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Excellence In Podiatric Care
An ankle sprain is a sudden sideways motion, a twist, or a misstep. When your foot lands off- balance, muscles may give way, allowing the ankle joint to move too far. If ligaments connecting the foot and ankle bones overstretch or tear, a sprain is the result.
These sudden injuries are painful, both at the time they occur, and throughout the healing process. Depending on the sprain, swelling and bruising may extend from your ankle to your foot. With proper care sprains can heal correctly, and in many cases, you can reduce the risk of re-injury.
Bunions are a very common foot problem. Bunions are “bumps” on the inside of the foot near the big toe. Bunions can rub against shoes, turn red and swell. They are mostly uncomfortable when wearing shoes. Bunions are hereditary and common with certain foot types. Good shoes and wider shoes can help, sometimes foot pads may also help. If the bunion gets too painful, sometimes surgery is necessary.
If you are a candidate for surgery, there are different types of surgery that are best depending on your pathology. This can be discussed with your podiatric physician/surgeon. There is recovery time after surgery and different procedures will dictate how long you may need to rehabilitate.
Tailors bunions or “bunionette” is a bunion on the outside of the foot. Treatments are the same as for bunions.
This is an inflammation of a “bursa” which is a soft tissue “padding” the body forms in an area of pressure. When you have too much pressure or irritation, usually from shoes, this causes the bursa to get inflamed and you get “bursitis”.
Common areas of bursitis are on the back of the heal, under the heel and on the sides of the foot in the bunion and tailors bunion areas of the foot. At times under the ball of the foot can form a bursa.
Treatment for bursas can range from anti-inflammatory medication, ice, physical therapy, cortisone injections, bracing, offloading and change in shoes.
Diabetes can contribute to foot problems in two ways. It can cause decreased feeling in the feet, so that injuries such as cuts and scrapes may go unnoticed, or it can cause decreased circulation to the feet, resulting in a reduced blood supply that may be insufficient to fight infection and heal wounds. The risks of developing foot problems can be greatly reduced if you follow the simple principles of foot care and see your physician regularly.
Pressure ulcers are sores that occur when pressure cuts off the blood supply to the skin. The stress that is caused by the body’s weight, and the impact of the foot striking the ground can place the big toe, the heel and the ball of the foot at greatest risk for pressure ulcers. If left untreated, an ulcer may allow infection to enter your body. If the infection reaches the bloodstream or bone, your life or limb may be at risk. With your doctor’s help, pressure ulcers can be controlled and even prevented.
Foot pain comes in many forms. Foot pain is common and can be treated. We all have probably had some type of foot pain in the past. The best way to treat most foot pain is through good supportive shoes. If this does not help and the pain is becoming frustrating, make an appointment to see a specialist to help resolve your foot pain.
Foot pain in children is rare due to lack of musculoskeletal problems at an early age.
Children, especially 4 years and younger, do not know “what pain is” and do not complain at times when they do have pain. If a child does complain of pain, then this should be evaluated. If a parent is concerned about foot problems in a child that may not complain, but may not be as active as they were and refrain from previous activities and “limp”, they also should be evaluated.
Most major foot concerns such as clubfoot or other early childhood deformities will be diagnosed at birth.
Common complaints that parents have their child evaluated for are “pigeon toed”, “feet turned in”, “walk on tip toes” or “flat feet”. The child may not complain of pain, but the parents are concerned. Many of the above issues the child will grow out of, but an evaluation by a podiatrist or orthopedist may help diagnose the issue and put the parents concerns at ease.
A common child foot condition is heel pain in the back of the heel under the Achilles tendon, this is known as “Sever’s canlcaneal apophysitis”. This is commonly seen in active children ages 10 to 14 years old. It is and inflammation in the growth plate in the back of the heel and is usually associated with high impact activities. This is usually treated with immobilization, heel lifts, reduced activities and inserts.
Some child foot conditions are hereditary and may run in the family.
Other common child foot conditions are ingrown toenails and wart.
