Foot Health

Abscess

What is it?
An abscess is a collection of pus under the skin. Abscesses are considered localized infections that can cause pain and illness. An abscess can initiate the growth of aggressive infections and spread to other parts of the body. When an abscess develops on the foot, the area involved may become red, hot, swollen, and tender. This infection can spread and ultimately affect other tissues in the foot and leg requiring aggressive treatments. When abscesses become large and go untreated, the infection can spread to the bone and lead to a bone infection (osteomyelitis). Once the bone becomes infected, more extensive surgery may be necessary to resolve the infection.

Achilles Tendonitis

What is it?
The Achilles tendon is the thickened cord or fibrous band that runs down the back of one’s leg and attaches to the heel bone. A prime function of this muscle or tendonous structure is to assist in moving the foot up and down. Athletes at all competitive levels, frequently encounter problems with this tendon. It is subject to injury from a direct impact, can suffer from over use or excessive training, or can just start hurting as a result of shoe pressure. The patient with an Achilles tendonitis will most often have pain and swelling in the lower portion of the tendon just above the heel, will have discomfort when moving the foot upwards thus stretching the tendon, and will probably note that the condition has worsened over time. These patients can have significant discomfort and will frequently take themselves out of physical activities prior to visiting the physician.

Ankle Sprains

Definition:
Ankle sprains are one of the most common conditions we treat in our office. Take a wrong step, walk on uneven ground or be active in athletics, and sooner or later, you will probably have an ankle sprain. By definition, an ankle sprain is a type of injury involving some degree of ligamentous trauma, be it over stretching, partial rupture, or total tear. Along with this ligament injury is some level of ankle joint instability, which can become an invitation for future reinjury and weakness. Ankle sprains usually involve either the inside or outside aspects of the ankle. The outer variety being the much more prevalent due to its weaker structures and greater tendency for injury. The typical presentation of an ankle injury is acute pain, swelling, bluish-black bruising or discoloration, loss of motion and one’s inability to weight bear without discomfort. A thorough examination by a foot specialist is recommended in order to rule out other problems such as fractures, tendon ruptures, and dislocations.

Athletes Foot

What is it?
You do not have to be a member of a sports team to get athlete’s foot. In fact you don’t even have to play a sport. The condition itself usually results from an overgrowth of a particular fungus organism. In most cases, the areas between the toes and the arch of the foot are most often involved. Athlete’s foot may appear in different stages, each with its own presentation. For instance, the acute stage may have blisters or have intense itching. In addition, there may be maceration between the toes; and occasional drainage. The chronic condition is characterized more by a dry and scaly appearance and rarely itches. There is some confusion as to how this skin condition can be transmitted but at the present time, the consensus of opinion is that there is some type of contagious capacity. In short, you might be able to catch it from the next guy or gal, so watch your barefoot walking! Occasionally, an athlete’s foot condition will become infected and require more extensive therapy. In actuality, the threat of subsequent infection is probably a prime reason for treating more aggressively the earlier stage of the condition. One might think what is really so bad about a little itching between the toes. Well, by itself, probably not a whole lot. But in those cases where that little itching develops into a more involved complication, then we might be facing a more serious problem which might require a more extensive treatment plan.

Bunions

What are they?
Bunions are those unsightly enlargements or bumps that occur on the inside areas of your feet. A bunion deformity can cause a wide range of problems for the patient and consequently can involve a varied approach to treatment. An important point to consider in the understanding of this problem is that it is a progressive deformity. In other words, a bunion will in most cases worsen with time. No one can predict how fast the deformity will progress or to what extent it will cause debility or symptoms but most authorities would agree that sooner or later, it will worsen. Bunions, by nature, can cause pain in certain shoes, become a common site for arthritic changes, lead to secondary compensatory problems such as hammertoes or pain in the fat pad area. They may cause serious aesthetic or shoe wear concerns for certain individuals especially women who have to wear higher styled type shoes. Whatever the extent of involvement, a bunion deformity should warrant consideration by the patient and some level of professional evaluation by a foot specialist.

