The Achilles tendon is as a strong band of tissue connecting the muscles of the lower leg (calf) to the back of the heel bone.
What type of injuries are typically associated with this tendon and how are they caused?
Achilles tendonitis refers to a condition of irritation and inflammation of the tendon which is fairly common and relatively short- lived, with appropriate treatment. Achilles tendinosis, on the other hand, involves chronic Achilles swelling and pain due to likely degeneration and microscopic tears within the tendon itself.
Most Achilles tendon injuries are related to overuse, repetitive stress. Athletes and “weekend warriors” alike are susceptible, as are those who are more likely to stress their feet with long days at work. Individuals with flat feet (pronation) are also more likely to develop Achilles tendonitis due to the increased strain on the tendon due to their foot type.
Symptoms of Achilles tendonitis typically include swelling, pain, and inflammation at the back of the heel.
A thorough foot examination is usually required to diagnose an Achilles tendon condition, with potential use of imaging studies such as X-ray, ultrasound, and MRI should they be necessary.
Home treatments of Achilles tendonitis usually involves rest, icing, anti-inflammatory medication, appropriate shoe choices/padding of the back of the shoe. Further treatment, depending on the nature of the injury, may involve bracing, heel lifts, physical therapy, custom made foot orthotics, shoe and activity modification. Surgery is usually not necessary, unless there is longstanding pathology in the tendon itself unresponsive to conservative measures.
A bunion (hallux abducto valgus) is a bump on the side of the foot near the big toe joint. In affected individuals, this bump tends to progress over time, causing the first toe to begin to lean towards the second, resulting in even greater deformity. The “bump” itself is caused by the bone leading up to the big toe (first metatarsal) shifting over time.
Bunions are most often caused by an inherited foot type that is somewhat predisposed to bunion formation. Improper footwear may speed the progression of the deformity as well.
Many people have mild/moderate bunions, and suffer no symptoms at all. However, should symptoms occur, they usually involve pain, inflammation, swelling, and possible burning/numb sensations in the area of the bump itself.
Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.
Bunions are usually fairly obvious, however further investigation is usually necessary to ascertain the degree of deformity, underlying foot conditions that may have contributed to the formation of the bunion, as well as potential arthritis in the big toe joint itself.
Bunion deformities usually progress over time, though sometimes very slowly.
Treatment options for bunions include simple observation of a painless bump, X-rays to evaluate the big toe joint, custom made foot orthotics, icing, anti-inflammatory medication, padding, shoe changes, activity modification, and occasionally injections of steroid.
Surgery is typically discussed if all non-surgical treatment options have failed to relieve the pain associated with the bunion itself. Your doctor will discuss surgical options with you, which usually involve either either shaving off a small part of the bone at the area of the bunion, or repositioning of the bone itself so that it does not protrude any longer.
X ray findings, activity level, and age all factor in the decision making process, and recovery time is usually dependent on the surgical procedure performed.
Charcot foot is a condition that can usually occur in patients with severe nerve damage (neuropathy) of their feet and changes in blood flow causing weakening of the bones. With continued walking, these bones may fracture and cause the foot to change its shape, even collapse in the arch area.
Charcot foot can lead to significant disability and even amputation if not diagnosed and treated appropriately. Diabetic patients are usually predisposed to neuropathy, and this often predisposes them to Charcot foot.
Decreased sensation may make the patient somewhat unaware of this condition, and he/she may continue to walk, thus making the injury worse. Preventative measures are the key to slowing or even halting progression of this condition.
The symptoms of Charcot foot usually include redness, swelling, warmth of the foot, and sometimes even pain.
Early diagnosis of Charcot foot is very important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.
Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.
Conservative treatment usually consists of immobilization, bracing, custom shoes and activity modification.
In some cases, the Charcot deformity may become severe enough that surgery is necessary. The foot and ankle surgeon will determine the proper timing as well as the appropriate procedure for the individual case.
Certain measures taken by the diabetic/neuropathic patient may help to prevent Charcot foot:
- Keeping blood sugar levels under control can help reduce the progression of nerve damage.
- Get regular check-ups from a podiatrist.
- Check both feet every day—and see a foot doctor immediately if you notice signs of Charcot foot.
- Avoiding foot injury
- Following your podiatrist’s recommendations for foot care.
An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are thick bands of connective tissue that connect one bone to another. There are numerous ligaments supporting the ankle joint, and a sprain may affect an individual or multiple ligaments.
A sprain may involve a simple stretched ligament, or a more significant partial or even complete tear of a ligament.
Sprained ankles are usually the result of a roll or twist of the ankle,commonly while running, wearing poor shoegear, or running or walking on an uneven surface. Previous sprains also tend to predispose a person to future sprains.
The symptoms of an ankle sprain may include pain around the ankle joint, bruising, difficulty walking, and joint stiffness.
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 there is no 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.