Fungus toenails are thick toenails usually discolored and caused by fungus, mycotic infection of the toenail.
There are many reasons toenails may become thickened or discolored. To recieve an appropriate diagnosis, a culture or biopsy of the toenail may be taken to decide the best treatment.
There are multiple treatments for fungus toenails including oral therapy, topical therapy, surgical removal of the toenail, local reduction of the toenail and laser therapy. Sometimes I feel that multiple treatments may produce the best results. I may recommend an oral treatment along with local reduction on a regular basis and laser therapy.
Your little toes help to balance and propel your body when you move. As your foot flattens, the little toes bend to grip the ground. Then they straighten, acting like levers to push your foot so you can walk, run or dance. But if the front of your foot is wide, you may develop a problem know as a hammertoe. In general, the term “hammer-toe” describes a buckling of any of the toe joints. Joints at the end or middle of the toe as well as the joint near the ball of the foot may be affected. Toe joints usually curl because of a muscle imbalance, or tight tendons. Hammertoes vary in severity and in the number of joints involved.
Hammertoes may be flexible or rigid, depending on the joint’s ability to move. A flexible joint may become more rigid as you age. You can straighten a flexible hammertoe with your fingers.
Although they look painful, a flexible hammertoe may not hurt. A rigid hammertoe cannot be moved. Rigid joints may cause pain and distort foot movement. This may put extra stress on the ball of the foot, causing a callus (a corn on the bottom of the foot).
Heel pain is most commonly plantar fasciitis which is an inflammation of the insertin of the plantar fascia of the foot in the heel bone causing heel pain.
Sometimes the term “heel spur syndrome” and plantar fasciitis are the same thing but actually most “classic” heel pain is not associated with a heel spur, but inflammation of the plantar fascia.
Heel pain can be associated with tarsal tunnel pain, calcaneal nerve pain, bursitis and stress fractures which all seem to have close to the same symptoms as the above heel pain.
Heel pain in the back of the heel is ususally associated to a heel spur/bursitis pain that can be caused by a “pump bump”, irritation from shoe counter pressure.
Achilles tendonitis can cause heel pain in the back of the heel.
For different treatment for the above concerns, please see associated symptoms and diagnosis.
Heel spur syndrome or heel pain is usually caused by a mechanical problem involving the alignment of the foot. There is a dense fibrous band of tissue in the bottom of the foot known as the plantar fascia. The plantar fascia inserts into the heel bone and spreads out across the bottom of the foot. Due to the mechanical misalignment of the foot, excessive tension is placed on this band of tissue causing inflammation and pain. The size or presence of a heel spur does not always correlate with the amount of pain. Heel pain is usually worse in the morning, especially the first steps, or after periods of rest. As the pain intensifies, the heel can hurt even while resting.
There is a possibility in some patients, the pain will go away. However, in most cases, the longer a patient waits to seek treatment, the more chronic the condition usually becomes. In most instances, conservative care includes shoe modifications, medications, injections and physical therapy. If pain and discomfort persist after conservative measures have been exhausted, then surgery is recommended.
Ingrown toenails are a very common foot problem. Usually the side or sides of the toenail turn red, swell and hurt. Some causes of ingrown toenails can be tight shoes, foot deformitites, hereditatry, “digging at the border” or home surgery of the nail, and trauma to the toenail. Most commonly the large toenails are the usual nails to be affected, but the other nails may also have concerns. Ingrown nails may not always turn red, but be tender.
Common treatments may include removing a portion of the affected toenail. This can be done by avulsing the problematic portion of the toenail and may also be accompanied with a procedure to “kill” the root or matirx of the nail so it does not come back.
Warm soaks and changes in shoes can help ingrown toenails. Home surgery usually makes the ingrown nail worse. If home treatment does not work, allow your podiatric physician to take care of the problem.
Neuromas are painful nerve entrapments that form in the ball of the foot. Classic pain is under the 3rd and 4th toes which may include burning, sharp, zinging pain that can be inconsistent but become more consistent. It may feel like walking on a rock or hot poker depending on the severity. The symptoms may be confused with capsulitis, tendonitis and other ball of the foot symptoms.
