Our Services
Our services typically include an initial consultation and diagnosis to determine the cause and extent of your particular condition. Following the diagnosis, we will discuss with you and then administer the prescribed treatment.
Common Foot & Ankle Conditions
At Brandywine Podiatry, we offer a wide variety of podiatric services to address the most common problems of the feet and ankles including: (Click a condition to learn more.)
Achile's Tendon
The Achilles tendon, the largest and single strongest tendon in the body, connects the heel bone to the muscles in the back of your leg and thigh. The primary function of the Achilles tendon is to transmit the power of these muscles to the foot enabling walking and running.
Print Handout | Read More ▼
How Does It Occur?
Achilles tendon injuries can occur especially when the tendon is subjected to strong forces such as in velocity sports: running, soccer, basketball, tennis, and baseball. Additionally, aging, and the Achilles tendons poor blood supply also increases your chance of injury.
Symptoms
If you experience pain, tenderness, swelling or stiffness anywhere along the tendons path you may have Achilles tendonitis or Achilles tendonosis.
Treatment
The mainstay of treatment for tendonitis or tendonosis is ice, rest and nonsteroidal anti-inflamatory drugs, but physical therapy, orthotic inserts and surgery may be needed in recalcitrant cases. In patients with tendon rupture, casting or surgery is required. Appropriate treatment of Achilles tendon injuries often leads to full recovery.Aging
Medicine and health awareness have progressed so rapidly since 1900 that life expectancy of the average American has increased by about 30 years. Older persons have become an increasingly significant proportion of our total population — and their numbers are growing rapidly. In 1900, for example, there were three million Americans aged 65 or older. In the year 2000, older people outnumber children for the first time in history.
If older people are to live useful, satisfying lives, they must be able to move about. Mobility is a vital ingredient of the independence that is cherished by our aging population, and foot ailments make it difficult or impossible for them to work or to participate in social activities.
According to the US National Center for Health Statistics, impairment of the lower extremities is a leading cause of activity limitation in older people. As if foot problems weren’t enough of a nuisance, they can also lead to knee, hip, and lower back pain that undermine mobility just as effectively. The NCHS says one-fourth of all nursing home patients cannot walk at all and another one-sixth can walk only with assistance.
Print Handout | Read More ▼
Mirror of Health
The human foot has been called the “mirror of health.” Foot doctors, or doctors of podiatric medicine (DPMs), are often the first doctors to see signs of such systemic conditions as diabetes, arthritis, and circulatory disease in the foot. Among these signs are dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness, and discoloration. Always seek professional care when these signs appear.
Foot Problems Can Be Prevented
For reasons that are difficult to fathom, many people, including a lot of older people, believe that it is normal for the feet to hurt, and simply resign themselves to enduring foot problems that could be treated. There are more than 300 different foot ailments. Some can be traced to heredity, but for an aging population, most of these ailments stem from the cumulative effect of years of neglect or abuse. However, even among people in their retirement years, many foot problems can be treated successfully, and the pain of foot ailments relieved.
Whether due to neglect or abuse, the normal wear and tear of the years causes changes in feet. As persons age, their feet tend to spread, and lose the fatty pads that cushion the bottom of the feet. Additional weight can affect the bone and ligament structure. Older people, consequently, should have their feet measured for shoe sizes more frequently, rather than presuming that their shoe sizes remain constant. Dry skin and brittle nails are other conditions older people commonly face. Finally, it’s a fact that women, young and old, have four times as many foot problems as men, and high heels are often the culprits.
Observing preventive foot health care has many benefits. Chief among them are that it can increase comfort, limit the possibility of additional medical problems, reduce the chances of hospitalization because of infection, and lessen requirements for other institutional care.
Keep Them Walking
Studies show that care for a bedridden patient costs much more than care for an ambulatory patient. In their private practices and in foot clinics, podiatric physicians are providing services designed to keep older people on their feet, and they serve in hospitals and nursing homes across the country.
Records indicate that amputations and other forms of surgery due to infections of the feet, many brought about by diabetes, have been significantly reduced in recent years because of early diagnosis and treatment. Further reduction in this area is a goal of Healthy People 2010, a US Department of Health and Human Services campaign endorsed by podiatric physicians, to encourage understanding and application of preventive medical practices.Ankle Fracture
A fracture is a partial or complete break in a bone. In the ankle, fractures can range from the less serious avulsion injuries (small pieces of bone that have been pulled off) to severe shattering-type breaks of the tibia, fibula, or both. Ankle fractures are common injuries that are most often caused by the ankle rolling inward or outward.Many people mistake an ankle fracture for an ankle sprain, but they are quite different and therefore require an accurate and early diagnosis. They sometimes occur simultaneously.
Print Handout | Read More ▼
Signs and Symptoms
An ankle fracture is accompanied by one or all of these signs and symptoms:
- Pain at the site of the fracture, which in some cases can extend from the foot to the knee
- Significant swelling, which may occur along the length of the leg or may be more localized
- Blisters may occur over the fracture site. These should be promptly treated by your surgeon.
- Bruising, which develops soon after the injury
- Inability to walk—however, it is possible to walk with less severe breaks, so never rely on walking as a test of whether a bone has been fractured
- Change in the appearance of the ankle so that it differs from the other ankle
- Bone protruding through the skin—a sign that immediate care is needed! Fractures that pierce the skin require immediate attention because they can lead to severe infection and prolonged recovery.
What to Do
Following an ankle injury it is important to have the ankle evaluated by a foot and ankle surgeon for proper diagnosis and treatment. If you are unable to do so right away, go to the emergency room and then follow up with a foot and ankle surgeon as soon as possible for a more thorough assessment. Until you are able to be examined by a doctor, the “R.I.C.E.” principle should be followed. This involves:- Rest. It is crucial to stay off the injured foot, since walking can cause further damage.
- Ice. To reduce swelling and pain, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Compression.Wrap the ankle in an elastic bandage or wear a compression stocking to prevent further swelling.
- Elevation. Keep the foot elevated to reduce the swelling. It should be even with or slightly above the hip level.
Diagnosis
The foot and ankle surgeon will examine the affected limb, touching specific areas to evaluate the injury. In addition, the surgeon may order x-rays and other imaging studies, as necessary.
Treatment
Treatment of ankle fractures depends upon the type and severity of the injury. Options include:- Immobilization. Certain fractures are treated by protecting and restricting the ankle and foot in a cast or splint. This allows the bone to heal.
- Prescription medications. To help relieve the pain, the surgeon may prescribe pain medications or antiinflammatory drugs.
- Surgery. For some injuries, surgery is needed to repair the fracture and other related injuries, if present. The foot and ankle surgeon will select the procedure that is appropriate for your injury.
Follow-up Care
It is important to follow your surgeon’s instructions after treatment. Failure to do so can lead to infection, deformity, arthritis, and chronic pain.Ankle Sprain
An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement. Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.
Print Handout | Read More ▼
Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position.Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. Sometimes ankle sprains occur because of weak ankles, a condition that some people are born with. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.
Signs and Symptoms The signs and symptoms of ankle sprains may include:- Pain or soreness
- Swelling
- Bruising
- Difficulty walking
- Stiffness in the joint
These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains—instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if you don’t have pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain—whether it’s your first or your fifth—requires prompt medical attention.
If you think you’ve sprained your ankle, contact your foot and ankle surgeon for an appointment as soon as possible. In the meantime, immediately begin using the “R.I.C.E.” method—Rest, Ice, Compression, and Elevation—to help reduce swelling, pain, and further injury.
Why Prompt Medical Attention Is Needed
There are four key reasons why an ankle sprain should be promptly evaluated and treated by a foot and ankle surgeon:- First, an untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle.You may also develop weakness in the leg.
- Second,you may have suffered a more severe ankle injury along with the sprain. This might include a serious bone fracture that could lead to troubling complications if it goes untreated.
- Third, an ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far.
- Fourth, rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.
In evaluating your injury, the foot and ankle surgeon will take your history to learn more about the injury. He or she will examine the injured area, and may order x-rays, an MRI study, or a CT scan to help determine the severity of the injury.
Non-surgical Treatment and Rehabilitation
When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins. Your foot and ankle surgeon may recommend one or more of the following treatment options:- Immobilization. Depending on the severity of your injury, you may receive a short-leg cast, a walking boot, or a brace to keep your ankle from moving. You may also need crutches.
- Early physical therapy. Your doctor will start you on a rehabilitation program as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
- Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.
- Icing. You may be advised to ice your injury several times a day until the pain and swelling resolves.Wrap ice cubes, or a bag of frozen peas or corn, in a thin towel. Do not put ice directly on your skin.
- Compression wraps. To prevent further swelling, you may need to keep your ankle wrapped in an elastic bandage or stocking.
When Is Surgery Needed? In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments. The foot and ankle surgeon will select the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.
After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see your foot and ankle surgeon during this period to ensure that your ankle heals properly and function is restored.Arthritis
Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes; just as a sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are associated with many different illnesses.
Print Handout | Read More ▼
Arthritis and the Feet
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 the primary targets.
Arthritic feet can result in loss of mobility and independence, but that may be avoided with early diagnosis and proper medical care.
Some Causes
Besides heredity, arthritic symptoms may arise in a number of ways:
- Through injuries, notably in athletes and industrial workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
- 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.
- Using drugs, both prescription drugs and illegal street drugs, can induce arthritis.
- As part of a congenital autoimmune disease syndrome of undetermined origin. Recent research has suggested, for instance, that a defective gene may play a role in osteoarthritis.
Some Symptoms
Because arthritis can affect the structure and function of the feet it is important to see a doctor of podiatric medicine if any of the following symptoms occur in the feet:
- Swelling in one or more joints
- Recurring pain or tenderness in any joint
- Redness or heat in a joint
- Limitation in motion of joint
- Early morning stiffness
- Skin changes, including rashes and growths
Some Forms of Arthritis
Osteoarthritis is the most common form of arthritis. 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) 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 to suffer RA.
RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute rheumatoid arthritis. However, the disease system has been known to be active for months, or years, then abate, sometimes permanently.
Gout (gouty arthritis) 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, 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.
Diagnosis
Different forms of arthritis affect the body in different ways; many have distinct systemic affects that are not common to other forms. Early diagnosis is important to effective treatment of any form. Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn’t treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most forms of arthritis cannot be cured but can be controlled or brought into remission; perhaps only five percent of the most serious cases, usually of rheumatoid arthritis, result in such severe crippling that walking aids or wheelchairs are required.
Treatment
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 that is 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.
Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by medication. In such a complex disease system, it is no wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line drug of choice for most forms of arthritis and the benchmark against which other therapies are measured.
The control of foot functions with shoe inserts called orthoses, or with braces or specially prescribed shoes, may be recommended. Surgical intervention is a last resort in arthritis, as it is with most disease conditions; the replacement of damaged joints with artificial joints is a possible surgical procedure.Athlete's Foot
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 fungus growth.
The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.
Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.
Print Handout | Read More ▼
Symptons
The signs of athlete's foot, singly or combined, are dry skin, itching, scaling, inflammation, and blisters. Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads.
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 by contaminated bed sheets or clothing to other parts of the body.
Prevention
It is not easy to prevent athlete's foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene. Daily washing of the feet with soap and water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture, help prevent the fungus from infecting the feet. Also helpful is daily use of a quality foot powder.
Tips
- Avoid walking barefoot; use shower shoes.
- Reduce perspiration by using talcum powder.
- Wear light and airy shoes.
- Wear socks that keep your feet dry, and change them frequently if you perspire heavily.
Treatment
Fungicidal and fungistatic chemicals, used for athlete's foot treatment, frequently fail to contact the fungi in the horny layers of the skin. Topical or oral antifungal drugs are prescribed with growing frequency.
In mild cases of the infection it is important to keep the feet dry by dusting foot powder in shoes and hose. The feet should be bathed frequently and all areas around the toes dried thoroughly.
Consult Your Podiatrist
If an apparent fungus condition does not respond to proper foot hygiene and self care, and there is no improvement within two weeks, consult your podiatrist. The podiatrist will determine if a fungus is the cause of the problem. If it is, a specific treatment plan, including the prescription of antifungal medication, applied topically or taken by mouth, will usually be suggested. Such a treatment appears to provide better resolution of the problem, when the patient observes the course of treatment prescribed by the podiatrist; if it's shortened, failure of the treatment is common.
If the infection is caused by bacteria, antibiotics, such as penicillin, that are effective against a broad spectrum of bacteria may be prescribed.
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.Bunions
A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion–from the Latin "bunio," meaning enlargement–can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor’s bunion."
Print Handout | Read More ▼
Bunion Symptoms
- 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.
How Do You Get a Bunion?
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 in the joint and cause the deformity. They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.
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 on to 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.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
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.
Bunion Relief?
- Apply a commercial, nonmedicated bunion pad around the bony prominence.
- Wear shoes with a wide and deep toe box.
- If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid high-heeled shoes over two inches tall.
- See your podiatric physician if pain persists.
Conservative Treatment for Bunion Pain
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.
The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatric physician may recommend these treatments:
Padding & Taping
Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
Medication
Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.
Physical Therapy
Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Orthotics
Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
Surgical Options
When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatric physician. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.
Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.
Bunion Tips
- Wear comfortable shoes that conform to the shape of your foot.
- Wear shoes with a wide and deep toe box.
- Always fit the larger foot and have your feet sized each time you purchase shoes.
- Apply a commercial, nonmedicated bunion pad around the bony prominence.
- If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid high-heeled shoes over two inches tall.
- Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.Calluses
Children's Feet
You worry about your children's teeth, eyes, and other parts of the body. You teach washing, brushing, and grooming, but what do you do about your child's feet--those still-developing feet which have to carry the entire weight of the body through a lifetime?
Many adult foot ailments, like other bodily ills, have their origins in childhood and are present at birth. Periodic professional attention and regular foot care can minimize these problems in later life.
Neglecting foot health invites problems in other parts of the body, such as the legs and back. There can also be undesirable personality effects. The youngster with troublesome feet walks awkwardly and usually has poor general posture. As a result, the growing child may become shy, introverted, and avoid athletics and social functions. Consultation between the podiatrist, pediatrician, and other medical specialists helps to resolve these related problems.
Print Handout | Read More ▼
Your Baby's Feet
The human foot--one of the most complicated parts of the body--has 26 bones, and is laced with ligaments, muscles, blood vessels, and nerves. Because the feet of young children are soft and pliable, abnormal pressure can easily cause deformities.
A child's feet grow rapidly during the first year, reaching almost half their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet.
Here are some suggestions to help you assure that this development proceeds normally:
- Look carefully at your baby's feet. If you notice something that does not look normal to you, seek professional care immediately. Deformities will not be outgrown by themselves.
- Cover baby's feet loosely. Tight covers restrict movement and can retard normal development.
- Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions which prepare the feet for weightbearing.
- Change the baby's position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.
Starting to Walk
It is unwise to force a child to walk. When physically and emotionally ready, the child will walk. Comparisons with other children are misleading, since the age for independent walking ranges from 10 to 18 months.
When the child first begins to walk, shoes are not necessary indoors. Allowing the youngster to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength, as well as the grasping action of toes. Of course, when walking outside or on rough surfaces, babies' feet should be protected in lightweight, flexible footwear made of natural materials.
Growing Up
As a child's feet continue to develop, it may be necessary to change shoe and sock size every few months to allow room for the feet to grow. Although foot problems result mainly from injury, deformity, illness, or hereditary factors, improper footwear can aggravate preexisting conditions. Shoes or other footwear should never be handed down.
The feet of young children are often unstable because of muscle problems which make walking difficult or uncomfortable. A thorough examination by a podiatrist may detect an underlying defect or condition which may require immediate treatment or consultation with another specialist.
The American Podiatric Medical Association has long known of the high incidence of foot defects among the young and recommends foot health examinations for school children on a regular basis.
Sports Activities
Millions of American children participate in team and individual sports, many of them outside the school system, where advice on conditioning and equipment is not always available. Parents should be concerned about children's involvement in sports that require a substantial amount of running and turning, or involve contact. Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports. Sports-related foot and ankle injuries are on the rise as more children participate actively in sports.
Children's Feet Tips
Problems noticed at birth will not disappear by themselves. You should not wait until the child begins walking to take care of a problem you've noticed earlier.
- Remember that lack of complaint by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it.
- Walking is the best of all foot exercises, according to podiatrists. They also recommend that walking patterns be carefully observed. Does the child toe in or out, have knock knees, or other gait abnormalities? These problems can be corrected if they are detected early.
- Going barefoot is a healthy activity for children under the right conditions. However, walking barefoot on dirty pavements exposes children's feet to the dangers of infection through accidental cuts and to severe contusions, sprains, or fractures. Another potential problem is plantar warts, a condition caused by a virus which invades the sole of the foot through cuts and breaks in the skin. They require protracted treatment and can keep children from school and other activities.
- Be careful about applying home remedies to children's feet.
- Preparations strong enough to kill certain types of fungus can harm the skin.
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.Claw Toe
Corns
Diabetic Foot Care Guidelines
Diabetes mellitus is a chronic disease that affects the lives of nearly 24 million people in the United States, nearly 6 million of whom are unaware that they even have the disease. In 2007 alone, 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older. The disease is marked by the inability to manufacture or properly use insulin and impairs the body’s ability to convert sugars, starches and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.
Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.
Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.
The socioeconomic costs of diabetes are enormous. In 2007, the total annual economic cost of diabetes was estimated at $174 billion -- about $116 billion of which are direct costs from the disease with $58 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.
The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.
According to a recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes. Diabetes is the leading cause of end-stage kidney disease, accounting for about 44 percent of new cases. Diabetes is also the leading cause of new cases of blindness among adults aged 20 to 74.
While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.
Print Handout | Read More ▼
How Do You Get Diabetes?
No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.
Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:
- A family history of the disease
- Obesity
- Prior history of developing diabetes while pregnant
- Being over the age of 40
- Being a member of one of the following ethnic groups: African American, Native American, Latino American, Asian American, Pacific Islander
African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease. Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group. Native Americans are at a significantly increased risk for developing diabetes, and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.
Of all the risk factors, weight is the most important, with more than 80 percent of diabetes sufferers classified as overweight.
The Role of Your Podiatric Physician
Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.
In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:
- Skin color changes
- Elevation in skin temperature
- Swelling of the foot or ankle
- Pain in the legs
- Open sores on the feet that are slow to heal
- Ingrown and fungal toenails
- Bleeding corns and calluses
- Dry cracks in the skin, especially around the heel
Wound Healing
Ulceration is a common occurrence with the diabetic foot and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates.
If You Have Diabetes Already...Do:
Wash feet daily.
Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily but avoid getting it between the toes.
Inspect feet and toes daily.
Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.
Lose Weight.
People with diabetes are commonly overweight, which nearly doubles the risk of complications.
Wear thick, soft socks.
Socks made of an acrylic blend are well suited but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.
Stop smoking.
Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.
Cut toenails stright across.
Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatric physician for assistance.
Exercise.
As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what’s best for you.
See your podiatric physician.
Regular checkups by your podiatric physician—at least annually—are the best way to ensure that your feet remain healthy.
Be properly measured and fitted every time you buy new shoes.
Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.
New shoes should be comfortable at the time they’re purchased and should not require a "break-in" period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.
Don't go barefoot
Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers. Never go barefoot.
Don't wear high heels, sandals, and shoes with pointed toes.
These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.
Don't drink in excess.
Alcohol can contribute to neuropathy (nerve damage) which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.
