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Prism Podiatry is now Modern Foot & Ankle.

Click on a podiatric condition to learn about its causes and symptoms and the different ways we can treat it.

The Achilles tendon is the largest tendon in the body, connecting your heel bone to large muscles in your calf. The Achilles tendon is responsible for extending your foot. This tendon is very important for pushing off the ground when walking, running, and playing sports. Because it is such an important tendon, it can easily be damaged or injured.

Causes of Achilles Pain

Achilles pain can be caused by

  • Injury (e.g., increasing your activity too quickly over a short period of time.)
  • Over-use
  • Improper stretching prior to exertion
  • Incorrect form during physical activity
  • Pre-existing foot issues (e.g., flat feet or high arches)
  • Chronic high heel wearers

Symptoms

Pain is the most prominent symptom of an Achilles injury. The pain will be most noticeable when you try to move the foot down against resistance. The involved tendon may also swell. The pain may come and go or gradually get worse over time.

More severe injuries can occur to this tendon. Often people might hear a pop or a snap while playing sports in their Achilles tendon. This could indicate a possible rupture of the tendon and needs immediate attention.

Types of Achilles Injuries

Achilles Tendonitis

Literally meaning “inflammation of the Achilles tendon,” Achilles tendonitis is a type of injury that often causes soreness or stiffness in the Achilles tendon, located about 1-2cm above your heel bone. Sometimes the pain can radiate or originate right behind the heel bone. Icing and resting the area can often help treat this area; however, if you notice the pain getting worse, it is best to seek treatment with us as soon as possible.

Achilles bone spur

Bone spurs are the result of excess bone formation. Often these spurs, when formed on the back of the heel bone, can cause significant pain to the Achilles tendon. Bone spurs can cause worsening pain and are often a progressive problem. Left untreated, these bone spurs can cause tears or ruptures to the Achilles tendon.

Achilles Tendon tear/rupture

A common injury amongst “weekend warriors,” a partial or complete tear or rupture of the Achilles tendon is the result of the sudden stretching of it. People who experience Achilles tendon ruptures often say they heard a large pop and thought someone had stepped on the back of their shoe. These types of injuries can cause long-term pain and deformity, and immediate care is often required.

When You Should Seek Care with Us:

If the pain doesn't go away with ice and rest, or if the pain persists beyond a week, you must schedule an appointment with our physician immediately. Remember that time is of the essence; effectively treating these injuries is imperative to preventing long-term sequelae.

Types of Treatment We Offer:

Conservative Therapy:

Rest—Rest the affected area. Stay off the injured foot or ankle to prevent further injury. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.

Ice—Apply ice to the affected area and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace wrap) around the affected foot or ankle.

Elevation—Elevate the affected extremity on a stack of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

Immobilization—A CAM immobilization boot may be dispensed to prevent movement of the ankle joint, which aids in healing.

Bracing—Sometimes wearing an ankle brace for weeks to months after the injury can help long-term healing and prevent re-injury

Physical Therapy—Physical therapy can assist in healing the ankle joint and prevent re-injury.

Custom-Molded Orthotics—The control of foot functions with shoe inserts (i.e., orthotics) may be recommended to restrict motion and reduce pain.

Minimally-Invasive Therapies:

Amniotic Membrane Injection Therapy

Platelet-rich plasma injections

Topaz ablation

Surgical Therapies:

Typically, Achilles tendon pathologies (with the exception of ruptures) do not require surgical intervention; however, scar tissue, as a result of chronic inflammation, may be the cause of your pain. Removing (debriding) the scar tissue may be recommended.

Complete ruptures of the Achilles tendon often require surgical intervention to reattach the tendon. Patients are often required to stay off their surgically-repaired foot for several weeks to allow the tissue to heal.

The ankle joint consists of the tibia, fibula, and talus. If one of these bones is broken, it is considered an ankle fracture. Fracture of the ankle bones can be the result of almost any type of trauma to the lower extremity. Common causes include sports injuries, tripping or falling, and car accidents. Often people injure their ankle and do not seek treatment as they think their injury is not serious enough to warrant care. This delay in treatment can cause problems in the ankle joint months to years later.

 

Causes of Ankle Fractures:

  • Twisting or rolling your ankle
  • Car accident
  • Fall from high height
  • Tripping or stumbling
 

Symptoms:

  • Pain, sometimes very severe.
  • Swelling
  • Bruising
  • Deformity to the ankle
  • Inability to bear weight
 

When You Should Seek Care With Us:

If you notice a deformity to the ankle after the injury, you need to see a medical professional immediately. If no deformity is noted and the pain doesn't go away with ice and rest, or if the pain persists beyond a few days, you must schedule an appointment with our physician immediately. Remember that time is of the essence; effectively treating these injuries is imperative to preventing long-term issues with the ankle joint.

 

Types of Treatment We Offer:

 

Conservative Therapy:

Some ankle fractures can be treated conservatively, if there is no significant deformity or malalignment of the ankle joint.

Rest—Rest the affected area. Stay off the injured foot or ankle to prevent injury. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.

Ice—Apply ice to the affected area and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace wrap) around the affected foot or ankle.

Elevation—Elevate the affected extremity on a stack of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

Immobilization—A CAM immobilization boot may be dispensed to prevent movement of the ankle joint. This aids in healing.

 

Surgical Therapies:

If the fracture is so severe that the ankle joint is out of alignment, surgery will be required. The purpose of this surgery is to correct the position of the bones to allow the ankle to heal appropriately. This surgery often involves the implantation of plates and screws to hold the fractured bones in place while they heal. Patients are often not permitted to put any weight on their surgically repaired ankle for 6-8 weeks.

The ankle joint consists of the tibia, fibula, and talus. Surrounding these bones are fibrous structures called joint capsule and ligaments. When these soft tissue structures are overstretched and injured, the result is an “ankle sprain.”  Common causes include sports injuries, tripping, or falling. Often people injure their ankle and do not seek treatment, thinking their injury is not serious enough to warrant care. This delay in treatment can cause problems in the ankle joint months to years later. It is always easier to treat lower extremity issues when they are new.

