Foot
Bunions (Hallux Valgus)
Bunion is an enlargement of the first
metatarsal bone at the base of the big
toe. The big toe deviates towards the
second toe. The symptoms bunions include
redness, swelling, and pain at the site
of the enlargement. These symptoms occur
when wearing shoes that rub against the
enlargement, irritating the soft tissues
underneath the skin and producing
inflammation. Overtime they can develop
callosities, deformities of lesser toes
and arthritis in the big toe joint.
Bunions need not be treated surgically
unless they are painful and interfering
with daily activities. Recent advances
in surgical techniques have led to a
very high success rate in treating
bunions.
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Hallux Rigidus
(Stiff Big Toe)
Hallux rigidus is a
condition caused by arthritis at the
base of the big toe. It commonly affects
active people as a result of repeated
minor trauma. The stiffness of the toe
is especially noticeable on the upward
bending caused by walking
or running.
This stiffness causes pain. A bump on
the top of the big toe can be noticed.
Surgery should only be undertaken if
your symptoms are significant.
Surgery involves removing excess bony
prominence, fusion of the big toe joint
or a total toe joint replacement.
Tailor's Bunion (Bunionette)
Tailor's
bunion is an enlargement of the fifth
metatarsal bone at the base of the
little toe. The symptoms of tailor's
bunions include redness, swelling, and
pain at the site of the enlargement.
These symptoms occur when wearing shoes
that rub against the enlargement,
irritating the soft tissues underneath
the skin and producing inflammation.
Surgery is often considered when pain
continues despite wearing comfortable
shoes. Surgery is highly successful in
the treatment of tailor's bunions.
Hammertoes
Hammer toe is
bending of one or both joints of the
second, third, fourth, or fifth (little)
toes. This abnormal bending can put
pressure on the toe when wearing shoes,
causing callosities to develop.
Hammertoes usually start out as mild
deformities and get progressively worse
over time. In the earlier stages,
hammertoes are flexible and the symptoms
can often be managed with noninvasive
measures. But if left untreated,
hammertoes can become more rigid and
surgery is needed to correct the
deformity.
Morton's Neuroma
A
Morton’s neuroma is a thickening of
nerve tissue that may develop at the
base of the second, third or fourth
toes. A neuroma is the result of
compression and irritation of the nerve.
You will probably have Pain, Tingling,
burning, or numbness in the foot.
Surgery may be considered in patients
who have not received adequate relief
from other treatments.
Cavus Foot
(High-Arched Foot)
Cavus foot is a
condition in which the foot has a very
high arch. Because of this high arch, an
excessive amount of weight is placed on
the ball and heel of the foot when
standing. Cavus foot can lead to a
variety of signs and symptoms, such as
pain and instability. It can develop at
any age, and can occur in one or both
feet. Cavus foot is often caused by a
neurologic disorder or other medical
condition—for example, cerebral palsy,
Charcot-Marie-Tooth disease, spina
bifida, polio, muscular dystrophy, or
stroke.
If non-surgical treatment
fails to adequately relieve pain and
improve stability, surgery may be needed
to decrease pain, increase stability,
and compensate for weakness in the foot.
Surgery is also considered for cases
that are likely to get worse—even if
there is currently no pain or
instability. In these instances, the
goal of surgery is to help reduce the
severity of future problems.
The
surgeon will choose the best surgical
procedure or combination of procedures
based on the patient's individual case.
In some cases where an underlying
neurologic problem exists, surgery may
be needed again in the future due to the
progression of the disorder.
Flexible
Flatfoot
Flexible flatfoot is one of
the most common types of flatfoot. It
typically begins in childhood or
adolescence and continues into
adulthood. It usually occurs in both
feet and generally progresses in
severity throughout the adult years. As
the deformity worsens, the soft tissues
(tendons and ligaments) of the arch may
stretch or tear and can become inflamed.