Calluses

Calluses on the bottom of the foot are about as common as any condition we see on the foot. Years ago, we used to judge a man’s working ability or performance by the condition of his hands. It was quite simple, a good hard worker had callused hands and as for his feet, they just weren’t part of the job interview. Calluses, like corns, are thickened layers of skin, which are nature’s response to excessive friction and pressure. Initially, a hot spot or blister may be present but if the pressure continues, a callus will often form. These lesions will usually form beneath weight bearing, bony segments of the foot. Characteristically this includes the metatarsal heads or ball of the foot, the heel, and the under surface of certain toes. Contrary to frequent belief, calluses do not grow and spread by any living intention. However, they are capable of involving adjacent skin areas as a result of continued friction and pressure characteristic of certain areas of the foot.

Not all calluses cause discomfort. A callus may be small, medium, or large in area but thin and diffuse in thickness. These are normally non-painful and can be effectively dealt with by paddings, insoles, and certain types of abrasive treatment procedures. On the other hand, calluses may become deep and punctuate with circular type cores in their center. These are the ones that can indeed cause grief and most often will lead to a visit at the local foot doctor’s office. This painful type of callus may be due to an underlying problem in bone structure, a particular type of skin condition, or perhaps a response to a foreign body. Various treatment methods are available by the foot specialist that are geared towards re-establishing proper balance and weight distribution. As with many problems of the foot one could try to accommodate these lesions with padding, try to control foot strike and function by an arch supportive device or correct the orthopedic condition that exists. These problems should be seen as early as possible so as to minimize the necessary treatment involved.

Cellulitis

What is it?
A cellulitis is an infection of the soft tissue. This type of infection is much different from osteomyelitis, which is an infection of the bone. A cellulitis of the foot or lower leg is usually red, hot, swollen, and tender. A classic description of cellulitis is "red streaking" leading up the foot or leg. Patients that are immunocompromized or have weak immune systems are more likely to suffer from cellulitic episodes. A cellulitic foot or leg can be very painful and can cause the patient a great deal of disability. If a cellulitis is not properly and aggressively treated, the infection may spread quickly through the surrounding tissues and become even more serious requiring more aggressive treatment.

Corns

What are they?
Corns are the hard, thickened areas of skin, which frequently are located on the top, ends, and outer portions of toes. Corns are our body’s response to chronic friction and pressure. The response is to build up skin to protect the area of friction. Often times, an underlying section of bone beneath the corn is the culprit. As the skin builds up so does the pressure and pain to the area. III fitted shoes, abnormal toe structure, and arthritic conditions are common causes of these annoying lesions.

Diabetic Feet

What is it?
Diabetes is a disorder that affects many people in our society. Diabetes mellitus is a condition in which the body is unable to transport sugar from the blood to the cells. People who suffer from this disease cannot produce or use insulin, which is necessary to keep the sugar under control. Many sufferers of this disease will complain of constantly being thirsty, hungry, and frequently having to urinate. Diabetic patients often have problems with their circulation, which can result in foot pain, and problems. If this disease is not identified and goes untreated, it can lead to severe health issues and occasionally death. This disease process can affect your kidneys, eyes, sense of feeling in your feet and the circulation to the foot.

EPAT Therapy

Your heel not only supports the weight of your body, but it also absorbs the impact each time your foot hits the ground and helps to spring you forward with every step you take. Although your heel can handle heavy loads, too much stress can lead to problems.
What is the most common source of heel pain?
Pain under the heel is frequently associated with plantar fasciopathy. This condition affects the band of connective tissue that runs along the bottom of the foot from the heel to the base of the toes. According to statistics, plantar fasciopathy affects 1 in 10 people at some point during their lifetime. In the United States alone, more than two million people receive treatment for this painful condition.

Flat Feet

What are they?
A flat foot condition exists when there is a marked flattening or lowering of the longitudinal arch. The foot actually appears collapsed in the midsection area and during walking or standing. It seems rolled-in so that the inside of the foot contacts the ground. These patients will frequently complain of wearing out or breaking down their shoes rapidly because of the foot position. Common symptoms or complaints from patients with flat feet include fatigue, cramping, bunions, corns, calluses, shin splints and heel pain. It should be noted however, that not all flat feet are problems, nor do they all require treatment. Pain should be the number one motivating force to seek treatment. Congenital flat feet or those present at birth frequently are not clinical problems while those developed over time often need additional consideration. Particular concerns are those feet that have a normal appearing arch during non-weight bearing periods but assume a more flattened appearance during standing. These feet are frequently excessively pronating or rolling-in at the arch and are the ones that most often produce clinical symptoms.

