expert type icon EXPERT

Dr. Michael Hercules Theodoulou, D.P.M.

Podiatrist (Foot and Ankle Specialist)

Dr. Michael Theodoulou is a podiatrist practicing in Somerville, MA. Dr. Theodoulou is a medical doctor specializing in the treatment of the foot , ankle and related parts of the leg. As a podiatrist, Dr. Theodoulou diagnoses and treats conditions of the feet. The feet are key body parts that give a person stability, absorb shock, allow for walking and standing and are necessary for overall well-being. So, the feet need expert care. Podiatrists can specialize in surgery, wound care, sports medicine, diabetic care and pediatrics.
30 years Experience
Dr. Michael Hercules Theodoulou, D.P.M.
  • Somerville, MA
  • William M Scholl College of Podiatric Medicine
  • Accepting new patients

Are arch supports the only way to treat neuroma?

Morton's neuroma represents chronic inflammation with secondary scarring (fibrosis) around the nerve sheath or lining. It typically affects the common intermetatarsal nerve between READ MORE
Morton's neuroma represents chronic inflammation with secondary scarring (fibrosis) around the nerve sheath or lining. It typically affects the common intermetatarsal nerve between the 3rd and 4th toes. Its cause may be traumatic, biomechanical induced, environmental (poor foot wear to include high heels, tight toe box), rheumatic (underlying arthritic disorder), and
idiopathic (no defined explanation). There are a variety of treatments to include shoe modifications, foot orthos with metatarsal pad to relieve pressure from the area, physical therapy, nerve block with corticosteroid, and finally surgery for either decompression or excision. There are other less investigated procedures to include ablations of nerve with chemical or
thermal probe and shock wave treatment.

Initial management includes shoe modification, metatarsal pad with or without supportive insole, activity modification and judicious use of anti inflammatory such as ibuprofen if permitted. If this does not produce improvement, I would recommend x-rays to rule out differential causes of pain to include stress fracture, joint disorder. Other imaging techniques for neuroma include ultrasound and MRI. If definitively neuroma then consider nerve block with cortisone and physical medicine. If this all fails, you may need to investigate more invasive treatment such as surgery and if this does not appeal to you some of the other less investigated approaches mentioned.

Is a bunion a bone growth?

Bunions are indeed a deviation of the long first metatarsal bone and the corresponding phalangeal bone of the great toe. There is a progressive inward deviation of the long metatarsal READ MORE
Bunions are indeed a deviation of the long first metatarsal bone and the corresponding phalangeal bone of the great toe. There is a progressive inward deviation of the long metatarsal bone while the great toe reciprocally begins to point toward the lesser toes. Over time with repetitive pressure to the area, there may be some development of new bone growth or if secondary arthritis develops due to malalignment of the joint. It is for this reason when surgically corrected, the bone cannot only be cut away, but some type of realignment procedure is required. Bunions are principally a familial or hereditary condition.

What can I do to prevent bunions?

Although the cause of bunions can involve environmental, traumatic, and event systemic arthritic factors, the most common reason is familial or genetic. There is a notable genetic READ MORE
Although the cause of bunions can involve environmental, traumatic, and event systemic arthritic factors, the most common reason is familial or genetic. There is a notable genetic predisposition for women. What does this mean for prevention? It is quite challenging to impede progression. With that said, there are management measures that can be done to assist in the relief of localized pain and dysfunction without aggressive intervention such as surgery. Shoes with limited heel height not to exceed two inches with larger toe box to minimize compression is a great start. If there are identified overall biomechanical factors contributing to its presentation such as over pronation of the foot, orthotics controlling these factors may be of assistance. The marketed bunion splints have no evidence-based medicine or scientific support for the restoration of foot anatomy or retarding progression, but they may assist in local pain relief. Ultimately, if pain or dysfunction notably impacts the quality of life and failed these nonoperative measures, then surgery may be required.

How are corns under a toenail removed?

Corns under the nail, or medically referred to as subungual keratomas, develop not dissimilar to other identified corns. There is excessive pressure borne on the nail bed resulting READ MORE
Corns under the nail, or medically referred to as subungual keratomas, develop not dissimilar to other identified corns. There is excessive pressure borne on the nail bed resulting in thickening and keratinizing of the nail bed epithelium or skin. These are challenging to eliminate as they are protected by the overlying nail plate. Frequently, a portion of the nail may need to be removed to gain access. This may be done under local anesthesia if it is too sensitive to be done without anesthetic. As this is not a frequent area to develop these lesions due to protection from the nail plate, it may be wise to biopsy the presentation if there is any suspicion that this is not keratinized skin (abnormal coloration, irregular borders, altered appearance of the surrounding nail bed skin, etc.). If there is any appreciation or local deformity, it may be wise to also obtain an X-ray to rule out a not uncommon bone growth or exostosis that develops on the distal phalanx that can contribute to these lesions (subungual exostosis or osteochondroma). If this is present, the bone enlargement may also need to
be reduced and biopsied.