Proper diagnosis of an ankle sprain is essential, as an untreated sprain may lead to chronic ankle instability with persistent discomfort and weakness around the ankle joint. Occasionally an ankle fracture may also occur, and if left untreated this could lead to serious complications. Proper rehabilitation from a sprain is essential to a speedy recovery.
In evaluating your injury, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. X-rays or other advanced imaging studies may be ordered to help determine the severity of the injury.
Prompt conservative management of an ankle sprain is essential to recovery. This usually includes a period of rest, icing, compression, elevation, early physical therapy and anti-inflammatory medication.
When Is Surgery Needed?
In very severe cases, or cases of chronic ankle instability which have not responded to conservative measures, surgical intervention may be a viable option to either re-attach or tighten the ankle ligaments.
Diabetes can be potentially very dangerous for the feet, due to the potential for nerve damage, reduced blood flow and a weakened immune system. A small cut may go unnoticed (as might a rock in a shoe) and this could lead to an infection or wound that could put a diabetic patient at risk for amputation.
Some of the recommendations for preventative diabetic footcare include:
- Daily foot inspection for cuts, blisters, corns, and ingrown toenails.
- Washing feet in lukewarm water and drying off between the toes. Never moisturize between the toes as moisture tends to accumulate there and cause open sores.
- Periodic foot exams by a podiatrist.
- Never going barefoot. Wear shoes, sandals or slippers with a solid sole to protect against cuts or scrapes on the bottom of the foot.
- Wear white or light colored socks so that if there is a cut of any sort you can see any bleeding.
- Never cutting calluses yourself and being careful when cutting your nails, or getting this done by a podiatrist.
- Keep blood sugars under control.
- Do not smoke (smoking reduces blood flow in your feet).
Flatfoot is often a complex disorder, with many symptoms and varying degrees of deformity and disability. There are usually several types of flatfoot (flexible flatfoot, pediatric flatfoot, adult/acquired flatfoot), all sharing one particular characteristic: partial or total collapse (loss) of the arch.
Symptoms of a flat foot may include:
- Pain in the arch, inside or outside of the foot
- Knee, lower back and hip pain
- Rolling in of the ankle (pronation)
- General foot/ankle ache
A thorough foot examination by a qualified podiatrist is usually required to ascertain the type of flatfoot and dictate proper treatment. X rays may be necessary to assist with this.
Activity modification, orthotics, shoegear modification, rest, and physical therapy all have a part to play in conservative treatment of flatfoot.
Should conservative measures fail to relieve symptoms, your podiatrist may discuss the possibility of foot surgery with you, pending X ray findings and considering your activity level, age and general health.
The foot consists of 26 bones and 33 joints. These bones are hard at work every day supporting our full body weight through our various activities and occasionally can sustain fractures (cracks or breaks in the bone). Symptoms of this include pain, bruising, swelling, and inability to bear weight in the affected foot.
Your podiatrist will examine your foot and likely take X rays to diagnose a fracture, then proceed with a treatment plan that may include icing, rest, immobilization or the possibility of surgery to repair a fracture that may not heal otherwise.
A ganglion cyst is a benign soft tissue mass that arises from either a tendon sheath or joint capsule. It usually presents as a sac filled with a jelly like fluid, and is one of the most common soft tissue masses in the body. They usually occur at the wrist, as well as the foot, and can grow and shrink on their own over time.
Although the exact cause of ganglion cysts is unknown, they may arise from trauma – whether a single event or repetitive micro-trauma.
A ganglion cyst is associated with a lump that may be painful, cause some tingling and burning, or make it difficult to wear tighter fitting shoes.
Physical examination by a podiatrist, with the potential for further studies such as X-ray, ultrasound or MRI would be beneficial for proper diagnosis.
There are various options for treating a ganglion cyst on the foot, either simple observation, shoe modification, or fine-needle aspiration to remove the fluid would be beneficial.
Surgery is discussed when conservative methods have failed and the ganglion cyst has recurred. Surgery (removal of the sac itself) also has a risk of recurrence, though usually lower than needle aspiration.
A hammertoe occurs when one or more of the toes is in a contracted position, occasionally causing pain due to pressure points at the contractures. They usually begin as mild deformities that can progress over time.
Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.
The most common cause of hammertoe is a muscle/tendon imbalance that is usually a result of a combination of a predisposed foot type and shoegear/activity contribution. Hammertoes are generally worsened by cramped footwear.
Common symptoms of hammertoes include:
- Pain with tight shoes
- Corns and calluses on a toe
- Contracture of the toe
- Redness of a toe near the joint, and a potential open sore here
Non surgical management of hammertoes usually involves padding of corns and calluses, toe splinting, shoegear modification, and orthotic (foot arch support) therapy.
Surgical correction of a hammertoe is usually performed when all manner of conservative therapy has failed and when the hammertoe begins to more seriously affect the quality of the patient’s daily activity level. The surgical procedures for hammertoes are quite varied and usually tailored towards the individual, taking into account X ray findings, age and activity level.
