What is an accessory navicular?

Each foot is made up of 28 bones. In approximately 10% of the population there is an “extra” bone on the inner part of the foot (by the arch). The accessory bone is also referred to as an os navicularum or os tibiale externum. It is often incorporated with a tendon (posterior tibial tendon) that is responsible for “push-off” during gait.

This abnormal bone structure is congenital (present at birth), therefore not common in everyone.

What is accessory navicular syndrome?

Majority of times, people are usually unaware that they have an accessory navicular bone as it does not cause any issues. In some cases, the extra bone can get irritated and cause a painful conditions known as accessory navicular syndrome. This can be resultant due to:

• Trauma

• Mechanical: improper foot wear

• Overuse: increase in activity

• Biomechanical: Flatfoot/fallen arch

Signs and symptoms?

It can affect people of all ages, although most commonly it appears in adolescence when the bones are maturing. The most common signs and symptoms are:

• Pain and throbbing in the midfoot, worst upon standing for an extended period of time

• A visible prominence on the inner part of the foot, just above the arch

• Swelling and redness at the bony prominence

Diagnosis

The foot and ankle specialist will ask about symptoms and exam the foot for any skin irritation, prominence, and swelling. Overall, the foot structure, muscle strength, joint motion and integrity of the tendons will be examined. X-rays are routinely performed to confirm diagnosis. Although, if there is ongoing pain and inflammation, other further imaging such as an MRI are commonly used to evaluate the condition.

Treatment:

Nonsugically

The goal is to relieve the symptoms.

• Immobilization

• Ice

• Medications: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

• Physical therapy

• Orthotics/Inserts

• Rest: switching to another activity that isn’t as high impact on the foot

If non-surgical treatment fails to relieve the symptoms, surgery may be recommended.

What is the Achilles tendon?

The achilles tendon (also known as heel cord) is a tough band of fibrotic tissue that connects the calf muscle to the heel bone (calcaneus). Its function is to help the heel lift from the ground. It's responsible for the movement in which the top of your foot points downwards, away from the leg. Commonly, this is the motion that is utilized when you press down on a gas pedal .

Achilles tendonitis and tendonosis

Achilles tendonitis is the inflammation of the achilles tendon. Over time, if this is not corrected, it may lead to degeneration of the tendon which is known as achilles tendonosis. Degeneration is also known as micro-tears in the tendon and in some cases, this can lead to rupture in the tendon.

Causes:

The most common cause of this disorder is “overuse”. It is notoriously associated with a sudden increase of repetitive activity. This causes more stress on the tendon leading to injury. People whose work and/or activity put more stress on their feet and ankles are at increased risk. Therefore, Athletes, laborers, and weekend warriors- those who are less conditioned and participate in athletics only on weekends- are at high risk for developing this condition. Another common cause of this disorder is improper foot gear

Symptoms:

• Pain commonly along the course of the tendon or at the insertion of the bone. Additionally, the pain worsens with ambulation and resolves at rest

• Tenderness and discomfort when squeezing the tendon from side to side

• As the disorder progresses, the tendon may become enlarged and develop nodules (bumps) in the location of injury

Diagnosis:

The foot and ankle specialist will ask about symptoms and exam the foot for any skin irritation, prominence, and swelling. Overall, the foot structure, muscle strength, joint motion and integrity of the achilles tendon will be examined. X-rays are routinely performed. Although, if there is ongoing pain and inflammation, other further imaging such as an MRI are commonly used to evaluate the condition.

Treatment:

The goal is to relieve the symptoms.

• Immobilization

• Ice

• Medications: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

• Physical therapy

• Orthotics/Inserts/night splints

• Rest: switching to another activity that isn’t as high impact on the foot If non-surgical treatment fails to relieve the symptoms, surgery may be recommended.

What is the Achilles tendon?

The achilles tendon (also known as heel cord) is a tough band of fibrotic tissue that connects the calf muscle to the heel bone (calcaneus). Its function is to help the heel lift from the ground. It's responsible for the movement in which the top of your foot points downwards, away from the leg. Commonly, this is the motion that is utilized when you press down on a gas pedal

What is an Achilles tendon rupture?

When the achilles tendon is stretched beyond its capacity, a partial or full thickness rupture may ensue. The most common way that the tendon ruptures is by a forceful jump (i.e basketball) or falling from a height. Commonly, the term “weekend warrior” is associated with an achilles tendon rupture. This term describes a typical, middle aged individual who is less conditioned and participates in athletics only on weekends. Less commonly certain medications may weaken the tendon and contribute to the rupture.

Signs and symptoms

• Frank pain (feels like a kick or stab) in the back of the ankle or leg. Frequently subsiding to a dull ache after.

• Popping or snapping sensation

• Difficulty walking and difficulty pushing “downwards”. The difficulty walking is emphasized when trying to walk up a hill or up stairs

• Swelling, bruising These are concerning symptoms which require prompt medical attention. One should immediate start “RICE”

• Rest: stay off the injured area

• Ice: apply a thin towel and then the ice, never put ice directly on the skin

• compression : wrap the foot with an ACE bandage

• Elevation: elevate on 2 pillows or above the level of the heart

Diagnosis:

The foot and ankle specialist will ask about symptoms and exam the foot with focus on the motor strength. Overall, the foot structure, muscle strength, joint motion and integrity of the achilles tendon will be examined. Most commonly there will be weakness upon pushing down ( as on a gas pedal). X-rays and MRI’s are routinely performed.

Treatment:

Varies between surgical and non-surgical management. The decision is based on the severity of the rupture, the patient activity level, and the patients health status. Generally non-surgical treatment is associated with a higher rate or re-rupture and weakness in push off strength, therefore is reserved for less active patients and those with multiple comorbidities. Nonsurgical treatment involves the use of casts, braces, boots, heel lifts to help correct the injury. Surgical repair often decreases the likelihood of re rupturing and increases the patient's push off strength. Various surgical options are available. Your Foot and Ankle Doctor will discuss all treatment options at great length and tailor the appropriate treatment plan for you.

What is a posterior tibial tendon?

The posterior tibial tendon is one of the most important tendons in the leg and foot. It connects a muscle which is located in your calf to a bone on the inner part of the foot by the arch . The function of the tendon is hold up your arch and provide support to the foot when walking

What is Posterior Tibial Tendon Dysfunction (PTTD)?

The posterior tibial tendon, which is responsible for helping to maintain an arch, starts to degenerate. Once it begins to degenerate, the tendon loses its function to maintain the arch. Therefore, it causes the arch to flatten. Another name for PTTD is often known as acquired flatfoot because its the most common type of flatfoot developed during adulthood. This deformity occasionally happens in one foot, but can happen in both. It is progressive, meaning it will worsen unless its corrected

Causes:

Overuse with improper shoewear is the most common cause of Posteior tibial tendon dysfunction.

Symptoms

Initially there is pain and swelling to the inside of the foot. As it progresses, the arch flattens and there is inward rolling of the ankle. In more advanced cases, arthritis of the foot and ankle ensues.

Nonsurgical management:

It depends on the stage of progression, although generally treatment consist of:

• Immobilization

• Medications: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

• Physical therapy

• Orthotics/Inserts/bracing

• Rest: switching to another activity that isn’t as high impact on the foot

• Shoe modification: more supportive

If non-surgical treatment fails to relieve the symptoms, surgery may be recommended.

Diabetic complications and amputation preventions

People living with diabetes are at risk for developing foot problems. In the feet, diabetes can affect the nerves leading to nerve damage (neuropathy), vessels causing poor circulation, the skin causing dry skin (xerosis), and decreased immunity to infection. Initially with Neuropathy, one may experience tingling which may be worse at night. Additionally, the pain may be so severe that it impacts one's ability to sleep. Overtime, the tingling may progress to numbness. It may feel like your feet are “ asleep” and feel “heavy”, like one has sat on them too long and they are numb. When one starts to experience numbness it is concerning, as though they may not detect any injury or irritation. Additionally, diabetes affects circulation which may lead to the area not healing, or healing very slowly. Since diabetes can also affect immunity, a tiny cut may have a hard time resisting infection. Diabetes increases the risk of developing a wide range of foot problems. A small foot problem can turn into serious complications

Diabetes-related foot and leg problem

• Infections and ulceration (sore) : An ulcer also known as a sore is a break in the skin. This break in the skin gets concerning as though it can communicate with deeper structures like muscles, tendon, ligaments, and bone. Because diabetes affects the blood circulation and immunity, a small break or in the skin or blister can start tunneling deep and communicate with the deeper structures. Additionally, it is easy for the ulcer to become infected and the area to not heal. Infection can lead to a common---and serious--- complication which may lead to loss of toe, foot, limb and in a few cases your life.

• Corns and calluses: corns and calluses are thickening of the skin due to excessive pressure. If they are not managed properly they can turn into ulcers

• Dry, cracking skin (xerosis): Diabetes affects the glands that moisturize the skin leading it to dry skin. Dry skin may turn into cracks which can become sores and lead to infection

• Nail disorders: ingrown toenails and fungal nails not managed properly can lead to infection

• Hammertoe and bunion deformity: any bony prominences can lead to an area of abnormal pressure. Abnormal pressure when wearing tight shoes may lead to either corn/ callus production or a break in the skin. This may lead to an ulceration

• Charcot foot: this is a complex deformity which has a high risk of limb loss

• Poor blood flow: the vessels below the knee often become narrow and resist blood flow. This can lead to tissue dead also known as gangrene and prevent the wound from closing

What your Foot and ankle Surgeons can do?

The foot and ankle doctors can help wounds heal, and prevent amputation. There are many non-surgical and surgical options available to prevent limb loss. Getting regular foot checkups and seeking immediate help when you notice something small is instrumental in preventing wounds and lead to limb loss. We will work closely with your other healthcare providers to ensure the best care

Your proactive measures Please follow the listed guidelines and call Foot and Ankle Doctors if you notice any problems:

Inspect your feet daily: if your eyesight is poor have someone else do it

• Skin or nail problems: look for any cuts, scrapes, redness, drainage, smell, rash, discoloration, loss of hair, discolored toenails,

• Check for signs of swelling, foot turning red, hot, swollen. Seek care immediately

• Do not ignore leg pain: pain that occurs at night with little activity could imply a blockage of any artery in the lower extremity. Seek care immediately

• Nail cutting: always cut your nails straight across

• No bathroom surgery: do not attempt trimming your own calluses or corns yourself. Do not use any over the counter medicated pads

• Keep floor free of sharp objects

• Never go barefoot

• Check socks and shoes: shake shoes before wearing them. Make sure the socks are not bundled up

• Have your circulation and sensation checked by one of the physicians of the Foot and Ankle Doctors.

Even with prompt care and treatment of infection and complications there are changes wherein an amputation is necessary to remove all infected tissue, save the limb or even save a life.

Arthritis literally means “joint inflammation”. There are over 100 diseases that can lead to arthritis. When arthritis affects the joint initial symptoms include stiffness, swelling, and pain, as the disease progresses it can lead to deformity, impair joint function and decrease the ability to walk.

The most common cause is osteoarthritis, although other causes include, but are not limited to, rheumatoid arthritis and psoriatic arthritis.

The Foot and Ankle Doctors are up-to-date with the new advances in technology to help prevent immobility from arthritis and help restore function.

What is an ankle fracture?

There are 2 long bones that help make up the ankle complex whose names are the tibia and fibula. When one or both of these bones break it is known as an ankle fracture. The intensity varies and the fracture can be as minor as an avulsion injury (small piece of bone that has been slightly pulled-off) to severe shattering-type breaks of the tibia, fibula or both. The risks involved with neglecting an ankle fracture can result in severe post traumatic ankle arthritis.

Symptoms

• Pain at the site of the fracture, occasionally so severe that it leads to inability to walk

• Significant swelling

• Blistering: this is a concern sign and should prompt immediate evaluation

• Bruising

• Bone protruding with the skin turning more pale-this is a concern sign and should prompt immediate evaluation

• Inability to move the ankle-this is a concern sign and should prompt immediate evaluation

• Numbness and tingling-this is a concern sign and should prompt immediate evaluation

• Foot turning cooler then usual and more pale-this is a concern sign and should prompt immediate evaluation

Diagnosis

The foot and ankle specialist will evaluate the ankle and make appropriate diagnosis and treatment. X-rays are routinely performed. In some cases a CT scan is performed.

Non-surgical

Treatment vary based on severity. It is imperative to start “RICE” protocol.

• Rest: stay off the injured area

• Ice: apply a thin towel and then the ice, never put ice directly on the skin

• Compression : wrap the foot with an ACE bandage

• Elevation: elevate on 2 pillows or above the level of the heart

It is of the utmost importance to remain non-weight bearing on that limb and keep it protected with a splint or cast. Premature walking can lead to severe arthritis which can be debilitating.

When is surgery needed?

One of the physicians from the Foot and Ankle Doctor team will review all risks, benefits, and alternatives in great detail and choose the best procedure to repair the ankle.

What is chronic ankle instability?

Chronic ankle instability is commonly known as “ a weak ankle” that “ keeps rolling” and “giving way”. This condition often develops after repetitive ankle sprains. With this condition, it is common to experience the ankle feel wobbly when walking on uneven ground. At times, it can be so severe one feels these same sensations when standing on flat surfaces. Additionally, it is common to experience persistent discomfort and swelling.

Causes

Usually develops after an ankle sprain that has not healed properly. During an ankle sprain the ligament is usually stretched and occasionally torn. The function of those ligaments is to keep all the bones in the ankle joint together similar to the function of a seatbelt in a car. If inadequate healing occurs after it's been stretched or torn, the foot will move slightly out of the ankle joint and balance often gets impacted. Proper rehabilitation is needed to strengthen the muscles around the ankle joint to help with balance. In some rare cases, compression or destruction of a nerve can cause this condition. If chronic ankle instability goes untreated it can lead to additional problems in the ankle joint such as arthritis.

Diagnosis

The foot and ankle specialist will evaluate the ankle and make appropriate diagnosis and treatment. X-rays are routinely performed. In some cases further testing is performed.

Nonsurgical

• Physical therapy

• Bracing

• Medication: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

Surgical:

One of the physicians from the Foot and Ankle Doctor team will review all risks, benefits, and alternatives in great detail and choose the best procedure to repair or reconstruct the damaged ligament(s). This is tailored based on each individual's level of activity and severity of injury.

What is an ankle sprain?

A sprain is defined as either a stretch or tear of a ligament. A ligament is a band of tissue that connects one bone to another. Often it binds to the joint and helps maintain “rigidity”. The function of ligaments provides stability by limiting side to side movement, essentially acting like a seatbelt.

The severity of an ankle sprain is dependent on whether the ligament was stretched, partially torn, or fully torn.

Causes:

Most commonly it's from a sudden twist that forces the ankle joint out of its normal position. It frequently occurs while playing a sport, improper shoe gear, or running/walking on an uneven surface. In some rarer cases, one is born with weak ankles.

Symptoms:

• Pain

• Swelling

• Bruising

• Difficulty walking

• Stiffness

Most commonly the foot is rolled inward and the symptoms are experienced on the outside near the ankle. Occasionally, the foot can roll outwards and the pain can be experienced on the inner part of the ankle.

Why prompt medical attention is needed:

• Untreated ankle sprains can lead to chronic ankle instability and other troubling complications

• Sometimes an ankle sprain can mask an ankle fracture. If an ankle fracture is left untreated troubling complications may arise

• Mainstay of therapy is based on early rehabilitation, if it is delayed it can cause balance issues

Diagnosis

The foot and ankle specialist will evaluate the ankle and make appropriate diagnosis and treatment. X-rays are routinely performed. In some cases further testing is performed.

Non surgical treatment:

• Rest: stay off the injured area

• Ice: apply a thin towel and then the ice, never put ice directly on the skin

• Compression : wrap the foot with an ACE bandage

• Elevation: elevate on 2 pillows or above the level of the heart

• Early Physical therapy

• Medication: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

• immobilization/ ankle brace

When surgery is needed:

One of the physicians from the Foot and Ankle Doctor team will review all risks, benefits, and alternatives in great detail and choose the best procedure to repair or reconstruct the damaged ligament(s). This is tailored based on each individual's level of activity and severity of injury

This is a very common infection of the skin that is caused by a fungus. Fungus infections can occur anywhere on the body, when it is localized to the foot it is known as tinea pedis also known as athletes' feet. It's called athlete's foot because athletes often have sweaty feet and use facilities where fungus was most commonly found.