I have pain in my ankle and it may need surgery. Will my diabetes make it difficult to heal my ankle?

Optimizing a patient's health before any type of surgery, particularly elective surgery is absolutely critical. With regards to musculoskeletal surgery, there are comorbid conditions READ MORE
Optimizing a patient's health before any type of surgery, particularly elective surgery is absolutely critical. With regards to musculoskeletal surgery, there are comorbid conditions that may influence the outcome and any acute complications that may occur. Glycemic or blood sugar control is absolutely critical from the standpoint of wound healing, reduction of
secondary infection risk, and bone healing. Elevated blood sugars impact healing at the cellular level and influence compromised immune response. Blood sugars can be monitored acutely with finger sticks and getting a snapshot understanding of current control, but more frequently, we utilized a test known as the hemoglobin A1c to get a better understanding of her overall glycemic control over an extended period of time. Although there is no consensus, we do appreciate that a hemoglobin A1c representing normal glycemic control is ideal. In my own practice, I typically utilize an A1c of 7.5 mg/dL as a cutoff point for elective surgery. As a side other factors that are looked at particularly when it comes to bone and joint
surgery include the health of the bone from the standpoint of vitamin D as well as social factors such as smoking, which can also impact wound healing and bone healing.

What is the best way to clean your feet when you have diabetes?

Appropriate hygienic care of the feet is particularly important in those individuals who suffer from diabetes. Cleansing with warm water and antibacterial soap on daily basis is READ MORE
Appropriate hygienic care of the feet is particularly important in those individuals who suffer from diabetes. Cleansing with warm water and antibacterial soap on daily basis is important. It is critical to dry the feet well after bathing particularly between the toes. Replacement of skin moisture is also important with appropriate lotions or creams as diabetes can have impact on the normal regulation of skin moisture resulting from autonomic neuropathy. Refrain from daily water soaks as this can be extremely drying to the skin. Monitor for any cracks or fissures that can result in skin breakdown and potential site of infection. If concerned about skin presentation of the lower extremities, please consult a medical
specialist such as a primary physician, dermatologist, or podiatrist.

What can I do for my dry and cracked heels?

This is not an uncommon disorder resulting from excessive dryness of the skin associated with barefoot walking causing this local fissuring. Clearly avoidance of being barefooted READ MORE
This is not an uncommon disorder resulting from excessive dryness of the skin associated with barefoot walking causing this local fissuring. Clearly avoidance of being barefooted is critical. I recommended skin emollients or lotions to prevent this fissuring and cracking. There are multiple products available over-the-counter which are useful for this. I do oftentimes recommend a product such as ammonium lactate lotion or cream that can be obtained with a 5% strength over-the-counter and a 12% strength with prescription.

Should I see a podiatrist for my feet If I have diabetes?

Diabetes is an endocrine disorder that results in impaired glucose metabolism. The persistence of elevated blood sugars can impact multiple organ systems that frequently can be READ MORE
Diabetes is an endocrine disorder that results in impaired glucose metabolism. The persistence of elevated blood sugars can impact multiple organ systems that frequently can be reflected in injuries to the lower extremities and feet. Diabetes can impact peripheral circulation, sensation and immune response to injury including the presence of infection. Diabetic
feet require special attention by medical practitioners who have a keen appreciation for subtle changes that may portend future complications. Reduced ability to palpate pulses in the feet, diminished or absent hair growth, sluggish capillary return, altered skin temperature can suggest reduced blood flow. Reduced appreciation for tactile sensation to light touch, sharp stimulus, vibratory appreciation can suggest reduced feeling. Inability to mount an appropriate immune response to local microbial contamination can result in severe infection. For these reasons, diabetics are encouraged to have a periodic evaluation by a foot specialist. Depending on the identified risk presentation, the frequency of visits will be determined by the specialist.

I have an ingrown toenail. How would it be removed?

Ingrown toenails can be effectively managed during an ambulatory visit at a specialist clinic. A common procedure performed is the removal of the affected nail margin with chemical READ MORE
Ingrown toenails can be effectively managed during an ambulatory visit at a specialist clinic. A common procedure performed is the removal of the affected nail margin with chemical cauterization of the nail matrix utilizing phenol (an acid solution). This is done under a digital local anesthetic block. The acid solution destroys the cells of the matrix responsible for regenerating the nail in this region preventing recurrence. Recovery from this procedure is usually very quick with recommendations of warm water soaks frequently with Epsom salts and maintenance of local bandage for 10 to 14 days. In the event the ingrown nail has associated infection which prevents the use of phenol, the offending nail spicule may be removed under a digital anesthetic block and you may be given a short course of oral antibiotic to assist in resolving the infection. In this latter circumstance, the nail will likely regenerate and there may be the future risk of recurrence.

