Foot and Ankle Disorders
Did you know the foot has 26 bones, 33 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that 75 percent of all Americans will experience foot problems at one point or another in their lifetimes.
Click on the tabs below to read articles on foot disorders and conditions.
- Ankle Fractures
- Ankle Sprain
- Diabetic Foot Care
- Flexible Flatfoot
- Heel Pain
- Ingrown Nail
- Neuroma CDFA
- Plantars Wart
- Toe and Metatarsal Fractures
What Is an Ankle Fracture?
A fracture is a partial or complete break in a bone. In the ankle, fractures can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both.
Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward. Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
Signs and Symptoms
- An ankle fracture is accompanied by one or all of these signs and symptoms:
- Pain at the site of the fracture, which in some cases can extend from the foot to the knee
- Significant swelling, which may occur along the length of the leg or may be more localized
- Blisters may occur over the fracture site. These should be promptly treated by your surgeon.
- Bruising, which develops soon after the injury
- Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured
- Change in the appearance of the ankle so that it differs from the other ankle
- Bone protruding through the skin—a sign that immediate care is needed! Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.
What to Do
Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment.
Until you are able to be examined by a doctor, the “R.I.C.E.” principle should be followed.
- Rest. It is crucial to stay off the injured foot, since walking can cause further damage.
- Ice. To reduce swelling and pain, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Compression. Wrap the ankle in an elastic bandage or wear a compression stocking to prevent further swelling.
- Elevation. Keep the foot elevated to reduce the swelling. It should be even with or slightly above the hip level.
The foot and ankle surgeon will examine the affected limb, touching specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.
Treatment of ankle fractures depends upon the type and severity of the injury.
- Immobilization. Certain frac- tures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
- Prescription medications. To help relieve the pain, the surgeon may prescribe pain medications or anti- inflammatory drugs.
- Surgery. For some injuries, surgery is needed to repair the fracture and other related injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury.
It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, defor- mity, arthritis, and chronic pain.
What Is an Ankle Sprain?
An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.
Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as
strains, which affect muscles rather than ligaments.
What Causes a Sprained Ankle?
Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an
Sometimes ankle sprains occur because of weak ankles, a condition
that some people are born with. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.
Signs and Symptoms
The signs and symptoms of ankle sprains may include:
- Pain or soreness
- Difficulty walking
- Stiffness in the joint
These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains—instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if you don’t have pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain—whether it’s your first or your fifth—requires prompt medical attention.
If you think you’ve sprained your ankle, contact your foot and ankle surgeon for an appointment as soon as possible. In the meantime, immediately begin using the “R.I.C.E.” method—Rest, Ice, Compression, and Elevation—to help reduce swelling, pain, and further injury.
Why Prompt Medical Attention Is Needed
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:
- First, an untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle.You may also develop weakness in the leg.
- Second, you may have suffered a more severe ankle injury along with the sprain. This might include a serious bone fracture that could lead to troubling complications if it goes untreated.
- Third, an ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
- Fourth, rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.
In evaluating your injury, the foot and ankle surgeon will take your history to learn more about the injury. He or she will examine the injured area, and may order x-rays, an MRI study, or a CT scan to help determine the severity of the injury.
Non-surgical Treatment and Rehabilitation
When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:
- Immobilization. Depending on the severity of your injury, you may receive a short-leg cast, a walking boot, or a brace to keep your ankle from moving. You may also need crutches.
- Early physical therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
- Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
- Icing. You may be advised to ice your injury several times a day until the pain and swelling resolves.Wrap ice cubes, or a bag of frozen peas or corn, in a thin towel. Do not put ice directly on your skin.
- Compression wraps. To prevent further swelling, you may need to keep your ankle wrapped in an elastic bandage or stocking.
When Is Surgery Needed?
In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.
After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored.
Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.
What Is a Bunion?
Bunions are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot.With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment— producing the bunion’s “bump.”