Fungal infections are more common in warmer weather because feet tend to sweat more. Fungus tends to live in moist, damp areas such as showers, locker rooms, and swimming pools. It tends to affect the feet because fungus thrives to thrive in dark, moist, warm environments such as shoes.

Athletes' feet usually produce itchy, dry, scaling skin. Commonly it is found on the soles of both feet and between the toes. In advance cases it can cause blistering, inflammation, and fissures. In these advanced cases, bacterial infections may occur. The fungus can spread to other body parts, including the toenails.

Avoid walking barefoot and good foot hygiene can help decrease spread. Feet should be washed daily with soap and water and thoroughly dried. If your feet tend to sweat a lot, recommend more frequent sock changes. Antifungal powder, stray, creams, shampoos, and/or oral medications can be used to treat the fungal infection. The physicians at the Foot and Ankle Doctors can help tailor the treatment as per each individual's case.

A discolored toenail usually black, purple or dark brown is commonly noticed after something has dropped on the toe. This discoloration is due to bleeding between the nail and the nail bed (where the nail adheres), as blood clots it turns black, purple or dark brown. Depending on how severe the initial injury was, this can encompass part of the nail and even occasionally the whole nail. Occasionally there may be an associated fracture of the bone under the nail. We recommend you visit the physicians at The Foot and Ankle Doctors to take a closer look.

When the lesser toes (second, and third) toenails are involved, this is commonly known as “runners toe”. Commonly this occurs because 1) nail is slightly too long or 2) shoe is either too tight or too loose. It is important to make sure the nails are not grown too long prior to your run and your shoes are well fitted.

Occasionally black toenails can be caused because of toenail fungus, chronic ingrown nails or other health problems affecting the body

Rarely, a more severe cause of a black toenail is linked to a malignant tumor (cancer) known as malignant melanoma. Early diagnosis and treatment are integral for good prognosis.

Black toenails can be caused by quite a few different causes, it is very important that all black toenails be further evaluated by the physicians at The Foot and Ankle Doctors.

Bone infection is more commonly known as Osteomyelitis. This can be a very life altering and threatening condition. It is caused by a variety of microbial organisms ( bacterial, fungal). The most common cause of bone infection is staphylococcus aurerus.

How does it happen?

• Infection can enter the bone through the environment ( ie. bone sticking out of body)

• It can spread from somewhere else in your body through the blood stream

• It can occur from a wound

To diagnose this condition, the foot and ankle specialist will thoroughly evaluate foot and ankle. Blood work, X-rays are initially performed. In some cases further testing is performed.

This is a severe life threatening condition which requires prompt diagnosis and treatment for good prognosis.

A bone tumor is an abnormal growth of cells. There are 2 broad categories of bone tumors: benign (noncancerous) or malignant (cancerous). Bone tumors are relatively rare in the foot and ankle and occur in about 3% of the cases.

Symptoms may include:

• Pain

• Fractures from slight injury

• Swelling, generally localized to that specific location

To diagnose this condition, the foot and ankle specialist will thoroughly evaluate the foot and ankle. X-rays are initially performed. In some cases further testing is performed.

Brachymetatarsia is commonly known as a shorter toe. Most commonly this is noticed on the 4th toe. Sometimes it may even appear that the 4th toe is raised above and the 3rd and 5th toes are touching.

This condition occurs because the long bones in the foot also known as metatarsals fail to fully develop. Generally bones grow at the growth plate during childhood, if the growth plates close prematurely it results in a short bone.

The initial concern is about the toe being shorter then the subsequent toes, although as time progresses more pain is noted to the ball of the foot. Additionally, this may be responsible for abnormal painful calluses.

In some cases, if there is no pain or discomfort this maybe managed with careful shoe selection. In other cases if pain and other symptoms arise surgical intervention may be warranted.

There are 26 bones in the foot. The function of these bones are to support our weight, help us propel, and keep us standing. When a bone is stressed past its limit, a fracture ensues. This is common during a traumatic event i.e fall when the bone is stressed past its limit. Pain, swelling, redness, and bruising are frequently noticed once an injury occurs. Fractures can be easily diagnosed with x-ray and other imaging modalities.

Treatment is usually centered around:

• Rest: stay off the injured area

• Ice: apply a thin towel and then the ice, never put ice directly on the skin

• Compression : wrap the foot with an ACE bandage

• Elevation: elevate on 2 pillows or above the level of the heart

• Immobilization is a cast/splint/cam walker boot

What is a bunion?

A bunion also known as a hallux valgus is often described as a protrusion of bone on the side of the big toe. The bone that is protruded is known as the metatarsal. This causes a muscle imbalance which causes the big toe to start pointing to the 2nd toe, instead of straight ahead. This deformity is progressive meaning it will worsen with time. It can become so severe that the big toe starts to go on top or bottom of the 2nd toe. This can lead to further arthritis in the big toe joint.

Causes?

Bunions are most likely caused because of genetic-passing down from generation to generation. Other factors that may cause a bunion and make it worsen is improper shoe gear, and foot type. In some cases trauma can lead to a bunion to develop

Symptoms?

Symptoms usually occur during later stages, although some people remain asymptomatic (having no symptoms). Usually symptoms occur when wearing crowded shoes (tight shoes) or high heels. Additionally, spending a long period on your feet can aggravate your symptoms.

Diagnosis?

Most of the time the prominence is physically evident with a protrusion noted at the big toe joint. However to fully evaluate a bunion, x-rays are commonly performed. Since bunions are progressive, Proper and prompt assessment can help determine how quick the deformity may progress and prevent destruction to the joint.

Non-surgical treatment?

There is no way to reverse a bunion with conservative therapy (non-surgically), although there are ways to help slow down the progression and reduce the chance of joint damage. The goal of non-surgical therapy is to calm down the symptoms

• Change in shoe gear-wider shoes, more supportive shoes

• Padding

• Medications: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

• Icing: apply a thin towel and then the ice, never put ice directly on the skin

• Injection therapy- rarely used unless it is due to bursitis (inflammation of bursal sac)

• Orthotics/Inserts

• Rest: switching to another activity that isn’t as high impact on the foot

When is surgery needed?

If non-surgical treatment fails to relieve the pain and it starts to affect your daily quality of life, it is time to discuss surgical options.

There are over 100 different kinds of bunion procedures, your physicians at Foot and Ankle Doctors can help determine the right procedure and tailor it based on each individual's level of activity and severity of injury.

A bursa is a small fluid-filled-sac, similar to a cushion, that is located near a joint, bone, or tendon. Bursitis is inflammation of that fluid filled sac. Inflammation occurs secondary to friction, commonly the bursal sac gets irritated in shoe gear. In some cases that bursal sac can become infected

Symptoms

• Localized redness

• Swelling

• Pain

• Fever or chills. Warmth around the site with redness. Red streaks up the leg (lymphatic streaking) . These are very concerning signs and need immediate evaluation

Therapy:

• Rest: stay off the injured area

• Ice: apply a thin towel and then the ice, never put ice directly on the skin

• Compression : wrap the foot with an ACE bandage

• Elevation: elevate on 2 pillows or above the level of the heart

• Immobilization

• Medication: nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. In some cases oral steroids may be used.

If non-surgical treatment fails to relieve the symptoms, surgery may be recommended.

Calcaneal apophysitis, also known as Sever’s disease, is the inflammation of the growth plate in the heel bone. The growth plate is a weak area in the heel bone that allows the bone to grow. This plate is not fully developed until age 14. Therefore, typically, children between the age of 8 to 14 can get inflammation in this area if there is too much repetitive stress.

Causes:

The inflammation of the growth plate is due to overuse and stress of the heel bone. This can be in the form of sports which involve repetitive impact of the heel bone on a hard surface. Sports that are known to cause calcaneal apophysitis include soccer, track and basketball. Also, a tight Achilles tendon, or any biomechanical problem such as flatfoot or high arched foot can attribute to calcaneal apophysitis.

Other risk factors for development of calcaneal apophysitis include the following.

1. Obesity

2. Wearing non supportive shoes

3. Wearing cleated athletic shoes

4. Participating in activity beyond a child’s ability

Symptoms:

Symptoms of calcaneal apophysitis in children include pain in the back of the bottom of the heel, limping, walking on toes, difficulty running, and jumping. Patients might complain of the foot being tired easily. Squeezing the side of the heel usually reproduces the pain.

Diagnosis:

History of the condition, with special attention to the type of activity, is important for the diagnosis. Physical examination to reproduce the pain can localize the area of discomfort. X-ray of the heel can be ordered to evaluate the condition, and rule out other causes of heel pain.

Treatment:

Once the diagnosis has been made, the following treatments can be implemented.

• Reduce activity. The child needs to reduce or stop any activity that causes pain.

• Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel.

• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

• Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue.

• Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile.

Calcaneal apophysitis may reoccur before the closure of the growth plate. Once the growth plate closes, the symptoms should not return.

Calcaneus, also known as the heel bone, is a large bone that forms the foundation of the rearfoot. This bone is also involved in the movement of the subtalar joint, which allows the rearfoot to be mobile, and adapt to uneven terrains when walking.

The structure of the calcaneus is often compared to a hardboiled egg; the calcaneus has a hard outer shell that can be the weight of the body. The interior of the calcaneus is composed of porous bone that is must lighter in weight, and more fragile. In a calcaneal fracture, the entire bone collapses, and can longer bear the body weight. The fracture can also involve the neighboring joints that can cause arthritis and chronic pain.

Cause:

Most calcaneal fractures result from traumatic events, such as falling from height, or an automobile accident. The direct impact on the calcaneal bone causes acute fractures. Less commonly, calcaneal fracture can occur from severe ankle sprains. Overuse or repetitive stress on the heel can also cause stress fracture of the calcaneus.

Calcaneal fractures can be broadly categorized into 2 types; intra-articular (involving the joints) or extra-articular (do not involve the joint) fractures. Intra-articular fractures are more common, and incurs damage to the joint cartilage. Extra-articular fractures are often avulsion fractures (a piece of bone pulled off the main piece of bone by a tendon), or stress fracture from overuse injury.

Symptoms:

Acute calcaneal fractures have sudden onset of pain in the heel, and inability to bear weight on it. Swelling, bruising at the heel and ankle might also be observed.

For stress fractures in the calcaneus, the pain develops slowly, and is often described as dull pain. Swelling in the heel area might be observed.

Diagnosis:

A thorough history and physical examination must be performed. Evaluation of the foot, with special attention directed to the rearfoot is required. X-ray or computed tomography (CT) scan may be ordered to further assess the fracture pattern.

Treatment:

Treatment of the calcaneal fracture is dictated by the fracture pattern, joint involvement, skin involvement, and activity level of the patient. Conservative treatments can involve the following.

• Rest, ice, compression and elevation (RICE). Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.

• Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weight bearing.

For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the subtalar joint. The surgeon will choose the best surgical approach for the patient.

Calf pain is a common complaint in the lower extremity. There are a wide range of causes for calf pain; from muscle strain, to poor blood flow, to direct injuries. The calf pain may be an emergent issue, or a self resolving issue.

Overactivity can cause muscle strains in the calf. This type of injury is usually sore in nature. The patient is able to walk, however, with minor to moderate soreness. Dietary imbalance can also cause calf pain in the form of muscle cramps. A wide range of dietary supplementation can help with this issue.

Poor blood flow to the legs, known as peripheral arterial disease, can cause pain . When the disease is mild, the patient will experience pain in the calf during activity. As the disease worsens, patients might experience pain at the calf even when at rest. Another cause is deep vein thrombosis. This disease involves a blood clot in the deep vein of the leg that prevents blood from returning to the heart. It is a serious problem, and should receive medical attention right away.

Tearing of the calf muscle, or tendonitis of the neighboring tendons can also produce calf pain. An acute tear of muscles or tendons needs to be assessed by a physician and appropriately treated.

Callus is a thickened area of skin on the foot caused by increased friction at the site. The friction can be from shoes or socks. Callus formation is the body’s mechanism to protect the skin. Callus becomes an issue when the thicken skin presses on the underlying soft tissue or nerve causing discomfort or injury.

Treatment options include padding the area, wearing the appropriate shoewear, and periodic removal of the callus. Your physician can provide the treatment to remove the callus. Avoid attempting to remove the callus at home as this can lead to serious injuries and infections.

Capsulitis is a condition in which the capsule of a joint is inflamed. The capsule of a joint holds the joint together, and helps with the movement. The 2nd toe joint is prone to capsulitis because, aside from the big toe joint, it bears more weight than all the other toe joints. When the big toe joint is dysfunctional, the 2nd toe joint shares the weight, and can become overloaded.

Cause:

The cause of 2nd toe joint capsulitis is a result of abnormal foot mechanics. This can stem from severe bunion deformity, a second toe longer than the big toe, unstable foot, and tight calf muscles.

Symptoms:

Capsulitis of the 2nd toe is a gradual and progressive condition. As the condition worsens, so do the symptoms. Symptoms can include the following:

1. Pain at the ball of the foot. Patient complains of discomfort like a marble in the shoe, or bunched up socks

2. Swelling at the base of the toes

3. Difficulty with wearing shoes, especially high-heeled shoes

4. Pain when walking barefoot

As the condition worsens, the following symptoms might appear.

1. 2nd toe drifting toward the big toe

2. 2nd toe lying on top of the big toe

3. Acute pain at the bottom of the 2nd toe

Diagnosis:

The symptoms of capsulitis of the 2nd toe is similar to Morton’s neuroma. A careful examination of the foot is important. Certain maneuvers can be performed to reproduce the symptom. The stability of the 2nd toe joint can be assessed. If necessary, imaging such as X-ray, ultrasound, or MRI may be ordered.

Treatment:

If the capsulitis is diagnosed early, conservative treatment is effective. Treatment can include the following.

• Rest and ice. Staying off the foot and applying ice packs help reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.

• Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.

• Stretching. Stretching exercises may be prescribed for patients who have tight calf muscles.

• Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.

• Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.

As the deformity progresses, and the 2nd toe drifts onto the big toe, surgery may be considered. The type of surgery might involve correction of the big toe deformity, along with 2nd toe deformity.

Cavus foot, also known as a high arched foot, is a condition in which the foot has an excessive high arch. This type of foot architecture places a high amount of pressure in contact with the ground due to reduced area of contact. Cavus foot can lead to a variety of signs and symptoms such as pain and instability. Patients can develop high arched feet at any age.

Cause:

Cavus foot is commonly caused by neurological disorders, or other medical conditions such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy or stroke. The high arched foot caused by these diseases usually have a worsening nature. Some patients may present with a high arched foot at birth due to inherited structural abnormalities. These usually do not worsen through life. Injury to specific structures such as tendons can also lead to development of a high arched foot.

Symptoms:

Aside from the visually obvious high arch of the foot, the following symptoms may present:

• Hammertoes (bent toes) or claw toes (toes clenched like a fist)

• Calluses on the ball, side or heel of the foot

• Pain when standing or walking

• An unstable foot due to the heel tilting inward, which can lead to ankle sprains

Diagnosis:

A careful history of the patient, with particular focus on family history is important. A thorough examination of the foot, with biomechanical examination including gait assessment is helpful. Also, noting the type of deformity of the foot is vital. For assessment of the bone structure of the foot and ankle, X-ray of the foot can be taken. If neurological deficit is suspected, a patient can obtain a neurological exam by a neurologist.

Treatments:

Conservative treatments of a cavus foot includes the following options:

• Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot.

• Shoe modifications. High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.

• Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop.

• Physical therapy. Work on muscle strengthening and balance of the foot and ankle.

If the symptoms do not improve, or the deformity is severe enough to demand surgery, many different surgical options can be considered. This will take into account the stability, muscle strength, and desired surgical function outcome of the patient.

Charcot foot is a condition characterized by severe fracturing of the foot in patients with significant nerve damage to the foot. Due to lack of feeling in the foot, even as the fracture occurs, the patient continues to walk on it. This causes further bone fractures, and joint collapse. Ultimately, the foot arch collapses, and becomes a rocker bottom foot.

Charcot foot is a serious condition that often leads to severe deformity, disability and amputations. Patients should seek immediate medical care if signs of Charcot foot appear.

Causes:

Diabetes is a common cause of neuropathy, the loss of feeling in the foot. Other causes of neuropathy include vitamin deficiencies, trauma to nerves, medications, infections, and inherited disorders. In addition, a tight Achilles tendon has been shown to increase the pressure of the foot leading to Charcot development.

Symptoms:

The symptoms of Charcot foot includes the following:

1. Warmth. One foot is usually warmer than the other foot

2. Redness

3. Swelling

4. Pain or soreness. Despite the nerve damage to the foot, some patients can experience pain and soreness during Charcot development.

