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Below, you’ll find a sampling of podiatric conditions. Click on a condition to learn about its causes and symptoms and the different ways we can treat it.
Below, you’ll find a sampling of podiatric conditions. Click on a condition to learn about its causes and symptoms and the different ways we can treat it.
The Achilles tendon is the largest tendon in the body, connecting your heel bone to large muscles in your calf. The Achilles tendon is responsible for extending your foot. This tendon is very important for pushing off the ground when walking, running, and playing sports. Because it is such an important tendon, it can easily be damaged or injured.
Achilles pain can be caused by
Pain is the most prominent symptom of an Achilles injury. The pain will be most noticeable when you try to move the foot down against resistance. The involved tendon may also swell. The pain may come and go or gradually get worse over time.
More severe injuries can occur to this tendon. Often people might hear a pop or a snap while playing sports in their Achilles tendon. This could indicate a possible rupture of the tendon and needs immediate attention.
Literally meaning “inflammation of the Achilles tendon,” Achilles tendonitis is a type of injury that often causes soreness or stiffness in the Achilles tendon, located about 1-2cm above your heel bone. Sometimes the pain can radiate or originate right behind the heel bone. Icing and resting the area can often help treat this area; however, if you notice the pain getting worse, it is best to seek treatment with us as soon as possible.
Achilles bone spur
Bone spurs are the result of excess bone formation. Often these spurs, when formed on the back of the heel bone, can cause significant pain to the Achilles tendon. Bone spurs can cause worsening pain and are often a progressive problem. Left untreated, these bone spurs can cause tears or ruptures to the Achilles tendon.
Achilles tendon tear/rupture
A common injury amongst “weekend warriors,” a partial or complete tear or rupture of the Achilles tendon is the result of the sudden stretching of it. People who experience Achilles tendon ruptures often say they heard a large pop and thought someone had stepped on the back of their shoe. These types of injuries can cause long-term pain and deformity, and immediate care is often required.
If the pain doesn’t go away with ice and rest, or if the pain persists beyond a week, you must schedule an appointment with our physician immediately. Remember that time is of the essence; effectively treating these injuries is imperative to preventing long-term sequelae.
Typically, Achilles tendon pathologies (with the exception of ruptures) do not require surgical intervention; however, scar tissue, as a result of chronic inflammation, may be the cause of your pain. Removing (debriding) the scar tissue may be recommended.
Complete ruptures of the Achilles tendon often require surgical intervention to reattach the tendon. Patients are often required to stay off their surgically-repaired foot for several weeks to allow the tissue to heal.
The ankle joint consists of the tibia, fibula, and talus. If one of these bones is broken, it is considered an ankle fracture. Fracture of the ankle bones can be the result of almost any type of trauma to the lower extremity. Common causes include sports injuries, tripping or falling, and car accidents. Often people injure their ankle and do not seek treatment as they think their injury is not serious enough to warrant care. This delay in treatment can cause problems in the ankle joint months to years later.
If you notice a deformity to the ankle after the injury, you need to see a medical professional immediately. If no deformity is noted and the pain doesn’t go away with ice and rest, or if the pain persists beyond a few days, you must schedule an appointment with our physician immediately. Remember that time is of the essence; effectively treating these injuries is imperative to preventing long-term issues with the ankle joint.
Some ankle fractures can be treated conservatively, if there is no significant deformity or malalignment of the ankle joint.
If the fracture is so severe that the ankle joint is out of alignment, surgery will be required. The purpose of this surgery is to correct the position of the bones to allow the ankle to heal appropriately. This surgery often involves the implantation of plates and screws to hold the fractured bones in place while they heal. Patients are often not permitted to put any weight on their surgically repaired ankle for 6-8 weeks.
The ankle joint consists of the tibia, fibula, and talus. Surrounding these bones are fibrous structures called joint capsule and ligaments. When these soft tissue structures are overstretched and injured, the result is an “ankle sprain.” Common causes include sports injuries, tripping, or falling. Often people injure their ankle and do not seek treatment, thinking their injury is not serious enough to warrant care. This delay in treatment can cause problems in the ankle joint months to years later. It is always easier to treat lower extremity issues when they are new.