Don't wear anything that is too tight around the legs.
Pantyhose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, as can men’s dress socks if the elastic is too tight.
Never try to remove calluses, corns, or warts by yourself.
Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.Diabetic Wound Care
A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.
Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.
Print Handout | Read More ▼
Who Can Get a Diabetic Foot Ulcer?
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 a 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.
How do Diabetic Foot Ulcers Form?
Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling 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. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament. 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 retard healing.
What is the Value of Treating a Diabetic Foot Ulcer?
Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.
Controlling Blood Glucose
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 accomplish this will enhance healing and reduce the risk of complications.
Surgical Options
A majority of noninfected foot ulcers are treated without surgery; however, when this 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 bony “bumps.”
Healing Factors
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.
How Can a Foot Ulcer be Prevented?
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.
You are at high risk if you:- have neuropathy,
- have poor circulation,
- have a foot deformity (i.e., bunion, hammertoe),
- wear inappropriate shoes,
- have uncontrolled blood sugar.
Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day—especially between the toes and the sole—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible, no matter how “simple” it may seem to you.
The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:
- lowering blood sugar
- appropriate debridement of wounds
- treating any infection
- reducing friction and pressure
- restoring adequate blood flow
The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.Fifth Metatarsal Fracture
Fractures (breaks) are common in the fifth metatarsal—the long bone on the outside of the foot that connects to the little toe. Two types of fractures that often occur in the fifth metatarsal are:
- Avulsion fracture. In an avulsion fracture, a small piece of bone is pulled off the main portion of the bone by a tendon or ligament. This type of fracture is the result of an inversion injury, in which the ankle rolls inward.Avulsion fractures are often overlooked when they occur with an ankle sprain.
- Jones fracture. Jones fractures occur in a small area of the fifth metatarsal that receives less blood and is therefore more prone to injury.A Jones fracture can be either a stress fracture (a tiny hairline break that occurs over time) or an acute (sudden) break. Jones fractures are caused by overuse, repetitive stress, or trauma. They are less common and more difficult to treat than avulsion fractures.
Other types of fractures can occur in the fifth metatarsal. Examples include mid-shaft fractures, which usually result from trauma or twisting, and fractures of the metatarsal head and neck.
Print Handout | Read More ▼
Signs and Symptoms
Avulsion and Jones fractures have the same signs and symptoms. These include:
- Pain, swelling, and tenderness on the outside of the foot
- Difficulty walking
- Bruising may occur
Diagnosis
Anyone who has symptoms of a fifth metatarsal fracture should see a foot and ankle surgeon as soon as possible for proper diagnosis and treatment. To arrive at a diagnosis, the surgeon will ask how the injury occurred or when the pain started. The foot will be examined, with the doctor gently pressing on different areas of the foot to determine where there is pain.
The surgeon will also order x-rays. Because a Jones fracture sometimes does not show up on initial x-rays, additional imaging studies may be needed.
Treatment
When it is not possible to see a foot and ankle surgeon immediately, the “R.I.C.E.” method of care should be performed. This involves:
- Rest. It is crucial to stay off the injured foot, since walking can cause further damage.
- Ice. To reduce swelling and pain, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put the ice directly against the skin.
- Compression.Wrap the foot in an elastic bandage or wear a compression stocking to prevent further swelling.
- Elevation. Keep the foot elevated to reduce the swelling. It should be even with or slightly above the hip level.
Options for Treatment of an Avulsion Fracture May Include:
- Immobilization. Depending on the severity of the injury, the foot is kept immobile with a cast, cast boot, or stiff-soled shoe. Crutches may also be needed to avoid placing weight on the injured foot.
- Surgery. If the injury involves a displaced bone, multiple breaks, or has failed to adequately heal, surgery may be needed.
Options for Treatment of a Jones Fracture May Include:
- Immobilization. As with avulsion fractures, initial treatment may involve immobilization, but typically for a longer period of time because these fractures take longer to heal.
- Bone stimulation. A pain-free external device is used to speed the healing of some fractures. Bone stimulation may be used as part of the treatment or following an inadequate response to immobilization.
- Surgery. Surgery may be needed, since Jones fractures often do not heal through immobilization and bone stimulation.
If surgery is required for treatment of a fifth metatarsal fracture, the foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.Flat Feet
Foot and Ankle Injuries
Foot and ankle emergencies happen every day. Broken bones, dislocations, sprains, contusions, infections, and other serious injuries can occur at any time. Early attention is vitally important. Whenever you sustain a foot or ankle injury, you should seek immediate treatment from a podiatric physician.
Print Handout | Read More ▼
This advice is universal, even though there are lots of myths about foot and ankle injuries. Some of them follow:
Myths
- "It can't be broken, because I can move it." False; this widespread idea has kept many fractures from receiving proper treatment. The truth is that often you can walk with certain kinds of fractures. Some common examples: Breaks in the smaller, outer bone of the lower leg, small chip fractures of either the foot or ankle bones, and the often neglected fracture of the toe.
- "If you break a toe, immediate care isn't necessary." False; a toe fracture needs prompt attention. If X-rays reveal it to be a simple, displaced fracture, care by your podiatric physician usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Often, fractures do not show up in the initial X-ray. It may be necessary to X-ray the foot a second time, seven to ten days later. Many patients develop post-fracture deformity of a toe, which in turn results in a deformed toe with a painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.
- "If you have a foot or ankle injury, soak it in hot water immediately." False; don’t use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain. Your podiatric physician may make additional recommendations upon examination.
- "Applying an elastic bandage to a severely sprained ankle is adequate treatment." False; ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.
- "The terms 'fracture,' 'break,' and 'crack' are all different." False; all of those words are proper in describing a broken bone.
Before Seeing the Podiatrist
If an injury or accident does occur, the steps you can take to help yourself until you can reach your podiatric physician are easy to remember if you can recall the word “rice.”
- Rest. Restrict your activity and get off your foot/ankle.
- Ice. Gently place a plastic bag of ice wrapped in a towel on the injured area in a 20-minute-on, 40-minute-off cycle.
- Compression. Lightly wrap an Ace bandage around the area, taking care not to pull it too tight.
- Elevation. To reduce swelling and pain, sit in a position that allows you to elevate the foot/ankle higher than your waist.
- For bleeding cuts, cleanse well, apply pressure with gauze or a towel, and cover with a clean dressing. See your podiatrist as soon as possible. It’s best not to use any medication on the cut before you see the doctor.
- Leave blisters unopened if they are not painful or in a weight-bearing area of the foot. A compression bandage placed over a blister can provide relief.
- Foreign materials in the skin—such as slivers, splinters, and sand—can be removed carefully, but a deep foreign object, such as broken glass or a needle, must be removed professionally.
- Treatment for an abrasion is similar to that of a burn, since raw skin is exposed to the air and can easily become infected. It is important to remove all foreign particles with thorough cleaning. Sterile bandages should be applied, along with an antibiotic cream or ointment.
Prevention
- Wear the correct shoes for your particular activity.
- Wear hiking shoes or boots in rough terrain.
- Don't continue to wear any sports shoe if it is worn unevenly.
- The toe box in “steel-toe” shoes should be deep enough to accommodate your toes comfortably.
- Always wear hard-top shoes when operating a lawn mower or other grass-cutting equipment.
- Don’t walk barefoot on paved streets or sidewalks.
- Watch out for slippery floors at home and at work. Clean up obviously dangerous spills immediately.
- If you get up during the night, turn on a light. Many fractured toes and other foot injuries occur while attempting to find one’s way in the dark.
Foot Orthotics
Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely “arch supports,” although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient by altering slightly the angles at which the foot strikes a walking or running surface.
Doctors of podiatric medicine prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form.
Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.
Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.
Print Handout | Read More ▼
Rigid Orthotics
The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic or carbon fiber and is used primarily for walking or dress shoes. It is generally fabricated from a plaster of paris mold of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary.
Rigid orthotics are chiefly designed to control motion in two major foot joints, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function.
Soft Orthotics
The second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes.
The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthotic is usually bulkier and may well require extra room in shoes or prescription footwear.
Semirigid Orthotics
The third type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This orthotic is not a crutch, but an aid to the athlete. Each sport has its own demands and each sport orthotic needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semirigid orthotic is constructed of layers of soft material, reinforced with more rigid materials.
Orthotics for Children
Orthotic devices are effective in the treatment of children with foot deformities. Most podiatric physicians recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe or an athletic shoe.
Usually, the orthotics need to be replaced when the child’s foot has grown two sizes. Different types of orthotics may be needed as the child’s foot develops and changes shape.
The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.
Other Types of Orthotics
Various other orthotics may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot, ice skate boot, or inline skate boot. Combinations of semiflexible material and soft material to accommodate painful areas are utilized for specific problems.
Research has shown that back problems frequently can be traced to a foot imbalance. It’s important for your podiatric physician to evaluate the lower extremity as a whole to provide for appropriate orthotic control for foot problems.
Orthotic Tips
- Wear shoes that work well with your orthotics.
- Bring your orthotics with you whenever you purchase a new pair of shoes.
- Wear socks or stockings similar to those that you plan on wearing when you shop for new shoes.
- Return as directed for follow-up evaluation of the functioning of your orthotics. This is important for making certain that your feet and orthotics are functioning properly together.
Footwear
Children's Shoes
When a child begins to walk, shoes generally are not necessary. Allowing an infant to go barefooted indoors, or to wear only a pair of socks, helps the foot grow normally and develop its muscles and strength, as well as the grasping ability of toes.
As children grow more active, and their feet develop, the need for shoes becomes apparent. It becomes necessary to change shoe sizes at a pace that frequently surprises and even dismays parents, to allow room for growth.
When purchasing shoes for children, remember these tips:
- Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends—at the ball of the foot, not in the middle of the shoe.
- The child’s foot should be sized while he or she is standing up and fully weight-bearing.