Diagnosis:

Careful examination of the foot, with in depth history relating to the onset of the symptoms is important. To assess the severity of the bone fracture and joint collapse, an X-ray of the foot can be ordered. Other advanced imaging such as CT scan can also be of help.

Treatment:

The appropriate treatment for Charcot foot should start as soon as diagnosis is made. Non surgical treatments includes the following:

• Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non weight bearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot or brace and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients.

• Custom shoes and bracing. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activities—as well as help prevent recurrence of Charcot foot, development of ulcers and possibly amputation. In cases with significant deformity, bracing is also required.

• Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.

Surgery is necessary if the deformity is severe. Timing of the surgery after the initial deformity must be considered. The type of surgery will be assessed on an individual basis.

Club foot, also known as congenital talipes equinovarus, is a deformity at birth in which the foot points down and inward. This deformity is present in 1 in 1000 children, and occurs more often in males than females. The exact cause of the deformity is not fully understood. However, it is believed to be a combination of genetics, congenital conditions, and environment. Also, this deformity can affect one or both feet.

The deformity itself is not painful. However, without proper correction, it can lead to a lifetime of disability. Therefore, treatment is often started early after birth.

Symptoms:

The top of the foot is usually twisted downwards, and inward. Aside from the foot deformity itself, the affected leg may be slightly shorter as well. The calf muscles in the affected leg are usually underdeveloped.

Diagnosis:

Clubfoot is often recognized soon after birth. X-ray of the foot to assess the severity of the deformity can be ordered.

Treatment:

The treatment for clubfoot can start 1-2 weeks after birth. The goal of the treatment is to improve the shape of the foot before walking starts. Below are treatment options for clubfoot deformity.

1. Stretching and casting (Ponsetti method). This is the most common treatment for clubfoot. The foot is corrected into position, and placed in a cast. This process is repeated every week for several months. A minor procedure is performed at the end to lengthen the Achilles tendon.

2. Surgery. If the deformity is not able to be corrected with stretching and casting, more invasive surgery is then needed. Also, if deformity is not corrected at an early age, and persists into adulthood, then surgery might be required.

There is a wide range of causes for cold feet. Cold feet can result from underlying medical conditions that cause poor blood flow to the feet, such as peripheral vascular disease (PVD), blockage or narrowing of arteries, Raynaud’s phenomenon, and heart diseases. Some medications can also cause constriction of the arteries, or decrease arterial pressure which leads to less blood flowing to the feet.

Hormonal abnormalities, such as hypothyroidism, adrenal insufficiency, nerve disorder, and autoimmune disorders can all cause cold feet. To properly diagnose the cause of your cold feet, a detailed history, and physical examination are required by your physician.

Compartment syndrome is a buildup of pressure within the foot after an injury or intense exercise. Due to the increased pressure, blood is unable to be bumped to the foot, and can result in death of the soft tissue. There are 2 types of compartment syndrome; acute compartment syndrome and exertional compartment syndrome.

Acute compartment syndrome is a result of injury to the site, such as crush injury to the foot. This type of compartment syndrome is a medical emergency. Immediate surgery is required to prevent damage to the nerves, blood vessels, and muscles of the foot. Symptoms can include severe pain, coldness, pale skin, loss of feeling, and lack of blood pulses.

Exertional compartment syndrome results from build up of pressure in the soft tissue from performing repetitive motions such as running, bicycling and swimming. It is a chronic condition, and usually is not a medical emergency. The syndrome presents as aching, burning, or cramping of the leg and foot. Symptoms are relieved by rest, and discontinuation of activity.

Contact dermatitis is a type of dermatitis that results from contact of the skin with an irritant. This irritant is something that the skin had previous been in contact with, and has developed an immune response to. Common irritants of the foot include shoes, harsh chemicals, or poison ivy.

When coming in contact with the irritant, an allergic reaction is triggered. Symptoms include redness, itchiness, small blisters and warmth. For patients with other systemic diseases, such as diabetes, the resulting wound can be difficult to heal. Make sure to have the skin assessed by a physician for proper treatment.

A corn is a small thicken spot of skin on the foot. It is caused by increased friction at the site, such as rubbing against an area of the shoe. A corn is different from a callus by a central core of hard material, commonly referred to as “central nidus” in a corn. Patients with foot deformities are at higher risk of developing corns. Deformities include hammertoes, and bunions.

Corns cause pain at the site from pressure. Treatment options include padding the area, wearing the appropriate shoewear, and periodic removal of the corn. Your physician can provide the treatment to remove the corn. However, without correcting the underlying foot deformity, the corn will likely to recur after removal. Avoid attempting to remove the corn at home or use medical corn pads, as this can lead to serious injuries and infections.

COVID toes refers to purplish-red lesions on the feet, initially believed to result from SARS-CoV-2 virus, which causes COVID-19. The toes often appear tender, and make walking difficult. At this time, there is few conclusive research on this condition to definitively point to the cause. However, there are preliminary studies that do shed some light on the cause of this condition.

2 research were conducted, and both did not find the SARS-CoV-2 virus to be the cause of the condition. Instead, the skin lesions are theorized by the authors to arise from the quarantine state itself. Meaning, people were walking at home without proper footwear, causing more stress on the toes. This is especially true for children quarantining at home.

To note, this is preliminary research, and does not conclusively rule out the viral cause of COVID toes. Further and more conclusive research is required to determine the exact cause of COVID toes. If you have noticed any changes to your feet, please see your physician for proper consultation.

Cracked heel is a condition caused by dry skin (xerosis) at the back of the heel. This condition is frequently caused by wearing open-back shoes, increase weight, or increase friction from the back of the shoes. Systemic diseases such as diabetes or loss of nerve function can also increase the risk of dry skin at the site.

Application of cream or moisturizer over the back of the heel can reduce cracking of the dry skin. If an open wound is noted, please see your physician for evaluation and treatment.

A ganglion cyst is a sac of fluid from the outpouching of a tendon sheath or joint capsule. The word “ganglion” means a knot, which is often a description of the ganglion cyst just underneath the skin. Ganglion cyst is a common benign soft tissue mass in the foot. They vary in size, location, and symptoms.

Cause:

The exact cause of ganglion cyst formation is unclear. However, there is suspicion that it arises from trauma.

Symptoms:

Aside from cosmetic concerns regarding the ganglion cyst, it can be both asymptomatic or symptomatic. Some patients experience tingling or burning when the ganglion cyst presses on a nerve. Others experience dull pain or aches when it presses against a tendon or joint. Most commonly, the ganglion cyst results in difficulty with wearing shoes, due to the protrusion of soft tissue.

Diagnosis:

Initially, visual assessment of the ganglion cyst is vital for the diagnosis. To further assist with diagnosis, the physician will shine a light through the cyst. Since a ganglion cyst is filled with fluid, the light should shine through. Also, the ganglion cyst should move freely underneath the skin. The physician might also elect to remove a small amount of the cyst fluid for analysis. Lastly, if there is concern regarding the ganglion cyst, or to rule out other soft tissue pathologies, X-ray and other advanced imaging may be ordered.

Treatment:

There are various conservative treatment of ganglion cysts including the following:

• Monitoring but no treatment. If the cyst causes no pain and does not interfere with walking, the surgeon may decide it is best to carefully watch the cyst over a period of time.

• Shoe modifications. Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst.

• Aspiration and injection. This technique involves draining the fluid and then injecting a steroid medication into the mass. More than one session may be needed. Although this approach is successful in some cases, in many others, the cyst returns.

If symptom relief is not achieved with conservative treatments, then surgical treatments may be considered. To note, even with surgical removal of the ganglion cyst, there is moderate chance of recurrence.

Dancing places a lot of stress on your foot and ankle. Common dancer’s injuries includes the following:

1. Dancer’s fracture or 5th metatarsal fracture.

2. Lateral ankle sprain from landing awkwardly from a jump.

3. Bunions (hallux valgus) due to tight fitting shoes and repetitive irritation to the big toe joint

4. Stress fracture from repetitive loading

5. Ankle impingement syndrome from bone structures that pinches the soft tissue when the ankle is in a certain position.

6. Trigger toe/ flexor hallucis longus tenosynovitis due to inflammation of the tendon canal, causing the tendon to be stuck.

7. Sesamoiditis, hallux rigidus, plantar fasciitis, and Achilles tendonitis

Veins are responsible for transporting the blood back to the heart. The leg contains superficial veins, which are closer to the skin, and deep veins, which lies deeper in the legs. Deep vein thrombosis is a condition in which a blood clot forms in the deep vein. Deep vein thrombosis can happen at other parts of the body as well.

The clot prevents the blood from returning back to the heart. The condition is very dangerous, and is considered a medical emergency. If the blood clot breaks loose, it can travel up the vein, and causes a blockage in the lung. In the lung, it is known as pulmonary embolism. This condition causes difficulty breathing, and can cause death. Blood clots in the thighs are more like to travel to the lung, compared to blood clots in the legs.

Risk factors:

There are many risk factors for developing deep vein thrombosis including the following.

Blood or vein conditions:

• Previous DVT

• Varicose veins

• Blood clotting disorders

• Family history of DVT or blood clotting disorders

Other medical conditions:

• Heart disease

• Chronic swelling of the legs

• Obesity

• Inflammatory bowel disease

• Cancer

• Dehydration

• Sepsis

Women's health issues:

• Hormone replacement therapy

• Birth control pills containing estrogen

• Pregnancy or recent childbirth

Other:

• Age over 40 years old

• Immobility (through inactivity or from wearing a cast)

• Recent surgery

• Trauma (an injury)

• Smoking

Symptoms:

Not all patients with deep vein thrombosis have symptoms. However, if you experience any of these symptoms, please contact your physician, or seek emergency treatment.

1. Swelling in the leg

2. Pain in the calf or thigh

3. Warmth and redness of the leg

Diagnosis:

Symptoms of deep vein thrombosis can be similar to other conditions such muscle ache, infection, fracture or arthritis. If deep vein thrombosis is suspected, blood test, Doppler ultrasound, venogram, MRI or angiogram may be ordered.

Treatment:

Once deep vein thrombosis is confirmed, the location of the clot may dictate the type of treatment. Hospitalization might be necessary. Treatment can include the following:

1. Medication. A blood thinner is usually prescribed to prevent further clotting from happening.

2. Compression stocking. This can decrease pain and swelling.

3. Surgery. Procedures might be warranted, and performed by a vascular surgeon.

Complications:

As previously mentioned, development of pulmonary embolism is a serious complication of deep vein thrombosis. Symptoms of pulmonary embolism includes:

1. Shortness of breath

2. Chest pain

3. Coughing up blood

4. A fleeting of impending doom

Other complications of deep vein thrombosis includes injury to the vein, which can lead to future blood clot at the stie, or venous dysfunction such as venous insufficiency.

Preventative measures:

In order to decrease the risk factors associated with deep vein thrombosis, the patient should perform the following:

1. Exercise the legs regularly

2. Stay hydrated by drinking plenty of fluids; avoid alcohol and caffeine

3. Consider wearing compression stockings.

Contact dermatitis is a type of dermatitis that results from contact of the skin with an irritant. This irritant is something that the skin had previous contact of, and had developed an immune response for. Common irritants of the foot include shoes, harsh chemicals, or poison ivy.

When coming in contact with the irritant, an allergic reaction is triggered. Symptoms include redness, itchiness, small blisters and warmth. For patients with other systemic diseases, such as diabetes, the resulting wound can be difficult to heal. Make sure to have the skin assessed by a physician for proper treatment.

Diabetes is a serious disease that demands extra attention, as many of its complications can result in serious consequences. In the foot especially, diabetes can result in decreased or loss of feelings. Furthermore, it can reduce blood flow to the toes, making it harder to heal any types of wounds. Lastly, diabetes can make your immune system less effective at fighting off infections.

Below are the guidelines to follow in order to avoid serious foot problems.

1. Inspect your feet daily. Check for any break in the skin including scrapes, cuts, or blisters. If you are unable to perform this task, ask someone to assist with this task.

2. Wash your feet in lukewarm water, never hot water. Wash your feet daily. The temperature of the water should be lukewarm - the temperature you would use on a newborn baby.

3. Be gentle when bathing your feet. Wash your feet with soft cloth, or sponge. Never scrape the skin of your feet hard. After washing, blot dry your feet; pay special attention in between the toes.

4. Moisturize your feet. Apply moisturizer daily to keep your feet from drying. Do not apply moisturizer in between the toes, as moisture trapped in between the toes can cause infections.

5. Cut nails carefully. Cut nails straight across, and do not cut into the edges. If you are unable to perform this task due to any safety reason, please see a podiatric physician.

6. Never treat corn or calluses yourself. Many diabetes associated complications arise from “bathroom surgeries” or as simple as treating corn at home. Visit your doctor for treatment.

7. Wear clean and dry socks. Change your socks daily.

8. Consider socks made specifically for patients living with diabetes. These diabetic specific socks have more cushion, no elastic tops, and are made of material that is more breathable, and wick away moistures.

9. Wear socks to bed. If your feet get cold at night, do not use a heating pad or hot water bottle, as it can cause damage to your feet. Wear socks to keep your feet warm at night.

10. Examine the inside of your shoes. Before you put on your shoes everyday, examine the inside of the shoes to make sure there are no debris, pebbles or other objects.

11. Keep your feet warm and dry. Do let your feet get wet in the rain or snow. If your socks get wet, exchange for a dry, clean one as soon as possible.

12. Consider using an antiperspirant on the sole of your feet. If you have excessive sweating, consult your doctor regarding antiperspirants to reduce sweating in the feet.

13. Never walk barefoot. Even at home, always wear shoes or slippers to protect your feet.

14. Take care of your diabetes. Keep your blood sugar level under control.

15. Do not smoke. Smoking causes many vascular problems in your feet.

16. Get periodic foot exams: See your podiatric physician on a regular basis to have your feet assessed.

Diabetic neuropathy is nerve damage caused by diabetes. The nerve damage can lead to decreased sensation to the skin, decreased strength to the muscles, and decreased autonomic responses such as sweating. often affects the hands and feet, thus the other name of diabetic peripheral neuropathy. It is a condition that develops and worsens overtime due to the elevated blood glucose level. Due to the lack of, or diminished sensation, to the hands and feet, patients often can develop skin ulcerations that can lead to infection.

Other deformities of the foot that can result due to diabetic neuropathy includes bunions, hammertoes, numbness, and cracked skin.

Symptoms:

Symptoms of diabetic neuropathy can be categorized into 3 broad types; affecting the sensation, the muscle movements, and involuntary controls. Patients with diabetic neuropathy can experience numbness and tingling in the foot. As the disease progresses, soe patient will experience pain, such as sharp and shooting pain. Some patients also experience weakness and loss of muscle tone in the lower extremities. Oftentimes, imbalance during walking will result. Lastly, patients will develop dry feet, with cracked skin due to decrease autonomic control (involuntary control).

Diagnosis:

A complete history and physical exam can be useful in identifying diabetic neuropathy. The specific type of symptom can differentiate diabetic neuropathy from other nerve injuries. Specific test to assess the presence of proper sensation in the foot is important. Reflex, ability to feel vibration can be incorporated into the testing as well.

Treatment:

Unfortunately, there is no treatment for daibetic neuropathy, as the nerve damage is permanent. However, to prevent worsening of the symptoms, blood glucose control is vital. Symptom relief can be achieved through medication, or a combination of medications. For muscle weakness due to neuropathy, physical therapy can be helpful.

To prevent development of ulcerations and associated infections, keep blood sugar level under control, wear well fitted shoes, inspect feet everyday, and have regular appointment with your physician for foot assessment.

Drop foot is a condition characterized by inability to lift the foot at the ankle. This results in the forefoot dragging or scraping on the ground when walking. To compensate, patients will attempt to raise their thighs when walking, as though climbing stairs, resulting in a special type of gait known as “steppage gait.”

Causes:

This is often caused by nerve disorder, muscle disorder, or central nervous system disorder. Risk factors for development of drop foot includes crossing your legs, prolonged kneeling, or wearing a leg cast.

Diagnosis:

Physical exam which includes gait exam, joint range of motion, muscle strength testing, reflexes is important. If overgrowth of bone is suspected to cause the drop foot, then imaging such as X-ray, CT scan or MRI can be ordered.

Electromyography (EMG) and nerve conduction studies can be ordered to determine the location and damage along the affected nerve.

Treatment:

Treatment of drop foot depends on the cause. Below are a few options for treatment of drop foot.

