In today’s fast-paced world, people are more likely to injure themselves. Our office is able to diagnose and treat emergencies in which the lower extremity (foot and ankle) is involved. Typical emergencies include ankle fractures, sprains, injuries to toenails, thermal injuries, puncture wounds, and foreign body injuries.
Ankle Sprains
Ankle sprains are fairly common injuries. An ankle sprain is actually the stretching or tearing of one or more ligaments on either side or both sides of the ankle. A ligament is a thick band of tissue between two bones, similar to a rubber band. If you stretch it and never allow it to return to its original shape it will lose its elasticity. This increases the possibility of repeat ankle sprains.
Sprained ankles can occur without fractures. When a sprain occurs with a fracture of one or more of the ankle bones, treatment becomes more complex. X-rays are utilized to treat fractures.
Symptoms of sprained ankles and fractures are similar: discoloration around the ankle and foot, pain and swelling. Swelling is the body’s defense mechanism to prevent further injury.
If ankle sprains are left untreated or under-treated, they can lead to chronic ankle instability, resulting in more frequent ankle sprains.
Arthritis
Because of their unique function of providing support for all body movement, each of the foot’s 33 joints is more susceptible to arthritis than other parts of the body. You may experience tenderness, pain, swelling or limited motion on the joints. Arthritis is a complex disease and has many types and subtypes. It can, for simplicity’s sake, be divided into two basic types. Osteoarthritis is more commonly known as “wear and tear arthritis” and can be caused by mal-alignment, trauma or a history of infection in the joints. Rheumatoid arthritis is one of a family of autoimmune disease where the body’s own immune system is mistakenly triggered to attack itself. Both types of arthritis may have links to hereditary factors.
Broken Toes
Broken toes frequently go untreated because many people believe that nothing can be done for a broken toe and therefore do not seek medical attention. The truth of the matter is many times broken toes become displaced and then require treatment by realignment. If left untreated, there is more of a chance having problems in the future.
The most common toe fracture is caused by bumping the toe against a piece of furniture. Symptoms of a broken toe include discoloration, swelling and pain. Remember, if you are a diabetic or have decreased circulation or any type of neuropathy (numbness, loss of feeling) prompt medical attention is of the utmost importance.
Bunion:
What is a bunion?
A bunion (Hallux Valgus) is a prominent bump on the inside of the foot around the big toes joint. This bump is actually a bone protruding towards the inside of the foot. Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe. This discomfort commonly causes a patient to walk improperly.
Another type of bunion is called a Tailors bunion or bunionette. This type of bunion forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.
What causes a bunion?
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by improper fitting footwear. Tight, narrow dress shoes with a constrictive toe area can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. The toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for both men and women to realize that wearing shoes, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.
Treatment options
In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort. Make an appointment with a podiatrist to get the appropriate shoes and orthotics.
There are several conservative treatments to alleviate the pain and discomfort of a bunion but the only actual cure is surgery. This procedure is called a bunionectomy. There are many variations of this operation and a professional specializing in the foot called a podiatrist usually performs it. Most bunionectomies involve the removal of a section of bone and the insertion of pins to rejoin the bone. Sometimes the surgeons may move ligaments or tendons in order to realign the bones. After this procedure, the bones and other tissues are held in place while they heal by compression dressing.
Children’s Growth Plate Fractures
Epiphyseal fractures are fractures of the growth plates in children. Children’s bones are not completely formed and if injured and left untreated deformities could result.
If the growth plate is injured, it may lead to a shortened bone or an angulation type of deformity in the bone. When a child sprains an ankle, limps or complains of pain it is important to seek proper podiatric medical treatment. Children usually will not complain of pain without cause. Young patients with a foot or ankle sprain may have a fracture of the growth plate in any of the foot or ankle bones. This could require immobilization in a cast.
Corns
The body’s response to excessive amounts of pressure against the skin manifests itself by forming thick, hardened skin or corns. Corns are most often the result of an enlarged bone or bone spur pinching the skin against a shoe. A corn can be indicative of a pressure point between the toes.
Soft corns refer to corns that exist between the toes. They are the result of two bones rubbing against each other, pinching the skin. Sometimes more than one soft corn will form.
Treatment options:
Conservative treatment can consist of one or more of the following.
Trimming, digital splinting and/or padding of the corn.
