Diabetic foot Care

Dec 10

Posted by efootpain in Callus, Corns, Diabetic Foot Care, Foot Pain, Foot Treatment, Fungus Toenails, Medicine | No Comments

Diabetic foot care is an important factor in the overall health care of a diabetic patient.  Podiatrists help reduce the risk factors of diabetic patients that may lead to many debilitating complications.  These complications include mild conditions as fungal toenails, ingrown toenails, calluses, corns, and small fissures or cuts in the foot.  More severe problems include soft tissue and bone infections, foot ulcerations, leg venous ulcerations, and amputation of the toes or feet.

Diabetic foot care is recommended by Northwest podiatry centers as preventative treatment for long term care of the foot and ankles.  Podiatrists treatment involve debridement of painful and thick fungal toenails, debridement of callous tissue that are pre-ulcerative, fitting of special diabetic shoes and inserts, x-rays and diagnostic ultrasound studies to review the proper biomechanical structures of the feet.  Diabetic patients must follow the foot care treatment protocol recommended by their podiatrist to enjoy the benefits of overall medical health.

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Podiatrist

Dec 7

Posted by efootpain in Board Certified Podiatrist, Foot Pain, Foot Treatment, Medicine, Podiatrist Medical Education, Podiatrist Medical School, Podiatrist Training | No Comments

A Podiatrist is a specialist in the medical, biomechanical, and surgical treatment of diseases in the foot and ankle.  In the United States, the podiatrist is licensed as a Doctor of Podiatric Medicine or D.P.M.  Training of a podiatrist requires attendance in a four year Podiatry Medical School program.  In addition, further training of up to 2 to 3 years of residency training in an accredited hospital or university institution.  Many podiatry medical schools are affiliated with medical school programs.  There are approximately eight podiatric medical schools in the United States.  They are located in California, Arizona, Iowa, Ohio, Illinois, Florida, Pennsylvania, and New York.

Entrance into a college of podiatric medicine requires at least 90 semester hours of college credit at an accredited institution.  The actual minimum semester credit hour requirements for all colleges of podiatric medicine include the following prerequisites according the American association of Colleges of Podiatric Medicine.  These courses include biology, chemistry, organic chemistry, physics, and English.  Most of these courses require between 8 to 12 semester hours depending on the podiatric medical school with laboratory courses included.

The podiatrist medical education is focused on the medical, biomechanical, and surgical aspects of treatment of the foot and ankle.  Rotations in various specialties are integrated with their training including vascular surgery, family medicine, internal medicine, radiology, pathology, anesthesiology, emergency medicine, general surgery, orthopedic surgery, psychology, endocrinology, plastic surgery, and neurology.  By learning all aspects of human body the podiatrist is well suited to recognize medical symptoms vital to obtaining the correct diagnosis and treatment regime.

Podiatrists are licensed in all 50 states, the District of Columbia, and Puerto Rico. Podiatrists practice in individual or group practices.  Hospital and surgical center affiliation and credentialing may be obtained in order for the podiatrist to perform medical and surgical procedures.  In addition, podiatrists may also work with HMOs, PPOs, Extended care facilities, health professional schools, Veterans affairs departments, Municipal health departments, and the Public health service department.

Podiatrists strive to become board certified in their specialty that are classified under board certified in primary podiatric medicine and biomechanics, podiatric foot surgery, podiatric reconstructive rear foot surgery, and diabetes prevention and treatment of the diabetic foot wounds and foot wear.  Podiatric board certification requires the graduation from an accredited podiatric medical school, completion of an approved podiatry residency, practice experience by years, case submissions, and passing a written, computer based, and oral examination.  In addition, CME (continuing medical education) is essential and mandatory in many states in which podiatrists are required to obtain up to 50 hours of education a year to expand their knowledge and learn new techniques.

