John T Carroll, DPM FAQs

A podiatrist, also known as a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of foot and ankle problems. This includes common problems such as bunions, heel pain, spurs, hammertoes, neuromas, ingrown toenails, warts, corns, and calluses. A podiatrist also treats sprains, fractures, infections, and injuries of the foot, ankle, and heel. Podiatrists attend undergraduate medical school training and graduate school for a doctorate degree in podiatry. Podiatrists are required to take state and national exams, as well as be licensed by the state in which they practice.

According to the American Podiatric Medical Association, there are an estimated 15,000 practicing podiatrists in the United States. Podiatrists are in demand because of a rapidly aging population. The association also notes that foot disorders are among the most widespread and neglected health problems affecting people in this country.

Typically, podiatrists:

• Consult with patients and other physicians on how to prevent foot problems.
• Diagnose and treat tumors, ulcers, fractures, skin and nail diseases, and deformities.
• Perform surgeries to correct or remedy such problems as bunions, clawtoes, fractures, hammertoes, infections, ruptured Achilles, and other ligaments and tendons.
• Prescribe therapies and perform diagnostic procedures such as ultrasound and lab tests.
• Prescribe or fit patients with inserts called orthotics that correct walking patterns.
• Treat conditions such as: bone disorders, bunions, corns, calluses, cysts, heel spurs, infections, ingrown nails, and plantar fasciitis.

You'll need to consult with a podiatrist for diagnosis and treatment of foot and ankle problems. Reach out to us if you experience any of the following:

• Persistent pain in your feet or ankles
• Changes in the nails or skin on your foot
• Severe scaling, peeling, or cracking on the heel or foot
• Blisters on your feet

Signs of bacterial infection:

• Increased pain, swelling, redness, tenderness, or heat.
• Red streaks extending from the affected area.
• Discharge or pus from an area on the foot.
• Foot or ankle symptoms that do not improve after two weeks of treatment with a nonprescription product.
• Spreading of an infection from one area of the foot to another, such as under the nail bed, skin under the nail, the nail itself, or the surrounding skin.
• Thickening toenails that cause discomfort.
• Heel pain accompanied by a fever, redness (sometimes warmth), or numbness.
• Tingling in the heel; persistent heel pain without putting any weight or pressure on your heel
• Pain that is not alleviated by ice or over-the-counter painkillers (such as aspirin, ibuprofen or acetaminophen).
• Diabetics with poor circulation who develop Athlete's Foot.

The foot is made up of 26 bones, 33 joints, 107 ligaments, 19 muscles, and numerous tendons. Complex biomechanics keep all these parts in the right position and moving together. Given these intricacies, it is not surprising that most people will experience some problem with their feet at some time in their lives.

Within each foot, the essential structure can be summed up as follows:

• Seven short tarsal bones make up the heel and back of the instep.
• Five metatarsal bones spread from the back of the foot toward front and make up the structure for the ball of the foot. Each metatarsal is associated with one of the toes.
• Fourteen phalanges, small bones, form the toe structure.
• Tarsal and metatarsal bones provide the structure for the arch of the foot.
• Bands of ligaments connect and hold all the bones in place.
• A thick layer of fatty tissue under the sole helps absorb the pressure and shock that comes from walking and everyday movements.

Foot and ankle problems can occur due to:

• Improper footwear, physical stress, or small mechanical changes within the foot.
• Arthritic foot problems, which involve one or more joints.
• Congenital foot problems, which occur at birth and are generally inherited.
• Infectious foot problems caused by fungal, viral, or bacterial problems.
• Tumors, also known as neoplastic disorders, which are the result of abnormal growth of tissue anywhere on the foot and may be benign or malignant.
• Traumatic foot problems, which are associated with foot and ankle injuries, such as fractures.

Some of the most common foot problems are:

