- Ankle Sprains
- Athlete's Foot
- Burning Feet
- Corns & Calluses
- Diabetic Foot Concerns
- Flat Feet
- Fungal Toenails
- Gait Problems
- Ingrown Nail
- Joint Pain
- Plantar Fasciitis/Heel Pain
- Shin Splints
- Sweating/Odor problems
- Tailor's Bunion
An ankle sprain is a very general and broad term, which could apply to a variety of injuries in or around the ankle or foot. Uncharacteristic stress on the ankle bones or twisting of the muscles and ligaments around the ankle are a couple causes of ankle sprains. The sprain itself is usually a stretched or tore ligament, and its severity and location determine the treatment protocols and durations.
Symptoms of an Ankle Sprain:
- Acute pain following an injury
- Ankle may feel weak
Treatment of an Ankle Sprain:
- “RICE” Therapy-Rest, Ice, Compression and Elevation
- Braces to support the weakened ankle ligaments
- Physical therapy to strengthen balance and stability of ankle
- Surgery would be considered by your podiatrists depending on tests results and severity of injury
The term ankle sprain is so general that if you are at all concerned that you may have injured your ankle, you should schedule an appointment with your podiatrist. The longer that you wait for treatment, the more likely you will be to have long lasting ankle problems following an injury.
Athlete’s Foot is thus named because athletic shoes are more prone to be sweaty, damp and warm, which are all environments that fungus love to live. Athlete’s foot, known as Tinea Pedis (Tinea=Fungus and Pedis=Foot), occurs most commonly in the dark, damp, and warm areas of your body. The fungus usually begins to grow between the toes, but can spread to include the entire foot. Athlete’s Foot can be contracted from showers, swimming pools and locker rooms, so it is always advised to carry an extra pair of shower shoes with you to these places.
Symptoms of Athlete’s Foot:
- Dry Skin
- Skin maybe scaly or flake off
- Severe cases have painful inflammation of blister formation
Treatment of Athlete’s Foot:
- Prevention by not walking barefoot and keeping socks and shoes dry
- Over the counter antifungals or fungicides could be effective in minor cases
- Prescription antifungal topical creams
- In severe cases, an oral anti-fungal could be prescribed by your podiatrist
Blisters of the Foot and Ankle
Blisters of the foot are the result of friction. Heat, dirt and moisture are all factors that can add to the friction that your skin experiences. So, prevention and treatments are aimed at limiting these three root causes. When your skin is rubbing excessively with your shoes or clothing, the outer layer of skin separates from the inner layers and fills with a fluid. The fluid can be clear (usually lymph fluid) or bloody (aka a “blood blister”) which denotes that the injury was a little more severe involving destruction of capillaries in the lower skin layers. You should also be aware if their is an odor as this could indicate an infection which would require you to see a podiatrist.
- Wear proper fitting shoes that are well broke in, especially if performing vigorous activities.
- Keep feet dry. Wet shoes and socks will increase friction and rate of blister formation.
- Change socks regularly, and check for holes or seams, and use foot powder to keep them dry.
- If you know that you are going to be in situation that will entail a lot of friction, you can apply tape or other product to the area of your feet that is most susceptible. The blister forming is the body’s defense to the friction, so adding tape to the area just helps your body in its protection.
Blister Treatment: Should it be drained?
When not to drain:
- If there is no pain
- If it is filled with blood
- You are diabetic or have PVD
When to drain and how:
- If the blister has not burst, and it is painful on a weightbearing area then I would recommend to drain it
- You should use a sterilized needle with just a small puncture to the base of the blister. Try to leave as much of the skin as possible as it is a protective layer. Area should be cleaned and a layer of tape applied if activity is resuming.
- If you believe infection is present or they continue to occur, you should see your podiatrist.
Bunions are a common disorder that we see in our podiatric office. Bunions most commonly appear as a bump on the side of the big toe, and they are frequently found in women. Pain is typically associated with bunions, but not always. The underlying issue causing the “bunion bump” is a shifting of the bones. The big toes pushes towards the second toe, and the bone behind the big toe pushes outwardly. Bunions are a progressive disorder, meaning that they will become worse over time if left untreated.
Symptoms of Bunions:
- Pain while wearing shoes
- Bump on the inside of the foot
- Could be red and swollen when irritated
- Big toe could become numb
Treatment of Bunions:
- Icing may relieve acute pain
- Padding around the bump when wearing shoes
- Anti-inflammatories could be helpful
- Medicated pads
- Injections of cortisone
- Shoe orthotics
- Modification of shoe gear and activities
- Depending on many factors, a podiatrist may consider surgery
Burning feet can signify many different conditions. Burning could just be the result of a long day at work, or it could be as serious as a symptom of diabetes. Prolonged sensations of burning for a couple weeks, or if it is progressively becoming worse or spreading require medical attention.