1. Braces or splints

2. Physical therapy

3. Nerve stimulation

4. Surgery

Dried heels are a type of dry skin (xerosis) at the back of the heel. This condition is frequently caused by wearing open-back shoes, increase weight, or increase friction from the back of the shoes. Systemic diseases such as diabetes or loss of nerve function can also increase the risk of dry skin at the site. Application of cream or moisturizer over the back of the heel can reduce the cracking from the dry skin. If an open wound is noted, please see your physician for evaluation and treatment.

Application of cream or moisturizer over the back of the heel can reduce the cracking from the dry skin. If an open wound is noted, please see your physician for evaluation and treatment.

Equinus is a condition in which the ankle is unable to bend upward sufficiently for walking. This can happen to one or both feet. Due to the deformity, patient’s will compensate for this limited ankle motion by flattening the arch of the foot, or picking up the heel early when walking, and sometimes toe walking. This in turn gives a patient a horse like gait when walking, thus the name equinus (horse like). Other compensations include placing increased pressure on the ball of the foot.

It is these compensations that causes issues to develop in the foot and ankle.

Below are a list of problems that can develop from these compensations.

1. Plantar fasciitis (heel pain)

2. Calf cramping

3. Tendonitis (inflammation of the Achilles tendon or other tendons)

4. Metatarsalgia (pain at the ball of the foot)

5. Flatfoot

6. Arthritis of the midfoot

7. Pressure sores on the ball of the foot or ach

8. Bunions and hammertoes

9. Ankle pain

10. Shin splints

Cause:

The most common cause of equinus is tightness in the Achilles tendon (calf muscle). The tightness can be congenital (present at birth) or acquired. Patients can develop tight Achilles tendons from being in a cast, being on crutches, frequently wearing high-heeled shoes. Systemic diseases such as diabetes can affect the fibers of the Achilles tendon, and cause tightness.

The lack of motion at the ankle can also be from a piece of bone blocking the motion. A small piece of bone that breaks off at the front of the ankle from prior trauma can restrict the motion. Another cause is one leg being shorter than the other.

Diagnosis:

Many patients are made aware of their equinus deformity after suffering from other foot problems. To diagnose equinus, the ankle’s ability to move up and down sufficiently is assessed. A gait assessment is also helpful in identifying the compensatory movements. If required, X-rays may be ordered. If the equinus is neurological in nature, then referral to a neurological might be required.

Treatment:

Conservative treatment for equinus is often effective, and can be performed by a patient at home. The treatment options are listed below.

• Night splint. The foot may be placed in a splint at night to keep it in a position that helps reduce tightness of the calf muscle.

• Heel lifts. Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.

• Arch supports or orthotic devices. Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.

• Physical therapy. To help remedy muscle tightness, exercises that stretch the calf muscle(s) are recommended.

If the symptoms cannot be resolved, or if the deformity is severe, then surgical treatment can be considered.

Extra bones, also known as accessory ossicles, are common in the foot and ankle. It can be painless, and is usually found incidentally on an X-ray. Sometimes they are painful, and cause significant discomfort. In this case, treatment is required, which can be both conservative, and surgical. Surgical treatment can involve removal of the piece of extra bone.

Extra bones can be present at birth, or developed after birth. Most often, extra bones that develop after birth are a result of trauma. A piece of bone breaks off, and becomes an extra bone.

Some of the common extra bones in the foot and ankle are listed below.

1. Accessory navicular syndrome

2. Os trigonum Syndrome

3. Os tibiale externum

Fractures are common in the 5th metatarsal bone of the foot. This bone lies on the outside of the foot, just behind the pinky toe. Generally, 2 types of fracture can happen at the 5th metatarsal, avulsion fractures and jones fractures.

Avulsion fractures occur when a piece of bone is pulled off the main portion of the bone by the tendon that attaches at that site. This can occur from ankle sprains. Jones fracture occurs in an area of the 5th metatarsal bone that receives less blood from the surrounding arteries. This makes the bone more difficult to treat and heal. For more information regarding Jones fracture, please refer to the respected section.

Symptoms:

Fracture of the 5th metatarsal involves pain at the site, with associated tenderness, on the outside of the foot. Patients might experience difficulty walking, and bruising at the site.

Diagnosis:

A complete history, and careful physical examination is important. The location of the pain is key to identifying a 5th metatarsal fracture. An X-ray for further assessment of the metatarsal bone is recommended.

Treatments:

Conservative treatment for metatarsal fracture is often recommended if the fracture is non displaced (non shifted), or if the patient is not an active athlete. Initial conservative treatments can include the following.

• Rest: Stay off the injured foot. Walking may cause further injury.

• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Compression: An elastic wrap should be used to control swelling.

• Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.

After implementing the initial treatment, if symptoms do not improve, or healing is delayed, the following might be implemented.

• Immobilization. Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot.

• Bone stimulation. A pain-free external device is used to speed the healing of some fractures. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.

• Surgery. If the injury involves displaced (shifted) bone, or multiple breaks, then surgery is required.

Pediatric flatfoot is a childhood condition in which the arches of the feet are collapsed. This type of deformity makes mobility, and exercise painful. If left untreated, this type of condition can result in permanent deformity, with accompanying chronic pain and instability in adulthood.

Pediatric flatfoot can be broadly categorized into 2 types, flexible and rigid. Flexible flatfoot exhibits normal arch when non weight bearing, however, once weight bearing, the arch collapses. In the case of rigid flatfoot, the arch collapses regardly of the weight bearing status. Most rigid flatfoot will exhibit symptoms.

Symptoms:

Not all children will have symptoms. Some will complain of pain, tenderness, or cramping in the foot, leg and knee. Some of the symptoms that parents might observe include outward tilting of the heel, awkwardness or clumsiness in walking and difficulty with shoes. Due to the deformity, the child might not be able to keep up with playmates, tires easily, or voluntarily withdraw from physical activity.

Diagnosis:

A careful pediatric history is important. Also important is a complete, and thorough physical exam which include weight bearing and non weight bearing biomechanical exams. Patient’s shoes should be assessed for wear patterns as well. Flatfeet can be associated with issues of the hip, knees, ankle or the foot.

To further analyse the deformity, x ray, CT scan, MRI or bone scan might be ordered.

Treatment:

For children who exhibit symptoms, physician therapy, shoe modification, anti-inflammatory medication or orthotic devices may be first recommended. If the symptoms cannot be resolved, or if the deformity is severe, surgery can be considered.

It is important to note that babies often appear to have flatfoot, and the symptoms abate with time. If the symptoms do not improve, then stretching exercises, or soft braces can be implemented. If a patient does not exhibit symptoms, typically, no treatment is required. Instead, monitoring, and reevaluation on a regular basis by a physician is suffice.

Arthritis is joint inflammation. Due to the active nature of the foot, arthritis is common in the foot and ankle. Symptoms for arthritis include swelling, pain, warmth, and decreased range of motion at the joint. Functionally, arthritis can affect the ability to participate in activity, such as walking.

There are multiple types of arthritis in the foot, the most common form is osteoarthritis. For more information, please refer to osteoarthritis of the foot and ankle. Other arthritis of the foot and ankle includes rheumatoid arthritis, and gouty arthritis.

Foot bumps are bony outgrowth that extends outwards in the foot. They can be natural enlargement of a foot bone, or an extra piece of bone. For foot bumps that are not painful, and only cosmetically unpleasing, conservative treatment is usually recommended. When these bumps become painful, and affects the function of the foot, then surgery can be considered after conservative treatments.

Some common foot bumps are listed below:

1. Bunions,

2. Tailor’s bunions

3. Accessory Navicular Syndrome,

4. Haglunds Deformity (pump bump)

Lumps are generally soft tissue outgrowth in the foot. These can be an extension or enlargement of the joints, muscles, nerve, fat, or tendons. These lumps should be checked by a physician, especially if it causes discomfort or pain. Some common foot lumps are listed below:

1. Cyst

2. Lipoma

3. Schwannoma

Foot odor stems from bacteria or fungus growing in the shoes, and attaches to the skin. Some bacteria can eat away the top layer of the skin, producing foul odor. This condition is often caused by excessive sweating of the feet, usually year round. People who wear shoes on a daily basis also have a higher chance of developing foot odor. To prevent foot odor, hygiene is very important. Feet should be washed daily with soap and water. Clean dry socks should be worn. Physicians can also prescribe topical medication to decrease the sweating of the feet. A variety of other treatments for personal hygiene may be employed.

Rash of the feet is common, and can have a variety of etiology. A common reason for foot rash is athlete’s foot. THis is caused by a fungal infection of the feet. Other causes include eczema, which presents with itchiness to the skin. Another cause is allergic reaction to certain things that are in contact with the skin. This can be a new pair of shoes, socks, or sandals. Examination of the foot rash by a physician can help reach the correct diagnosis. Appropriate treatments for the rash based will be based on the cause of the rash.

Eczema is a condition in which patches of skin become inflammation, itchy, cracked, and rough. Some types of eczema can cause blistering as well. Atopic dermatitis is the most common form of eczema.

Eczema is not contagious. It is often triggered by certain foods such as nuts, dairy. Other environmental factors that can trigger eczema include smoke, pollen, soap, and fragrances. Most children outgrow the condition. However, there are patients that continue to experience it throughout adulthood.

There are multiple injuries to the foot and ankle that are more common in football players. These often result from running, side to side cutting, and direct trauma.

Below are a list of common football injuries to the foot and ankle.

1. Inversion ankle sprain causing damage to the ankle ligaments. The ankle sprain can also result in peroneal tendon injuries.

2. Ankle fracture, metatarsal fractures, Lisfranc fractures, and turn toe

3. Contusions and bone bruises from direct impact

4. Overuse injuries such as plantar fasciitis, Achilles tendonitis, sesamoiditis, stress fractures, posterior tibial tendonitis (PTTD), and calcaneal apophysitis in children and adolescents.

Since our feet and ankle are responsible for bearing our body weight, and allow us to participate in activity, foot and ankle fractures are common. There are 26 bones in the foot. Symptoms of foot and ankle fractures include pain, swelling, redness and bruising. Diagnosis of foot fracture can be confirmed through X ray.

Some of the more common foot fractures are listed below.

1. Lisfranc Injury

2. Fracture of the 5th metatarsal

3. Fracture of the calcaneus

4. Toe fractures

5. Metatarsal fractures

6. Ankle fracture

Calcaneus, also known as the heel bone, is a large bone that forms the foundation of the rearfoot. This joint is involved in the movement of the subtalar joint, which allows the rearfoot to be mobile, and adapt to uneven terrains when walking.

The structure of the calcaneus is often compared to a hardboiled egg; the calcaneus has a hard outer shell that can bear the weight of the body. The interior of the calcaneus is composed of porous bone that is must lighter in weight, and more fragile. In a calcaneal fracture, the bone collapses, and can longer bear the body weight. The fracture can also involve the neighboring joints that can cause arthritis and chronic pain.

Cause:

Most calcaneal fractures result from traumatic events, such as falling from height, or an automobile accident. The direct impact on the calcaneal bone causes acute fractures. Less commonly, calcaneal fracture can occur from severe ankle sprains. Overuse or repetitive stress on the heel can also cause stress fracture of the calcaneus.

Calcaneal fractures can be broadly categorized into 2 types; intra-articular (involving the joints) or extra-articular (do not involve the joint) fractures. Intra-articular fractures are more common, and incurs damage to the joint cartilage. Extra-articular fractures are often avulsion fractures (a piece of bone pulled off the main piece of bone by a tendon), or stress fracture from overuse injury.

Symptoms:

Acute calcaneal fractures have sudden onset of pain in the heel, and inability to bear weight on it. Swelling, bruising at the heel and ankle might also be observed.

For stress fractures in the calcaneus, the pain develops slowly, and is often described as dull pain. Swelling in the heel area might be observed.

Diagnosis:

A thorough history and physical must be performed. Evaluation of the foot, with special attention directed to the rearfoot is required. X ray of the foot, or computed tomography (CT) scan might be ordered to further assess the fracture pattern.

Treatment:

Treatment of the calcaneal fracture is dictated by the fracture pattern, joint involvement, skin involvement, and activity level of the patient. Conservative treatments can involve the following.

• Rest, ice, compression and elevation (RICE). Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.

• Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weight bearing.

For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. The surgeon will choose the best surgical approach for the patient.

Fractures are common in the 5th metatarsal bone of the foot. This bone lies on the outside of the foot, just behind the pinky toe. Generally, 2 types of fracture can happen at the 5th metatarsal, avulsion fractures and jones fractures.

Avulsion fractures occur when a piece of bone is pulled off the main portion of the bone by the tendon that attaches at that site. This can occur from ankle sprains. Jones fracture occurs in an area of the 5th metatarsal bone that receives less blood from the surrounding arteries. This makes the bone more difficult to treat and heal. For more information regarding Jones fracture, please refer to the respected section.

Symptoms:

Fracture of the 5th metatarsal involves pain at the site, with associated tenderness, on the outside of the foot. Patient might experience difficulty walking, and bruising at the site.

Diagnosis:

A complete history, and careful physical examination is important. The location of the pain is key to identifying a 5th metatarsal fracture. An X-ray for further assessment of the metatarsal bone is recommended.

Treatments:

Conservative treatment for metatarsal fracture is often recommended if the fracture is non displaced (non shifted), or if the patient is not an active athlete. Initial conservative treatments can include the following.

• Rest: Stay off the injured foot. Walking may cause further injury.

• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Compression: An elastic wrap should be used to control swelling.

• Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.

After implementing the initial treatment, if symptoms do not improve, or healing is delayed, the following might be implemented.

• Immobilization. Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot.

• Bone stimulation. A pain-free external device is used to speed the healing of some fractures. Bone stimulation, most commonly used for Jones fractures, may be used as part of the treatment or following an inadequate response to immobilization.

• Surgery. If the injury involves displaced (shifted) bone, or multiple breaks, then surgery is required.

A fracture is a break in the bone. Fractures can be divided into 2 categories; traumatic fractures and stress fractures. Traumatic fractures are caused by direct application of force to the bone causing the fracture. This type of fracture can be a result of stubbing your toes against the leg of a table. Stress fractures are tiny hairline breaks usually caused by repetitive stress, such as walking. For example, runners can have stress fractures from the repetitive loading of the foot during running. Abnormal foot structure, and shoewear also contributes to occurrence of stress fractures. Most fractures in the toes are traumatic fractures.

Symptoms:

Acute fractures are usually associated with acute pain at the site of fracture. A sound at the time of the break might be audible. With a displaced fracture (fracture that has shifted), an abnormal appearance of the foot might be observed. Bruising and swelling is observed the next day.

Treatment:

Treatment of non displaced fractures (non shifted) can be conservative involving rest, non-weight bearing, immobilization, and/or casting. However, if the fracture is displaced (shifted), and affects the mechanical function of the foot and ankle, surgery is recommended.

Below are treatment options specific to toe fractures:

• 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. Use of a postoperative shoe or boot walker is also helpful.

• Buddy taping the fractured toe to another toe is sometimes appropriate, but in other cases, it may be harmful.

Frostbite is a result of exposure to extreme cold of a body part. As the ice crystals form in the tissue, cell death can occur. Since the foot and ankle are furthest away from the heart, it is particularly prone to frostbite.

Mild exposure of body parts to the cold will often produce pain and irritation to the skin. As the exposure increases, the site might experience a burning sensation, or later, numbness. Blistering of the skin can occur. As the cold exposure progresses, the skin will lose all sensations, and permanent damage to the skin will result. As the cold penetrates the skin, arteries, muscles and tendons might become affected.

Frostbite can be prevented by limiting exposure to the cold. This involves keeping the feet as warm and dry as possible. If frostbite is suspected, the feet should be rewarmed by immersion in warm water (100 degrees fahrenheit). During this time, do not rub or massage the foot, as it might cause skin damage. Early treatment of frostbite by a physician is vital to limit the amount of soft tissue damage.

Gangrene results from lack of blood circulation to the tissue, resulting in lack of oxygen delivered to the site, causing death and decay of the tissue. There are generally 2 types of gangrene, wet (caused by bacterial infection) and dry (no infection). In most cases, wet gangrene is more urgent, than dry gangrene, as wet gangrene can spread quickly. Some of the common causes of gangrene includes diabetes, arteriosclerosis, tobacco abuse, burns and frostbite.

Treatment of gangrene involves surgical removal of the dead tissue, If infection is present, antibiotics may be prescribed.

Golf involves quick and sudden, intense movement of the body. In the foot ankle, several types of injury can result from the sport.

