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

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.

I have a recurrent problem of ingrown toenails. What should I do?

Ingrown toenails can impact quality of one's life due to pain and repeated infection. If this is a recurring problem a minimally invasive office-based procedure under digital anesthetic READ MORE
Ingrown toenails can impact quality of one's life due to pain and repeated infection. If this is a recurring problem a minimally invasive office-based procedure under digital anesthetic can be performed to excise the involved nail margin with destruction by surgical excision or cauterization with medicine of the nail matrix to prevent recurrence. This can be a very gratifying procedure for those who suffer from repeated episodes.

Snapping noise and pain in heel or back of the ankle

The audible sound coming from soft tissue in joints often times is a benign process but if it is related to associated pain or dysfunction to the area may define underlying pathology READ MORE
The audible sound coming from soft tissue in joints often times is a benign process but if it is related to associated pain or dysfunction to the area may define underlying pathology that requires investigation and potential treatment. Given your history of trauma I would suggest that there is some ongoing process that needs further evaluation. I would caution the use of any type of cortisone injections around the Achilles tendon as this has demonstrated potential risk for rupture. I would encourage evaluation by a specialist well trained in and foot and ankle issues for a proper evaluation to include necessary imaging such as x-rays and it indicated advanced imaging such as MRI or CT scan. Based on this hopefully a definitive diagnosis can be made with prognosis and treatment options

I have a little bone growth just under my toe. Will it have to be treated with surgery?

Bone enlargements or growths are not uncommon findings, particularly with toes. These may represent simple degenerative spurs or in fact, may represent small benign bone tumors. READ MORE
Bone enlargements or growths are not uncommon findings, particularly with toes. These may represent simple degenerative spurs or in fact, may represent small benign bone tumors. One frequently encountered is identified as an osteochondroma. This does represent a benign overgrowth of bone with cartilage surface. Treatment of these bone groups is based on symptomatology and impact on local function and pain. Clearly, if there are any concerns regarding appearance based on radiographs, then an excisional biopsy is always recommended. Further, if one cannot obtain relief or improved function by offloading the affected area with the appropriate footwear or digital padding, then surgery is the most effective treatment, as these enlargements will not spontaneously regress and there is no medical management that will allow for dissolution of the overgrowth of bone.

How is a diabetic foot treated?

The diabetic foot is not a disease entity unto itself, but is a description for potential concern regarding complications of the lower extremity and foot-related to the diabetic READ MORE
The diabetic foot is not a disease entity unto itself, but is a description for potential concern regarding complications of the lower extremity and foot-related to the diabetic state. Hyperglycemia or elevated blood sugar can impact multiple systems and thereby tissues that can impact foot presentation. Of notable concern is the circulatory and nervous system.
Diabetics are prone to diseases of these systems resulting in poor circulation and loss of nerve function that may leave an individual susceptible for injury to include wounds as well as bone and joint trauma. It is for this reason that we recommend to our diabetics vigilant regular examination of their lower extremities and feet to include visual examination and manual palpation. Stringent glycemic control is the mainstay of care, but when complications do develop immediate attention by a specialist well-versed in the diabetic foot is critical to prevent significant sequelae. Patients with identified compromise to include neurologic and vascular of the lower extremities warrant regular examination by such a specialist and in fact hygienic care to include management of nail disorders and skin disorders is typically covered by insurance with the understanding of this risk.

Can a bunion be treated without surgery?

Bunion deformities represent truly a misalignment of the great toe joint. This joint is comprised of the proximal phalanx of the great toe and the first metatarsal bone. The deformity READ MORE
Bunion deformities represent truly a misalignment of the great toe joint. This joint is comprised of the proximal phalanx of the great toe and the first metatarsal bone. The deformity is considered principally to be familial in etiology but can be worsened by environmental factors to include activity, trauma and foot wear. As there is progressive misalignment of the joint deterioration or ankylosis of the joint can occur. Unfortunately, this deformity is initially best managed with activity modification, shoe modification and analgesics as required and used judiciously. Much of the advertised bunion splints did not produce any sustainable reduction of deformity. Ultimately, if this deformity impacts your quality of life, then surgical correction is warranted. There are a myriad of different surgeries available based on clinical and radiographic presentation.

I have a weird growth on my ankle. What could it be?

There are a variety of neoplasms or new growths that can occur affecting all tissues of the human body. Firstly it needs to be established where the growth presents. On the skin READ MORE
There are a variety of neoplasms or new growths that can occur affecting all tissues of the human body. Firstly it needs to be established where the growth presents. On the skin these can result from neoplasm, infection, trauma. Viral infections consistent with HPV present as warts. Altered cellular activity of the skin can produce benign and malignant skin lesions. We evaluate these lesions based on presentation of color, size, shape and border presentation. Traumatic injuries can produce hypertrophic scars and keloids. Deep to the skin and subcutaneous tissue soft tissue masses and elevations can represent cystic lesions such as ganglions, fatty tumors known as lipomas. Beyond the subcutaneous layer around joints we can develop tumors of the joint lining or synovial tissue. Again these can be benign or malignant. Fast-growing lesions that are painless are concerning. These can represent sarcomas. Finally lesion of bone can develop. Again this can result from altered cellular activity resulting in new bone growth and palpable prominence. Given all of this as a potential I would recommend evaluation by a medical specialist with appropriate workup to include imaging as indicated.

