Dear Dr. Roach: I am an 85-year-old female. Three years ago, a podiatrist diagnosed neuropathy (non-diabetic). He prescribed an orthotic for my shoe, measured some numbness and said come back in a year. I have made two yearly visits with his cutting my nails and checking feeling, which has progressed with numbness in my toes and the balls of my feet.
That doctor has moved out of town. I am wondering if I really need to see a podiatrist. I can get a free pedicure. I only have occasional pain that is minimal. I do have a bunion. Will I eventually need a different orthotic? I can just buy the same kind each year. If I do see a doctor, should it be a podiatrist or a neurologist?
P.H.
There are many kinds of neuropathy. The term just means something wrong with the peripheral nerve. It can present with symptoms that could include numbness, pain, weakness and loss of reflexes. It sounds like you have numbness and no other significant symptoms, and protecting your feet becomes the most important preventive treatment.
You are the most important person to do that. Do daily checks of your feet, which needn’t take more than a minute. Look for broken skin, warmth, redness and blisters; check especially between the toes. Any changes should be brought promptly to the attention of your doctor. You will want to wear well-fitting shoes and socks. There are many that are recommended for people with neuropathy. The shoes should be fitted with you wearing the orthotic.
Many orthotics need to be custom fitted, in which case you will need to see the podiatrist at least periodically.
Podiatrists are the real experts in foot care of a person with a neuropathy, but any doctor can do a periodic exam. If you have any concerning changes, a visit to the podiatrist would still be the next step, but a podiatrist is not necessary if you are doing daily self-exams and getting a doctor’s exam periodically (every three months is often recommended). Any increase in pain should be an indication to visit a new podiatrist.
A word about pedicures. It’s best to be seen by a person who has expertise in taking care of a person with neuropathy. Even though you don’t have diabetes, a person experienced with diabetic pedicures would be a good choice.
Dear Dr. Roach: I just recovered from a blood clot in my leg. I had to take Eliquis for six months. What are some options for birth control? My gynecologist said that I shouldn’t take birth control pills since I was taking them when I got the blood clot.
A.R.
A discussion between your regular doctor and your gynecologist would be a really good idea here. A person who has a history of blood clotting with estrogen-containing oral contraceptives should certainly avoid taking them. The best choice is probably an intrauterine device (IUD), because it is both safe and effective, and does not increase clot risk. Oral progestin-only options are available (often called the “minipill”) and are almost as effective. Many experts avoid injection of progesterone, as there might be an increased risk of clotting, as seen in some studies.
Because the most common type of progestin-only pill doesn’t stay long in the body compared with the much more commonly used combined oral contraceptives, it’s important to take the pill at the same time every day.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