Some things you can try at home to relieve burning feet:
- Soak your feet in cool water
- Switch your shoe gear to more comfortable shoes
- Rest and elevate your feet
If these attempts fail to alleviate the burning sensation, you should consult a podiatrist to explore other causes. Some of the more common causes are:
- Athlete’s Foot
- Diabetic Neuropathy
- Peripheral Arterial Disease
Corns and Calluses
Areas of pressure and friction can cause thickened patches of skin, called corns and calluses. Although, both terms refer to thickened skin, they differ by their location. Corns are typically referred to as the lesions on the tops of the toes or between the toes where they rub each other. The thickened areas of skin are called calluses if they are on the bottom of the feet or the palms of your hands. Both corns and calluses form for the same reason, an non-ideal bone structure that causes repetitive friction and pressure. The thickened skin, corns and calluses, is simply your body’s way to protect the underlying bone deformity.
Symptoms and Locations of Corns and Calluses:
- Pain ranging from sharp and shooting to dull and soreness depending on the location
- Calluses mostly found on metatarsal heads and on the inside of the big toe
- Corns usually found on the top of the toes and most commonly on the 5th toe
- If Friction is severe, open sores, or blisters, can form
Treatments for Corns and Calluses:
- If you have healthy feet and healthy circulation, you can soak your feet at home in warm soapy water to soften the calluses. You can then use a pumice stone or emery board to rub away the dead skin
- Continued moisturizer
- Padding can be applied next to the calloused areas, not directly on top of, in order to relieve the pressure
- Be Careful using over the counter callus removers as they typically contain acid and can cause more harm than good
- If calluses continue to occur, surgery to correct the underlying bone deformity could be considered by your podiatrist
A cyst is a fluid filled sac that occurs either at the joints of the feet and ankles or from a sheath of a tendon. They can occur anywhere in the body, but are most commonly found in the hands and feet. Cysts themselves are typically harmless and painless. They can incur pain if they grow large enough to apply pressure to adjoining structures or be compressed in shoes. Cysts maybe soft or a little bit firm, and when you press on it, you should be able to feel the mushy fluid. Cysts occur due to a weakness in the covering of a joint space or a tendon. The weakness can be caused by a repetitive trauma of a tendon over a bony prominence or the pressure from a shoe on a tendon or joint space. This daily trauma leads to a swelling with fluid into a confined space causing the lump to form. Cysts most commonly appear in women between the ages of 20 and 40, but it is not uncommon to see them in any demographic of people. They most commonly form on the top of the foot where the top of the shoe rubs your feet.
Treatments of Ganglion Cysts:
Diagnosis is typically made with a diagnostic ultrasound revealing a fluid filled sac on top of the tendon. Once more serious conditions have been ruled out, treatment of cysts is typically conservative. Ganglion cysts used to be referred to as “bible bumps” because people use to pop the fluid filled sac by dropping a book on top of the foot. This treatment is no longer recommended. If the cyst is not causing any pain and is not too unsightly, no treatment maybe required at all. Cysts can sometimes resolve on their own with no intervention. Unfortunately, they commonly reoccur, even with other treatments. Depending on the texture of the fluid within the cyst, they can be drained with a syringe within the office setting. The fluid is typically clear and slightly viscous. This is a relatively painless procedure, but the cyst may still grow back requiring additional drainage attempts. Cysts can be surgically removed in an outpatient surgery procedure.
The Diabetic Foot
Amputation of the foot or lower limb is the most frequently occurring complication for people with Diabetes. According the the American Diabetes Association, Diabetes affects over 5% of the population, and different segments of the population are more or less likely to be afflicted with diabetes and its complications. Diabetics must constantly monitor the health of their feet, as there are a number of complications and risk factors that could lead to problems.
A small wound or blister on the foot may not be a serious concern to the typical person, but to a diabetic a minor abrasion or ill-fitting shoe could cause major complications. The Diabetic foot is at an increased risk because of a decreased blood flow, which inhibits the healing ability of the body. Since the wound is slow to heal, the risk for infection greatly increases. Thus, as blood flow slows, risk of infection increases 2536a8*nd the spread of the infection is accelerated. The first step a diabetic should take is to inspect their feet daily. To accomplish this, a mirror could be used to see all aspects of the foot or someone else could inspect them for you.
Dos and Don’ts for Diabetic Foot Health:
1) Inspect feet Daily. Look for areas of pressure, wounds, punctures of the skin, calluses, nail problems, scratches and redness.
2) Monitor the warmth and dryness of your feet. Always keep your feet warm, and keep them dry in the snow and rain. When going to bed, wear a warm, loose fitting pair of socks. After a shower, dry your feet thoroughly by dabbing and make sure they are dry between your toes.
3) Feet should be washed with soap and water daily, and you should never soak your feet.
4) Use quality, diabetic approved lotions to keep feet moisturized. You should avoid using anti-septic solutions, drugstore medications and any sharp instruments on your feet.
5) Trim your nails straight across. Do not cut out the corners.
6) Buy shoes and socks very carefully. Shoes should be inspected and tried on to ensure proper fit and comfortability. A clean pair of dry socks should be wore every day. You should avoid socks with holes, wrinkles and big seams across the toes. These all can rub the skin and cause irritations.
