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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

For a runner, what aftercare do you recommend to ensure feet health?

Heel pain after running can result for multiple reasons at impact several types of tissue. Most commonly, this may simply represent a plantar fascial strain. The typical algorithm READ MORE
Heel pain after running can result for multiple reasons at impact several types of tissue. Most commonly, this may simply represent a plantar fascial strain. The typical algorithm of rest, ice and elevation and judicious use of medication such as acetaminophen or ibuprofen can be considered. If this is a recurring problem there may be suggestion that there may be some inappropriate environmental factors or functional factors of the foot contributing to this. Environmental factors can include footwear utilized, terrain that you are running on. Further it is important to identify whether this is affecting both heels or just a singular heel. Functional factors can include poor foot posture such as an overpronation requiring some type of mechanical control or support, overtightening of the posterior muscle groups such as the Achilles tendon necessitating appropriate pre- and post-exercise stretching. Heel pain can also represent injury to the bone itself and may simply present as a bone bruise or contusion or even a stress fracture. I would suggest that this type of pain does not typically recover with rest and ice and continues to hurt with activities of daily life. If pain does not appropriately resolve with simple interventions as suggested or is a recurring problem, this may suggest that you would benefit from evaluation by a foot and ankle specialist.

Right below my big toe hurts when putting on my shoes. What should be done?

This could represent many things. Starting from superficial to deep, the questions that must be asked include is there any changes of the overlying skin to include callus, skin READ MORE
This could represent many things. Starting from superficial to deep, the questions that must be asked include is there any changes of the overlying skin to include callus, skin rash or eruption. This can cause focal sensitivity with outward pressure. Immediately deep to the skin resides the extensor tendon to the great toe. If this becomes prominent it can produce
local irritation and sensitivity and tendinitis. In the surrounding soft tissue are the neurovascular bundles. Local pressure can produce nerve irritation and neuritis. Finally deep to this are the structures of bone and joint. Local bone spurs and degenerative arthritis can cause focal tenderness, but this would also most commonly occur with activity. I would suggest that if symptoms become increasingly worse to include involvement in activity or increasing pain you would be best served having evaluation by medical provider. If it is found that this is being impacted by a singular shoe or a certain style of shoe then these should be avoided.

I have what looks like a blister but it isn't going away. It's also painful. What should I do?

Based on your description, you are presenting with what we call a pustule. These are raised skin lesions with accumulation of underlying purulence. There are multiple causes to READ MORE
Based on your description, you are presenting with what we call a pustule. These are raised skin lesions with accumulation of underlying purulence. There are multiple causes to include both noninfectious and infectious. Infectious can represent both bacterial and fungal. Noninfectious can include disorders of skin such as psoriasis. Sometimes this presentation can include systemic complaints of fever and general malaise. Given its persistence and clinical presentation I would encourage evaluation by a medical provider to include specialist of dermatology or podiatry. This may require local aspiration or incision and drainage with appropriate cultures and if deemed infectious appropriately treated with antimicrobial.

I have a blue spot on my heel which looks like a blood clot. What could this be?

You may be quite accurate with your diagnosis. Thrombosed varix of superficial venules can develop and present as painful lesions of bluish hew often times on the soles of the READ MORE
You may be quite accurate with your diagnosis. Thrombosed varix of superficial venules can develop and present as painful lesions of bluish hew often times on the soles of the feet. These may develop from local trauma. These lesions are self-limiting but may take several weeks to resolve. Warm compresses to the area can improve local symptoms. Clearly, if
the lesion fails to improve as suggested or there is worsening I would encourage evaluation by a medical specialist to include a podiatrist or dermatologist.

I have flat feet and running is becoming painful. What should I do?

The postural deficit of a flat foot is not an uncommon clinical presentation. Many individuals do not have associated symptoms as a result of this. In fact, in the pediatric and READ MORE
The postural deficit of a flat foot is not an uncommon clinical presentation. Many individuals do not have associated symptoms as a result of this. In fact, in the pediatric and adolescent population, we commonly do not treat for a flat foot unless the child presents with associated symptoms of pain and/or dysfunction. We consider this the same in the adult
population. When someone does start to complain of fatigue or soreness, particularly with physical activity, we usually do escalate treatment for the management of this deformity. Initial care is quite conservative to evaluate factors that have influenced the development of this discomfort. This can include evaluation of your training regimen as well as the
environment that you're running. Footwear can have a significant influence, too.

