Artho, means joint and –itis, means inflammation. There are approximately 38 causes of arthritis and most of these conditions affect the human foot. The most common of these conditions is osteoarthritis, this is the simple wearing and tearing away of the cartilage of the joints. Age, excessive weight, ill-fitting shoes and trauma (injury) are the main causes of osteoarthritis. Fortunately, this condition is very treatable.
A bunion is a common term for a medical condition known as Hallux Valgus. Hallux Valgus is the tilting of the big toe away from the mid-line of the body. It is usually characterized by a lump or bump that is red, swollen and/or painful on the inside of the foot at the big toe joint. There are many causes of bunions, but the primary one is heredity. Tight, ill-fitting shoes or shoes that constrict the forefoot over a long period of time can exacerbate your foot condition and cause progression of your bunions faster. High heels and constricting shoes are the primary causes of progression of Hallux Valgus. Treatment for bunions occurs conservatively in the form of custom shoes to reduce irritation, accommodative padding to reduce pressure to the bony prominence, arch supports or custom orthotics to control the mechanical faults causing the bunion deformity and arrest the progression or at least slow it. Surgery is the only measure to correct the deformity. Surgical correction involves the repositioning of the bone structure to re-create a more normal function of your foot and return stability to your ambulation. Surgical repair is an outpatient surgical procedure and in many cases involves only minimal down time.
Calluses are thickened skin caused from friction and pressure, they are usually caused by an underlying bony prominence rubbing against the shoe or an adjacent bone. Many calluses are also caused by mechanical problems with your foot structure causing unusual frictional irritation from your shoes during walking. Treatment can be as simple as modifications to your shoes, a prescription orthotic device to control the mechanics of your foot structure or a pad to reduce pressure. In some cases surgical correction is necessary to completely correct the deformity causing the skin irritation.
Children's Foot Treatment
Child foot deformities are frequently misdiagnosed and undertreated. We recommend evaluation when a child is first born and again when they begin walking. Many times the pediatricians will tell parents their child will “grow out of it” regarding a visible deformity of a concern of a parent. Unfortunately, many times the child compensates and other foot or leg deformities occur as a result of the foot deformities that appear to have self corrected themselves. We examine the newborns and early walkers to evaluate for better foot function beyond the traditional pudgy little feet that young children have to be able to identify the underlying abnormalities that may not be grossly visible. Most children can be easily treated through better shoes and orthotic therapy (inserts in their shoes) or in the more severe cases a simple series of castings to correct many foot deformities.
Corns are thickened skin (calluses) caused by the rubbing of the shoe against a contracted toe or from two toes rubbing against each other with the underlying bone structure causing compaction and thickening of the involved skin. Treatment involves reducing the friction and pressure to the involved toes. This can be accomplished using various forms of padding, periodic trimming of the calluses along with more appropriate shoes to reduce friction and pressure as well as surgical correction to realign the toes or reduce the bony enlargement on the affected toes. Surgical correction is accomplished in a simple outpatient procedure and recovery time is relatively short.
Cysts are fluid filled masses under the skin. Some common cysts of the feet include synovial cysts, ganglia and cutaneous mucoid cysts. Most foot cysts are located under the skin, although occasionally they may be found in tendons or bones. The synovial or ganglionic cysts are connected to a nearby joint or tendon. Mucoid cysts are frequently connected to a joint. If they are located near the nail they may cause the nail to grow improperly. Most cysts are mildly to severely painful because of the pressure created by your shoes. When the cyst presses on a nerve it can cause severe sharp pain which many times lancinates (shoots) into the foot or up into the ankle. Some cysts form as a result of repeated injury to your foot. Ganglion cysts may be treated by numbing the area and extracting the fluid inside. A steroid may then be injected into the cyst to try to prevent it from filling again. Loose fitting comfortable shoes are likely your best preventative conservative measure. If this along with accommodative padding fail to prevent pressure irritation, surgical excision is generally warranted. Recovery from the surgical procedure is fairly short as healing is limited to soft tissues.