7) Contact a podiatrist. All diabetics should have at the very least a yearly examination of your feet and circulation.
Foot Related Diabetic Complications:
1) Diabetic Neuropathy:
Neuropathy could be painful or painless. It can cause you to lose sensation in your feet and lower limbs, and this is the time that you must be most cautious as a diabetic. Loss of feeling means you may not feel an injury or excessive heat or cold. You could have a nail in your shoe and not know it, You could have frozen toes and not feel it, You could have a blister or an ulcer and never know it until there is a volatile infection. Daily foot inspections and your choice of shoe and sock gear are especially important when you have decreased sensation. You should contact your podiatrist if you feel that you may have diabetic neuropathy.
2) Foot Ulcers:
Foot ulcers most commonly occur on the ball of the foot or the big toe since those are the areas of your foot that receive the most pressure. However as a podiatrist, I have seen ulcers on every aspect of the foot and ankle. An area of high pressure may begin with a small callus that builds up overtime, but they can continue to progress as the diabetic is not aware of the excess pressure and rubbing. An ulcer requires immediate medical attention, as they can become infected and lead to loss of a limb. X-rays will need to be taken to ensure that an infection has not traveled to the near-by bone. A podiatrist will also remove other dead skin in the area and may culture the wound if there is a possibility of infection. For the ulcer to heal, it is important to stay off of your feet. If this is not an option, your podiatrist maybe able to fashion a brace or shoegear that offloads the pressure. Once it is healed, you will still have to treat the area very carefully as it may return.
3) Calluses and Skin Changes
Calluses occur more frequently and they thicken more quickly in people with diabetes. These calluses occur at high pressure areas of the foot, and if not trimmed the dead skin can break down and become an ulcer. You should not try to cut the corns and calluses yourself (or apply chemical agents to break them down) because if done incorrectly or too deeply, ulcers or infections could occur. The ADA recommends the daily use of a pumice stone while your feet are wet. Since your feet also become more dry and crack and peel, you should also apply some lotion after the pumice stone.
4) Toenail changes with Diabetic feet
Your toenails may also become thick, discolored and very hard. Since you are likely to have decreased circulation to your feet, your toenails will also suffer. Fungal infections become more difficult for your body to combat, and all ten toenails maybe thick and discolored. Your normal toenail clippers may no longer be effective in trimming your nails. In this case, you should contact your podiatrist to evaluate your feet and nails to determine if you qualify to have a regular visit to the podiatrist for your feet to be checked and your nails to be trimmed.
Additional Resources concerning Diabetic Foot Health:
Although flat feet are common in young children, adults with flat feet could suffer from many symptoms and severities of the condition. The arch in flat footed individuals could be partially or totally collapsed, thus causing a variation in the symptoms. Since the flat feet are typically due to overpronation of the foot, the ankle will also suffer. One easy way to tell if you have flat feet is to sit your shoes on a table. If they lean in towards each other, you could be overpronating.
Flat feet may not cause any pain or symptoms in many people, however if pain begins in feet, knees or your back, you should have your feet evaluated.
Symptoms of Flat feet:
- Flattened appearance on X-Ray evaluation
- Pain in arches, ankles, knees or back
- Other symptoms vary depending on cause of the collapsed arch
Treatments of Flat feet:
- First off, you must consider what is causing your flat feet
- Bracing to support tendons during activities
- Orthotics to support the arch
- Anti-inflammatories (both steroidal and non-steroidal options)
- Physical therapy to strengthen weakened tendons
- When all conservative treatments fail, your podiatrist could consider surgical correction
When you think of the term fracture, you typically think of a single traumatic event which lead to a broken bone, but this is not always the case. Fractures that occur over time with repetitive stress are called Stress Fractures. I see stress fractures as a source of pain and discomfort quite regularly. A stress fracture begins with the overuse or the over training of a muscle. This overuse causes the muscle to tire and transfers stress on to nearby bones, causing tiny fractures. Studies have shown that the repeated pounding of the foot on hard surfaces involved in long distance running is a leading cause of stress fractures. Stress fractures can also occur from the everyday rigors, such as work, that our feet endure. Stress fractures typically only require rest and immobilization to heal.
For more complicated fractures, such as displaced broken bones, recovery could require surgery and a little longer time off of your feet. Treatment protocols can usually be determined by in office x rays. Once we determine that there is a fractured bone, we can determine how severe that it is. In any fracture, bone requires at least 6-8 weeks to heal.
Symptoms of Stress Fractures:
Treatment Depends on Fracture:
- “RICE” Therapy
- Immobilization in a Fracture walking boot or cast
- Possible surgery
Fungus loves to grow in a warm, dark, and moist environments. For these reasons, your feet are especially susceptible to fungal infections. It may begin as a white or yellow spot under your toenail, but as it grows deeper into your nail, it can cause your toenail to discolor entirely and become crumbly, and rather unsightly in more serious infections.