- There should be about one-half inch of space (or a thumb’s width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.
- Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Feel the inside of the shoe for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot. Look for signs of irritation on the foot after the shoe is worn.
- Shoes should not slip off at the heels. Children who tend to sprain their ankles will do better with high-top shoes or boots.
- Both feet should be measured, and if they are two different sizes, shoes should be chosen that fit the larger foot best.
Print Handout | Read More ▼
Women's Shoes
Women inflict more punishment on their feet in part from improper footwear that can bring about unnecessary foot problems. Some of the problems result from high-heeled shoes (generally defined as pumps with heels of more than two inches). Doctors of podiatric medicine believe such heels are medically unsound and attribute postural and even safety problems to their use.
To relieve the abusive effects of high heels, women can limit the time they wear them, alternating with good quality sneakers or flats for part of the day.
They can also vary heel height. There are comfortable and attractive “walking” pumps (also called “comfort” or “performance” pumps) for work and social activities, that blend fashion considerations and comfort. These pumps offer athletic shoe-derived construction, reinforced heels, and wider toe room.
Activity has a bearing on the considerations; wearing the right shoe for a particular activity is probably as important a factor in the choice of shoes as any.
Perhaps the best shoe for women is a walking shoe with laces (not a slip-on), a polymerized composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height.
Men's Shoes
The best shoes for men are good quality oxford styles, shoes ordinarily associated with wing-tip or cap toe designs. Also suitable are slip-ons, dressy loafers, and low dress boots.
Men as well as women should buy shoes for work, leisure, and special activities, matching the shoe to the activity.
Male (and female) office workers should earmark three to five pairs of shoes for business hours—general oxfords and loafers for men; pumps and oxfords for women. Cushioned-sole shoes that give good support are essential for those who spend most of their working days on their feet.
There is no question about the need for foot protection for those who work in heavy industry. Safety shoes and boots—those that are waterproof or water-resistant, with insulated steel toe caps and soles of non-conducting materials—help prevent injuries to the feet and reduce the severity of injuries that do occur.
Shoes for Athletics
Different sports activities call for specific footwear to protect feet and ankles. Sports-specific athletic shoes are a wise investment for serious athletes, though perhaps a less critical consideration for the weekend or occasional athlete; nevertheless, it’s a good idea to use the correct shoe for each sport. Probably a more important consideration is the condition of the shoe—don’t wear any sport or other shoes beyond their useful life.
Athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved.
For example, a running shoe is built to accommodate impact, while a tennis shoe is made to give relatively more support and permit sudden stops and turns. For sports, “cross trainers” are fine for a general athletic shoe, such as for physical education classes. But if a child is involved more heavily in any single sport, he or she should have a shoe specifically designed for that sport.
Shoe Care
For longer service, keep shoes clean and in good repair. Avoid excessive wear on heels and soles. Give your shoes a chance to breathe—don’t wear the same pair two days in a row (you prolong the life of shoes by rotating their use). Never wear hand-me-down shoes (this is especially important for children).
Seal of Acceptance
The American Podiatric Medical Association awards its Seal of Acceptance to a wide variety of shoes (and shoe-related products), which have been deemed to enhance a consistently applied program of daily foot care and regular professional treatment.
The intent of such endorsements is to make a significant contribution to the foot health and foot health education of the public.
For a list of shoe companies holding the APMA Seal of Acceptance, visit the APMA's online seal information.
Buying Tips
- Have your feet measured while you’re standing.
- Always try on both shoes, and walk around the store.
- Always buy for the larger foot; feet are seldom precisely the same size.
- Don’t buy shoes that need a “break-in” period; shoes should be comfortable immediately.
- Don’t rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers’ sizing molds) also vary.
- Shop for shoes later in the day; feet tend to swell during the day, and it’s best to be fitted while they are in that state.
- Be sure that shoes fit well—front, back, and sides—to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe.
- Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
- Buy shoes that don’t pinch your toes, either at the tips, or across the toe box.
- Try on shoes while you’re wearing the same type of socks or stockings you expect to wear with the shoes.
- If you wear prescription orthotics—biomechanical inserts prescribed by a podiatric physician—you should take them along to shoe fittings.
Forefoot Surgery
Hammertoes
A hammertoe deformity is a contracture of the toe(s), frequently caused by an imbalance in the tendon or joints of the toes. Due to the “buckling” effect of the toe(s), hammertoes may become painful secondary to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making it difficult to wear shoes. Your podiatric physician may suggest correction of this deformity through a surgical procedure to realign the toe(s).
Print Handout | Read More ▼
Neuromaclose [x]
An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes. Several factors may contribute to the formation of a neuroma.
Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just some of the conditions that may cause a neuroma. Symptoms such as burning or tingling in the ball of the foot or in the adjacent toes and even numbness are commonly seen with this condition. Other symptoms include swelling between the toes and pain in the ball of the foot when weight is placed on it.
Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe.
Your podiatric physician will suggest a treatment plan. If conservative treatment does not relieve the symptoms, then your podiatric physician will decide, on the basis of your symptoms, whether surgical treatment is appropriate.
Bunionette (Tailor's Bunion)
A protuberance of bone at the outside of the foot behind the fifth (small) toe, the bunionette or “small bunion” is caused by a variety of conditions including heredity, faulty biomechanics (the way one walks) or trauma, to name a few. Pain is often associated with this deformity, making shoes very uncomfortable and at times even walking becomes difficult. If severe and conservative treatments fail to improve the symptoms of this condition, surgical repair may be suggested. Your podiatric physician will develop a surgical plan specific to the condition present.
Bone Spurs
A bone spur is an overgrowth of bone as a result of pressure, trauma, or reactive stress of a ligament or tendon. This growth can cause pain and even restrict motion of a joint, depending on its location and size. Spurs may also be located under the toenail plate, causing nail deformity and pain. Surgical treatment and procedure is based on the size, location, and symptoms of the bone spur. Your podiatric physician will determine the surgical method best suited for your condition.
Postoperative Care
The type of foot surgery performed determines the length and kind of aftercare required to assure that your recovery from surgery is rapid and uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. A satisfactory recovery can be hastened by carefully following instructions from your podiatric physician.
Your Feet Aren't Supposed to Hurt
Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.General Foot Health
The human foot is a biological masterpiece. Its strong, flexible, and functional design enables it to do its job well and without complaint—if you take care of it and don’t take it for granted.
The foot can be compared to a finely tuned race car, or a space shuttle, vehicles whose function dictates their design and structure. And like them, the human foot is complex, containing within its relatively small size 26 bones (the two feet contain a quarter of all the bones in the body), 33 joints, and a network of more than 100 tendons, muscles, and ligaments, to say nothing of blood vessels and nerves.
Print Handout | Read More ▼
Tons of Pressure
The components of your feet work together, sharing the tremendous pressures of daily living. An average day of walking, for example, brings a force equal to several hundred tons to bear on the feet. This helps explain why your feet are more subject to injury than any other part of your body.
Foot ailments are among the most common of our health problems. Although some can be traced to heredity, many stem from the cumulative impact of a lifetime of abuse and neglect. Studies show that most Americans experience foot problems of a greater or lesser degree of seriousness at some time in their lives; nowhere near that many seek medical treatment, apparently because they mistakenly believe that discomfort and pain are normal and expectable.
There are a number of systemic diseases that are sometimes first detected in the feet, such as diabetes, circulatory disorders, anemia, and kidney problems. Arthritis, including gout, often attacks foot joints first.
Specialized Care
Your feet, like other specialized structures, require specialized care. A doctor of podiatric medicine can make an important contribution to your total health, whether it is regular preventive care or surgery to correct a deformity.
In order to keep your feet healthy, you should be familiar with the most common ills that affect them. Remember, though, that self-treatment can often turn a minor problem into a major one and is generally not advisable. You should see a podiatric physician when any of the following conditions occur or persist.
Athlete’s foot is a skin disease, usually starting between the toes or on the bottom of the feet, which can spread to other parts of the body. It is caused by a fungus that commonly attacks the feet, because the wearing of shoes and hosiery fosters fungus growth. The signs of athlete’s foot are dry scaly skin, itching, inflammation, and blisters. You can help prevent infection by washing your feet daily with soap and warm water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture. Athlete’s foot is not the only infection, fungal or otherwise, which afflicts the foot, and other dry skin/dermatitis conditions can be good reasons to see a doctor of podiatric medicine if a suspicious condition persists.
Blisters are caused by skin friction. Don’t pop them. Apply moleskin or an adhesive bandage over a blister, and leave it on until it falls off naturally in the bath or shower. Keep your feet dry and always wear socks as a cushion between your feet and shoes. If a blister breaks on its own, wash the area, apply an antiseptic, and cover with a sterile bandage.
Bunions are misaligned big toe joints which can become swollen and tender. The deformity causes the first joint of the big toe to slant outward, and the big toe to angle toward the other toes. Bunions tend to run in families, but the tendency can be aggravated by shoes that are too narrow in the forefoot and toe. There are conservative and preventive steps that can minimize the discomfort of a bunion, but surgery is frequently recommended to correct the problem.
Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas. Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist’s instructions.
Foot odor results from excessive perspiration from the more than 250,000 sweat glands in the foot. Daily hygiene is essential. Change your shoes daily to let each pair air out, and change your socks, perhaps even more frequently than daily. Foot powders and antiperspirants, and soaking your feet in vinegar and water, can help lessen odor.
Hammertoe is a condition in which any of the toes are bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Although the condition usually stems from muscle imbalance, it is often aggravated by ill-fitting shoes or socks that cramp the toes. Avoid pressure on the toes as much as possible. Surgery may be necessary to realign the toes to their proper position.
Heel pain can generally be traced to faulty biomechanics which place too much stress on the heel bone, ligaments, or nerves in the area. Stress could result while walking or jumping on hard surfaces, or from poorly made footwear. Overweight is also a major contributing factor. Some general health conditions—arthritis, gout, and circulatory problems, for example—also cause heel pain.
