Foot Support: orthotics,
shoe gear
We provide expert diagnosis and
treatment of:
- Achilles Tendonitis
- Accidental Injury
- Ankle Sprains and Injuries
- Arch Pain
- Arthritis
- Athlete’s Foot or
Rashes
- Bunions
- Corns and Calluses
- Diabetic Foot Infections or
Problems
- Flexible Flat Feet
- Fractures of Toes and
- Metatarsals
- Fungus Toenails
- General Foot Pain
- Gout
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- Hammertoes
- Heel Pain and Spurs
- Infections
- Ingrown or Sore Toenails
- Metatarsalgia
- Nail Disorders
- Neuromas
- Orthotics
- Painful Joints
- Pediatric Heel Pain
- Plantar Fasciitis
- Tarsal Tunnel
- Tendonitis
- Tumors
- Warts
- Wounds
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Ankle
Sprains and Injuries
Ankle twists or sprains are a very common foot/ankle injury many times
ignored, tolerated and/or mistreated. Most common of the sprains is the
inversion sprain, when the foot goes down and in toward your other
foot. Many of the sprains are mild and only result in stretching of the
ankle ligaments. This can be treated with the usual Rest, Ice,
Elevation and Compression, known as RICE and recovery should be less
than a week. If, however, your ankle sprain is more severe with
swelling, bruising or inability to bear weight, your evaluation and
treatment must be more in-depth. An x-ray of the foot will be needed to
rule out a possible fracture of a metatarsal, the most common being the
fifth metatarsal on the outside of your foot. MRI examination is
beneficial to evaluate the integrity of the ankle joint and its
ligaments and tendons. Clinically an assessment for range of motion as
well as ligament stability will need to be done. If a non-displaced
fracture is noted, immobilization is needed for 6 to 8 weeks. If a
displaced fracture is noted, surgical repair may be warranted with up
to a 3 month recovery to get back to pre-injury activity levels. If
ligament damage is noted, immobilization and “RICE”
is required for about 3 weeks. Continued ligament healing then requires
use of an ankle-support device and possibly physical therapy until the
tissues completely recover. This is a slow process as ligaments can
take up to 18 weeks to heal and at the end of the healing cycle the
ligament may be prone to re-injury. If recurrent ankle sprains are a
problem or excessive ankle motion is noted post-injury, an MRI exam and
surgical consultation is needed to evaluate if surgical intervention is
need to reestablish ankle stability and integrity.
Arthritis
Joint stiffness, pain or tenderness, swelling and/or redness that
persists for more than two weeks—all may signal arthritis.
There are many forms of arthritis that damage our bodies, especially
the joints, gradually wearing away protective cartilage where the bones
meet to make a joint. The force our body weight generates on the toe
and ankle joints makes them particularly susceptible to arthritis. Your
feet will carry you the equivalent of five times around the world
during your lifetime!
As cartilage erodes and bone rubs
against bone, the joint becomes painful. Movement may become limited as
bone ends erode or thicken, sometimes developing painful outgrowths, or
spurs. This is very common in the great toe joint, where motion upon
walking becomes limited and eventually painful. This is referred to as
“turf toe” and is quite common after injury to the
joint. If left untreated, damage to cartilage can seriously weaken the
joint, often leading to altered gait and limited activities due to pain.
Rheumatoid arthritis and osteoarthritis
are two common forms of arthritis that affect millions of Americans,
especially those over age 45. Rheumatoid arthritis is a
“systemic” disease that can affect the entire body.
Osteoarthritis, sometimes called degenerative arthritis, or referred to
as joint “wear and tear,” is isolated to the
joints. Pain and stiffness caused by cartilage destruction develop
slowly as a result of years of everyday living and pounding.
Arthritis of the feet is very common
since 25% of the bones of your body are in your feet. Add to that the
many miles that you travel daily and have traveled over your life, and
you can see that feet can easily show the affect of the abuse. Many
times the symptoms of foot arthritis can be controlled by medications,
orthotics and physical therapy. In early stages, orthotics are
beneficial in treating “turf toe.”