Should I stay away from pedicures?

Inappropriately maintained soaking tubs, instruments, or anything else that comes into contact with our skin and associated structures does pose risk for infection. The number READ MORE
Inappropriately maintained soaking tubs, instruments, or anything else that comes into contact with our skin and associated structures does pose risk for infection. The number one method to prevent the spread of infection in hospital settings is appropriate cleansing of hands and use of universal precautions to include gloves. Translated to soaking tubs, if facilities do not appropriately cleanse and disinfect between patron use this can cause the spread of infection. Breaks in our skin can allow for contamination and infection. Individuals who are immunocompromised are that much more susceptible and at risk - example diabetics, elderly. I would casually observe cleansing procedures of the facility that you use for pedicures. I would also ask management how instruments and tubs are cleaned and disinfected between customers. If not satisfactory, I would avoid obtaining services from them. If you have any open or recent cuts or wounds to the feet, I would avoid pedicures until they are fully healed.

How are bunions removed?

I prefer the word corrected versus removed when dealing with bunion deformities. It is a misconception that this represents bone overgrowth although that can occur as part of the READ MORE
I prefer the word corrected versus removed when dealing with bunion deformities. It is a misconception that this represents bone overgrowth although that can occur as part of the deformity. This in fact is a deformity where the long first metatarsal bone deviates away from the other lesser metatarsal bones with reciprocal inward deviation outward deviation of the great toe to the lesser toes. This is in fact deviation of joints and not a true intrinsic deformity of bone. Its correction surgically can be achieved with corrective bone cuts to realign the metatarsal bone or selective fusions involving the deviating joints.

I have a heel spur. Does the treatment involve anesthesia?

Heel spurs are typically appreciated at two sites - on the inferior or bottom of the heel and posteriorly or back of the heel. Both are intimately related to the attachment of READ MORE
Heel spurs are typically appreciated at two sites - on the inferior or bottom of the heel and posteriorly or back of the heel. Both are intimately related to the attachment of soft tissue with the insertion of the plantar fascia on the bottom and the Achilles tendon at the back. The development of bone prominences represents repetitive strain and microtrauma at these
attachment points resulting in acute micro bleeding with secondary calcification and ossification of the soft tissue. Over time these prominences enlarge and can be appreciated on plain film radiographs and clinically with visible and palpable presentation when discussing those of the back of the heel. Commonly these spurs are can be managed conservatively without surgical intervention. Particularly bone spurs associated with the plantar fascia. In both cases, it is believed the pain generator is not the bone spur, but the acutely or chronically inflamed or degenerated connective tissue. Most cases of plantar fascia/heel spur pain resolve with good conservative care of appropriate footwear, arch support or heel cushion, program of stretching and judicious use of anti-inflammatory medication. When surgery is indicated, the bone spur is frequently not addressed and it is simply the plantar fascia that may be partially released or selectively debrided with ultrasound guidance. Posterior heel spurs are a little more challenging and may require removal if they become large enough to interfere with footwear and the counter of the shoe rubbing on the back of the heel. In both cases, anesthesia is frequently afforded with plantar fascia procedure requiring at a minimum local anesthetic to the area and potentially IV sedation. The posterior heel spur being more invasive frequently requires sedation with a regional block or general anesthetic.

What should I do to prevent my feet from hurting in the snow?

Clearly excessive cold exposure to the extremities can produce pain. Our body tends to shunt blood to vital organs when in the cold leaving extremities such as hands and feet vulnerable. READ MORE
Clearly excessive cold exposure to the extremities can produce pain. Our body tends to shunt blood to vital organs when in the cold leaving extremities such as hands and feet vulnerable. Prolonged cold exposure can produce conditions such as Chilblains, a reversible thermal injury of tissue to advancing degrees of frost bite that in extreme cases can cause death of tissue. There are certain conditions that may predispose an individual to increased cold sensitivity such as Raynaud's disease or phenomenon. Individuals with this may have an underlying connective tissue disease or simply develop increased spasticity of the small blood vessels particularly to the fingers and toes in response to cold exposure. The reduced blood flow prompts the pain. It is important to note that the chemicals and salts applied to the roadways and sidewalks lowers the freezing point of water. Persistent immersion of feet in puddles with lower than freezing water temperatures can heighten risk for injury. Prevention is to keep extremities warm with appropriate layering of socks and use of footwear resistant to water. If extremities should get wet, it is best to dry as soon as possible.

Can bunions indicate an underlying foot problem?