Heel spurs are growths of bone on the underside of the heel bone. They can occur without pain; pain may result when inflammation develops at the point where the spur forms. Both heel pain and heel spurs are often associated with plantar fasciitis, an inflammation of the long band of connective tissue running from the heel to the ball of the foot. Treatments may range from exercise and custom-made orthotics to anti-inflammatory medication or cortisone injections.
Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure. Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers. If the ingrown portion of the nail is painful or infected, your podiatric physician may remove the affected portion; if the condition reoccurs frequently, your podiatrist may permanently remove the nail.
Neuromas are enlarged, benign growths of nerves, most commonly between the third and fourth toes. They are caused by bones and other tissue rubbing against and irritating the nerves. Abnormal bone structure or pressure from ill-fitting shoes also can create the condition, which can result in pain, burning, tingling, or numbness between the toes and in the ball of the foot. Conservative treatment can include padding, taping, orthotic devices, and cortisone injections, but surgical removal of the growth is sometimes necessary.
Warts are caused by a virus, which enters the skin through small cuts and infects the skin. Children, especially teenagers, tend to be more susceptible to warts than adults. Most warts are harmless and benign, even though painful and unsightly. Warts often come from walking barefooted on dirty surfaces or littered ground. There are several simple procedures which your podiatric physician might use to remove warts.
Top Ten Foot Health Tips
Diseases, disorders and disabilities of the foot or ankle affect the quality of life and mobility of millions of Americans. However, the general public and even many physicians are unaware of the important relationship between foot health and overall health and well-being. With this in mind, the American Podiatric Medical Association (APMA) would like to share a few tips to help keep feet healthy.
- Don't ignore foot pain—it's not normal. If the pain persists, see a podiatric physician.
- Inspect your feet regularly. Pay attention to changes in color and temperature of your feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate athlete's foot. Any growth on the foot is not considered normal.
- Wash your feet regularly, especially between the toes, and be sure to dry them completely.
- Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet because they are more prone to infection.
- Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest and replace worn out shoes as soon as possible.
- Select and wear the right shoe for the activity that you are engaged in (i.e., running shoes for running).
- Alternate shoes—don't wear the same pair of shoes every day.
- Avoid walking barefooted—your feet will be more prone to injury and infection. At the beach or when wearing sandals, always use sunblock on your feet just as on the rest of your body.
- Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.
- If you are a person with diabetes, it is vital that you see a podiatric physician at least once a year for a check-up.
Hammer Toe
A hammertoe is a contracture—or bending—of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at 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 to females than males.
Print Handout | Read More ▼
There are two different types:
Flexible Hammertoes:
These are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammertoes because they are still moveable at the joint.
Rigid Hammertoes:
This variety is more developed and more serious than the flexible condition. Rigid hammertoes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammertoe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.
Symptoms
- Pain upon pressure at the top of the bent toe from footwear.
- The 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.
How Do You Get a Hammertoe?
A hammertoe is formed due an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammertoe. Arthritis is another factor, because the balance around the toe in people with arthritis is so disrupted that a hammertoe may develop. Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.
What Can You Do for Relief?
- Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
- Wear a shoe with a deep toe box.
- If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid heels more than two inches tall.
- A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
- Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
- See your podiatric physician if pain persists.
What Will Your Podiatrist Do to Treat a Hammertoe?
The treatment options vary with the type and severity of each hammertoe, although identifying the deformity early in its development is important to avoid surgery. Podiatric medical attention should be sought at the first indication of pain and discomfort because, if left untreated, hammertoes tend to become rigid, making a nonsurgical treatment less of an option.
Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.
Padding and Taping:
Often this is the first step in a treatment plan. Padding the hammertoe 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.
Medication:
Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.
Orthotic Devices:
Custom 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.
Surgical Options:
Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain.
Severe hammertoes, which are not fully reducible, may require more complex surgical procedures.
Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.
Your Feet Aren't Supposed to Hurt
Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.
Hammertoe Tips
- Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
- Wear a shoe with a deep toe box.
- If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
- Avoid heels more than two inches tall.
- A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
- Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
- See your podiatric physician if pain persists.
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.Heel Pain
In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered.
When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.
Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.
Print Handout | Read More ▼
Heel Pain
Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.
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, sometimes disabling, can occur in the front, back, or bottom of the heel.
Heel Spurs
A common cause of heel pain is the heel spur, 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. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome."
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by 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 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. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite 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 it 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.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation
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.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—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.
Disease and Heel Pain
Some general health conditions can also bring about heel pain.
- Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
- Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
- Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
- Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendinitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
- Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
Stress fractures of the heel bone also can occur, although infrequently.
Children's Heel Pain
Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief. Other good news is that heel spurs do not often develop in children.
Prevention
A variety of steps can be taken to avoid heel pain and accompanying afflictions:
- Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters.
- Wear the proper shoes for each activity.
- Do not wear shoes with excessive wear on heels or soles.
- Prepare properly before exercising. Warm up and do stretching exercises before and after running.
- Pace yourself when you participate in athletic activities.
- Don’t underestimate your body's need for rest and good nutrition.
- If obese, lose weight.
Podiatric Medical Care
If pain and other symptoms of inflammation—redness, swelling, heat—persist, you should limit normal daily activities and contact a doctor of podiatric medicine.
The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.
Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.
A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of 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.
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.
Heel Pain Tips
- If you have experienced painful heels try wearing your shoes around your house in the evening. Don't wear slippers or socks or go barefoot. You may also try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back.
- If the pain persists longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort.
- If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program.
- Begin an exercise program slowly. Don't go too far or too fast.
- Purchase and maintain good shoes and replace them regularly.
- Stretch each foot and achilles tendon before and after exercise.
- Avoid uneven walking surfaces or stepping on rocks as much as possible.
- Avoid going barefoot on hard surfaces.
- Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
- If it hurts, stop. Don't try to "work through the pain."
Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.
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 podiatric foot and ankle surgeon is best trained 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. 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.
Causes of Plantar Fasciitis
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 a person’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.
Diagnosis
To arrive at a diagnosis, the podiatric 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, a bone scan, or magnetic resonance imaging (MRI) 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.
Treatment Options
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 10 minutes several times a day helps reduce inflammation.
- 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. Your shoes should provide a comfortable environment for the foot.
- Medications. Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
- Lose weight. Extra pounds put extra stress on your plantar fascia.
If you still have pain after several weeks, see your podiatric surgeon, who may add one or more of these 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.
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 podiatric 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. If you are overweight, it is important to reach and maintain an ideal weight. For all patients, wearing supportive shoes and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.Heel Spurs
High Blood Pressure
The Podiatric Physician and Cardiovascular Ailments
As a member of the health care team, your doctor of podiatric medicine (DPM) is vitally concerned about hypertension (high blood pressure) and vascular disease (heart and circulatory problems). There are several reasons for this concern. First, because you are a patient, your podiatric physician and surgeon is interested in all aspects of your health and your treatment program. Second, he or she supports the goals of high blood pressure detection, treatment, and control.
Print Handout | Read More ▼
Your podiatric physician should know if you have any of the following cardiovascular or related conditions:
Hypertension and/or cardiovascular disease: Hypertension sometimes causes decreased circulation. A careful examination is required to determine if there is lower than normal temperature in any of the extremities, absence of normal skin color, or diminished pulse in the feet. The concern is that these are signs of arterial insufficiency (reduced blood flow). Increased or periodic swelling in the lower extremities is important because it may mean that hypertension has contributed to heart disease.
Rheumatic heart disease: Persons who have had rheumatic heart disease must be protected with prophylactic antibiotics prior to any surgical intervention. If you take medication for this condition, tell your podiatric physician. Any medication you may be taking for high blood pressure, a heart condition, or any other reason should be reported to the DPM to ensure that it does not conflict with medications that may be prescribed in the treatment of your feet.
Diabetes: This condition frequently affects the smaller arteries, resulting in diminished circulation and decreased sensation in the extremities. Let your podiatric physician know if you have ever been told that you have diabetes, particularly if you are talking medication or insulin for this condition.
Ulceration: Open sores that do not heal, or heal very slowly, may be symptoms of certain anemias, including sickle cell disease. Or they may be due to hypertension or certain inflammatory conditions of the blood vessels. Your DPM is on the alert for such conditions, but be sure to mention if you have ever had this problem.
Swollen feet: Persistent swelling of one or both feet may be due to kidney, heart, or circulatory problems.
Burning feet: Although it can have a number of causes, a burning sensation of the feet is frequently caused by diminished circulation.
Control of High Blood Pressure
High blood pressure is a major risk factor for cardiovascular disease. Uncontrolled high blood pressure can cause fatal strokes and heart disease. As a health care provider, your podiatric physician assists in controlling this public health problem. There are three major areas in which he or she provides this important public service:
Detection: Many podiatric physicians routinely take every patient's blood pressure and determine if it is elevated.
Treatment: After confirming that blood pressure is elevated and making this information part of the patient's record, the DPM refers all patients with elevated blood pressure to their primary care physicians for evaluation, diagnosis, and treatment.
Long-Term Control: By encouraging patients at every visit to adhere to treatment, and by monitoring reductions in blood pressure, side effects of treatment, and referring for reevaluation as needed, the podiatric physician facilitates long-term control.
Foot Health Tips
Diseases, disorders and disabilities of the foot or ankle affect the quality of life and mobility of millions of Americans. However, the general public and even many physicians are unaware of the important relationship between foot health and overall health and well-being. With this in mind, the American Podiatric Medical Association (APMA) would like to share a few tips to help keep feet healthy.
- Don't ignore foot pain—it's not normal. If the pain persists, see a podiatric physician.
- Inspect your feet regularly. Pay attention to changes in color and temperature of your feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate athlete's foot. Any growth on the foot is not considered normal.
