Q&A

What’s the cause of the pinkish-red oval area on the pad of my client’s toes?

Q.

I have a client who has a recurring problem with her fourth toes during the winter months. Both of her “ring finger” toes develop a pinkish-red oval area on the pad. Then a month later, when I see her again, the skin has become dry and hard like a callus, with the layers of skin peeling away to reveal a deeper, dark epicenter.  It’s extremely painful for her and, needless to say, we do not touch it. But it clears up in the summer when she’s wearing open-toed sandals, so I suspect it has to be due to the boots she wears in the winter. Plus she never puts lotion on her feet or uses a foot file in between visits. What do you think causes this?

A.

The fourth toe (ring finger toe) is the one that gets squashed in good-looking shoegear. When shoes come to more of a point in front, rather than a square, the toes take the brunt of this shape. A pointed or “c-shaped last” (the proper name for a curve in front of a shoe) is a good-looking, fashionable shoe. But the toes are not good-looking or fashionable. Closed shoes such as winter boots can put excessive pressure on the pads of those toes. The dark epicenter is blood. Basically, her winter boots are bruising her toes and causing the tips to bleed. I usually see this on the second toe (closest to the big toe), often with runners. The answer to her issue is, as you suspected, a file and some good lactic/salacylic/uric acid cream daily. And invest in new boots!

— Dr. Johanna Youner, DPM, FACFAS, has been in private practice in

New York City since 1996 (www.healthyfeetny.net).

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