Common Symptoms of a Fungal Nail Infection
- Thickened Nails (as the fungus grows upward instead of outward)
- Brittle or Crumbly Nails
- Dull Nails, with no shine
- Dark color, most typically a dull yellow
- Maybe accompanied by a foul odor
- Occasionally pain, from the nail ingrowing or applying pressure in a shoe
Nail fungus most commonly affects older individuals for several reasons. First and foremost, circulation is the most poor to the feet, and as you grow older, circulation decreases even more disabling your ability to ward off infections. Also, being older, you have a greater chance to have encountered fungus in the environment while having a damaged nail. Damage to a nail allows the fungus the opportunity to infect the nail. Patients with diabetes and circulation disorders are the most common people we treat for fungal toenail infections.
Though a fungal infection is unsightly, in most cases it poses no immediate risk to an individual. Patients with diabetes or other immunosuppressed conditions must be treated for a toenail fungal infection as it could lead to greater complications. Please consult your podiatrist if this is the case.
Treatment of Fungal Toenails
If you have researched fungal toenails at all, you are acutely aware that the market is loaded with antifungal treatments, both claiming to prevent and cure a fungal infections. Unfortunately, the truth of the matter is that most over the counter treatments are rarely effective, and prescriptions take months if not years to completely eradicate the infection.
Topical medications– These can be purchased at the store, on the internet, or by prescription. They are rarely effective by themselves, but can be used in conjunction with oral medications. They are best if applied after the nails have been debrided so that the medication can act deeper in the nail.
Antifungal Lacquer- These also come in a variety options. One is by prescription and can be effective when used for mild cases for about a year. The other option is an antifungal nail polish that can be applied directly to the nail.
Oral Medications- These have proven to be the most effective in treating fungal toenail infections. They are usually taken periodically, and it takes 6-12 months for new uninfected nail to grow.
Laser Antifungal treatment- Can be effective, but it is not covered by insurance and long term results have not been determined yet.
Regular Nail Debridement- This is the most common, easiest and safest treatment for older individuals, or patients with Diabetes. According to Medicare guidelines, a person can have their nails debrided every ten weeks if they meet certain criteria. Some patients require it less frequently, as their nails may grow slower.
Gait Analysis and Treatment
Analysis of your feet, ankles and legs during the process of gait could be important factor in determining the cause of foot pain and the appropriate treatments. Abnormal gait can cause many problems, such as heel pain and bunions. Each aspect of your gait could be an indicator of the underlying causes of your foot pain. Your problem could occur when your foot strikes the ground, when your foot is in the air, or when you are pushing off of the ground. Improper gait mechanics overtime can cause pain to rise up your body. You could experience knee pain, hip pain or back pain in relation to the way that you walk. Discrepancey of the length of your legs could also be a contributing factor to your pains.
Children are the patients for whom we most commonly have to perform gait analysis. Children’s feet and gait undergo many alterations as they grow from their first step into adults. Their toes may point inwards or outwards while they walk, or issues could only occur while they are running. All of the physicians at Community Foot Specialists are trained in gait analysis and diagnosing conditions simply by watching children walk or run.
Treatments for gait problems can vary depending on the condition. If the pain is causing the gait abnormality, we will need to treat the underlying condition. If the gait itself is causing the pain in your feet or other parts of your body, we will develop a treatment regiment that corrects the gait abnormality. A pair of custom orthotics could help with many of the issues that arise during gait. Sometimes muscles need to be strengthened or you may need to be retrained to walk properly. In these cases, we would recommend a series of visits to a physical therapist to help with exercises to make the muscles of the foot and leg stronger. In any case, we will take the time to analyze your gait and the biomechanics of your foot and ankle to ensure the correct resolution of your gait problems.
Although gout typically affects the joint of the big toe, it is actually a systemic inflammatory condition that may require maintenance treatments. Gout is the most common inflammatory arthritis affecting men over 40 years of age. It is characterized by “gout flares” that cause an extreme amount of pain, swelling and redness in the big toe. The flare itself typically only lasts a few days, but over time they may become more painful, last longer and occur more frequently. Gout itself is caused by high uric acid levels in the blood, causing crystals that may precipitate in joints, most commonly the big toe(~75%). As your uric acid levels increases, the likelihood of gout flares also increases.
Gout flares most commonly occur at certain times of the year, onset during the night and without warning. These are all important aspects that are used in its diagnosis. The symptom that I hear the most from patients is that “it hurts to even have my sheet touch it while laying in bed.” Since the gout flare is an inflammatory attack, treatment at this point is aimed at relieving the extreme pain with some sort of anti-inflammatories.
Triggers for Gout Attacks
- Alcohol (or Dehydration)
- Medications (often “water pills”)
- Certain diets high in purines
- Rapid lowering of uric acid levels with uric acid lowering medicines
As a podiatrist, it can be anti-inflammatories and steroids can be a great treatment to relieve a painful attack, but how do you keep them from coming back. Changing your diet is the first step. Avoiding foods high in purines and staying hydrated will help reduce formation of gout crystals. Other lifestyle changes should be made as well, such as adding an exercise routine. In some cases, a maintenance medication must be started in order to lower blood uric acid levels.
