The Comprehensive Resources on Foot Pain, Foot Pain Treatment and Foot Care

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Corns

CORNS

 

“Corns” are a commonly used term for painful bumps or lumps on the foot or toe.  Many times used in error, “corns” are accurately used to describe a thickening of skin over an area of irritation on a toe.  Just as we develop a thickening of our skin on the palms of our hands after performing a repetitive movement over a period of time, the same bodily reaction occurs when outside pressure on a boney prominence on one, or more, of our toes.  The word “corns” describe this skin thickening on a toe, and only toes, as compared to the thickening of the skin of the bottom or side of the foot, which are referred to as “calluses”.  Discoloration of the skin on a toe, without any thickening, cannot necessarily be referred to as corns.

 

The key to understanding what “corns” are is to understand the causes that produce a corn.  Without pressure from a, tight shoe, improper foot function, or some other exterior irritation, “corns” will not occur.  However, if a “hammer toe” deformity is present, it is almost impossible to prevent corns.    In most cases, a corn results from a structural contraction of the toe, that causes pressure from shoes, socks, or foot function that initiates a reaction from the body to form a “keratosis” over the pressure point.  This keratosis is an attempt by the body to protect the area of bone from this abnormal pressure.  Simply put, “corns” are a protective response of the body in an attempt to cushion the area of bone that is getting too much pressure.  The word “keratosis” is medical terminology for a hardening of skin, anywhere on the body.

 

 Treatments for corns consist of removing pressure from the area of bone that is irritated.  Removing pressure from the area, with a pad, wider shoe, or band-aid are commonly used conservative, over- the counter treatments for a corn.  If the irritation was the result of a one-time incident, these conservative methods should be successful.  If the cause is from a structural foot problem or deformity, simple pressure reducing treatments are usually unsuccessful.

 

Many self applied “corn pads” contain a very powerful acid.  The acid is used to burn away the hard skin, therefore reducing pressure and pain from the irritated area.  This may be acceptable in some instances, but with patients with compromised health, such as vascular disease, neuropathy, or diabetes, should not use this type of treatment i due to the possibility of tissue injury and subsequent infection.

 

In most cases, corns are secondary to a hammer toe deformity.  The toe is abnormally contracted, which causes a rigid deformity of the knuckle of the toe and a prominent pressure point on the toe.  Any irritation from a shoe or sock on this knuckle will cause a blister and subsequent corn to form on the toe.  The best treatment of this problem is surgical correction of the hammer toe.  Other treatments may give temporary relief, but if the deformity continues, so will the corns.

 

Conservative treatment with pads, acid therapy, and wider or longer shoes may give temporary relief.  Seeing your Podiatrist to remove the corn by shaving off the hard skin will also give temporary relief.  However, it is important that one realizes what is causing their corn problem, and what can be done to give you temporary or permanent relief of your symptoms; long lasting relief usually requires surgical correction.

 

 

DR Podiatrist

DR  PODIATRIST

 

Dr Podiatrist is an often misunderstood term.  A Podiatrist is a doctor – a physician and surgeon of the foot an ankle.  It is a medical specialty, similar to orthopedics or pediatrics, that specializes in intensive study of foot pathology and treatment thereof.  A Podiatrist is trained in the basic medical sciences for a period of 4 years, but during those years will concentrate of the treatment, both medically and surgically, of the foot and ankle. Residency and internship follow graduation from 4 years of Medical school.

 

Though varying with individual State laws, the Podiatrist is licensed to treat the foot, ankle, and lower leg. Podiatrists are able to write prescriptions, perform surgery in hospitals and surgical centers, and are recognized as Physicians and Surgeons of the Foot.  Their services are covered by Medicare and most insurance companies.

Foot Problems

FOOT PROBLEMS

 

Foot problems are one of the most common sources of pain that we as humans experience.  Most of us are on our feet the majority of time during the day, and as the old saying goes, “when our feet hurt, we hurt all over”.

 

Foot problems can range from a simple blister on our toe to painful, disabling deformities such as bunions.  Pain levels can range from the inability to wear shoes for a day or so to total disability. Fortunately, modern Podiatric care can offer treatment plans, either conservative or surgical, that will render those suffering from foot problems relief.