• Bunions—misaligned big toe joints that swell and become tender, causing the first joint of the big toe to slant outward and the second joint to angle toward the other toes. Bunions are usually hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. It can be corrected through surgery
• Hammertoes—usually stemming from muscle imbalance, this condition occurs when the toe is bent into a claw-like position. Hammertoe can affect any toe, but most frequently occurs to the second toe, when a bunion slants the big toe toward and under it. Selecting shoes and socks that do not cramp the toes may help reduce pain or discomfort.
• Heel Spurs—growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel later calcifies to form a spur. Proper warm-up exercises and the use of appropriate athletic shoes can reduce the strain to the ligament and prevent the formation of heel spurs.
• Ingrown Toenails—toenails with corners or sides that dig painfully into the skin. Ingrown toenails occur due to improper nail trimming, but can also result from poor foot structure, shoe pressure, fungus infection, heredity, and injury. Women are more likely to have ingrown toenails than men. To prevent the problem from occurring, trim toenails straight across, select proper shoe styles and sizes, and respond to foot pain as quickly as possible.
• Neuromas—enlarged benign growths of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Depending on the severity, treatments may include orthotics (shoe inserts), cortisone injections, and, in extreme cases, surgical removal of the growth.
• Plantar Fasciitis—an inflammation on the bottom of the foot that leads to heel and arch pain. A variety of foot injuries or improper foot mechanics can lead to plantar fasciitis. Treatments range from icing and foot exercises to the prescription of custom orthotics to correct the foot position and help alleviate pain.
• Sesamoiditis—an inflammation or rupture of the two small bones (known as sesamoids) under the first metatarsal bone. Proper shoe selection and orthotics can help.
• 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.
• Stress Fractures—incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization.

1. Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.

2. Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete's Foot. Any growth on the foot is not considered normal.

3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.

4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.

5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.

6. Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).

7. Alternate shoes, don't wear the same pair of shoes every day.

8. Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.

9. Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.

10. If you are a diabetic, please contact our office and schedule a check-up at least once a year.

Foot and ankle problems can occur due to:

• Improper footwear, physical stress, or small mechanical changes within the foot.
• Arthritic foot problems, which involve one or more joints.
• Congenital foot problems, which occur at birth and are generally inherited.
• Infectious foot problems caused by fungal, viral, or bacterial problems.
• Tumors, also known as neoplastic disorders, which are the result of abnormal growth of tissue anywhere on the foot and may be benign or malignant.
• Traumatic foot problems, which are associated with foot and ankle injuries, such as fractures.

Some of the most common foot problems are:

• Bunions—misaligned big toe joints that swell and become tender, causing the first joint of the big toe to slant outward and the second joint to angle toward the other toes. Bunions are usually hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. It can be corrected through surgery
• Hammertoes—usually stemming from muscle imbalance, this condition occurs when the toe is bent into a claw-like position. Hammertoe can affect any toe, but most frequently occurs to the second toe, when a bunion slants the big toe toward and under it. Selecting shoes and socks that do not cramp the toes may help reduce pain or discomfort.
• Heel Spurs—growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel later calcifies to form a spur. Proper warm-up exercises and the use of appropriate athletic shoes can reduce the strain to the ligament and prevent the formation of heel spurs.
• Ingrown Toenails—toenails with corners or sides that dig painfully into the skin. Ingrown toenails occur due to improper nail trimming, but can also result from poor foot structure, shoe pressure, fungus infection, heredity, and injury. Women are more likely to have ingrown toenails than men. To prevent the problem from occurring, trim toenails straight across, select proper shoe styles and sizes, and respond to foot pain as quickly as possible.
• Neuromas—enlarged benign growths of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Depending on the severity, treatments may include orthoses (shoe inserts), cortisone injections, and, in extreme cases, surgical removal of the growth.
• Plantar Fasciitis—an inflammation on the bottom of the foot that leads to heel and arch pain. A variety of foot injuries or improper foot mechanics can lead to plantar fasciitis. Treatments range from icing and foot exercises to the prescription of custom orthoses to correct the foot position and help alleviate pain.
• Sesamoiditis—an inflammation or rupture of the two small bones (known as sesamoids) under the first metatarsal bone. Proper shoe selection and orthoses can help.
• 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 orthoses for pronation can help prevent shin splints.
• Stress Fractures—incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization.

The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It is also the most frequently ruptured tendon, usually as a result of a sports injury. Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Activities That Can Cause Achilles Tendonitis

• Running up a hill or climbing stairs.
• Overuse, stemming from the natural lack of flexibility in the calf muscles.
• Rapidly increasing mileage or speed when walking, jogging, or running.
• Starting up too quickly after a layoff in exercise or sports activity, without adequately stretching and warming up the foot.
• Trauma caused by sudden or hard contraction of the calf muscles when putting out extra effort, such as in a sprint.
• Improper footwear and a tendency toward overpronation.

Achilles tendonitis often begins with mild pain after exercise or running that gradually worsens.

Other Symptoms Associated With Achilles Tendonitis:

• Recurring localized pain, both mild and severe, along the tendon during or a few hours after running.
• Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone.
• Sluggishness in your leg.
• Mild or severe swelling.
• Stiffness that generally diminishes as the tendon warms up with use.