How can I prevent corn in my feet from happening again?

Skin calluses and corns can be caused for many reasons. The most common reason is repetitive friction or irritation of the skin with underlying bone prominence causing local impingement. READ MORE
Skin calluses and corns can be caused for many reasons. The most common reason is repetitive friction or irritation of the skin with underlying bone prominence causing local impingement. The skin's reaction is to thicken and protect the area forming this organized corn or callus. The most effective treatment is to relieve the overlying pressure to include modification of shoes with larger toe box, digital pads and periodic reduction with some type of callus stone or pumice stone. Other reasons for corns and calluses can include dermatologic disorders that may be hereditary as well as infectious processes such as plantars warts. If these lesions become painful and persistent and are not simply a concern for aesthetic reasons, it would be appropriate to consult a medical specialist such as a podiatrist or dermatologist.

My feet swell up in the cold. Is this normal?

Swelling of the lower extremities can occur for many reasons. This does represent fluid exiting the vascular system into the surrounding tissue. The suggestion that this is occurring READ MORE
Swelling of the lower extremities can occur for many reasons. This does represent fluid exiting the vascular system into the surrounding tissue. The suggestion that this is occurring during the winter may support some type of vascular process. There are people with cold sensitivities that promote a constrictive effect to the blood vessels that then cause reactive hyperemia and focal swelling. These vascular constrictive disorders can include conditions such as Raynauds phenomenon or disease. If you have
associated complaints of joint pain or other systemic complaints, there may be consideration to be seen by her primary care provider or a rheumatologist to make sure that there is no underlying rheumatic process that may be contributing to this. Other factors besides the cold that may stimulate this process can include tobacco misuse, which should clearly be avoided. Obviously, continued protection from extreme thermal cold is also important, utilizing layered socks and avoiding immersion into water such as
street puddles that may develop.

A glass pricked my foot and even after a month the spot hurts. What should I do?

Penetrating injuries to the bottom of the foot are not an uncommon presentation and can cause some lingering issues both with potential for retained material as well as the local READ MORE
Penetrating injuries to the bottom of the foot are not an uncommon presentation and can cause some lingering issues both with potential for retained material as well as the local trauma to the soft tissue. Frequently, a retained foreign body will present with residual local inflammation of the soft tissue, the occasional build-up of callus tissue,
local purulent or clear drainage, and focal tenderness. The inflammatory process is the body's response to the foreign substance in its effort to eliminate the material. It is not unheard of to see gradual elimination of foreign substance over time as a "splitting" or expression through an opening of the skin if it remains superficial. Deeper retained objects can encapsulate and remain benignly present, but if they produce pain or dysfunction, they will require surgical excision. Many times, the retained objected is removed at the time of injury, but the persistent pain is a result of the local penetrating trauma to the tissue. This should improve within a few weeks from time of injury. Signs that suggest a follow-up evaluation include persistent redness to the area, drainage, pain that does not trend in an improved or resolved fashion, visualization of a persistent wound, and even identification of the retained foreign object. If there remains a concern for a retained foreign object, X-rays and even an ultrasound can be performed to help identify its presence.

I am experiencing foot pain while sitting. What could be the reason?