 

Causes of Ankle Sprains:

  • Twisting or rolling your ankle
  • Unstable ankles
  • Pre-existing foot deformity
  • Tripping or stumbling
  •  

    Symptoms:

  • Pain, sometimes very severe
  • Swelling
  • Bruising
  • Inability to bear weight
  • Unstable ankle weeks to months after injury
  •  

    When You Should Seek Care With Us:

    Ankle sprains are usually easily treated during the acute phase of the injury (i.e., within the first week or two). If the pain doesn't go away with ice and rest, or if the pain persists beyond a few days, you must schedule an appointment with our physician immediately. Remember that time is of the essence; effectively treating these injuries is imperative to preventing long-term issues with the ankle joint.

     

    Types of Treatment We Offer:

     

    Conservative Therapy:

    Ankle sprains respond very well to conservative therapy, which includes

    Rest—Rest the affected area. Stay off the injured foot or ankle to prevent injury. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.

    Ice—Applying ice to the affected area and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

    Compression—Wrapping an elastic bandage (such as an Ace wrap) around the affected foot or ankle to decrease swelling.

    Elevation—Elevate the affected extremity on a stack of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

    Immobilization—A CAM immobilization boot may be dispensed to prevent movement of the ankle joint, which aids in healing.

    Bracing—Sometimes wearing an ankle brace for weeks to months after the injury can help long-term healing and prevent re-injury

    Physical Therapy—Physical therapy can assist in healing the ankle joint and prevent re-injury.

     

    Surgical Intervention:

    In rare cases, surgical intervention may be required. These rare cases occur when the ligaments holding the ankle together are completely torn, causing the ankle joint to become very unstable. Surgery involves repairing those ligaments. Patients are often not permitted to put any weight on their surgically-repaired ankle for 6-8 weeks.

Arthritis is a condition that results in the degradation of a joint’s cartilage. Cartilage is the protective covering on the ends of the bones that make up a joint. When this cartilage wears down, the joint and bone become progressively more inflamed and swollen. Arthritis has numerous causes and can affect almost any bone in the body. Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.

 

Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted and there is no way to avoid the pain of the tremendous weight-bearing load on the feet.

 

Arthritis is a disabling and, occasionally, crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.

 

Causes of Arthritis:

  • Through injury and overactivity, notably in athletes and industrial workers. Previous injuries that have been ignored (which injuries of the feet tend to be) can often develop into arthritis. Arthritis as a result of “wear and tear” is often the most common reason for arthritic pain in the feet.
  • Through bacterial and viral infections that strike the joints. The same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
  • In conjunction with bowel disorders such as colitis and ileitis, frequently resulting in arthritic conditions in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from arthritis, but treating them can relieve arthritic pain.
  • The use of drugs, both prescription and illegal, can induce arthritis.
 

Types of Arthritis:

 

Osteoarthritis: Osteoarthritis is the most common form of arthritis in the feet. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Walking may become erratic. It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

 

Rheumatoid arthritis (RA): RA is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern—both ankles or the index fingers of both hands, for example. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men are to suffer from RA.

 

RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, which is marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute RA; however, the disease system has been known to be active for months or years, then abate, sometimes permanently.

 

Gout (gouty arthritis): Gout is a condition caused by a buildup of the salts of uric acid—a normal byproduct of the diet—in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women are, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.

 

Psoriatic arthritis: Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

 

Traumatic arthritis: Traumatic arthritis is a form of arthritis that is caused by blunt, penetrating, or repeated trauma or from forced inappropriate motion of a joint or ligament. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.

 

Symptoms:

  • Joint swelling, warmth, redness
  • Tenderness when stressing joint or applying weight on joint
  • Increased pain when rising after long periods of rest
  • Increased morning stiffness in joint
  • Limitation of motion at joint
 

When You Should Seek Care With Us:

People tend to come to see us for arthritic conditions when the pain in their affected joints does not get relieved with simple at-home remedies such as rest and anti-inflammatories. The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if possible. Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.

 

Types of Treatment We Offer:

Depending upon how severe the arthritic pain is determines how well a patient will be able to recover. Treatment ranges from non-invasive and conservative to surgical procedures.

 

Conservative Therapy:

Arthritis can respond very well to conservative therapy, if treated early

   

Rest—Rest the affected area. Stay off the foot to prevent pain. Walking, running, or playing sports on an injured foot or ankle may make the arthritic pain worse.

Anti-inflammatories—Both oral or injectable anti-inflammatory medications are very useful in treating arthritic conditions.

Ice—Apply ice to the affected area and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace wrap) around the affected foot or ankle to decrease swelling.

Elevation—Elevate the affected extremity on a stack of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

Immobilization—A CAM immobilization boot may be dispensed to prevent movement of the ankle joint. This aids in healing.

Bracing—Sometimes wearing an ankle brace for weeks to months after the injury can help long-term healing and decrease recurrences.

Physical Therapy-Physical therapy can assist in reducing inflammation and regaining mobility of the arthritic joint. Custom Molded-Orthotics—The control of foot functions with shoe inserts called orthotics may be recommended to restrict motion and reduce pain.

 

Surgical Intervention:

Surgical intervention is a last resort in arthritis, as it is with most disease conditions. Damaged joints can be replaced surgically with artificial joints. If the condition is severe, sometimes fusing the two bones together that make up the arthritic joint can eliminate all arthritic pain.

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment, which encourages fungal growth. Although many rashes look the same, they are not all caused by fungus. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.

 

Causes of Athlete’s Foot

  • Walking barefoot in public spaces
  • Wearing non-moisture wicking socks
  • Wearing shoes without socks
  • Barefoot walking at gyms and pools
  • Sharing spaces with someone who has had athlete’s foot

    Symptoms

    The signs of athlete's foot, singly or combined, include the following:

    • Dry skin
    • Itching and burning, which may increase as the infection spreads
    • Scaling and cracking
    • Inflammation
    • Blisters, which often lead to cracking of the skin. When blisters break, small, raw areas of tissue are exposed, causing pain and swelling.
     

    Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread through contaminated bed sheets or clothing to other parts of the body.

     

    When You Should Seek Care With Us:

    Although athlete’s foot is very common, it is often poorly treated and sometimes hard to cure. Diagnosis by our doctor is easy and can be done either clinically or via a non-invasive skin test. Prescription topical or oral antifungal therapies can then be prescribed.