If you have suffered from gout attacks in the past or fear that you maybe having a flare please contact your podiatrist for evaluation. You can also visit gout.com to download materials that could help you manage your gout.
Hammertoes derive their name from their hammered appearance as they contract at the joint causing the joint of the toe to rise, pushing into the top of the shoe, and the endtip of the toe to push into ground, or the sole of the shoe. Hammertoes most commonly occur in the 2nd-5th toes. Hammertoe in the seconddigit can be related to an untreated bunion that is pushing sideways causing the secondtoe to rise. Muscle or tendon tightening on the bottom of the toe, wearing shoes with a tight toebox, and heredity can all contribute to the development of Hammertoes.
Symptoms of Hammertoes:
- Corns or calluses either on the joint of the toe or the tip of the toe
- Pain or redness in toes
- Painful while wearing shoes
- May become inflexible overtime and very difficult to manipulate
Treatment of Hammertoes:
- Trim build-up of skin on corns, should be performed by a podiatrists
- Several types of padding are available to accommodate your specific need
- Adjusting your shoegear to make room for Hammertoes
- There are several different surgical options for Hammertoe correction, which you could discuss with your podiatrist
Infections of the Foot and Ankle
Infections of the foot and ankle can lead to very serious, life threatening conditions, especially if you are diabetic or have peripheral vascular disease (PVD). In healthy patients, without the aforementioned conditions, foot infections are typically the cause of a traumatic event. The exception to this is fungal infections (ie athlete’s foot or onychomycosis). Fungus is a micorbe, in and of itself, so please view the page for Fungal infections. However, the majority of the patients who experience infections of the foot have compromised health, diabetes or PVD.
Diabetic Foot Infections:
Diabetic foot infections are a complicated condition. The infection itself is typically comprised of a number of different bacteria making it difficult to treat just with the use of antibiotics. The combination of diabetic peripheral neuropathy and compromised vascularity put these patients at great risk of further complications, such as ulcerations, infection traveling to the bone (osteomyelitis) and amputation (as well as the morbidity that is associated with amputation). Diabetics with infections of the foot or ankle require immediate medical attention, and in some cases require hospitalization.
Ingrown Nail Infections:
Other than diabetic foot infections, infections due to an ingrown nail are the most common infections that we see at Community Foot Specialists. As an ingrown nail continues to grow, it can break the skin creating an avenue for infection to enter the wound. In many cases when treated promptly, these infections can be cleared up with an antibiotic and removal of the intruding nail border. If left untreated overtime, these infections can become very difficult to treat with simple antibiotics. Staph infections (MRSA) and other dangerous bacteria can infect the wound. We often see teenagers, who try to cut the nail out themselves and do not seek immediate treatment, allow these infections to progress to dangerous extremes including the possibility of bone involvment (Osteomyelitis). In any case that an ingrown nail breaks the skin, you should see your podiatrist.
These are just the two most common causes that we see for infections of the foot. There are numerous other causes with numerous different microorganisms. In treating serious infections, especially in diabetics, we believe in a team approach to eradicating the infection and ensuring that the underlying causes are accounted for and treated. We will involve the primary care physician and a wound treatment center if needed to provide a comprehensive treatment.
Ingrown toenails come in a variety of shapes and sizes, and in some cases can be preventable. When the toenail begins to grow down into the skin, the ingrown toenail could become very painful. Although it is true that the way you trim your toenails can contribute to the occurrence of an ingrown toenail, there are many other factors such as fungal infection, injury, pressure applied by shoes and heredity. If left untreated for a time, ingrown toenails can be prone to cause infection, in which case treatment is needed.
Symptoms of an Ingrown Toenail:
- Initially, painful when pressure is applied
- Inability to see nail borders as they are growing into the skin
- Skin may bubble over the nail
- When infected, Ingrown nail will be red, swollen, feverish and could be draining pus
Treatments for an Ingrown Toenail:
- Soak the foot in warm, soapy water several times a day
- Avoid wearing tight shoes and socks
- If infected, could require antibiotics only if prescribed by a physician
- May require surgical removal of the ingrown toenail in a simple in office procedure
Prevention of Ingrown Toenails:
- Cut your toenails straight across and not down into the skin
- If fungal infection is present, treat underlying factors to prevent it from becoming ingrown
- Wear proper fitting shoes and socks
Joint Pain in the Foot
Joint pain in the foot is a vast issue to explore and discuss. Each foot by itself has 26 bones and over 30 joints. Many of us have experienced some sort of joint pain throughout our lives, so hopefully we can recognize when it is our joints that are causing the pain in our feet.