In more resistant cases, reconstructive
surgery is needed to give improvement in joint motion and the benefit
of reduced pain. The goals of surgery are different for each individual
and will need to be discussed with us. While surgical care will not
cure arthritis or completely restore the joint to its natural health,
it will ease pain and make daily activities more manageable. Early
recognition is key!
Bunions
A bunion, from the latin “bunio” meaning
enlargement, is a protuberance of bone or tissue around a joint. This
enlargement occurs either at the base of the great toe or on the
outside of the foot, at the base of the little toe where it is called a
“bunionette” or “tailor’s
bunion.”
Bunions at the base of the great toe
usually begin when the big toe starts moving toward the smaller toes
and this crowding puts pressure on the join, pushing it outward. Both
men and women can develop bunions, although it appears that bunions are
more commonly seen on women’s feet. Bunions develop from a
weakness in the bone structure of your foot. Because of the instability
of the bones and ligaments which form the various joints and arches in
your foot, the joints have a tendency to move out of proper alignment.
The deformity runs in families and people with flat feet or low arches
are more prone to develop the problem. Bunions also maybe associated
with various forms of arthritis. Bunions are a progressive deformity,
getting worse with time, and as bunions become more severe, the joint
moves further out of proper alignment and eventually arthritis will
damage the joint space.
As bunion deformities progress, they do
become quite symptomatic and bothersome. The skin and deeper tissues
around the bunion also may become swollen or inflamed from increased
pressure of footwear. The other toes can be affected by a bunion, as a
result of pressure from the great toe pushing inward toward the lesser
toes. Shoes which used to fit gradually become too tight and walking
and everyday activities become uncomfortable. Inactivity becomes the
exercise of choice!
Treatment initially is to relieve
pressure on the bunion and smaller toes with larger shoes and
restriction of painful activities. Eventually, given the progressive
nature of the bunion, surgical correction of the bunion is required.
Due to the structural nature of the problem, the metatarsal bone needs
to be cut and realigned to re-establish its normal alignment. In
addition, the surrounding tendons and ligaments may need to be
repositioned to help realign the joint in a straight position. This
procedure is performed in an out-patient hospital setting with
anesthesia so that you won’t feel, see or hear anything. You
can generally go home within a couple hours of completing the surgery.
Pain and deformity are significantly
reduced in the great majority of patients who undergo bunion surgery.
In addition to easing pain, the purpose of bunion surgery is to remove
the enlargement and realign the join to restore normal function. This
means that after surgery, the foot can carry the body’s
weight properly, and that special shoes are no longer needed. As with
most conditions, early diagnosis and treatment is essential before
structural joint damage occurs. So that that you can return to your
activities without lasting complications, make an appointment today and
see what is causing your discomfort and what can be done so that your
everyday pain may be reduced.
Fungus
Infections (Skin and Nails)
The fungal problems seen most often
are athlete’s foot and fungus nails. A fungus is common mold
that thrives the three D’s: dark, damp and dirty. On the
feet, it can grow on and between the toes, as well as soles and
toenails. Chronic fungal infections are most common in adults, while
acute fungal infections are seen more in children.
The risk is low, but athlete’s
foot is a mildly contagious infection. This fungus can make your feet
itch, burn, and the skin on the bottom of your feet crack, blister, or
peel. Athletes aren’t the only one who can get this as anyone
who has feet that perspire heavily or if your work shoe creates a most
environment, may get a fungal infection. Most environments are perfect
place for fungi to thrive. You don’t hear of
athlete’s hands!
Fungal infections usually start
underneath the tip of your toenail, and then spread back toward the
cuticle and to other nails. Your nail may thicken and become so brittle
that trimming crumbles the nail. It can become brown, green, and black
or may fall off. The fungal nail also becomes thick and so may become
painful as it hits your shoe. The nail may also grown curved and become
ingrown. As the fungus grows, foul smelling, moist debris can be seen.
Treatment is best begun at early stages
of infection. Both skin and nail infections can be treated with oral
and topical medications. Dependent on the extent and state of your
infection, the safest, most effective treatment will be started. Fungal
infections don’t happen overnight and consequently
aren’t cured overnight. Effective nail treatment requires the
good healthy nail toe “push” the infected fungal
nail as it grows out, which may take 8 to 10 months. Medications may or
may not completely eliminate the fungus, but early treatment is
imperative for good results.