Ankle sprains are usually easily treated during the acute phase of the injury (i.e., within the first week or two). If the pain doesn’t go away with ice and rest, or if the pain persists beyond a few days, you must schedule an appointment with our physician immediately. Remember that time is of the essence; effectively treating these injuries is imperative to preventing long-term issues with the ankle joint.
Ankle sprains respond very well to conservative therapy, which includes
In rare cases, surgical intervention may be required. These rare cases occur when the ligaments holding the ankle together are completely torn, causing the ankle joint to become very unstable. Surgery involves repairing those ligaments. Patients are often not permitted to put any weight on their surgically-repaired ankle for 6-8 weeks.
Arthritis is a condition that results in the degradation of a joint’s cartilage. Cartilage is the protective covering on the ends of the bones that make up a joint. When this cartilage wears down, the joint and bone become progressively more inflamed and swollen. Arthritis has numerous causes and can affect almost any bone in the body. Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.
Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted and there is no way to avoid the pain of the tremendous weight-bearing load on the feet.
Arthritis is a disabling and, occasionally, crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.
Osteoarthritis is the most common form of arthritis in the feet. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Walking may become erratic. It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.
Rheumatoid arthritis (RA):
RA is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern—both ankles or the index fingers of both hands, for example. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men are to suffer from RA.
RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, which is marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute RA; however, the disease system has been known to be active for months or years, then abate, sometimes permanently.
Gout (gouty arthritis):
Gout is a condition caused by a buildup of the salts of uric acid—a normal byproduct of the diet—in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women are, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.
Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.
Traumatic arthritis: Traumatic arthritis is a form of arthritis that is caused by blunt, penetrating, or repeated trauma or from forced inappropriate motion of a joint or ligament. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.
People tend to come to see us for arthritic conditions when the pain in their affected joints does not get relieved with simple at-home remedies such as rest and anti-inflammatories. The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if possible. Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.
Depending upon how severe the arthritic pain is determines how well a patient will be able to recover. Treatment ranges from non-invasive and conservative to surgical procedures.
Arthritis can respond very well to conservative therapy, if treated early with:
Surgical intervention is a last resort in arthritis, as it is with most disease conditions. Damaged joints can be replaced surgically with artificial joints. If the condition is severe, sometimes fusing the two bones together that make up the arthritic joint can eliminate all arthritic pain.
Athlete’s foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment, which encourages fungal growth. Although many rashes look the same, they are not all caused by fungus. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete’s foot.
The signs of athlete’s foot, singly or combined, include the following:
Athlete’s foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete’s foot may persist for long periods. Consequently, the infection may be spread through contaminated bed sheets or clothing to other parts of the body.
Although athlete’s foot is very common, it is often poorly treated and sometimes hard to cure. Diagnosis by our doctor is easy and can be done either clinically or via a non-invasive skin test. Prescription topical or oral antifungal therapies can then be prescribed.
Our doctor will determine if a fungus is the cause of your problem. In minor cases, athlete’s foot can be treated with over-the-counter antifungal medications. In more severe cases, doctors may prescribe oral and/or topical antifungal medications. In either case, keep infected feet dry and clean.
Metatarsalgia is a broad term to describe generalized inflammation, pain, and swelling to the ball of your foot. There are numerous causes for metatarsalgia. Although not serious, metatarsalgia can hamper your daily routine and sometimes take weeks to resolve.
Ball-of-foot pain can be caused by numerous pathologies and issues, such as:
Metatarsalgia sometimes is relieved with simple home remedies such as rest and other over-the-counter anti-inflammatories. If at-home remedies do not improve within 5-7 days, we recommend you come to our office for a more thorough treatment plan.
Most cases of metatarsalgia can be relieved by non-invasive treatments, such as:
A bone spur is a generic term for an outgrowth of bone that can occur on almost any bone in the body. Also called an osteophyte, bone spurs can form in any bone but are most commonly found in joints, where two or more bones come together. In the lower extremity, bone spurs often are formed on areas of heavy stress, such as the big toe joint or where large tendons and ligaments attach (e.g., the heel bone).
People tend to come to see us for bone spurs when the pain in their affected joints does not get relieved with simple at-home remedies, such as rest and anti-inflammatories. Sometimes the bone spur becomes so large and painful, it can cause micro-tears in the surrounding soft tissue. Bone spurs are a progressive problem, meaning they get worse with time. Typically, treating bone spurs early will allow for a more successful treatment outcome.