Orthotics or inserts in shoes to correct improper walking.
Injections to relieve pain and inflammation.
Larger or extra depth shoes to accommodate toe deformities.
If these conservative methods are unsuccessful in treating your deformity, then corrective toe surgery should be considered. Your podiatrist will conduct a thorough medical history and examination to determine your options. Lab tests, advanced imaging studies and X-rays will be scheduled if necessary.
The surgical correction of your toe deformity may be performed in the office, outpatient surgical center or as one-day hospital surgery.
Flat Feet
The arch of your foot is its main supportive structure. If this arch loses strength, the bony framework begins to collapse, causing your foot to flatten. Like a sagging bridge, the weakness in the middle strains the joints at both ends of your foot.
Discomfort from flat feet often doesn’t appear for years. At some point, pain may be felt and walking may become awkward as increasing strain is put on your feet and calves. The excess strain from flat feet can cause other foot problems, such as hammertoes, bunions, heel spurs, arch strain, corns, neuromas, and sagging joints. Flat feet can also affect other parts of the body, causing fatigue, pain, or stiffness in the ankles, knees, hips, and lower back.
Foreign Bodies
A foreign body injury occurs when an object breaks through the skin and becomes embedded within the deeper tissues of the foot.
When a puncture wound occurs in the foot, a podiatrist should be consulted to assess if an object is embedded in the foot. Often an X-ray is not enough to visualize the object unless it is composed of metal. These injuries sometimes require further studies to identify the foreign body and its location. If a foreign object is left in the foot, it can continue to move into the deeper tissues and require surgical removal. This injury can also require antibiotic treatment or a tetanus shot.
Fungal Toenails
Yellow discoloration, stripes, debris under the nail and thickening could be indications of a fungal infection. Although there are numerous reasons why a nail may thicken and loosen from the nail plate, fungal infection is the most common. Fungal infection of the toenails leads to: gray, yellow or brown discoloration of toenails; separation from the nail-bed; dry, hard or thick nails; and a distinct odor. Fungal toenails can develop because of nail injury or an inherited, low resistance to the fungus.
Hammertoes
A hammertoe is a flexible or rigid contraction usually affecting the second, third, fourth, or fifth toes. Most often a biomechanical abnormality results in the larger muscles of the foot and leg overpowering the smaller intrinsic muscles of the foot. Muscle imbalance leads to a bending or “buckling” of the tow joints. These buckled or contracted positions create any number of problems within and on top of the toe deformity. One or more small joints become prominent on top of the malpositioned toe. Tendons, ligaments, and joint capsules in that area have a greater chance of tightening and shortening. Shoe irritation of the deformed digit results in corns, skin inflammation and inability to wear shoes comfortably. If left untreated, these conditions can progress to ulcers or infections.
A flexible hammertoe refers to a reducible hammertoe refers to a reducible hammertoe in contrast to the rigid hammertoe where the deformity is fixed or not easily straightened. There are many causes of hammertoes. Some are congenital, hereditary or acquired. An inherited condition may mean an inherited muscle imbalance around the toe or a parent with an abnormally long toe. An acquired hammertoe refers to those caused by short stockings or short/pointed shoes, especially where a long toe is present. Arthritic patients and those with diabetic neuropathy can be more susceptible to hammertoes.
Treatment options:
Though many find relief with corn pad removers or cushioning pads, these are only temporary relief. The most effective treatment for a hammertoe is a surgical correction. Through a small incision, the deformity is reduced and the tendons are rebalanced around the joint. The procedure is an outpatient procedure and the patient goes home in a special post-operative shoe but can walk immediately after the procedure.
Ingrown Toenails
One of the most common foot problems is an ingrown toenail. Nails grow inward for a variety of reasons that include hereditary growth patterns, a history of trauma, nail disease such as fungal infection and poor self-care. As we age, it is normal for our toenails to thicken. As nails thicken, they also curve into the flesh at the ends and sides of the toe.
When a nail grows into the skin, several things begin to occur. What starts as a minor irritation may, if untreated, cause the toe to swell, become red and produce acute pain. Continued irritation to the nail groove can cause the skin to break, making infection a possibility. The presence of pus at the edge of the nail can be a serious problem and should cause you to see your Podiatric physician right away. Diabetics and people with poor circulation are at greater risk for severe infection and should see their doctor at the first sign of irritation.
