Podiatry Articles

The following podiatry articles are approved and provided by the American College of Foot and Ankle Surgeons. The official podiatry sources are listed below each article.

Arch Pain

Foot pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as “arch pain.” Although this description is non-specific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as plantar fasciitis and is sometimes associated with a heel spur.

In most cases, arch pain develops from overuse, unsupportive shoes, weight gain, or acute injury. If arch pain persists beyond a few days, see a foot and ankle surgeon for treatment to prevent this condition from becoming worse.

http://footphysicians.com/what-is/ns_arch-pain.htm

Athlete’s Foot

Athlete’s foot is a skin infection caused by fungus. A fungal infection may occur on any part of the body; on the foot it is called athlete’s foot, or tinea pedis. Fungus commonly attacks the feet because it thrives in a dark, moist, warm environment such as a shoe.

Fungal infections are more common in warm weather when feet tend to sweat more. Fungus thrives in damp areas such as swimming pools, showers, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is commonly found, thus the term “athlete’s foot.”

Athlete’s foot usually produces itchy, dry, scaling skin. It is commonly seen on the soles of the feet and in between the toes. In advanced cases, inflammation, cracks, and blisters may form; an infection caused by bacteria can also result. The fungus can spread to other areas of the body, including toenails.

Avoiding walking barefoot combined with good foot hygiene can help reduce the spread of the fungus. Feet should be washed every day with soap and water and thoroughly dried, including between the toes. Feet should be kept as dry as possible. If your feet sweat a lot you may need to change your socks during the day. Anti-fungal powders, sprays, and/or creams are often utilized to treat athlete’s foot. Your foot and ankle surgeon will recommend the best treatment for you.

http://footphysicians.com/what-is/ns_athletes-foot.htm

Bunions (Hallux Abducto Valgus)

Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

What is a Bunion?

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Causes
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.

Although wearing shoes that crowd the toes won’t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.

Symptoms
Symptoms, which occur at the site of the bunion, may include:

Pain or soreness
Inflammation and redness
A burning sensation
Possible numbness

Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Diagnosis
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, the foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.

Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.

Non-Surgical Treatment
Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays by your surgeon are advised.

In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These include:

Changes in shoewear. Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
Padding. Pads placed over the area of the bunion can help minimize pain. These can be obtained from your surgeon or purchased at a drug store.
Activity modifications. Avoid activity that causes bunion pain, including standing for long periods of time.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
Icing. Applying an ice pack several times a day helps reduce inflammation and pain.
Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
Orthotic devices. In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.

When Is Surgery Needed?
If non-surgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with a foot and ankle surgeon. Together you can decide if surgery is best for you.

A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain.

In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

http://footphysicians.com/footankleinfo/bunions.htm

Callus

A callus is a thickened area of skin on the foot caused by pressure and repeated rubbing, such as from a shoe or sock. The rubbing causes the skin to produce a layer of protective skin (a callus). Calluses vary in size, and can become painful.

There are a number of treatments for painful calluses. People who have calluses are cautioned against performing “bathroom surgery,” as this can lead to cuts and infection. A foot and ankle surgeon can evaluate the cause of the calluses and recommend the treatment most appropriate for your condition. However, if the underlying cause of the callus is not treated or removed, the callus may return.

http://footphysicians.com/what-is/ns_callus.htm

Corns

A “corn” is a small circular thickened lesion in the skin of the foot. It usually forms due to repeated pressure on the skin, such as the rubbing of a shoe. The name “corn” comes from its resemblance to a kernel of corn. A corn is different from a callus in that it has a central core of hard material.

People with foot deformities, such as hammertoes, often suffer from corns because the tops of the bent toes rub against the tops of shoes.

There are a number of treatment options for corns. When corns get hard enough to cause pain, a foot and ankle surgeon will recommend the treatment option most appropriate for you. However, if the underlying cause of the corn is not treated or removed, the corn may return. It is important to avoid trying to remove a corn at home or using medicated corn pads, as serious infection may occur.

To learn more, listen to the Corns and Hammertoes podcast.

http://footphysicians.com/what-is/ns_corns.htm

Flexible Flatfoot

What Is Flatfoot?
Flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common: partial or total collapse (loss) of the arch.

Other characteristics shared by most types of flatfoot include:

“Toe drift,” in which the toes and front part of the foot point outward
The heel tilts toward the outside and the ankle appears to turn in
A tight Achilles tendon, which causes the heel to lift off the ground earlier when walking and may make the problem worse
Bunions and hammertoes may develop as a result of a flatfoot.

Flexible Flatfoot
Flexible flatfoot is one of the most common types of flatfoot. It typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.

The term “flexible” means that while the foot is flat when standing (weight-bearing), the arch returns when not standing.

Symptoms
Symptoms, which may occur in some persons with flexible flatfoot, include:

Pain in the heel, arch, ankle, or along the outside of the foot
“Rolled-in” ankle (over-pronation)
Pain along the shin bone (shin splint)
General aching or fatigue in the foot or leg
Low back, hip or knee pain.

Diagnosis
In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when you stand and sit. X-rays are usually taken to determine the severity of the disorder. If you are diagnosed with flexible flatfoot but you don’t have any symptoms, your surgeon will explain what you might expect in the future.

Non-surgical Treatment
If you experience symptoms with flexible flatfoot, the surgeon may recommend non-surgical treatment options, including:

Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
Orthotic devices. Your foot and ankle surgeon can provide you with custom orthotic devices for your shoes to give more support to the arches.
Immobilization. In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot.

When is Surgery Necessary?
In some patients whose pain is not adequately relieved by other treatments, surgery may be considered. A variety of surgical techniques is available to correct flexible flatfoot, and one or a combination of procedures may be required to relieve the symptoms and improve foot function.

http://footphysicians.com/footankleinfo/flatfoot.htm

Heel Pain (Plantar Fasciitis)

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.

What Is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Causes
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

Symptoms
The symptoms of plantar fasciitis are:

Pain on the bottom of the heel
Pain that is usually worse upon arising
Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.

Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non-Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
Ice. Putting an ice pack on your heel for 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 non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

When Is Surgery Needed?
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.

Long-term Care
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

http://footphysicians.com/footankleinfo/heel-pain.htm

Nail Fungus

A fungus is an organism that lives in warm moist areas. Fungus of the toenails is a common problem that can affect people of all ages, although it most commonly affects individuals who are older.

Toenail fungus often begins as an infection in the skin called tinea pedis (also known as athlete’s foot). The fungus often starts under the nail fold at the end of the nail. Over time it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.

Many people have difficulty with their toenails and need assistance in caring for them. A foot and ankle surgeon can diagnose the cause of toenail problems and recommend treatments.

http://footphysicians.com/what-is/nail-fungus.htm