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never
What Causes a Bunion?
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.
Although wearing shoes that crowd the toes won’t actually cause bunions in the first place, it sometimes makes the deformity get progressively worse. That means you may experience symptoms sooner.
Symptoms occur most often when wearing shoes that crowd the toes— shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can
aggravate the symptoms of bunions.
Symptoms, which occur at the site of the bunion, may include:
- Pain or soreness
- Inflammation and redness
- A burning sensation
- Perhaps some numbness
Other conditions which may appear with bunions include calluses on the big toe, sores between the toes, ingrown toenail, and restricted motion of the toe.
Bunions are readily apparent—you can see the prominence at the base of the big toe or side of the foot. However, to fully evaluate your condition, the podiatric foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.
Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike—some bunions progress more rapidly than others. Once your podiatric surgeon has evaluated your particular case, a treatment
plan can be developed that is suited to your needs.
Sometimes observation of the bunion is all that’s needed.A periodic office evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases, however, some type of treatment is needed.
Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These options include:
- Changes in shoewear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
- Padding. Pads placed over the area of the bunion can help minimize pain. You can get bunion pads from your podiatric surgeon or purchase them at a drug store.
- Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
- Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.
- Icing. Applying an ice pack several times a day helps reduce inflammation
- Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.
- Orthotic devices. In some cases, custom orthotic devices may be provided by the podiatric surgeon.
When Is Surgery Needed?
When the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with your podiatric surgeon. Together you can decide if
surgery is best for you.
Recent advances in surgical techniques have led to a very high success rate in treating bunions.
A variety of surgical procedures are performed to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, as well as correct soft tissue changes that may also have occurred. The goal of these corrections is the elimination of pain.
In selecting the procedure or combination of procedures for your particular case, the podiatric surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
Diabetes can be dangerous to your feet—even a small cut could have serious consequences. Diabetes may cause nerve damage that takes away the feeling in your feet. 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—so you could develop a blister, then a sore, then a stubborn infection that might cause amputation of your foot or leg.
To avoid serious foot problems that could result in losing a toe, foot, or leg, be sure to follow these guidelines.
❑ Inspect your feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything.
❑ Wash your feet in lukewarm (not hot!) water. Keep your feet clean by washing them daily. But only use lukewarm water—the temperature you’d use on a newborn baby.
❑ Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting—and make sure to carefully dry between the toes.
❑ Moisturize your feet—but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But DON’T moisturize between the toes—this could encourage a fungal infection.
❑ Cut nails carefully—and straight across. Also, file the edges. Don’t cut them too short, since this could lead to ingrown toe nails.
❑ Never trim corns or calluses. No “bathroom surgery”—let your doctor do the job.
❑ Wear clean, dry socks. Change them daily.
❑ Avoid the wrong type of socks. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks (they can fit poorly and irritate the skin).
❑ Wear socks to bed. If your feet get cold at night, wear socks. NEVER use a heating pad or hot water bottle.
❑ Shake out your shoes and inspect the inside before wearing. Remember, you may not feel a pebble—so always shake out your shoes before putting them on.
❑ Keep your feet warm and dry. Don’t get your feet wet in snow or rain.Wear warm socks and shoes in winter.
❑ Never walk barefoot. Not even at home! You could step on something and get a scratch or cut.
❑ Take care of your diabetes. Keep your blood sugar levels under control.
❑ Don’t smoke. Smoking restricts blood flow in your feet.
❑ Get periodic foot exams. See your podiatric foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
What Is Flatfoot?
Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common—partial or total collapse (loss) of the arch.
Other characteristics shared by most types of flatfoot include:
- “Toe drift,”where the toes and front part of the foot point outward
- The heel tilts toward the outside and the ankle appears to turn in.
- Ashort Achilles tendon, which causes the heel to lift off the ground earlier when walking and may act as a deforming force
- Bunions and hammertoes may occur in some people with flatfeet.