Mallet Toe
A mallot toe is similar to a hammertoe, except the deformity occurs closer to the end of the toe.
Metatarsalgia
Metatarsals comprise the ten long bones located on your feet, similar to the knuckles on your hand. They are positioned right before the toes and sometimes referred to as the “ball of the foot.” Painful conditions that involve the central metatarsal region (or second, third and fourth metatarsals) are referred to as metatarsalgia.
Nail Trauma
Everyone at some time has either stubbed a toe or dropped something on a toe. When this happens, the nail often is injured and bleeding beneath the nail can occur. The nail may then turn black or blue and eventually be lost. Your podiatrist may need to release the blood under the nail and if severe enough remove the entire nail. The nailbed or skin under the nail could have suffered significant laceration and/or a fracture of the bone beneath the nail.
This injury is serious and needs professional wound care and possibly antibiotic therapy as soon as possible.
Regrowth of the nail after injury depends on the extent of damage to the nail “root” or matrix. These are the specialized cells of the skin that produce the hard nail plate. If the nail matrix is not involved in the injury, then the chances of having a normal nail return are good. If the matrix cells are damaged, the nail may return thickened and/or deformed.
Orthotics: Treatment for Foot and Leg Dysfunction and Pain
We recommend the use of a foot orthotic to control, relieve or treat your foot disorder. These devices may relieve pain or prevent the return of painful foot symptoms through control of foot function and mechanics.
Normally, the best orthotics are custom-made and specifically crafted to meet the needs of a particular patient. They may be combined with other forms of treatment such as injections, medications, physical therapy or surgery. Therefore, they are an important component in the treatment and prevention of many foot disorders.
Because we are born with different foot structures, and because we engage in different occupations and activities, there are specific grades of orthotics for individual patients. Orthotics can be used for children, adults, athletes, elderly patients and often patients following surgery.
Overlapping Toe
An overlapping toe is one that is malpositioned from birth or acquired over time. It often produces some abnormality in the tendon, ligaments or skin, many times producing painful corns. All of the toe deformities mentioned can lead to other positional deformities, enlargement of bone tissue or bone spurs. Shoes further aggravate these conditions and can cause additional pain, inflammation and corns.
Peripheral Vascular Disease
Peripheral Vascular Disease (PVD) is any number of disease processes that can affect the vascular tree in the extremities. It can be arterial, venous or lymphatic in nature.
Arterial PVd by example is a build up of plaque in the arteries that exist in the legs. When this occurs, blood flow is slowed and some strctures of your body, such as your skin, muscle and soft tissue, do not get enough oxygen-rich blood.
Types of PVD
Atherosclerosis: thickening and hardening of the arteries. Usually involving the large- or medium-sized arteries. The arteries narrow and eventually become blocked. This is also known as Peripheral Arterial Disease (PAD).
Microvascular disease: It affects the smaller arteries and is most commonly associated with Diabetes Mellitus. A side effect is a lack of sensation or feeling (neuropathy) to the skin, which in turn develops into ulcerations.
Venous disease: This sluggish return of blood flow exiting the legs is due to defective valves in the veins. Defective valves produce sluggish blood and possibly deep vein thrombus (clot) formation, which in turn can travel to the lungs causing difficulty in breathing and even death. Superficial veins can develop phlebitis.
Plantar Fasciitis
The plantar fascia is a ligament-like band running from your heel to the ball of your foot. This band pulls on the heel bone, raising the arch of your foot as it pushes off the ground. But if your foot moves incorrectly, the plantar fascia may become strained. The fascia may swell and its tiny fibers may begin to fray, causing plantar fasciitis.
Causes
Plantar fasciitis is often caused by poor foot mechanics. If your foot flattens too much, the fascia may overstretch and swell. If your foot flattens too little, the fascia may ache from being pulled too tight.
Symptoms
With plantar faciitis, the bottom of your foot may hurt when you stand, especially first thing in the morning. Pain usually occurs on the inside of the foot, near the spot where your heel and arch meet. Pain may lessen after a few steps, but it comes back after rest or with prolonged movement.
Related problems
A heel spur is extra bone that may grow near the spot where the plantar fascia attaches to the heel. The heel spur may form in response to the plantar fascia’s tug on the heel bone.
Bursitis is the swelling of a bursa, a fluid-filled sac that reduces friction between a ligament and a bone. Bursitis may develop if a swollen plantar fascia presses against a plantar bursa.