Diabetic Foot Care
Diabetes can be dangerous to your feet. Even a small cut could have serious consequences. Due to the effects of diabetes on circulation, specifically the very small blood vessels called capillaries, many side effects will be seen. Frequently, patients with diabetes have vision problems due to the effect of poor circulation of the small vessels on the retina. Diabetes may also cause nerve damage that takes away the feeling in your feet for the same reason. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you might not notice a pebble in your shoe or some other source of irritation including a staple in the sole of your shoe or even a torn lining in your shoe that could cause a blister. This open wound could lead to an infection, which frequently leads to amputation because of the poor circulation of these small vessels in diabetic patients. Early detection and treatment of foot problems in diabetic patients is the key to prevention of amputation. Your podiatric physician is part of a team approach to your diabetic care. A simple daily inspection program to observe your feet is critical to this early warning approach. Clean your feet daily, dry them well and examine them for simple cuts, corns, calluses, cracks in the skin, bruises, discoloration of any kind, open wounds and swelling. If improvement is not noted within a few days you should contact our office for an immediate appointment. Rapid and aggressive treatment for wounds and ulcers is the key to preventing amputation or reducing the severity of an amputation.
Flat feet in and of themselves are not necessarily a problem. Flat feet however do not allow for shock absorption while walking which can contribute to earlier arthritis in the feet as well as the ankles, knees and hips. Treatment of flat feet, especially flexible flat feet can improve the fatigue, onset of arthritis and general foot pain associated with this condition. Treatment is most frequently more supportive footwear along with arch supports or prescription orthotics. These are simple devices that complement stabilizing shoes to better control your foot mechanics and prevent excessive flattening of the foot. They can also easily be moved from shoe to shoe. In some instances a surgical procedure can be performed to prevent the excessive collapse of the flexible flat foot.
Foot & Ankle Surgery
Foot and ankle surgery today now focuses on the return to full function and normal activities rather than only pain reduction. We employ the latest techniques and reconstructive foot surgery to allow you to return to full activity as soon as possible and the procedure in most cases is performed in an outpatient setting. Quicker return to work and recreational activities are due to improvements in the various aspects of foot an ankle surgery. Ambulation with weight-bearing is frequently possible immediately following foot surgery.
A fracture is a break in a bone, fractures are divided into Traumatic Fractures (those fractures that occur as a result of an injury) and Stress Fractures (those fractures that occur as a result of repeated micro-trauma such as sports and exercise). Fractures take several weeks to heal properly and in some cases fractures can fail to heal (developing a “non-union”). Treatment for fractures may be as simple as a fracture below the knee walker or even a simple fracture shoe to stabilize the bone structure and allow for healing. In some instances, non-weightbearing with crutches may be necessary to prevent excessive pressure and potential displacement of the fracture fragments leading to a nonunion. If the fracture is severe enough or if the bone fragments are displaced far enough apart to prevent healing, surgical correction with internal fixation using pins, screws and/or surgical plates may be necessary to allow for proper stabilization and healing of the fracture. This can also most frequently be accomplished in an outpatient setting.
Fungus nails are thickened, deformed and often painful toenails that are caused by an infection of fungus. Fungus infects the nail, decays it, and causes the nail to become thickened. Besides the unpleasant appearance, the thickened nails can lead to pain due to pressure in the shoes or ulceration and infection in patients with poor circulation or diabetes. This simple problem in patients who are “at risk” could be a cause of possible amputation. Therefore intervention and treatment using medications or removal with regrowth are advised as two preventative measures for recurring fungal nails.
Geriatric Foot Care
Many older patients suffer from various symptoms including arthritis, poor circulation and simple difficulties of caring for their feet and nails due to vision problems or physical problems of reaching for their feet. Providing basic care for nails and calluses, as well as arch support therapy or prescription orthotics for arthritis in many cases keep patients mobile, healthier and allows for participation in lifes daily activities in an enjoyable way.
