Common Foot & Ankle Problems We Treat

A hammer toe is a contracture of one or both of the joints in the lesser toes. Hammertoes usually start out as mild deformities and get progressively worse over time. In the early stages, hammertoes are often flexible and the symptoms can often be managed with non-invasive treatments. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Although hammertoes are readily apparent, to understand why they have developed will require an examination by our podiatrist. The physician will likely take x-rays, perform a range of motion exam and possibly a gait analysis to observe how you walk. Hammertoes are progressive, and the rate they progress will be determined by the cause. Once your physician determines what is causing the deformity, a treatment plan can be developed that is suited to your needs.

An ingrown nail is a nail that curves into the skin. The medical term is onychocryptosis. It may or may not be painful and may or may not cause infection. An ingrown nail that becomes infected or inflamed causes paronychia along the border of the nail. Ingrown toenails that are inflamed or infected are usually very painful. 

Treatment Options:

• Trimming & Soaking
• Wedge Resection
• Antibiotics
• Nail Removal
• Subungual Exostectomy

A Neuroma is an enlarged nerve. A Morton’s Neuroma, the most common type in the foot, causes intense pain in the ball of the foot that shoots out to the third and fourth toes. Numbness, cramping and tingling in the 3rd or 4th toes is also common. The second and third toes can also be affected, but this is much more uncommon.

A neuroma is diagnosed by good questioning and a physical exam of the foot by a podiatrist. Pressing on certain areas of the foot will reproduce the pain. Squeezing the foot together and pushing up under the nerve will, in many cases, yield a positive “Mulder’s Click”. The clicking feeling associated with pain shooting to the toes is diagnostic for a Morton’s neuroma.

What are the most common conditions affecting the pediatric population?

1. Calcaneal Apophystitis

Also known as Sever’s disease, this condition affects children between the ages of 8-14, who are active. Pain is most commonly in the back of the heel, along the growth plate, and is caused by traction and pulling of the Achilles tendon. Inflammation develops along the heel’s growth plate from repetitive stress and activity. Pain can persist until the growth plate fuses.

Treatments can include: rest, ice, stretching, heel lifts, and orthotics

2. Flat Feet

As the term suggests, “flat feet” is the excessive flattening of the arch with standing and walking. Symptoms can include fatigue, night cramps and pain. Untreated, the condition can lead to ankle sprains, bunions, hammertoes, joint pain and arthritis.

Treatment: Good, supportive shoes and prescription orthotics. In more severe cases, or cases unresponsive to orthotics, surgery may be indicated.

3. Ingrown Toenails

Ingrown toenails occur when the side of the nail grows into the skin, leading to pain and possible infection. They can be caused by incorrect nail trimming and tight shoes, but can also be hereditary.

Treatment: permanent or temporary removal of the affected nail border.

4. Warts

Warts are caused by the Human Papilloma virus and are very common in children. The virus grows into the skin and can spread. When the warts appear on the bottom of the foot they can cause significant pain and debilitation. Because the plantar skin is thick, most over-the-counter treatments are not usually effective.

Treatment: a powerful topical medication is the most effective and relatively pain-free. Recalcitrant warts may need to be surgically excised.

Plantar fasciitis is commonly referred to as “heel spur syndrome”. It is inflammation of the plantar fascial band that runs from the bottom of the heel to the ball of the foot. This band acts as the “bowstring” of the foot – helping to maintain the arch.

Many other disorders can cause heel and arch pain – -but plantar fasciitis is the most common heel problem that we treat. A variety of foot injuries, foot structure or improper foot mechanics can lead to plantar fasciitis.

What are the most common foot and ankle injuries?

1. Ankle Sprains

When you “twist your ankle”, you can injure one or more of the ligaments that support the ankle, ranging in severity from a mild sprain to a complete tear.

Treatment involves: rest, ice, bracing, physical therapy to strengthen ankle joint

2. Turf Toe

Turf toe is a sprain of the big toe joint after excessive upward bending of the big toe, caused by jamming or repetitive injury from pushing off. Symptoms: pain, swelling, and limited joint range of motion.

Treatment: rest, ice, compression, and elevation, less-flexible footwear.

3. Shin Splints

Shin splints are the result of inflammation of the periosteum along the tibia. It occurs after running or walking, and results in pain in the shins and is caused by flat feet, calf tightness, overuse, worn out or improper sneakers.

Treatment: rest, ice, non-steroidal anti-inflammatory drugs, stretching exercises, properly fitted shoes, and orthotics. If not treated, shin splints may eventually result in a tibial stress fracture.

A stress fracture occurs when a small crack develops in the cortex of the bone. Over time, if left untreated the crack will expand until the fracture line extends through the whole bone. Most stress fractures occur in the weight-bearing bones of the foot such as the metatarsals, most commonly the 2nd and 3rd metatarsals. Stress fractures can also occur in the heel, the navicular of the fibula.

Diagnosing

Physical exam and x-rays will be obtained. While most stress fractures don’t show up on the bone like a trauma induced fracture will, but there will be slight changes at the periosteum (dense layer of vascular connective tissue that envelopes the bones) of the bone where the stress fracture exists. In addition to traditional x-rays that show bones, our diagnostic ultrasound machine reveals soft tissue disorders, so we are well equipped to diagnose any foot or ankle problem.

Treatments

Rest, use of a custom splint or post op shoe or immobilization via a below the knee pre-fabricated cast such as an AirCast or a fiberglass cast applied by a podiatrist. The site of the stress fracture and degree of pain will determine the treatment. If there is a deficiency in bone density that will need to be addressed as well.

Nail fungus, also known as Onychomycosis, is an embarrassing, usually chronic condition that impacts your quality of life and can lead to serious health problems for those with diabetes or immune disorders. Nail infection can cause permanent deformity of the nail, which can interfere with walking, participating in sports, and being able to wear shoes comfortably – not to mention the embarrassment from the way the nails look. It can also start as a result of a family history of susceptibility, increasing age, poor health, nail trauma, warm or moist climates, exposure to infected nails in sports/fitness and communal bathing areas, and tight shoes. Fungal infections vary in degree and in severe cases can be extremely painful, unsightly and difficult to treat.