What can you do?
You can’t stay off your feet altogether, but you can reduce overuse and the risks that come with it. Also, be sure to follow your podiatrist’s treatment plan. Take medications as directed, and wear orthoses if you have them, even while at home.
Reduce Overuse
Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce strain on the plantar fascia and the possibility of overuse by following these suggestions:
Lose any excess weight.
Avoid running on hard or uneven ground.
Wear shoes or house slippers that support your arch.
Puncture Wounds
Other common traumatic injuries treated by podiatrists are puncture wounds and foreign bodies.
A puncture wound occurs when you step on a sharp or jagged object and it breaks through the skin and enters the deeper tissue of the foot,
These injuries typically occur in the warmer weather when people are tempted to go outside barefooted or when they walk around their house in stocking feet.
Tendonitis
When you use a set of muscles too much, you’re likely to strain the tendons (soft tissues) that connect those muscles to your bones. At first, pain or swelling may come and go quickly. But if you do too much too soon, your muscles may overtire again. The strain may cause a tendon’s outer covering to swell or small fibers in a tendon to pull apart. If you keep pushing your muscles, damage to the tendons adds up and tendonitis develops. Over time, pain and swelling may limit your activities. But with your doctor’s help, tendonitis can be controlled. Both your symptoms and your risk of future problems can be reduced.
Thermal Injuries and Chemical Burns
The two most common thermal injuries are burns and frostbite. These injuries can occur from exposure to extremes in temperature, resulting in tissue damage and loss. Burns, of course, are sustained when a hot object has contact with the skin for a sufficient amount of time to damage the skin and underlying structures. Conversely, prolonged exposure to cold results in what is commonly known as frostbite.
Chemical burns result from exposure if the skin to an acid or caustic chemical agent. Most commonly, the improper use of over-the-counter corn removers result in such burns. Chemical burn severity is dependent upon the strength or concentration of the chemical agent. Specific treatment usually involves removal and neutralization of the chemical agent.
In all of the above cases prompt treatment and evaluation can often prevent infection and further tissue loss.
Ulcer:
What is it and Why should You be Concerned
An ulceration of the skin is a disorder that results in the breakdown of skin layers. This could involve the various layers of the skin, subsequent soft tissue, muscle and bone. The skin is the largest organ system of the body that protects us from the outside. Therefore, ulcer formation is a serious problem adversely affecting the skin’s protective resilience and possibly causing acute infection, tissue death, limb loss and even loss of life.
Warts
A wart is an infection caused by a virus, which can invade your skin through small cuts or breaks. Over time, the wart develops into a hard, rough growth on the surface of the skin. A wart is most commonly seen on the bottom of the foot (plantar wart), but can also appear on the top. Children, teens, and people with allergies or weakened immune systems are more vulnerable to the wart virus.
Nerve Entrapment
Morton’s Neuroma
A neuroma usually occurs between the third and fourth toes, although possible between the others. It is caused by an entrapment or pinching of the nerve between the metatarsals. As irritation continues the nerve enlarges, causing pain, cramping and burning. Symptoms can travel into the web-space or toward the tips of the toes, and are frequently aggravated by tight shoes.
Your podiatrist may choose conservative measures before considering surgery. These include injections, padding, strapping and physical therapy. If padding and strapping prove to the successful, your doctor may recommend accommodative orthoses for your shoes. When conservative methods fail to relieve pain, surgical treatment is a viable option. Through an incision made over the area, the enlarged nerve is located and removed. This procedure can be performed in the office or outpatient surgical setting.
Tarsal Tunnel Syndrome
Another common nerve entrapment disorder of the foot and ankle is tarsal tunnel syndrome. Tarsal tunnel syndrome is similar to carpal tunnel syndrome in the wrist, both are associated with compression and entrapment of a major nerve. This nerve is located inside and behind the ankle. Symptoms related to the syndrome include numbness, burning and general pain in the foot and ankle. It can be aggravated by overuse. Occasionally nerve conduction studies or MRIs can be used to evaluate the condition. Conservative treatment includes injection of anti-inflammatory medications, physical therapy or use of functional orthoses in the shoes. If this does not give enough relief, the compression on the nerve can be reduced with surgical release of the overlying ligament. Generally this gives a favorable result.