     

    Types of Treatment We Offer:

    Our doctor will determine if a fungus is the cause of your problem. In minor cases, athlete’s foot can be treated with over-the-counter antifungal medications. In more severe cases, doctors may prescribe oral and/or topical antifungal medications. In either case, keep infected feet dry and clean.

A bone spur is a generic term for an outgrowth of bone that can occur on almost any bone in the body. Also called an osteophyte, bone spurs can form in any bone but are most commonly found in joints, where two or more bones come together. In the lower extremity, bone spurs often are formed on areas of heavy stress, such as the big toe joint or where large tendons and ligaments attach (e.g., the heel bone).

 

Causes:

  • Joint damage due to arthritis.
  • Trauma
  • Tendonitis
 

When You Should Seek Care With Us:

People tend to come to see us for bone spurs when the pain in their affected joints does not get relieved with simple at-home remedies, such as rest and anti-inflammatories. Sometimes the bone spur becomes so large and painful, it can cause micro-tears in the surrounding soft tissue. Bone spurs are a progressive problem, meaning they get worse with time. Typically, treating bone spurs early will allow for a more successful treatment outcome.

 

Symptoms:

  • Tenderness on the foot
  • Palpable bony mass or knot
  • Joint stiffness
  • Pain when walking
  • Swelling
  •  

    Types of Treatment We Offer:

    Bone spurs can typically treated with conservative and surgical options, depending on the severity of the pain associated with the spur and the extent of the spurring.

     

    Conservative Options:

    Custom Molded-Orthotics—provide cushioning and support to the spurred areas.

    Rest—Rest the affected area. Stay off of the foot to prevent pain. Walking, running, or playing sports may worsen the pain.

    Anti-inflammatory Medication—Both oral or injectable anti-inflammatory medications are very useful in treating bone spurs.

    Ice—Apply ice to the affected area and reapply it for 15–20 minutes every three or four hours for the first 48 hours after the injury. Ice can decrease inflammation associated with the spur.

    Elevation—Elevate the affected extremity on a stack of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

    Immobilization—A CAM immobilization boot may be dispensed to prevent movement of the affected joint. This aids in healing and decreases inflammation.

    Physical Therapy—Physical therapy can assist in reducing inflammation and regaining mobility of the spurred joint.

     

    Surgical Options:

    If conservative options do not work, surgery is a viable option to reduce or eliminate the pain associated with bone spurs. In cases of severe bone spurs, where surrounding soft tissue may be injured, the surgeon would excise the spur and repair any surrounding soft tissue injury.

    A bunion is a bump on the joint at the base of the big toe. Bunions form when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated; sometimes, arthritis can develop. The big toe joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A similar process can occur on the outside of the foot near the pinky toe. That deformity is called a bunionette.

     

    Causes

    Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability of the big toe joint, causing deformity. Below are some specific causes for this instability. Bunions can be caused by years of abnormal motion and pressure over the big toe joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk (also called biomechanics).

     

    Tight or Poorly-Fitting Shoe Gear—Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women. Heredity—Although bunions tend to run in families, it is the foot type that is passed down, not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type onto their children, who, in turn, are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

    Neuromuscular Conditions and Congenital Deformities

    Occupational Stress—Occupations that place undue stress on the feet are also a factor. Ballet dancers, for instance, often develop the condition.

     

    Symptoms

    The symptoms of a bunion include the following:

    • Development of a firm bump on the outside edge of the foot at the base of the big toe
    • Redness, swelling, or pain at or near the MTP joint
    • Corns or other irritations caused by the overlap of the first and second toes
    • Restricted or painful motion of the big toe
     

    When You Should Seek Care With Us?

    Like many foot problems, bunions are a progressive problem, meaning they get worse over time and tend to not resolve on their own. If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less and less of an option.

     

    Types of Treatment We Offer:

    Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.

     

    Conservative Options:

    It is important to remember that there is no non-surgical cure for bunions. The goal of conservative therapy for this condition is to reduce the progression of the deformity and symptoms. The only true way to remove the actual deformity is through surgical intervention. Some conservative measures to ease pain associated with bunions include:

    Padding and Taping—Often the first step in a treatment plan, padding the bunion minimizes pain and allows you to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain. Anti-Inflammatory Medication—Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.

    Corns and calluses are areas of thickened skin that develop on top of bony prominences to protect that area from irritation or excess rubbing. If the thickening of skin occurs on the bottom of the foot, it's called a callus. If it occurs on the top of the foot (or toe), it's called a corn. Corns and calluses are not contagious but can become painful if they get too thick. Sometimes these calluses can cause issues with the softer underlying skin, potentially causing ulcerations or wounds. In people with diabetes or decreased circulation, they can lead to more serious foot problems.

     

    Causes

    Corns often occur where a toe rubs against the interior of a shoe. Excessive pressure at the balls of the feet—common in women who regularly wear high heels—may cause calluses to develop on the balls of the feet. In addition, sometimes the fat pad on the bottom of our feet becomes thin, making the bones more prominent. This makes your foot susceptible to calluses. In addition, people with certain deformities of the foot, such as hammertoes or bunions, are prone to corns and calluses.

     

    Symptoms

    • Thick or rough area of skin
    • Hardened raised bump
    • Tenderness under the skin
    • Occasionally a wound or ulceration can form in the center of the corn
     

    When You Should Seek Care With Us:

    It is best to visit our office as soon as the corns or calluses cause pain and discomfort that inhibit your daily life.  People with diabetes, poor circulation, or other serious illnesses are at serious risk of developing more serious issues and should see our office for regular care for these lesions.

     

    Types of Treatment We Offer:

    Corns and calluses are usually diagnosed through simple clinical examination. Conservative measures are usually reserved for mild to moderate corns and calluses. More significant corns, caused by underlying bony deformities, may need surgical intervention.

     

    Conservative Therapy:

    Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

    Changing Shoe Gear—This helps take pressure off of the bony deformities and lessen the recurrence of the corns and calluses.

    Debridement—Larger corns and calluses can be reduced in size by using a blade to carefully shave away the thickened, dead skin—right in the office. The procedure is painless because the skin is already dead. Additional treatments may be needed if the corn or callus recurs.

     

    Surgical Options:

    For more significant corns and calluses, treating the underlying bony deformity by removing the excess bone can significantly help or permanently fix the corns and calluses.

    Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14-24% of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85% of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable. 

       

    A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.

