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Common Foot & Ankle
Plantar fasciitis or heel spur syndrome commonly results from inflammation of the band of fibrous connective tissue (fascia or "ligament") running along the bottom surface of the foot, from the heel to the ball of the foot. 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 commonly leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone. The condition is most often successfully treated with conservative measures such as use of anti-inflammatory medications and ice packs, stretching exercises, and orthotics devices.
Custom Orthotics or Custom Sandals: these are custom arch supports that help in correcting abnormal or irregular walking pattern. Orthotics perform functions that make standing, walking, and running more efficient and comfortable by altering the mechanism by which the foot strikes a walking or running surface. Doctors of podiatric medicine take a plaster mold of your foot to make custom orthotics or sandals. The device is a conservative approach to many foot problems and is a method of control or prevention of further foot problems. Orthotics change foot function and therefore minimize stress forces that could ultimately cause foot deformity and pain. Most foot and ankle conditions may benefit from the use of orthotics.
Ankle sprains are the most common
athletic injury. Nearly 85% of ankle sprains occur laterally, or on
the outside of ankle joints. Sprains on the inside ligaments are
less common. An ankle sprain occurs when the ankle rolls causing
the ligaments to be stretched or torn. Many sprains occur when
participating in sports, or by twisting the ankle when walking on
an uneven surface. Some individuals, due to their bone structure or
foot type, are more prone to ankle sprains. Although ankle sprains
often heal without need for surgery, it is important to consider
the problem as a partial dislocation of the ankle joint and treat
it accordingly. Early treatment is key in preventing further
sprains, painful joints, or fractures in the future.
Achilles tendonitis can cause
inflammation and degeneration of the achilles tendon. The pain
caused by achilles tendonitis can develop gradually without a
history of trauma.
Achilles tendonitis is aggravated by activities that repeatedly
stress the tendon, causing inflammation. It is a common problem
often experienced by athletes, particularly distance runners. The
most common cause is over-pronation (flat
feet). This occurs because
the arch collapses upon weight bearing, adding stress on the
achilles tendon. Other factors that lead to achilles tendonitis are
improper shoe selection, inadequate stretching prior to engaging in
athletics, a short achilles tendon, direct trauma (injury) to the
tendon, and heel bone deformity.
Foot & Ankle Trauma/Fractures: Toe fractures, midfoot fractures, as well as rearfoot/ankle fractures. These can be caused by acute trauma from sports, accidents, or other activities. You may also get stress fractures from overuse. See your foot and ankle specialist right away to treat injuries and prevent future arthritic conditions.
Hammertoes: Tendon imbalance is the
major cause of toe deformities in adults. The tendons may stretch
or tighten to compensate for imbalance of the foot. Thus, people
with abnormally long toes, flat
feet or high arches have a greater tendency to
develop toe deformities. Over time, the toe may become permanently
deformed and arthritic changes may develop. Patients can
benefit from custom orthotics or may need surgery to illeviate the
pain and deformity.
Ingrown Toenails occur when the
curvature of the nail pushes down the side of the toe and goes into
the skin. This causes pain and discomfort and, in many cases, can
result in infection. The leading cause of ingrown toenails is
inheritance, although the way the patient trims his or her nails
can be a contributing factor. Improper nail spa services can also
lead to an ingrown toenail. There are both conservative and
permanent methods to help in both treating the current condition
and preventing future recurrences.
Many diabetics are at risk for developing a serious foot
condition at some time in their life which can result in
hospitalization. Most of these problems are preventable through
proper care and regular visits to a foot and ankle specialist.
Common serious problems include infection, ulcerations, or
gangrene that may lead, in severe cases, to amputation of a toe,
foot or leg.
The key to amputation prevention in diabetic patients is early
recognition and regular foot screenings, at least annually, from a
podiatric physician. Furthermore, many diabetics may be eligible
for custom shoes and that may help prevent many of the problems
associated with diabetes. Early warning signs may include:
- Skin color or temperature changes
- Swelling or pain in foot/ankle or legs
- Open sores that are slow to heal
- Ingrown toenails
- Bleeding or cracks in the skin
Diabetic Wounds/Ulcerations: Foot ulcers
are sores that occur on the feet of people with diabetes or other
conditions that cause peripheral neuropathy. Up to 25% of people with diabetes develop foot
problems. Diabetic foot ulcers usually occur on the bottom of the
foot and are the leading cause of leg amputations in the United
States. However, the sooner diabetic foot ulcers are treated, the
better the outcome. If undetected, the sore may become larger and
infected. Leading causes of ulceration are: Neuropathy
(decreased feeling in your feet), peripheral arterial disease, venous
disease, improper shoes,
foot deformities, decreased vision, and/or smoking.
