COMMON CONDITIONS

The heel bone is the largest bone in the foot and bears all the body’s weight every time you make a step.  The stress on it is tremendous.  Painful heels and heel spur syndrome are usually secondary to biomechanical faults.  These faults: flexible flat feet, high arched foot deformities and tight Achilles tendon cause a great amount of stress on the plantar fascia.

Heel Spurs

Symptoms: Sharp pain on the bottom of your heel when walking.

Cause: Often accompanies plantar fasciitis and is a result of repeated tearing away of the membrane that is attached to the heel bone, resulting in the development of a bony protrusion (spur).

Plantar Fasciitis

Symptoms: Pain in the heel and arch is most severe in the morning or after sitting for a long time and decreases with activity.

Causes:  Inflammation of the band of fibrous connective tissue on the bottom of the foot that is usually caused by excessive pronation (rolling in of the foot and ankle) and poor fitting shoes.  This is the most common type of heel pain.

Treatment: We offer our patients a new technology for Heel Spurs and Plantar Fasciitis: EXTRACORPOREAL SHOCK WAVE THERAPY, (link to ESWT page) a non-invasive, non-surgical treatment that is safe and as effective as surgery.  It reduces inflammation and stimulates a healing response in the injured tissue. Other options include: orthotics, surgery, or appropriate pain medication.

Achilles Tendonitis

Symptoms:  Pain at the back and slightly above the heel with or without a bump. Pain can radiate into the ankle area and may be sharp when walking.

Cause:  Inflammation of the Achilles tendon usually caused by overuse that results in the fibers being torn or stretched.

Treatment:  Rest, ice, anti-inflammatory medication for acute pain and daily stretching. Orthotics may help.

Haglund’s Deformity

Symptoms:  A painful reddish bump (bony growth under the skin) on the back of your heel, in the area where the Achilles tendon attaches to the bone.

Cause:  Repeated pressure from poorly fitted or constructed shoes.

Treatment:  Avoid shoes that irritate your heel area. Wear supportive backless shoes or ones with a low back, but not flip-flops. You may see a reduction in the swelling of the area, but the bony growth will not go away, so taking care in future selection of shoes must be a priority. Surgical correction may be an option.

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ARCH PAIN

The arch of the foot has been referred to as the perfect architectural structure to provide support and shock absorption.  Knowing the type of arch you have should influence the type of shoes you wear.  A high or low arch can also predispose you to certain types of injury.   One out of every three people has a high or low arch that could be problematic.

Flat Feet

Symptoms: Pain after long periods of standing and difficulty standing on the tiptoes of the affected foot.  Your foot aches, particularly in the heel or arch area, and you may have swelling along the inner side.  Lower-back pain may accompany these foot symptoms.

Causes: Heredity and severe cases of diabetes, arthritis or injury to muscles and tendons of the foot.

Treatment:  Having flat feet is a serious matter.  If you are experiencing pain and think it is related to flat feet, you should come in for a podiatric examination, gait analysis, and possibly x-rays to determine if orthotics or surgery would be helpful.

High Arch

Symptoms: Rigid bony foot that is hard to fit into shoes.  You are prone to ankle sprains or twisted ankles.  You may experience generalized pain in the following areas: under the ball of the foot, the top of the instep, and your heel area.

Causes: Heredity.

Treatment: Wear shoes with a deep toe box that provide lots of cushioning and support.  Avoid very rigid shoes.  Orthotics may help some people.  However, surgery may be necessary in severe cases.

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TOES AND BALL OF FOOT PAIN

Thanks to cramped and high-heeled shoes, as well as fungal infections, the front part of the foot is a popular target for many foot conditions.

Hammertoe

Symptoms: One or more toes are permanently bent at the first joint.  It may be painful to wear shoes and corns may develop on these toes.

Causes:  Usually due to muscle imbalance.  Tight shoes, high heels, and nylons that squeeze the toes can aggravate it.  Heredity and arthritis can also be factors.

Treatment: Wear shoes with lots of toe room.  Avoid wearing high heels.  Hammertoe pads available at drugstores can help reduce pressure.  Ice can ease acute pain.  Treatment options include taping and padding, custom orthotic devices and/or corrective surgery.

Bunion

Symptoms:  A painful enlargement at the joint of the big toe. The joint may be swollen and tender.

Causes: The joint becomes misaligned due to heredity, abnormal motion, and pressure over the joint due to poor foot mechanics while walking, poorly fitted or poorly constructed shoes, arthritis or a combination of these.

Treatment:  Wear shoes with wide toe boxes and good support to avoid putting extra pressure on the bunion. Apply ice and take anti-inflammatories for temporary relief of acute pain. If pain is interfering with daily activities, we recommend an x-ray to determine if orthotics and/or corrective surgery are necessary.

Morton’s Neuroma
 
Symptoms:  Burning pain in the toes; may also be in the ball of the foot.  Pain generally gets worse when wearing shoes or walking.

Causes:  Enlarged benign growth of nerves, most often between the third and fourth toes, due to irritation or pressure from shoes.