Foot pain at rest can be caused for a lot of reasons. Frequently, it is not musculoskeletal as discomfort is appreciated without loading of the injured foot and associated bone READ MORE
Foot pain at rest can be caused for a lot of reasons. Frequently, it is not musculoskeletal as discomfort is appreciated without loading of the injured foot and associated bone and soft tissue structures. Inappropriate sitting can cause postural impingement of peripheral nerves. This can occur at the lower back level, knee, ankle, and foot. Numbness and tingling sensation is often accompanied by this presentation. Frequent repositioning while sedentary can help minimize this. If pain and stiffness are appreciated after prolonged sitting and putting weight on the extremity, this can represent injury to the soft tissue and joint be it from an arthritic process or prior overuse injuries. When resting our body does limit blood flow to peripheral extremities and a "gelling phenomenon" occurs. Until the body part is moved and blood resumes, soft tissues can feel tight and present with discomfort. This is often reflected in the morning stiffness associated with arthritis conditions. Finally, poor circulation can present
as rest pain when inadequate arterial circulation reaches to the distal extremity. This can be a finding in patients with arterial occlusive disease prompted by atherosclerosis or tobacco misuse. Your presentation sounds quite benign and I believe can be relieved with postural repositioning when sitting for prolonged periods and pumping exercises of the foot to promote circulation to the area.

What is the meaning of the term ballerina foot?

Ballerina foot frequently refers to the ideal ballet foot, which is found to be supple and possess an accentuated instep arch. Sadly, most ballerinas do not often present this READ MORE
Ballerina foot frequently refers to the ideal ballet foot, which is found to be supple and possess an accentuated instep arch. Sadly, most ballerinas do not often present this way. The repetitive stress loading to the foot performing the required positions often results in over use injuries to tendon, ligament, bone, and joint. Some of the common ailments seen in ballerinas include posterior ankle impingement syndrome, flexor tendinitis, degenerative changes, particularly to the great toe, and acquired digital
contractures. It is an unfortunate tale that the ideal foot presentation is frequently lost due to the nature of the activity.

Does swelling around the ankle indicate a serious injury?

Swelling is a physiologic response to the trauma resulting in injury to small blood vessels promoting the bruising that is seen, but also an escape of fluid from the vascular system READ MORE
Swelling is a physiologic response to the trauma resulting in injury to small blood vessels promoting the bruising that is seen, but also an escape of fluid from the vascular system into the interstitial or soft tissue. The initial phase of healing following the bodies initial management of local bleeding through clotting is an inflammatory phase with introduction of factors and other transmitters promoting migration of cells necessary to promote healing of the tissue. There are many factors that may contribute to the swelling of the area and not all equate to severity of injury. With that said, it would make sense that the greater the injury, the more likely to have greater tissue involvement and the swelling would be worse. When this occurs in a closed compartment of tissue, a concerning secondary condition known as compartment syndrome may occur. For most injuries beyond swelling we consider pain to the area, local deformity, and associated dysfunction of part to grade severity. If there is no noted deformity, the part functions pain free with no appreciated altered movements and, in the case of an ankle's ability to bear weight on the extremity, understand swelling is a physiologic response that will resolve with rest, elevation, and time. If it fails to do so, this may be a greater indicator of injury.

Why do my feet hurt when I wear flats or heels?

The majority of cases with regards to heel pain relate to a condition known as plantar fasciitis. There are many reasons to get overuse fascioapthies and tendinopathies of the READ MORE
The majority of cases with regards to heel pain relate to a condition known as plantar fasciitis. There are many reasons to get overuse fascioapthies and tendinopathies of the foot and ankle. This can be related to environmental factors such as foot wear and activities. Increased body weight can also play a significant role particularly when it
comes to lower extremity musculoskeletal conditions. Obviously, there is always concern regarding potential medical disorders such as different types of arthritis that may present with this type of discomfort. I have found moderation in everything seems to be the answer. Excessively high-heeled shoes as well as poorly supportive slip on flat shoes tend not to do well. A slight wedge can always be beneficial and can be achieved with many types of clogs as well as good walking shoes or running shoes with a
heel lift. We encourage stretching exercises particularly for the posterior leg muscle groups of the calf that are readily identified as runners wall lean stretches and foot dorsiflexion stretch exercises. If these modifications and exercises are done and pain relief is not achieved, then an evaluation by a qualified medical specialist would be a reasonable consideration.

Can anyone get athlete's foot?

