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

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.

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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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.

  

FOOT CORNS

The term “foot corns” when associated with the foot refers to areas of thickening of the skin on a toe or toes.  The thickening or “keratosis” is usually found on the top of the toe, over one of the two “knuckles” of the toe.  If the corn is found just behind the toenail it is located on the distal knuckle, or “distal interphalangeal joint’; if it is on the knuckle farther back toward the area where the toe meets the rest of the foot, it is over the proximal knuckle or the “proximal interphalangeal joint”.  The corns found in these areas are hard corns, as the tissue is thickened, hard, and many times yellowish in color.

“Corns” are formed by the body as a protective response of skin thickening secondary to irritation to normal bony areas.  Temporary corns, usually starting as a blister, are formed by the body when irritation occurs to a toe from a tight shoe or excess walking.  These disappear after the cause of irritation is removed.  Usually, foot corns are chronic painful lesions (keratosis) formed by the body secondary to bony deformities of the toe, such as a “hammertoe”.  Relief is obtained by removing the thickening of the skin with conservative treatment, or straightening out the hammertoe with surgery.

Corns can also be found in-between the toes where they are referred to as soft corns, since the moisture between the toes keep the corn soft.  As with hard corns, they can be temporary secondary to a one time irritation, or chronic due to bony deformity of the toe.  Treatment is the same as with “hard corns”; conservative or surgical.  Conservative treatments range from padding to removal if the hard skin, whereas surgical treatment refers to straightening of the toe with some bone removal.

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FOOT CARE

Discussions regarding proper foot care can be widely diversified.  The feet are our “organs for propulsion”, and just like our brain functions to keep our body organized and functioning and the heart keeps our blood circulating, our feet keep us moving.  If they are neglected, just as any organ of our body, they can fail.  Unfortunately, our feet are the most widely neglected part of our body.

Proper care of our feet is important for us to be able to stand, walk, run, work and enjoy our leisure time.  Make sure to wear sensible shoes that fit well and fit the activity you are participating in.  Wearing flip-flops to the beach is fine; not for all day shopping at the local mall.

Every-day care:

Our feet are always in contact with a surface and require protection from contaminants located on these surfaces such as bacteria, viruses, fungi, and chemicals (to name a few).  We protect our feet and body with shoes and good hygiene. Proper bathing of you feet with soap and water on a daily basis, with careful drying, especially between the toes, is necessary.  Pathogens love to grow in dark, moist areas, and what is better that damp feet inside of a dark shoe?  Application of a cornstarch- based bath powder after bathing would be beneficial.  Inspect your feet – top, bottom, and in-between the toes on a daily basis.  Take action if redness, itching, blisters, cuts, rashes or bruises are noticed.  Wear shoes or sandals routinely.

SHOES and Hosiery

It is common sense to wear shoes that fit, or else they will be uncomfortable and could cause irritation and pain.  But it is also important to wear proper fitting hose.  Socks that are too tight can cause constriction resulting in swelling.  Hose made with some synthetic products in hot climates can cause excess perspiration, resulting in dampness.  “Support” hose should be recommended by a medical professional and fit professionally, or could cause circulation problems.

When in doubt, have your shoes fit by a professional.  Be sure your shoes are wide enough around the “ball” of your foot (where your toes connect to the rest of your foot) so as to not be constrictive and that when standing you have ½ inch of toe space from your longest toe to the end of the shoe.  Make sure the tops of your toes are not rubbing on the shoe, and when trying shoes on be sure you are wearing the type of socks you will be wearing with the shoe you are going to purchase.  Walk around the store to make sure they are comfortable.  Finally, make sure that the soles of your shoes will match the activity you are wearing them for; shoes with a hard sole with no traction control would not be good if you were working on damp, slippery surfaces.

Common foot problems

Corns, calluses, blisters, rashes (athlete’s foot), warts, ingrown toenails, heel pain, bunions and hammertoes are some of the common foot problems.  Injuries can result in strains, sprains, or fractures.  Many can be treated effectively with conservative methods, and others need professional (sometimes surgical) care.