Treatment:  Avoid high heels and tight shoes; wear shoes with a wide toe area, low heels, and a soft sole.  Consider shoe inserts or orthotics.  We will show you how to properly tape and pad the area.  If pain interferes with daily activities we recommend corticosteroid injections to reduce the swelling and inflammation.

Nail Fungus
 
Symptoms:  Yellow discolored and thickened toenails; may also have white marks.  May be painful when wearing shoes.  Can also have a foul smell.

Causes:  Fungal infection beneath the surface of the nail resulting from contact with microscopic fungi in the environment, especially in damp areas where people walk barefoot (showers, locker rooms, swimming pools).  Easily spread by sharing nail clippers with an infected person.  Often starts in the skin as athlete’s foot.

Treatment:  Varies depending on severity.  Daily cleansing over many months and following the hygiene tips listed on our “Foot Basics” page may relieve or suppress mild infections.  You can also try tea tree oil (found in health food stores).  Over-the-counter topical creams for nail fungus (available in pharmacies) are safe and may help.  The infection is best treated with oral medication and a prescribed topical therapy.  If nails are thick enough to be painful, you should make an appointment to discuss removal of the nail, laser treatment and medications.

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SKIN CONDITIONS OF THE FOOT

Most of the time, our feet are like mushrooms, stuck in dark, moist places, making them susceptible to all sorts of bacteria, fungi or irritation.

Corns and Calluses

Symptoms:  Raised bumps or ridges of compacted dead skin cells.  Corns are usually found on the top or sides of toes, and calluses on the soles of feet.  Friction and pressure from shoes can burn or be painful.

Causes:  Repeated friction and pressure from poorly fitting shoes or from rubbing against an irregularity in the shoe.  Can also be caused by friction from skin rubbing against bony areas of the foot during repeated activity such as walking or running.

Treatment: Laser is used in the office or the hospital for skin disorders such as seed corns and warts.

Warts
 
Symptoms:  Can occur anywhere on the foot.  Those on the bottom are called plantar warts and look similar to calluses but have one or more tiny black pinpoints and can feel like you are walking on a pebble.

Cause:  A virus that is usually picked up in moist places such as public pools.  It can be spread from person to person.

Treatment:  May disappear on their own or by using an over-the- counter treatment containing salicylic acid.  For stubborn painful warts, make an appointment to discuss laser treatments, surgical removal or freezing of the warts.

Athlete’s Foot

Symptoms:  Dry scaly skin, itching, inflammation and small blisters, usually on the bottom of the foot and between the toes.

Cause: Fungus that breeds in warm, dark, moist places such as feet that perspire heavily and shoes that don’t get aired out.  Can also be in public places, such as gyms and pool locker and shower rooms.

Treatment:  Use an over-the-counter anti-fungal cream.  If you don’t get relief within two weeks, come in and we’ll prescribe a prescription anti-fungal.  Powders work best between toes; creams work better on exposed skin.  You can also try tea tree oil.

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DIABETIC FOOT CARE

We offer a special program for diabetics of all ages. Our exams are comprehensive, informational and continually monitored. We have a multidisciplinary approach with internists, neurologists, dieticians and orthopedic involvement.

Like all diabetics, you should monitor your feet. If you don't, the consequences can be severe, including amputation, or worse.

Minor injuries become major emergencies before you know it. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases your blood flow, so your injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly.

If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Feel each foot for swelling. Examine between your toes. Check six major locations on the bottom of each foot: The tip of the big toe, base of the little toes, base of the middle toes, heel, outside edge of the foot and across the ball of the foot. Check for sensation in each foot.

If you find any injury -- no matter how slight -- don't try to treat it yourself. Go to a doctor right away.

Diabetic Foot Deformities

When your feet lose their feeling, they are at risk for becoming deformed. One way this happens is through arthritis. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. The shape of your foot warps as your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt.  In addition, open sores from friction may form ulcers that can become infected.

A doctor may treat your diabetic foot ulcers and early phases of Charcot fractures with a total contact cast or a custom-walking boot. Surgery is considered if your deformity is too severe for a brace or shoe.

DOS

• Inspect your feet daily for blisters, cuts and scratches. Always check between your toes.
• Wash your feet daily. Dry carefully.
• Avoid extreme temperatures. Test water with your hands or elbow before bathing.
• If your feet feel cold at night, wear socks.
• Inspect the insides of your shoes daily for foreign objects and rough areas.
• For dry feet, use a very thin coat of lubricating oil such as baby oil.  Apply this after bathing and drying your feet.
• Shoes should be fitted by a foot care specialist and be comfortable at the time of purchase.
• See your family doctor regularly and be sure to have your feet examined at each visit.

DON’TS

• Do not smoke.
• Do not soak your feet in hot water.
• Do not walk on hot surfaces such as sandy beaches or on the cement around swimming pools.
• Do not walk barefooted.
• Do not use chemical agents for the removal of corns and calluses.
• Do not wear mended stockings and avoid stockings with seams.
• Do not use oil or cream between your toes.
• Do not wear sandals with thongs between the toes.
• Do not cut corns or calluses; see your podiatrist.
• Do not cross your legs. This can cause pressure on the nerves and blood vessels.

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