- Wash your feet regularly, especially between the toes, and be sure to dry them completely.
- Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet because they are more prone to infection.
- Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest and replace worn out shoes as soon as possible.
- Select and wear the right shoe for the activity that you are engaged in (i.e., running shoes for running).
- Alternate shoes—don't wear the same pair of shoes every day.
- Avoid walking barefooted—your feet will be more prone to injury and infection. At the beach or when wearing sandals, always use sunblock on your feet just as on the rest of your body.
- Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.
- If you are a person with diabetes, it is vital that you see a podiatric physician at least once a year for a check-up.
Ingrown Toenails
Nail Problems
Barometers of Health
Toenails often serve as barometers of our health; they are diagnostic tools providing the initial signal of the presence or onset of systemic diseases. For example, the pitting of nails and increased nail thickness can be manifestations of psoriasis. Concavity—nails that are rounded inward instead of outward—can foretell iron deficiency anemia. Some nail problems can be conservatively treated with topical or oral medications while others require partial or total removal of the nail. Any discoloration or infection on or about the nail should be evaluated by a podiatric physician.
Print Handout | Read More ▼
Nail Ailments
Ingrown Toenails
Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is usually the victim of this condition but other toes can also become affected.
Ingrown toenails may be caused by:
- Improperly trimmed nails (Trim them straight across, not longer than the tip of the toes. Do not round off corners. Use toenail clippers.)
- Heredity
- Shoe pressure; crowding of toes
- Repeated trauma to the feet from normal activities
If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water, then apply an antiseptic and bandage the area.
People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self treatment and seek podiatric medical care as soon as possible.
Other "do-it-yourself" treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications, should be avoided. Nail problems should be evaluated and treated by your podiatrist, who can diagnose the ailment, and then prescribe medication or another appropriate treatment.
A podiatrist will resect the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a chemical, a laser, or by other methods.
Fungal Nails
Fungal infection of the nail, or onychomycosis, is often ignored because the infection can be present for years without causing any pain. The disease is characterized by a progressive change in a toenail's quality and color, which is often ugly and embarrassing.
In reality, the condition is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair one's ability to work or even walk. This happens because the resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.
Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. 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 especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.
Prevention
- Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.
- Clean and dry feet resist disease.
- Washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection.
- Shower shoes should be worn when possible in public areas.
- Shoes, socks, or hosiery should be changed more than once daily.
- Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
- Wear shoes that fit well and are made of materials that breathe.
- Avoid wearing excessively tight hosiery, which promote moisture.
- Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks.
- Disinfect instruments used to cut nails.
- Disinfect home pedicure tools.
- Don't apply polish to nails suspected of infection—those that are red, discolored, or swollen, for example.
Treatment of Fungal Nails
Treatments may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.
A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail.
Newer oral antifungals, approved by the Food and Drug Administration, may be the most effective treatment. They offer a shorter treatment regimen of approximately three months and improved effectiveness. Podiatrists may also prescribe a topical treatment for onychomycosis, which can be an effective treatment modality for fungal nails.
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 of 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 podiatric physician can lead to more problems. With new technical advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.
Nail Care Tips
- Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.
- Clean and dry feet resist disease.
- Washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection.
- Shower shoes should be worn when possible in public areas.
- Shoes, socks, or hosiery should be changed more than once daily.
- Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
- Wear shoes that fit well and are made of materials that breathe.
- Avoid wearing excessively tight hosiery, which promote moisture.
- Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks.
- Disinfect instruments used to cut nails.
- Disinfect home pedicure tools.
- Don't apply polish to nails suspected of infection—those that are red, discolored, or swollen, for example.
Neuromas
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 toes that brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.
The principal symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. 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.
Print Handout | Read More ▼
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.
How Do You Get a Neuroma?
Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma.
Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.
Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.
Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.
Repeated stress, common to many occupations, can create or aggravate a neuroma.
What Can You Do for Relief?
Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.
High heels should be avoided whenever possible because they place undue strain on the forefoot and can contribute to a number of foot problems.
Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, podiatric medical treatment or surgery may be necessary to remove the tumor.
Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.
Treatment by Your Podiatric Physician
Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction. Podiatric medical care should be sought at the first sign of pain or discomfort; if left untreated, neuromas tend to get worse.
The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case.
Padding and Taping:
Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.
Medication:
Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.
Orthotic Devices:
Custom 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 condition.
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. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.
Your Feet Aren't Supposed to Hurt
Remember that foot pain is not normal, and any disruption in foot function limits your freedom and mobility. It is important to schedule an appointment with your podiatrist at the first sign of pain or discomfort in your feet, and follow proper maintenance guidelines to ensure their proper health for the rest of your life. The advice in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.
Neuroma Tips
- Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
- Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.
- High heels should be avoided whenever possible because they place undue strain on the forefoot and can contribute to a number of foot problems.
- Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
- For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, podiatric medical treatment or surgery may be necessary to remove the tumor.
- Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.
Plantar Fasciitis
Plantar Wart
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but technically only those on the sole are properly called plantar warts.
Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.
Print Handout | Read More ▼
Identification Problems
Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.
It is also 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 a wart. It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.
Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.
Source of the Virus
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.
If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.
Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
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. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.
Tips for Prevention
- Avoid walking barefoot, except on sandy beaches.
- Change shoes and socks daily.
- Keep feet clean and dry.
- Check children's feet periodically.
- Avoid direct contact with warts—from other persons or from other parts of the body.
- Do not ignore growths on, or changes in, your skin.
- Visit your podiatric physician as part of your annual health checkup.
Self Treatment
Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.
Professional Treatment
It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.
Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.
Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.
Tips for Individuals with Warts
- Avoid self treatment with over-the-counter preparations.
- Seek professional podiatric evaluation and assistance with the treament of your warts.
- Diabetics and other patients with circulatory, immunological, or neurological problems should be especially careful with the treament of their warts.
- Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.
What is a Plantar Wart?
Awart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.
There are two types of plantar warts:
- A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional “satellite”warts.
- Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.
Signs and Symptoms
The signs and symptoms of a plantar wart may include:
- Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
- Pain. A plantar wart usually hurts during walking and standing, and there is pain when the sides of the wart are squeezed.
- Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the infected capillaries (tiny blood vessels).
Plantar warts grow deep into the skin. Usually this growth occurs slowly—the wart starts off small and gets larger over time.
What causes a Plantar Wart?
Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body. Typically, the plantar wart virus is acquired in public places where people go barefoot, such as locker rooms, swimming pools, and karate classes. It can also be acquired at home if other family members have the virus.
Diagnosis and Treatment
To diagnose a plantar wart, the foot and ankle surgeon will examine the patient’s foot and look for signs and symptoms of a wart.
Although plantar warts may eventually clear up on their own, most patients desire faster relief. The goal of treatment is to completely remove the wart.
The foot and ankle surgeon may use topical or oral treatments, laser therapy, cryotherapy (freezing), or surgery to remove the wart.
Regardless of the treatment approaches undertaken, it is important that the patient follow the surgeon’s instructions, including all home care and medication that has been prescribed, as well as follow-up visits with the surgeon.Warts may return, requiring further treatment.
If there is no response to treatment, further diagnostic evaluation may be necessary. In such cases, the surgeon can perform a biopsy to rule out other potential causes for the growth.
Although there are many folk remedies for warts, patients should be aware that these remain unproven and may be dangerous. Patients should never try to remove a wart themselves—this can do more harm than good.Podiatric Medicine
Podiatric medicine is the profession that strives to improve the overall health and well-being of patients by focusing on preventing, diagnosing, and treating conditions associated with the foot and ankle. Doctors of Podiatric Medicine (DPMs) are physicians and surgeons who practice on the lower extremities, primarily on feet and ankles. DPMs are licensed in all 50 states, the District of Columbia and Puerto Rico to diagnose and treat the foot and its related or governing structures by medical, surgical, or other means. The vast majority of states also include ankle care as part of the podiatric physician’s scope of practice.
More than 75 percent of all Americans will experience foot and ankle problems of varying degrees at one time in their lives and thus, the need for podiatric physicians continues to grow. There are approximately 15,000 doctors of podiatric medicine practicing in the United States today. The skills of these physicians are in increasing demand as the baby boom generation swells the ranks of older Americans at almost three times the growth rate of the general population. In addition, the general public’s emphasis and interest in sports and health increases the need for healthy feet and the services of podiatric physicians are in greater demand.
Print Handout | Read More ▼
Scope of Practice
Podiatrists are America’s premier foot and ankle physicians. As such, their scope of practice allows them to diagnose and treat a myriad of diseases, symptoms and disorders. Podiatrists are often the first to identify systemic diseases in patients, such as diabetes and the associated complications, high blood pressure and heart disease. Patients from all walks of life and of all ages—from pediatric to geriatric—require the kind of expertise that only a doctor of podiatric medicine can provide.
Podiatric physicians provide a vast array of medical services to their patients. They:
- perform complete medical histories and physical examinations
- prescribe drugs
- perform surgery
- set fractures and treat sports-related injuries
- prescribe and fit orthotics, insoles, and custom-made shoes
- order and perform physical therapy
- take and interpret X-rays and other imaging studies
- work as valued members of a community’s health care team
Nearly all private and public health insurance plans provide coverage for the services of doctors of podiatric medicine. Even though third-party coverage of podiatrists’ services generally includes the medical and surgical care of foot complaints, details of such coverage can and do vary among the plans. The same applies to federal health insurance plans, including Medicare, federal employee health benefits, and federal employee compensation programs.
