What we treat...

From routine checkups to treatments for surgery, Pamela Tola, DPM is equipped to handle all your podiatric needs. To help you understand your options, we've included descriptions of some of our leading services on this page.

Children with in-toeing and out-toeing Crooked toes Diabetics Flatfeet and high arched feet Foot and ankle injuries Foot and ankle joint pain Fungus toenails Heel and arch pain Infections in the foot or ankle Ingrown toenails

Leg, foot or ankle cramps Numbness or tingling in the feet Painful bunions Painful corns and calluses Poor circulation Senior citizens Sports related injuries Tight muscles Ulcers and sores on the legs, feet and ankles

Our Specialties

Our practice offers a full array of podiatric services to help you maintain healthy feet.  To help you better understand your treatment options, we’ve included descriptions of some of Dr. Tola’s areas of expertise.  

• Chronic heel pain
• Ttreatment for warts, ingrown nails, skin cancer
• Advanced wound care for foot and leg ulcers
• Comprehensive diabetic foot care
• Custom and therapeutic orthotics/insoles
• Diabetes education
• Urgent foot and ankle treatment for sprains, fractures and sports injuries
• Foot and ankle care for children
• Fungal nail treatment
• Neuropathy care
• Sports medicine
• Circulation Problems of the foot and leg

 

Arch Enemy

Flat feet may have kept you out of the army, but was it worth the pain?

While most people with flat feet (25% of Americans) don't have a problem, flat feet can cause disabling foot pain as well as knee pain, shin splints, achilles tendonitits and plantar fasciitis. "A person with foot or leg pain should pay particular attention to whether one foot is flatter than the other," stated Glenn B. Pfeffer, MD, Assistant Clinical Professor of Orthopaedics at the University of California, San Francisco, speaking at the American Academy of Orthopaedic Surgeons Orthopaedics Update web conference. He emphasized that "a falling arch should cause rising concern."

It is important for people with foot pain to know if they have flat feet. The following tests can help you determine your arch type:

1. Footprint Test
   When you get out of a swimming pool, look at your footprint on the concrete. The front of the foot will be joined to the heel by a strip. If your foot is flat, then the strip is the same width as the front of the foot, creating a footprint that looks like a stretched out pancake ("flat as a pancake"). With a normal arch, the strip is about half the width of the front of the foot. If you have a high arch, only a thin strip connects the front of the foot with the heel. Both footprints should be the same.
2. Shoe evaluation
   Put your shoes on a flat table and view them at eye level from behind. See if the sole is worn evenly. A flat foot will cause more wear on the inside of the sole, especially in the heel area. The shoe will easily rock side to side. A flat foot will also cause the upper part of the shoe to lean inward over the sole. Both shoes should wear about the same way.

If you have pain in one foot, you should make sure you don't have a fallen arch on that side. There are two good tests you can perform at home to detect this problem:

1. Tiptoes Test
   Place your fingertips on a wall that you are directly facing and stand on your tiptoes on one foot. If you can't do it, a fallen arch may be the culprit.
2. Too Many Toes Sign
   Stand with your feet parallel. Have someone stand in back of you and look at your feet from behind. You can also do it yourself if you stand with your back to a mirror. Normally only the pinky toe is visible from behind. If one foot is flatter than the other, the 4th and sometimes the 3rd toe on that foot can also be seen.

If you have flat feet and foot pain, especially if one foot is flatter than the other, you should have an evaluation by an orthopaedic surgeon. You may have a problem with the posterior tibial tendon, the main tendon that supports the arch. Factors that can contribute to this problem are obesity, diabetes, high blood pressure, certain types of arthritis and athletic overuse.

In some cases a shoe insert/orthotic can be used to alleviate the symptoms of flat feet. However, Dr. Pfeffer strongly advises that you first see an orthopaedic surgeon in order to make sure the source of the foot pain is not serious.

An orthopaedic surgeon is a physician with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

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Warts

What are Plantar Warts?

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but technically only those on the sole are properly called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.

Identification Problems

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

Source of the Virus

The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.

Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

When plantar warts develop on the weight-bearing areas of the foot—the ball of the foot, or the heel, for example—they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Tips for Prevention

• Avoid walking barefoot, except on sandy beaches.
• Change shoes and socks daily.
• Keep feet clean and dry.
• Check children's feet periodically.
• Avoid direct contact with warts—from other persons or from other parts of the body.
• Do not ignore growths on, or changes in, your skin.
• Visit your podiatric physician as part of your annual health checkup.

Self Treatment

Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Professional Treatment

It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.

Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.
Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Tips for Individuals with Warts

• Avoid self treatment with over-the-counter preparations.
• Seek professional podiatric evaluation and assistance with the treament of your warts.
• Diabetics and other patients with circulatory, immunological, or neurological problems should be especially careful with the treament of their warts.

Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.

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Your Children's Feet

You worry about your children's teeth, eyes, and other parts of the body. You teach washing, brushing, and grooming, but what do you do about your child's feet--those still-developing feet which have to carry the entire weight of the body through a lifetime?
Many adult foot ailments, like other bodily ills, have their origins in childhood and are present at birth. Periodic professional attention and regular foot care can minimize these problems in later life.
Neglecting foot health invites problems in other parts of the body, such as the legs and back. There can also be undesirable personality effects. The youngster with troublesome feet walks awkwardly and usually has poor general posture. As a result, the growing child may become shy, introverted, and avoid athletics and social functions. Consultation between the podiatrist, pediatrician, and other medical specialists helps to resolve these related problems.

Your Baby's Feet

The human foot--one of the most complicated parts of the body--has 26 bones, and is laced with ligaments, muscles, blood vessels, and nerves. Because the feet of young children are soft and pliable, abnormal pressure can easily cause deformities.
A child's feet grow rapidly during the first year, reaching almost half their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet.
Here are some suggestions to help you assure that this development proceeds normally:

• Look carefully at your baby's feet. If you notice something that does not look normal to you, seek professional care immediately. Deformities will not be outgrown by themselves.
• Cover baby's feet loosely. Tight covers restrict movement and can retard normal development.
• Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions which prepare the feet for weightbearing.
• Change the baby's position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.

Starting to Walk

It is unwise to force a child to walk. When physically and emotionally ready, the child will walk. Comparisons with other children are misleading, since the age for independent walking ranges from 10 to 18 months.
When the child first begins to walk, shoes are not necessary indoors. Allowing the youngster to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength, as well as the grasping action of toes. Of course, when walking outside or on rough surfaces, babies' feet should be protected in lightweight, flexible footwear made of natural materials.

Growing Up

As a child's feet continue to develop, it may be necessary to change shoe and sock size every few months to allow room for the feet to grow. Although foot problems result mainly from injury, deformity, illness, or hereditary factors, improper footwear can aggravate preexisting conditions. Shoes or other footwear should never be handed down.
The feet of young children are often unstable because of muscle problems which make walking difficult or uncomfortable. A thorough examination by a podiatrist may detect an underlying defect or condition which may require immediate treatment or consultation with another specialist.
The American Podiatric Medical Association has long known of the high incidence of foot defects among the young and recommends foot health examinations for school children on a regular basis.

Sports Activities

Millions of American children participate in team and individual sports, many of them outside the school system, where advice on conditioning and equipment is not always available. Parents should be concerned about children's involvement in sports that require a substantial amount of running and turning, or involve contact. Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports. Sports-related foot and ankle injuries are on the rise as more children participate actively in sports.

Children’s Feet Tips

Problems noticed at birth will not disappear by themselves. You should not wait until the child begins walking to take care of a problem you've noticed earlier.

• Remember that lack of complaint by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it.
• Walking is the best of all foot exercises, according to podiatrists. They also recommend that walking patterns be carefully observed. Does the child toe in or out, have knock knees, or other gait abnormalities? These problems can be corrected if they are detected early.
• Going barefoot is a healthy activity for children under the right conditions. However, walking barefoot on dirty pavements exposes children's feet to the dangers of infection through accidental cuts and to severe contusions, sprains, or fractures. Another potential problem is plantar warts, a condition caused by a virus which invades the sole of the foot through cuts and breaks in the skin. They require protracted treatment and can keep children from school and other activities.
• Be careful about applying home remedies to children's feet.
• Preparations strong enough to kill certain types of fungus can harm the skin.

Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.