     

    Regular diabetic check-ups by a podiatrist, with preventative trimming (debridement) of nails and calluses can significantly reduce the instances of lower extremity ulcerations and limb loss.

     

    Causes

    Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

     

    Ulcers form due to a combination of factors:

    • Lack of feeling in the foot
    • Poor circulation
    • Foot deformities
    • Irritation (such as friction or pressure)
    • Trauma or injury
    • Accidental cuts or abrasions as a result of attempting home nail and callus care
     

    Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. 

     

    Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body's ability to fight off a potential infection and also slow healing. 

     

    Symptoms

    Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage in your sock. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

     

    When You Should Seek Care With Us:

    The best way to treat a diabetic ulceration is to not get one in the first place. To do that, please attend regular check-ups at our office every 2-3 months for a foot examination, trimming of thickened nails and calluses, and a thorough examination of the sensation and circulation to the feet.

     

    Once an ulcer is noticed, you must visit our office immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce healthcare costs.

     

    Types of Treatment We Offer:

    The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing begins, the less chance for an infection. To do this, we use a multispecialty approach, making sure to align and coordinate our treatments with those of the other practitioners on the healthcare team, such as primary care doctors, endocrinologists, and nutritionists.

       

    There are several key factors in the appropriate treatment of a diabetic foot ulcer:

    • Prevention of infection
    • Taking the pressure off the area (off-loading)
    • Removing dead skin and tissue (debridement)
    • Applying medication or dressings to the ulcer
    • Managing blood glucose and other health problems
     

    Not all ulcers are infected. If it is determined that an infection may be present, however, a treatment program consisting of antibiotics, wound care, and, possibly, hospitalization will be necessary.

     

    For optimum healing, ulcers, especially those on the bottom of the foot, must be off-loaded.  You may be asked to wear special footgear, a brace, or specialized castings or use a wheelchair or crutches.  These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.

     

    Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline and betadine to cutting-edge modalities such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

     

    For a wound to heal, there must be adequate circulation to the ulcerated area, which means consultations with other physicians, such as vascular surgeons, may be necessary.

     

    Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.

     

    Surgical Options:

    A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or other bony bumps (exostoses).

     

    Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

    Flat Feet is a deformity characterized by a collapsing arch that comes into near or complete contact with the ground. Depending upon the extent of the fallen arches, the patient may experience anywhere from minimal to significant pain. This deformity can start at almost any age and can significantly limit the daily routine for the patient, if the deformity is severe. Fallen arches can sometimes result in pain “up the chain” to your knees, hips, and lower back, as a result of the asymmetry that develops.

     

    Causes:

    • Stretched or torn tendons
    • Obesity
    • Hereditary
    • Broken or dislocated bones
    • Damage or inflammation of the posterior tibial tendon (PTT), which connects from your lower leg, along your ankle, to the middle of the arch
    • Arthritic conditions
    • Nerve problems and nerve conditions
     

    Symptoms:

    Some people experience little to no pain; however, many people experience at least one of the following:

    • Feet tire easily
    • Painful or achy feet, especially in the areas of the arches and heels
    • The inside bottom of your feet become swollen
    • Foot movement, such as standing on your toes, is difficult
    • Back and leg pain
    •  

      When You Should Seek Care With Us:

      Like many foot problems, fallen arches are a progressive problem, meaning they get worse with time and tend to not resolve on their own. If pain persists, podiatric medical attention should be sought. Treatment ranges from very conservative options to surgical procedures, depending on the severity

       

      Types of Treatment We Offer:

      As mentioned above, the severity of the condition and pain determines the treatment path. These are just a few of the treatment options.

       

      Conservative Options:

      Rest and ice—Used to relieve pain and reduce swelling.

      Stretching exercises

      Anti-Inflammatory Medication—Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.

      Physical Therapy—Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating fallen arches and their associated soft tissue involvement.

      Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

      Bracing—For more significant deformities, these custom-molded braces can be used to prevent the fallen arch from getting worse and causing more discomfort.

              

      Surgical Procedures:

      In some instances, surgical intervention is required. Our doctors will evaluate the condition to find the appropriate corrective procedure. These procedures include:

      • Fusing foot or ankle bones together (arthrodesis)
      • Removing bones or bony growths or transposing tendons to change the biomechanics of the foot.
      • Cutting or changing the shape of the bone
      • Grafting bone to your foot to make the arch rise more naturally

    Gout is a type of inflammatory arthritis that can cause pain, swelling, and degradation of bone depending upon the location. Gout is sometimes caused by the abnormal metabolism of uric acid. People with gout either produce too much uric acid (diet) or their kidneys are not able to remove enough uric acid from the body. As a result, this uric acid builds up, causing episodes of pain and swelling in some joints. The big toe joint and ankle joint are most commonly affected in the feet; however, gout can form at any joint.

     

    Causes

    • Kidney problems
    • Certain foods high in uric acid, such as shellfish, alcohol, and steak
    • Heredity
    • Medications (diuretics, aspirin)
    • Trauma to joint
    •  

      Symptoms

    • Inflammation, swelling, and redness
    • Intense unilateral (one-sided) joint pain
    • Limited range of motion in the affected joint
    • Large deformity of joint as a result of uric acid deposits (tophii)
    • Occasional ulcerations caused by tophii
    •  

      Types of Treatment We Offer

      Treatment for gout is almost always conservative. First-line therapy includes treating the symptoms (the inflammation and swelling) by use of anti-inflammatories or cortisone injection. For more significant symptoms, specialized gout medications may be prescribed on a short-term basis.

       

      If the gout is recurrent, the patient would benefit from long term anti-gout medication to lower the blood’s uric acid.

       

      Surgery would only be recommended for longstanding untreated gout where large deposits will need to be removed to regain function of the joint.

       

    Haglund’s deformity is a bone spur at the area where the Achilles tendon attaches into the upper back portion of the heel bone (calcaneus). This condition is progressive and can cause significant pain, swelling, and limitation of activity. Sometimes it's called “pump bump” because the deformity often occurs in women who wears pumps.

