Athletes foot

Athlete's foot is a term used to describe a form of fungus infection of the feet. The medical term for athlete's foot is tinea pedis.

Athlete's foot is a very common skin condition. Many people will develop it at least once in their lives. Athlete's foot occurs mostly among teenage and adult males. Athlete's foot is uncommon in women and children under the age of 12.

Athlete's foot should not be ignored--it can be easily treated, but it also can be very resistant to treatment.

Moisture, sweating and lack of proper ventilation of the feet present the perfect setting for the fungus of athlete's foot to grow.

Symptoms of Athlete's Foot?

Athlete's foot may affect different people in different ways. Some of the common symptoms of Athlete's foot are:

  • itching,
  • scaling,
  • peeling and cracking of the skin between the toes,
  • redness,
  • scaling ,
  • even blisters on the soles and along the sides of the feet.

The fungi that causes athlete's foot grows in moist, damp places. Sweaty feet, not drying feet well after swimming, running, or bathing, tight shoes and socks, and a warm climate all contribute to the development of athlete's foot.

Bunions

A bunion is generally considered as an enlargement of the joint (a lump of bone) at the base and side of the big toe - (specifically, the first metatarsophalangeal joint). Bunions form when the toe moves out of place. As the big toe bends towards the others this lump becomes larger and the bunion can become painful - arthritis and stiffness can eventually develop. Hallux valgus or hallux abducto valgus (HAV) is the name used for the deviated position of the big toe and a bunion refers to the enlargement of the joint - most of the time the two go together and can just be referred to as 'bunions'.

The word bunion is from the Latin "bunion," meaning enlargement.

Flatfeet

Flat foot is a condition where the longitudinal arch or instep of the foot collapses and comes in contact with the ground. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. In some individuals, the longitudinal arch never develops.

Most flat feet do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line.

Some common symptoms of a flat foot are:

  • A flat look to one or both of your feet
  • Uneven shoe wear and collapse of your shoe toward the inside of your flat foot
  • Lower leg pain
  • Pain on the inside of your ankle
  • Swelling along the inside of your ankle
  • Foot pain

Painful flat feet in children may be caused by a condition called tarsal coalition. Tarsal coalition is a condition where two or more of the bones in the foot fuse together, limiting motion and often leading to a flat foot.

Flat feet can also be caused by fallen arches. Years of wear and tear can weaken the tendon that is responsible for shaping the arch. Fallen arches can also be caused by injury such as inflammation of the tendons in the foot.

Arthritis

The pain and stiffness you feel in your foot and ankle as you grow older could be arthritis. If left untreated, this nagging pain can grow worse, eventually becoming so excruciating that you can no longer walk even short distances. Severe arthritis can restrict your mobility and limit your quality of life, but with proper treatment, you can slow the development of arthritis and lead a more productive life.

This page answers basic questions about the arthritic foot and offers information on treatment of this condition.

What is Arthritis?

Arthritis is a broad term for a number of conditions that destroy the workings of a normal joint.

Arthritis may occur in your back, neck hips, knees, shoulders or hands, but it also occurs in your feet and ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle. There are many different types of arthritis.

The most common type, osteoarthritis (OSS-tee-oh-ar-THRIE-tiss), results from the "wear and tear" damage to joint cartilage (the soft tissue between joint bones) that comes with age The result is inflammation, redness, swelling and pain in the joint.

Also, a sudden and traumatic injury such as a broken bone, torn ligament, or moderate ankle sprain can cause the injured joint to become arthritic in the future. Sometimes a traumatic injury will result in arthritis in the injured joint even though the joint received proper medical care at the time of injury.

Another common type,rheumatoid arthritis, is an inflammatory condition caused by an irritation of the joint lining (the synovium). People with rheumatoid arthritis for at least 10 years almost always develop arthritis in some part of the foot or ankle.

Other types of inflammatory arthritis include gout, lupus, ankylosing spondylitis, and psoriatic arthritis.