 

The most commonly treated foot problems are ingrown toenails, heel pain, warts, corns, calluses, flat feet, and bunions.  Ankle sprains and strains are also frequently seen in the Podiatrists’ office.  It is not uncommon that immediate relief can be offered a patient in one or two treatments by their Podiatrist.  However, long term relief of these problems may require longer treatment plans or surgical correction.  Surgery is usually performed either as an out-patient at a hospital or surgical center, or, for minor procedures, in the Podiatrists’ office.  Depending on what procedure is performed, recovery times can range from one day to a few weeks.

 

One of the most common, painful complaints is ingrown toenails.  These are caused when the nail breaks off under the skin due to trauma, improper trimming, or a nail deformity.  This usually results in infection.  Treatment requires removal of the offending nail portion.  If the deformity or injury is severe enough, removal of the corresponding portion of nail root is also required.  Reoccurrence is likely if this procedure is not performed.  Warts, another common foot problem, are caused by a virus, and if the virus is not eliminated from the tissue, the problem continues.  Heel pain, caused by spurs or plantar fasciitis usually respond favorably to conservative care with exercise, anti-inflammatory drugs, and custom shoe inserts called orthotics.  Flat foot problems   also respond well to orthotic therapy.  Corns, calluses, and bunions, if not responsive to conservative care, respond well to surgical intervention.

 

Foot problems, although being one of the most common reasons for chronic pain and disability, can sometimes respond to conservative methods with some success.  Many times, foot problems respond temporarily to “drug-store remedies”. These treatments are not for everyone, however.  Patients suffering from circulatory disease, diabetes, lack of nerve sensation, poor vision and infections should not attempt to treat common foot problems by themselves.  In these cases, the advice of a Podiatrist is recommended.  When conservative therapy fails, surgery is usually the treatment of choice.

Chiropodist

CHIROPODIST

 

In the United States, the term “Chiropodist” is an old term that was used to define a person who treats the foot.  The term is still used in the British Isles and some countries in the European Union; also in Australia and New Zealand.  In the United States, the term “Chiropodist” has been replaced with “Podiatrist” many years ago. 

 

The word Chiropodist originated from a term referring to hands and feet.  At some time in past years that may have been true, but in recent times a Chiropodist only treated foot problems.

 

The Chiropodist degree has not been awarded by Medical schools in the United States for quite some time.   Chiropodists were generally trained in non-surgical treatment of the foot.  A Podiatrist, however, is trained in both medical and surgical treatment of the foot, ankle, and lower leg and is recognized as a Physician and Surgeon of the Foot.  The Doctor of Podiatric Medicine degree, or D.P.M., is the commonly recognized designation for a Physician treating foot and ankle pathology.

Ankle

Ankle

 

By Adam Bryniczka, D.P.M.

 

 

 

            The ankle is a ginglymus joint that connects the foot to the lower leg and that helps propel the body through the gait cycle.  The ankle joint is also known as the talocrural joint which aids in stability, shock absorption, and proprioception.  The ankle joint is a crucial weight-bearing joint which allows the foot to move up and down upon the lower leg.  (The side to side motion of the foot is primarily provided by the subtalar joint which is located just below the ankle joint).  

The ankle is made up of a very complex anatomic network of bones and soft tissue structures.  The ankle comprises of three bones. Two of the bones are located in the lower leg called the tibia and fibula, and one bone is located in the foot called the talus.  There are two bony prominences that are felt on the inside and outside of the ankle joint which are called the medial malleolus and lateral malleolus.  The medial malleolus is a direct extension of the tibia and is located and felt on the inside of the foot.  The bony prominence located on the outside of the ankle is called the lateral malleolus and it is a continuation of the fibula.  There are three articular facets located within the ankle joint, which are made up of cartilage that allows range of motion within the joint.

The soft tissue structural anatomy is made up of the ankle joint capsule, syndesmosis, and ligaments.  The ankle joint capsule harbors synovial fluid within the ankle joint to allow range of motion within the joint.  The syndesmosis is located just above the ankle joint line and is made up of the anterior inferior tibiofibular, posterior inferior tibiofibular, and interosseous ligaments as well as the interosseous membrane.  These soft tissue structures contribute to the stability of the ankle.