Health problems such as rheumatoid arthritis or diabetes sometimes increase the risk of developing flatfoot. In addition, adults who are overweight frequently have flatfoot.
Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years.As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.
The term “flexible” means that while the foot is flat when standing (weight bearing), the arch returns when not standing. In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff.
Symptoms, which may occur in some persons with flexible flatfoot,
- Pain in the heel, arch, ankle, or along the outside of the foot
- “Turned-in” ankle
- Pain associated with a shin splint
- General weakness/fatigue in the foot or leg
Diagnosis of Flexible Flatfoot
In diagnosing flatfoot, the podiatric foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don’t have any symptoms, your podiatric surgeon will explain what you might expect in the future.
If you experience symptoms with flexible flatfoot, the podiatric surgeon may recommend various treatment options, including:
- Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
- Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
- Orthotic devices. Your podiatric surgeon can provide you with custom orthotic devices for your shoes to give more support to the arches.
- Immobilization. In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
- Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
- Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
- Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot.
- Surgery. In some patients whose pain is not adequately relieved by other treatments, surgery may be considered.
A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, joint fusions, or insertion of implant devices.
In selecting the procedure or combination of procedures for your particular case, the podiatric surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
What Is Gout?
Gout is a disorder that results from the build-up of uric acid in the tissues or a joint—most often the joint of the big toe. An attack of gout can be miserable, marked by the following symptoms:
- Intense pain that comes on suddenly—often in the middle of the night or upon arising
- Redness, swelling, and warmth over the joint—all of which are signs of inflammation
What Causes Gout?
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid.
Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it’s also the coolest part of
the body—and, thus, the most likely target of gout. However, gout can
affect any joint in the body.
The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body’s ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications (“water pills”), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men and also occurs in women.
Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to
reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat.
In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.
Initial treatment of an attack of gout typically includes the following:
- Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
- Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
- Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
- Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce the swelling.
The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment.
If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.
When Is Surgery Needed?
In some cases of gout, surgery is required to remove the uric acid crystals and repair the joint. Your foot and ankle surgeon will determine the procedure that would be most beneficial in your case.
What Is Hammertoe?
Hammertoe is a contracture — or bending—of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. Common symptoms of hammertoes include:
- Pain or irritation of the affected toe when wearing shoes.
- Corns (a buildup of skin) on the top, side, or end of the toe, or between two toes. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
- Calluses (another type of skin buildup) on the bottom of the toe or on the ball of the foot. Corns and calluses can be painful and make it difficult to find a comfortable shoe. But even without corns and calluses, hammertoes can cause pain because the joint itself may become dislocated.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.
Corns are more likely to develop as time goes on—and corns never really go away, even after trimming. In more severe cases of hammertoe, open sores may form.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
What Causes Hammertoe?
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.
Hammertoes are often aggravated by shoes that don’t fit properly—for example, shoes that crowd the toes. And in some cases, ill-fitting shoes can actually cause the contracture that defines hammertoe. For example, a hammertoe may develop if a toe is too long and is forced into a cramped position when a tight shoe is worn.
Occasionally, hammertoe is caused by some kind of trauma, such as a previously broken toe. In some people, hammertoes are inherited.
Treatment: Non-Surgical Approaches
There are a variety of treatment options for hammertoe. The treatment your podiatric foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:
- Trimming corns and calluses. This should be done by a healthcare professional. Never attempt to do this yourself, because you run the risk of cuts and infection. Your podiatric surgeon knows the proper way to trim corns to bring you the greatest benefit.
- Padding corns and calluses. Your podiatric surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your podiatric surgeon about this option.
- Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels—conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
- Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.
- Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.
- Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, are often prescribed to reduce pain and inflammation.
- Splinting/strapping. Splints or small straps may be applied by the podiatric surgeon to realign the bent toe.
When Is Surgery Needed?
