Description: Achilles tendonitis is inflammation or irritation of the tendon that attaches to the back of the heel (calcaneus). The tendon is formed from the calf muscle.
Cause: This condition can be caused bya tight calf muscle causing excessive pulling on the heel bone. It can also be caused from direct injury or overuse during exercise or certain forms of activities such as working on a ladder. If the forces are strong enough, a rupture of the Achilles tendon can occur.
Treatment: Achilles tendinitis is treated with anti-inflammatory medications, ice, rest, immobilization and physical therapy. Biomechanical control with orthotics can also be employed in addition to a heel lift to reduce the strain on the Achilles tendon.A ruptured Achilles tendon will require surgical repair, followed by as much as 12 weeks in casts or walker boots.
Description: Athlete’s foot (Tinea Pedis) is a contagious fungal infection that usually occurs between the toes and in other areas of the foot. The condition is more common in men than in women, It can cause tingling and burning or even blisters between the toes and/or on the soles of the feet. It can also cause dry cracking red skin on the bottom of the feet. Sometimes it can lead to bacterial infections of the foot. People with diabetes are especially prone to this.
Cause: The fungus that causes athlete’s foot likes to live in dark, moist areas like swimming pools, showers, bathrooms, saunas, fitness centers, locker rooms. It is most often picked up by walking barefoot in these types of areas. The fungus can live in footwear and on surfaces of mats, rugs, clothes and linens for up to six months.
Athlete’s foot can be spread by skin-to-skin contact between people and even between people and household pets. People with weakened immune systems are particularly susceptible to athlete’s foot and other fungal infections.
Treatment: To help prevent athlete’s foot, wear socks that wick moisture away from the foot, wash your feet with soap daily and dry them thoroughly. Wear protective foot gear in public showers, pools, fitness centers. Athlete’s foot generally can be treated effectively with over-the-counter topical medications. Particularly difficult cases may require eith topical or oral prescription medication from a podiatrist.
Bunions (Hallux Abducto Valgus)
Description: A bunion is a protrusion of the 1st toe joint. It is not so much a growth of bone occurs, as it is a misalignment of the first metatarsal and the great toe which appears as a bony prominence on the inside of the foot. Bunions are more prevalent in females and prevalence increases with age. Bunions are progressive and usually become worse over time. During the progression, the weakening of the 1st toe joint causes a drifting of the 1st toe towards the second toe. Sometimes the condition can be so severe that the 1st toe will overlap or under left the second toe. When this occurs on the 5th toe (pinky toe), is called a bunionette or Tailor’s bunion.
Cause: Bunions are usually due to instability in the functioning of the foot and can be aggravated by certain types of shoes. They can cause redness, inflammation and pain either on motion of the joint or pressure against the bone. When ignored, a bunion deformity can lead to arthritis in the joint.
Treatment: Proper fitting shoes are important to alleviate pressure on the bunion. Sometimes spot stretching the shoe at the painful area can help alleviate shoe pressure. Over-the-counter bunion pads are also available to also help reduce pressure on the area. When caught early on, functional orthotics can help reduce the biomechanical influences causing the bunion, thereby slowing down the progression of the deformity. Weight-bearing x-rays are critical to evaluate the angular relationships of the bones causing the deformity and sometimes surgical correction is necessary to reduce the bony prominence and realign the altered angle of the bone(s).
Description: A callus is thickening of the skin as a result of excessive pressure or friction on a specific area. Calluses are commonly form on the bottom of the foot, the back of the heel, or the side of the 1st toe. Some calluses may have a central core which can be very painful. This is usually due to pressure from a bone either due to a prominence of the bone or excessive pressure because of abnormal mechanical functioning of the foot during walking.
Cause: Calluses can be caused by high-heel shoes, poorly fitting shoes, abnormalities occurring during walking, loss of the fat pad on the bottom of the foot, bony prominences, obesity, flat or high arched feet.
Treatment: Calluses are treated by a podiatrist by reducing the thickness of the callused skin with a special blade. This is non-painful and is performed in the office. Callus pads can be helpful in reducing pressure on the painful area. Other specialized pads are available through podiatrist depending on the specific condition and foot structure. Accommodating or controlling the function of the foot with an orthotic is a more permanent, long-term solution to preventing buildup of the callus. Sometimes surgical intervention is required to alleviate pressure from a bony deformity.
Description: Corns are like calluses in that they are buildup of thick skin to to friction and pressure, but they occur either on the top or the sides of the toes. Like calluses, they can develop a core in the center of the lesion which can press on a nerve ending in cause severe pain. Chronic irritation of the corn can cause inflammation and sometimes a breakdown of the skin leading to a wound.
Cause: Corns are usuallycaused from poorly fitting shoes. Contracted or bent toes (hammertoes) cause excessive pressure of the top of the toe against the shoe. Corns between the toes (soft corns) are typically a result of a small protrusion or bone spur of one the bones in the toes.