1. Plantar fasciitis, which results in heel pain. This type of injury can be exacerbated by excessive walking.

2. Pain at the ball of the foot that pivots to help the drive through the swing. Specifically, metatarsalgia, capsulitis, neuroma, and increased pain at the big toe joint can result.

Gout is a disorder in which uric acid builds up in the joint causing pain.The disease often affects joints in the hands and feet. Uric acid is present in the blood, and eliminated through urine. In people who have grout, the uric acid level becomes elevated either because of uric acid buildup from increased uric acid production, or not enough clearance from the kidney through urine.

Uric acid can form crystals in the hands and feet more easily because of the cooler temperature. Once the uric acid forms crystals, it is attached by defense cells of the body, causing inflammation.

Cause:

Factors that put a person at risk of developing out includes high blood pressure, diabetes, obesity, surgery, chemotherapy, and stress. Consuming foods that are high in purine can also trigger a gout attack. Furthermore, tendency to accumulate uric acid is often inherited.

Symptoms:

Attack Of gout is often characterized by acute pain, often sudden onset, often in the middle of the night.The area of gout attack can also have inflammation, such as redness, swelling and warmth.

Diagnosis:

A thorough history and physical exam is vital. The affected joint is examined. Blood work can be helpful in ruling out other causes of joint pain. X-ray of the foot can help in determining the presence of gout, as gouty destruction of joints is unique in presentation.

Treatment:

Treatment of gout 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 swelling.

If a patient experiences repeated gouty attack, medication to control uric acid in the blood might be required. This is often performed by your primary care doctor.

Haglund’s deformity, also known as pump bump, is a bone enlargement at the back of the heel. This is also the site where the Achilles tendon attaches to the heel. Haglund’s deformity causes pain and discomfort from rubbing against the back of the shoe. This can also result in painful bursitis , which is inflammation of the bursa (a fluid filled sac between the tendon and bone).

Heredity plays a role in the formation of Haglund's deformity. A specific group of foot deformities such as a high arched foot, a tight Achilles tendon, or tendency to walk on the outside of the feet can increase the chance of Haglund’s deformity.

Symptoms:

Symptoms of Haglund’s deformity include a noticeable bump at the back of the heel that causes pain and swelling when rubbed against the back of the shoe. The site can become inflamed. Patients can also experience pain at the site of the Achilles tendon, at the back of the heel.

Diagnosis:

Careful examination of the heel can pinpoint the exact site of the pain. A palpable bump at the back of the heel can be seen as well. To further assess the structural deformity, X-ray of the foot can be ordered.

Treatments:

Conservative treatments for Haglund’s deformity are to decrease symptoms, and prevent further irritation at the site. It includes the following:

• Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation. Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.

• Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.

• Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.

• Shoe modification. Backless or soft backed shoes help avoid or minimize irritation.

• Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation.

• Orthotic devices. Custom arch supports control the motion in the foot.

• Immobilization. In some cases, casting may be necessary.

If conservative treatment fails to improve the symptoms, then surgical treatment may be considered. Surgical treatment can include resection of the bump, and reattachment of the Achilles tendon at the site.

Hallux rigidus is a condition of the big toe joint in which the joint is unable to bend freely. Due to the restricted movement, pain and stiffness results. Hallux is the medical term for the big toe, and rigidus indicates lack of movement. Hallux rigidus is a form of degenerative arthritis.

The big toe joint is involved extensively in walking, stooping down, climbing up or even standing. Therefore, the lack of movement at the joint can become debilitating. Hallux rigidus is a progressive disease, and involves a limited range of motion. The less severe form of hallux rigidus is hallux limitus, where there is decrease in movement at the joint.

Causes:

The main causes of this condition is faulty function (biomechanics) and abnormal foot structures. WIth these causes, the joint undergoes excessive wear and tear, leading to deteriorated joint function. For example, patients with flatfoot have decreased rigidity of the foot to propel off during walking. Therefore, the big toe is constantly in the over extended position to assist with walking. This unusual motion, in the long term, causes degeneration of the big toe joint.

Overuse due to activity levels, inflammatory diseases such as rheumatoid disease, grout can also cause the joint to break down, and become rigid.

Symptoms:

Early signs of the disease include pain and stiffness in the big toe joint during walking, standing, and bending. The pain and stiffness is further aggravated by cold, damp weather. As the disease progresses, patients might experience difficulty with certain activities.

As the disease worsens, the pain increases. Patients might have difficulty with wearing shoes. As the pain impacts the patient's gait pattern, pain in the hip, knee or lower back can occur. If the symptoms are severe, the patient will walk with a limp.

Diagnosis:

The earlier the diagnosis, the early the treatment can be implemented to slow the progression of the disease. Once a bone spur is present, the condition is likely more difficult to treat. A careful physical exam, with biomechanical examination, is vital. X-ray of the foot to assess the quality of the joint, and degree of deformity is recommended.

Treatments:

Conservative treatment for hallux rigidus is primarily for symptom control. Treatments can include the following.

• Shoe modifications. Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.

• Orthotic devices. Custom orthotic devices may improve foot function.

• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

• Injection therapy. Injections of corticosteroids may reduce inflammation and pain.

• Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

If the symptoms worsen, or if the deformity is severe, surgery may be considered. The type of surgery will depend on the type of deformity, severity of the deformity, age, activity level, and other factors.

Hammertoe is an abnormal contracture (bending) of the 2nd, 3rd, 4th or 5th toes of the foot. The contracture can occur at one or multiple joints of a single toe. The contracture can be flexible, or non flexible. Issues associated with these contractures include pressure at certain sites, causing pain when wearing shoes, and when walking. Most hammertoes are progressive in nature, unless intervention is applied.

Causes:

The cause of hammertoes is muscle or tendon imbalance. This imbalance leads to unequal pull of the toe in a certain direction. The cause of the imbalance can be neurological or structural. This can be inherited, caused by trauma, or underlying neurological diseases.

Symptoms:

Improper shoewear can also aggregate the deformity. Patients often complain of pain or irritation from the irritation. Corns and callus can build up on the toes, in between the toes, and ball of the foot. If the irritation is serious, inflammation, redness, or ulcerations might occur.

Diagnosis:

It is important to understand the underlying cause of the hammertoe deformity, and not just accept the diagnosis as is. This requires a thorough history, and comprehensive physical exam. To assess the degree of osseous (bone) deformity, X-ray can be acquired.

Hammertoes are progressive, as they do not improve over time. Early diagnosis and treatment of the hammertoe is important to avoid worsening.

Treatments:

Conservative treatments for hammertoe deformities involve mainly symptom relief, and slow the progression of the condition. This involve the following:

• Padding corns and calluses. Your foot and ankle 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 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 toebox 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. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.

If symptom relief is not able to be achieved through conservative treatment,or if the deformity is severe, then surgery can be considered. The procedure for the correction will depend on the extent of the deformity, the number of toes involved, your age, your activity level and other factors.

Heel fissures are cracked in the skin of the heel. This condition is due to xerosis (dryness) of skin, commonly due to wearing open back shoes, increasing weight or friction at the site. The presence of dry skin can also be due to underlying problems, such as diabetes, or loss of nerve function.

To prevent heel fissures, keep the skin at the site moist by using moisturizers. Also, avoid open back shoes. Open fissures have the potential of getting infected. Therefore, if there are any non healing fissures, or open wounds, please see a physician.

Plantar fasciitis is a common podiatric condition caused by inflammation of the plantar fascia. Plantar fascia is a band of tissue that extends from the heel to the toes. It functions to maintain the arch, and allows proper function of foot movement. The most common cause of plantar fasciitis is abnormal foot architecture. People with overly high arch, or flat feet tend to develop plantar fasciitis. Increased activity, which places more strain on the plantar fascia, can also contribute to the inflammation. Wearing non supportive shoes that does not fully support the feet can also cause plantar fasciitis.

Symptoms:

Symptoms of plantar fasciitis include pain on the bottom of the heel, along the arch of the foot, and pain that is usually present upon arising. Many patients experience pain when they take their first few steps in the morning. Furthermore, the pain does improve after walking for a while. If the inflammation is severe, the pain can worsen, with development of swelling at the site of pain.

Diagnosis:

Medical history and careful examination can help arrive at the diagnosis. During examination, the physician can rule out other causes of heel and arch pain in the foot. If the presentation is atypical, or there concern regarding other pathologies, x-ray of the foot can be ordered. Bone spurs are often found at the site of the pain at the heel. However, research has shown that the spur does not cause the pain, it is the inflammation of the plantar fascia that is causing the pain.

Treatments:

Conservative treatments for plantar fasciitis can include the following:

• 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 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.

• 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.

• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

• Padding, taping and strapping. Placing pads in the shoe softens the impact of walking. Taping and strapping help 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.

Approximately 90% of patients will have symptom relief with conservative treatment. However, If the symptoms do not improve with conservative treatment, surgical treatment may be considered. There are multiple different procedures for treatment of plantar fasciitis.

Cavus foot, also known as a high arched foot, is a condition in which the foot has a excessive high arch. This type of foot architecture places a high amount of pressure intact with the ground due to reduced area of contact. This type of foot can lead to a variety of signs and symptoms such as pain and instability. Patients can develop high arched feet at any age.

Cause:

Cavus foot is commonly caused by neurological disorders, or other medical conditions such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy or stroke. The high arched foot caused by these diseases usually have a worsening nature. Some patients may present with a high arched foot at birth due to inherited structural abnormalities. These usually do not worsen through life.

Symptoms:

Aside from the visually obvious high arch of the foot, the following symptoms may present:

• Hammertoes (bent toes) or claw toes (toes clenched like a fist)

• Calluses on the ball, side or heel of the foot

• Pain when standing or walking

• An unstable foot due to the heel tilting inward, which can lead to ankle sprains

Diagnosis:

A careful history of the patient, with particular focus on family history is important. A thorough examination of the foot, with biomechanical examination including gait is helpful. Also, noting the deformity of the foot is vital. For assessment of the bone structure of the foot and ankle, X-ray of the foot can be taken. If necessary, patient can obtain a neurological exam by a neurologist.

Treatments:

Conservative treatments of a cavus foot includes the following options:

• Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot.

• Shoe modifications. High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.

• Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop.

• Physical therapy. Work on muscle strengthening and balance of the foot and ankle.

If the symptoms do not improve, or the deformity is severe enough to demand surgery, many different surgical options can be considered. This will take into account the stability, muscle strength, and desired surgical function outcome of the patient.

Inflammation is the body’s reaction to protect and repair itself. This natural process channels more blood to the area, resulting in accumulation of fluid in that region. This will cause the site to swell, increase warmth, redness, and pain. Inflammation is vital for healing, and protection; however, excessive amounts of inflammation can hinder healing.

Inflammation can be categorized into 2 general types; acute and chronic. Acute inflammation occurs immediately as a response to trauma. It is the focus of this section. Inflammation caused by infection is a different type of inflammation, and will be explained in another section.

Treatment:

To reduce acute inflammation, and decrease swelling, pain, proper treatment must be implemented. This includes the following:

• Rest: Stay off the foot or ankle. Walking may cause further injury.

• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Compression: An elastic wrap should be used to control swelling.

• Elevation: The foot or ankle should be raised slightly above the level of your heart to reduce swelling.

• Nonsteroidal anti-inflammatory medication (NSAIDs): This type of medication can decrease inflammation.

If the symptoms of inflammation does not improve within 2 to 3 days, or the pain worsens after 3 days, please consult a physician for further workup.

Ingrown toenail is a condition in which the nail curves and grows into the surrounding skin. The intrusion of the nail into the skin causes pain, redness, warmth, and sometimes infection. Infection of the ingrown toenail is often accompanied by drainage and foul odor. Ingrown toenails will often recur without proper treatment.

Cause:

There are many causes of ingrown toenails including

• Heredity. In many people, the tendency for ingrown toenails is inherited.

• Trauma. Sometimes 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.

• Improper trimming. The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.

• Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.

• Nail conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

Treatment:

Once ingrown toenail develops, conservative treatment may be attempted first. This includes soaking the foot in room temperature water, with added Epsom salt. Gently massaging the side of the nail to reduce inflammation.

Avoid the attempt of removing or resecting the nail border at home. This type of “bathroom surgery” can often worsen the condition, leaving the nail jagged, which can cause further irritation to the surrounding skin.

If signs of infection, including drainage, mal-door, redness, warmth are noted, please see your podiatric physician.

Minor surgical procedures including partial nail avulsion (removal of the offending border), or complete nail avulsion (complete removal of the nail) can be done for lasting effect. However, there remains the risk of recurrence. In the presence of infection, antibiotics might be prescribed as well. You must finish the full course of the antibiotics that was prescribed to you.

Post Surgical Procedure:

Following the procedure, a light dressing will be placed over the procedure site. Most people experience a mild to moderate amount of pain after the procedure. Reduce activity for the day, and resume normal activity the next day. You may be instructed to soak your foot to allow drainage of the procedure site after a few days. Make sure to keep the procedure site dry after soaking.

Preventative Measures:

• Do not cut a notch in the nail. Contrary to what some people believe, this does not reduce the tendency for the nail to curve downward.

• Do not repeatedly trim nail borders. Repeated trimming does not change the way the nail grows and can make the condition worse.

• Do not place cotton under the nail. Not only does this not relieve the pain, it provides a place for harmful bacteria to grow, resulting in infection.

• Over-the-counter medications are ineffective. Topical medications may mask the pain, but they do not correct the underlying problem.

Neuroma is the thickening of the nerve tissue that surrounds the nerve itself. The thickening is a result of compression and irritation of the nerve at the site. In the foot, it is commonly found in between the metatarsals. Metatarsal bones are located just behind the toes. In the foot, neuroma that is in between the 3rd nad 4th metatarsals are referred to as Morton’s Neuroma. Once the tissue thickens, it causes even more pressure and stress on the nerve, causing pain and numbness.

The nerve thickening can be caused by wearing shoes that causes the toe pinched together, such as high heeled shoes. People with certain foot deformities, such as bunions, hammertoes, flatfeet, or excessively flexible feet are at greater risk of developing neuroma. Sports that involve repetitive trauma to the area can also cause neuroma development.

Symptoms:

The symptom of neuroma begins gradually, but progressively worsens. The pain is often present when wearing shoes, with relief after taking the shoes off. People with neuroma of the foot often complain of tingling, burning and numbness radiating to the toes. Others describe a dull pain which feels like sometime is inside of the ball of the foot when walking. Many patients state the pain is like the shoe or sock is bunched up when walking.

Diagnosis:

History of the symptoms and careful examination of the foot is important. The physician will attempt to reproduce the symptoms by pinching the site of the neuroma. If necessary, imaging such as ultrasound or MRI may be ordered. Earlier diagnosis of neuroma often leads to less invasive treatments.

Treatments:

Conservative treatment for neuroma involves symptom relief, and prevention of further irritation of the nerve itself.

• 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 foot and ankle 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.

• Shoe modifications. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.

• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

• Injection therapy. Treatment may include injections of cortisone, local anesthetics or other agents.

If symptoms relief is not able to be achieved, or the symptoms worsen, then surgical consideration may be considered.

Intoeing, also known as pigeon toes, is a condition which the feet points inwards when walking. This condition is commonly seen in children, which majority of them grow out of it without any treatment or intervention. However, there are some that continue to have intoeing gait into late childhood.

Intoeing can cause significant tripping, due to the abnormal gait. Aside from tripping, patients with intoeing often complain of pain with activities, and difficulty with shoes.

Diagnosis:

A comprehensive history from childbirth to current age is vital. Careful examination of the foot, and biomechanical exam, including gait exam, should be performed. The cause of the inteing, whether it's hip, knee, ankle, or foot should be determined. X-ray of the area noted to the cause of the intoe should be carefully assessed.

Treatment:

Depending on the location of the deformity, and the degree of the deformity, appropriate treatment will be implemented. This includes of conservative and surgical options.

There are a total of more than 30 joints in the foot, and any of them can cause joint pain. Usually these pain are accompanied by swelling, tenderness, stiffness, redness, bruising, and warmth. There are a variety of pathologies that can cause joint pain in the foot. The cause might be from trauma, infection, inflammation, arthritis, bursitis, gout or structural foot problems.

Some of the common causes of joint pain in the foot includes the following;

1. Bunions

2. Capsulitis of the 2nd toe

3. Gout

4. Osteoarthritis of the foot and ankle

5. Rheumatoid arthritis

6. Tailor’s bunion

7. Tarsal coalition

Please refer to each specific pathology in their respective section for more detail.