Treatment:

• A bandage specifically designed to restrict motion of the tendon.
• Taking nonsteroidal, anti-inflammatory medication for a period of time. (Note: Always consult your physician before taking any medication)
• Corrective shoe inserts, also called orthotics, designed to help support the muscle and relieve stress on the tendon. Both nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescribed custom orthotics may be recommended depending on the length and severity of the problem.
• Rest and switching to exercises that do not stress the tendon (such as swimming).
• Strengthen the weak muscle group in front of the leg, calf, and the upward foot flexors with stretching, exercises, massage, and ultrasound.

In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.

Peroneal tendons are two tendons that support two important foot muscles (peroneus brevis and peroneus longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of the foot while standing.

Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.

Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains have also caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.

Xanthomas are cholesterol deposits that appear in the Achilles tendon. High cholesterol levels can cause the formation of these cholesterol deposits, which appear as small lumps. Aside from treating the underlying cholesterol problem, treatment for xanthomas may require taking a biopsy of the lesion but leaving the nodules intact.

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems.

Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising.

Treatment includes resting and elevating the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments.

To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercising, stretching, and wearing well-fitted shoes.

Chronic lateral ankle pain is recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.

Signs and Symptoms Include:

• Ankle instability
• Difficulty walking on uneven ground or in high heels.
• Pain, sometimes intense, on the outer side of the ankle
• Repeated ankle sprains
• Stiffness
• Swelling
• Tenderness

Although ankle sprains are the most common cause of chronic lateral ankle pain, other causes may include:

• A fracture in one of the bones that make up the ankle joint
• Arthritis of the ankle joint
• Inflammation of the joint lining
• Injury to the nerves that pass through the ankle. In this case, the nerves become stretched, torn, injured by a direct blow, or pinched under pressure.
• Scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, putting pressure on the ligaments
• Torn or inflamed tendon
• Treatments for Chronic Lateral Ankle Pain Include:
• Over the counter or prescription anti-inflammatory medications to reduce swelling. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.
• Physical therapy, including tilt-board exercises that focus on strengthening the muscles, restoring range of motion, and increasing your perception of joint position.
• Ankle braces or other supports.
• Steroid medication.
• Immobilization to allow the bone to heal (in cases of fractures).

Osteochondritis is a lesion that usually causes pain and stiffness of the ankle joint and affects all age groups. Osteochondritis is caused by a twisting-type injury to the ankle. Symptoms include swelling and ankle pain.

Immobilization of the foot and ankle for a period of time usually resolves the problem. In more severe cases, however, surgery may be prescribed. During the surgery, loose fragments of cartilage and bone are removed from the ankle joint and, in some cases, small drill holes are made in the defect to stimulate new blood vessels and help form scar tissue that will fill the defect.

Capsulitis is an inflammation of the ligament on the bottom of the foot. It is usually caused by trauma or abnormal structural functioning, which overstretches the ligament that attaches one of the toe bones to a metatarsal bone. Wearing high heels or other poorly fitting footwear and performing repetitive activities that bend the toes, such as ladder climbing, are also known causes.

Pain in the forefront of the foot is the most common symptom of capsulitis. Capsulitis is often misdiagnosed as Morton's neuroma because of similar symptoms.

Noninvasive treatments are used to resolve capsulitis, including:

• Wearing low-heeled shoes with firm soles that fit properly
• Decreasing or temporarily discontinuing the activity responsible for the onset of the inflammation
• A short course of oral anti-inflammatory medication. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS
• Cortisone injections

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and ORTHOTICS are common treatments for painful progressive flatfoot. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation. 

Sesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe—one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.

Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.

Symptoms Include:

• Pain under the big toe or on the ball of the foot.
• Swelling and bruising.
• Difficulty and pain in bending and straightening the big toe.

Surgery is usually not required to treat sesamoiditis. Treatments generally include:

• Discontinuation of the activity causing the pain and inflammation.
• Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.
• Icing the sole of the foot.
• Wearing shoes that are soft-soled and low-heeled.
• Using cushioning in shoes to relieve stress.
• Injection of a steroidal medication to reduce swelling.

If symptoms persist, you may need to wear a removable brace on the leg for 4-6 weeks to give the inflammation time to subside and the bones to heal.

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems.

Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising.

Treatment includes resting and elevating the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments.

To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercise and stretching, and wearing well-fitted shoes.

According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.

The ankle has two joints, one on top of the other, and three bones. A broken ankle can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.

There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.

Symptoms of a Broken Ankle Include:

• Bruising
• Swelling
• Immediate and severe pain
• Inability to put any weight on the injured foot
• Tenderness to the touch
• Deformity, particularly if there is a dislocation or a fracture

The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.