Treatment of Arthritis of the Foot and Ankle

Proper treatment of foot and ankle arthritis addresses both pain and joint deformity. Pain develops when the joint is injured. Injury to the joint may result from swelling caused by inflammatory arthritis or from the loss of joint surface (cartilage), often caused by trauma. If left untreated, the foot and ankle may eventually become deformed.

If your doctor suspects you have arthritis of the foot and ankle, he/she will ask you to have a complete medical history and physical examination. X-rays and laboratory tests often can confirm the type and extent of the arthritis. Other tests such as a bone scan, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be used to evaluate your condition.

Once your doctor confirms you have arthritis, he/she will recommend a treatment regimen, which may include medications by mouth (Anti-inflammatories), injections (steroids), physical therapy, occupational therapy, or orthotics such as pads in your shoes, shoe inserts, additions to the insoles or heels of your shoes, or custom-made braces. Surgery may be necessary. This may mean cleaning the arthritic joint, eliminating the painful motion of the joint, replacing the joint with an artificial joint or a combination of all these.

After surgery, you will require a period of rehabilitation when your foot might have to be in a cast and you might have to wear special shoes or braces for a while.

You Are An Important Part of the Treatment

You are often told you must live with arthritis, but that does not mean that you have to stop living. You should take an active part in your treatment; seek treatment for arthritis as early as possible to help control pain and reduce damage to the joint; take medications as directed, exercise, control your weight, and participate in all aspects of your care.

Remember, if you have questions about the need for a test, or the risks or benefits of your treatment, ask your doctor.

Even with the best of treatment, arthritis of the foot and ankle may continue to cause you pain or changes in your activities. However, proper diagnosis and treatment will help to minimize these limitations and allow you to lead a more productive, active lifestyle.

Heel pain

There are many forms of foot pain, but heel pain can be one of the most troubling. The most common form of heel pain in people is known as "Heel Spurs" or "Plantar Fasciitis" (pronounced PLAN-tar fashee-EYE-tiss). Many resources label them one in the same, however heel spurs and plantar fasciitis are slightly different.

Plantar Fasciitis occurs when the long, flat ligament on the bottom of the foot (Plantar Fascia) stretches irregularly and develops small tears that cause the ligament to become inflamed. The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia.

A Heel Spur is actually a type of bone growth that develops on the outside of the heel bone where the plantar fascia ligament attaches. Spurs may form when the plantar fascia becomes inflamed causing calcification or bone growth. They are often described as having a small hook shape to them, which causes pain by irritating the surrounding soft tissue.

Although the plantar fascia is invested with countless sturdy 'cables' of connective tissue called collagen fibers, it is certainly not immune to injury. In fact, about 5 to 10 per cent of all athletic and exercise injuries are inflammations of the fascia, an incidence rate that in the United States would produce about a million cases of plantar fasciitis/heel spurs per year. Middle aged, overweight, and athletic individuals are more prone to plantar problems, as are non-athletic people who spend a lot of time on their feet or suddenly become active after a long period of lethargy. A recent study found that over 50 per cent of people who suffer from plantar fasciitis are on their feet nearly all day.

Plantar fasciitis and heel spurs usually develop gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain. In some cases, the inflamed ligament may not heal because many people who are developing the conditions do not completely stop the aggravating activity.

A number of factors are directly associated with development of plantar fasciitis and heel spurs. These factors can lead to the change of the gait (the way the feet strike the ground), which can cause additional injury.

Risk factors for include:

  • Biomechanical factors, such as decreased flexibility in the foot and ankle, imbalances in muscle strength (muscles in one leg or foot are weaker than the other), abnormal foot mechanics (when stepping down), and tightness in the Achilles tendon.
  • The repetitive nature of sports activities and improper training.
  • Sudden increases in weight.
  • Rapidly increasing the length of time spent on the feet.
  • Running or walking up steep hills.
  • Wearing shoes that are worn out.
  • Wearing shoes that do not have a cushioned sole or enough arch support.
  • Abruptly changing the intensity or duration of athletic activities.