Hammertoes
and Corns
A hammertoe deformity usually refers
to an abnormal toe position where one or more small toes buckle or
bend-under, out of their normal straight position. Many disorders can
affect the joints of the toes, causing pain and preventing the foot
from function as it should. People of all ages can have toe problems,
from infants born with deformities, to older adults with acquired
deformities. Over time, these deformities develop from being a flexible
tendon deformity to one that affects the bone and therefore is rigid
and non-bending.
Hammertoes are most commonly found on
the second (next to the big toe) and fifth (or small) toes. Because of
this abnormal toe position, the joint of the toe becomes prominent on
top of the buckled toe. The tendons and ligaments then begin to
contract and accelerate the problem. Skin irritation (inflamed skin
areas) or even corns – (an accumulation of hard dead skin
cells) may form on top of these prominent, contracted joints where
shoes are likely to rub. This usually will lead to pain and inability
to wear most types of shoes comfortably, especially if the pressure or
corn is on the small toe. Many people feel the corn is causing the pain
and are disappointed when trimming of the corn does not give good
long-term relief. In reality, the corn is nature’s protection
or “band aid” between the shoe and bone. This
pressure will soon lead to inflammation or bursitis and the inability
to wear a lot of your shoes. A bone spur, which is an overgrowth of
bone, will occur within the toe joint if outside pressure continues to
irritate the bone.
Any toe problem that causes pain or
discomfort while walking should be evaluated. Ignoring the symptoms can
aggravate the condition, and over time may lead to an infection, a
breakdown of tissue or ulceration. For people with poor circulation or
an underlying medical problem, prompt attention is a must.
Treatment of hammertoe pain is directly
dependent on the extent of development of the deformity. Early
recognition and modification of shoe gear can give good relief.
However, if structural changes have occurred in the toe and the
deformity is painful or permanent, surgical correction is recommended
to relieve pain, correct the problem and provide a stable, functional
toe. The type of surgery performed will depend on a thorough evaluation
of the toe, the factors causing the deformity and which treatment is
likely to be the most successful. Dependent on the number of toes
affected, the surgical correction can many times be done in the
surgical suite of our office with local anesthesia. Generally, the
patient can return to activities in a few days wearing a cut-out
surgical shoe while the toe heals.
If there are pressure calluses or corns
that are causing pain in your everyday activities, it is imperative
that early diagnosis be obtained and your options discussed.
Heel
Pain and Spurs
The heel bone bears all of the body’s weight with each step
and sharp pain, stiffness or aching on the bottom of your foot or in
your heel is a very common ailment. The pain is often at its worst upon
awakening in the morning or after resting, causing limping for a few
minutes before your foot “loosens up.” As you
continue your daily activities, the pain may return and not go away
with activity.
Heel pain originates deep within the
foot, directly on the heel bone or within the foot’s
connective tissues, called the “plantar fascia.”
This fibrous band extends from the heel bone, supports the arch and
reaches across to the toes. Pain can result when these tissues become
irritated or inflamed, eventually causing boney spurs to develop on the
heel bone.
Most cases of heel pain are characterized by inflammation. First, the
fascia begins to pull on the bone and the tissues become irritated,
then inflamed. This inflammation is called plantar fasciitis.
A projection or growth of bone may form
on the heel bone when the fascia pulls over an extended period of time.
While some heel spurs are painless, others that are determined to be
the cause of chronic heel pain may require medical treatment. Not all
heel spurs hurt: it is the inflammation of the structures that causes
the pain and thus treatment is aimed at reducing stress on the foot and
decreasing inflammation. Injury, overuse or mechanical causes can bring
on discomfort in the heel. A correct evaluation and diagnosis is
imperative for successful treatment as most heel pain can be relieved
without surgery.