Podiatric Education
The preparatory education for DPMs includes four years of undergraduate work, followed by four years at an accredited podiatric medical school, and then successful completion of a hospital-based residency program. There are currently eight colleges of podiatric medicine in the United States:
- Arizona Podiatric Medicine Program at Midwestern University in Glendale, Arizona
- Barry University School of Graduate Medical Sciences in Miami Shores, Florida
- California School of Podiatric Medicine at Samuel Merritt College in Oakland, California
- College of Podiatric Medicine and Surgery at Des Moines University in Des Moines, Iowa
- New York College of Podiatric Medicine in New York, New York
- Ohio College of Podiatric Medicine in Cleveland, Ohio
- Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University in North Chicago, Illinois
- Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania
All of the colleges go through a rigorous evaluation process by the Council on Podiatric Medical Education, which is recognized by the U.S. Department of Education and the Council on Higher Education Accreditation. The colleges all grant the degree of Doctor of Podiatric Medicine or DPM, with some also offering degrees in other academic areas as well.
Applicants for admission are required to complete the Medical College Admissions Test (MCAT) as a prerequisite, although some of the colleges accept other examinations such as the Graduate Record Examination (GRE) or Dental Admission Test (DAT). Individuals may apply to any or all of the colleges by submitting a single application through the application service of the American Association of Colleges of Podiatric Medicine (AACPM), an APMA-related organization.
The course of instruction leading to the DPM degree is four years in length. The first two years are largely devoted to classroom instruction and laboratory work in the basic medical sciences, such as anatomy, physiology, microbiology, biochemistry, pharmacology, and pathology. During the third and fourth years, students concentrate on courses in the clinical sciences, gaining practical experience in college and community clinics and accredited hospitals. Clinical courses include general diagnosis (history taking, physical examination, clinical laboratory procedures, and diagnostic radiology), therapeutics (pharmacology, physical medicine, orthotics, and prosthetics), surgery, dermatology, neurology, orthopedics, and anesthesia, among others.
After completing the four-year course and receiving the DPM degree, the graduate is eligible to take a state board examination to obtain a license to practice. Most states require at least one year of residency; the industry standard for podiatric medicine is now two years of postgraduate training.
As they near graduation, nearly all students seek postdoctoral residency programs. These programs, designed to strengthen and refine the practitioner’s podiatric medical, orthopedic, and surgical skills, are based in hospitals accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and/or the American Osteopathic Association. The programs are at least two years in duration, and may extend to four years.
Almost all states have established some continuing podiatric medical education requirements for license renewal, and there is heavy attendance at many educational programs and seminars developed and presented each year by the colleges and local, state, and national podiatric medical associations.
Special Areas of Practice
APMA's Joint Committee on the Recognition of Specialty Boards recognizes and approves two specialty boards that certify podiatrists in:
- podiatric surgery
- primary podiatric medicine and orthopedics
Podiatrists with certification in these areas have passed written and oral examinations and have demonstrated superior knowledge and experience in the specific specialty. The certification boards are the American Board of Podiatric Surgery (ABPS) and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM).
Some podiatric physicians choose to do research and those doctors can usually be found at one of the eight colleges of podiatric medicine. Research opportunities are available throughout the country and many doctors are published in the peer-reviewed Journal of the American Podiatric Medical Association (JAPMA.)
Podiatric Medicine in the Community
While many podiatric physicians work in private or small group practices, DPMs also serve on the staffs of hospitals and long-term care facilities, on the faculties of schools of medicine and nursing, as commissioned officers in the Armed Forces and U.S. Public Health Service, in the Department of Veterans Affairs, and in municipal health departments.
Consistent with the podiatrist's education and licensure, JCAHO, the American Medical Association, and other organizations recognize the right of qualified podiatric physicians to serve on the staffs of hospitals and other health care facilities. Most of the podiatrists practicing in the United States have full staff privileges at hospitals; many also have surgical centers in or attached to their own offices.
There is a strong and growing role for podiatrists in public health. There has been a podiatric health section in the American Public Health Association (APHA) for over three decades, and the relationship between APMA and APHA is strong and reciprocal.
The American Podiatric Medical Association
The American Podiatric Medical Association (APMA), established in 1912, is the premier professional organization representing the nation’s doctors of podiatric medicine, or podiatrists. APMA represents the vast majority of podiatric physicians in the country. Under APMA’s umbrella of organizations are 53 component societies in states and other jurisdictions, as well as 22 affiliated and related societies.Rearfoot Surgery
Many conditions can affect the back portion of the foot and ankle. Fortunately, many of these problems can be resolved through conservative treatments. However when pain persists or deformity occurs, surgical intervention can often help alleviate pain, reduce deformity, and/or restore the function of your foot or ankle.
Print Handout | Read More ▼
Heel Surgery
Two common conditions that can cause pain to the bottom of the heel are plantar fasciitis and heel spur(s). Although there are many causes of heel pain in both children and adults, most can be effectively treated without surgery. When chronic heel pain fails to respond to conservative treatment, surgical care may be warranted.
Plantar Fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot.
Heel Spur(s) or heel spur syndrome are most often the result of stress on the muscles and fascia of the foot. This stress may form a spur on the bottom of the heel. While many spurs are painless, others may produce chronic pain.
Based on the condition and the chronic nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Your podiatric physician will determine which method is best suited for you.
There are many other causes of heel pain, which has become one of the most common foot problems reported by patients of podiatric physicians. Many of them have a basis in heredity, as do a lot of other foot conditions. Among the causes are stress fractures and stress-fracture syndrome, entrapped nerves, bruises, bursitis, arthritis (including gout), deterioration of the fat pad on the heel, improper shoes, and obesity, just to name some. Most of these conditions will be treated nonsurgically, though surgery may be recommended in some instances.
Haglund's Deformity (pump bump)
This deformity is characterized by a bony enlargement on the back of the heel. Although not always painful, it may become so if bursitis develops near the Achilles tendon secondary to footwear irritation. If attempts at shoe modification and other medical treatments fail to improve this condition, surgical correction may be beneficial. Based on X-ray evaluation and other tests or examinations, your podiatric surgeon will select an operative treatment to alleviate the condition.
Insertional Achilles Clarification/Spur
This deformity differs from Haglund's deformity, in that spur formation or calcification at the insertion of the achilles tendon is the cause of pain. Often associated with achilles tendinitis, this deformity can often be difficult to treat medically and therefore surgical treatment may be necessary in chronic cases. There are many causes of this condition, including arthritis, but the most common appears to be overuse syndrome, where trauma occurs where the achilles tendon attaches to the heel bone. Surgical treatment includes removal of the bone spur and/or calcification, along with repair of the achilles tendon.
Reconstructive Surgery
Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.
Preoperative Testing and Care
As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to obtain a successful surgical outcome. Prior to surgery, the podiatric surgeon will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status that may be ordered by the podiatric physician include blood studies, urinalysis, EKG, X-rays, blood flow studies (to better evaluate the circulatory status of the foot/legs), and biomechanical examination.
A consultation with another medical specialist is sometimes advised by a podiatric physician, depending on your test results or a specific medical condition.
Postoperative Care
Surgery of the rearfoot requires close care following surgery. To assure a rapid and uneventful recovery, it is important to follow your podiatric surgeon's advice and postoperative instructions carefully. Rest, ice, compression and elevation of your foot/ankle postoperatively is often advised. The usage of bandages, splints, casts, surgical shoes, crutches, or canes may be necessary after surgery. Your podiatric surgeon will also determine if and when you can bear weight on an operated foot.Ruptured Tendons
Sesamoiditis
Shin Splints
Stress Fractures
Tailor's Bunion
Tailor's bunion, also called a bunionette, is an enlargement of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The enlargement that characterizes a tailor's bunion occurs at the metatarsal “head,” located at the far end of the bone where it meets the toe. Tailor's bunions are not as common as bunions, which occur on the inside of the foot, but both are similar in symptoms and causes.
The symptoms of tailor's bunions include redness, swelling, and pain at the site of the enlargement. These symptoms occur when wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.
Why do we call it “tailor's bunion”? The deformity received its name centuries ago,when tailors sat crosslegged all day with the outside edge of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the little toe.
Print Handout | Read More ▼
Causes of a Tailor's Bunion
Often a tailor's bunion is caused by an inherited faulty mechanical structure of the foot. In these cases, changes occur in the foot’s bony framework that result in the development of an enlargement. The fifth metatarsal bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it.
Sometimes a tailor's bunion is actually a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head. Heredity is the main reason that these spurs develop.
Regardless of the cause, the symptoms of a tailor's bunion are usually aggravated by wearing shoes that are too narrow in the toe, producing constant rubbing and pressure. In fact, wearing shoes with a tight toe box can make the deformity get progressively worse.
Diagnosis
Tailor's bunion is easily diagnosed because the protrusion is visually apparent. X-rays may be ordered to help the foot and ankle surgeon determine the cause and extent of the deformity.
Treatment: Non-surgical Options
Treatment for tailor's bunion typically begins with non-surgical therapies. Your foot and ankle surgeon may select one or more of the following options:
- Shoe modifications. Wearing the right kind of shoes is critical. Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
- Injection therapy. Injections of corticosteroid are commonly used to treat the inflamed tissue around the joint.
- Padding. Bunionette pads placed over the area may help reduce pain. These pads are available from your foot and ankle surgeon or at a drug store.
- Icing. An ice pack may be applied to reduce pain and inflammation. Wrap the pack in a thin towel rather than placing ice directly on your skin.
When Is Surgery Needed?
Surgery is often considered when pain continues despite the above approaches. Surgery is highly successful in the treatment of tailor's bunions.
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.Tarsal Tunnel Syndrome
The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
Print Handout | Read More ▼
What Is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve. The posterior tibial nerve runs along the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.Although tarsal tunnel syndrome may not be as well known as carpal tunnel syndrome, it is nevertheless a cause of foot and ankle pain in adults.
Symproms
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
- Tingling, burning, or a sensation similar to an electrical shock
- Numbness
- Pain, including shooting pain
The symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot—such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment if any of the symptoms of tarsal tunnel syndrome occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made.