Most joint pain is treated initially with rest, elevation, limitation of walking/weight bearing. Use of nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can be helpful. If the issue is with the abnormal foot architecture, orthotics can be prescribed. Surgery can be considered conservative treatments are not effective and if the cause of the pain can be corrected surgically.

There are a total of more than 30 joints in the foot. Swelling of the joint is initiated by a trigger, such as infection, which causes the body to increase the blood flow to the area. This in turn results in accumulation of fluid in the tissue surrounding the joint, called swelling. Swelling is often accompanied by stiffness, redness, warmth and pain.

Joint swelling may be caused by many other diseases such as inflammatory, degenerative, traumatic, or infective diseases. Crystal forming diseases such as gout is a common cause of swelling in the foot.

Jones fracture occurs near the base of the 5th metatarsal, which is on the outside of the foot. The fracture occurs due to overuse, repetitive stress or trauma, common in athletes. This can result in either a stress fracture (tiny hairlines breaks), or acute fracture. This fracture is of particular importance because this area of fracture receives less blood from the neighboring blood vessels, making healing more challenging. Compared to other fractures, it is more difficult to treat.

Symptoms:

Symptoms of Jones fracture include pain and swelling at the site of the fracture. Due to the pain, patients will have difficulty walking. Sometimes, presence of bruise will be present on the outside of the foot.

Diagnosis:

Aside from detailed history of the accident, and careful physical exam of the area, X-ray of the foot is important. Aside from presence of the fracture, any displacement (shifting of broken bone), or anatomical derangement can be observed.

Treatment:

Conservative treatment may be implemented for non displaced fracture (non shifted) of patients who are not active athletes.

• Rest: Stay off the injured foot. Walking may cause further injury.

• Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

• Compression: An elastic wrap should be used to control swelling.

• Elevation: The foot should be raised slightly above the level of your heart to reduce swelling.

If the fracture fails to heal accordingly, bone stimulators can be considered. Bone stimulators are machines that produce an external energy that assist with bone healing. Bone stimulators are usually non invasive, and can be operated at home.

If conservative treatment fails to control symptoms, or if a patient is an active athlete, then surgical treatment may be considered.

Lacrosse involves extensive side to side cutting, and running which can cause a variety of injuries to the foot and ankle.

The following are a few of the common injuries in Lacrosse players.

1. Ankle sprain with damage to the ankle ligaments.

2. Peroneal tendon injuries

3. Ankle fractures, metatarsal fractures, Lisfranc fractures,

4. Turf toe

5. Plantar fasciitis, Achilles tendonitis

6. Stress fractures

7. Posterior tibial tendonitis (PTTD)

8. Calcaneal apophysitis

Please refer to each respective section for more information.

The LIsfranc injury is an injury to the Lisfranc joint. THis joint is between the metatarsal bones (long bone behind the toes), and the tarsal bones (bones in the ach). The joint covered my multiple bands of tissue to hold it in place. Injury to these bands of tissue will cause instability of the foot.

Injury to the Lisfranc joint commonly occurs in automobile accidents, military personnel, runners, horseback riders, football players. The injury can also occur as simple as missing a step on a staircase. These injuries all occur from direct or indirect forces to the foot.

Types:

There are 3 types of Lisfranc injuries. Sprain of the ligaments around the Lisfranc joint is the least severe of the 3 types. Patients might experience instability of the joint in the middle of the foot. Fracture of the bone in the joint can either be an avulsion (a small piece of bone is pulled off) or complete break of the bone in the midfoot. Lastly, dislocation of the bone in the LIsfranc joint from external forces, which focus the midfoot out of the normal anatomical position. These types of injuries often are accompanied by torned ligaments.

Symptoms:

Patients who suffer Lisfranc injuries experience swelling of the foot, pain throughout the midfoot when standing. In severe injuries, patients are not able to bear weight. The foot might appear bruised on the arch, or top of the foot. Lastly, the foot might appear widened.

Diagnosis:

Lisfranc injury can sometimes be misdiagnosed as ankle sprains. Complete history with a comprehensive physical exam is important. The location of the deformity and pain can assist with the diagnosis. X ray or CT scan of the foot can offer a closer look at the deformity.

Treatments:

Conservative treatment of Lisfranc injury is reserved for mild cases of the injury. These can include the following;

• Immobilization. Sometimes the foot is placed in a cast to keep it immobile, and crutches are used to avoid putting weight on the injured foot.

• Oral medications. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, help reduce pain and inflammation.

• Ice and elevation. Swelling is reduced by icing the affected area and keeping the foot elevated, as described above.

• Physical therapy. After the swelling and pain have subsided, physical therapy may be prescribed.

Surgery is required if the symptoms do not improve after conservative treatment, or there is ligament tear, or fractures.

Melanoma is cancer of the cells underneath the skin that is responsible for production of pigments (skin color). The cancer is malignant because it expands, and spreads to other areas of the body, with a high mortality rate once progressed to advanced stages. Melanoma can occur in all age groups, even the young.

Melanoma of the foot can often go unnoticed. By the time diagnosis is made, it is frequently in advanced stages. Therefore, early detection and diagnosis is vital.

Cause:

The main cause of melanoma is exposure to ultraviolet (UV) light from the sun, or tanning beds. The exposure can be high dose during a short period of time, such as going to the beach, or low dose but long exposure time. Some factors can place a person at higher risk of melanoma such as light skin color, skin with freckles, blond or red hair, blistering sunburn before the age of 18, numerous moles, especially if it appears at a young age.

Signs:

Melanoma can occur anywhere on the skin, even areas of the body that is not exposed to the sun. Melanoma is often present as a spot on the skin which is brown, black or blue. In some cases, it can be white or even red. Four signs of melanoma, known as ABCDs, can be of concern if observed during self inspection.

1. Asymmetry - melanoma is usually asymmetrically, which means one half the melanoma is not the same as the other half.

2. Border- the border is usually irregular.

3. Color - melanoma is typically mixed of colors or hues, rather than a single solid color.

4. Diameter - Melanoma grows in diameter, whereas moles remain the same size, and usually small. A spot more than 5mm is cause for concern.

Diagnosis:

A careful history and physical exam is vital. The history of the spot in regards to increase in size, bleeding, pain should be concerns. The physician will also determine if biopsy for definitive diagnosis of the lesion is warranted.

Prevention:

Precautions such as use of sunscreen, wearing hats, and sunglasses to decrease exposure to the skin to harmful UV rays from the sun is encouraged. Frequent inspection of the skin to make sure of no irregular lesions is also important. If you wear nail polish, remove it occasionally to check the skin underneath the nail to make sure of no discolored spots/streaks.

Staphylococcus aureus is a bacteria that is known to cause serious infections. The bacteria are commonly found on the skin or in the nose of even healthy individuals. Most of the time, these bacteria do not cause issues. However, at times, it can enter the body through cracks in the skin or open wounds causing systemic or deep infections.

In recent years, several strains of Staphylococcus aureus that are resistant to antibiotics (methicillin-resistant Staphylococcus aureus) have become more common. These MRSA strains make antibiotics less effective, and treatment is more challenging.

Symptoms of staph infections, in general, include redness, swelling, pain, drainage at the wound site. Systemic symptoms of infection include fevers, chills, nausea, vomiting, and low blood pressure. If you have a cut or scrap that you suspect is infected, please see your physician for examination.

Fungus is present in our environment. With trauma to the nails, fungus can enter and develop underneath the nails causing infection of the nail beds. This in turn causes the nails to become thickened, raised and yellow in color.

Toe fungus often begins as infection of the surrounding skin called tinea pedis (athlete’s foot). Overtime, it grows underneath the naisl, causing the nail infection. This condition affects people of all ages.

Treatment of fungal nails can be topical, oral, or nail matrixectomy (entire nail removal).

Neuroma is the thickening of the nerve tissue that surrounds the nerve itself. The thickening is a result of compression and irritation of the nerve at the site. In the foot, it is commonly found in between the metatarsals. Metatarsal bones are located just behind the toes. In the foot, neuroma that is in between the 3rd and 4th metatarsals are referred to as Morton’s Neuroma. Once the tissue thickens, it causes even more pressure and stress on the nerve, causing pain and numbness.

The nerve thickening can be caused by wearing shoes that causes the toes to pinch together, such as high heeled shoes. People with certain foot deformities, such as bunions, hammertoes, flatfeet, or excessively flexible feet are at greater risk of developing neuromas. Sports that involve repetitive trauma to the area can also cause neuromas.

Symptoms:

The symptom of neuromsa begins gradually, but progressively worsens. The pain is often present when wearing shoes, with relief after taking the shoes off. People with neuromas of the foot often complain of tingling, burning and numbness radiating to the toes. Others describe a dull pain which feels like sometime is inside of the ball of the foot when walking. Many patients state the pain is like the shoe or sock is bunched up when walking.

Diagnosis:

History of the symptoms and careful examination of the foot is important. The physician will attempt to reproduce the symptoms by pinching the site of the neuroma. If necessary, imaging such as ultrasound or MRI may be ordered. Earlier diagnosis of neuroma often leads to less invasive treatments.

Treatments:

Conservative treatment for neuroma involves symptom relief, and prevention of further irritation of the nerve itself.

• 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 foot and ankle 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.

• Shoe modifications. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.

• Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

• Injection therapy. Treatment may include injections of cortisone, local anesthetics or other agents.

If symptoms relief is not able to be achieved, or the symptoms worsen, then surgical considerations may be implemented.

Neuropathy is the damage of the nerves. This can often cause weakness, numbness and pain in the extremities. The feet is a common region that is affected by this disease. Neuropathy of the extremities can be caused by traumatic injuries, infections, metabolic problems such as diabetes, inherited, or exposure to toxins. The most common cause of neuropathy is by metabolic diseases.

Many patients with neuropathy describe the symptoms as stabbing, burning or tingling.

For more information regarding different types of neuropathy, please refer to the follow;

1.Peripheral neuropathy

2. Diabetic neuropathy

Osteoarthritis, also known as degenerative arthritis, is the breakdown of the cartilages in joints. Cartilages allow free movement of the joint. This condition affects millions of people in the US. The condition affects various joints in the body, including the hands, feet, spine, hips and knees. In the foot, this condition happens frequently in the big toe joint. Less commonly, it happens in the midfoot and ankle.

Causes:

Osteoarthritis is a result of wear and tear of the joint from repetitive motions. As the cartilage wears down, the bones come in contact with each other, and cause pain.

Injuries can also lead to osteoarthritis, usually through direct injury to the cartilage, or changing the optimal alignment of the joint causing extra wear and tear. For example, severely stubbing the toe can cause cartilage injury, which might result in osteoarthritis.

Abnormal foot architecture can also increase the chance of developing osteoarthritis due to suboptimal movement of the joints. Both flatfoot and high arch foot are known to increase the risk of osteoarthritis.

Symptoms:

Symptoms include pain and stiffness in the joint, swelling in or near the joint, or difficulty bending the joint. A common pathology associated with osteoarthritis is the development of bone spurs. These bone spurs are the body’s mechanism to limit movement at the joint, in order to reduce pain.

Diagnosis:

A thorough history and physician examination is important. Pain with movement of the joint can direct the physician to the diagnosis. X-ray of the foot can also allow physicians to assess the integrity of the cartilage, and bone.

Treatment:

Non surgical treatments involve symptom relief. It involves the following:

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally, a prescription for a steroid medication is needed to adequately reduce symptoms.

• Orthotic devices. Custom orthotic devices (shoe inserts) are often prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain.

• Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and can help prevent further deformity.

• Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve.

• Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication.

• Physical therapy. Exercises to strengthen the muscles, especially when osteoarthritis occurs in the ankle, may give the patient greater stability and may help him or her avoid injury that might worsen the condition.

If symptom relief cannot be achieved through conservative treatments, surgeries can be considered. The goal of surgery is to decrease pain, and increase function.

Osteomyelitis is an infection of the bone. This can be caused by microorganisms such as bacteria, or fungus. The most common bacteria to cause a bone infection is staphylococcus aureus.

There are several routes in which these organisms can be introduced into the bone. It may enter through an injury, such as an open fracture, when the bone pierces through the skin. The organism can travel through the bloodstream and get carried into the bone. Lastly, an open wound can become the site at which the bacteria enters the bone beneath it.

To diagnose osteomyelitis, an X-ray may be ordered. If systemic infection is suspected stemming from the infected bone, blood work may be warranted. Treatment options for osteomyelitis includes antibiotics and surgeries.

Osteopenia is a condition in which there is decreased bone density. When the boss density decreases to a certain level, it is known as osteoporosis. Osteoporosis is a condition in which the bones become weak and thin due to lack of calcium or vitamin D. This condition is often referred to as the “silent disease” because people might have osteoporosis, but do not realize it. Often, people become aware of this issue after suffering a fracture.

Osteoporosis is more commonly seen in older women, compared to other demographics. In the feet, the most common site of fracture, associated with osteoporosis, is the metatarsals. These are the bones behind the toes. When this happens, there is pain, swelling, and redness at the site of the fracture.

Diagnosis:

Bone density can be measured using low levels of X-ray. It is a painless test, and takes only a few minutes.

Treatment:

The primary goal of treatment is to decrease or slow the rate of bone density loss. Treatment for mild osteoporosis is to minimize risk factors such as smoke cessation, nutritional supplementation, and suitable exercises. The more aggressive method to prevent additional bone loss is through medication.

Peripheral arterial disease is a result of diminished blood flow in the arteries to the legs and feet due to some type of disease process. Blood flow is important for proper function, and diminished blood flow can cause a variety of issues. The presence of peripheral arterial disease may indicate other widespread arterial disease in the body that can affect the brain, and heart.

Symptoms:

Most people do not complain of symptoms of peripheral arterial disease during the early stages of the disease. However, as the disease worsens, symptoms such loss of hair on the feet and legs, change in toenail color, cold legs or feet might appear. The most obvious symptom is muscle pain and cramping during walking; or at late stages of peripheral arterial disease, leg pain even at rest. Some patients might develop non healing ulcerations in the lower extremities.

Risk Factors:

Risk factors for peripheral arterial disease includes;

• Being over age 50

• Smoking (currently or previously)

• Diabetes

• High blood pressure

• High cholesterol

• Personal or family history of PAD, heart disease, heart attack or stroke

• Sedentary lifestyle (infrequent or no exercise)

Diagnosis:

Obtaining a comprehensive medical history and careful physical examination is vital. Evaluation of the pulses in the feet, and assessment of the skin can assist with diagnosis of peripheral arterial disease. Non invasive tests are available that can more accurately determine the diminished blood flow to the lower extremity. Ankle Brachial Index (ABI) is one such test. Other more advanced and comprehensive tests are available if required.

Treatment:

In early stages of peripheral arterial disease, lifestyle changes including smoking cessation, regular exercise, and heart healthy diet are recommended. As the disease progresses, medication might be required to improve the blood flow to the extremities, and decrease symptoms. In severe cases, surgeries might be required.

Associated Issues:

Peripheral arterial disease can cause further complications associated with existing foot deformities such as hammertoes, and bunions. These deformities can cause ulcers to form at sites of high pressure, resulting in ulceration that does not heal from lack of blood flow. There are many other associated issues due to peripheral arterial disease.

To avoid these complications, patient’s should:

• Wash your feet daily. Use warm (not hot) water and a mild soap. Dry your feet—including between the toes—gently and well.

• Keep the skin soft. For dry skin, apply a thin coat of lotion that does not contain alcohol. Apply over the top and bottom of your feet but not between the toes.

• Trim toenails straight across and file the edges. Keep edges rounded to avoid ingrown toenails, which can cause infections.

• Always wear shoes and socks. To avoid cuts and abrasions, never go barefoot—even indoors.

• Choose the right shoes and socks. When buying new shoes, have an expert make sure they fit well. At first, wear them for just a few hours daily to help prevent blisters and examine the feet afterward to check for areas of irritation. Wear seamless socks to avoid getting sores.

• Check your feet every day. Check all over for sores, cuts, bruises, breaks in the skin, rashes, corns, calluses, blisters, red spots, swelling, ingrown toenails, toenail infections or pain.

• Call your foot and ankle surgeon. If you develop any of the above problems, seek professional help immediately. Do not try to take care of cuts, sores or infections yourself.

The 2 peroneal tendons in each foot and ankle are responsible for turning the foot side to side. One of the tendons attaches to the outer midfoot, the other one attached to the inside of the arch. Another function of the peroneal tendons is to stabilize the ankle and prevent ankle sprains. Injuries to the tendons can be acute (occur suddenly) or chronic (occur over a period of time). Active individuals or sports athletes are more susceptible to peroneal tendon injuries.