Nearly one-fourth of all the bones in your body are in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful, but rarely disabling. Most of the time, these injuries heal without operative treatment.

There are two types of foot fractures: stress fractures and general bone fractures. Stress fractures usually occur in the bones of the forefoot extending from the toes to the middle of the foot. Stress fractures are like tiny cracks in the bone surface. They can happen with sudden increases in exercise (such as running or walking for longer distances or times), improper training techniques, or a change in surfaces.

Most other types of fractures extend through the bone, and are called bone fractures. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. Bone fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. If the fracture does break through the skin, it is called an open fracture.

Because of the complex structures in the foot, there are some other, more specific types of fractures that can occur. For example, the fifth metatarsal, known as the little or pinky toe, is susceptible to a variety of different fractures. The relationship between the ankle and the foot can be compromised by an ankle-twisting injury, which may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is known as a Jones fracture, which occurs near the base of the bone and disrupts its blood supply. This injury may take longer to heal or require surgery.

Common symptoms for any type of foot fracture includes pain, swelling, and sometimes bruising. Be sure to seek medical attention for any suspected foot fracture.

Osteochondritis are lesions that usually cause pain and stiffness of the ankle joint and affect all age groups. Osteochondritis is caused by a twisting-type injury to the ankle. Symptoms include swelling and ankle pain.

Immobilization of the foot and ankle for a period of time usually resolves the problem. In more severe cases, however, surgery may be prescribed. During the surgery, loose fragments of cartilage and bone are removed from the ankle joint and, in some cases, small drill holes are made in the defect to stimulate new blood vessels and to help form scar tissue that will fill the defect.

Osteochondromas are benign bone tumors that form in the bone beneath the toenail. Osteochrondromas account for about half of all benign bone tumors, and occur mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not painful.

In some cases, osteochondromas may cause a deformity in the toenail or lead to an ingrown toenail. When problematic, osteochondromas may be removed surgically. However, they can recur after the procedure.

Shin splints refer to pain on either side of the leg bone that is caused by muscle or tendon inflammation. The problem is usually related to a collapsing arch, but may be caused by a muscle imbalance between opposing muscle groups in the leg.

Proper stretching before and after exercise and sports, corrective shoes, or orthotics (corrective shoe inserts) can help prevent shin splints.

Many sports are hard on the feet because of quick repetitive movements, constricting footwear, and/or increased exposure to injury or trauma. Following is a brief overview of some of the most common injuries that result from particular sports.

Martial Arts and Kick Boxing

Injuries commonly seen as a result of martial arts and kick boxing include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended to help prevent injury: specifically, a minimum of 15 minutes of stretching before performing any kicking or punching.

Aerobics

Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot. That is why proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability.

Team Sports

Activities such as football, baseball, basketball, soccer, field hockey, and lacrosse often lead to ankle injuries as a result of play on artificial surfaces, improper footwear, and/or inadequate stretching.

Amniotic Band Syndrome (ABS) is an uncommon congenital abnormality that causes entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero. It can result in disfigured feet. ABS affects about one in every 1,200 births and is believed to be the cause of 178 in 10,000 miscarriages. Some researchers believe that ABS is caused by early amniotic rupture, which leads to the formation of fibrous strands that entangle limbs and appendages. Treatment may include surgical excision of the fibrous band and any necrotic tissue.

Please contact our office to discuss your specific diagnosis and treatment options.

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe.

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain.

Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries.

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

• Protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems.
• Removal of corns and calluses on the foot.
• Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth.
• Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing.
• Exercises to maintain joint mobility and prevent stiffness or arthritis.
• Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

Claw toe is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken muscles in the foot. The term stems from the toes' appearance toes that look like claws digging down into the soles. Claw toe may lead to the formation of painful calluses. Claw toe worsens without treatment and may become a permanent deformity over time.

Common Symptoms of Claw Toe Include:

• Toes bent upward from the joints at the ball of the foot.
• Toes bent downward at the middle joints toward the sole of the foot.
• Corns on the top of the toe or under the ball of the foot.

Claw toe deformities are easier to repair when detected early. Splints or tape is used to hold the toes in correct position.

Clubfoot is one of the most common, non-life threatening, major birth defects among infants globally. Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet clubbed. The exact cause is unknown. Two out of three clubfoot babies are boys. Clubfoot is twice as likely to occur if one or both parents and/or a sibling has had it. Less severe infant foot problems are often incorrectly called clubfoot.

Clubfoot twists the heel and toes inward. It often appears like the top of the foot is on the bottom. Additionally, the clubfoot, calf, and leg are smaller and shorter than normal. When clubfoot is detected at birth, it is not painful and is correctable.

