One of the most common questions, or to be honest, complaints I get in my podiatry practice involves patients paying their office copayment (copay).  Patients argue with our reception staff, billing staff, the medical assistants, the physicians, and pretty much anyone that will listen about being charged a copay each time they are seen at our office.  Many patients believe that we set their copayment amount, and it is our office that requires that they pay it.  This seems to be a very widespread misunderstanding, so I thought a blog entry might help clear this up. 

First and foremost to the understanding of copays is to know that your doctor’s office has very little to do with your copay.   Wikipedia defines an insurance copay as, “ a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed.”  In other words, your copay is an amount of money set by your insurance company (not your doctor’s office).  When you enter into a contract with your insurance company you agree to pay this copay amount each time a medical service is rendered.   This amount is often printed on your insurance card.  A lot of times a primary care physician (like your family doctor or pediatrician) will have a lower copay amount than a specialist like me (a podiatrist), or a heart specialist, ear nose and throat specialist, etc.  Insurances also usually have separate copays for office visits, inpatient hospital visits, outpatient surgery, emergency room visits, and prescription drugs. 

At Advanced Foot and Ankle Care, surgery is a large part of our practice, and patients often have questions about their copays for scheduled post-op follow up visits.  Some insurance policies do not require a copay during the post-operative follow up time (called the global period) since an office visit is usually not charged during this time.  Some insurance policies do require a copay during this time if services other than a visit are performed (x-rays are taken, a cast is put on, or you are seen for a condition separate from the surgical follow up).  This will often vary by specific insurance plan.  It is your responsibility, not the office’s to check on the specifics of your plan.  

This brings us to another popular question.  If you already pay a premium to your insurance company every month, why do they even require copays?  Insurance companies use copays to make you responsible for a small portion of your healthcare expenses.  They want you to know that your medical care is not free.  Having to pay a copay may discourage people from running to the doctor for every trivial condition they may have (i.e. sniffles or the common cold, for which there is no cure).  So basically copays save insurance companies a substantial bit of money.  On the other hand, people with multiple serious health conditions, especially the elderly, may need to see many different doctors a week, but do not go to these appointments because they cannot afford the multiple copays. 

So, what happens if you do not have the money for your copay?  Most offices ask that if your insurance has a copay, you pay before you are seen.  This is not unreasonable.  If you are there, obviously we expect that services will be rendered.  If a patient objects to this, and sometimes they do, we do allow them to pay upon check out after their appointment.  In the end the amount is the same whether you pay before or after your appointment.  If a patient refuses to pay their copay one of a couple of things may happen.  You could be refused service, or if you are a patient in good standing (you have never had late payments, do not have an outstanding balance, and do not frequently miss appointments) then you may be billed for the copayment amount.   If you have complaints or questions about your copay our office staff, specifically the billing staff, will do their best to answer these questions in our Sidney, OH office, but the most appropriate place to find answers is with your insurance company.   

Hillarie Amburgey, DPM

Neuropathy is a common complication for those with diabetes. It is caused by damage to the nerves of the body due to high blood sugar levels. Since the nerves that go to the foot are some of the longest in the body, these are particularly affected by this condition.    Signs of diabetic neuropathy include pain, tingling, or numbness to the foot. Due to lack of sensation in the foot, injuries can easily go unnoticed and lead to severe complications.

 Since we see the effects of diabetes every day in our different offices, we at Advanced Foot and Ankle Care want remind those with diabetes on how best to care for their feet:

 Never walk barefoot.

 Because those with diabetic neuropathy lack sensation to their feet, they could easily step on something like a piece of glass or other sharp object, and yet not notice it. For this reason, we advise our patients to never walk barefoot, even in their own home.

 Check your feet daily

Check your feet at least once a day for any injuries. Check the entire foot, even between the toes. If you have trouble doing this by yourself, try using a mirror or ask a family member for help. Make sure to see your podiatrist if you notice any sores on the bottom of your feet.

 Practice good foot hygiene

Make sure to wash and then thoroughly dry your feet daily. Drying your feet is important to prevent the growth of the fungus that can cause athlete’s foot. Use lotion on your feet if they are especially dry, but skip the area between the toes to prevent foot fungus. Always wear socks with shoes, and change them during the day if you find your feet can get very sweaty. Your podiatrist may want to see you at regular intervals throughout the year to make sure your feet are healthy; if so, make sure you keep these important appointments.

 Wear the right shoes

 Wear shoes that are sensible and comfortable. Do not wear high heels, or shoes that are tight in the toe box. If you have difficulty finding sensible shoes, our podiatrists would be happy to give you their recommendations. In some cases, they may even prescribe special shoes that are designed for those with diabetes.

 Dr. Eric Polansky

Despite the name, anyone can get Athlete’s foot. Athlete’s foot is a common term for a foot fungus that grows in warm, moist areas, especially where people walk barefoot. For this reason, it is possible to contract Athlete’s foot by walking barefoot in public areas such as locker rooms, changing rooms, and pool areas.