Hammertoes / Bone Spurs
Hammertoes and exostoses (bone spurs) can be grouped under arthritis. Hammertoes, bone spurs, and exostoses are all a result of an imbalance of the muscle structures of the toes, and when the toes become crooked, bent, or buckle under it cause the joints to protrude. A hammertoe is a contracture of the toe and gives the appearance of a “hammer head” and frequently can cause corn formation over the top portion of the toe due to irritation of the contracted toe from the top of the shoe. It also can cause a corn on the end of the toe, in more severe contractures due to the pressure of the end of the toe on the bottom of the shoe because of its contracted and more rigid position. Exostoses or bone spurs can occur on the sides of the toes causing pain and callus formation resulting in soft corn formation between the toes with associated pain. Treatment conservatively occurs in the form of periodic trimming of the callus production and accommodative padding along with extra-depth shoes to provide reduced irritation. If this is insufficient, then surgical correction is advised. Surgical therapy for hammertoes is a relatively straightforward procedure and return to activity is fairly quick.
Heel Pain/Plantar Fasciitis
Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, a bruise incurred while walking, running, or jumping on hard surfaces, wearing poorly constructed footwear, or being overweight. 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 ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel. Possible treatments include anti-inflammatories, arch supports, stretching, physical therapy, prescription orthotics, night splints and good immobilizers. These can all be used to resolve the pain. Surgery in limited cases is necessary, but most often the heel pain responds to good conservative therapy.
Ingrown Nails / Fungus Nails
An ingrown toenail is a condition in which the nail is cutting into the surrounding flesh. This condition is usually very painful and can be associated with infection of the toe. A nail is ingrown when one, or both corners or sides of the nail grow into the skin of the toe. Irritation, redness, uncomfortable sensations of warmth as well as swelling, pain and infection can result from an ingrown toenail. A simple office procedure can be preformed to permanently resolve the ingrown nail and prevent reoccurrences.
In many areas of the foot due to the numerous joints, ligaments, muscles and tendons, inflammatory pain can occur and be relieved by injection therapy. Injection therapy is most often accomplished with a steroidal anti-inflammatory designed to attack the heart of your pain, which is inflammation in and/or around the affected tendon, ligament, muscle or joint. Injection therapy can also be used to complement other modalities of treatment such as physical therapy.
Our clinic treats all forms of injuries from simple sprains and strains to the more complex injuries including fractures. Lacerations, puncture wounds, removal of foreign bodies such as glass and splinters are also frequently seen and treated at Family Foot Clinic.
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads, or can be more isolated affecting just the first metatarsal head (near the big toe) which is frequently referred to as sesamoiditis. Sesamoiditis is inflammation of two small bones located underneath the big toe joint similar to the kneecap in the knee. Excessive pressure to the big toe joint frequently inflames these two small bones. Treatment for metatarsalgia or sesamoiditis frequently is anti-inflammatory in nature and is also treated with various pads, arch supports and prescription orthotics in addition to appropriate footwear. These treatments are designed to be preventative by reducing the stress that causes the pain syndrome. Many times isolated calluses will form at the site of a specific metatarsal that is out of alignment or has become less flexible due to arthritis at the joint just behind it where it attaches to the foot and therefore increases pressure in the ball of the foot due to this inflexibility. Occasionally surgical correction will be necessary to realign the metatarsal to reduce this isolated stress.
Simple primary podiatric care in the form of nail debridement (trimming) is necessary in patients who have vision problems or significant arthritis in their hands and are unable to properly care for their nails on their feet themselves. Many patients are unable to reach their feet and properly care for their nails and also require podiatric assistance to prevent complications from lack of care. While this may seen to be a simple condition to self treat, many patients have extreme difficulty and with lack of treatment can get infections and severe pain along with skin lacerations from something as simple as a long, thickened or an ingrown nail.
