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Universal City 210-375-3318
Pleasanton 830-569-FEET (3338)
Toll-Free: 855-972-9512
Next Step Foot & Ankle Clinic

Frequent Foot Questions: What You Want to Know About Ankle and Foot Health

Exploring medical options to cope with pain can be very overwhelming, and it can be hard to know where to start. Here, we share our most commonly asked questions from people just like you. Whether you are wondering what is causing your pain or trying to find out what treatment options are available to you, find answers here in our frequently asked questions section.

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  • How Soon Can I Get My Blood Work Done Before Surgery?

    Once you get your orders for blood work, you can get your blood work done within 30 days of surgery.

  • a Pre-Surgery Checklist

    Have you...

    • Received Post Op Boot?
    • Received Crutches?
    • Received Prescription for Knee Walker?
    • Practiced with Knee Walker or Crutches, if you will use them?
    • Scheduled Post Op Appointments?
    • Filled Prescriptions?
    • Arranged for a ride?
    • Done lab work?
    • Read Post Op Instructions?

  • What do I do with my FMLA forms?

    If you will be filing Disability or FMLA forms with your employer, please fill out the employee section and sign them before giving them to us so we can submit them directly on your behalf.  We can provide you with a temporary Handicap Parking Application as well.  Please get forms to us as soon as you have a surgery date to give us plenty of time to complete them!

  • How Should I Prepare for Surgery?

    In general, before your surgery, you will need to:

    • Stop any aspirin or Advil (Ibuprofin) 7 days before surgery.
    • Stop smoking as soon as you schedule surgery and do not resume until well after surgery, if at all.
    • If you use a knee walker or crutches after your surgery, practice using them well in advance of your surgery.
    • Pick up pain medications before your surgery date.
    • Take your regular medications on surgery day as instructed by the facility nursing staff on your pre-admissions call.
    • Wear comfortable clothes, including loose pants. shorts or a skirt/dress that will fit over bulky casts or a cam walker.
    • Have a person over 18 drive you to and from your surgery.
    • Show up 2 hours prior to surgery time for Northeast Methodist, 1 hour prior to surgery time for other facilities.
    • Bring photo id and insurance cards on the date of surgery
    • Do not bring valuables to facility on surgery day

  • How Does the MLS Laser Work?

    In a nutshell, the MLS Laser stimulates the mitochondria in cells to jump start the body's own healing process.

    Laser energy stimulates cells to remove toxins, like histamine and cytokine, out of cells.  They allow oxygen and food loads into the cell.  They block the pain signals to the nociceptros in the brain, and release endorphins and encephalin.  Laser light increases ATP production and cell growth.  It brings blood flow to the area and increases angiogenesis of capillaries.

    In fratures, it will increase osteoblast production within the first 10 days only.

    Like an antibiotic, each treatment is cumulative in its effectiveness, building off the previous treatments. 

  • What are the specifications of the MLS Laser?

    The MLS Laser is a Class IV Laser and uses multiple synchronized diodes.  

    It features 2 wavelengths: 808 nanometers and 905 nanometers.  The wavelengths are in the infrared spectrum.  They are invisible to the eye, but can be seen using a cell phone camera.

    The 808 wavelength is for inflammation, and is long lasting.  The 905 wavelength is analgesic and is fast acting.  Together, they are very effective.  

    The MLS wavelengths combine and synchronize the 808nm and 905nm in a unique and proprietary way.  The MLS wave form is patented.

    The laser can penetrate 3cm to 5cm deep and generates no heat.  There are no known harmful effects.

  • Can MLS Laser Therapy be used over medical implants or over metal?

    Yes, MLS Laser Therapy is a treatment using light.  No heating is involved with the surgical or metal implants.  It can be used safely with no side effects.  It is extremely effective for post-operative wound healing. 

  • Can MLS Laser Therapy be used in conjunction with other forms of treatment?

    Yes, MLS Laser Therapy is sometimes more effective when combined with other forms of therapy, including physical therapy, chiropractic, massage, soft tissue mobilization, electrotherapy, and following surgery. 