The goal of treating clubfoot is to make the infant's clubfoot (or feet) functional, painless, and stable by the time he or she is ready to walk. Serial casting is the process used to slowly move the bones of a clubfoot into the proper alignment. The doctor starts by gently stretching the child's clubfoot toward the correct position. A cast is put on to hold the foot in place. One week later, the cast is removed, the baby's foot is stretched a little farther toward the correct position, and a new cast is applied. X-rays are used throughout the process to check on progress toward proper foot alignment. Casting generally repeats for 6-12 weeks, and may take up to 4 months.

About half the time, clubfoot straightens with casting. Once the proper foot alignment is achieved, the child is fitted with special shoes or braces to keep the foot straight once corrected. These maintenance devices are used until the child has been walking for up to a year or more. Muscles for children with clubfoot commonly try to return to the clubfoot position; a regular occurrence among 2 and 3 year olds, but a condition that may continue up to age 7.

In some cases, stretching, casting, and bracing is not enough to correct clubfoot. Surgery may be required to adjust the tendons, ligaments, and joints in the foot and ankle.

Dysplasia, also known as epiphysealis hemimelica, is a disorder that affects the bone joints. It is characterized by overgrowth of the cartilage on the end of one or more of the long bones (carpal or tarsal bones) in the hand or foot. Usually only one limb is involved. Dysplasia may cause limbs that are unequal in length. Less often, the cartilage on other bones, such as those in the ankle, knee, or hip joint, can be impacted.

Enchondromas are small benign tumors made up of cartilage that form in the bone beneath the toenail. Enchondromas are the most common bone tumors of the hands and feet and usually are painless. The tumor can involve large portions of the bones, causing thinning of the cortex. This can weaken the bone and cause it to break spontaneously. When enchondromas occur in the small bone in the end of the toe, they can cause pain that may mimic the pain of ingrown toenails.

Ollier's Disease, also known as enchondromatosis, frequently occurs in the small bones in the hands and toes (phalanges) and the long bones behind the phalanges, called metatarsals. This condition is characterized by multiple enchondromas.

Maffucci's Syndrome is a very rare form of enchondromatosis that combines multiple enchondromas in bones anywhere in the body with benign soft tissue tumors (known as hemangiomas), which are associated with blood vessels. This condition tends to appear in the hands and feet, and has a greater tendency toward malignant transformation than Ollier's Disease.

Because they are painless, most enchondromas are discovered when X-rays are taken for another reason. CT scans and MRI can also help in diagnosing enchondromas.

The majority of enchondromas require no treatment. Only in cases where the tumors are aggressive and begin destroying bone tissue do they require further attention, often surgical removal.

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed, and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

Gordon Syndrome is an extremely rare disorder that belongs to a group of genetic disorders known as the distal arthrogryposes. These disorders typically involve stiffness and impaired mobility of certain joints of the lower arms and legs (distal extremities) including the knees, elbows, wrists, and/or ankles.

Joints affected by this disorder tend to be permanently fixed in a bent or flexed position. In the foot, Gordon Syndrome is characterized by the abnormal bending inward of the foot. The range and severity of symptoms may vary from case to case. Gordon Syndrome is believed to be an inherited condition.

Haglund's Deformity (also known as pump bump or retrocalcaneal bursitis) is a painful enlargement on the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of irritation from rigid heel counters in shoes (the piece of leather forming the back of a shoe) that rub up and down on the back of the heel bone.

Changing shoes, soaking feet, and anti-inflammatory medications often mitigate the symptoms of this problem. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Hallux Limitus is a condition that results in stiffness of the big toe joint. It is normally caused by an abnormal alignment of the long bone behind the big toe joint, called the first metatarsal bone. Left untreated, Hallux Limitus can cause other joint problems, calluses, and/or diabetic foot ulcers. Painful bone spurs also can develop on the top of the big toe joint.

Anti-inflammatory medications, cortisone injections, and/or functional ORTHOTICS are some of the common treatments for stiff big toe. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. Surgery may be required if spurring around the joint becomes severe.

An unmovable big toe, known as Hallux Rigidus, is the most common form of arthritis in the foot.

Hallux Rigidus occurs as a result of wear-and-tear injuries, which wear down the articular cartilage, causing raw bone ends to rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The resulting stiff big toe can make walking painful and difficult.

Symptoms Include:

• A bump, like a bunion or callus, that develops on the top of the foot.
• Pain in the joint when active, especially as you push-off on the toes when you walk.
• Stiffness in the big toe and an inability to bend it up or down.
• Swelling around the joint.