Neuromas are enlarged benign growths of peripheral nerves. They are most common between the third and fourth toes but can also be seen between the second and third toes at the level of the metatarsal and toe joints. They are most frequently caused by injury, pressure from adjacent metatarsals or tissues such as ligaments rubbing against and irritating these nerves. Conservative treatment is centered around reducing the inflammation of the nerve through physical therapy, anti-inflammatory therapy both orally and by injectable routes and potential mechanical control using orthotic devices (sophisticated arch supports). Sclerosing therapy using an injection of a local anesthetic and a sclerosing material stops the nerves conduction and in doing so eliminates the pain without the need for surgery in many cases. This is a cost effective and non-surgical treatment for neuromas.If conservative management fails surgical excision is the ultimate alternative and will generally resolve the pain leaving only a small area of numbness at the site of the neuroma. These nerves are sensory nerves only and do not affect the mechanics or function of the foot. Therefore the surgical procedure is substantially pain relieving while not affecting gait or function.
Biomechanical examination of the foot and leg is an important step in determining the underlying cause of painful, foot, leg, hip and lower back pain syndromes. This examination involves both weight bearing and non-weight bearing measurements of joint alignment in the lower limb, and gait analysis. Prescription orthotics are used for a number of conditions such as: Plantar fasciitis (heel pain) Achilles tendionosis. Ankle and forefoot pain. Low arched feet. High arched feet. Diabetic foot complications. Running injuries Shinsplints Knee and lower back pain. Tired aching legs and feet. Morton’s neuroma. In some cases an off the shelf device (OSD) is all that is required, or the patient may wish to try an OSD initially to see if this helps, or use such a device until the custom made orthotic is ready. Orthoses can be specially made to fit all types of shoes from sneakers, casual lace shoes, ski boots, to low cut court shoes. If a custom device is required, and an examination is performed to determine the foots range of motion and mechanical position and a casting is performed to capture this position. A prescription is written and sent with the castings to the lab for fabrication of a device recommended by our physician to properly control your foot stressful condition and alleviate your pain. The materials used to make the orthotics are dependent upon your foot flexibility or inflexibility, sports or activities including work that you are involved with, your weight and especially your foot structure. This is determined by our physician at the time of your biomechanical examination and casting When they return from the laboratory they will be dispensed after properly checking them for fit and proper fabrication. Our Dr. will follow you during your adjustment period until you are functioning well with the orthotics and without pain complaints. Orthotic therapy rarely fails when prescribed for appropriate conditions in which they will improve function. They are not however the panacea for all foot problems. In some instances surgical correction will be ultimately necessary to solve related foot conditions.
The Plantar Fascia is a strong inelastic band of fibers which begins at the heel and extends into the toes on the bottom (plantar aspect) of the foot. When the Plantar Fascia becomes inflamed, the pain is mainly in the heel but can also occur in the arch of the foot. Medically, this condition is called Plantar Fasciitis. When the Plantar fascia becomes inflamed and the pain is mainly in the heel and has a calcaneal (heel) spur, medically this condition is called Plantar Fasciitis/Heel Spur Syndrome. The usual cause of Plantar Fasciitis/Heel Spur Syndrome is excessive pulling on the Plantar Fascia from either excessive exercise, poor fitting shoe gear or poor foot alignment such as pronation (collapsing of the arch) or a rigid high arch structure while running or standing. Plantar fascia pain usually begins as a mild pain to either the arch area or the bottom of the heel. The discomfort in the foot is usually most noticeable with the first step in the morning and seems to improve after a period of “warming up” the foot. It is frequently associated with two other symptoms; pain upon arising after you had been resting and pain on activity. These 3 symptoms are almost always seen together and are therefore called the Triad of Plantar Fasciitis. If untreated, the pain can become intolerable. In some individuals, as previously mentioned, actual heel spur formation can occur at the site of where the Plantar Fascia is connected to the heel. The heel spur is actually a ridge of bone that forms as result of the chronic irritation of the plantar fascia where it attaches to the heel. The ridge of bone is not the main problem. The plantar fascia is the primary anatomical structure that is causing the inflammatory pain to the patient. If the pulling on the plantar fascia is corrected, it is important to understand that the heel spur that formed from the pulling is not important and does not need to be removed with surgery. There are many other doctors who get the heel spur confused with the cause of the pain and tell the patient that a heel spur is causing their pain when in fact it is the injury to the Plantar Fascia that needs to be medically treated and is well known to our podiatric physician. Treatment using arch supports or prescription orthotics and in more severe cases, combined with physical therapy or injection therapy, usually resolves the majority of plantar fasciitis heel spur syndromes conservatively without the need for surgery. Occasionally but most often infrequently surgical correction will be necessary to resolve the severe cases.