The ligamentous structures that help hold the bones of the ankle joint together are divided into two categories called the lateral collateral ligaments and the medial collateral ligaments.  The lateral collateral ligaments are comprised of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments.  The medial collateral ligaments, also called the deltoid ligaments, are divided into superficial and deep portions.  The superficial deltoid ligaments are made up of the tibionavicular, calcaneotibial, and superficial posterior talotibial ligaments.  The deep deltoid ligaments are made up of the anterior talotibial and deep posterior talotibial ligaments.  These ankle joint ligaments are very durable, but not completely resistant to injuries.

 The most common injuries seen in the ankle joint are sprains, ligament ruptures, and bone fractures.  These injuries can be treated with or without surgery.  If these injuries are not treated properly, they can lead to arthritis within the ankle joint.

    Ankle sprains are the most common injuries that are seen in emergency rooms at the hospitals.  Ankle sprains occur when there is a sudden twist or rotation of the foot upon the lower leg.  This puts strain on the ligaments of the ankle joint which can cause different types of structural problems.  An ankle sprain occurs when the ligaments of the ankle become overstretched or even partially torn during excessive motion.   If the sprain or excessive motion is great enough, the ligament or ligaments can even rupture.  An avulsion fracture can occur when the ligament does not rupture, but the bone breaks with the ligament still attached.  These problems are very different and are treated in different ways.

The most common ankle sprain that occurs is when the foot falls inward, called an inversion ankle sprain.  This direction of excessive motion usually damages the lateral collateral ligaments of the ankle and the pain is located on the outside of the ankle.  The first and most common ankle ligament that gets damaged is the anterior talofibular ligament.  When the sprain is greater, it can cause damage to the calcaneofibular ligament or even more severe, the posterior talofibular ligament.   

Another type of ankle sprain is called an eversion ankle sprain. Here, the foot falls outward.  This can lead to pain on the inside part of the ankle.  The superficial deltoid and sometimes deep deltoid ligament can become injured depending on the severity of the sprain.

Ankle sprains are commonly treated without surgery.  The conservative treatment follows the pneumonic PRICE.  The P stands for protection, the R for rest, the I for ice, the C for compression, and the E for elevation.  Protection can consist of a cast, or a walking boot.  Rest is important to allow the sprained ligaments to heal.  Ice is important to decrease the inflammation that occurs during the healing process of the sprain.  Compression is equally important to reduce the swelling.  Elevation also reduces the swelling that occurs during the healing process.  The process can take up to 3-5 weeks depending on the severity of the injury, followed by a rigorous physical therapy regiment.

  Surgery is indicated when the pain has not been resolved in a reasonable period of time, or when the ligaments are ruptured, or when there is a loss of ankle stability.  Some surgeries involve direct primary repair of the ruptured ligament or ligaments.  Tendon transfers, tendon grafts, and rerouting of ligaments can be used when a direct repair is not enough to stabilize the ankle.  An avulsion type fracture can be repaired with the use of anchors that reattach the tendon to the bone.

When the injury is more severe than an ankle sprain, the articular cartilage within the ankle joint can become damaged.  The location of the talus bone within the ankle joint predisposes itself to impaction injuries that occur during a fall from a height or excessive rotation within the ankle joint.  When this occurs, the articular cartilage of the talus can become weakened or even fractured.  When the cartilage gets weakened, it can form large cyst like lesions called Osteochondral Dessicans.  This osteochondral injury to the talus is a very difficult injury to diagnose and is often not seen on radiographs.  A Magnetic Resonance Imaging may be required to help diagnose the injury and define the treatment plan. 

When an Osteochondral Dessicans or osteochondral lesion occurs, conservative measures do not have very high success rates and surgical intervention is usually required.  The surgical treatment of osteochondral defects varies greatly.  The main purpose of surgery is to resolve pain which may involve replacing the cartilage that is damaged with healthy cartilage from a different location within the body or from a cadaver.     

When an ankle injury occurs at very high velocity, the bones of the ankle can become deformed and lead to fracture.  The bones that most commonly break within the ankle are the tibia and fibula.  The orientation that the bones break depends on the forces that are applied and the direction in which it occurred in. 

An “open” ankle fracture is a serious injury that involves a broken bone within the ankle in the presence of a break in the skin.  There is a high chance of infection with an open ankle fracture and so treatment involves multiple procedures and intravenous antibiotics.  A “closed” ankle fracture is less serious and is described by any fracture of bones within the ankle in which the skin is still totally intact.