Neuromas are most common between the 3rd and 4th toes, known as Morton’s Neuroma, and sometimes between the 2nd and 3rd toes. Other areas are less common.
Therapy includes a good pair of shoes, which can help alot. It is recommended to refrain from wearing tight shoes or high heeled shoes. If this does not help, anti-inflammatory medication, padding, orthotics, inserts, cortisone injections, schlerosing injections can help reduce symptoms.
Surgery is indicated when other therapies fail. Surgery includes excising the nerve causeing the problem or releasing the nerve.
Custom molded orthotics are inserts that are custom made for only one person and their feet. Custom molded orthotics can help multiple foot problems and depending on the diagnosis, foot type and other concerns, a custom moled orthotic can be very beneficial.
What are “custom fit” orthotics?
These are not custom molded orthotics. These are over the counter type inserts that are not made specifically for your foot. These can help foot problems, but the concern is the price and what diagnosis the treatment is for. If a custom fit or over the counter insert is more than $100.00 a pair, I feel it is not worth the price you are paying.
If someone tries to diagnose your foot condition that is not a podiatric physician or physician then I feel you are not being adequately treated. Do not let a non-licensed person prescribe custom foot or custom fit orthotics.
Custom molded orthotics are only prescribed by a physician and made by a physicain or pedorthotist who are licensed to cast for and make custom molded orthotics.
In my practice I have both custom molded orthotics and non custom orthotics. I feel with the proper diagnosis the above are appropriate in regards to price and the reduction of foot pain.
Peripherial Artery Disease is a concern for many people and may cause strokes and carotid artery blockage. There are large and small vessel diseases, PAD is a large vessel disease with decreased blood flow and decreased circulation from the upper legs down to the feet.
Symptoms of PAD are most commonly silent, much like a silent heart attack. Therefore many people have PAD and do not know it. Symptoms may present with pain in the calf, feet or buttocks when walking that makes you want to sit down and rest. Also cramping, burning intermittent pain that is relieved by sitting or massaging the area and night pain or rest pain.
Smoking, diabetes, poor diet, family history, hypertension, high cholesterol, coronary artery diaseae and other diseases can add to the risk of Peripheral Artery Disease. It is a concern for diabetics with small vessel disease that can be part of PAD.
If you experience any of the above symptoms or are concerned, make an appointment for a consultaion and possible PADNET lower extremitiy evaluation to help diagnose what is causing your sypmtoms.
If you have been diagnosed with Peripheral Artery Disease, I can refer you to a specialist to help reduce risks associated with PAD and possibly resolve it.
With regards to diabetes and PAD, this may cause or keep foot ulcerations from healing which is a risk factor for limb loss.
Peripheral Neuropathy is a loss of peripheral nerves that can cause pain in the legs and feet. This is most commonly associated with diabetes, but can also be associated with chemotherapy, anemia, vitamin deficiences and other medical conditions.
The pain can vary with each person, possibly burning, tingling, numbness, hot or cold stabbing pain, achy and many other descriptions. The symptoms are usually noted at night or when resting, although they may be bothersome all the time.
Low back issues can also cause some of the above symptoms.
The concerns with diabetes is pain and loss of sensation in the feet. When loss of sensation is noted in a diabetic patient, it can increase the chances of skin break down and foot ulcerations which can lead to many diabetic complications.
The symptoms of peripheral neuropathy can be treated with some topical and oral medicatons. Also acupuncture and a pain specialist can help treat the symptoms. Neuropathy can have difficult sypmtoms to treat, everyone seems to respond differently with regards to the different treatments. Make and appointment for an evaluation and discussion on the possible therapy for neuropathy.
All diabetics should be checked each year for Diabetic Peripheral Neuropathy, if DPN is suspected, treatment can sometimes be given to decrease the chances of foot pressure points.
In my office I can do a clinical check of your feet and a nerve conduction test to evaluate for Diabetic Peripheral Neuropathy and loss of sensation.
