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

Do heel bone fractures require surgery?

The heel bone known medically as the calcaneus is an extremely unique bone critical for the function of the hindfoot and the ability to appropriately load weight onto the foot. READ MORE
The heel bone known medically as the calcaneus is an extremely unique bone critical for the function of the hindfoot and the ability to appropriately load weight onto the foot. It possesses articular facets on its top surface to form a complex joint with the overlying bone known as the talus that we refer to as the subtalar joint. Distally it also has a joint that articulates with the tarsal cuboid bone of the mid-foot. The broad body of the calcaneus posteriorly also serves as an insertion for the largest and
strongest muscle tendon complex of the body appreciated as the Achilles tendon. There are multiple ligamentous attachments to this bone that maintain the stability and structure of the foot and ankle. Interestingly, with its significant need for weightbearing load, it is not terribly well designed structurally to do this. It has a thin cortical shell with significant medullary space and we frequently correlate this to almost like an egg with a hard shell and soft yolk in the middle. Fractures of this bone can become challenges depending on the mechanism of injury as well as the anatomic involvement. Broadly speaking we can speak of fractures that involve the complex joint surfaces and those fractures that do not. Not knowing the type of fracture that you have suffered makes it difficult to tell you whether surgery is indicated or not. Fractures that do not involve the articular surface and are considered nondisplaced body type fractures frequently do not require any surgery and heal quite readily given the nature of the bone. Those fractures that we refer to as intra-articular or joint involving that cause displacement and compression of the heel bone remain somewhat controversial in their treatment. For years, a conservative approach was considered given potential wound healing complications associated with surgical exposure. More recently, with an
evolution of surgical techniques, there has been greater interest in recommendation for anatomic reduction of these fractures to restore the gross normal anatomy of the heel bone speaking of its height with in length. Fractures that do involve the subtalar joint surfaces do have high risk for posttraumatic arthritis that may produce prolonged disability and require ultimately surgical fusion of this joint. Given the challenging nature of these fractures and the risk for long-term disability, these do require evaluation by a specialist well-versed in their management. If you have any concerns regarding your healing and treatment recommendations, I would highly encourage a second confirmatory opinion.

I am getting frequent ankle swelling. Can it be cured?

There are many reasons for developing peripheral swelling or edema. This swelling can represent inflammatory reaction due to overuse syndromes and injuries of the musculoskeletal READ MORE
There are many reasons for developing peripheral swelling or edema. This swelling can represent inflammatory reaction due to overuse syndromes and injuries of the musculoskeletal system, arthritic or rheumatic disorders, infectious, tumor, vascular and fluid exchange processes of the tissues due to electrolyte imbalances and other organ disease processes to include kidney and liver function.

Clinical history is critical to assisting in what may be the potential cause. Frequently asymmetric or single leg swelling is representative of a local process of the extremity. When there is bilateral (both limb) involvement, this more than likely represents a systemic or generalized process. It is also critical to understand whether there is associated pain with the presentation. Painful peripheral swelling of joints can represent rheumatic processes. It is also extremely important to identify how long the swelling persists and what is done to relieve the presentation. Given you describe yourself as an 18-year-old girl who appears to be healthy and active as this presentation is developing after running or workout sessions, then the more likely factors appear to revolve around musculoskeletal disorders. Medical evaluation should include basic laboratory studies, radiographs of the ankles and a good physical examination of the involved anatomy with subsequent studies as required to determine the cause of this presentation.

How to reduce the pain due to ankle sprain?

Rotational injuries of the ankle can present as mild, moderate, and severe. For many years the poor ankle sprain has been considered to be of a limited problem that resolves with READ MORE
Rotational injuries of the ankle can present as mild, moderate, and severe. For many years the poor ankle sprain has been considered to be of a limited problem that resolves with appropriate rest. Interestingly the ankle joint is the most frequently injured joint of the body and can create persistent problems in up to 40% of the cases 6 months following the injury. Appropriate early treatment is absolutely critical.

Why do I wake up with pain in my heels everyday?

There are many reasons to suffer from morning pain and stiffness involving the musculoskeletal system. Oftentimes referred to as a gelling phenomenon, the connective tissue that READ MORE
There are many reasons to suffer from morning pain and stiffness involving the musculoskeletal system. Oftentimes referred to as a gelling phenomenon, the connective tissue that makes up much of the structure of our bones, joints, ligaments and tendons are impacted by reduced perfusion of blood while we sleep particularly to the extremities. If there is underlying disease process this appears to be heightened as we get up in the morning. A common disorder that impacts the heel is a condition known as plantar fasciitis. This is an inflammatory degeneration of the broad fascia/ligament on the bottom of the foot that is a dynamic stabilizer of the foot and maintenance of the instep. At its proximal attachment into the heel bone we can produce inflammatory irritation. A common complaint of patient suffering from this disorder is something we refer to as post static dyskinesia. Meaning after being sedentary or sleeping the first few steps are quite painful and stiff until there is increased perfusion to the area and there is a gradual relief of pain. This is akin to the athlete who sustained an acute injury while playing their sport but continues to play without initial significant impact. Once taken off the court or playing field the connective tissue begins to tighten up. Morning pain and stiffness can also be the result of joint disease to include arthritis. This is also a common complaint that is heard with stiffness and pain to the involved joints. Given that you have been suffering from this for 1 year, it would
be most appropriate to seek medical evaluation and a determination as to the potential cause for these complaints. Plantar fasciitis is a readily treated disorder with appropriate stretching, shoe and activity modification, heel lift or supportive over-the-counter insole and will improve. Unfortunately arthritic disorders are more challenging and may require greater and more prolonged management in order to achieve an improved pain and functional state.

