the woman needed her big toe amputated.

The good news is that you can do a few simple things to minimize this danger.

1. Be Sure You’re Healthy Enough For a Pedicure

Consider your health first. Do you have diabetes, poor circulation, neuropathy (numbness or burning in the feet) or skin problems on your feet? These may increase your risk of infection, and you might not want to chance a pedicure.

If you are not sure if you’re healthy enough for a pedicure, have your feet checked by a podiatrist and get his or her opinion.   

2. Check Your Legs, Feet and Ankles Before the Pedicure

Any breaks in the skin, nicks, cuts or other sores on your legs, feet or ankles increase the risk of germs penetrating your skin, and until these problems heal you should avoid pedicures.

Along these lines, don’t shave your legs for at least one day prior to your pedicure as razors can leave tiny breaks in the skin too small for you to see, but large enough for nasty bacteria to enter.

3. Ask the Pedicurist Questions

There are a few simple questions you should ask the pedicurist or nail salon at your first visit or even over the phone before you go.

  • Is the pedicurist licensed? They should be. And you should be able to see the license prominently displayed.
  • Are the pedicurist’s instruments disposable? If not, ask how they clean the instruments. The best way to kill germs is by cleaning the instruments in a sterilization machine called an autoclave.   Soaking instruments in a disinfectant solution is not as good, but can be okay if a hospital grade disinfectant is used and the solution is changed regularly.
  • How does the salon clean the footbath (and is it cleaned after every customer)?  Footbaths can breed germs. If the customer who last used it had an infected sore on their foot, you’ll want to be sure the salon disinfected it properly.  

4.  See How the Salon Looks

The salon should be clean with no dirt, debris, or hair or nail clippings on the floor or counters, and it should be organized, with bottles clearly labeled and instruments put away in drawers or containers.

If this is not the case, it is likely the salon isn’t taking the time to properly disinfect footbaths or instruments.

 5. Pay Attention to the Pedicurist

The pedicurist should be neat and presentable, with clean hands, or better yet, they should wear latex gloves.

And prior to the pedicure, he or she should examine your feet and ask about medical problems that may affect your feet.   

6. Be Wary of Pain

A pedicure should never hurt.

Pain during a pedicure may mean the pedicurist is doing something wrong or it could be signal your foot has problem that needs medical attention. Either way, it means its time to stop the pedicure.

Final Thoughts on Pedicures

When salons follow some relatively simple steps pedicures can be safe, soothing and a great reward for our battered feet.

If you have doubts about your salon or pedicurist, don’t risk your health, trust your instincts and go somewhere else.

Please feel free to share your experiences with pedicures.

– Dr. Nirenberg

Are Big Feet Related to Breast Cancer?

June 2, 2009

big feet

Women with bigger feet (the average UK shoe size is a five), trunk and shoulder breadth in childhood had a greater risk of breast cancer, according to a study at Bristol University.

An increased foot size might be linked to greater calorie intake during childhood, which has been linked to an increased risk of breast cancer.

Source: Mail Online

Dr. Nirenberg’s Comments:

This is one of those interesting, but probably useless facts. At best, it may mean that women with large feet should have more mamograms.

Five Tips to Fix Your Aching Feet

May 29, 2009
Bunions, Flat Feet & Weak Ankles

Bunions, Flat Feet & Weak Ankles

Most of us don’t think about our feet until they hurt.

Even then, we limp around hoping the pain will go away. But with two to three times our body weight pushing down on each foot with every step, it usually doesn’t.

Fortunately, you can do a few things for relief.


1. Wear Only Great-Fitting Shoes

In one study, 88% of women admitted that at some point they knowingly squeezed their feet into shoes that were too small.

Further, as we age, our feet tend to become larger, but most people insist on wearing the same shoe size they wore years ago.

In addition to making sure your shoes fit properly, make sure they have a good arch support and that the heel counter—the area that wraps around your heel—is firm and strong.


2. Feet Need Exercise, Too

I can hear the couch potatoes now:  “My feet get enough exercise.”  Perhaps, but walking to the fridge or standing in line at McDonald’s isn’t exactly exercise.

Most people agree our entire body needs exercise, but few people think about keeping their feet in shape.

Yet, with the average person walking over a hundred thousand miles in their lifetime, feet need all the help they can get.