The traditional remedies for plantar fasciitis include stretching the calf, massaging, decreasing one's activities, losing weight, purchasing better-fitting shoes (with a raised heel and arch support), icing the sore heel, and taking ibuprofen. The most common treatment is one of the most basic, a heel cup or pad. Such devices can eliminate the condition and help you regain your mobility without the need for expensive and complicated remedies.

Corns and Calluses

A corn or callus are areas of thickened skin that occur in areas of pressure. They are actually a normal and natural way for the body to protect itself. For example, callus develops on the hand when chopping a lot of wood - its a normal way for the skin to protect itself. In the foot, the skin will thicken up to protect itself when there are areas of high pressure. The problem occurs when the pressure continues, so the skin gets thicker. It eventually becomes painful and is treated as something foreign by the body.

Diabetic Feet

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

Foot and Ankle Injuries

Immediate Treatment

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.

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 effect, and prevents swelling and pain. Your podiatrist 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 your- self 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 weightbearing 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 SURGERY

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.

Nail problems

An ingrown toenail is a condition in which the toenail grows into the flesh of a toe. It often occurs in the big toe.

If not treated properly, the tissue around the ingrown nail will become infected.

The most common symptoms are:

  • pain
  • swelling and redness around the toenail
  • hard, swollen and tender nail
  • redness around nail
  • pus draining from nail

There are many causes. The most common causes are:

  • improperly cut toenails
  • poorly fitted shoes
  • unusually curved toenails
  • trauma to the nail
  • trauma to the toe

Hammer toes

In a hammertoe the deformity usually exists in one toe (at the proximal inter phalangeal joint) - the base of the toe points upward and the end of the toe points down.

The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

Hammer toes can be due to a number of things. Several factors are known to increase the risk of developing hammer toes:

  • some people are just structurally prone to develop hammer toes (hereditary)
  • tight footwear is an important factor in the cause of hammer toes as well as providing the pressure that causes the symptoms
  • weaker small muscles in the foot may also play a role.

Neuroma

Morton's neuroma is a non-cancerous tumor of a nerve. It is more common in women than in men.

It usually occurs in the space, between the third and fourth toes.

Morton's neuroma, is also called plantar neuroma.

The most common symptoms are:

  • burning pain in the ball of foot
  • numbness in the toes
  • sharp or dull pain between the third and fourth toes

Arterial Doppler Study

P.A.D. is a common condition that affects 8-12 million people in the US every year. It is a type of Peripheral Vascular Disease (PVD) that is characterized by the narrowing of the arteries most commonly in the legs caused by plaque build-up, often referred to as Atherosclerosis.

The plaque build-up then diminishes the blood supply to the extremities, potentially causing harmful complications. P.A.D. is a serious under-diagnosed, under-treated disease. It is often referred to as a silent killer, as most people show no symptoms of P.A.D. If you have P.A.D. your chances of a long life are reduced dramatically, and the risk of heart attack or stroke is increased 7-10 times.

Over 120,000 amputations, in the US, annually are caused from P.A.D. The most evident symptom is leg pain when exercising, which subsides with rest - referred to as claudication.

Unfortunately, most people attribute pain while walking or exercising to the aging process and don’t receive proper diagnoses – leg pain is NOT normal.

Risk Factors for P.A.D.

As we age, our risk of P.A.D. progressively increases. Other risk factors include:

  • Diabetes
  • Smoke Currently or in the Past
  • High Blood Pressure
  • High Cholesterol
  • Obesity
  • Family History of Heart Disease
  • Previous Heart Disease

All of these risk factors are cumulative.

Q-Clear™ Laser Treatment

Laser treatment of the nail may reduce thickness, improve appearance, and make trimming easier. However, treatment is not generally considered medically necessary unless other factors are present such as diabetes, poor circulation, excessive pressure, pain, or lack of normal sensation.

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