Treatment: Corns are treatedconservatively by trimming the thick hard skin by a podiatrist. Over the counter corns pads can also help to alleviate the pressure from the shoe, but having a shoe spot stretched where the toe is rubbing is also helpful. Extra depth shoes are sometimes used to allow more room for hammertoes so the shoe doesn’t rub the top of the toe. People with poor circulation and diabetics, should avoid corn remover products except under the care of a physician since if left unchecked, these devices can lead to infection and ulceration. Sometimes, surgical correction for straightening the toe is the best alternative to prevent the corn from returning permanently.
Description: A ganglion is a fluid-filled cyst (mass) that typically forms near the ankle or on top of the foot. It is not usually painful unless there is pressure on it from a shoe or if it increases in size over time. If a ganglion develops over a nerve, a tingling sensation will develop. These soft tissue masses are benign.
Cause: Ganglions occur most often in women aged 25-45. They usually develop as a result of injury or irritation over a tendon or joint. As a result of an injury, the tissues swell and fill with joint fluid or fluid from the lining of a tendon.
Treatment: Drainage of the fluid will usually relieve symptoms although the ganglion has a high rate of recurrence. If the cyst is painful or continues to enlarge, surgical removal is recommended.
Description: Gout is an form of arthritis–inflammation that can cause an attack of sudden burning pain, stiffness, and swelling in a joint–caused by a buildup of uric acid in the blood. The most common sign of gout is a sudden attack of swelling, tenderness, redness, and sharp pain, which often occurs in the knees, ankles, the big toes and other parts of the feet. Attacks are sporadic and can last a few days or many weeks.
Most of the uric acid in the bloodstream is filtered and disposed of in the urine. But when uric acid accumulates in the blood, it forms crystals that gravitate to the joints.
Gout is a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation.
- Acute gout is a painful condition that typically affects one joint.
- Chronic gout is repeated episodes of pain and inflammation, which may involve more than one joint.
Causes, incidence, and risk factors
Gout is caused by having higher-than-normal levels of uric acid in your body. This may occur if:
- Your body makes too much uric acid
- Your body has a hard time getting rid of uric acid
If too much uric acid builds up in the fluid around the joints (synovial fluid), uric acid crystals form. These crystals cause the joint to swell up and become inflamed.
The exact cause is unknown. Gout may run in families. It is more common in men, in women after menopause, and those who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood.
Cause: Common causes of this buildup include the following:
Drinking too much alcohol
Taking certain medications such as diuretics
Eating too much meat or fish, which are high in purines
Purines are natural substances found in every cell of the body and present in most foods. Eating too many foods high in purines leads to the overproduction of uric acid. Foods high in purines include high-protein foods such as organ meat (liver, kidneys, sweetbreads); anchovies, sardines, and herring; legumes (dried beans, peas); consommé and gravies; mushrooms, spinach, asparagus and cauliflower; and beer and other alcoholic beverages.
Treatment: The best way to prevent gout is to prevent the buildup of uric acid in the blood. Changing your diet and avoiding foods high in purines may help lower your risk of having future attacks. Doctors recommend that people who have gout maintain a healthy body weight through moderate daily exercise and regulation of their fat and caloric intake.
Avoid diets that promise quick or extreme weight loss as they can increase uric acid levels in the blood. The American Medical Association recommends a diet high in complex carbohydrates (whole grains, fruits, vegetables), low in protein (15 percent of calories from sources such as soy, lean meats, poultry), and no more than 30 percent of calories from fat (10 percent animal fat). Drink plenty of fluids and don’t overindulge in caffeinated drinks.
Shoes or boots that provide sufficient width in the toe box ensure minimal compression and rubbing of the big toe (the first metatarsal phalangeal joint), a common location for gout. Wearing inserts and/or orthotics that provide cushioning and proper arch support help reduce stress on the feet.
Gout is typically not a serious condition, but it is important to see your doctor after an episode of gout, even if you are no longer in pain. This is because the uric acid accumulation that caused the gout attack may still be irritating the joints and could eventually cause serious damage. Your doctor can prescribe medications that will prevent and even reverse the uric acid accumulation. (Remember to take all medications as prescribed.)
Description: A heel spur is a growth of bone usually on the bottom or back of the heel bone. It is usually associated with the plantar fascia or Achilles tendon.
Cause: The pulling of plantar fascia and the repetitive stresses on the heel bone causes calcium deposits to build up which leads to a heel spur.
Treatment: Treatments are geared towards reducing the pulling of the plantar fascia by supporting the arch and controlling the mechanics of foot with orthotics. In addition, reducing inflammation around the heel spur and stretching the plantar fascia is important. Physical therapy is helpful with increasing the flexibility of the fascia. Today, there are many advanced treatments for heel spur pain.
Description: Dr. Thomas G. Morton (1835-1902) recognized a condition that causes a growth or enlargement of the nerve when it gets compressed between the metatarsal bones. This condition is not a tumor and is benign, but can lead to pain, tingling, numbness in the toes.