Bone spurs can typically treated with conservative and surgical options, depending on the severity of the pain associated with the spur and the extent of the spurring.
If conservative options do not work, surgery is a viable option to reduce or eliminate the pain associated with bone spurs. In cases of severe bone spurs, where surrounding soft tissue may be injured, the surgeon would excise the spur and repair any surrounding soft tissue injury.
A bunion is a bump on the joint at the base of the big toe. Bunions form when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated; sometimes, arthritis can develop. The big toe joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A similar process can occur on the outside of the foot near the pinky toe. That deformity is called a bunionette.
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability of the big toe joint, causing deformity. Below are some specific causes for this instability. Bunions can be caused by years of abnormal motion and pressure over the big toe joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk (also called biomechanics).
The symptoms of a bunion include the following:
Like many foot problems, bunions are a progressive problem, meaning they get worse over time and tend to not resolve on their own. If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less and less of an option.
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.
It is important to remember that there is no non-surgical cure for bunions. The goal of conservative therapy for this condition is to reduce the progression of the deformity and symptoms. The only true way to remove the actual deformity is through surgical intervention. Some conservative measures to ease pain associated with bunions include:
When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatrist. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
Bunions are progressive, but very treatable. It is easier to surgically treat mild to moderate bunions than it is to treat severe ones. The type of bony surgery is based on the severity of the bunion. Because more severe bunions may require surgery and time off your feet, it is recommended to perform surgery as early as possible when pain if first noticed. Mild to moderate bunions permit surgeries that allow you to bear weight right after surgery; pain is usually minimal and well-controlled. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning other joints in the foot. Recovery takes time, and swelling and some discomfort are common for several weeks following surgery.
Corns and calluses are areas of thickened skin that develop on top of bony prominences to protect that area from irritation or excess rubbing. If the thickening of skin occurs on the bottom of the foot, it’s called a callus. If it occurs on the top of the foot (or toe), it’s called a corn. Corns and calluses are not contagious but can become painful if they get too thick. Sometimes these calluses can cause issues with the softer underlying skin, potentially causing ulcerations or wounds. In people with diabetes or decreased circulation, they can lead to more serious foot problems.
Corns often occur where a toe rubs against the interior of a shoe. Excessive pressure at the balls of the feet—common in women who regularly wear high heels—may cause calluses to develop on the balls of the feet. In addition, sometimes the fat pad on the bottom of our feet becomes thin, making the bones more prominent. This makes your foot susceptible to calluses. In addition, people with certain deformities of the foot, such as hammertoes or bunions, are prone to corns and calluses.
It is best to visit our office as soon as the corns or calluses cause pain and discomfort that inhibit your daily life. People with diabetes, poor circulation, or other serious illnesses are at serious risk of developing more serious issues and should see our office for regular care for these lesions.
Corns and calluses are usually diagnosed through simple clinical examination. Conservative measures are usually reserved for mild to moderate corns and calluses. More significant corns, caused by underlying bony deformities, may need surgical intervention.
For more significant corns and calluses, treating the underlying bony deformity by removing the excess bone can significantly help or permanently fix the corns and calluses.
Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14-24% of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85% of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.
A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.
Regular diabetic check-ups by a podiatrist, with preventative trimming (debridement) of nails and calluses can significantly reduce the instances of lower extremity ulcerations and limb loss.
Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.
Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem.
Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing.
Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage in your sock. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.
The best way to treat a diabetic ulceration is to not get one in the first place. To do that, please attend regular check-ups at our office every 2-3 months for a foot examination, trimming of thickened nails and calluses, and a thorough examination of the sensation and circulation to the feet.
Once an ulcer is noticed, you must visit our office immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce healthcare costs.
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing begins, the less chance for an infection. To do this, we use a multispecialty approach, making sure to align and coordinate our treatments with those of the other practitioners on the healthcare team, such as primary care doctors, endocrinologists, and nutritionists.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Not all ulcers are infected. If it is determined that an infection may be present, however, a treatment program consisting of antibiotics, wound care, and, possibly, hospitalization will be necessary.
For optimum healing, ulcers, especially those on the bottom of the foot, must be off-loaded. You may be asked to wear special footgear, a brace, or specialized castings or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.
Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline and betadine to cutting-edge modalities such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal, there must be adequate circulation to the ulcerated area, which means consultations with other physicians, such as vascular surgeons, may be necessary.
Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.
A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or other bony bumps (exostoses).
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.
Flat Feet is a deformity characterized by a collapsing arch that comes into near or complete contact with the ground. Depending upon the extent of the fallen arches, the patient may experience anywhere from minimal to significant pain. This deformity can start at almost any age and can significantly limit the daily routine for the patient, if the deformity is severe. Fallen arches can sometimes result in pain “up the chain” to your knees, hips, and lower back, as a result of the asymmetry that develops.
Some people experience little to no pain; however, many people experience at least one of the following:
Like many foot problems, fallen arches are a progressive problem, meaning they get worse with time and tend to not resolve on their own. If pain persists, podiatric medical attention should be sought. Treatment ranges from very conservative options to surgical procedures, depending on the severity
As mentioned above, the severity of the condition and pain determines the treatment path. These are just a few of the treatment options.
In some instances, surgical intervention is required. Dr. Siegel would evaluate the condition to find the appropriate corrective procedure. These procedures include:
Gout is a type of inflammatory arthritis that can cause pain, swelling, and degradation of bone depending upon the location. Gout is sometimes caused by the abnormal metabolism of uric acid. People with gout either produce too much uric acid (diet) or their kidneys are not able to remove enough uric acid from the body. As a result, this uric acid builds up, causing episodes of pain and swelling in some joints. The big toe joint and ankle joint are most commonly affected in the feet; however, gout can form at any joint.
Treatment for gout is almost always conservative. First-line therapy includes treating the symptoms (the inflammation and swelling) by use of anti-inflammatories or cortisone injection. For more significant symptoms, specialized gout medications may be prescribed on a short-term basis.
If the gout is recurrent, the patient would benefit from long term anti-gout medication to lower the blood’s uric acid.
Surgery would only be recommended for longstanding untreated gout where large deposits will need to be removed to regain function of the joint.
Haglund’s deformity is a bone spur at the area where the Achilles tendon attaches into the upper back portion of the heel bone (calcaneus). This condition is progressive and can cause significant pain, swelling, and limitation of activity. Sometimes it’s called “pump bump” because the deformity often occurs in women who wears pumps.
Symptoms vary from minor to severe, depending upon the size of the bone spur and the activity of the patient.
Like many foot problems, Haglund’s deformity (or pump bump) is a progressive problem, meaning it will get worse with time and tend to not resolve on its own. If pain persists, podiatric medical attention should be sought. Treatment ranges from very conservative options to surgical procedures, depending on the severity.
Treatment will depend on the severity of the condition.
If none of the non-surgical methods provide adequate relief, your podiatrist may recommend surgery to correct the deformity and reshape the heel bone to prevent the spur from tearing the Achilles tendon.
A hammertoe is a deformity at the joints of the toe that causes the toe to take on a contracted or bent position. This bending causes the toe to take on a mallet or hammer appearance when viewed from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common in females than they are in males. Often corns develop on the tops of the deformed joints. The symptoms associated with hammertoes can be relieved through conservative measures; however, surgery is the only way to reduce the deformity and return the shape of the toe to its normal position.
Visiting our office at the first sign of a contracture of a toe or irritation on the top of the toe is often a good idea. Treating hammertoes early with conservative measures will slow the progression of the deformity. Like many foot problems, hammertoes are a progressive problem, meaning they get worse with time and tend to not resolve on their own. Treatment ranges from very conservative options to surgical procedures, depending on the severity of the condition.
As mentioned previously, conservative care often involves treating the symptoms associated with hammertoes. This usually does not correct the underlying disorder. This includes the following:
Often, conservative treatments are unsuccessful and surgical intervention is required to fix the underlying deformity. Hammertoes are progressive and often get worse with time. Fixing the deformities early on usually results in a quicker surgical recovery and better outcome.
For less severe deformities, removing the bony prominence and restoring normal alignment of the toe joint often resolves the pain. Severe hammertoes, which are not fully reducible, may require more complex surgical procedures, which may include fusion of the affected joint or elongating tendons.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, which is sometimes disabling, can occur in the front, back, or bottom of the heel and has a multitude of causes
There are numerous causes for heel pain. The most common is the result of faulty biomechanics, trauma, and poorly-fitted shoes. Heel pain can be traced back to three main causes:
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs result from strain on the muscles and ligaments of the foot, stretching of the long band of tissue that connects the heel and the ball of the foot, and repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly-fitted or excessively-worn shoes, or obesity.
Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and is painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Excessive Pronation/Faulty Biomechanics: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. Excessive pronation—i.e., excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Other secondary causes for heel pain include:
Heel pain can be very painful but is very successfully treated when you seek the care of a professional. Typically we recommend patients come to see us after trying at-home remedies for a few days with no relief. If you have new onset heel pain that is unrelenting, there is concern for possible rupture or fracture and you must see us as soon as possible.
90% of patients with acute heel pain find complete relief with conservative measures. It is rare to require surgical intervention for heel pain, but there are circumstances when it is warranted.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth. New modalities such as platelet-rich plasma, Topaz, and TenEx may also be used and are considered minimally-invasive.
Ingrown nails are nails whose corners or sides dig painfully into the soft tissue surrounding the nail. This usually occurs on the inside and outside border of the nail. This leads to irritation, redness, and swelling. Sometimes a small infection can develop. The big toe is the most common location for this condition, but other toes can also become affected.
Ingrown toenails may be caused by the following:
You should see our office immediately if any drainage or excessive redness is present around the toenail. If a short trial of home treatment has not resulted in improvement of the condition, you should visit our office. In addition, if you have diabetes or poor circulation, you should seek immediate treatment at the first signs of an ingrown toenail as it can lead to more severe complications.
Ingrown toenails are treated with a minor in-office procedures in which the doctor trims and removes the ingrown portion of the nail. If ingrown nails are a chronic problem, a procedure to permanently prevent ingrown nails at the affected area only can be done. Recovery is minimal and relatively painless.
A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth metatarsal bones, but can be found anywhere in the body. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women, usually due to shoe gear.
Often neuromas are hard to treat without professional care as they tend to get worse over time. Podiatric care should be sought at the first sign of pain or discomfort.
Neuromas can be successfully treated with conservative care, including.
When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Any pain following surgery is easily managed with medications and rest.
Plantar fasciitis is inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and is painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone.
Plantar fasciitis can be very painful and debilitating but is very successfully treated when you seek the care of a professional. Typically we recommend patients come to see us after trying at home remedies for a few days with no relief. If you have new onset heel pain with unrelenting pain, there is concern for possible rupture or fracture and you must see us as soon as possible.
90% of patients with acute plantar fasciitis find complete relief with conservative measures. It is rare to require surgical intervention for heel pain, but there are circumstances when it is warranted.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth. New modalities, such as platelet-rich plasma, Topaz, and TenEx, may also be used and are considered minimally-invasive.
Warts are one of several soft tissue conditions of the foot that can be quite painful. Warts are caused by a virus that lives within the deepest layer of the skin, making them difficult to treat. Those that appear on the sole of the foot are called plantar warts. Plantar warts are usually benign. Children, especially teenagers, tend to be more susceptible to warts than adults are. Warts are usually treated conservatively, but can be very stubborn to completely resolve. Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts that appear on the top of the foot or on the toes are generally raised and fleshier. Sometimes, warts can be confused for corns or rough skin. It is important to note that warts can be very resistant to treatment and have a tendency to re-occur.
Plantar warts are caused by a virus that lives underneath the skin. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.
Plantar warts are very difficult to treat without the help of a trained professional. Our office has treatment options available that are not available over-the-counter to the general public. It is wise to visit our office when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis. It is possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as warts.
First-line therapy for warts in our office is trimming down the dead skin on top of and surrounding the wart. This is usually painless and allows for medication to penetrate the lesion more effectively. Next, a medication called Cantharone is applied directly to the skin. Cantharone comes from a bug called a blister beetle that kills other insects by spraying a substance that causes blistering. This medication does not hurt upon initial application, but may sting 2-3 days later. After two weeks, the patient returns and the blistered wart is painlessly trimmed away. Sometimes additional treatments may be needed. Our physician has been using this medication with great success.
For more stubborn warts, a simple surgical procedure to excise the wart, performed under local anesthetic, may be indicated. A procedure known as CO2 laser cautery is performed under local anesthesia in an outpatient surgery facility to excise the lesion and cauterize bleeding tissue. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions. Postoperative care involves daily foot soaks for a week and daily bandaid applications.