Athlete's foot is a representation of a superficial skin infection produced by mold like fungi that are environmentally acquired. It is noted to be contagious. Environments that READ MORE
Athlete's foot is a representation of a superficial skin infection produced by mold like fungi that are environmentally acquired. It is noted to be contagious. Environments that tend to be warm and moist are quite conducive to this type of fungal growth. The majority of these infections are produced by a class of fungi known as dermatophytes. They are sensitive to many topical antifungal products that are readily available over-the-counter. These do respond quite favorably after a few days to a
few weeks of use. Good hygienic care of the feet to prevent exposure to environments conducive to this type of mold-like growth is critical specifically gym showers, pool decks and other areas of high traffic. It must be appreciated that there are other types of dermatitis that can produce similar findings of athlete's foot to include redness, scaling, itchiness and if your condition does not respond timely to traditional anti-fungal preparations it may be of benefit to have the skin eruption or rash evaluated by a medical provider. Skin scraping can be performed painlessly to determine if there are presence of fungal elements. If sterile you may be suffering from a noninfectious dermatitis that may better respond to other treatment such as topical steroids or lotions.

Why are my feet so crooked?

Unfortunately, structural deformities of the feet, particularly bunions, are found to have a familial predisposition. They are more common in women. There are no long-term studies READ MORE
Unfortunately, structural deformities of the feet, particularly bunions, are found to have a familial predisposition. They are more common in women. There are no long-term studies suggesting ability to inhibit deformity development with orthopedic bracing, exercises, shoe modification, or medication. We do appreciate environmental factors that may accelerate deformity presentation both in severity and symptoms. These include inappropriate foot wear, increased physical demands of loading to include
excessive body weight, injury, and concomitant disease states (often those that affect the musculoskeletal system, such as arthritis, connective tissue disorders, metabolic bone disease, etc.). Things we can do to minimize foot deformity impact on our quality of life - make sure shoes are well-fitted, accommodate foot structure well, and have limited heel height; maintain a healthy body weight; regular exercise that does not cause reproducible pain to the feet particularly over areas of deformity; and monitoring for any other associated signs such as developing joint pains to include feet and elsewhere in the body. Although feet may not always be aesthetically beautiful regarding deformity presentation, the more important aspect is that they are pain free and allow us to remain mobile and active. When dealing with these deformities, the latter must always be considered paramount.

Can I run with flat feet?

It is extremely challenging to define what is a normally functioning foot from the standpoint of anatomic appearance. Ultimately, it is one that allows an individual to perform READ MORE
It is extremely challenging to define what is a normally functioning foot from the standpoint of anatomic appearance. Ultimately, it is one that allows an individual to perform activities without pain or dysfunction. The appearance or presentation of flatfoot does not necessarily condemn an individual to disability regarding performance of activities such as running. In fact I treat many patients for other reasons with underlying flatfoot that has never been symptomatic. This can also be said for the opposite presentation of a high arched foot. With that said, if you have found limitations of pain or dysfunction particularly with athletic activity this needs to be evaluated. My general first consideration is whether the deformity is what we call supple or rigid in nature. Supple deformities are flexible in nature with collapse of the foot that can be reduced to some degree with manipulation. The arch can often be reconstituted with support. These individuals do exceedingly well with good supportive foot wear and orthotic insole, whether this be custom or prefabricated.

My mother is diabetic and has thick nail growth in her feet. How can we cut them while avoiding injury?

Individuals suffering from diabetes can be at risk for complications involving the lower extremities and particularly the feet. As a disease, diabetes can produce injury to the READ MORE
Individuals suffering from diabetes can be at risk for complications involving the lower extremities and particularly the feet. As a disease, diabetes can produce injury to the peripheral nerves and circulation. This may leave the patient with impaired sensation and poor blood flow. Secondary findings can include dermatologic changes such as nail thickening, dryness of skin, and risk for infection. We often do not encourage palliative hygienic self care for maintenance of nails, trimming of calluses/corns in these individuals as local injury can lead to significant problems. Health care providers, particularly the specialty of podiatry, are highly knowledgeable in the management of the diabetic foot. Screening by a podiatrist can establish a risk stratification by assessing circulation, nerve function, structural deformity and skin integrity. A patient with diabetes demonstrating compromise in any of these areas would be best cared for on a periodic basis by a foot specialist. The value of these services has been recognized by insurance payers to include Medicare and is a covered benefit when criteria is met.