In some cases, usually when the hammertoe has become more rigid, surgery is needed to relieve the pain and discomfort caused by the deformity. Your podiatric surgeon will discuss the options and select a plan tailored to your needs.Among other concerns, he or she will take into consideration the type of shoes you want to wear, the number of toes involved, your activity level, your age, and the severity of the hammertoe.
The most common surgical procedure performed to correct a hammertoe is called arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint.
Another surgical option is arthrodesis, which is usually reserved for more rigid toes or severe cases, such as when there are multiple joints or toes involved. Arthrodesis is a procedure that involves a fusing of a small joint in the toe to straighten it. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing.
It is possible that a patient may require other procedures, as well—especially when the hammertoe condition is severe. Some of these procedures include skin wedging (the removal of wedges of skin), tendon/muscle rebalancing or lengthening, small tendon transfers, or relocation of surrounding joints.
Often patients with hammertoe have bunions or other foot deformities
corrected at the same time. The length of the recovery period will vary, depending on the procedure or procedures performed.
Heel pain is most often caused by plantar fasciitis—a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst. Because there are several potential causes, it is important to have heel pain properly diagnosed. A podiatric foot and ankle surgeon is best trained to distinguish between all the possibilities and determine the underlying source of your heel pain.
What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed—resulting in heel pain.
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel
- Pain that is usually worse upon arising
- Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
Causes of Plantar Fasciitis
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches— either overly flat feet or high-arched feet—are more prone to developing plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.
To arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
• Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
• Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
• Ice. Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation.
• Limit activities. Cut down on extended physical activities to give your heel a rest.
• Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Your shoes should provide a comfortable environment for the foot.
• Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
• Lose weight. Extra pounds put extra stress on your plantar fascia. If you still have pain after several weeks, see your podiatric surgeon, who may add one or more of these approaches:
• Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
• Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
• Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
• Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
• Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
• Physical therapy. Exercises and other physical therapy measures may be used to help provide relief. Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your podiatric foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. If you are overweight, it is important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
What Is an Ingrown Toenail?
When a toenail is ingrown, the nail is curved downward and grows into the skin, usually at the nail borders (the sides of the nail).
This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if your toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
What Causes an Ingrown Toenail?
Ingrown toenails can develop for various reasons. In many people, the tendency to have this common disorder is inherited. In other cases, an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
The most common cause of ingrown toenails is improper trimming. Cutting your nails too short encourages the skin next to the nail to fold over the nail. Another cause of ingrown toenails is wearing shoes that are tight or short.
Certain nail conditions are often associated with ingrown toenails. For example, if you have had a toenail fungal infection or if you have lost a nail through trauma, you are at greater risk for developing an ingrown toenail.
Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if you suspect you have an infection, or if you have a medical condition that puts your feet at high risk—for example, diabetes, nerve damage in the foot, or poor circulation.
If you don’t have an infection or any of the above conditions, you can soak your foot in room-temperature water (add Epsom’s salt if you wish), and gently massage the side of the nail fold to help reduce the inflammation.
Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it’s time to see a foot and ankle surgeon.
The foot and ankle surgeon will examine your toe and select the treatment best suited for you. Treatment may include:
• Oral antibiotics. If an infection is present, an oral antibiotic may be prescribed.
• Surgery. A simple procedure, often performed in the office, is commonly needed to ease the pain and remove the offending nail. Surgery may involve numbing the toe and removing a corner of the nail, a larger portion of the nail, or the entire nail.
• Permanent removal. Various techniques may be used to destroy or remove the nail root. This treatment prevents the recurrence of an ingrown toenail. Your surgeon will determine the most appropriate procedure for you.
Following nail surgery, a light bandage will be applied.Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.
Preventing Ingrown Toenails
Many cases of ingrown toenails may be prevented by following these two important tips:
• Trim your nails properly. Cut your toenails in a fairly straight line, and don’t cut them too short. You should be able to get your fingernail under the sides and end of the nail.