Although there are many different causes for heel pain, plantar fasciitis is the most common cause of heel pain in patients in our office. It is sometimes known as “heel spur syndrome” when a bone spur is present on X ray.
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.
There are many causes of plantar fasciitis, from arch problems (high or low arches), to improperly fitting footwear, walking/standing on hard surfaces, weight gain, sports injuries, etc.
The symptoms of plantar fasciitis are usually a combination of the following:
- Pain on the bottom of the heel
- Pain in the arch of the foot
- Pain that is usually worse upon arising (from sleep or sitting, often improves within minutes of walking)
- Pain that increases at the end of a long day on your feet
A thorough physical examination is key to diagnosing plantar fasciitis, as there a few conditions that have similar symptoms.
Treatment of plantar fasciitis usually involves a combination of stretching exercises, icing, activity limitation, shoegear modification, anti-inflammatory medication, orthotic therapy, physical therapy, night splints, steroid injection, immobilization,and avoidance of barefoot walking.
When Is Surgery Needed?
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 foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
An ingrown toenail is a toenail that has begun to curve, and cut into the skin beside it, causing redness, pain and swelling.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.
Causes of ingrown toenails include a hereditary compoment, improper nail trimming, injury to the nailbed, tight fitting shoes, or a nail condition such as a fungal infection. Nails should be trimmed straight across and not too short.
Soaking of the toe with warm water and Epsom salts helps to bring down any inflammation associated with an ingrown toenail, however if symptoms persist it would be wise to seek the expertise of a podiatrist. Depending on the presentation, various forms of treatment may be recommended, ranging from antibiotics, wedge resection, to permanent nail border removal.
A neuroma is an inflammation and thickening of a nerve. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. The thickening of the nerve is the result of compression and irritation of the nerve over time, leading to the potential for nerve damage. Tight fitting/tapered/high heeled shoes can be notorious for this. Certain types of foot deformity can also predispose a person to a neuroma, as can certain activities and injuries as well.
Symptoms of a neuroma usually consist of tingling, burning or numbness, pain, or strange feelings in the foot.:
To arrive at a diagnosis, the podiatrist will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed.
In developing a treatment plan, your foot and ankle surgeon will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem, and conservative treatments include padding, icing, orthotic therapy, activity modification, shoe modification, anti-inflammatory medication and injection therapy.
Surgery may be considered in patients who have not responded adequately to non-surgical treatments. Your podiatrist will determine the approach that is best for your condition. The length of the recovery period will vary, depending on the procedure performed.
Cartilage is the tissue that is found between bones that lets them move fluidly against each other and protects them during movement. In osteoarthritis there is a breakdown of this cartilage, leading to the pain of bone moving unprotected against the adjacent bone. This can also lead to degeneration of the joint, bone spurring, and restriction of motion. Osteoarthritis is a “wear and tear” arthritis, and is the most common form of arthritis.
Repetitive use and potential malalignment of joints can contribute to osteoarthritis. Injuries of the foot may also have a part to play.
People with osteoarthritis in the foot or ankle experience pain, stiffness, swelling, and difficulty with joint mobility.
Your podiatrist will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. X-rays may be ordered to evaluate the extent of the disease.
To help relieve symptoms, your podiatrist may choose from a variety of methods including oral anti-inflammatories, orthotic therapy, bracing, immobilization, steroid injection or physical therapy.
When Is Surgery Needed?
When osteoarthritis has progressed substantially or failed to improve with non-surgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient’s condition and lifestyle.
A wart is a small growth on the skin that develops when the skin is infected by a virus, typically appearing on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.
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.
The symptoms of a plantar wart may include thickened skin (resembling a callus), pain with pressure (more from side-to-side compression), and little black dots at the site of the lesion (these are small blood vessels/capillaries)
Plantar warts grow deep into the skin. Usually this growth occurs slowly, with the wart starting small and becoming larger over time.
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. There are various treatments including topical preparations, cryotherapy (freezing), acid treatments, or surgery to remove the wart.
Rheumatoid arthritis (RA) is a disease in which the immune system malfunctions and attacks healthy joints. RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint.
Foot problems caused by RA commonly occur in the forefoot, and include, in addition to the abnormal appearance of deformities, pain, swelling, joint stiffness, and difficulty walking.
RA is diagnosed on the basis of a clinical examination as well as blood tests.
To further evaluate the patient’s foot and ankle problems, the surgeon may order x-rays and/or other imaging tests.
While treatment of RA focuses on the medication prescribed by a patient’s primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include orthotic therapy, accommodative shoes, aspiration of joint fluid, or steroid injections.
When is Surgery Needed?
When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. The foot and ankle surgeon will select the procedure best suited to the patient’s condition and lifestyle.