What shoes should I wear for hammertoe?

Prevention of deformity can be challenging as many times this is a dynamic process resulting from familial or hereditary factors as well as foot function and structure. Generally READ MORE
Prevention of deformity can be challenging as many times this is a dynamic process resulting from familial or hereditary factors as well as foot function and structure. Generally speaking I manage these for the here and now. Large toe box shoes to minimize pressure on the deforming digits is imperative. These are represented by round or square toe shoe box with good height. Limiting any type of closed fashion shoe that is triangular or pointed at the end to minimize compression on the digits. Maintaining heel height to less than 2 inches. Even with these measures deformity may progress as shoes frequently are not the cause but can influence or splint the deformity.

I have a painful, swollen ankle following an injury. What to do?

Your assessment is quite correct and untimely healing of an injury warrants evaluation by a medical specialist with probable need for X-rays to assess for structural damage that READ MORE
Your assessment is quite correct and untimely healing of an injury warrants evaluation by a medical specialist with probable need for X-rays to assess for structural damage that my be impeding healing. There is a lot of local anatomy at risk for injury in this often downplayed process of the ankle sprain

I am not able to flex my foot. Why?

The ability for a body part to move requires multiple organ systems to include bone, muscle tendon and nerve. The inability to flex the foot suggests some type of disruption in READ MORE
The ability for a body part to move requires multiple organ systems to include bone, muscle tendon and nerve. The inability to flex the foot suggests some type of disruption in this process. This may result from muscle tendon pathology, neurologic failure to promote a muscle contraction or a combination thereof. Given the limited information provided by the question I would suggest that more than likely there is no neurologic component to this as you apparently also suggest pain but this is not guaranteed. More than likely failure is occurring through the musculoskeletal system and may result from overuse processes to produce tendinitis which can weaken function and produce pain when recruited. Depending chronicity of the disorder treatment and prognosis varies. In acute cases appropriate rest, ice and anti-inflammatory may be all that is required. In chronic cases, mitigating the factors that have caused the overuse process is required to include activity modification, addressing any biomechanical issues and physical medicine rehabilitation. Given that this is a recurring consistent problem I would recommend evaluation by a medical specialist who can more appropriately evaluate her presentation and obtain require test such as x-rays that may help define this process.

Is foot amputation the only solution for gangrene?

Unfortunately gangrene represents death of tissue that will necessitate debridement to vital healthy tissue. When it involves the distal extremity such as the foot, the amount READ MORE
Unfortunately gangrene represents death of tissue that will necessitate debridement to vital healthy tissue. When it involves the distal extremity such as the foot, the amount of tissue that often has to be removed may leave the individual with a nonfunctional extremity that will be better served with amputation and prosthesis. As terrible as this may sound return to a better life may occur faster with this approach versus heroic measures requiring multiple surgeries, associated risks and no guarantees regarding outcome.

My grandfather's wound is not healing. What should we do?

There are many reasons for a wound to fail to advance to appropriate healing. Globally, diabetes appears to be a significant factor regarding development of foot ulcerations and READ MORE
There are many reasons for a wound to fail to advance to appropriate healing. Globally, diabetes appears to be a significant factor regarding development of foot ulcerations and wounds and their ability to heal. The disease impacts multiple systems to include vascular, neurologic and immune mediated processes. Ongoing infection is a critical factor in wound healing failure. It requires appropriate medical management with topical or systemic antibiotics often dictated by appropriate cultures from the wound site. But medical management may be limited in resolving the process and surgical debridement of any nonhealing, devitalized tissue is also warranted when medical management does not produce adequate resolution. Inadequate blood flow can also be a factor as this is what provides appropriate oxygenation of tissue to advance the healing process and also to deliver necessary antibiotics if provided systemically. Wounds on the bottom of the foot are also exposed to significant mechanical stress load from daily walking and standing and appropriate pressure reduction is necessary to allow for advancement of healing. Plantar or wounds on the bottom of the foot are an extremely complicated presentation that required a wound care specialist frequently to address the specific needs and allow for timely healing and prevention of further infection, increase in wound size and greater complications. If there has not been an appropriate reduction of wound size and typically we suggest by at least 50% within 4 weeks with current management this warrants consideration of treatment modification and again I would recommend seeing a wound care specialist.