Conditions causing Joint Pain in our feet
- Rheumatoid Arthrities
- Structural abnormalities
- And on and on
Symptoms of Joint Pain:
- Bruising over the joints
Diagnosis and Treatment:
If you are experiencing foot pain and are not sure of the cause, X-rays can be taken to determine the structural integrity and space within the joints of your feet. Forms of arthritis will show a narrowing of the joints between the bones. Treatment will depend on results of the diagnostic procedures. If the pain is due to an anti-inflammatory process, oral medications, such as NSAIDs or low dose steriod packs, can help to reduce the inflammation, but these medications are not a long term treatment. For a more comprehensive look at your joint pain, you should contact your podiatrist.
Neuromas can cause a painful condition that most commonly affects the ball of the foot. Neuromas are caused when there is a compression of the nerves. This compression can result from repetitive stresses, such as running, wearing shoe gear that squeezes the toes together, mechanical deficiencies in the long bones behind the foot (called the metatarsals), or other foot deformities such as Bunions, Hammertoes or Flat Feet. All of these act to compress one of the nerves that branch just behind the toes causing the nerve to swell. Each of these nerves branch into two of the toes, thus symptoms are commonly reported in two toes. There is a common misperception that neuromas are tumors, but this is not true in the purest form of the term “tumor.” Neuromasare simply a swelling of one of the small nerves that run into the toes. The two most common neuromas that I treat are between the 2nd and 3rd toes, or between the 3rd and 4th toes. The neuroma between the 3rd and 4th toes (the third interspace) is called a Morton’s Neuroma.
Symptoms of a Neuroma:
- Tingling, burning or numbness (most commonly reported in one or two of the toes)
- Pain or irritation (usually on ball of the foot and extending into the toes)
- Feeling like there is something inside of the foot
- Feeling like there is a “pebble in the shoe” or a “bunched up sock”
Diagnosing a Neuroma:
Neuromasare typically diagnosed by your podiatrist with a thorough medical history, including symptoms and relief of symptoms, and a physical examination of the foot. A skilled podiatrist can typically feel the swollen nerve in either the 2nd or 3rd interspace. X-Rays can be helpful in ruling out other conditions that can mimic a neuroma, such as a stress fracture of a metatarsal or arthritis of the joints. Since neuromasare an enlarged nerve, they, themselves, cannot be seen on X-Ray, however ruling out other conditions is important in the treatment process. If you have a stress fracture, any use of steroids is contraindicated. Diagnostic Ultrasounds can be performed to confirm the neuroma diagnosis.
Treatment Options for a Neuroma:
As a podiatrist, I always exhaust all conservative options prior to considering surgery. In our podiatry practice, we have achieved great success in neuroma treatments without ever considering surgery. Our first line of treatment involves padding shoes, so that some of the pressure is removed from the metatarsal area (the ball of the foot), icing the inflamed area and modifying shoe gear. If you are someone who has a history of wearing constrictive shoe gear, I would recommend wearing shoes that have a wider toe box to alleviate some of the pressure applied to metatarsal region. If either these treatments fail or the neuroma has been present for a while and becoming more painful, I would recommend an injection therapy.
Cortisone injections are injected into the interspace that is being affected. They act to reduce the inflammation, thus alleviating the pressure that is being placed on the nerve. They, by themselves, will not cure the neuroma, but they will alleviate the acute symptoms and allow us an opportunity to make shoe gear modifications or mold orthotics to prevent recurrence of the nerve entrapment. Cortisone injections can be given up to three times within a twelve month period or as needed to alleviate the pain.
Alcohol sclerosing injections are used to “deaden” the nerve, so that it can no longer “feel” pain or the other symptoms. Sclerosing injections need to be performed multiple times every two weeks until there is a total relief of all symptoms. In these cases, patients usually report that the pain never returns, and if it does, it can be years later.
If all of these conservative attempts fail, your podiatrist can consider surgical intervention to remove the area of the nerve that is enlarged and causing the entrapment and symptoms. In my experience, surgery is rarely needed as most patients report a dramatic improvement in their symptoms with the aforementioned options.
Regardless of the treatment option that works to alleviate your symptoms, I recommend being fitted for a custom pair of orthotics. Orthoticswill act to prevent any recurrence of symptoms down the road. They are equipped with a “metatarsal pad” that slightly lifts the area just behind your toes so that the nerve is no longer at risk of becoming entrapped and thus inflamed.
Plantar Fasciitis/ Heel Pain
Heel pain, or Plantar Fasciitis, is one of the most common conditions that we see in the office. Many patients often relate their heel pain to “heel spur syndrome.” Although there could be a heel spur present on the bottom of the calcaneal bone, the pain is most often due to inflammation of the plantar fascia band, which is a fibrous tissue that stretches across the bottom of the foot from the heel bone to the metatarsals at the front of the foot.
- Injury to the plantar fascia
- Flat feet
- High arched feet
- Pain near the heel
- Pain after resting or waking
- Pain may subside with initial activity and return after the more time on feet
Treatments vary from care at home to surgical intervention in the most severe cases. Cases requiring surgery are very few, and we follow a specific treatment regimen that has yielded terrific results. If you are in the initial stages of heel pain, we recommend some easy treatments that you can do from the comfort of your home.