CORNS AND CALLUSES

Corns and calluses, if never present before, often follow blistering of an area of the skin of the foot or toes, secondary to irritation from shoes, hose, or abnormal activity.  Corns are associated with the toes, whereas calluses are associated with the side or bottom of the foot.  Over a period of time the blistered area can harden into a thickening of the skin over an area that was irritated, and becomes painful   If the irritation is removed, the corn or callus, and pain, should gradually disappear.  If the corn or callus is a chronic condition, it is usually associated by a contraction or deformity of the toe (hammertoe, or a problem with a prominent metatarsal bone. Professional examination and treatment is recommended in these chronic conditions.

RASHES, ATHLETE’S FOOT, WARTS

Rashes and athlete’s foot can be caused by an irritant such as a fungus, chemical, or an allergen (poison ivy or insect bite).   Warts are caused by a virus.  There are many non-prescription remedies available for these skin conditions, but if no results are seen with a 7-10 days professional assistance is recommended

INGROWN TOENAILS

Ingrown toenails are conditions whereby the edge of the toenail pinches the skin alongside, causing pain and many times infection.  Sometimes these are caused by improper nail trimming or a tight shoe, but oftentimes there is an actual nail curvature that causes the nail to grow improperly.  Chronic infected, ingrown toenails can easily be treated by your medical professional.

HEEL PAIN

Heel pain is usually associated by plantar fasciitis (an inflammation of the plantar fascia or arch ligament) where it attaches to the bottom of the heel bone.  Heel pain can also be associated with a heel spur, or an enlargement of the attachment point of the heel bone to the plantar fascia.  Sometimes pads help the problem, but oftentimes professional help is needed, and if a chronic problem, orthotics with physical therapy, stretching and icing is necessary.  Some situations may need surgical intervention.

BUNIONS

Bunions are dislocation or deviation of the great toe (hallux) at the big toe joint (first metatarsal joint).  The medical term for a bunion is “hallux valgus”.  This is not a temporary condition; it is a progressive problem that gets worse with time. Bunions can be irritated by improper footgear and result in temporary pain, but usually it is a chronic problem resulting in constant pain (with or without shoes) requiring appropriate medical evaluation and treatment.

SPRAINS AND STRAINS

Injuries to the foot and ankle are common, and fortunately our body is able to heal minor injuries quickly.  However, if there is considerable swelling, eccymosis (black and blue), and pain either at rest or when bearing weight, should NOT be dismissed as a simple strain or sprain.  Professional examination and treatment with X-rays and possible a MRI is necessary to rule out a significant injury.  Without proper treatment, an injury passed off as a simple strain or sprain may result in a lifelong problem.

The “common-sense” approach to foot care should result in the prevention of many common foot ailments.  Unfortunately, injuries and our environment can cause problems that even the best preventative methods cannot avoid.  Contact your local Podiatrist or medical professional whenever there is a foot related issue that persists for any length of time.

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BUNION TREATMENT

Before talking about “bunion treatment” it is important to understand what a “bunion” is.  Many times it is used generically (and incorrectly) to refer to a bump or lump on the foot.  A “bunion” is correctly described as an angular deformity with dislocation of the large toe (hallux) where the large toe meets the rest of the foot (first metatarsal-phalangeal joint).   Treatment consists of removing pressure from the deformed joint surface (conservative) or actual straightening of the toe and joint by surgery.

A “bunion” is usually an inherited deformity.  In over 90% of patients suffering from bunion pain, there is a family history of similar deformities.  Bunions are progressive, bony foot deformities, and in most cases, treatment consists of surgical repair.  Temporary pain relief can be obtained with wider shoes, thus keeping pressure away from the bone surfaces, but as time goes on the joint can become further displaced, enlarged, or stiff causing chronic pain.  When these conditions manifest themselves, surgery is usually the only cure.  Improper footgear only irritates the underlying deformity; it is not the primary cause of the problem and pain.

Simple removal of the enlarged bone that forms from the chronic dislocations is usually not enough, since pain is secondary to the joint restriction or dislocation.  Surgical procedures where the bones are straightened and allowed to heal over a period of time are usually the most successful in long term pain relief.

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BONE SPURS

Is there such a thing as bone spurs?  Should this term be used to explain pain?  This has been a point of contention amongst medical professionals for years.  Like many colloquial expressions used in the English language, the term “bone spur” is used “generically” to explain an abnormal bump or growth on a bony surface.