     

    Causes

    • Genetic predisposition
    • Heredity
    •  
    • High arches
    • Over-pronation
    • Tight calf muscles
    • High heels
    • Stiff shoes
    •  

      Symptoms

      • Symptoms vary from minor to severe, depending upon the size of the bone spur and the activity of the patient.
      • Enlarged bony bump near the back of your heel bone
      • Blisters on your heels as a result of your shoes rubbing against the bump
      • Swelling
      • Pain with flat shoes; possible relief with wearing a small heel
       

      When You Should Seek Care With Us:

      Like many foot problems, Haglund’s deformity (or pump bump) is a progressive problem, meaning it will get worse with time and tend to not resolve on its own. If pain persists, podiatric medical attention should be sought. Treatment ranges from very conservative options to surgical procedures, depending on the severity.

       

      Types of Treatment We Offer:

      Treatment will depend on the severity of the condition. 

      Conservative Options:

      Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

      Shoe modification—Over-the-counter heel pads, heel lifts, or arch supports, can be used change the position of your feet in your shoes to relieve pressure on the back of your foot. Transitioning from high heels to a flatter type shoe slowly will prevent progression of the deformity.

      Stretching and Physical Therapy—Stretching the calf muscles can reduce the amount of pulling at the bone-tendon interface, decreasing pain at the spur.

      Medication—Topical anti-inflammatory medication, applied directly to the heel, may provide pain relief. Oral anti-inflammatory medication (such as ibuprofen) can help as well.

      Immobilization—If the area is extremely inflamed, a custom-made soft cast or walking boot may be used to immobilize the area and allow it to heal.

       

      Surgical Options:

      If none of the non-surgical methods provide adequate relief, your podiatrist may recommend surgery to correct the deformity and reshape the heel bone to prevent the spur from tearing the Achilles tendon.

    A hammertoe is a deformity at the joints of the toe that causes the toe to take on a contracted or bent position. This bending causes the toe to take on a mallet or hammer appearance when viewed from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common in females than they are in males. Often corns develop on the tops of the deformed joints. The symptoms associated with hammertoes can be relieved through conservative measures; however, surgery is the only way to reduce the deformity and return the shape of the toe to its normal position.

     

    Causes

    • Tendon and muscle imbalance
    • Flat feet/over-pronation
    • Heredity
    • Trauma
    • Arthritis
    • Tight/poorly-fitting shoes
    • Equinus/lack of ankle flexibility
     

    Symptoms

    • Pain at the top of the bent toe upon pressure from footwear
    • Formation of corns on the top of the joint
    • Redness and swelling at the joint contracture
    • Restricted or painful motion of the toe joint
    • Pain in the ball of the foot at the base of the affected toe
    • Deformity/cosmetic concerns
    • Nail deformity
     

    When You Should Seek Care With Us

    Visiting our office at the first sign of a contracture of a toe or irritation on the top of the toe is often a good idea. Treating hammertoes early with conservative measures will slow the progression of the deformity. Like many foot problems, hammertoes are a progressive problem, meaning they get worse with time and tend to not resolve on their own. Treatment ranges from very conservative options to surgical procedures, depending on the severity of the condition.

     

    Types of Treatment We Offer

     

    Conservative Therapy:

    As mentioned previously, conservative care often involves treating the symptoms associated with hammertoes. This usually does not correct the underlying disorder. This includes the following:

     

    Padding and Taping—Often padding and taping are the first steps in a treatment plan. Padding the bony prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.

    Shoe Gear Modification—Larger toe boxes and wider shoes can be used to accommodate the deformed toes. This will result in decreased pressure against the joints and relieve pain.

    Medication—Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.

    Custom-Molded Shoe Inserts—Custom-made shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe deformity.

     

    Often, conservative treatments are unsuccessful and surgical intervention is required to fix the underlying deformity. Hammertoes are progressive and often get worse with time. Fixing the deformities early on usually results in a quicker surgical recovery and better outcome.

     

    Surgical Options:

    For less severe deformities, removing the bony prominence and restoring normal alignment of the toe joint often resolves the pain. Severe hammertoes, which are not fully reducible, may require more complex surgical procedures, which may include fusion of the affected joint or elongating tendons.

    The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, which is sometimes disabling, can occur in the front, back, or bottom of the heel and has a multitude of causes

     

    Causes

    There are numerous causes for heel pain. The most common is the result of faulty biomechanics, trauma, and poorly-fitted shoes. Heel pain can be traced back to three main causes:

     

    Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs result from strain on the muscles and ligaments of the foot, stretching of the long band of tissue that connects the heel and the ball of the foot, and repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly-fitted or excessively-worn shoes, or obesity.

    Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and is painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

    Excessive Pronation/Faulty Biomechanics: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. Excessive pronation—i.e., excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

     

    Other secondary causes for heel pain include:

    • Heredity
    • Obesity
    • Overuse
    • Poorly-fitted shoes
    • Trauma/fracture
    • Arthritic conditions (gout, rheumatoid)
    • Inflamed bursa (fluid-filled sac)
    • Haglund’s deformity
    • Bone bruise
     

    Symptoms

    • Stabbing or shooting pain at or around the heel bone
    • Pain on first step in morning or after long periods of rest
    • Pain at heel or arch with increased activity
    • Palpable bony mass or knot on bottom or back of heel
    • Pain when walking
    • Swelling
     

    When You Should Seek Care With Us

    Heel pain can be very painful but is very successfully treated when you seek the care of a professional. Typically we recommend patients come to see us after trying at-home remedies for a few days with no relief. If you have new onset heel pain that is unrelenting, there is concern for possible rupture or fracture and you must see us as soon as possible.

     

    Types of Treatment We Offer

    90% of patients with acute heel pain find complete relief with conservative measures. It is rare to require surgical intervention for heel pain, but there are circumstances when it is warranted.

     

    Conservative Options:

    Anti-Inflammatory Medication—Early treatment might involve oral or injectable anti-inflammatory medication.

    Rest and Icing—Used to relieve pain and reduce swelling

    Stretching exercises

    Taping and Strapping—May be used for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attached to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

    Physical Therapy—Often used to provide relief of the. Ultrasound therapy is a popular technique for treating fallen arches and their associated soft tissue involvement.

    Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the heel pain.

    Amniotic Membrane Injections—New injectable medications on the market today contain sterilized and micronized amniotic membrane. Amniotic tissue is filled with anti-inflammatory blood products and growth factors that facilitate healing of injured areas, including the plantar fascia.