If you experience symptoms with flexible
flatfoot, the foot and ankle surgeon may
recommend various treatment options,
including Activity modifications,
Weight loss, Physical therapy, Orthotic
devices, Shoe modifications and Surgery.
Flat Foot (Adult type)
"Adult-acquired flatfoot"
Posterior Tibial Tendon Dysfunction (PTTD)
Posterior tibial tendon dysfunction
(PTTD) is an inflammation and/or
overstretching of the posterior tibial
tendon in the foot. An important
function of the posterior tibial tendon
is to help support the arch. But in
PTTD, the tendon’s ability to perform
that job is impaired, often resulting in
a flattening of the foot. Overuse of the
posterior tibial tendon is frequently
the cause of PTTD. In fact, the symptoms
usually occur after activities that
involve the tendon, such as running,
walking, hiking, or climbing stairs. The
symptoms of PTTD may include pain,
swelling, a flattening of the arch, and
an inward rolling of the ankle.
In
many cases of PTTD, treatment can begin
with non-surgical approaches that may
include Orthotic devices or
Immobilization. Sometimes a short-leg
cast or boot is worn to immobilize the
foot and allow the tendon to heal
In
cases of PTTD that have progressed
substantially or have failed to improve
with non-surgical treatment, surgery may
be required. For some advanced cases,
surgery may be the only option. Surgical
treatment may include repairing the
tendon, realigning the bones of the
foot, or both. Your foot and ankle
surgeon will determine the best approach
for your specific case.
Heel Pain
(Plantar Faciitis)
Plantar fasciitis
is an inflammation of the band of tissue
(the plantar fascia) that extends from
the heel to the toes. People with
plantar fasciitis often describe the
pain as worse when they get up in the
morning or after they've been sitting
for long periods of time.
After a
few minutes of walking the pain
decreases, because walking stretches the
fascia. For some people the pain
subsides but returns after spending long
periods of time on their feet. The
main stay of treatment is exercise
program to stretch the fascia. A soft
insole is used to help the pain. In some
cases, corticosteroid injections are
used to help reduce the inflammation and
relieve pain.
Plantar Fibroma
A
plantar fibroma is a fibrous knot
(nodule) in the arch of the foot. It is
embedded within the plantar fascia, a
band of tissue that extends from the
heel to the toes on the bottom of the
foot. A plantar fibroma can develop in
one or both feet, is benign
(non-malignant). The characteristic sign
of a plantar fibroma is a noticeable
lump in the arch that feels firm to the
touch. This mass can remain the same
size or get larger over time, or
additional fibromas may develop. People
who have a plantar fibroma may or may
not have pain. Non-surgical treatment
may help relieve the pain of a plantar
fibroma, although it will not make the
mass disappear.
Stress
Fractures
Stress fractures are tiny,
hairline breaks that are usually caused
by repetitive stress. Stress fractures
often caused by increase in daily
activity. They may be caused by an
abnormal foot structure, deformities, or
osteoporosis. Stress fractures should
not be ignored, because they will come
back unless properly treated.
Achilles Tendon Rupture
An Achilles
tendon rupture is a complete or partial
tear that occurs when the tendon is
stretched beyond its capacity. Forceful
jumping, or sudden accelerations of
running, can overstretch the tendon and
cause a tear. An injury to the tendon
can also result from falling or
tripping. A person with a ruptured
Achilles tendon may experience sudden
pain (which feels like a kick or a stab)
in the back of the ankle or calf,
difficulty walking (especially upstairs
or uphill) and difficulty rising up on
the toes
The diagnosis of an
Achilles tendon rupture is typically
straightforward and can be made through
this type of examination. In some cases,
however, the surgeon may order an US or
MRI. Surgery offers important potential
benefits. Besides decreasing the
likelihood of re-rupturing the Achilles
tendon, surgery often increases the
patient’s push-off strength and improves
muscle function and movement of the
ankle.
