The following article is based on Dr. Titko’s long-standing expertise with helping with the relief and prevention of a wide range of painful foot and ankle problems.


The number one reason a person with diabetes is admitted to the hospital is for foot ulcers or openings in the skin.

  • 70% of these ulcers result in amputation.
  • A corn or a callus (hard skin on top of your toes or on the ball of your feet) indicates a pressure point and in people with diabetes, this means an area at greater risk of ulceration or infection.
  • Prevention is the key to avoiding amputation.
  • By wearing properly fitted shoes, before an ulcer starts, the risk of amputation is reduced. In addition to fitting properly, the shoes must have solid support with protective custom inserts.
  • If your feet have nerve damage (neuropathy) from diabetes, you may be unaware of ill-fitting shoes. Shoes that are too tight or too small can lead to ulcers.
  • Fortunately, most insurance plans cover custom fitted shoes and inserts for those feet at risk of damage as a result of diabetes. These shoes are available by prescription only from your podiatrist.
  • Don’t wait until it is too late to be sure that your shoes will help keep your feet healthier, longer.


 A bunion is a bump just behind your great toe and is hereditary in nature.

  • Pain from a bunion is different for everyone; size is not an indicator of pain.  Bunions can be painful whether they are small or large and some are not painful at all.
  • If there is pain from the bunion, it is usually noticed after, rather than during, activity.
  • Bunions occur in women more frequently than in men.
  • Shoe pressure against the bump or arthritis in the great toe joint can be a source of pain. Bunions may be more painful in tight fitting shoes.
  • Ice, wider shoes, and over-the-counter medications may be helpful to reduce the pain in the early stages.
  • Because bunions form as a result of a mechanical defect in the foot structure, orthotics (custom prescribed inserts for your shoes) may help to alleviate the pain.
  • Although surgery is sometimes necessary, your podiatrist can offer other treatment options that may help you avoid or delay surgery for this joint pain.


If you have ever turned your ankle or felt like your “ankle gave out on you”, you may have suffered one of the most under treated injury of the body – an ankle sprain.

  • If it hurts bad enough you may go to the emergency room or have x-rays taken at your doctor’s office. Even if the x-rays show no broken bones, there could be damage to the ankle that can’t be seen on the x-rays.
  • If x-rays say nothing is broken, try starting with exercises for your ankle: pretend your foot is a pencil and draw out the alphabet three times a day.
  • You may feel it’s not bad enough to initially seek medical attention and decide to “just walk it off.” But if there is bruising or if the pain or swelling persists, then your ankle requires more investigation.
  • Ligaments help your ankle to feel stable and secure. Tendons give your ankle strength. When bones don’t break, frequently ligaments or tendons tear. If left undiagnosed or untreated, a “simple sprain” can lead to long term weakness, instability and pain.
  • Because ligaments and tendons can’t be seen on an x-ray, an ultrasound or MRI will help diagnose tendon or ligament tears. Your podiatrist can help your ankle become less swollen, less painful and regain its strength and stability.


  • Once you have had a wart on your foot, there is a 20% chance you are going to get another one.
  • If you have warts on your feet you can easily share them with your friends and family.
  • Frequently, but not always, warts on your feet can look like raised areas with dark dots (that look like seeds but they are not) or flat and whitish-yellow in color. Usually there is pain when standing if they are on your heel or the ball of your foot.
  • You may start with one, but more may be coming soon. They tend to spread to other feet through wet surfaces such as the shower floor, bathroom tile or rug.
  • Use caution when trying to treat these areas with medications bought at the store. Many of these treatments involve using acid on your feet and may cause chemical burns.
  • Recognize that not all lesions on your feet are warts; they may be calluses, clogged sweat glands (like a pimple you may get on your face but very painful) or a host of other skin conditions including melanoma (skin cancer).
  • Professional diagnosis and treatment by a podiatrist are recommended for their enhanced safety and effectiveness.


The most common cause of heel pain is known as Plantar Fasciitis. It may be caused from over strain or under support of your feet, trauma or poor mechanics.

  • A podiatrist can do a complete exam to check for other causes of heel pain including: stress fracture, damaged nerves, tumor and many others.
  • Plantar fasciitis is easier to treat with faster results if diagnosed early. Some at home remedies for heel pain; take over-the-counter anti-inflammatory medicine, apply ice to your heel 15 min of every hour, roll your arch over a baseball or can of soup and wear good supportive, comfortable shoes.
  • If your heel pain persists you many need x-rays to rule out other causes of heel pain such as a fracture, tumor, or foreign body. Ultrasound or MRI can help rule out tendonitis or arthritis.
  • Your podiatrist can help to control any mechanical defect of your feet with the use of orthotics or physical therapy, and the recommendation of the proper shoes to wear. You may need your feet strapped/taped for enhanced support. The use of other medications can help relieve your heel pain.
  • There are some exciting new treatments for heel pain that are minimally invasive and may give long lasting relief.
  • The key to quick and long-lasting comfort is an early diagnosis and immediate start of treatment.


  • If you were less active in the cooler months and waited for the sun to come out to increase your activities – your feet may not be ready. Without properly preparing your feet for increased exercise, you may develop heel pain, muscle strains or tendonitis in your ankles.
  • Your shoes should match your sport. For example; do not run long distances in basketball shoes. You should always wear firm soled athlete shoes for all sports or activities, not flimsy, non-supportive shoes. If you do develop heel or ankle pain you may need custom-made orthotics – these offer superior support to any over-the-counter shoe insert.
  • Proper stretching of your tendons may help to prevent foot and ankle pain during sports or activities. Consider rolling your arch over a can of soup or a frozen bottle of water and with your knee extended pull your toes up toward your nose to stretch your Achilles before and after sports or fitness activity.
  • If you have foot or ankle pain that occurs either during or after your fitness activity, see your podiatrist for a complete exam, proper diagnosis and treatment options to alleviate these pains and to prevent future injuries or pain.


  • Ingrown toenails can cause pain and become infected.  If the skin around you nail is red or if pus is seen around the nail, some self-treatments may make the condition worse.
  • Try soaking your toe in luke-warm water with a little Epsom salts or liquid dishwashing detergent. Apply an antibiotic ointment and band aid to the nail area. If no improvement is seen in 2-3 days, you may require professional treatment.
  • Ingrown toenails are usually hereditary in nature, but sometimes trauma can be the cause. Be sure to check your children’s nails, especially if you have suffered from this condition.
  • Try wearing wider shoes to prevent the pressure on your toe which would increase you pain.
  • Antibiotics may temporarily offer relief.
  • If pain, redness or pus continues, seek professional intervention from a podiatrist for lasting comfort.

For the last 17 years, Dr. Titko has been leading the charge for good foot health through her practice at the Center for Foot Care. Together with her staff, she has developed the Center for Foot Care into a practice that provides superior quality medical and surgical care of the foot and ankle to the local and extended communities of Cincinnati. You can reach Dr. Titko at either of her office locations, in Mt. Healthy on Hamilton Avenue at 513-729-4455 or in Erlanger on Dixie Highway at 859-341-0575. For more information, visit