Bunion deformities represent a progressive misalignment of the great toe with deviation developing between the bone of the great toe and the corresponding metatarsal bone. This READ MORE
Bunion deformities represent a progressive misalignment of the great toe with deviation developing between the bone of the great toe and the corresponding metatarsal bone. This deformity is most often a consequence of familial or genetic predisposition and affects women more than men. The deformity may also develop from local trauma to the area. Finally,
different types of arthritis may be a contributing factor to its presentation to include osteoarthritis and rheumatoid arthritis. If you are suffering from other joint discomfort beyond the great toe or have other systemic complaints it would be prudent to be medically evaluated. Bunion deformities typically become more painful if there is developing arthritis within the joint as bump pain alone can be relieved with appropriate foot wear that minimizes compression to the area.`

I have a bulging bone just below my toe. What could it be?

This bulge may represent many things from a misaligned bone to new growth of bone or soft tissue. Given that you have identified this presentation and it is clearly creating symptoms READ MORE
This bulge may represent many things from a misaligned bone to new growth of bone or soft tissue. Given that you have identified this presentation and it is clearly creating symptoms of pain, this should be evaluated by an appropriate specialist. At the least some type of imaging should be considered. Initially x-rays are obtained but if these do not suggest derangement of bone or joint other forms of imaging can be considered to include musculoskeletal ultrasound and MRI.

Why do I have swollen feet inspite of taking anti-inflammatory medicines?

Swelling of the lower extremities can result not just from inflammation, but also due to fluid retention.Inflammation in fact is a form of fluid leaving the vascular system and READ MORE
Swelling of the lower extremities can result not just from inflammation, but also due to fluid retention.Inflammation in fact is a form of fluid leaving the vascular system and entering into the interstitial tissue through capillary leakage due to reaction from injury whether acute or chronic. Swelling or peripheral edema can also result from excessive fluid resulting
from organ issues related to kidney, heart, liver; or local vascular issues frequently seen with venous insufficiency or lymphedema. If this swelling does not remit as anticipated with current medical management, I do believe it is important that further investigation occurs to determine why the swelling in your feet persists.

Why does my ankle sprain easily?

Recurring ankle sprains may result from functional or structural dysfunction. Functional suggests that there is no significant structural weakness that permits the ankle to rotate READ MORE
Recurring ankle sprains may result from functional or structural dysfunction. Functional suggests that there is no significant structural weakness that permits the ankle to rotate excessively. It may result from weakened surrounding musculature particularly the peroneals when dealing with inversion sprains (most common when ankle roles out) or can also
suggest proprioceptive dysfunction. Nerve endings around our joints that allow us to appreciate spatial relationships of our anatomy and appropriately adjust if placed in awkward positions. Structural dysfunction results from true ligament disturbance by tear or attenuation or bony deformity that drives our ankle to rotate inappropriately. There are situations that ankle instability arises from both functional and structural deficits.

I think I have an ingrown toenail. What does this usually look like?

Ingrown toenails are an incurvation of a nail corner resulting in local pain and inflammation of the surrounding skin. These frequently affect the great toe. If allowed to persist READ MORE
Ingrown toenails are an incurvation of a nail corner resulting in local pain and inflammation of the surrounding skin. These frequently affect the great toe. If allowed to persist they can become locally infected with increasing redness, drainage and exuberant granulation tissue. In the early stages these can frequently be managed with local medical care hi performance of warm water baths with antibacterial soap or Epsom salts. If permitted to advance and not getting better oftentimes these do require surgical removal. On occasion systemic antibiotics are also given by mouth.

What are the best shoes recommended for people with flat feet?

Flat feet are a common presentation represented by reduction of the in step vault, outward rotation of the heel, and in more severe cases the fore part of the foot turned out on READ MORE
Flat feet are a common presentation represented by reduction of the in step vault, outward rotation of the heel, and in more severe cases the fore part of the foot turned out on the rear part. This is often referred to as overpronation. When symptomatic this type of foot posture benefits from good mechanical support. Generally in the running shoes we speak of motion control or stability. Structure of the shoes include a rigid sole with firm counter and lace up. Briefly shoes that represent this include new balance, Asics, Brooks, Saucony in running type shoes. Casual walking shoes include Clark, mephisto, Ecco.

How are calluses treated?

Calluses typically represent a reaction of the skin due to overloading or excessive pressure. Relieving pressure by soft insoles, shoe modification can be quite beneficial. Mechanical READ MORE
Calluses typically represent a reaction of the skin due to overloading or excessive pressure. Relieving pressure by soft insoles, shoe modification can be quite beneficial. Mechanical reduction of the calluses with a pumice or callus stone after bathing can be also helpful. We ask particularly patients that may be compromised with diabetes, peripheral vascular disease or peripheral neuropathy to refrain from any type of medicated acid type callous remover as this may cause injury to the skin causing and healing complications.