  There are many classification systems that are used by surgeons to help guide the treatment of ankle fractures.  A common and easy system that is used to describe ankle fracture is the Danis Weber classification, which is based on the location of the fracture within the fibula bone.  A Danis Weber A is a fracture on the fibula that is below the ankle joint.  A Danis Weber B is a fracture on the fibula that occurs at the ankle joint.  Finally, a Danis Weber C is a fracture on the fibula that occurs above the ankle joint. 

The management of ankle fractures is determined by the amount of displacement of the fractured bone, any loss of stability within the ankle joint, and if an open fracture is present.  Any ankle fracture can have fracture blisters associated with this traumatic event.  Fracture blisters can contain blood or serous fluid within the blister which can be treated by draining them or by deroofing the blister and applying a sterile protective bandage.

The nonsurgical treatment is implemented when there is no loss of ankle stability, fracture displacement or breaks in the skin.  The nonsurgical management consists of ice, elevation, compression, and immobilization with a below the knee cast.

Surgery is indicated when the ankle fracture is considered “open,” or when there is a loss of stability, or when there is displacement of the fracture bones.  Surgery is usually delayed for 7-10 days to reduce the swelling that occurs with ankle fractures.  The fractured bones are fixed with screws, plates, K-wires, Steinmann pins, and external fixation devices.  The post operative period is determined by the time is takes for healing of the bone and soft tissues.

Another associated disorder that can occur with or without ankle fractures is an injury to the syndesmosis of the ankle joint.  The syndesmosis helps control the stability of the ankle joint which is located just above the tibia and fibula articulation.  An injury to the syndesmosis displays an excessive amount of space within the ankle joint making it unstable and painful.  Surgery is performed to stabilize the syndesmosis and ankle joint by using screws and suture material.    

Any injury that occurs within the ankle joint can lead to arthritis with or without the proper treatment.  The chances of arthritis forming within the ankle are decreased by the length of time treatment starts and the severity of injury.  Arthritis can be displayed within the ankle joint by forming bony exostoses and decreasing ankle joint space leading to decrease range of motion.  This can be treated with cortisone injections temporarily or by surgical fusion or total ankle replacement.

Hammertoes

Hammer Toes

 

 Author: Dr. Craig Halihan

 

            Hammer toes is a chronic arthritic deformity that affect the small joints of the toes. When the joint close to the foot is affected, it is known as a hammer toe. When the joint close to the nail is affected, it is known a mallet toe. When both joints are affected it is known as a claw toe. These often painful deformities can be either very rigid and cannot be passively reduced, or flexible and can be reduced using gentle manual manipulation. The more rigid the deformity, the less conservative treatment will be effective. When the deformities become more rigid, they tend to be more painful.

 

            Hammer toes are often the result of poorly fitting shoes, years of high heel use, flat feet and very high arched feet. In fact mild flexible cases often respond to a simple change of shoe type or size. Hammer toes can also result form injuries or neuromuscular conditions and diabetes. Hammer toes are also often associated with bunion deformities. When the great toe begins shifting toward the smaller toes they often run out of space and are forced into an upward position to accommodate the new position of the great toe, resulting in a hammer toe deformity.

 

            Signs and symptoms of hammer toes are typically:

 

  • painful corns and calluses on the peak of the joint or on the bottom of       the foot.

 

  • Pain and limited range of motion of the joints.

 

  • Claw like or bent appearance of the toe at one or both of the joints.

 

It is recommended that you see a doctor if pain is constant or affects your ability to walk or wear shoes. Check ups are also recommended for people suffering form associated bunion deformities or in cases where multiple toes are affected.

 

            Treatment depends on the degree of rigidity and pain.

 

  • Flexible and non-painful deformities: treated with conservative strapping or a change in shoes. Sometimes accommodative padding can be employed.
  • Flexible but painful deformities: treated sometimes with strapping and padding, but sometimes a tendon release may be necessary to relieve pain. This can be done with a simple small incision and tendon release. There is often a short recovery period, ambulating in a surgical shoe for 2-3 weeks.
  • Rigid painful deformities: these rarely respond to conservative treatment, but generally respond very well to a surgical approach. Arthroplasties are used to reshape and straighten deformed toes. This returns them to a straight non painful position. Sometimes in cases where the deformity is really bad, joint fusions may be required to relieve pain and return  the toe to a straight position.