     

    Surgical Options:

    Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth. New modalities such as platelet-rich plasma, Topaz, and TenEx may also be used and are considered minimally-invasive.

    Ingrown nails are nails whose corners or sides dig painfully into the soft tissue surrounding the nail. This usually occurs on the inside and outside border of the nail. This leads to irritation, redness, and swelling. Sometimes a small infection can develop. The big toe is the most common location for this condition, but other toes can also become affected.

     

    Causes:

    Ingrown toenails may be caused by the following:

    • Improperly-trimmed nails
    • Heredity
    • Shoe pressure; crowding of toes
    • Repeated trauma to the feet from normal activities
    • Infection surrounding the nail
    •  

      Symptoms:

      • Pain and tenderness along the nail border
      • Redness and swelling
      • Drainage
      • Infection surrounding the nail
      • Odor
      • Prominent skin tissue (proud flesh)
      • When You Should Seek Care With Us:

         

        You should see our office immediately if any drainage or excessive redness is present around the toenail. If a short trial of home treatment has not resulted in improvement of the condition, you should visit our office. In addition, if you have diabetes or poor circulation, you should seek immediate treatment at the first signs of an ingrown toenail as it can lead to more severe complications.

         

        Types of Treatment We Offer:

        Ingrown toenails are treated with a minor in-office procedures in which the doctor trims and removes the ingrown portion of the nail. If ingrown nails are a chronic problem, a procedure to permanently prevent ingrown nails at the affected area only can be done. Recovery is minimal and relatively painless.

    Metatarsalgia is a broad term to describe generalized inflammation, pain, and swelling to the ball of your foot. There are numerous causes for metatarsalgia. Although not serious, metatarsalgia can hamper your daily routine and sometimes take weeks to resolve.

     

    Causes:

    Ball-of-foot pain can be caused by numerous pathologies and issues, such as:

    Overuse—Runners and active individuals have a higher prevalence of metatarsalgia because of the trauma the forefoot endures when striking the ground while running

    Short Achilles tendon—Also known as equinus, if your Achilles tendon is chronically short, usually due to high heels or lack of stretching, this can place extra pressure on the ball of the foot and cause inflammation and pain

    Excess weight—Places more pressure on the ball of foot

    Certain foot deformities-People with high arches can put extra pressure on the ball of the foot.

    Poorly-fitting shoes—Too narrow of shoes or shoes with lack of support can increase inflammation and pain to the forefoot.

    Neuromas—Benign inflammation of the nerves in the forefoot can mimic metatarsalgia. Often the causes of metatarsalgia can cause neuromas.

     

    Symptoms:

    • Sharp, aching or burning pain in the ball of your foot
    • Pain that worsens when you stand, run, or flex 
    • Inability to walk barefoot on hard surfaces
    • Shooting pain, numbness, or tingling in your toes
    • A feeling of having a pebble in your shoe
     

    When You Should Seek Care With Us:

    Metatarsalgia sometimes is relieved with simple home remedies such as rest and other over-the-counter anti-inflammatories. If at-home remedies do not improve within 5-7 days, we recommend you come to our office for a more thorough treatment plan.

    Types of Treatment We Offer:

    Most cases of metatarsalgia can be relieved by non-invasive treatments, such as:

    Padding—Often padding and taping are the first steps in a treatment plan. Padding forefoot minimizes trauma to the area, thereby minimizing pain. This allows the patient to continue a normal, active life.

    Shoe Gear Modification—Larger toe boxes and wider shoes can be used to accommodate the deformed toes. This will result in decreased pressure across the forefoot and relieve pain.

    Custom-Molded Orthotic Devices—Custom-made shoe inserts produced by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of forefoot pain.

    Stretching and Physical Therapy—Stretching the calf muscles can reduce the amount of forefoot pressure, thereby decreasing trauma to the area.

    Anti-Inflammatory Medication—Topical anti-inflammatory medication, oral anti-inflammatory medication (such as ibuprofen), and cortisone injections at the area of pain can decrease or resolve the pain associated with metatarsalgia.

     

    Occasionally, the pain may be due to something more serious, such as a rupture of a joint capsule or a neuroma. In those cases, outpatient surgery may be performed to permanently correct those issues.

    A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth metatarsal bones, but can be found anywhere in the body. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women, usually due to shoe gear.

     

    Causes

    Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma.

    • Trauma and overuse can cause damage to the nerve, resulting in inflammation or swelling of the nerve.
    • Improper footwear that causes the toes to be squeezed together can irritate the nerves in the ball of the foot, leading to a neuroma.
    • Repeated stress, common to many occupations, can create or aggravate a neuroma.
     

    Symptoms

    • Pain in the forefoot and between the toes
    • Tingling and numbness in the ball of the foot
    • Swelling between the toes
    • Pain in the ball of the foot when weight is placed on it
    •  

      When You Should Seek Care With Us:

      Often neuromas are hard to treat without professional care as they tend to get worse over time. Podiatric care should be sought at the first sign of pain or discomfort.

       

      Types of Treatment We Offer

      Conservative Options:

      Neuromas can be successfully treated with conservative care, including.

      Padding—Often padding is the first step in a treatment plan. Padding forefoot minimizes trauma to the area, thereby minimizing pain. This allows the patient to continue a normal, active life.

      Shoe Gear Modification—Larger toe boxes and wider shoes can be used to accommodate the forefoot, which decreases pressure across the forefoot and relieves pain.

      Custom-Molded Orthotic Devices—Custom-made shoe inserts made by our physicians may be useful in controlling foot function and reducing pressure on the nerve.

      Stretching and Physical Therapy—Stretching the calf muscles can reduce the amount of forefoot pressure, thereby decreasing trauma to the nerve

      Medication—Topical anti-inflammatory medication, oral anti-inflammatory medication (such as ibuprofen), and cortisone injections into the area of pain are very successful at decreasing the inflammation at the neuroma, thereby decreasing the pain.

       

      Surgical Options:

      When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Any pain following surgery is easily managed with medications and rest.

    Plantar fasciitis is inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and is painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone.