- Icing by rolling a frozen water bottle underneath your foot
- Stretching your calf muscles multiple times a day
- Towel stretch sitting down pulling the top part of your foot back towards you
If these heel pain treatments are not effective, or you have been suffering with heel pain for a period of time, we recommend seeing your podiatrists. Initial treatments consist of an oral anti-inflammatory, a boot that passively stretches your foot while at rest and continued home physical therapy. Cortisone injections could be required if pain does not resolve. Our first priority is to relief you of your acute heel pain. Once that is achieved, we suggest a shoe orthotic to prevent recurrence of heel pain. Shoe orthotics help correct the underlying mechanical problem that caused your heel to hurt in the first place. If all of these treatments fail to fully alleviate your heel pain, we could consider a minimally invasive procedure. Fortunately, these cases are few and far between. In most cases, patients are pleasantly surprised that their heel pain significantly decreases with just a couple visits to the podiatrists.
Shin Splints are a common complaint from runners and other participants in activities that require a lot of stopping and starting. Shin Splints are the common term for a condition called medial tibial stress syndrome. The tibia is the large bone running down the front of the lower leg. The pain related to shin splints occur when there is too much force applied to your shinbone (the tibia) and the connective tissues that connect the muscles to the bones.
Pain along the front of the leg when beginning activity is the most common symptom. You may also experience some mild swelling along the front of the leg. The condition may worsen to the point that it continues to hurt at rest. The most common causes are running downhill, on a tilt, wearing old worn-out shoes, or beginning a training routine too hard or too fast.
The condition is mostly inflammatory, so the treatment is the same as other inflammatory conditions. Rest from the precipitating activity. It is not recommended that you rest entirely, just try activities that do not involve the same impact, ie swimming or bicycling. Ice and elevation will also reduce the inflammation and the pain. You should also consider your shoe gear. If your shoes are old or worn, a new pair of shoes with good arch support could be beneficial. Rigid arch supports could also help in reducing the pain.
Sweating/ Odor Problems
It is natural for feet to sweat to a certain degree. Unfortunately, for some, the sweating becomes excessive (hyperhydrosis). Sweating is a normal process that allows the body to relieve heat and cool down. The feet have sweat glands just like any other part of the body. When feet become odoriforous, it means that there is bacteria present that is feeding on the sweat.
Treatments for bad foot odor:
- Good Hygiene. Wash your feet with antibacterial soap 2-3 times a day
- Never put back on a pair of socks that are dirty
- Have a couple different pair of shoes to wear
If you try these methods and your feet continue to sweat more than normal and have an odor, you should see your podiatrist for additional treatments.
A Tailor’s Bunion, or Bunionette, is a bony protrusion just below the pinky toe. It derives its name from the bunion because it is the same condition just on the opposite side of the foot. As the little toe pushes in toward the other toes, the bump just below the toe pushes outward. Tailor’s Bunions are less common than typical bunions below the big toe.
Symptoms of a Tailor’s Bunion:
- Redness and swelling when irritated
- Irritated by tight shoe gear that rubs or pushes on little toe
- Pain and enlargement at the site
Treatments of a Tailor’s Bunion:
- All of the treatments of a bunion are the same as a Tailor’s bunion
- Padding around the area to offload the pressure
- Wearing shoes with more area in the toebox
- Oral anti-inflammatories (both steroidal and non-steroidal)
- Orthotic devices
- If all other treatments fail, surgical correction is an option
Tendonitis of the Foot and Ankle
Tendonitis is a broad term that simply means inflammation of a tendon. Though tendonitis can occur anywhere in the body (ie Tennis elbow is a tendonitis), the foot and ankle are particularly susceptible to inflammed tendons because we use and overuse them so much. A tendon is a soft tissue that attaches a muscle to a bone. Tendonitis is typically a progressive disorder, meaning that initially you may just experience a strain causing mild pain and swelling, and it is reoccurring if the underlying causes are not treated. Overtime, if left untreated, the small strain may continue to swell and pull small fibers apart. As the damage continues to build up, tendonitis may develop. One of the best treatments for any tendonitis is rest, however it is not always an option to remain off of our feet giving them the rest that they need to heal properly.
The symptoms can vary depending on the tendon in the foot or ankle which is inflammed. The locale of the pain is usually the sight of the inflammed tendon. For example, pain on the rear of the ankle may indicate Achilles’ Tendonitis. Pain on the inside of the foot may indicate PTTD (Posterior Tibial Tendonitis Disorder), outside of the ankle maybe peroneal tendonitis, and pain on the top of the foot maybe anterior tibial tendonitis. Palpation over the inflammed tendon will cause pain, and different actions will cause the different aspects of the foot to hurt at different times. Ankle instability could be another symptom tendonitis. The pain may begin just after a particular activity, but as it progresses, pain may continue while at rest.