Foot Odor

The topic of foot odor is obviously a personal and sensitive subject. Rarely is it the primary discussion at an evening party and when brought up between close friends, only occasionally does it receive more than a bashful grin. But in all seriousness, offensive foot odors can be a real problem. For many so afflicted, it is common to ignore the condition or accept is as one would hair loss or freckles. However, it should be emphasized that this condition is very treatable. Professional care is available to treat the cause and effects of foot odor. In the majority of cases, a successful resolution of the problem is readily attainable.

Foot odor in general, is usually a manifestation of excessive perspiration. For many, the hands and feet are frequent sites of pooling with resultant wet areas and occasional skin discoloration. Thus, our first line of attack in treating this problem is to effectively reduce or minimize excessive perspiration. An attempt is made to limit the use of nylon stockings and socks which traditionally promote perspiration. Shoes should be changed rather frequently and the use of breathable leathers as opposed to the more occlusive synthetic shoe materials is encouraged. Topical applications, soaks, and occasional oral medications are given for the purpose of reducing the output of perspiration.

Perhaps the most important factor involved in this condition is the chemical make-up of perspiration itself, for it is this factor indeed, which causes odor. The old saying, "You are what you eat," certainly applies in this case. Dietary intake modifications are essential in order to affect the end result. Obviously, garlic, onions and other higher spiced foods must be greatly reduced until the condition is well under control. It is important to keep in mind that an offensive foot odor is a treatable condition, and once the causative factor is identified, one that can usually be remedied.

Fungal Nails

What are they?
Not all discolored, thickened, or deformed nail plates are due to fungus infections. Indeed, many are due to trauma, congenital (birth) changes and other conditions such as drug use, high fever ailments and circulatory problems. The actual fungus nail itself is one that is diagnosed through clinical cultures and identification of the involved organism. It is usually a thickened and yellowish-brown discolored nail plate surface. In most cases, the infection starts at the end of the toenail and progressively involves the remainder of the plate. The vast majority of fungus nails are asymptomatic or painless and for many, are more of a cosmetic problem than anything else. Most authorities agree that fungus nails are not contagious between people but a progressive involvement from one toe to another is still a confusing issue for many.

Gout

What is it?
Gout is a disorder that involves elevated levels of uric acid in the blood. The crystals from the uric acid then settle from the blood stream into various joints of the body, and most commonly, the big toe joint. Gout is a chronic disease that begins with recurring attacks. When an attack develops, it can last several days and the joint becomes swollen, red and extremely painful. Patients often complain of not being able to tolerate a sheet resting on their big toes or other parts of their feet such as their heels or even their ankles. The foot is commonly affected because it is subjected to continued pressure in walking, increased exposure to trauma and its greater tendency for anatomic blood pooling to occur.

Acute Gout Attack

What is it?
An acute gout attack is an inflammatory process that occurs in a joint secondary to a high concentration of uric acid in the blood. It is most commonly seen in the middle age, elderly and is much more common in men. It can occur in any joint in the body but is most commonly seen in the big toe joint followed by the knee and the ankle. It is extremely painful and is characterized by a red, hot, swollen joint. Patients who are undergoing acute gout attacks are usually in extreme pain and find it most difficult to even bear weight during normal walking. Sometimes just the touch of the bed sheets over the area can illicit a great deal of pain.

High Arches

Definition
A high arched foot is one where there is a marked elevation of the longitudinal arch both on and off weight bearing. This type of foot by itself is usually not a problem but tends to cause other difficulties, which frequently require treatment. For instance, the high arched foot creates excessive pressure on the ball of the foot and frequently produces thick and uncomfortable calluses. Hammertoes are also common with this foot type, which may cause problems with certain shoes. In addition, the high arched foot is notoriously known as a poor shock absorber, frequently resulting in discomfort and bursitis in the heel.