Perhaps the term “bone spur” is easy to understand and less frightening to a patient than advising the patient that they have an abnormal enlargement of bone.  Just like the term “cartilage deposit” is used to describe a bony bump, the term bone spur is used so as to not alarm the patient.

In all actuality, the term “bone spur” is used to describe an enlargement or overgrowth of bone, usually associated with a joint or the heel, where the bone has enlarged due to a genetic or biomechanical abnormality.  The “bone spur” takes years to develop, and is not noticed by the patient until pain is present.  Often the term “bone spur” is used to describe a enlargement of the bottom of the heel, and looks like a “spur” when visualized with an X-ray.  This type of spur is actually an elongation of the bottom portion of the heel secondary to stress exerted on the heel due to tightness of the plantar fascia, or arch ligament.  It is associated with chronic heel pain, usually noticed after periods of rest or first thing in the morning.

Abnormal enlargement of bone (bone spurs) are usually associated with joint surfaces.  As the bone enlarges, restriction of joint motion occurs, and pain will ensue.  The enlargement of bone can very often take on the appearance of a spur when visualized with an X-Ray.  In these situations, the pain caused is due to the restriction of motion of the joint, not the actual spur.  Unfortunately, we use the term to describe the appearance of the problem, not why the problem exists.

“Bone spurs” cannot be dissolved by physical therapy or cortisone injections.  The pain associated with spurs is reduced with these treatments.  The only way “spurs” can removed is by surgical excision.

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Ingrown Toenails

Author – Gary F Ochwat DPM

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Ingrown toenails are a common foot condition in which the nail is curved downward and the side of the toenail grows into the flesh of the toe.  This irritates the skin creating pain and redness and sometimes leads to infection.

Common causes of ingrown toenails include hereditary, trauma improper trimming and tight fitting shoes.  Toenail fungus may also cause the nail to become ingrown.

Prevent ingrown toenails by trimming your toenails properly.  Cut the nails straight across and do not cut them too short.  Avoid wearing tight fitting shoes.  It is a myth that cutting a “V” in the nail allows the nail to grow straight.  This is simply not true.  The toenail will continue to grow curved downward.

Self care treatment includes soaking the toe in warm water for 15-20 minutes and apply a topical antibiotic ointment twice a day.  When an infection is present, seek professional care from a Podiatrist.  This is especially true for those at risk because of diabetes or vascular disease.  Often a minor procedure  is performed to permanently remove the ingrown side of the toenail.  This is a common, painless treatment procedure performed under local anesthesia in the Podiatrist’s office.

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Arch Pain

Arch pain is a treatable, but chronic condition of the foot that most often occurs from Plantar Fasciitis. This very common condition is the result of inflammation of a ligament in the bottom (plantar) aspect of the foot. The ligament attaches from the inferior aspect of the heel bone (calcaneous) to the inferior aspect of the toes (phalanges).

Symptoms:

 

    • Pain upon waking with the first few steps or after prolonged sitting.
    • Inability to tolerate flat shoes or walking barefoot
    • A sharp trigger point pain in one or both heels, may cause limping

Causes:

    • Flat or high arched foot structure
    • Prolonged standing
    • Working on very hard surfaces
    • Very common among runners
    • Associated heel spurs

Differentials:

    • Calcaneal (heel bone) stress fracture
    • Plantar Fascia partial tear or rupture
    • Plantar Fibromas
    • Bone cysts
    • Foot strain

Evaluation  – At your appointment, your doctor will perform a history and physical, take x-rays to rule out causes for your heel or arch  pain, beside plantar fasciitis. Be prepared to ask questions about your condition and give details about your habits including work conditions, exercise activities and typical choices for shoe gear. Be prepared to discuss when the pain occurs and what makes it worse or feel better, this will help make an accurate diagnosis.

Treatment – There are many treatment options available, but it is important to remember that this tends to be a chronic foot structure related condition. A person once prone to this condition can see a return of the pain if activities that trigger it are prolonged. Treatment options include:

    • Physical therapy, stretching and icing
    • Orthotics
    • Cortisone injections
    • Shoe gear modification to supportive shoes

Most cases will respond to conservative care, but there are surgical options available for those cases that do not respond. This includes resection of associated heel spurs and shock wave therapy.

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