 

It is usually a good idea to treat any other contributing deformities, such as bunions or flat feet. A good consultation with your doctor, will shape your treatment options and answer all of your questions.

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Flat Feet

Flat Feet

 

“Flat Feet” is a widely used generic medical term that describes some type of decrease in the height of the arch that is located on the inside of the foot.  In some cases, a person with flat feet has a slight decrease in arch height, while in other cases, there is no arch visualized. Flat feet are considered normal in infancy and in young children until 8-10 years of age.  Around this time, an arch should be identified. However; most people with flat feet never develop pain.

There are many different terms that are used to describe a person with flat feet.  Some of these include pes planus, pes valgus, equino valgus, collapsing pes valgo planus, and talipes calcaneovalgus.   Although flat feet is a broad term, it is a very complex disorder that not only affects the arch but also other parts of the foot and/or ankle.  The most commonly associated disorders with flat feet are bunions, hammertoes, heel pain, midfoot collapses and dislocations, and an everted or valgus position of the heel and/ or ankle as well as equinus.  Since there are so many associated disorders that can cause symptoms with flat feet, the associated disorders should also be treated concurrently when treating flat feet.  

In general, there are two very common presentations of flat feet which are termed “flexible” and “rigid”.  A “flexible” flat foot means that the arch collapses upon weight bearing of the foot while the arch of the foot is visible when the foot is not touching the ground.  Flexible flat feet commonly occur in the pediatric or adolescence and can continue into adulthood.  If symptomatic and not properly treated, a flexible flatfoot can become stiff or rigid and potentially develop in a more severe condition.  The second common presentation of flat foot is termed “rigid” which means that the height of the arch is the same whether or not the foot is touching the ground during weight-bearing.  Rigid flat feet can be caused by many factors including arthritis, tarsal coalitions, and congenital vertical talus. 

The severity of symptoms that occur with flat feet varies from person to person as well as the location on the lower leg and foot. The symptoms are not defined by how low the height of the arch is but rather the adaptive changes in bone, tendons, and ligaments.  At times, there are patients that have no visible arch height, who are asymptomatic, while patients with a very slight decrease in their arch height have severe symptoms.  

After diagnosing flat feet by a physical examination and radiographs as well as other imaging modalities, the treatment regiment should begin promptly.   There are non-surgical and surgical treatment protocols to help treat the pediatric as well as the adult acquired flat foot.  The conservative treatments are based on controlling the pathological movements of the bones, ligaments, and tendons.  This is done by custom molded foot orthotics, and/ or foot and ankle braces.  Rest, ice, compression, elevation and an organized physical therapy regiment helps decrease the tenderness, inflammation, and swelling that occurs.

When considerable effort of conservative treatment has failed to relieve symptoms, surgical intervention is indicated. The type of procedure that is performed is highly variable because each flat foot is unique to each other.  The principles behind the vast array of surgical procedures available are based on to correct each area of soft tissue, ligament, and bone that is contributing to the pathologic symptoms.   The surgical procedures can range from implants, soft tissue releases, and tendon transfers to osteotomies and fusions of bones with or without bone grafts.  The recovery period is dependent on the surgical procedure performed which can range from 8- 12 weeks followed by physical therapy.

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Best Podiatrist

Best Podiatrist

 

What is the best podiatrist?  The following information will give you a synopsis of what to look forward in finding the best podiatrist in your area.  The first source of information that is important in finding the best podiatrist is determining their undergraduate education, the college of podiatric medicine attended, and the number of years of training received in residency and / or fellowship.  Another source of information that is important is to determine the board certification status.  A podiatrist can become board qualified in forefoot and rearfoot and ankle surgery or just board qualified in forefoot surgery depending on passing a written examination.

After board qualification status is achieved, a podiatrist will have up to seven years to submit surgical cases for review and approval in order to sit and take the oral examination.  If passed, the podiatrist will become board certified in either forefoot surgery or rearfoot and ankle surgery or both.  A podiatrist will continue on a yearly basis for licensure approval where he or she will need to obtain continuing medical education hours in order to renew their license.  Therefore; the best podiatrist is one that is board certified and is very experienced in their field of expertise.