What are the symptoms?

Athlete’s foot commonly causes red, flaky, and cracked skin on the bottom of the foot or the skin between the toes. It is commonly itchy and painful.

What can I do to prevent Athlete’s foot?

First and foremost, it is best not to walk barefoot in the same areas as other people. Instead, we recommended wearing flip-flops or other waterproof footwear if using public areas such as locker room showers.

Try to keep your feet as dry as possible. If your feet get very sweaty, try to change your socks during the day. Avoid wearing the same shoes every day, and give your shoes a chance to fully air dry. Drying your shoes out will make it less likely for the fungus to grow.

If someone in your family has Athlete’s foot, it is best to clean and disinfect the shower or bath after they use it. Avoid sharing towels, as damp towels provide another environment for the fungus to grow.

How do you treat it?

There are several over-the-counter products to treat Athlete’s foot found at your local pharmacy.

If these do not work for your foot, at Advanced Foot and Ankle Care in Piqua Ohio, we can prescribe a prescription strength topical treatment, if necessary. For the most difficult cases, oral antifungal drugs may be necessary.

Eric Polansky, DPM

Warts are the 2nd most common dermatologic problem.  The only thing seen more often by dermatologists is acne. It affects 10% of children most commonly seen in ages 12-16. They are only slightly less common in adults at 7-10%.

Who gets them?

Anyone can get them, but some people are more susceptible. Children between 12 and 16 are most affected by plantar warts because they're more likely to go barefoot in public areas. The virus that causes plantar warts can enter the body through a cut or small abrasion on the foot.  In addition, those who have undergone an organ transplant or chemotherapy are at risk because their immune systems are compromised. They can also spread from one family member to another if the carrier doesn't wear shoes or slippers indoors.

What are they?

Warts are small, rough lumps on the skin that are benign (non-cancerous). They often appear on the hands and feet and can look different  depending on where they appear on the body and how thick the skin is. A wart on the sole of the foot is called a verruca.A wart is caused by the Human Papillomavirus(HPV), which causes the top layer of skin to thicken in a small area.  Some warts stay small, but they can grow quite large and cluster an entire area of the foot if left untreated.

The appearance of each type of wart will depend on several factors:

-- Where it is located on your body

-- The strain (type) of HPV that is responsible for the wart

-- Factors such as whether you have a weakened immune system

-- Whether you have rubbed or knocked the wart

How do you treat warts?

There are several over-the-counter topical treatments that all have the same degree of efficacy.  Most of these products are designed to eat away at the dead dry layers of the wart and the surrounding skin.

The doctors at Advanced Foot & Ankle Care have a number of treatment methods to their disposal.  The treatment used varies on where the wart is located, the age of the patient, and the patients’ expectations.                                       If a topical agent is used, many applications may be required over the course of several but the technique is highly successful. The most successful treatment is with the use of a CO2 laser to destroy the wart. Each of our 4 office locations, including our Piqua office, has one of these lasers.

Since certain HPV types are oncogenic (able to produce invasive malignant cancers), it is possible that plantar warts can rarely become invasive malignancies. Any wart-like lesion on the sole of the foot that does not resolve after appropriate therapy and continues to enlarge should be biopsied and examined by a pathologist. Warts can grow back. This indicates a virus is still in the body and growing. However, this is not cause for undue alarm. The virus that causes plantar warts is relatively harmless and causes few problems.

For any questions, contact Advanced Foot and Ankle Care at any of our 4 office locations.

Dr. Jeff Carlson

Steven Tyler, of Aerosmith and American Idolfame, is a famous sufferer of a common foot problem known as a neuroma. A neuroma is a thickening of a nerve as a response to irritation, and can be very painful. Most people with this condition describe pain or tingling between their toes, most commonly between the third and fourth toes. The pain can also affect the ball of the foot, and usually gets worse when bearing weight on this area.

One of the most common causes of a neuroma is shoe choice. Women are more likely than men to develop a neuroma, due to wearing high-heeled shoes. These types of shoes crowd the toes together, and cause the nerves of the feet to become “pinched”. This pinched nerve will thicken due to pressure, and will cause pain. Because of this, switching to more sensible shoes, such as shoes with a low heel and wide toe box, is recommended.

Shoe choice is not the only to blame, as those with flat feet or high arches are more likely to develop neuromas. Neuromas can also be associated with bunions, hammertoes, and other foot deformities. Custom orthotics can help correct some of these problems, and thus decrease the chance of developing a neuroma.

For our patients at Advanced Foot and Ankle Care in Sidney, Ohio, with a neuroma, we recommend orthotics and three steroid injections over three weeks to take pressure off the affected area and get rid of the pain. This course of treatment works for the majority of our patients, but for the rest we prescribe an anti-inflammatory drug and recommend wearing a night splint for an hour a day.

In rare cases where these other treatments don’t fully get rid of the pain, we may recommend surgery to remove a portion of the irritated nerve. In this case, we will use your own stem cells taken from your blood to speed the healing process.

Eric Polansky, DPM