Could weight be a contributing factor for ankle and knee pain?

Increased body mass is a significant factor to overuse processes of the musculoskeletal system particularly the lower extremities. It has been determined that with walking and READ MORE
Increased body mass is a significant factor to overuse processes of the musculoskeletal system particularly the lower extremities. It has been determined that with walking and running we can produce pressure loads of approximately 5-1/2 times our body weight in the ankle and 2-1/2-3 times in the knees. When you consider the small surface areas particularly attributed to the ankle joint we can appreciate why this joint is the most frequently injured joint of the body. Further there are no tendinous
attachments to the talus which is the bone that resides within the ankle mortise and as a result the stability of this joint complex is based on bony architecture and surrounding ligamentous support. Clearly exercise is critical for good health to include cardiovascular, musculoskeletal and even mental but we must be cautious and understand the limits of our body and appreciate the activity and its pressure that it is exerting through the skeletal system. I have frequently advised patients with notably
higher BMI to begin with appropriate dietary restriction under physician guidance and begin weight loss in this fashion prior to engaging in high intensity activities in an effort to further lose weight through caloric burn. Alternative exercises that do not put excessive pressure on the lower extremity joints to include use of a stationary bike, aquatic exercise are a great initial means to do this. As body mass improves with weight loss then increased exertional activities such as higher intensity walking and running can be initiated with reduced risk of injury.

What's this feeling on the bottom of my toe?

Your subjective symptoms of a prickling feeling on the bottom of your great toe randomly is most suggestive of some type of peripheral nerve process. More than likely it is local READ MORE
Your subjective symptoms of a prickling feeling on the bottom of your great
toe randomly is most suggestive of some type of peripheral nerve process.
More than likely it is local and effects one of the cutaneous or skin
nerves in the area. Given that you do not describe any radiating
presentation to involve other parts and it is quite limited in its area of
involvement this appears to be a benign focal irritation. Since you do not
describe any type of overlying skin eruption or rash, I do not believe
there is any type of skin disorder that may similarly present with this
type of feeling. I do not believe any formal evaluation or treatment is
required other than observation. Clearly if symptoms become more constant
and begin to involve a greater area of the foot this would warrant some
type of medical evaluation. There are systemic causes for what we
described as peripheral neuropathy to include diabetes and other metabolic
disorders, nutritional vitamin deficiencies, metal toxicities, traumatic or
entrapment and many that are simply idiopathic, we simply do not know the
cause. Best recommendation at this time is to simply keep a close eye on
the process and make sure there is no appreciated worsening.

Dull pain in my big toe with no presumed cause, what is it?

there are potentially many reasons for the cause of a general dull ache to the big toe. These can include musculoskeletal problems, vascular and neurologic. From a musculoskeletal READ MORE
there are potentially many reasons for the cause of a general dull ache to
the big toe. These can include musculoskeletal problems, vascular and
neurologic. From a musculoskeletal consideration one would have to consider
arthritic processes that cause joint pain. This may have resulted from old
trauma, repetitive mechanical injury or systemic cause for arthritis.
Vascular complications can include arterial insufficiency. Unfortunately
tobacco misuse has caused identified diseases of the peripheral arterial
system which can cause insufficiency and secondary pain. We also frequently
appreciate this in our diabetic population as this disease also impacts
peripheral circulation.Finally nerve processes can also produce chronic
pain. There are many reasons for peripheral neuropathy to include the
previously mentioned diabetes. There can also be nerve compression and
previous nerve injury. Regardless, if this pain is chronic and has not
found to improve on a timely basis or in fact has been worsening, it would
be best advised to seek specialty medical care in order to have a good
examination to include potential x-rays and other necessary laboratory
studies to better understand why he may be suffering from this discomfort.

Do store orthotics work?

Orthotic appliances are used to treat biomechanical and structural dysfunctions of the human foot and lower extremity. An appropriate diagnosis is always critical to achieve a READ MORE
Orthotic appliances are used to treat biomechanical and structural dysfunctions of the human foot and lower extremity. An appropriate diagnosis is always critical to achieve a most efficacious response. This can only be done by seeing an experienced provider in the management of these disorders. With that said, there are many common conditions that can be
readily identified by the consumer (patient) and achieve satisfactory results with an off-the-shelf insert. These conditions include flat feet, plantar fasciitis (heel pain), arch pain/fatigue and metatarsalgia (pain in the ball of the foot). There are many products that can be purchased at local retail stores that will provide similar benefit to that of a custom foot orthosis without the cost in handling these presentations.

Ingrown toenail surgery now have thick ridged nails

Sadly nails can become disfigured and "scarred" with any type of trauma to include ingrown nail surgery. This can be very challenging to restore. It is possible you acquired a READ MORE
Sadly nails can become disfigured and "scarred" with any type of trauma to include ingrown nail surgery. This can be very challenging to restore. It is possible you acquired a secondary fungal infection. Nail specimen can be obtained to assess for fungal presence and appropriately treat with the best option being an oral systemic. I have also found that with several nail growth cycles which take 6 to 8 months one can appreciate return of an improved toenail. So you may simply want to be patient and perform good hygienic management of nail trimming and see if with time things improve.

It is a frustrating disorder and unfortunately no definitive treatment to guarantee return of your normal nail appearance.