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ANKLE SURGEONS

Ankle Surgeons

 

By: Craig W. Halihan D.P.M.

 

Ankle surgeons are podiatric physicians who are specially trained to perform ankle and reconstructive surgery. They are licensed to provide complete medical and surgical care of not only the foot, but the ankle joint as well. The ankle is a very important and complex joint that requires special care and training to treat. Care includes:

           

  • Ankle fracture repair
  • Achilles tendon rupture repair
  • Ankle ligament rupture stabilization and repair
  • Flat foot reconstruction
  • Post traumatic salvage and fusions
  • Trauma care to the Fibula and Tibia

 

Care is extended to patients of all ages.

 

            Training for podiatric ankle surgeons is extensive. Four years of undergraduate pre-medical studying leading to a bachelor’s degree is required. This is followed by four years of medical training that is in line with and along side MDs and Dos. This training leads to the DPM degree and qualifies the candidate as a physician. After extensive testing the candidate is licensed and then goes through residency training that includes all of the required rotations of MD residency training as well as extensive surgical training in the Foot and Ankle. After completion of residency and more testing the candidate can now be licensed to practice as an attending physician and surgeon. Once in practice the physician begins compiling cases and experience that will eventually qualify him/her to sit for board certification. At this stage the candidate is considered board qualified.

 

            Once the required experiences of ankle surgeons are acquired the candidate will undergo rigorous written and oral testing. When completed, the candidate will classified as board certified.

Board certified physicians have gone through extensive testing, training and real world experience by the time the patients see them in their private practices. This gives the patient confidence that their foot and ankle surgeon is up to the task of getting them on their feet and back to their lives.

Corns

   CORNS

 

Author:  Gary F Ochwat, DPM                                 

                                                                                           

 

Corns are areas of thickened skin on the toes of the foot which occurs in areas of pressure.  A hard corn will occur on the top or tip of the toe as a result of a hammertoe. A hammertoe may be flexible or rigid, and can occur on any of the lesser toes. The reason that the toe “hammers or buckles” is because ligaments and tendons have tightened, cocking the toe upward, causing a pressure point for shoes to rub on, therefore causing the corn.  The most common toes affected are the second toe and the baby toe.

A soft corn occurs between the toes. Soft corns are most commonly found between the fourth and fifth toes. 

 Causes of corns are tight shoes, toe deformities such as hammertoes or a bony prominence or spur on the toe.  Sometimes all the toes can be affected. Corns that are not treated will eventually become painful and irritated when wearing closed shoes.

 

Treatments for   corns include wearing wider or extra depth shoes, and using over the counter corn pads to provide a cushion between the corn and the shoe.  Beware of medicated pads which contain salicylic acid as over use of these pads can cause infections and ulcers.  This is especially true if you have diabetes or poor circulation. Never try to cut the corn yourself.  Try soaking your foot in warm water, then use a pumice stone to gently file away the thickened skin.

 Visit a Podiatrist to have   painful corns properly evaluated and treated.  After a thorough history and examination, the Podiatrist will first determine the cause of the corn, and then develop a treatment plan.  X-rays may be taken to evaluate which type of bone pathology is the cause of the corn.  An x-ray will also show if the joint is affected by arthritis.

  Treatment options include periodic professional trimming of   corns.  Removing the corn will give temporary relief, but over time the corns will return until the underlying cause (hammertoe or spur) is addressed.    If conservative measures fail to alleviate the pain, a surgical consultation is indicated.

Surgical procedures involve straightening the toe (arthroplasty) or removing a bone spur.    Either is an out-patient procedure performed under local anesthesia or local with sedation (twilight sleep).   Sometimes the procedure can be performed in the Podiatrist’s office.  After the surgery, a bandage and surgical shoe will be worn for approximately 2-4 weeks depending on the severity of the problem. Splinting of the toe with a flexible gauze is applied by your surgeon to keep the toe in the correct position while it is healing.  

 

Corns are sometimes associated with other foot deformities such as bunions.  When you have a   bunion the big toe can cross over or push up the second toe causing a hammertoe and increased irritation when wearing closed shoes.  Often this is the time professional help is sought. 

 

If you have been suffering from corns and or hammertoes, and would like to know what can be done to correct the problem,  make an appointment with your Podiatrist for a thorough evaluation.