Haglund's Deformity ("pump
bump")
Haglund’s deformity is a bony
enlargement on the back of the heel that
most often leads to painful bursitis,
which is an inflammation of the bursa (a
fluid-filled sac between the tendon and
bone). In Haglund’s deformity, the soft
tissue near the Achilles tendon becomes
irritated when the bony enlargement rubs
against shoes. Non-surgical treatment of
Haglund’s deformity is aimed at reducing
the inflammation of the bursa. If
non-surgical treatment fails to provide
adequate pain relief, surgery may be
needed. The foot and ankle surgeon will
determine the procedure that is best
suited to your case.
Lisfranc
Injuries
The Lisfranc joint is the
point at which the metatarsal bones
(long bones that lead up to the toes)
and the tarsal bones (bones in the arch)
connect. The Lisfranc ligament is a
tough band of tissue that joins two of
these bones. It is important for
maintaining proper alignment and
strength of this joint.
Injuries to
the Lisfranc joint most commonly occur
in automobile accident victims, military
personnel, runners, horseback riders,
football players, and participants of
other contact sports. Lisfranc injuries
occur as a result of direct or indirect
forces to the foot. A direct force often
involves something heavy falling on the
foot. Indirect force commonly involves
twisting the foot. Anyone who has
symptoms of a Lisfranc injury should see
a foot and ankle surgeon right away.
Arthritis and problems with foot
alignment may develop. In most cases,
arthritis develops several months or
longer following a Lisfranc injury,
requiring additional treatment.
Charcot Foot
Charcot foot is a sudden
softening of the bones in the foot that
can occur in people who have significant
nerve damage (neuropathy).
The bones are weakened enough to
fracture, and with continued walking the
foot eventually changes shape. As the
disorder progresses, the arch collapses
and the foot takes on a convex shape,
giving it a rocker-bottom appearance,
making it very difficult to walk.
Charcot foot is a very serious condition
that can lead to severe deformity,
disability and even amputation. Because
of its seriousness, it is important that
patients with diabetes—a disease often
associated with neuropathy—take
preventive measures and seek immediate
care if signs or symptoms appear.
Charcot foot symptoms include warmth to
the touch, redness in the foot, swelling
in the area and pain.
Charcot foot
develops as a result of neuropathy,
which decreases sensation and the
ability to feel temperature, pain or
trauma. When neuropathy is severe, there
is a total lack of feeling in the feet.
Because of neuropathy, the pain of an
injury goes unnoticed and the patient
continues to walk—making the injury
worse.
Early diagnosis of
Charcot foot is extremely important for
successful treatment. To arrive at a
diagnosis, the surgeon will examine the
foot and ankle and ask about events that
may have occurred prior to the symptoms.
X-rays are also essential for
diagnosis.
Following the surgeon’s
treatment plan for Charcot foot is
extremely important. Failure to do so
can lead to the loss of a toe, foot, leg
or life.
Preventive Care
The
patient can play a vital role in
preventing Charcot foot and its
complications by following these
measures:
- Diabetes patients should
keep blood sugar levels under control.
This has been shown to reduce the
progression of nerve damage in the feet.
- Get regular check-ups from a foot
and ankle surgeon.
- Check both feet every day—and
see a surgeon immediately if there are
signs of Charcot foot.
- Be careful to
avoid injury, such as bumping the foot
or overdoing an exercise program.
- Follow the surgeon's instructions for
long-term treatment to prevent
recurrences, ulcers and amputation.
Ingrown Toenail
When a toenail is
ingrown, the nail is curved downward and
grows into the skin, usually at the nail
borders (the sides of the nail). This
“digging in” of the nail irritates the
skin, often creating pain, redness,
swelling, and warmth in the toe. If an
ingrown nail causes a break in the skin,
bacteria may enter and cause an
infection in the area, which is often
marked by drainage and a foul odor. The
most common cause of ingrown toenails is
improper trimming. Cutting your nails
too short encourages the skin next to
the nail to fold over the nail. Another
cause of ingrown toenails is wearing
shoes that are tight or short.
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