A sprain is a partial or complete tear of a ligament. A ligament is a strong stretch resistant band of tissue running between two bones to help stabilize the joint and in the case of the feet helps to support the arch by maintaining the numerous bones in stable position. Frequently sprains are associated with industrial injuries and sports injuries but can occur from stress in the home due to lack of poor footwear usage. Treatment is usually in the form of ice, compression support with an Ace bandage or elastic wrap, elevation and rest. In more severe cases cast immobilization and even non-weightbearing with crutch gait may be necessary to allow for adequate ligament stability during the healing process. Appropriate treatment can increase post ligament stability and reduce risk of injury in the future. Therefore adherence to the instructions by our physician will ensure a quicker return to activities with less risk of reinjury.
Spurs are bony enlargements and are not “calcium deposits”. While bone is part calcium the bone spurs usually caused by ligament attachment irritation/strain or trauma are actually bone overgrowth as a result of this constant irritation. Just because bone spurs are present does not mean that they need to be removed in many cases. However painful spurs can restrict motion at joints increasing the degeneration of that joint cartilage and more severe arthritis. Therefore surgical removal of the spurs will prolong joint life and decrease pain. If you have bone spurs, simple x-rays will detect the severity of the condition. Consultation with our podiatric physician can determine the best course of treatment for your spurs given their current severity and your symptoms.
Tendinitis is inflammation of a tendon which connects muscle to bone. Tendinitis can result from a sprain or strain as well as mechanical and structural faults within your foot and ankle. Treatment is usually conservative using rest, physical therapy techniques and supportive therapy such as cast immobilization or splints and elastic bandages. More severe tendinitis conditions can affect various tendons. Take the posterior tibial tendon in the arch of your foot as an example can cause rupture with eventual collapse of your arch and severe arthritic changes. Early intervention with orthotic therapy or arch supports may prevent the rupture of the tendon and these severe arthritic changes with early treatment. Achilles tendinitis can also be quite severe requiring surgical debridement if not treated early and aggressively. Physical therapy and anti-inflammatory therapy along with rest most often resolves this condition. Sometimes heel lifts can be used to reduce tension stress to the Achilles during recovery.
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions but also can occur without any history of skin irritation. They can appear anywhere on the skin, but technically only those on the sole of the foot are properly called plantar warts as they are on the plantar surface or bottom of the foot. Children and especially teenagers, tend to be the most susceptible to warts much more so than adults. Not all children get warts and so therefore some people seem to be immune. Not enough is known about the cause of viral infections including warts and therefore general precautions of good hygiene, with clean socks and frequent shoe changes are advised to minimize potential exposure and minimize trauma to the skin. Wart treatment includes topical acid applications, removal by dissection (curettage), cryotherapy (freezing), hyfrecation or laser removal as well as timely observation as some cases will self resolve. However the pain involved while waiting for the warts to resolve on their own, which may never occur, can be substantially disabling to anyone who is active and especially to young patients involved in sports or are very active. Treatment is most often nondisabling and allows for full activities and heals rapidly. Recurrence however is both frustrating to the patient as well as the physician. The good news is that it is believed that an immune mechanism occurs during development and that warts frequently do not return after the age of 20-25. We do see warts in adults but nowhere near as frequently as in children and teenagers.
Ulcers are most common in patients with diabetes but can occur in patients with poor circulation, either from poor arteries or vein problems. Early intervention or treatment can prevent more serious complications such as infections and amputation.