Pain relievers and anti-inflammatory medications are often prescribed to reduce swelling and ease the pain. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. Applying ice packs or soaking the foot in contrast baths (alternating cold and hot water) may also help reduce inflammation and control symptoms for a short period of time.

A stiff-soled shoe with a rocker or roller bottom design and possibly a steel shank or metal brace in the sole can help alleviate the symptoms. These types of shoes add greater support when walking and reduce the amount of bend in the big toe.

When damage is more severe, a surgical procedure may be performed to remove the bone spurs, as well as a portion of the foot bone, and allow the toe more room to bend.

Hallux Varus is a condition in which the big toe points away from the second toe. It is a possible complication from bunion surgery. The condition has been linked to a number of other causes, including congenital deformity, tight or short abductor hallucis tendons, trauma, injury, or an absence or surgical removal of a fibular sesamoid.

Treatment may focus on stretching the abductor hallucis tendon through specific exercises or toe splints. In severe cases, surgery may be recommended. During the surgery, a small incision is made on the side of the toe and the toe is splinted in a neutral or straight position.

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes of hammertoe include improperly fitting shoes and muscle imbalance.

Treatment for the condition typically involves wearing shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions, or nonmedicated corn pads may also relieve symptoms.

In severe cases, hammertoe surgery may be recommended to correct the deformity.

Jackson-Weiss Syndrome (JWS) is a rare genetic disorder characterized by foot abnormalities. Symptoms include abnormally broad big toes, webbing of the skin between the second and third toes, an inward angling of the toes, and/or malformation or fusion of certain bones within the feet. Jackson-Weiss Syndrome is inherited and affects both sexes equally.

Mallet toes are deformities caused by bone and muscle imbalances that become exaggerated in people with active lifestyles. Arthritis can also lead to mallet toes. Mallet toes can cause extreme discomfort and may be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time.

Treatment is designed to relieve pressure, reduce friction, and transfer forces from the sensitive areas. Shoes with a high and broad toe box (toe area) are recommended to prevent future irritation for people suffering from mallet toes. Other conservative treatments include forefoot supports, such as gel toe caps, gel toe shields, and toe crests. Gel forefoot supports provide immediate comfort and relief from common forefoot disorders without drying the skin.

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation.

Osteomyelitis is a type of bacterial bone infection that moves from acute to chronic phases quickly. The infection usually begins in another part of the body and spreads to the bone via blood. Traumatic injury, frequent medication injections, the use of a prosthetic device, and some surgical procedures can increase susceptibility to the underlying infection.

With osteomyelitis, the infected bone fills with a pus that deprives the bone of its needed blood supply. Over time, this can result in the death of bone tissue.

The presence of bone infection can be diagnosed with tests, such as bone scans and MRI.

Osteomyelitis infections are very difficult to cure with oral or intravenous antibiotics. In chronic cases, surgical removal of the dead bone tissue is usually required.

Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most commonly affected. Overlapping toes may develop in the unborn fetus. Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs. Sometimes they can be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straightened position. The pin, which exits the tip of the toe, may be left in place for up to three weeks. 

Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes). The cause of underlapping toes is unknown. It is speculated that they may be caused by an imbalance in muscle strength of the small muscles of the foot. If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe.

Peroneal tendons support two important foot muscles (Peroneus Brevis and Peroneus Longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of your foot while standing.

Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.

Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains also have caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.

The posterior tibial tendon starts in the calf, stretches down behind the inside of the ankle, and attaches to bones in the middle of the foot. This tendon helps hold the arch up and provides support when stepping off on your toes when walking. If it becomes inflamed, over-stretched or torn, it can cause pain from the inner ankle. Over time, it can lead to losses in the inner arch on the bottom of your foot and result in adult-acquired flatfoot.

Signs and symptoms of posterior tibial tendon dysfunction include:

• Gradually developing pain on the outer side of the ankle or foot.
• Loss of the arch and the development of a flatfoot.
• Pain and swelling on the inside of the ankle.
• Tenderness over the midfoot, especially when under stress during activity.
• Weakness and an inability to stand on the toes.

People who are diabetic, overweight, or hypertensive are particularly at risk. X-rays, ultrasound, or MRI may be used to diagnose this condition.

Left untreated, posterior tibial tendon dysfunction may lead to flatfoot and arthritis in the hindfoot. Pain can increase and spread to the outer side of the ankle.

Treatment includes rest, over-the-counter nonsteroidal anti-inflammatory drugs, and immobilization of the foot for six to eight weeks with a rigid below-knee cast or boot to prevent overuse. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Sesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe—one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.

Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.