My foot still hasn't healed after I fell last month. What should I do?

Wound healing is a complex cascade of cellular activity that promotes initially hemostasis or bleeding control followed by presentation of growth factors and other signaling events READ MORE
Wound healing is a complex cascade of cellular activity that promotes initially hemostasis or bleeding control followed by presentation of growth factors and other signaling events to advance laying down of collagen and ultimately advancement of cells to promote wound closure. After acute healing of the wound there is an ongoing remodeling process. There are
many factors that may interfere with wound healing. Mechanical factors such as repetitive stress to a wound that does not allow for appropriate maturation. This can occur over areas of excessive skin mobility or joint motion. It can also occur in areas of pressure loading on the sole of the foot. Our skin is a primary barrier of infection to the body. We colonize many
microorganisms on our skin that once this barrier is breached can then result in contamination and ultimately infection. Infection can retard the normal healing process and so it is imperative that it is resolved with local antiseptic care or systemic antibiotics. Intact vascular standing is also absolutely critical for appropriate wound healing particularly to the lower extremities and feet. Impairment of blood flow can slow healing as it impacts the ability for the previously mentioned signal factors and cells to migrate to the area. Individuals who
misuse tobacco products impact small vessel flow particularly to the skin and this can be a critical factor in delayed wound healing. Nutritional deficits and metabolic disorders also play a role in wound healing. Vitamin deficiencies and disease states such as diabetes can influence timeliness of healing. As I am uncertain as to what is meant by my foot wound has not healed and what it represents currently I cannot tell you whether it is appropriately recovering at this time. In an otherwise healthy individual superficial wounds will again heal with initial clotting and hemostasis for blood control followed by overlying eschar or scab with gradual contraction and loss of this eschar with new skin growth. If there remains a persistent open wound that is draining or failing to show contraction and closure then I do believe it would be best that this be medically evaluated and assessed for some of the common reasons if otherwise healthy as an individual to include persistent infection, failure to adequately protect the area from excessive stress or strain and potentially there may be a retained foreign body if in fact there was external forcible injury from a rock.

My feet sweat a lot. Is that normal or is it a problem?

Hyperhidrosis or excessive sweating of the feet can be caused for many reasons. Typically, it is a chronic idiopathic (unknown) condition, but it can also be secondary to other READ MORE
Hyperhidrosis or excessive sweating of the feet can be caused for many reasons. Typically, it is a chronic idiopathic (unknown) condition, but it can also be secondary to other medical conditions. The most common idiopathic presentation typically is localized to certain areas of the body and does affect the palms and soles of her hands and feet. Sweating helps us in thermoregulation, skin hydration as well as fluid and electrolyte balance. We identify 3 types of sweat glands on her skin to include eccrine, apocrine and apoeccrine. It is the eccrine sweat glands which are responsible for hyperhidrosis. These are found in highest #2 the palms and soles of the feet. The sweat glands are innervated by the sympathetic
nervous system. Emotional sweating is affected by different regions of the brain and may be a factor with regards to the development of this condition. It is for this reason that when under stress we tend to perspire more. Treatment clearly is to address factors that influence this. Things that overstimulate are sympathetic nervous system are attempted to be mitigated. Reducing stress, limiting caffeinated products can be quite helpful. First line of treatment is typically a topical antiperspirant most commonly with some type of aluminum chloride solution as a drying agent. Secondary therapy in severe cases can include use of botulinum toxin injections. These interfere with sympathetic nerve function by blocking the neurotransmitter acetylcholine. There are also oral systemic therapies to include anticholinergics, clonidine as well as beta blockers and benzodiazepines, however, there are side effects that limit primary use. Iontophoresis as a treatment based on electric current to inhibit sweating. Finally, in the most severe of cases when involving the upper extremities, endoscopic surgical thoracic sympathectomy has been performed.

I have a lot of heel pain in the mornings after going for a walk. What can I do to treat it?

The most common reason for heel pain due to overuse is plantar fasciitis. This is a repetitive injury of the broad band of connective tissue of the sole of the foot that helps READ MORE
The most common reason for heel pain due to overuse is plantar fasciitis. This is a repetitive injury of the broad band of connective tissue of the sole of the foot that helps statically support the instep. Contributing factors to this presentation is overuse with activity, being overweight, mechanical or structural issues of the foot and functional to include overtightening of muscle groups. Treatment for this is most commonly quite conservative to include activity modification, longitudinal arch support if identified as having overpronation or flatfeet, stretching exercises for the Achilles tendon and weight loss if indicated. Pain relief can be achieved with topical measures such as ice massage and is severe enough
medicine such as acetaminophen or ibuprofen if tolerated. Typically, this is a self-limiting process, but may require 6-9 months to fully recover. If pain becomes notably severe and does not demonstrate improvement, then an evaluation by foot and ankle specialist may be indicated.