Cause & Symptoms:

Tendonitis is inflammation of one or both of the tendons. THis can be caused by overuse injury, with repetitive movements putting strain on the tendons. Recurring ankle sprain can also lead to inflammation of the tendons. Symptoms often include pain, swelling, and warmth at the site of inflammation.

Acute tear of the tendons is caused by repetitive activity or trauma which causes partial or complete tear of the tendons. The symptoms are immediate, including pain, swelling, and weakness or instability. If untreated, acute tears can lead to altered shape of the foot, with the arch gradually becoming higher.

Degenerative tears are due to overuse that occurs over a long period of time. The tendons become stretched over overtime, until it eventually becomes thin and frayed. Having a high arch foot increases the chance of developing degenerative tears. Symptoms can include sporadic pain, weakness or instability, and increase height of the arch.

Subluxation of the tendons involves the tendons slipping out of the normal positions. Subluxation can occur due to abnormal anatomy of the tendons, or from trauma. During trauma, the soft tissue around the tendons that holds it in place is damage, leading to displacement of the tendons during activity. The trauma can be from a broken ankle, or severe ankle sprains.

Diagnosis:

Peroneal tendon injuries are often misdiagnosed as ankle sprains. A complete history, and careful examination of the foot and ankle is important. The site of the pain, instability, swelling, warmth and weakness can pinpoint to the site of injury. In addition, x-rays or other advanced imaging modalities can assist with the diagnosis.

Treatments:

Conservative treatment is reserved for tendons that are inflamed or relatively intact. It includes the following:

• Immobilization. A cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal.

• Medications. Oral or injected anti-inflammatory drugs may help relieve pain and inflammation.

• Physical therapy. Ice, heat or ultrasound therapy may be used to reduce swelling and pain. As symptoms improve, exercises can be added to strengthen the muscles and improve range of motion and balance.

• Bracing. The surgeon may provide a brace to use for a short while or during activities requiring repetitive ankle motion. Bracing may also be an option when a patient is not a candidate for surgery.

If the symptoms do not improve, or instability of the ankle exists, then surgery can be considered. Also, with acute tear of the tendons, surgical reapproximation of the tendon is often recommended. After surgery, physical therapy is an important part of rehabilitation.

Plantar fibroma is a fibrous nodule on the bottom of the foot. Anatomically, it is embedded in the plantar fascia, which is a band of tissue that extends from the heel to the toes. The fibrous nodule is benign, and grows slowly. Unfortunately, the nodule will not go away, and as the nodule increases in size, it can cause pain on weight bearing. The exact cause of plantar fibroma is not known.

Symptoms:

The nodule on the bottom of the foot can cause pain when weight bearing. As the size of the nodule increases, so does the pain. The pain is typically described as dull, and achy. When wearing shoes, the arch of the shoes can push up against the nodule causing pain.

Diagnosis:

Careful examination of the nodule site with palpation can lead to diagnosis of plantar fibroma. Sometimes, the palpation can lead to pain that extends to the toes. If the presentation is atypical of plantar fibroma, or there is suspicion of other pathologies, MRI or biopsy can be ordered to further evaluate the nodule.

Treatments:

Conservative treatments such as steroid injections, orthotic devices and physical therapy are all focused on symptom relief. Steroid injections have been shown to shrink the size of the nodule, thus reducing pain. However, the reduction is usually temporary, and will increase in size or return back to original size.

Definitive treatment for plantar fibroma is surgical removal. Surgical removal may result in flattening of the foot arch or hammertoe development.

Plantar wart is a small skin outgrowth caused by infection by a virus on the underside of the feet. It is common in children, adolescents and elderly. In general, warts can be classified into 2 types: solitary warts, and mosaic warts. Solitary wart is a single wart with tendency to increase in size, and sometimes form additional satellite warts. Mosaic warts, on the other end, are a cluster of warts in one area. These are more difficult to treat than solitary warts.

Cause:

Warts are caused by infection from human papilloma virus (HPV). The virus is introduced into the skin usually through small scratches, leading to rapid growth of virus infected cells at the skin surface.

Symptoms:

The symptoms of warts include thicken skin outgrowth that resembles a callus. These often appear with tiny black dots on the warts. These black dots are dried blood from tiny blood vessels. Once the wart increases in size, it can cause pain when walking and standing.

Treatment:

Most warts clear up without any medical intervention. However, If a wart does not resolve in a timely manner, treatments such as topical, or oral medications are available. Other treatment options include laser therapy, cryotherapy (freezing), acid treatment, or surgical excision (surgical removal). Regardless of the treatment, it is important for the patient to follow the surgeon’s instructions including all home care, medication, and follow up visits.

To note, warts can reoccur, which requires repeated treatments. Furthermore, most wart treatments span multiple weeks.

Puncture wounds are common in the foot. These wounds are small entry holes caused by a pointed object, such as a nail, or needle. Puncture wounds require different treatment compared to cuts, or scraps, as these may involve deeper structures of the foot. Proper treatment within the first 24 hours is important, as foreign objects can be retained in the body, and infection can result. According to a research, complications can be averted if treatment is provided right after the accident.

All puncture wounds are dirty wounds because they involve the penetration of an object that is not sterile. The dirtier the penetrating object, the higher the chance of infection. Puncture wounds can be caused by a variety of materials, ranging from glass, insulin needles, to toothpicks, and seashells. If these objects are lodged in the skin or body, it is referred to as a foreign object. It is important to have the foreign object removed.

Diagnosis:

A detailed history and physical exam can provide much needed information for the diagnosis and treatment. Usually, the deeper the penetration, the more likely that an complication such as infection will develop. Furthermore, injuries to deeper structures such as bones, tendons, blood vessels, and joints can result. For assessment of deep tissue injuries, imagine such as X- ray and other advanced imaging modalities may be ordered.

Treatment:

Puncture wounds should be assessed by a physician and receive treatment within 24 hours if possible. A tetanus shot might be necessary if the patient’s tetanus status is not up to date. Tetanus is an infection caused by a bacteria, often through an external wound, that causes lockjaw (tetanus). Once assessed, puncture wounds need to be cleansed properly, and monitored carefully during the healing process.

If a retained foreign body is noted during examination, removal of the forieng body is required. This can be done bedside, or in a surgical setting. If deep tissue injury resulted from the penetrating injury, such as lacerated tendon, surgery might be warranted for repair. Due to concern regarding infection, antibiotics may be prescribed.

Rash of the feet is common, and can have a variety of causes. A common reason for foot rash is athlete’s foot. This is caused by a fungal infection of the skin. Other causes include eczema, which presents with itchiness to the skin. Another cause is allergic reaction to certain things that are in contact with the skin. This can be a new pair of shoes, socks, or sandals. Examination of the foot rash by a physician can help reach the correct diagnosis. Appropriate treatments for the rash will be based on the cause of the rash.

Raynaud’s phenomenon is a condition that results in bluish white discoloration of the fingers and toes due to exposure to cold. This is a result of spasms in the small blood vessels. Initially the fingers or toes will turn white, then blue. Once the fingers and toes warm up, the skin at the stie will turn red. Oftentimes, the condition is accompanied by pain or numbness at the fingers and toes as well. Stress and smoking can worsen the symptoms.

This condition affects women more than men. The primary treatment is to avoid the cold. Smoke secession for smokers is also important. Medications such as calcium channel blockers can be taken orally for treatment.

Restless leg syndrome is characterized by an uncontrollable urge to move one’s legs usually due to an uncomfortable sensation. This occurs usually when the legs are at rest, such as when trying to sleep or traveling in a car. Moving the legs eases the uncomfortable sensation. Currently, there is no test to properly diagnose this syndrome. Risk factors for restless legs syndrome includes peripheral neuropathy, iron deficiency, kidney failure, and spinal cord conditions. There are medications available to reduce the restlessness in the legs.

Rheumatoid arthritis is a disease in which the immune system malfunctions, and attacks healthy joints. Specifically, it causes inflammation of the lining of the joints, mostly in the hands and feet. This can lead to damage to cartilages, and bones in the long term. Often, the joints, and surrounding soft tissues are swollen from the inflammation. In terms of symptoms, the joints become stiff or dislocated. Other presentations associated with rheumatoid arthritis include hammertoe deformities, bunions, heel pain, Achilles tendon pain, or flatfoot ankle pain.

Diagnosis:

Rheumatoid arthritis is diagnosed on the basis of clinical examination, and blood test. To further assess the extent of the joint damage, X-ray may be ordered.

Treatment:

For systemic treatment of rheumatoid arthritis, patients are prescribed medication by the primary care doctor, or rheumatologist. For foot specific treatments, your physician may include the following treatment options.

• Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking and give needed support to improve the foot’s mechanics.

• Accommodative shoes. These are used to relieve pressure and pain and to assist with walking.

• Aspiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain.

Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.

When conservative treatments do not alleviate symptoms of rheumatoid arthritis, surgery might be warranted. There are selected procedures for different types of rheumatoid arthritis induced deformities.

Runners are susceptible to overuse injuries such as heel pain from plantar fasciitis, Achilles tendonitis, sesamoiditis, stress fractures, and posterior tibial tendonitis. Calcaneal apophysitis are common problems in children and adolescents. These can result from improper training, improper shoewear, abnormal foot architecture, and prior injuries.

Sesamoid bones are 2 small bones embedded in the tendon on the underside of the ball of each foot, by the big toe joint. The bones assist with the movement of the big toe, and provide a weight bearing surface for absorption of impact. Sesamoid injuries can involve the bones, tendons, or the surrounding soft tissues in the joint. Activities such as running, basketball, football, golf, tennis, and ballet place increased force on the sesamoids, leading to higher chance of sesamoid injuries. Wearing high-heeled shoes can also be a contributing factor, since the majority of the weight is placed at the forefoot.

Types:

Turf Toe: This type of injury results from damage done to the soft tissue surrounding the big toe joint, when the joint is extended beyond the normal range. Turf toe can also result in soft tissue damages that are attached to the sesamoids or as a result of fracture of the sesamoid bones. For more information, please refer to Turf Toe.

Fracture:

An acute fracture in the sesamoid bones can be caused by direct trauma to the sesamoid bones. This type of fracture results in acute pain at the site, with immediate swelling. Repetitive impact, such as running, can cause stress fractures of the sesamoid bones. This type of fracture presents with long standing pain that tends to come and go.

Sesamoiditis:

This is an overuse injury causing chronic inflammation of the sesamoid bones, and the surrounding tendons. This is caused by increased pressure at the site. The pain comes and goes, usually aggravated with certain shoes or activities.

Diagnosis:

A thorough history with physical examination on the big toe joint can identify the issue. A biomechanical examination can also help assess the gait pattern which contributes to the condition. To assess the integrity of the sesamoid bone, an X-ray can be ordered. In cases in which the symptoms do not improve accordingly, advanced imaging can be considered.

Treatment:

Conservative treatment can include the following:

• Padding, strapping or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.

• Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.

• Physical therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range of motion, strengthening and conditioning) and ultrasound therapy.

• Steroid injections. In some cases, cortisone is injected into the joint to reduce pain and inflammation.

• Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.

Surgery can be considered if a patient fails conservative treatment.

Shin Splints often present as pain and swelling in front of the lower leg. These symptoms appear after repetitive activities, such as running or walking. The pain and discomfort stem from inflammation in the shin from the repeated pull of the muscles in the leg on the shin bone (tibia). Contributing factors of shin splints include flatfeet, calf tightness, improper training techniques, improper footwear, or activities on uneven surfaces.

Treatment for shin splints include rest, use of nonsteroidal anti-inflammatory drugs, icing and change in training habits. Stretching exercises and properly fitted shoes can also prevent the onset of shin splints. If untreated, shin splints can potentially result in stress fracture of the tibia bone.

There are 3 distinct types of cancers that appear on the skin of the foot: melanoma, basal cell carcinoma, and squamous cell carcinoma. Each type of cancer has unique presentations which allows the physician to distinguish the difference. Treatment of skin cancer can vary depending on type,location, and age of the patient. Some treatment options include chemotherapy, radiation therapy, and surgical excision.

Basal cell carcinomais the most common type of skin cancer, appearing on sun exposed areas. It presents as a smooth, raised bump, or a sore that does not heal. It rarely metastasizes or causes death because it grows slowly.

Squamous cell carcinoma appears in sun exposed areas as thick, red, scaly patches, or as bleeding ulcers. In some instances, it may spread to other areas of the body.

Melanoma begins in the cells of the skin that produces pigment for the color of the skin. This type of cancer is the most serious, and is known to spread to other areas of the body.

Smelly feet stems from bacteria or fungus growing in the shoes, and attaches to the skin. Some bacteria can eat away the top layer of the skin, producing foul odor. This condition is often caused by excessive sweating of the feet, usually year round. People who wear shoes on a daily basis also have a higher chance of developing smelly feet. To prevent smelly feet, hygiene is very important. Feet should be washed daily with soap and water. Clean, dry socks should be worn. Physicians can also prescribe topical medication to decrease the sweating of the feet. A variety of other treatments for personal hygiene may be employed.

Soft tissue biopsy is the removal of a small sample of the soft tissue for examination, and analysis. Most commonly, the tissue is examined under a microscope. The soft tissue can include skins, tendons, fats, and muscles. Some soft tissue biopsies are performed to rule out or confirm malignancy (cancer), infection, or other soft tissue pathologies. This allows physicians to reach an accurate diagnosis, and determine the most appropriate treatment for the pathology.

Procedure:

There are multiple types of biopsy techniques for different pathologies including shave biopsy, punch biopsy, and incisional/excisional biopsy.

Shave biopsy- a thin piece of skin tissue is shaved off.

Punch biopsy- a small round instrument is used to remove a small cylinder of tissue.

Incisional/excisional biopsy- a piece of the entire lesion is removed. Stitches are often needed.

Some of the common biopsy in podiatry involves the follow:

• Freckles (macules)

• Benign pigmented, or colored, spots (moles or nevus)

• Fungal or bacterial infections

• Rashes (such as eczema or dermatitis)

• Lesions related to a disease affecting the entire body (such as diabetes)

• Nodular conditions (such as a ganglion cyst, lipoma or fibroma)

• Toenail conditions (onychomycosis, psoriasis)

• Wart-like growths on the skin (benign keratoses)

• Premalignant conditions (actinic and seborrheic keratoses)

Staphylococcus aureus is a bacteria that is known to cause serious infections. The bacteria are commonly found on the skin or in the nose of even healthy individuals. Most of the time, these bacteria do not cause issues. However, at times, it can enter the body through cracks in the skin or open wounds causing systemic or deep infections.

Symptoms of staph infections include redness, swelling, pain, drainage at the wound site. Systemic symptoms of infection include fevers, chills, nausea, vomiting, and low blood pressure. If you have a cut or scrap that you suspect is infected, please see your physician for examination. Treatment of staphylococcus aureus infections involves antibiotics and drainage of the infected area.

In recent years, several strains of staphylococcus aureus that are resistant to antibiotics have become more common. These strains are commonly known as Methicillin Resistant Staph Aureus (MRSA). These drug resistant strains make antibiotics less effective, and treatment is more challenging.

Stressed fractures are tiny hairline fractures in the bone caused by repetitive microtrauma. This type of fracture may be caused by over training, overuse, improper training, or improper show wear. Osteopenia (low bone density) can also play a major role in development of stress fractures. If untreated, stress fractures can potentially turn into complete fractures.

Symptoms:

Stress fractures often result in pain at the stie after activity. The pain goes away when resting, but returns during activity. Pinpoint pain at the fracture site is present when touched. The degrees of swelling might vary, however, bruising should not be present.

Treatments:

Treatment of stress fractures can be conservative involving rest, non-weight bearing, immobilization, and/or casting. However, if the stress fracture progresses to complete fracture with displacement and affects the mechanical function of the foot and ankle, surgery is recommended. Physical therapy, exercise and rehabilitation may be included for return to normal activities.

Sweaty feet is a common disorder in which the sweat glands of the feet produce excess amounts of sweat. An abundance of sweat glands can be found in the feet and hand. There is a strong genetic disposition for people with sweaty feet. Another factor that contributes to sweaty feet is stress. Stress activates the brain to produce sweat to keep the body temperature under control.

Sweaty feet are often accompanied with mal-odor, and athlete’s foot. For this disorder, physicians can prescribe topical medication to reduce the sweating in the feet. Concurrent treatment for athlete’s foot can be performed.

Swollen feet or ankles can be caused by many factors, including, but not limited to, trauma, infection, tumor, varicose veins, lymphatic system derangement, poor circulation, hypertension, and congestive heart failure. A thorough history and physical exam can direct a physician to better determine the cause of the swelling.