  • How long does the MLS Laser treatment take?

    The typical course of treatment is 10 to 15 minutes, depending on the size of the area being treated.  Treatments are typically received 2 to 3 times per week.  Treatment plans are determined on an individual basis. 

  • What does MLS Laser Therapy have over other forms of therapy?

    It does not require the use of drugs or surgery, there are no known side effects, and it is quick / convenient.  Studies have shown that it si equal to or more effective than other forms of physical therapy.  These studies have performed at many prestigious institutions including Harvard University.

  • What happens if I get all the MLS Laser Treatments and I am not 100% better?

    Throughout treatment the Doctor will reevaluate your progress to make any necessary changes to the treatment protocol for maximum results.  After the 12th treatment the Doctor will evaluate your overall progress and discuss your options at that time.

  • How many MLS Laser treatments is it going to take for me to feel better?

    Most patients report a positive change within the first 2-3 treatments, but because everyone reacts differently, I cannot say for sure.  This does not necessarily mean you will be 100% better, it could be a simple improvement, such as a trip to the grocery store was not as painful.  For some more chronic conditions it may take up to 6 visits to feel the benfits of laser therapy. 

  • Am I going to feel anything during my MLS Laser Treatment?

    There is little or no sensation during the treatment.  There is no pain associated during laser application.  Laser treatment is relaxing and some people even fall asleep.

  • What is the MLS laser actually doing for me?

    Feet at the beach, looking at cloudsOur laser has 4 main effects that it is actually doing for you.  The first is an Analgesic effect, which gets rid of the pain.  It changes the way the no-ciceptors perceive the pain. The second and third are Anti-Inflammatory and Anti-Edema effects. It improves vascular and lymphatic circulation resulting in reduced inflammation and swelling. The fourth is a Therapeutic effect. The laser accelerates cellular reproduction and growth, which results in faster healing.

  • What type of training do you need to be a MLS Laser Technician?

    To be a Technician, you must go through a certification-training course with a laser specialist that has experience administering 1000s of patient protocols. Doctor at clipboard with stehoscope

  • What does MLS stand for?

    MLS stands for Multi-Wave Locked System. The MLS Therapy Laser treats pain, inflammation, and arthritis. Therapist examining a foot

  • What care is needed after ingrown toenail surgery?

    Post Op Instructions:  Ingrown Toenail Surgery

    First Day Care

    clipping the big nailGo home and if possible, keep foot elevated for the first day.  Leave bandage on for 24 hours.  Do not remove dressing.  You may add additional gauze on top of the dressing if needed.


    Second Day Care

    Wash toe with Anti-bacterial soap and rinse well.  Blot dry.  Apply triple antibiotic cream (such as NeoSporin) to surgery site and apply sterile bandage.  Repeat twice daily until the wound is healed.  Do not let the toe dry out!  Keep covered and treat it until you see us again two weeks.


    If you have questions, you can call our Universal City office at 210.375.3318 or Pleasanton office at 830.569.3338. 

  • Will Medicare cover the cost of a diabetic shoe?

    Insurance formEffective December 1, 2016.  Next Step Foot & Ankle Clinic will not be participating in any insurance carrier's diabetic shoe program.  This includes the Medicare Therapeutic Shoe Program.  We will continue to offer Diabetic Shoes for those who wish to pay for the shoes and inserts on their own.  



    Diabetes can be dangerous to your feet. Even a small cut can have consequences. Diabetes may cause nerve damage that takes away the feeling to your feet, making it harder to heal an injury or resist infection.

    In 1993, Congress passed the Medicare Therapeutic Shoe Bill, which allows qualified persons to receive Medicare assistance for protective shoes and inserts.

    Diabetic shoes and prescription inserts are intended to help prevent more serious foot health complications that can arise as a result of diabetes.

    Can you answer yes to any of these foot problems?

    • Poor Circulation
    • Foot Deformities
    • Pre-ulcerative callus formulation or peripheral neuropathy with a history of callus formation
    • History of previous foot ulceration
    • Previous amputation of the foot or part of the foot

    If you are a qualifying diabetic, Medicare and your supplemental insurance may reimburse for all or part of the cost of your Dr. Comfort shoes and prescription inserts.