Is my ankle sprained?

Any persistent pain or swelling to the ankle following injury exceeding more than 7 days does warrant evaluation by a medical professional or specialist. Sadly, the ankle sprain READ MORE
Any persistent pain or swelling to the ankle following injury exceeding more than 7 days does warrant evaluation by a medical professional or specialist. Sadly, the ankle sprain has often been overlooked as a minor musculoskeletal injury that is frequently self treated. By experience, study, and literature, these ankle injuries can cause individuals persistent problems up to 40% of the time 6 months following trauma. The ankle joint is an extremely confined joint with multiple tissues that can be injured to
include bone and cartilage, ligament, tendon and nerve. With this in mind, your injury may warrant more aggressive initial protection than simply a soft wrap and limited activity. Followed by this period of appropriate protection you may also benefit from formal physical medicine and rehabilitation in order to achieve a more expedient restoration of ankle function and reduce the likelihood of chronic issues.

There is a feeling of discomfort in my right foot. What could this be?

It will be extremely difficult to provide you a credible cause for this pain without more information. When evaluating a patient's complaint, clinicians must assess the nature READ MORE
It will be extremely difficult to provide you a credible cause for this pain without more information. When evaluating a patient's complaint, clinicians must assess the nature of the pain (aching, sharp, burning, etc), location (in your case what part of the foot), duration of symptoms etc.

What to do for swollen feet?

Leg swelling or peripheral edema is produced by expansion of fluid within the surrounding tissues. Generalized swelling results from increased fluid pressures across the capillary READ MORE
Leg swelling or peripheral edema is produced by expansion of fluid within the surrounding tissues. Generalized swelling results from increased fluid pressures across the capillary beds, reduced capillary oncotic pressure or increased capillary permeability. Sodium or salt retention by the kidneys can also produce swelling. It is not uncommon for diabetics to have some level of kidney disease. It may also be compensatory in response to reduced arterial blood volume resulting from heart failure and liver disease. Peripheral swelling can also result from poor blood circulation particularly related to venous blood flow. There are drugs that can influence organ systems specifically heart, liver and kidney that can also be associated with swelling. When looking at swelling of the legs, we often characterize the presentation as nonpitting or pitting. By their own name presentation, pitting swelling produces a dimpling effect when the tissues are pressed on with gradual expansion back to their swollen state. Pitting swelling is frequently related to the previously mentioned organ disease. Non-pitting edema does not produce a dimpling effect and may be associated with vein insufficiency or chronic lymphedema. Any type of acute single leg swelling should always raise the possibility of blood clot such as deep vein thrombosis that needs to be acutely evaluated. Given the history as presented, I do believe this swelling more than likely is related to her diabetes and potential impact on other organ systems by the disease itself or medications that are required. Elevation of the extremities can be extremely beneficial when sedentary to help manage the expansion of fluid out of the vascular system. It is imperative that the cause of the swelling be established in order to provide an effective treatment. This would be best handled by your primary care physician who can assess current medications, obtain appropriate laboratory studies, and assess organ systems.

The skin on my left foot feels raw after standing for a long time. Why?

The big clinical question is whether there are any perceived skin changes associated with this feeling. Meaning is there any type of rash, skin eruption, skin breakdown. Clearly READ MORE
The big clinical question is whether there are any perceived skin changes associated with this feeling. Meaning is there any type of rash, skin eruption, skin breakdown. Clearly if this does manifest then some type of dermatologic disorder is most likely the cause of your problem. This can include both infectious and noninfectious. From an infectious standpoint, the most likely cause is a fungal infection or athlete's foot they can be readily treated with many over-the-counter topical antifungals. Noninfectious disorders can include areas of eczema, contact dermatitis, psoriasis. These disorders may be best treated with a topical steroid. If it is simply drying out of the skin then a good skin lotion or emollient may be warranted. If there are no overlying skin changes then we must consider other systems that may be prompting the sensation of a raw feeling and numbness. Most likely this is some type of neuropathic process. Given the focal nature as described without any evidence of radiating type presentation both into the leg or distally into the foot this may simply present as a compression irritation of nerve distributing into this area.