Ingrown Nails

What are they?
Ingrown toenails are one of the most common conditions we see in our office. The problem is just what its name implies. The nail plate is too large for the under covering or bed and one or both sides are pressing into the skin. Ingrown nails can result from several possible causes such as improper cutting, abnormal nail structure and localized injury to the plate. The appearance of the toe involved may range from a sensitive redness and slight inflammation to a full-blown infection of the toe with pus and bleeding usually evident. The object of course, is to prevent the infectious stage from taking place and to remedy the problem earlier in its development.

Laser Treatment for Toenail Fungus

The laser is a treatment for nail fungus and is a safe in-office procedure which can restore the normal appearance of your nails. The laser is non-invasive with little to no pain during treatment. The patient can resume normal activity immediately after treatment.

Fungal nail infections are very common in adults and account for nearly half of all nail disorders. Technically known as onychomycosis, fungal nail infections can affect both your fingernails and toenails, but are most frequently seen in the toes. While the infection is a slow-growing one, a nail fungus can eventually cause the overlying nail to discolor, thicken, change texture, become increasingly brittle, break and even detach from the nail bed.

Left untreated an increasingly disfigured toenail can cause discomfort and irritation, especially while wearing shoes or walking. Not only that, fungal nail infections can spread to the other nails. If a diseased toenail breaks, it can also pierce the skin thereby allowing bacteria to enter, which can lead to a more serious type of infection. This is especially dangerous for individuals who have diabetes or a compromised immune system.

For all of these reasons, it is a good idea to give our office a call at the first sign of any discoloration, thickening or deformity of your toenails. Although a fungal nail infection can often be identified by its appearance, other conditions can produce a similar look, and an accurate diagnosis is essential for proper care. One thing is for certain; you can rest assured that our office will consider every aspect of your case in determining the best approach to care. Furthermore, we offer the most effective methods of care including the latest generations of topically applied medications, oral antifungal drugs, laser and surgical procedures.

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Orthotics

Neuromas

What are they?
Neuromas are nerve irritations that involve typically an enlarged or swollen segment of the nerve itself. In some cases, these neuromas can actually resemble a small grape in size and can cause significant discomfort to the patient. The individual with such an affliction will often complain of numbness, tingling, and/or burning sensations, which radiates into or involves two adjacent toes. Sometimes neuromas can be exquisitely painful. Most patients relate having to remove the shoe and rub their feet. In most cases, the neuroma will be located between the third and fourth digits of one foot with burning sensation involving the bottom of the metatarsal fat pad and the two involved toes. A second commonly involved site is between the second and third toes of the foot. The typical neuroma usually does not have redness, heat, swelling, or any apparent range of motion loss. Pressure on the bottom of the foot with manipulation of the involved digits will frequently produce the painful symptoms. Neuromas, generally speaking, do not go away on their own but usually require some form of professional care.

Neuropathy

What is it?
Neuropathy is a condition that affects the nerves in the body. Each nerve has a special covering and when that covering is damaged, the nerve doesn't function normally. A "tingling" sensation or a feeling of "pins and needles" may be a warning sign to the patient that their nerves are functioning abnormally. When the condition of neuropathy worsens, the patient may lose complete feeling in different parts of their body. Most commonly, neuropathy tends to affect the hands and feet. When the hands and feet become neuropathic, it is very difficult for one to carry out their activities of daily living.

Orthotics

What are they?
Foot orthotics are supportive devices that are designed specifically for the purpose of controlling foot motion, improving one's postural stability, reducing shock impact, and/or improving weight distribution. In most cases, these devices are functional in the sense that they also improve one's biomechanical performance during gait. A plaster impression is taken of your feet and used in the selection and fitting of a prescription orthotic. The particular information regarding anticipated cost, durability and use may vary depending upon the type of orthotic and should be discussed with your foot specialist.

Osteomyelitis

What is it?
Osteomyelitis is an infection of the bone. In order for the bone to become infected, a pathogenic or infection producing organism must gain access to the involved site. There are two basic types of osteomyelitis; acute and chronic. Acute osteomyelitis is one in which there is an "active" infection. The skin surrounding the wound is usually red, warm, swollen, and frequently has a foul smelling discharge from the wound site. Chronic osteomyelitis is just how it sounds; "a chronic or long-standing infection". The difference between acute and chronic osteomyelitis is that the acute form shows the traditional clinical signs of infection where the chronic form usually does not. Chronic osteomyelitis frequently involves exposed bone. However, the redness, heat, swelling, and malodorous drainage is usually not present.