     

    Causes:

    • Over-activity
    • Flat feet or fallen arches
    • Heredity
    • Obesity
    • Overuse
    • Poorly-fitted shoes
    • Trauma/fracture
     

    Symptoms:

    • Stabbing or shooting pain at or around the heel bone
    • Pain during first step in morning or after long periods of rest
    • Pain in heel or arch with increased activity
    • Pain when walking
    • Swelling
     

    When You Should Seek Care With Us:

    Plantar fasciitis can be very painful and debilitating but is very successfully treated when you seek the care of a professional. Typically we recommend patients come to see us after trying at home remedies for a few days with no relief. If you have new onset heel pain with unrelenting pain, there is concern for possible rupture or fracture and you must see us as soon as possible.

     

    Types of Treatment We Offer

    90% of patients with acute plantar fasciitis find complete relief with conservative measures. It is rare to require surgical intervention for heel pain, but there are circumstances when it is warranted.

     

    Conservative Options:

    Anti-Inflammatory Medication—Early treatment might involve oral or injectable anti-inflammatory medication.

    Rest and Icing—Used to relieve pain and reduce swelling.

    Stretching exercises

    Taping and Strapping—May be used for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

    Physical Therapy—Often used to provide relief. Ultrasound therapy is a popular technique for treating fallen arches and their associated soft tissue involvement.

    Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the plantar fasciitis.

    Amniotic Membrane Injections—New injectable medications on the market today contain sterilized and micronized amniotic membrane. Amniotic tissue is filled with anti-inflammatory blood products and growth factors that facilitate healing of injured areas, including the plantar fascia.

     

    Surgical Options:

    Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth. New modalities, such as platelet-rich plasma, Topaz, and TenEx, may also be used and are considered minimally-invasive.

    Warts are one of several soft tissue conditions of the foot that can be quite painful. Warts are caused by a virus that lives within the deepest layer of the skin, making them difficult to treat. Those that appear on the sole of the foot are called plantar warts. Plantar warts are usually benign. Children, especially teenagers, tend to be more susceptible to warts than adults are. Warts are usually treated conservatively, but can be very stubborn to completely resolve. Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts that appear on the top of the foot or on the toes are generally raised and fleshier. Sometimes, warts can be confused for corns or rough skin. It is important to note that warts can be very resistant to treatment and have a tendency to re-occur.

     

    Causes

    Plantar warts are caused by a virus that lives underneath the skin. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

     

    Symptoms

    Most warts are harmless, but may be painful.

    Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black.

    When plantar warts develop on the weight-bearing areas of the foot (the ball of the foot, or the heel, for example), they can

    be the source of sharp, burning pain.

     

    When You Should Seek Care With Us

    Plantar warts are very difficult to treat without the help of a trained professional. Our office has treatment options available that are not available over-the-counter to the general public. It is wise to visit our office when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis. It is possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as warts.

     

    Types of Treatment We Offer

    First-line therapy for warts in our office is trimming down the dead skin on top of and surrounding the wart. This is usually painless and allows for medication to penetrate the lesion more effectively. Next, a medication called Cantharone is applied directly to the skin. Cantharone comes from a bug called a blister beetle that kills other insects by spraying a substance that causes blistering. This medication does not hurt upon initial application, but may sting 2-3 days later. After two weeks, the patient returns and the blistered wart is painlessly trimmed away. Sometimes additional treatments may be needed. Our physician has been using this medication with great success.

     

    For more stubborn warts, a simple surgical procedure to excise the wart, performed under local anesthetic, may be indicated. A procedure known as CO2 laser cautery is performed under local anesthesia in an outpatient surgery facility to excise the lesion and cauterize bleeding tissue. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions. Postoperative care involves daily foot soaks for a week and daily bandaid applications.

    Stress fractures are small cracks in the bone as the result of repetitive trauma (stress) to a certain area. These cracks are sometimes very hard to see on X-ray and often mimic overuse soft tissue injuries or tendonitis. Stress fractures are often seen in active individuals or people who have recently ramped up their activity level. They are often found on weight-bearing bones of the feet, such as the metatarsal bones. More than 50% of stress fractures occur in the lower extremity.

     

    Causes

    Increasing the amount or intensity of an activity too rapidly

    Impact of foot against unfamiliar surface not normally used while training (e.g., a runner changing from asphalt to gravel)

    Improper shoe gear or equipment (e.g., barefoot running)

    Symptoms

    Increased pain with physical activity and decrease with rest.

    Swelling to area after physical activity

     

    When You Should Seek Care With Us

    Stress fractures usually do not go away without at least some period of immobilization. If pain to the forefoot, aggravated by activity does not improve with two weeks of rest, it is best to come to our office for a full examination and to take an X-ray.

     

    Types of Treatment We Offer

    Stress fractures are typically treated conservatively with rest, immobilization with a CAM walker, and ice. Patients often need to take a break from the activity that caused the stress fracture and allow 6-8 weeks for the bone to heal. Occasionally, if the fracture does not improve, a non-invasive bone stimulator may be ordered.

    Excessive sweating of the feet is called hyperhidrosis. It's more common in men than in women, and more common in young adults than older adults, however 3% of the population suffers from some form of hyperhidrosis. People whose feet sweat excessively typically also have problems with excessive sweating of the palms. 

      Causes

    Excessive sweating of the feet seems to be an inherited problem. No one knows exactly why it occurs, but people who sweat excessively seem to have a different “set point” than other people. People with hyperhidrosis sweat excessively almost all the time.

      Symptoms

    Feet that sweat excessively with no apparent triggering event

    Foot odor

    Emotional stress and worry regarding foot odor. Sweat-related anxiety and isolation can be particularly severe among teens with plantar hyperhidrosis

      When You Should Seek Care With Us

    If your feet sweat excessively, come see our podiatrist. According to the US National Library of Medicine, less than 40 percent of people with excessive sweating seek medical care. Hyperhidrosis can often be treated with simple conservative measures.

      Types of Treatment We Offer

    Treatment options are tailored to your symptoms and are almost always conservative. Treatment options vary from something as simple as changing your socks and shoes more often to Botox injections. Over-the-counter or prescription roll-on antiperspirants may be applied directly to the feet to decrease sweating

    Botox injections can temporarily control excessive sweating of the feet. (The effect generally lasts for about six to nine months.) Oral prescription medications, often anticholinergic, can be used to trick the sweat glands of the feet to not be as active.