Foot exercises tone, stretch, and strengthen feet, while alleviating fatigue, soothing soreness, and increasing blood flow.


3. Take the Plunge

Nothing soothes sore, aching feet more than a relaxing footbath.

You can use a bathtub or plastic basin, or for some serious relief, I recommend buying a massaging footbath.

Make sure the water is warm, not hot (I’ve seen patients soak in water so hot they received second-degree burns).

Add good quality bubble bath to the water; and for those who are not diabetic or have poor circulation, adding Epsom salts is great, too.


4. Moisturize Your Way to Healthier Feet

Good moisturizers can sooth dry, irritated skin.

The secret to finding a good moisturizer for your feet is not by price; more expensive doesn’t mean better.

Read the ingredients and avoid products with alcohol or alcohol derivatives—the best dry-skin products tend to be creams without alcohol.

These are gooier and absorb slowly, so I recommend applying them just before going to bed.


5. Nailing Down Nails

Caring for your nails will go a long way in helping to alleviate foot problems.

Long, jagged, and thickened toenails can catch on socks or pantyhose, dig into adjacent toes, or suffer injury by pressing against the inside of our shoes.

In my practice, I have seen unkempt nails lead to blisters, infections, ingrown toenails, and even gangrene.

When trimming your toenails, follow the contour of the toe and avoid cutting into the corners. Smooth any rough edges with a nail file.


Final Thoughts on Aching Feet

Caring for your feet is your responsibility. However, when problems don’t go away, become serious, or if you have diabetes or poor circulation, get professional help and see a podiatrist.

The Surprising Truth About High Heels

May 28, 2009



If you’re a woman with foot problems—perhaps bent, crooked toes such as hammertoes or bunions, or corns and calluses—it’s not due to wearing high heels.

Our doctors, mothers, and even pop magazine articles have sold us on the idea that women’s foot problems are often from wearing high heels.

However, after treating hundreds of women who had horrible feet and swore they rarely, if ever, wore high heels, I began to question if high heels were really the reason so many women had foot problems.

Could women’s feet be genetically unique from men’s?

And could these differences make them more likely to develop foot problems?

The answer was a resounding yes!  

Like the female brain and most of her body, doctors are finally beginning to realize the female foot is remarkably different from that of the male.

A woman’s feminine frame (generally, wider hips and proportionately shorter legs) and her precise chemical physiology (pregnancy, menopause, and menstrual cycle, or lack of a cycle) profoundly affect her feet, altering their function, shape, and at times, chance of injury.

Even the shape of a woman’s foot is unique.

Compared with males, women have a foot that is shorter and narrower with an instep that isn’t as long (the average American woman wears a shoe size of 8.5).

Taken together, all these factors create a “female foot” that is more prone to foot problems, such as hammertoes, bunions, and pinched nerves—with or without high heels.

Does this mean I recommend you wear high heels?

That would be like a nutritionist recommending Häagen-Dazs!

High heels place your feet in a weakened position, causing foot problems that would develop anyway to worsen more quickly, and high heels worn excessively can cause their own unique foot problems, such as pinched nerves, bent toes, or a shortened, tight Achilles tendon.   

Wearing high heels should be thought of like a dieter having a hot fudge sundae occasionally: it’s a decadent treat.

The key word is “occasionally,” and you should add to that “briefly.”

Now that you know the truth about high heels, feel free to slip on a sexy, gorgeous pair and look stunning—briefly and occasionally—guilt free!

Not Podiatrist Approved

May 28, 2009

Marc Jacobs Backward Heel

Marc Jacobs Backward Heel


Feet Need Vitamins too

May 27, 2009



Many of my older patients wish they had taken better care of their feet when they were younger.

Thankfully, doctors and the health food industry are finally recognizing what many people have wanted for years: safe, natural ways to keep their feet strong and healthy.

The safest, simplest way to keep your feet healthy throughout life is already in your kitchen: water.




Water regulates temperature and metabolism, delivers electrolytes to muscles and lubricates our joints.

With each foot containing 33 joints and depending on 19 muscles, even slight dehydration can cause your feet to cramp and fatigue.

I recommend drinking eight glasses of water a day.

Guzzling Mountain Dew, Mocha Frappuccinos or six-packs of Bud Light isn’t the same.

Caffeinated and alcoholic beverages can actually cause dehydration.