If you have any concerns, please make an appointement and let us help you with your pain.
Plantar Fasciitis is one of the most common foot problems. Symptoms are under the heel or arch or both, it is sharp pain, usually worse in the morning or after sitting. It can get better with activity or can be exacerbated with activites.
Heel spur syndrome is a common name for pain in the heel although heel spurs on the bottom of the heel usually do not cause the above symptoms.
Common treatments include anti-inflammatory medications, ice/heat, good shoes, physical therapy, braces, stretches, splints, cortisone injections, inserts and custom orthotics. There are also other modalities that can help with these symptoms if they become chronic such as platelet injections, radio frequency therapy and surgery.
Surgery can be beneficial if other therapies fail. Recent endoscopic plantar fascial releases have been very successful for those candidate opting for surgery with minimal invasion of the foot and quicker recovery.
Some other causes of heel pain may be tarsal tunnel, bursits, posterior heel pain and stress fractures.
A wart is an infection caused by a virus, which can enter through a small cut or break in the skin. A wart is commonly seen on the bottom of the foot (plantar wart), but it can also appear on the top. Children, teens, and people with weakened immune systems are more vulnerable to the wart virus.
This is a bump caused by a bunion on the outside of the foot by the small toe. Like the bunion by the large toe, this can be very tender and irritating when in rubbing in shoes. Changes in shoes can help reduce symptoms along with palliation and injections.
Surgery can also help reduce the Tailors bunion to help alleviate the pain.
Tarsal tunnel syndrome (TTS) refers to an entrapment of the posterior tibial nerve as it descends from the leg to the foot. This condition was first described by Keck and Lam in 1962. The terminal aspect of the posterior tibial nerve (L4-S1 nerve distribution) supplies the motor function to the muscles of the foot and the sensory innervation to the bottom of the foot. Varying degrees of entrapment of this nerve may effect either motor function, sensory function or both.
There are any number of reasons that tarsal tunnel occurs. Contributing factors include trauma, varicose veins, bone spurs and soft tissue tumors such as ganglionic cysts. Other contributing factors include biomechanical instability of the foot and ankle. Each of these contributing factors places pressure on the posterior tibial nerve creating the symptoms of tarsal tunnel syndrome. Most cases are ideopathic, meaning that the entrapment appears to be due to direct pressure from the lacinate ligament with no other visible cause.
Tendonitis is the inflammaiton of a tendon that causes pain and swelling. This can happen in many places of the foot.
Achilles tendonitis is the large tendon of the lower leg that attaches to the heel and a very common site for tendonitis.
Other areas common to tendonitis are the instep with regards to the Posterior tibial tendon, outside of the foot and ankle with regards to the Peroneal tendons and the Flexor tendons of the toes causing pain on the bottom of the toe.
When treating tendonitis, the best way is to reduce the inflammation and mechanical forces causing the tendonitis. Anti-inflammatory medication, ice, immobilization, bracing and custom orthotics can all help reduce the symptoms. Depending on how long there has been pain and where in the foot the tendonitis is located will determine therapy, at times surgery is needed.
A stress fracture is a break in a bone cause by repetitive stress. It may occur in any bone, but is quite common in the metatarsal bones of the foot. There is often no recollection of injury.
Thick toenails are usually associated with fungus which is a mycotic infection of the toenails. There are other factors that can cause thick toenails such as psoriasis and age.
There are multiple treatments for fungus toenails which include oral therapy, topical therapy, local reduction of the toenails, laser surgery and surgical removal of the toenail.
For oral therapy, a nail culture is necessary to determine if it is mycosis and I would recommend Lamisil. A liver panel is also recommended to evaluate pre-dosage liver function.
Nail softeners can also help with thick toenails.
The nail can be surgically removed as a adjunct procedure with the above treatments and permanent removal is necessary.
My office does not offer laser therapy, but if you are interested in this therapy, I can recommend a physician that does offer this service. Laser therapy is not typically covered by insurance plans.