    Tarsal tunnel syndrome is a condition where the tibial nerve (the largest nerve to enter the foot) is compressed, causing pain and numbness. The compression of the nerve occurs at the tarsal tunnel, a canal formed at the inner part of the ankle, just behind the medial malleolus, that large bony bump on the inside part of the ankle.

     

    Causes

    Tarsal tunnel syndrome can be caused by injury, disease, or due to the natural shaping of the foot. Causes include:

    • Flat feet or fallen arches, which can produce strain or compression on the tibial nerve
    • Swelling caused by an ankle sprain which then compresses on the nerve
    • Diseases such as arthritis or diabetes that can cause swelling, thus resulting in compression of the tibial nerve
    • A space-occupying lesion, i.e., an enlarged or abnormal structure, such as a varicose vein, ganglion cyst, swollen tendon, or bone spur that might compress the nerve
     

    Symptoms

    • Pain and tingling around the ankle
    • Swelling in the foot
    • Pain radiating up into the leg or down into the ankle and foot with a pins and needles feeling in the foot.
     

    When You Should Seek Care With Us:

    Patients who notice new evidence of numbness and tingling in the foot with radiation in the leg should see our office for a proper diagnosis. Our office will perform a full musculoskeletal examination and neurological examination. We may order additional non-invasive tests to develop an accurate diagnosis.

     

    Types of Treatment We Offer:

    Tarsal tunnel syndrome can be treated conservatively; however, surgical intervention may be warranted. The goal of conservative therapy is to reduce the swelling in the ankle that causes compression of the nerve.

     

    Conservative Options

    Anti-Inflammatory Medication—Early treatment may involve oral or injectable anti-inflammatory medication to reduce the swelling in the inner ankle area

    Rest and Icing—Used to relieve pain and reduce swelling

    Bracing and Strapping—May be used for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attached to the heel bone. This helps reduce motion at the ankle that can cause compression of the nerve.

    Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and to relieve pressure from the inner ankle.

     

    Surgical Treatment

    For more serious cases of tarsal tunnel syndrome, surgical intervention to reduce the underlying cause of the compression may be needed. In such cases the surgeon would decompress the nerve and relieve it of any impingements that may cause compression.

    Tendinopathy is a degenerative process that denotes chronic injury to a tendon. Tendons are fibrous structures that attach muscle to bone and are very common to injury in the lower extremity.

     

    Causes of Tendonitis

    Tendonitis can be caused by:

    • Injury (e.g., increasing your activity too quickly over a short period of time)
    • Over-use.
    • Improper stretching prior to exertion
    • Incorrect form during physical activity
    • Pre-existing foot issues (flat feet or high arches)
     

    Symptoms

    • Pain is the most prominent symptom of a tendon injury. The pain may come and go or may gradually get worse over time
    • The involved tendon may swell
    • Stiffness in joint near injured tendon
     

    When You Should Seek Care With Us

    If the pain is not relieved with ice and rest or if it persists beyond a week, it is time to see our team at Modern Foot and Ankle. Remember that time is of the essence. Effectively treating these injuries is imperative to preventing long-term sequelae.

     

    Types of Treatment We Offer:

     

    Conservative Options:

    Anti-Inflammatory Medication—Early treatment might involve oral medication. Typically cortisone is not injected directly into tendons.

    Rest and Icing—Used to relieve pain and reduce swelling

    Stretching Exercises

    Taping and Strapping—May be used for correcting biomechanical imbalance, controlling excessive pronation, and supporting the injured tendons.

    Physical Therapy—Often used to provide relief of the affected tendons.

    Custom-Molded Orthotics—These custom-made shoe inserts are useful in controlling foot function and may reduce symptoms and prevent worsening of the tendonitis

    Amniotic Membrane Injections—New injectable medications on the market today contain sterilized and micronized amniotic membrane. Amniotic tissue is filled with anti-inflammatory blood products and growth factors that facilitate healing of injured areas, including into tendons where cortisone injections are usually not performed

     

    Minimally-Invasive Therapies:

    • Amniotic membrane injection therapy Platelet-rich plasma injections Topaz ablation Tenex
     

    Surgical Therapies:

    Typically tendonitis does not require surgical intervention; however, scar tissue that forms as a result of chronic inflammation may be the cause of your pain, in which case removing (debriding) the scar tissue may be recommended.

     

    Complete ruptures of the tendons (sometimes the result of long-term tendonitis) often require surgical intervention to reattach the tendon. Patients are often required to stay off their surgically-repaired foot for several weeks to allow the tissue to heal.

    Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. The fungus causes the nail to become darker in color and smell foul. Debris often collects underneath the nail, making it appear thick and become painful. If ignored, the infection can spread. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Long-standing onychomycosis can also be accompanied by a secondary bacterial or yeast infection.

     

    Causes

    Toenails are vulnerable to fungal infection.  The most common ways of developing a fungal nail includes:

    • Walking barefoot around swimming pools, locker rooms, and shower, which helps transmit fungus from the ground to the feet.
    • Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection.
    • Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are also prone to fungal nails.
    • Other contributing factors may be a history of athlete's foot and excessive perspiration.
     

    Symptoms

    • Toenail fungus is often ignored because the infection can be present for years without causing any pain.
    • The toenail may have a change in quality and color. The nail may appear very dull and dark.
    • More severe fungal nails may be thickened and painful.
    • The nail may be separating from the nail bed due to fungal debris under the nail
     

    When You Should Seek Care With Us

    You should visit our office when you notice any discoloration, thickening, or deformity of your toenails. The earlier you seek professional treatment, the greater your chance at getting your nails to clear.  

    Types of Treatment We Offer

    Treatments may vary, depending on the nature and severity of the infection. The first steps in treating a fungal infection are to culture the nail, determine the cause, and form a suitable treatment plan. Common conservative care includes:

    Topical or Oral Medication—New medications on the market can be applied directly to the nail. Topical solutions however take many months to a year of daily applications to see success.

    Debridement—Removal of diseased nail matter and debris of an infected nail.

    Temporary Removal of Nail—In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal.

    Permanent Removal—A chronically painful nail that has not responded to any other treatment permits the fungal infection to be cured and prevents the return of a deformed nail.

     

    Trying to solve the infection without the qualified help of a podiatrist can lead to additional problems. With new technical advances in combination with simple preventive measures, the treatment of this lightly-regarded health problem can often be successful.

    Don't wait until it gets worse.
    Find relief today.