    Medicare allows one pair of Diabetic shoes per calendar year for patients who are being treated by their Primary Care Physician for diabetes or other qualifying peripheral vascular disease. Medicare requires a few things of their patients who want their diabetic shoes to be covered:

    1. Patient must be in a current treatment regimen by their Primary Care Physician for a qualifying condition such as diabetes or peripheral vascular disease.
    2. We must submit to Medicare clinical notes from your Primary Care Provider showing a face to face visit with your Medical Doctor (not a Physician's Assistant or Nurse) within the previous 6 months. These notes must document treatment of diabetes or the qualifying condition and must be signed and dated by the MD who provided the clinical notes.
    3. In addition, your MD must sign and date a Certifying Physician Statement noting the condition that qualifies you for Diabetic Shoes under the Medicare program and at least one other condition, such as a deformity that requires accommodation, peripheral neuropathy with callus formation.

    Next Step Foot & Ankle Clinic will provide you with a brochure you can take to your Primary Care Physician that is managing your diabetes to see if you qualify and get your paperwork started. This brochure explains the process for both you and your doctor and includes simple 1-2-3 instructions, along with the forms your doctor will need to complete. It also has some important facts about diabetes foot health. (Click here to see it.)

    As with all Medicare claims, Medicare pays 80% after the annual deductible is met, and the patient is responsible for their 20%. We will work with you to see if this is a covered benefit for you. We submit claims to Medicare for our patients electronically. Private insurance and cash patients may also obtain shoes from our office.   Please call us to begin your claim at 210.375.3318.  

  • What foot conditions are associated with diabetes?

    People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.

    Seniors gardening


    Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.

    Skin Changes

    Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.


    Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much callus may mean that you will need therapeutic shoes and inserts.

    Foot Ulcers

    Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

    Poor Circulation

    Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don't smoke; smoking makes arteries harden faster. 


    People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have peripheral arterial disease (PAD), which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.

    Dr. Darren Silvester and the staff at Next Step Foot & Ankle Clinic are dedicated to treating your diabetic feet and finding you the relief you need. Contact our office in Universal City, Texas today by calling 210-375-3318 or our Pleasanton, TX office at 830-569-3338 to start effectively managing your diabetes and foot health.

  • What is the benefit of diabetic shoes?

    Trying on shoesShoes for people with diabetes have a higher, wider toe box, giving your toes extra wiggle room. Toes that rub against each other or against a shoe get hot spots and blisters. Those do not heal as fast as they did before diabetes.

    Nerve damage caused by diabetes can make your toes feel numb. If this is the case, they cannot warn you when they are rubbing and blistering. The extra room in diabetes shoes protects your toes while you stand and walk.

    Now that you have diabetes, you need shoes that support your arches, ankles, and heels. Going barefoot is out. Flip-flops are out.

    Some people may overpronate (roll the feet too far inward) or underpronate (not roll the feet inward enough) when walking, which can also cause hot spots that may develop into blisters and sores. So the soles of shoes for people with diabetes have special stabilizers to keep feet level.

    You will notice that the soles are thick and wide. Thicker soles cushion your feet from wear and tear, and that little bit of extra width helps your feet to avoid those hot spots.

    Shoes made for people with diabetes also tend to be deeper than other shoes to make room for orthotics — the inserts that correct an uneven stride, cushion the heel, or support arches. Many patients with Type 2 diabetes use these inserts, so we need the extra depth.

    We are pleased to offer DJO (formerly Dr. Comfort) and SafeStep Shoes. Fitting is done in our office by our trained medical assistants, and shoes typically arrive in two weeks. Dr. Silvester and Dr. Danial will provide any needed follow-up and can modify insoles to ensure a proper and safe fit.  Next Step Foot & Ankle Clinic offers Diabetic Shoes on a self-pay basis.  We do not participate in any insurance carrier's diabetic shoe program.  This includes the Medicare Therapeutic Shoe Program.