Plantar Fasciitis

What is it?
Plantar fasciitis involves a localized swelling, irritation, and/or bursitis of the thickened fibrous bands supporting the bottom of one's foot. These tendon like bands run length wise from underneath the heel and fan out into the metatarsal heads or fat pad area of the foot. In most cases, painful symptoms arise at or near the point at which the bands are attached to the heel. When a person stands, these fibrous bands stretch and elongate under the pressure and pull on the heel. Eventually, a heel spur or calcium deposit may actually form in response to this constant pulling. Many of the patients who have this condition seem to have a similar presentation. There is frequently pain upon rising out of bed in the morning. The first few steps are excruciating but reduce quickly in their intensity. Later in the day, the individual with plantar fasciitis will notice pain after sitting and then getting up again. The pain is mostly localized to the heel and arch areas with occasional radiation of discomfort up the back of the leg. Well-padded shoes are helpful but rarely rectify the condition.

Plantar Warts

What are they?

Warts are one of the most misunderstood foot conditions. Usually, these lesions are non-contagious but can spread within the involved area of the same individual. In actuality, warts are encapsulated or walled off growths of viral tissue. Plantar warts on the feet are frequently painful with squeezing type pressure. In the vast majority of cases, the growth of a wart is preceded by some sort of skin puncture, wound defect or breakdown in the normal skins defense barrier that in all probability, allows an entry site for contamination. A lot of patients report getting warts after showering in a public place or at the swimming pool. Keeping the foot moist is one of the ways that the skin breaks down making us susceptible to warts. Once the wart makes a home in our skin it can spread to other parts of our foot. Whether we all have inactive or potential wart viruses circulating in our bodies or gain the virus through the wound is as of yet unclear.

An interesting and often confusing distinction must be made between certain calluses and plantar warts. Skin lines or striations can be seen passing through callus tissue whereas they will pass around a wart. Painful calluses in the ball of the foot are the commonly misdiagnose as warts. In addition, plantar warts, upon close examination, will often demonstrate small black dots which when trimmed will bleed. These are tiny blood vessels, which become caught in the growth itself and are absent in regular callus tissue. A final line of distinction in identifying a wart is in its response to pressure. Squeezing a wart will usually produce extreme pain as opposed to similar pain from direct pressure on calluses.

Stress Fractures

What are they?
As the name implies, a stress fracture is a break in the bone, which results from cumulative and/or repetitive strain to a particular site. These fractures are most commonly seen affecting the long bones or metatarsals of the foot. More specifically, they seem to involve most often, the three middle metatarsals with the second metatarsal being to most common. Pain in varying degrees is usually the chief complaint and it may or may not be accompanied by swelling and discoloration. A lump or soft tissue enlargement is frequently present over the site involved. Stress fractures are often problems because of their tendency to be missed or neglected. In most cases of metatarsal stress fractures, the actual bone break does not show on a regular x-ray for about ten days to two weeks from its onset. These fractures should be identified as soon as possible and properly managed by a specialist in order to insure a good result and prevent unnecessary disability.

Toe Fractures

Definition and Cause
Few injuries to the foot produce more pain than that of a fractured or broken toe. The mechanism or cause of a toe fracture seems embarrassingly obvious yet seemingly unavoidable. A sudden blow or stubbing of a toe against a heavy non-yielding object, an impact injury involving something dropping on top of a toe or that common injury of catching a small toe on the leg of a piece of furniture in your bedroom can each cause a fracture. The toe hurts high on the pain scale, swells and turns reddish pink, and after a day or so takes on a bluish bruised type of discoloration. If these signs are present and you just don't want to move that toe, then the chances are that you have a fracture.

Ulcers

What are they?
An ulceration is an absence of or defect in the normal lining of the skin layers (epidermis and dermis). In a sense, an ulceration is a hole or cavity in the skin that may be wet or dry and potentially, very resistive to healing. Patients with diabetes, poor circulation and those that are bedridden may have increased tendencies to develop ulcerations. The symptom level, clinical appearance, and response to therapy are largely dependent upon the type and location of the ulceration and the health of patient.