Drinking water, not only for your feet, but also for your whole body, should be common sense, yet at any time, 75 percent of Americans are mildly dehydrated.

Moderate or severe lack of water can make feet cold and more vulnerable to infection.

Dehydration can also make toenails brittle and the skin of our feet dry.

Dry skin may not seem like a big problem, but on the feet, dry skin can crack and develop deep, painful fissures that are at risk for infection.


A patient with dry skin on their heel.

A patient with dry skin on their heel.


I’ve seen simple breaks in the skin, particularly in the feet of the elderly and people with diabetes, lead to catastrophic infections, at times resulting in the foot’s amputation.

However, dry skin on the feet may indicate more than just a lack of moisture.

Sometimes it’s psoriasis, a fungal infection or a sign of a more serious condition, such as diabetes, poor circulation or a thyroid disorder.

If your feet have severe or persisting dry skin, you should see a podiatrist.  

The best way to soothe dry skin is with moisturizers and applying vitamin A, D and E. You can put these on your feet separately, mix a concoction or buy a vitamin-enriched cream.

When choosing a cream, don’t go by price; more expensive doesn’t mean better.

Read the ingredients and avoid products containing alcohol or alcohol derivatives, which actually dry skin. Surprisingly, alcohol is common in many so-called moisturizers.

Dry, irritated skin also responds to foot powder, particularly when the powder is enriched with zinc or menthol.

A sprinkle a day will not only help keep the skin moisturized, but also lessen odor and perspiration.

Urea also helps keep feet healthy. A natural compound, urea attracts moisture, slowing its escape from the skin. Look for it by itself or in moisturizers.

For patients with severely cracked heels, I often prescribe medicated creams containing 40 percent urea.     

I also recommend urea for frail, brittle toenails.

To strengthen toenails, apply Biotin, a B vitamin, and take calcium and vitamin A. Vitamin C helps nails too—not that they have to fight off colds, but they can get painful hangnails, which this vitamin prevents.

Caring for your feet as you age also means keeping your bones strong.

Bones form the foot’s foundation, in turn supporting our entire body. With aging, bones lose strength and develop osteoporosis.

Combine osteoporosis in your feet—each foot a jigsaw puzzle of 28 small bones—with a one hundred and fifty or two hundred pound person landing on them repeatedly and you have a great chance for fractures.

Women past menopause are at the greatest risk for osteoporosis.

A simple test can check for osteoporosis and, if necessary, your doctor will prescribe medication.

To help prevent osteoporosis, eat foods rich in calcium and vitamin D and exercise regularly, doing activities that put weight on your feet such as walking, aerobics or weight lifting.

Lastly, vitamins and minerals—and in rare cases, even water—are not always safe for everyone. Before starting any supplements, always check with your doctor.

Common Foot Problems to Watch For

May 26, 2009
Painful Hammertoes & Fungal Toenails

Painful Hammertoes & Fungal Toenails

Eighty percent of people, at some point in their lives, have a foot problem that requires medical care.

However, many people let their problems persist and worsen untreated.

Here is a list of the most common foot problems I see in my practice that you can watch for to ensure the health of your feet.


Heel Pain

Heels get a bad rap. The dictionary defines a heel as a dishonorable person, and the term “Achilles’ heel” refers to a fatal weakness.

The reality is your heels are quite strong, though no other part of your foot malfunctions more. Heel pain is the number one reason people come see me.

Heel pain can be very complicated and may have a variety of causes, including a stress fracture, pinched nerve, bone cyst, or tumor.

Most patients with heel pain believe they have a heel spur.

This may be part of the problem, but the most common cause of heel pain—whether or not a heel spur is also present—is inflammation of the largest ligament in our foot, the plantar fascia. In doctor-speak, this problem is called plantar fasciitis.

 Treatments for plantar fasciitis range from custom-made arch supports (called orthotics), to simple stretching exercises, to the revolutionary, high-tech shockwave treatment. 


Nerve Problems

 Burning, numbness, tingling, or shooting pain in your feet or ankles often means something is wrong with a nerve.

Nerve problems are common in feet, so if you have one, don’t get nervous. Most of the time, the treatment is relatively simple.

The main nerve problems I see are:


  • Morton’s Neuroma

Not to be confused with Morton’s Steakhouse—which may cause a full stomach—Morton’s neuroma causes cramping, tingling (a feeling of pins and needles), burning, or shooting pain in the toes or ball of your foot.