Treatment for heel pain is directed at
the cause. It usually involves rest, prescription oral non-steroidal
anti-inflammatory medications, foot taping, cortisone injections and
orthotics. These medications reduce inflammation as does the
application of straps of tape which reduce the pull on tissues and help
support the bones and joints of the foot. This helps determine if
wearing orthotics will improve your condition. Consistent use of shoes
with laces, such as running shoes, provides good support and speed up
your recovery. Resolution of the pain is gradual and may take several
months. Occasionally, a night splint is recommended to help in
maintaining the length of the ligament.
Ingrown
or Sore Toenails
Most often the nail of the big toe is affected. The symptoms occur
because the skin around the nail is forced so close against the nail
that the nail appears to be “growing” into the
skin. Soft skin tissues react to the nail as if it’s a
foreign body. Inflammation, pain and infection often result. It is
important to seek prompt care especially if you are in a high-risk
health group- have diabetes or poor circulation- or if it is infected.
Ingrown toenails rarely respond long term to “bathroom
surgery.”
Treatment for a painful ingrown nail
consists of removing the ingrown portion of the nail for fast relief of
pain and infection. For bad or recurrent problems, we can chemically
treat the root of the ingrown nail so that the painful part of the nail
should not grow back. This is done in the office, with local anesthesia
and you can normally return to your normal activities with very little,
if any, discomfort. You will need to bandage the area for several weeks
to facilitate healing but you normal activities are encouraged. This
procedure usually produces nice long term relief for a very aggravating
and recurring problem.
Neuromas
A burning, numbness or tingling sensation that radiates at the base of
the toes is most likely caused by an inflamed benign nerve tumor or
neuroma. The nerve of the toes passes between the metatarsal bones but
because of trauma, tight-fitting shoes or other compression, the nerve
gets squeezed between the surrounding bones. Over time it subsequently
gets enlarged and often quite painful with symptoms radiating toward
the tip of the toes or up to the ankle. Most neuromas occur between he
third and fourth toes but can occur between any toes. Pain is usually
less severe when the foot is not bearing weight.
Evaluation and correct diagnosis is
important so that specific treatment can be started early. X-rays are
important to rule out any boney pathology. Eliminating mechanical
compression with changing of shoe gear, prescription of
anti-inflammatory medication and cortisone injections are first line
treatment options to attempt to reduce the swelling of the nerve. If
this fails, then a series of injections of a sclerosing agent may be
used to try and non-surgically destroy the nerve and receive relief of
symptoms.
Orthotics
Many foot problems and subsequent pain is due to the misalignment of
your foot. Your foot has 26 bones, 20 muscles, 33 complex joints and
over 100 ligaments that work to support your body weight as you walk.
Unfortunately, with time our feet begin to lose their stability and
pain often results. If it is determined that pain is caused by abnormal
foot function, then prescription functional orthotics are a good way of
attempting to restore normal function to your foot.
Orthotics limit the position of your
heel, therefore by controlling the amount of flattening of the rest of
your foot. Weight bearing stress is distributed throughout your foot
instead of concentrating in certain areas and the strain on soft tissue
and joints is markedly decreased, therefore reducing your pain.
Orthotics compensate for incorrect foot movement just like eyeglasses
improve vision.
Prescription orthotics are custom made
from a cast impression of your feet. They are usually made of a
polypropylene non-breakable material that flexes as your walk but still
holds your foot in a corrected position. This medical device maximizes
the success of your treatment, versus over-the-counter or store-front
arch supports. Many insurance companies reimburse for doctor-prescribed
orthotics for certain medical conditions, as prescription orthotics
have been shown to be quite effective for pain relief. Orthotics are
commonly used for heel pain, (fasciitis and spurs), tendonitis,
bursitis and painful joint problems.
Plantar
Warts
A wart is an infection caused by a virus most commonly seen in
children, teenagers and young adults. The virus invades the skin
through small cuts or breaks. Because they are commonly on the bottom,
or plantar portion of your foot, the wart grows into or deep into your
foot, making walking painful.
The virus can be picked up anywhere and
just like colds, which are caused by viruses, warts can be
“caught” by contact with other people who have
warts. This is espceiall6y true in public places like showers, gyms and
locker rooms where you go barefoot.