Podiatrists treat a vast array of medical problems in their daily practice.  Many podiatrists work in the office or clinic, hospital, and surgical setting.  They treat patients with pathology as heel pain (plantar fasciitis), ingrown toenail infection, onychomycosis (fungal nails), dry skin, athletes foot, fractures of the foot or ankle, plantars warts, flatfeet, tendon ruptures and tendonitis, arthritis, gout, neuroma (Mortons neuroma), soft tissue masses, running injuries, varicose veins, nerve disorders (as tarsal tunnel syndrome), hammertoes (corns and calluses), bunions, tailors bunions (bunionettes), diabetic foot care and ulcerations, pediatric heel pain, cellulites.

The podiatric patient may not only have foot and ankle pathology but also related medical diseases as diabetes, parkinson’s disease, fibromyalgia, multiple sclerosis that may contribute to the foot and ankle disease and requires a team of other medical specialties for complete health care.   The team approach in the care of the medical patient may require consultations or treatment by internal medicine, vascular, endocrinology, eye doctors, neurologists, physical therapists, dieticians, and many other specialties depending on the diagnosis.

Podiatrists not only treat patients medically but also surgically when indicated.

They use a vast array of surgical equipment as surgical screws and plates called internal fixation, external fixation devices as mini and large ring fixators, bone grafts, skin grafts, joint implants for the toes, ankles, or subtalar joint, arthroscopy equipment,

And Endoscopy equipment.  There are continuing innovations medical and surgical field for the care of the podiatric patient.

Diagnostic tests are also ordered by the podiatrist in order to obtain the most accurate diagnosis.  Some equipment may be in the office as the X-ray, diagnostic ultrasound, tuning fork, vascular testing equipment, and neurological testing equipment.  Other tests ordered may be performed at other facilities as the CT scan, MRI, flouroscan, bone scan, blood work, and some vascular and neurological exams.  These diagnostic measurements are important in the diagnosis of the podiatric patient.

The podiatrist treatment regime may consist of performing conservative care or surgical care.  The podiatrist is able to prescribe medications, perform manipulations of the foot and ankle, casting for broken bones, casting for custom orthotics, injections, physical therapy, debridement of tissue and toenails.  The podiatrist surgical care is also well rounded that may include ingrown toenail surgery, wart removal, bunion, hammertoes, diabetic debridement, amputations, external fixation devices, fracture and dislocation repair, reconstructive foot and ankle surgery, ankle arthroscopy.  The podiatrist is a well rounded medical professional and is important in the health care effort in providing patients with long term health and activity.

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Best Podiatrist

Dec 2

Posted by efootpain in Board Certified Podiatrist, Foot Pain | No Comments

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.

Ankle

Nov 24

Posted by efootpain in Ankle Bone, Ankle Fracture, Ankle Injury, Ankle Pain, Ankle Sprain, Ankle Sprain Treatment, Exercises, Foot Treatment, Glossary | No Comments

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.

Flat Feet

Nov 24

Posted by efootpain in Causes & Symptoms, Devices, Flat Feet, Flat Foot, Foot Pain, Foot Treatment, Glossary, Rigid Flat Feet | No Comments

“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.

CORNS

Nov 24

Posted by efootpain in Glossary | No Comments

“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

Nov 24

Posted by efootpain in Glossary | No Comments

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

Nov 24

Posted by efootpain in Foot Pain | No Comments

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

Nov 24

Posted by efootpain in Foot Pain, Glossary | No Comments

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.

SEEKING HELP FOR HEEL PAIN

Nov 24

Posted by efootpain in Foot Pain | No Comments

Heel pain can be nagging and dull or severe and debilitating or somewhere in-between. When the pain prompts a patient to seek medical treatment, there are a few things to keep in mind. Before a podiatrist can start treating the pain, a diagnosis must be determined.

Different conditions require different treatments. So, the first step is a physical examination, which will help determine the correct diagnosis. In addition, a thorough history is equally important. Information about the pain – its onset, duration and character – and any other symptoms will help the foot specialist determine the cause.

Other information that would be very helpful in determining both the diagnosis and effective treatments:

1. What makes the pain worse?
2. What makes the pain better?
3. What treatments have been tried by the patient?
4. Which previous treatments helped and which ones have not?
5. Has there been trauma?
6. Is there a history of any systemic arthritis?

All of these factors must be considered to evaluate the patient properly.

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