• Avoid poorly-fitting shoes. Don’t wear shoes that are short or tight in the toe box.Also avoid shoes that are loose, because they too cause pressure on the toes, especially when you run or walk briskly.
What Is a Neuroma?
Aneuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location—in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.
Symptoms of a Morton’s Neuroma
If you have a Morton’s neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring:
• Tingling, burning, or numbness
• A feeling that something is inside the ball of the foot, or that there’s a rise in the shoe or a sock is bunched up The progression of a Morton’s neuroma often follows this pattern:
• The symptoms begin gradually.At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
• The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
• Over time the symptoms progressively worsen and may persist for several days or weeks.
• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
What Causes a Neuroma?
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.
People with certain foot deformities— bunions, hammertoes, flatfeet, or more flexible feet—are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.
To arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests may be performed. The best time to see your podiatric surgeon is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.
In developing a treatment plan, your podiatric surgeon will first determine how long you’ve had the neuroma and evaluate its stage of development.
Treatment approaches vary according to the severity of the problem.
For mild to moderate cases of neuroma, treatment options include:
• Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
• Icing. Placing an icepack on the affected area helps reduce swelling.
• Orthotic devices. Custom orthotic devices provided by your podiatric surgeon provide the support needed to reduce pressure and compression on the nerve.
• Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
• Changes in shoewear. It’s important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Injection therapy. If there is no significant improvement after initial treatment, injection therapy may be tried.
When Is Surgery Needed?
Surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma— the affected nerve is either removed or released. Your podiatric surgeon will determine which approach is best for your condition.
The length of the recovery period will vary, depending on the procedure or procedures performed. Regardless of whether you’ve undergone surgical or nonsurgical treatment, your podiatric surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities that cause repetitive pressure on the foot.
What is a Plantar Wart?
Awart is a small growth on the skin that develops when the skin is infected by a virus.Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.
There are two types of plantar warts:
• Asolitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite”warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.
Signs and Symptoms
The signs and symptoms of a plantar wart may include:
• Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
• Pain. A plantar wart usually hurts during walking and standing, and there is pain when the sides of the wart are squeezed.
• Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the infected capillaries (tiny blood vessels). Plantar warts grow deep into the skin. Usually this growth occurs slowly—the wart starts off small and gets larger over time.
What Causes a Plantar Wart?
Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body. Typically, the plantar wart virus is acquired in public places where people go barefoot, such as locker rooms, swimming pools, and karate classes. It can also be acquired at home if other family members have the virus.
Diagnosis and Treatment
To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart. Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart. The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), or surgery to remove the wart.
Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon.Warts may return, requiring further treatment.
If there is no response to treatment, further diagnostic evaluation may be necessary. In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth.
Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove a wart themselves—this can do more harm than good.
The structure of your foot is complex, consisting of bones,muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist.A podiatric foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.
What Is a Fracture?
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.
Traumatic fractures (also called acute fractures) are caused by a direct blow or impact—like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.
Signs and symptoms of a traumatic fracture include:
• You may hear a sound at the time of the break.
• “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
• Deviation (misshapen or abnormal appearance) of the toe.
• Bruising and swelling the next day.
• It is not true that “if you can walk on it, it’s not broken.” Evaluation by the podiatric surgeon is always recommended. Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures.
Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include:
• Pain with or after normal activity
• Pain that goes away when resting and then returns when standing or during activity
• “Pinpoint pain” (pain at the site of the fracture) when touched
• Swelling, but no bruising Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your podiatric surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.
Consequences of Improper Treatment
Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:
• Adeformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
• Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
• Chronic pain and long-term dysfunction
• Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.
Treatment of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:
• Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
• Splinting. The toe may be fitted with a splint to keep it in a fixed position.
• Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
• “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.
• Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.
Treatment of Metatarsal Fractures
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.
For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.
Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your podiatric surgeon is an expert in correctly identifying these conditions as well as other problems of the foot.
Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:
• Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
• Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.
• Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
• Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
• Follow-up care. Your podiatric foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.