With any inflammatory disorder, RICE therapy should be the initially treatment:
If these simple at home therapies are not helping, your foot and ankle surgeon could suggest some ulterior treatment modalities. At first, the primary concern of the podiatrist is to relieve the acute pain. In addition to the RICE therapy, medicatons could be tried to alleviate the inflammation (these could be NSAIDS or a short, low dose of oral steriods). An anti-inflammatory patch could also be applied to the area. Bracing of the foot and ankle is also critical to limiting the motions of the ankle which are causing the strain and pain. Limiting activities and a slow return to normal level allows the tendon to rest shortly and then build strength to accommadate for your activity level.
Once the tendonitis and initial pain are relieved, the next concern is ensuring that the pain does not return. Continued use of bracing may help in preventing future cases of tendonitis. Also, a pair of custom orthotics could help relieve the underlying mechanical deformity which lead to the damage in the first place. Prevention is always the best treatment, so avoiding the too much, too soon mentality and stretching your foot and ankle prior to beginning activities is a great start.
Ulcers are breaks or wounds in the skin. Although they most frequently occur in diabetics, ulcers can occur in anyone, especially when blood flow to the lower limb and foot is compromised. Ulcers can begin in many ways, but in almost all cases they are dangerous and require medical attention. Ulcers most commonly occur along the bottom of the metatarsal heads (or balls of the feet)and on the big toe because those are the areas of the foot that are under the most pressure. Unfortunately, the skin can become ulcerated at any area, and they can be found on the heel, on the arch of the foot, on any of the toes and on the ankles. Ulcers often begin as a thickened area of skin in relation to an area of pressure. Over time, if a person is unaware of the increased pressure, due to conditions such as diabetes or neuropathy, that area can have a shearing force causing the skin to break open. This wound can continue to grow in depth and width until it receives treatment. This seems obvious, but often times a patient with diabetic neuropathy will never feel any wound and it will continue to grow. The longer the wound is open, the more likely it will encounter an infection.
Treatment of Ulcers:
First off, anytime that you are aware of an open wound on your feet in concurrence with diabetes or other vascular insufficiencies, you need to see a podiatrist. A podiatrist will begin with a physical examination and X-rays. X-rays will determine if an infection has traveled to the near-by bone, in which case further treatment is required. The podiatrist will also debride the layers of dead skin surrounding the ulcer to stimulate bleeding in the area and thus healing. If poor circulation is a concern, your foot doctor may also perform vascular testing to ensure that your circulation is healthy enough to heal the wound on its own. Depending on the depth of the wound, your podiatrist will likely want to see you every week until recovery is well on its way. During the recovery process, you should attempt to stay off of your feet as much as possible. The podiatrist can also fit you for a brace, or contact cast, or off loading shoe to relieve the excess pressure while you are on your feet.
If not treated quickly or properly, ulcers can develop into larger wounds and become infected. The infection is capable of traveling to deeper parts of the body, including bones. These are the cases that could indicate amputations of toes, or feet or lower limbs, so in any case please visit your podiatrist as soon as possible.
Verruca Plantaris, which are more commonly known as plantar warts, are usually found on the soles of the feet. A wart is a virus that infects the skin and can grow as a single lesion or as a cluster of lesions. Most plantar warts do not stick out above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin. Plantar warts usually appear as a thickened spot of skin. For this reason, they are commonly confused with corns and calluses. A common discrepancy between warts and calluses is that warts are painful when being squeezed sideways. Unlike corns and calluses, warts are not typically painful when being pushed directly.
Traditional Treatments for plantar warts include:
- Over the counter acid patches containing (salicylic acid)
- Freezing products (can be over the counter or in the clinic)
- Duct tape occlusion
- Surgical excision
The podiatrists at Community Foot Specialists have recently began a new treatment protocol for plantar warts. We begin by shaving away the callused skin that has built up around the lesion. Once the dead skin has been removed, we apply a small amount of Cantharone directly to the wart. We then cover it with a band aid in order to allow it to act on the lesion. The skin on the foot is likely to blister underneath of the wart. The blistering helps to cut off the wart’s blood supply.
The normal actions of these medications are to form a blister underneath the wart. This occurs within 24 hours of application. Since warts are highly vascularized, the blister formation kills the wart by cutting off its blood supply. There maybe some pain associated with the Cantharone application, in which case we recommend washing it off. Sometimes, it only requires one application for destruction of the wart. If needed, we can continue to apply Cantharone every two weeks until complete resolution. We have had great success with this wart treatment. If you have unresolving lesions on the bottom of your foot, please call your podiatrist.
Once this Cantharone treatment is applied you should expect:
- After 4 hours: mild discomfort may occur. Blister should occur after 24 hours.
- After 4 days: Crusted blisters should fall off leaving a spot that may be tender and itchy. Medication may be needed to control itching.
- After 7 days: May experience loss of pigment, but all symptoms should be gone.
Contact your Podiatrist if you have any questions about Cantharone Wart Treatment, or any other foot care needs.