Symptoms Include:

• Pain under the big toe or on the ball of the foot.
• Swelling and bruising.
• Difficulty and pain in bending and straightening the big toe.
• Surgery is usually not required to treat sesamoiditis. Treatments generally include:
• Discontinuation of the activity causing the pain and inflammation.
• Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.
• Icing the sole of the foot.
• Wearing shoes that are soft-soled and low-heeled.
• Using cushioning in shoes to relieve stress.
• Injection of a steroidal medication to reduce swelling.

If symptoms persist, you may need to wear a removable brace on the leg for 4 - 6 weeks to give the inflammation time to subside and the bones to heal.

Bone spurs are a very common foot problem. In the feet, they develop most frequently in the heel, near the toes, and on top of the big toe joint. The spurs are small outgrowths of bone. In and of themselves, they are generally harmless. However, their location may cause friction or irritation from shoes or other foot structures, which can lead to other foot problems.

Heel spurs refer specifically to bone spurs in the heel. Heel spurs are growths of bone on the underside, forepart of the heel bone and occur when the plantar fibrous band pulls at its attachment to the heel bone. This area of the heel later calcifies to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.

Anti-inflammatory medications, cortisone injections, corrective shoes, and/or orthotics (special shoe inserts) are some of the common treatments for spurs. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATION. Surgery may be prescribed if spurring around the joint becomes severe or leads to recurrent pain from persistent corns.

Tarsal coalition is a bone condition that causes decreased motion or absence of motion in one or more of the joints in the foot. The bones found at the top of the arch, the heel, and the ankle are referred to as the tarsal bones. A tarsal coalition is an abnormal connection between two of the tarsal bones in the back of the foot or the arch. This abnormal connection between two bones is most commonly an inherited trait.

The lack of motion or absence of motion experienced in a tarsal coalition is caused by abnormal bone, cartilage, or fibrous tissue growth across a joint. When excess bone has grown across a joint, it may result in restricted or a complete lack of motion in that joint. Cartilage or fibrous tissue growth can restrict motion of the affected joint to varying degrees, causing pain in the affected joint and/or in surrounding joints.

Symptoms usually include an aching sensation deep in the foot near the ankle or arch, accompanied by muscle spasms on the outside of the affected leg. Nonsurgical treatments, such as corrective shoes or custom orthotics, physical therapy, and anti-inflammatory medication, are the first courses of action. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. Surgery is sometimes performed in severe cases to allow for more normal motion between the bones or to fuse the affected joint or surrounding joints.

Diabetes is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease your body's ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur.

With damage to your nervous system, you may not be able to feel your feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes sores to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen.

Diabetic Complications and Your Feet

When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections in the legs and feet. First of all, poorly fitting shoes are one of the biggest culprits of diabetic foot complications. If you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately. Additionally, if you have common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or orthotics from your podiatrist may be necessary to further protect your feet from other damage.

People who have long-standing or poorly controlled diabetes are also at risk for having damage to the nerves in their feet, which is known in the medical community as peripheral neuropathy. If you have nerve damage, you may not be able to feel your feet normally and you may also be unable to sense the position of your feet and toes while walking and balancing, which can cause even more harm to your feet.

Normal nerves allow people to sense if their shoes are too tight or if their shoes are rubbing on the feet too much. With diabetes, you may not be able to properly sense minor injuries, such as cuts, scrapes and blisters-all signs of abnormal wear, tear, and foot strain. The following can also compromise the health of your feet:

• Poor circulation
• Trauma to the foot
• Infections
• Smoking

Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot, or leg by following proper prevention techniques offered by your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.

There are many kinds of cancers of the foot. Some take the form of cysts and lesions, while others are more widespread.

Malignant melanoma is a skin cancer that is curable if caught early. Although it makes up only one percent of skin cancers, malignant melanoma accounts for over 60 percent of skin cancer deaths. It is estimated that approximately 30 percent of melanomas occur in the lower extremities, and that 3 percent occur in the feet.

Neoplastic disorders, usually called tumors, are the result of abnormal growth of tissue. Both benign or malignant tumors occur in the foot.

Osteochondromas are benign bone tumors under the toenail. Osteochrondromas account for about half of all benign bone tumors in the foot, occurring mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not very painful. Sometimes, they can deform the toenail and cause an ingrown toenail. In rare cases, they are removed surgically.

A plantar fibroma is a benign tissue tumor or growth on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. There are a number of nonsurgical measures for treating plantar fibromas, such as orthotics. When these conservative measures fail to provide adequate relief of symptoms, surgical removal is a reasonable option.