Warts may appear hard or spongy with
tiny red, brown or black spots. They can grow up to an inch or more
across, occurring alone (solitary) or with smaller warts clustered
together (mosaic). They can persist for years and recur in the same
spot even after successful treatment. It is imperative that a correct
diagnosis be made as a wart could actually be something more serious.
If left untreated, warts may spread to other parts of the body,
especially the hands.
Treatment for warts is varied dependent on the size, number, location and
duration of time the warts have been present. Dr. Jack has been using the
new CryoProbe treatment for resistant, painful warts. This method allows
precise ablation of the wart with no blistering or pain following treatment.
Regular activities, including sports, are resumed the same day as treatment
and the patient is seen every two weeks to continue painless eradication of
the wart. Length of treatment time is dependent on the depth of the wart,
but pain usually decreases after the first treatment. The CryoProbe is the
latest advancement in painless cauterization of warts, eliminating surgical
anesthesia and disability. It is imperative that the whole wart virus be
eradicated to decrease the chance of recurrence and the CryoProbe has become
a wonderful tool in treating this stubborn virus. Call today for a
consultation with Dr. Jack to see if this modality can help you relieve a
painful problem.
Tarsal
Tunnel Syndrome
An impingement of the posterior tibial nerve as it courses behind the
medial ankle bone can result in pain, numbness and radiating stabbing
pains in the foot and ankle. This condition must be differentiated from
posterior tibial tendonitis and lumbar radiculopathy as treatment will
differ. Diagnosis of the condition is usually based on clinical
symptoms and by a diagnostic injection of the area which may relieve
symptoms almost immediately. Most tarsal tunnel syndrome will get
better with oral anti-inflammatory therapy, orthotics for controlling
the collapsing of the ankle and injection therapy. For those that do
not get the desired relief, a nerve conduction study and/or MRI may be
needed for further diagnosis. Surgical release of the tarsal tunnel may
occasionally be needed to give relief of symptoms, but it is imperative
for good results to get an early diagnosis and appropriate treatment.
The surgery is very similar to carpal tunnel release but performed on
the foot and ankle.
Wounds
of the Foot- Diabetic and Circulatory
Non-healing wounds have many reasons or etiologies but it is imperative
that they heal quickly and completely. Depending on their etiology,
depth of the wound, where the wound is located and length of time the
wound has been present, the treatments will differ. Before treatment of
a wound or ulcer can progress the patient’s circulation to
the wound must be evaluated. If there is little or no blood flow to the
wound, no treatment however novel or effective, will work. Circulation
must be first be established in order to have other medical treatments
be effective, such as antibiotics and other wound dressings. If an
abscess or cellulitis is present, rapid treatment is essential to
reverse the infection. . The infection must be treated with appropriate
antibiotics, either oral or intravenously, so that healing can begin.
Rapid, non-controlled infection in the absence of circulation is a
recipe for disaster and quick recognition and treatment is necessary.
Many times with diabetic and patients with neuropathy, pain is absent
and therefore infection can become overwhelming before the patient
realizes the severity of their problem.
Once circulation is found to be
adequate, topical or oral antibiotics can be used to their full
effectiveness. New topical wound treatments will also be effective at
this time. As a podiatrist and wound care specialist, we will select
appropriate wound care treatment according to the wound’s
appearance, tissue quality and stage of healing. Some of the newer
wound preparations can even speed wound healing. Treatment instructions
are important and are patient specific, with compliance regarding
dressing of the wound, off-weight bearing of the limb and a good dose
of patience is required, as these wounds take time to heal.
One last antidote on wound care is
acknowledging strict treatment of the systemic problems associated with
these wounds. For diabetics, proper sugar control can do a lot to
prevent and speed healing of ulcers. For leg ulcers, addressing venous
insufficiency and varicose veins with support hose can help prevent the
ulcers from occurring. Those with hypertensive leg ulcers need to be
treated for high blood pressure. So just because you have a wound on
your foot or leg, don’t overlook the systemic disease that
may have caused or influenced the wound, as you will only set your self
up for reoccurrence or further complications. Early diagnosis and
treatment is essential.