Swollen feet or ankles can be caused by many factors, including, but not limited to, trauma, infection, tumor, varicose veins, lymphatic system derangement, poor circulation, hypertension, and congestive heart failure. A thorough history and physical exam can direct a physician to better determine the cause of the swelling.

Synovitis is the inflammation of the lining of the joint. Diseases such as arthritis, gout, overuse injuries or direct trauma can cause synovitis. Symptoms of synovitis include redness, swelling, warmth and pain at the joint with motion.

Evaluation of the joint can help with diagnosis of synovitis, and rule out other cases of pain such as fractures, or infections. To rule out an infection, the fluid in the joint may be extracted, and analyzed. To rule out fractures, X-ray imaging may be ordered.

Treatment for synovitis includes ice, rest, immobilization, and anti-inflammatory medication. The anti-inflammatory medication can be oral or topical. If the symptom is severe, steroid injection in the joint to calm down the inflammation may be considered.

Tailor’s bunion is a prominence of the 5th metatarsal bone, at the base of the little toe. Tailor’s bunion is not as common as a bunion, but presents with similar symptoms. The pain and discomfort stems from pressure or friction at the site.

Tailor’s bunion is caused by abnormal mechanical structure of the foot. As a result, the 5th metatarsal bone protrudes outward, while the little toe drifts inwards. This shift creates a little bump on the sides of the foot, behind the little toe.

Symptoms and Diagnosis:

The symptoms include redness, swelling, and pain at the site in contact with the shoewear. Tailor’s bunion is easily diagnosed because of the prominent protrusion visually. X-ray can be ordered to assess the extent of the deformity, and observe any resulting arthritis.

Treatment:

Conservative treatment is meant to decrease the symptoms, and not cure the deformity. The following conservative treatments may be selected.

• Shoe modifications. Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.

• Padding. Bunionette pads placed over the area may help reduce pain.

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.

• Icing. An ice pack may be applied to reduce pain and inflammation. Wrap the pack in a thin towel rather than placing ice directly on your skin.

• Injection therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.

• Orthotic devices. In some cases, custom orthotic devices may be provided.

Surgical intervention can be considered if symptoms are not addressed by conservative treatments. The surgical procedure will depend on the degree of deformity. This will in turn dictate the recovery period, and other risk factors.

Talus in the bone resting on the bottom of the ankle joint, with the talar dome being part of the ankle joint. The dome is primarily covered in cartilage- a tough rubbery tissue that enables the ankle joint to move smoothly. A talar dome lesion is an injury to this cartilage, and the underlying bone. It is also known as osteochondral defect (OCD).

These dome lesions are usually caused by injury such as ankle sprain. The inability for the body to heal the dome lesion after the trauma causes further degradation of the surrounding area. Sometimes a loose piece of cartilage will break off from the dome, and float inside the joint.

Symptoms:

Unless the injury is extensive, it takes several months to a year for symptoms to develop. Symptoms include chronic pain in the ankle, which worsens with activity. The ankle joint might experience occasional clicks and catching feelings. Some patients complain of the ankle locking or giving out during range of motion. Lastly, swelling of the joint develops after activity.

For severe talar dome lesions, delayed or non treatment can cause arthritis with symptoms such as chronic pain, swelling ,and limited joint motion.

Treatments:

Conservative treatment is reserved for talar dome lesions that are stable - meaning without loose pieces of cartilage or bone.

• Immobilization. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. During this period of immobilization, non weight bearing range-of-motion exercises may be recommended.

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.

• Physical therapy. Range-of-motion and strengthening exercises are beneficial once the lesion is adequately healed. Physical therapy may also include techniques to reduce pain and swelling.

• Ankle brace. Wearing an ankle brace may help protect the patient from reinjury if the ankle is unstable.

If the damage to the talar dome is extensive, or in the presence of unstable lesion, surgical intervention should be considered. Surgery will involve removal of the loose cartilage or bone from the joint. The lesion site might receive other advanced treatment to assist with healing.

Tarsal coalition is the abnormal connection that develops between two bones in the foot. This abnormal connection can be composed of bone, cartilage, or fibrous tissue. The symptoms of this tarsal coalition stems from limited motion at the site, oftening resulting in pain. While most patients are born with this condition, the symptoms do not exhibit until bones begin to mature around age 9 to 16. Other causes of coalition include infection, arthritis, or a previous injury to the area. General symptoms include pain, fatigue in the legs, muscle spasm in the legs and feet, walking with a limp, and stiffness in the foot and ankle.

Diagnosis:

Obtaining information regarding the duration, and development of the symptoms, as well as a thorough examination of the foot and ankle is important. Limited range of motion at different joints can indicate the location of the coalition. In addition to a foot exam, X-rays and other advanced imaging such as CT scans can be ordered.

Treatment:

Conservative treatment involves symptom relief through the following.

• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.

• Physical therapy. Physical therapy may include massage, range-of-motion exercises and ultrasound therapy.

• Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.

• Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.

• Immobilization. Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot.

• Injection of an anesthetic agent. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization.

When the symptoms are not adequately alleviated through conservative treatment, surgical intervention should be considered. Resection of the coalition is an option to regain the mobility of the joint. If the coalition covers a large area of the joint, arthrodesis (fusion of the joint), might be desirable.

Tarsal tunnel syndrome involves the compression or squeezing of the posterior tibial nerve that results in numbness, shooting pain, burning pain and tingling sensation of the inside ankle, or bottom of the feet. The symptom is triggered by activity, or weight bearing.

Tarsal tunnel is a narrow space on the inside of the ankle that is covered by a thick ligament. Contained in the tunnel are the arteries, veins, tendons and nerves to the feet. One of the nerves is the posterior tibial nerve. When it is compressed, it elicits symptoms of tarsal tunnel syndrome.

Causes:

Tarsal tunnel syndrome can be caused by flat feet, or enlarged or abnormal structure within the tarsal tunnel. For example, varicose veins, ganglion cysts, arthritic bone spurs or swollen tendons can cause the impingement of the nerve. Other causes include acute ankle injuries, direct trauma to the tarsal tunnel, or systemic diseases such as diabetes or arthritis.

Diagnosis:

A thorough foot and ankle examination can assist a physician to arrive at the diagnosis. Tapping on the nerve at the tarsal tunnel site to reproduce the shooting pain can indicate whether tarsal tunnel syndrome is present or not. Advanced imaging can also be ordered to further visualize the site for any impingement from abnormal masses, or swelling of neighboring tendons. Other studies such as electromyography and nerve conduction studies can be helpful.

Treatments:

Conservative treatments for tarsal tunnel syndrome include rest, ice, oral medication, immobilization, physical therapy, injection therapy, orthotic devices, shoes and bracing. If conservative treatment is ineffective, surgical treatment can involve decompression of the impingement site within the tarsal tunnel.

Thick toenails can develop due to several reasons. As individuals grow older, toe nails often thicken. Thickening can also result from repeated trauma to the nail, such as running with improper shoewear. Acute trauma to the nail that damages the root of the nail can also cause thickening of the new nail.

One common cause of thickened toenails is fungal infection (onychomycosis). These fungal infections can be treated with topical,or oral medication. Other treatment options include laser, or matrixectomy. Please refer to “onychomycosis” for more details regarding fungal nails.

Systemic diseases such as psoriasis and hypothyroidism can cause the thickening of the toenails as well. These do present with a specific type of nail deformity.

Tingly feet is a common symptom of nerve injury or nerve loss. The nerves in the feet are a continuation of the nerves in the lower back. Pressure along the course of the nerves, or chemical changes in the nerves can cause tingly sensation in the feet. The tingly sensation is usually accompanied by a feeling of numbness, like the feet are falling asleep. Other sensations can include burning, or warm sensations.

Diabetes is one of the most common medical conditions that causes tingly sensation in the feet. In this case, patients should perform daily foot checks, to note the presence of foot wounds.

Tired feet is a common complaint that is due to various types of underlying medical conditions. Abnormal foot architecture, such as flatfeet or high arch feet, can result in tired feet from weight bearing. Other factors that can cause tired feet include obesity, improper footwear, pregnancy, leg swelling, sudden increase in activity level, or existing injuries. In order to determine the cause of the symptoms, a detailed workup by a physician is required.

Toe walking is a condition in which the patient walks on the toes or ball of the foot. This can be present in children, and adults. These conditions can either be habitual or caused by shortened Achilles tendons.

Toe walking is seen in children when they first start walking. Most children develop proper heel to toe gait with age. However, some children continue to have a toe walking gait. This condition can be caused by neurological or muscular disorders. A detailed biomechanical examination of the lower extremity is helpful in determining the etiology.

In adults, tight Achilles tendons can lead to a toe walking gait. In this type of gait, the equinus gait, the heel lifts early during ambulation. This type of gait can lead to other foot problems such as plantar fasciitis, and big toe joint pain. Stretching of the Achilles tendon can be attempted to reduce this pathology.

Turf toe is an injury of the big toe joint in which the toe is bent excessively upward causing a sprain. This type of injury usually results from sports activities involving pushing off repeatedly when running and jumping. Sports such as soccer, football, wrestling, gymnastics and dancing are considered higher risk.

Symptoms:

Symptoms of turf toe includes pain, swelling, and limited joint movement. If injury is from repetitive action, symptoms appear slowly and worsens over time. In direct injuries, the onset of pain is acute due to damage to cartilage and ligaments. Both types of injuries will result in pain that last several weeks to months in duration.

Diagnosis:

Physical exam of the joint with range of motion, together with medical history can provide the right diagnosis. To examine for any fractures, X-rays can be ordered. Other advanced imaging can be helpful if persistent pain and swelling does not resolve in a timely manner.

Treatment:

Initial treatment of rest, ice, compression and elevation is recommended. Acute turf toe can be immobilized to decrease symptoms. Less flexible shoes can assist with symptom relief as well. In severe cases, operative. treatment can be considered.

Ulcer, is a type of wound which consists of a break in the skin, exposing the underlying deep tissue. To differentiate ulcers from acute wounds, ulcers have underlying biological dysfunctions of the body leading to a break in the skin. Ulcers are seen in patients with diabetes, neuropathy, or vascular diseases. These diseases, and together with external forces can cause ulcers to occur. Open ulcers can put patients at increased risk of developing infection in the skin, deeper soft tissues, and bones. Signs and symptoms of infection may include drainage, warth, odor, redness, and pain.

Ulcers are treated with removing unhealthy tissue, and performing local wound care to assist with healing. To prevent ulcer formation, special shoes with paddings may be used. In the case of infection, antibiotics will be dispensed. In cases in which deeper infection of the soft tissue or bone is involved, surgical intervention will be required.

For more information regarding wounds in general, please refer to WOUNDS.

Varicose veins are superficial veins that are enlarged and twisted due to improper functioning valves within the veins. Varicose veins are caused by a wide array of etiologies, the most common one is venous hypertension from prolonged standing. Beside the prominent visible veins, other symptoms include swelling of the legs, ankles and feet. With chronic varicose veins, skin discoloration can result due to leakage of blood into the surrounding tissue. These skin changes can also develop into bleeding veins, and possibly ulcerations (wounds). Multiple imaging modalities are available to assess the competency of the veins. The initial treatment for symptomatic varicose veins is compression stockings. Worsening presentations might require surgical consideration.

Vitamin D is a fat soluble vitamin that is responsible for multiple biological effects. Among the effects, inadequate vitamin D leads to osteoporosis (low bone density), which may increase the chance of bone fracture. In the foot and ankle, this can often present as fractures of the metatarsal bones. Fracture of the ankle is also commonly seen. To check for vitamin D level, blood work can be obtained.

Vitamin D is produced by our body when exposed to the sun’s ultraviolet rays. However, people living in geographical areas where direct sunlight exposure is difficult,they can have decreased vitamin D levels. People who have low vitamin D levels can obtain additional vitamin D through diet supplements. These supplements have shown to slow bone loss, and reduce fractures, when taking in conjunction with calcium. Per the US Food and Drug Administration, daily value for vitamin D is 400 IU. People with vitamin D deficiency might require higher doses.

Wart is a small skin outgrowth caused by infection of a virus. It is common in children, adolescents and elderly. It is most commonly found on the bottom of the feet. In general, warts can be classified into 2 types: solitary warts, and mosaic warts. Solitary wart is a single wart with tendency to increase in size, and sometimes form additional satellite warts. Mosaic Warts, on the other end, are a cluster of warts in one area. These are more difficult to treat than solitary warts.

Cause:

Warts are caused by infection from human papilloma virus (HPV). The virus is introduced into the skin usually through small scratches, leading to rapid growth of cells at the skin surface.

Symptoms:

The symptoms of warts include thicken skin outgrowth that resembles a callus. These often appear with tiny black dots on the warts. These black dots are dried blood from tiny blood vessels. Once the wart increases in size, it can cause pain when walking and standing.

Treatment:

Most warts clear up without any medical intervention. However, If a wart does not resolve in a timely manner, treatments such as topical, or oral medications are available.. Other treatment options include laser therapy, cryotherapy (freezing), acid treatment, or surgical excision (surgical removal). Regardless of the treatment, it is important for the patient to follow the physician’s instructions including all home care, medication, and follow up visits.

To note, warts can reoccur, which requires repeated treatments. Furthermore, most wart treatments span multiple weeks.

Weak ankles are often described by the patients as ankles being “sore”, and “give away easily” while standing, or during weight bearing activities. Many etiologies contribute to weak ankles, including prior ankle injuries, nerve damage, or ligamentous laxity.

Most ankle injuries require several months to fully heal. During this time, the ankle remains weaker and less stable. During this time, participation in strenuous activity is not recommended. To regain the strength of the ankle, physical therapy can be prescribed.

Various nerve injuries to the lower extremity can lead to different types of weakness in the ankles, including inability to move the ankles up and down with sufficient force. This can be a result of trauma to the nerve, or other metabolic derangements. For these injuries, nerve conduction studies or advanced imaging studies are often helpful.

Lastly, repeated ankle sprains can lead to ligamentous laxity that lead to ankle instability. Foot and ankle surgeons can assess ankle stability through biomechanical workups to confirm the finding. Both conservative and surgical treatments for ligament laxity are available.

Webbed toes, also known as syndactyly, is a rare condition observed at birth. This condition is rare, and seen in only 1 in 2000 births. Webbed toes present with two or more toes that are partially or fully joined by a flexible skin bridge. In the feet, it is most commonly observed between the 2nd and 3rd toes. Depending on the digits involved, and degree of webbing, surgical correction may not be necessary.

Webbed toes can also be an intentional result of surgery to correct for toe deformities. In surgical procedures such as syndactylization, the lesser toes are webbed purposely to reduce interdigital maceration, or correct rotational deformities.

Minor trauma to the nail that results in damage only to the nail can result in white spots, or white streaks. This can be from repetitive trauma such as running in ill fitting shoes, or elongated nails. In the case of more severe trauma to the nail, bleeding below the nail can cause accumulation of blood, leading to black toenails. Treatment for this condition involves removing the offending factors. Which is the trauma. In most cases of white toenails, the white spots/streaks will grow out in a few months with no medical intervention required.

Other causes of white toenails include medical illnesses that result in protein deposition in the nails. Fungal infection of the nail (onychomycosis) may also cause yellow and white discoloration, with white subungual debris (debris underneath the nail). For onychomycosis, antifungal medical or nail matricectomy (nail removal) are treatment options.

A wound is a break in the surface of the skin. This break in the skin allows for introduction of infection to deeper areas of the body. Wounds can be broadly classified into 2 general categories: acute (wound) and chronic (ulcer).

Causes:

Acute wounds are often caused by external factors such as pressure, or heat. Chronic ulcers are generally caused by internal factors, such as diabetes, neuropathy, ischemia, and venous hypertension.

Diagnosis:

Superficial wounds are diagnosed clinically. The main concern regarding a wound is the presence of infection. Signs and symptoms of infection include drainage, odor, inflammation, swelling, and pain. For deeper wounds, including ulcerations, bone infection is a major concern. X ray is often utilized for initial assessment of bone infections.

For other underlying causes of ulcerations, such as vascular diseases, other advanced imaging studies can also be ordered.

Treatment:

Local wound care is implemented to assist with wound healing. Local wound care decreases the amount of bacteria at the site, provides a suitable environment for the wound to heal, and prevents further degradation of the wound site from external factors. At the same time, internal factors such as diabetes need to be kept under control. If deep infection is present, then surgical debridement with removal of non viable tissue is necessary.