Stress fractures are small cracks in the bone as the result of repetitive trauma (stress) to a certain area. These cracks are sometimes very hard to see on X-ray and often mimic overuse soft tissue injuries or tendonitis. Stress fractures are often seen in active individuals or people who have recently ramped up their activity level. They are often found on weight-bearing bones of the feet, such as the metatarsal bones. More than 50% of stress fractures occur in the lower extremity.
Stress fractures usually do not go away without at least some period of immobilization. If pain to the forefoot, aggravated by activity does not improve with two weeks of rest, it is best to come to our office for a full examination and to take an X-ray.
Stress fractures are typically treated conservatively with rest, immobilization with a walking boot, and ice. Patients often need to take a break from the activity that caused the stress fracture and allow 6-8 weeks for the bone to heal. Occasionally, if the fracture does not improve, a non-invasive bone stimulator may be ordered.
Excessive sweating of the feet is called hyperhidrosis. It’s more common in men than in women, and more common in young adults than older adults, however 3% of the population suffers from some form of hyperhidrosis. People whose feet sweat excessively typically also have problems with excessive sweating of the palms.
Excessive sweating of the feet seems to be an inherited problem. No one knows exactly why it occurs, but people who sweat excessively seem to have a different “set point” than other people. People with hyperhidrosis sweat excessively almost all the time.
If your feet sweat excessively, come see our podiatrist. According to the US National Library of Medicine, less than 40 percent of people with excessive sweating seek medical care. Hyperhidrosis can often be treated with simple conservative measures.
Treatment options are tailored to your symptoms and are almost always conservative. Treatment options vary from something as simple as changing your socks and shoes more often to Botox injections.
Tarsal tunnel syndrome is a condition where the tibial nerve (the largest nerve to enter the foot) is compressed, causing pain and numbness. The compression of the nerve occurs at the tarsal tunnel, a canal formed at the inner part of the ankle, just behind the medial malleolus, that large bony bump on the inside part of the ankle.
Tarsal tunnel syndrome can be caused by injury, disease, or due to the natural shaping of the foot. Causes include:
Patients who notice new evidence of numbness and tingling in the foot with radiation in the leg should see our office for a proper diagnosis. Our office will perform a full musculoskeletal examination and neurological examination. We may order additional non-invasive tests to develop an accurate diagnosis.
Tarsal tunnel syndrome can be treated conservatively; however, surgical intervention may be warranted. The goal of conservative therapy is to reduce the swelling in the ankle that causes compression of the nerve.
For more serious cases of tarsal tunnel syndrome, surgical intervention to reduce the underlying cause of the compression may be needed. In such cases the surgeon would decompress the nerve and relieve it of any impingements that may cause compression.
Tendinopathy is a degenerative process that denotes chronic injury to a tendon. Tendons are fibrous structures that attach muscle to bone and are very common to injury in the lower extremity.
Tendonitis can be caused by:
If the pain is not relieved with ice and rest or if it persists beyond a week, it is time to see our team at Modern Foot and Ankle. Remember that time is of the essence. Effectively treating these injuries is imperative to preventing long-term sequelae.
Typically tendonitis does not require surgical intervention; however, scar tissue that forms as a result of chronic inflammation may be the cause of your pain, in which case removing (debriding) the scar tissue may be recommended.
Complete ruptures of the tendons (sometimes the result of long-term tendonitis) often require surgical intervention to reattach the tendon. Patients are often required to stay off their surgically-repaired foot for several weeks to allow the tissue to heal.
Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. The fungus causes the nail to become darker in color and smell foul. Debris often collects underneath the nail, making it appear thick and become painful. If ignored, the infection can spread. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Long-standing onychomycosis can also be accompanied by a secondary bacterial or yeast infection.
Toenails are vulnerable to fungal infection. The most common ways of developing a fungal nail includes:
You should visit our office when you notice any discoloration, thickening, or deformity of your toenails. The earlier you seek professional treatment, the greater your chance at getting your nails to clear.
Treatments may vary, depending on the nature and severity of the infection. The first steps in treating a fungal infection are to culture the nail, determine the cause, and form a suitable treatment plan. Common conservative care includes:
Trying to solve the infection without the qualified help of a podiatrist can lead to additional problems. With new technical advances in combination with simple preventive measures, the treatment of this lightly-regarded health problem can often be successful.