A neuroma is a painful growth on a nerve that forms when the nerve becomes irritated.

Treatment for neuromas consists of using a special arch support, called an orthotic, and sometimes injections are needed. Surgery is rarely necessary.   


  • Tarsal Tunnel Syndrome

Almost everyone has heard of carpal tunnel syndrome in the hands, but few people realize the same problem occurs in our feet.

Tarsal tunnel syndrome may cause burning, tingling, shooting pain, or a cramping sensation in your foot.

The good news is that there is a light at the end of this tunnel. Tarsal tunnel syndrome is often easily treated with orthotics, injections or a short, outpatient procedure.   


  • Neuropathy

Neuropathy literally means a “disease of the nerves,” and it affects millions of people each year. Persons with neuropathy often experience loss of sensation, burning, tingling, or shooting pain.

The number one body part affected by neuropathy is the feet. Persons with diabetes are those most afflicted with neuropathy, but it also occurs in people with thyroid problems, vitamin deficiencies, alcoholism, and some types of arthritis.

Neuropathy has many treatment options and some people might opt for a new, somewhat controversial, procedure that involves surgically freeing up the nerves to restore normal sensation to their feet.


Arthritis of the Foot and Ankle

Degenerative joint disease, osteoarthritis, or just plain old “Arthur” is a deterioration of the joints between our bones.

When Arthur visits people’s feet or ankles, many believe they just have to live with it. This is far from the truth. The reality is podiatrists have many techniques to alleviate arthritis, including a high-tech, tiny arthroscopic camera that can remove arthritis from sore ankles.    


Nail Problems

I am not talking about rusty nails on your garage floor, but ingrown toenails and fungal toenails. Ingrown toenails occur when the edge of the nail grows deep into the flesh of the toe.

These are painful and can become infected. Fortunately, a brief, in-office technique can alleviate ingrown toenails, often permanently.

Fungal toenails are another story, and usually require a long course of medication.



These are protrusions of bone or bumps that form on the inside of the foot at the joint at the base of the big toe.

If you wear ill-fitting shoes, don’t blame them for bunions—blame your parents. Bunions are inherited. However, poor footwear can contribute to the formation of a bunion.

Numerous conservative treatments, such as trying wider shoes or foot soaks, can alleviate painful bunions, though getting rid of them requires a short, outpatient surgical procedure.


Other Big Toe Problems


  • Hallux Rigidus

With hallux rigidus, the big toe may look normal; however the inside of the joint at the base of the big toe is deteriorated and painful.

Sometimes the big toe won’t bend. Like bunions, simple treatments can lessen the pain, but in on some cases surgery is necessary.


  • Gout

Known as the “rich man’s disease,” gout doesn’t just affect the rich. Gout is a type of arthritis that most often occurs in the joint at the base of the great toe, causing redness, swelling, and pain.

Some patients have said the pain was so severe that they couldn’t stand the bed sheet resting on their toe. Other patients describe less intense symptoms.

Gout occurs when too much uric acid is present in your body. Uric acid is a natural chemical that your body manufactures, and you ingest in certain foods, like pork, beer, or liver.

Treatment consists of altering your diet to limit the amount of uric acid you ingest, and if that isn’t enough, medication is prescribed.


Corns and Callouses

Corns have nothing to do with plants that grow ears. Painful corns (and callouses) are a build-up of hard, dead skin that often occurs due to an abnormal bony prominence or a bone out of position.

Corns occur on toes and callouses are found on the bottom of the foot.

Contracted toes (hammertoes) cause corns to form, and callouses form when a bone or bones are out of position. Treatment of a corn or callous depends on what is wrong with the bone underneath them.


Final Thoughts on Common Foot Problems


These are the top foot and ankle offenders, but the list of problems I see in my practice is endless. If you have foot or ankle pain or another problem, the best thing you can do is have it checked by a podiatrist.

Shop for Your Feet

May 23, 2009
Footwear That’s Good for the Sole
Yoga Stick-e Socks

Yoga Stick-e Socks


Not all footwear is bad. Some is quite good. I recently tried Yoga Stick-e Socks and loved them.

They are designed for people who do yoga. The socks allow our feet to keep their natural shape while the sticky surface on their bottoms helps us “grasp” the mat or floor during difficult poses.


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