Causes
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
- A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with “fallen” arches can produce strain and compression on the nerve.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
- An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
- A person who is overweight may be prone to experiencing pressure on the posterior tibial nerve.
- Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.
Diagnosis
The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling.During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced.He or she will also press on the area to help determine if a small mass is present.
Sometimes an MRI is ordered, usually if a mass is suspected or in cases where initial treatment does not reduce the symptoms. In addition, special studies used to evaluate nerve problems—electromyography and nerve conduction velocity (EMG/NCV)—may be ordered if the condition shows no improvement with non-surgical treatment.
Treatment
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome.
These include:
- Rest. Staying off the foot prevents further injury and encourages healing.
- Ice. To reduce swelling in the tarsal tunnel, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
- Physical therapy. Ultrasound therapy, exercises, and other forms of physical therapy may be prescribed to reduce symptoms.
- Injection therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
- Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression on the nerve.
- Shoes. Supportive shoes, as recommended by your foot and ankle surgeon, may prove helpful.
- Bracing. Patients with flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.
- Surgery. Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.
Toe Metatarsal Fractures
The structure of your foot is complex, consisting of bones,muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A podiatric foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.
Print Handout | Read More ▼
What Is a Fracture?
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.
Traumatic fractures (also called acute fractures) are caused by a direct blow or impact—like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.
Signs and symptoms of a traumatic fracture include:
- You may hear a sound at the time of the break.
- “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
- Deviation (misshapen or abnormal appearance) of the toe.
- Bruising and swelling the next day.
- It is not true that “if you can walk on it, it’s not broken.” Evaluation by the podiatric surgeon is always recommended.
Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include:
- Pain with or after normal activity
- Pain that goes away when resting and then returns when standing or during activity
- “Pinpoint pain” (pain at the site of the fracture) when touched
- Swelling, but no bruising
Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your podiatric surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.
Consequences of Improper Treatment
Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:
- Adeformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
- Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
- Chronic pain and long-term dysfunction
- Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.
Treatment of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:
- Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
- Splinting. The toe may be fitted with a splint to keep it in a fixed position.
- Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
- “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.
- Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.
Treatment of Metatarsal Fractures
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.
For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.
Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments.Your podiatric surgeon is an expert in correctly identifying these conditions as well as other problems of the foot.
Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:
- Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
- Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.
- Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
- Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
- Follow-up care. Your podiatric foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.
Fractures
Walking
For a healthier, happier lifestyle, try walking--the most popular form of exercise.
It's easy, safe, and inexpensive. It's also relaxing and at the same time invigorating, requires little athletic skill, and does not call for club membership or special equipment other than sturdy, comfortable shoes. And it is fun and natural--good for your mind and self-esteem.
The results of walking are physically rewarding--a trim, fit body better able to enhance general health and add enjoyable years to your life.
Fundamental walking--also called healthwalking--can be done almost anywhere and at any time, year around--to the store, in the mall, or in your neighborhood; alone, with your dog, or with others; and at your own pace. It is simple, uncomplicated--physical fitness at your leisure.
Walking benefits most everybody, regardless of age. About 67 million men and women are walking regularly. Convinced that it is good exercise, they're making it a part of their daily routine. And their numbers are increasing every year, according to the President's Council on Physical Fitness and Sports.
Print Handout | Read More ▼
A Sure Way To Fitness
For those with a long history of inactivity, problems with obesity, or who just don't like strenuous activity, walking is an excellent way to begin an exercise program. You can start slowly, then increase your speed and maintain a steady pace. A good conditioning program begins with moderation and dedication.
Podiatric and family physicians recommend walking to ease or ward off a number of physically related ills. Walking can help you:
- Strengthen your heart and lungs, and improve circulation.
- Prevent heart attacks and strokes.
- Reduce obesity and high blood pressure.
- Boost your metabolic rate.
- Favorably alter your cholesterol.
- Improve muscle tone in your legs and abdomen.
- Reduce stress and tension.
- Reduce arthritis pain; stop bone tissue decay.
Walking: There's An Art To It
Before you start walking, some simple warmup exercises--but not strenuous, advanced stretching--can give your muscles added flexibility. Body twists at the waist, in a slow hula-hoop motion, and a few toe-touching or knee-bend exercises are appropriate. When you're ready to begin, the best way to start is walking 20 uninterrupted minutes at least three times a week. Walk at a comfortable pace, slowing down if you find yourself breathing heavily. Don't tire yourself. If 20 minutes is too much, cut back to l0 or l5 minutes. You can gradually increase your time and pace as your body adapts to the exercise.
There are several ways to measure your pace. One is to walk on routes which you have pre-measured with your car's odometer. Perhaps the simplest is to use a wristwatch. Count the number of steps you take in a 15-second period; if you're taking 15 in that time, you're walking about two miles an hour. At about 23, you're probably going three miles an hour, and at 30, the pace is close to four miles an hour.
You may want to keep an activity log, in which you jot down the dates, times, and estimated distances of your walks, plus other notes, such as routes, milestones, and incidental experiences.
Some Walking Tips:
- Move at a steady pace, brisk enough to make your heart beat faster. Breathe more deeply.
- Walk with your head erect, back straight, abdomen flat. Keep your legs out front and your knees slightly bent.
- Swing your arms freely at your sides.
- As you walk, land on the heel of your foot and roll forward to push off on the ball of your foot.
- At least at the beginning, confine your walks to level stretches of flat surfaces, avoiding excessively steep hills and embanked roadways.
- If you're walking in the evening, be sure to wear clothing with reflective material sewn in, or otherwise attached.
- Cool down after a long, brisk walk to help pump blood back up from your legs to where it's needed. Here's where some stretching exercises can be helpful. A good one is standing about three feet from a wall, with your hands flat on the wall. Then take five or six small steps backward, maintaining your hand contact with the wall. Repeat the exercise five to ten times.
Racewalking
Racewalking is a very specific technique that's used by walkers for both fitness and competition. It has greater aerobic benefits than healthwalking, since it is faster and increases the heartbeat rate.
If you get to the point where you think racewalking is for you, there are clubs which can be contacted in most places.
Walking Footwear: Comfort and Fit
Choose a good quality, lightweight walking shoe with breathable upper materials, such as leather or nylon mesh. The heel counter should be very firm; the heel should have reduced cushioning to position the heel closer to the ground for walking stability. The front or forefoot area of the shoe should have adequate support and flexibility.
Fit is very important. Go to a reputable store and have both shoes fitted for length and width with the socks you'll be using. (Do this late in the afternoon, since your feet do swell enough during the day to affect your shoe size.) Make sure the shoe is snug but not too tight over the sock. The shoe should have plenty of room for the toes to move around. Several walking shoes have qualified to use the APMA Seal of Acceptance.
Your choice of athletic socks is also important. Sports podiatrists frequently recommend appropriately padded socks of acrylic fiber. Acrylic fibers tend to "wick" away excessive perspiration, which active feet can produce from 250,000 sweat glands at a rate of four to six ounces a day, or even more. Again, there are popular brands of athletic socks which are authorized to use APMA's Seal of Acceptance.
Some Other Tips
- Check on the shoe width; it must comfortably accommodate the width of the ball of your foot.
- Make sure you get good arch support.
- See that the top of the heel counter of the shoe is properly cushioned and does not bite into the heel or touch the ankle bones.
Do You Need A Checkup?
If you are free of serious health problems, you can start walking with confidence. Walking is not strenuous; it involves almost no risk to health. You should, of course, exercise good judgment, not exceed the limits of your condition, and not walk outdoors during extreme weather periods, until you have a good walking program established.
You should, however, consult your family or podiatric physician before you begin a walking regimen. A checkup is suggested, particularly if you are over 60, have a disease or disability, or are taking medication. It is also recommended for those who are 35-60, substantially overweight, easily fatigued, excessive smokers, or have been physically inactive.
One of your physicians will help you determine your proper walking heart rate. Heart rate is widely accepted as a good method for measuring intensity during walking and other physical activities. The formula says that subtracting your age from the number 220 yields your maximum heart rate (beats per minute), and that the proper walking rate is 60-70 percent of that number. For a 50-year-old, that's 220 minus 50 equals 170; 60 percent of that is 102 and 70 percent is 119. Other factors should be considered, though; a physician's advice is the best indicator of your correct rate.
You are now ready to begin a walking program. It is a prescription for a healthier, happier life.
Shoe Tips
- Check on the shoe width; it must comfortably accommodate the width of the ball of your foot.
- Make sure you get good arch support.
- See that the top of the heel counter of the shoe is properly cushioned and does not bite into the heel or touch the ankle bones.
Warts
[BACK TO TOP]
Did you know?
At Brandywine Podiatry, our services include:
- 24 Hour Emergency Service
- Diabetic Wound Care Specialists
- Digital Foot & Ankle Imaging Analysis
- Heel Pain
- Joint Replacement
- Office Based Surgery
- Second Opinion
- Hospital Surgery
- Auto Accident Claims
- Laser Therapy
Foot Health Tips
- Properly fitted shoes are essential ―an astonishing number of people wear shoes that don’t fit right, and cause serious foot problems.
- A shoe with a firm sole and soft upper is best for daily activities.
- Shop for shoes in the afternoon; feet tend to swell during the day.
- Walking ―is the best exercise for your feet.
- Pantyhose or stockings should be of the correct size and preferably free of seams.
- Do not wear constricting garters or tie your stockings in knots.
- Never cut corns and calluses with a razor, pocket knife, or other such instrument; use over-the-counter foot products only with the advice of a podiatrist.
- Bathe your feet daily in lukewarm (not hot) water, using a mild soap, preferably one containing moisturizers, or use a moisturizer separately. Test the water temperature with your hand.
- Trim or file your toenails straight across.
- Inspect your feet every day or have someone do this for you. If you notice any redness, swelling, cracks in the skin, or sores, consult your podiatrist.
- Have your feet examined by a DPM at least twice a year.