If you experience sores or blisters on the foot or lower leg,
fever, skin redness or swelling, or other signs of infection, see
your podiatrist immediately.
Peripheral Neuropathy: numbness or lack
of protective pain sensation can be caused by various conditions
such as: Diabetes or high blood sugar (can lead to ulcerations), neurovascular factors
leading to blood vessel damage that carry oxygen and nutrients to
the nerves, autoimmune factors that cause inflammation in
nerves, mechanical injury to nerves such as tarsal tunnel
syndrome, genetic factors leading to nerve disease, or
smoking/alcohol use. Extremity symptoms may be
described as: numbness, tingling, or pain in the toes, feet, legs,
hands, arms, and fingers. Individuals with peripheral neuropathy
may also get wasting of the muscles of the feet or hands.
Disease or poor blood supply to the lower extremity
can cause discomfort or pain when you walk. The pain can occur in
your hips, buttocks, thighs, knees, shins, or upper feet because
PAD affects arteries that carry blood away from your heart to your
limbs. You are more likely to develop PAD as you age. Smoking or
having diabetes increases your chances of developing
the disease sooner. You may not feel any symptoms from peripheral
artery disease at first. The most common symptom is intermittent
claudication (IC). IC is discomfort or pain in your legs that
happens when you walk and goes away when you rest. You may not
always feel pain; instead you may feel a tightness, heaviness,
cramping, or weakness in your leg. PAD can lead to ulcerations.
Venous Disease/Varicose or spider
veins: The squeezing of leg muscles pumps blood back
to the heart from the lower body. Veins have valves that act as
one-way flaps. These valves prevent the blood from flowing
backwards as it moves up the legs. If the one-way valves become
weak, blood can leak back into the vein and collect there. This
problem is called venous insufficiency. Pooled blood enlarges the
vein and it becomes varicose. Spider veins can also be caused by
the backup of blood. Venous insufficiency can lead to lower
Metatarsalgia or ball of foot pain is
often caused by wearing shoes with thin soles and high heels. This
puts extra pressure on the bones in the ball of the foot. Standing
or walking on a hard surface for long periods also puts added
pressure on the bones, causing pain. Bunions and hammertoes can make the problem worse.
Sometimes high arches or arthritis can also cause metatarsalgia. The
most common symptom is pain in the ball of the foot. You may
benefit from orthotics, ask
your foot and ankle specialist today.
Neuromas are 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 toes that brings on pain, a burning sensation, tingling, or
numbness between the toes and in the ball of the foot. The
principal symptom associated with a neuroma is pain between the
toes while walking. Those suffering from the condition often find
relief by stopping their walk, taking off their shoe, and rubbing
the affected area. 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. There are many treatment
options including orthotics that may alleviate your symptoms.
Arthritis: osteoarthritis, rheumatoid
arthritis, or gouty arthritis
Feet are especially prone to develop arthritis because they take
a lot of pressure. Symptoms include aching or generalized pain in
one joint or an entire area of your foot. There are certain types
of arthritis which cause more deformity and pain.
Rheumatoid arthritis often causes moderate to severe bone
changes in the feet, especially in the toes and the ball of the
foot. The feet can become very painful and difficult to walk on. An
arthritic joint, from osteoarthritis or previous trauma, will
benefit from an evaluation from your foot and ankle specialist.
Gout is a form of arthritis that occurs as a result of the
build-up of uric acid in the body and the joint fluid. This
accumulation of uric acid typically occurs when the body has
difficulty processing certain protein substances that are found
naturally in our diets. The tendency to accumulate uric acid is
often hereditary. Gout usually starts with a sudden onset of
intense pain in one or more joints, usually the big toe joint of
the foot. The pain is accompanied by redness, swelling and warmth
over the joint. All arthritic conditions may contribute to or
result from bunion and hammertoes deformities. It is important
to verify the amount of damage and protect the joint. orthotics or possibly surgery may help realign
the forces or conditions that affect that particular joint.
Plantar Verrucae or warts are caused by
a virus that enters the body through a break in the skin. The virus
grows in warm, moist environments. Plantar warts often spread to
other areas of the foot, increase in size, and can form into a
cluster. They may be difficult to distinguish from calluses.
However, what differentiates them from a callus is that they have
tiny black dots on the surface layer which are ends of capillary
blood vessels. Plantar warts can be very painful and tender.
Although plantar warts may eventually disappear by themselves, you
should seek treatment if they are painful or to prevent spreading.
Biopsy & Pathology: cancer screening
of foot. Regular visits to your podiatrist can help in early
diagnosis of skin and other deeper pathologies.
Nail/Skin Disorders such as fungal
infections, bacterial infections, dermatological disorders, or
trauma (bleeding under the nail). All can be safely diagnosed and
treated by your foot and ankle specialist.