Cause: As result of a nerve being pinched usually between the 3rd and 4th metatarsal heads, inflammation and scarring occurs. The pinching is usually due to abnormal mechanics of the foot which allows the bones to “rub” together.
Treatment: Surgical removal of the neuroma is always an alternative, but a newer, more conservative approach with dehydrated alcohol injections around the nerve has been shown to be as successful as surgery. The injections shrink or shrivel the nerve so it does not cause pain. Orthotics are important in stabilizing the foot so the bones do not compress the nerve.
Description: Plantar fasciitis is inflammation at the site where fascia attach under your heel bone (plantar fasciitis or enthesopathy). It used to be known as policeman’s heel and is the most common cause of discomfort in this area. It frequently affects people with inflammatory arthritis but it can also occur in people without arthritis.
It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis is one of the most common causes of heel pain.
Cause: Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.
Plantar fasciitis is particularly common in runners. In addition, people who are overweight, women who are pregnant and those who wear shoes with inadequate support are at risk of plantar fascia.
Plantar Wart (Verruca)
Toe Nail Fungus (Onychomycosis)
Description: Common symptoms include:
- Thickening of the nail
- Whiteness, yellowing or other discoloration of the nail
- Brittleness, flaking or fragmenting of the nail and separation of the nail from the toe
Cause: The fungi that cause toenail infection—dermatophytes, yeasts, molds– thrive in warm, moist environments, such as swimming pools, showers, locker rooms, bathrooms, and in tight shoes that squeeze the toes together, making them damp and moist. Damp socks and shoes—especially plastic shoes–and warm, humid conditions also promote fungal growth. A fungus can live in footwear and on surfaces of floors, mats, rugs, clothes, and linens for up to six months. It can get under the skin or toenail through tiny cuts or small separations between the toenail and nail bed.
Like athlete’s foot, toenail fungus can be spread by skin-to-skin contact with a person whose toenail is infected, and even between people and household pets. People with diabetes, peripheral arterial disease or other conditions that affect blood flow to the legs and feet are particularly vulnerable to toenail fungal infections, as are people with weakened immune systems. These groups should be especially careful about exposing their feet to conditions likely to produce the problem.
Treatment: To prevent toenail fungal infection:
- Check your feet at least a few times a week (daily, if you have diabetes), looking carefully for any signs of toenail fungus. Also check carefully between your toes to see if there are any signs of athlete’s foot.
- Try to avoid going barefooted, especially in public places.
- Wash your feet well and dry them off carefully–especially between the toes—after bathing.
- IPFH suggests wearing properly selected and fitted, as part of an integrated approach, padded socks that help wick moisture away from the foot, with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot.
Properly designed and fitted shoes or boots have uppers made of mesh or another material that allows moisture to escape. If the shoe upper is made of leather, it should have vents or other openings that help evacuate moisture. Waterproof shoes do not allow moisture to escape and may create a wet environment conducive to the growth of fungus. Well-designed footwear also has few seams or raised areas that can cause pressure points or rub the skin, irritating feet that may already have been affected by toenail fungus.
Toenail fungal infection is also frequently accompanied by athlete’s foot, so take the same precautions to prevent toenail fungus as you would take to prevent athlete’s foot.
Most cases of toenail fungus do not respond well to topical treatments and are best treated with oral medication prescribed by a physician. Some early evidence suggests that laser treatment may be effective. This is an expensive option and more research needs to be done, but it could be an alternative for people who don’t want to risk the potential side effects, such as liver damage, of oral medications.
As noted earlier, people with diabetes and circulatory conditions are at increased risk for toenail fungal infections. In these individuals, an untreated infection can spread to the skin and cause blisters, lesions, open sores, allergic reactions due to the release of proteins into the bloodstream, or cellulitis, a potentially serious bacterial skin infection.
People with diabetes who have toenail fungus should see their doctor. Always talk to your doctor if you have soreness, pain, redness, swelling or other indications of foot problems that persist for more than a few days.
Description: Sesamoids are small nodular bones embedded in a tendon or a joint capsule.
Sesamoiditis is inflammation of the sesamoid bones or surrounding structure.
Cause: Sesamoiditis is usually caused by repetitive, excessive pressure on the forefoot.
It typically develops when first metatarsophalangeal joint is subjected to chronic pressure and tension.
The surrounding tissues respond by becoming irritated and inflamed.
This problem is common among ballet dancers and baseball catchers, or any activity that places constant force on the ball of the foot.
Minor cases require rest and the use of a modified shoe or a shoe pad with a cutout to reduce pressure on the affected area.
A Pedag orthotic with a metatarsal pad can be placed away from the joint to redistribute the pressure of weight bearing to other parts.
The big toe may be bound with tape or athletic strapping to immobilize the joint and allow healing.Oral anti inflammatory drugs can be used to reduce swelling.
Shin Splints—pain on either side of the leg bone caused by muscle or tendon inflammation. Shin splints are related to excessive foot pronation, but also may be related to a muscle imbalance between opposing muscle groups in the leg. Proper stretching before and after exercise and corrective orthotics for pronation can help prevent shin splints.
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