Giant cell tumors are benign tumors of the tendon sheath. These masses are generally found on the toes, top of the foot, or sides of the foot. They can also occur deep inside the foot. They are firm irregular masses that are typically painful.

Charcot Foot is a form of arthritis that often develops suddenly and without pain. Without any warning, the bones in the foot and/or ankle spontaneously fracture and fragment, often causing a severe deformity. The arch of the foot often collapses, and pressure areas develop on the bottom of the foot, leading to open sores or ulcers.

The average age of patients developing a Charcot Foot is 40 years. About one-third of patients develop a Charcot Foot in both feet and/or ankles.

Although nonsurgical treatments, such as elevation, icing, casts, and braces, can help alleviate pain and resolve open sores or ulcers, many of these deformities may require surgery to correct the fracture or remove bone fragments. This usually occurs in cases characterized by:

• Chronic deformity with increased plantar pressures and risk of ulcers.
• Chronic deformity with significant instability that cannot be corrected by braces.
• Significant deformity that may include ulcers that do not heal or respond to therapy.

Freiberg's Disease usually begins as a pain in the ball of a child's foot. Its onset is often linked to an injury to the growth plate of one of the long bones behind the toes, called metatarsals. The loss of blood flow to the growth plate causes pain. Freiberg's Disease is most frequently seen in adolescents between the ages of 13 and 15. It is three times as likely to occur in females than in males.

Treatment for Frieberg's Disease consists of reducing pressure under the affected bone. This may require the use of crutches and/or prescription of a custom orthotic.

Gout (also known as gouty arthritis) is a condition caused by a buildup of the salts of uric acid (a normal byproduct of the diet) in the joints. A single big toe joint is the most commonly affected area, possibly because it is subject to so much pressure in walking. Attacks of gouty arthritis are extremely painful. Men are more likely to be afflicted than women. Diets heavy in red meat, rich sauces, shellfish, and brandy have been linked to gout. However, other protein compounds in foods, such as lentils and beans, may play a role.

The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. The pain lasts for around three or four hours and then subsides. However, pain in the same toe usually returns within a few months.

Gout can be controlled by with prescription medications and diet. NOTE: PLEASE CONSULT WITH YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. The application of ice or cooling lotions helps alleviate pain and swelling during an acute phase. In some cases, specially-made shoes are prescribed to relieve the pain associated with gout.

Kaposi's Sarcoma is a cancerous lesion that can occur on the soles of the feet. The disease is usually associated with HIV infection and/or AIDS. The lesion is irregular in shape and has a purplish, reddish, or bluish-black appearance. Kaposi's Sarcoma lesions tend to spread and form large plaques or become nodular. The nodular lesions have a firm, rubbery appearance.

Kohler's Disease is a spontaneous loss of blood supply to a particular bone in the foot.

Treatments may include cast immobilization, reduced activities and foot orthotics or inserts.

Maffucci's Syndrome is a very rare form of enchondromatosis that combines multiple enchondromas in bones anywhere in the body with benign soft tissue tumors (known as hemangiomas), which are associated with blood vessels. This condition tends to appear in the hands and feet, and has a greater tendency toward malignant transformation than Ollier's Disease.

Some form of injury or trauma to the toe results in the formation of this bony irregularity or prominence.

Maffucci's Syndrome only requires treatment in cases where the tumors are aggressive and begin destroying bone tissue. In these cases, surgical removal is recommended.

Ollier's Disease, also known as enchondromatosis, frequently occurs in the small bones in the hands and toes (phalanges) and the long bones behind the phalanges, called metatarsals. This condition is characterized by multiple enchondromas. Some form of injury or trauma to the toe results in the formation of the bony irregularity or prominence.

As with the majority of enchondromas, Ollier's Disease generally requires no treatment. Only in cases where the tumors are aggressive and begin destroying bone tissue do they require further attention, often surgical removal.

Raynaud's Disease is a disorder that affects the hands and feet. It is caused by contraction of the smooth muscles controlling the small arteries supplying circulation into the hands and feet. This contraction, called a vasospasm, makes the arteries so small that they restrict blood flow. Exposure to cold temperature can often bring on a vasospasm.

Raynaud's Disease has no known cause and is most common in young women. Staying warm and exercising regularly to maintain healthy blood circulation throughout the body can help offset the disease.

Pain in the heel of a child's foot, typically brought on by some form of injury or trauma, is sometimes Sever's Disease. The disease often mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel.

A tight Achilles tendon may contribute to Sever's Disease by pulling excessively on the growth plate of the heel bone. This condition is most common in younger children and is frequently seen in the active soccer, football or baseball player.

Sport shoes with cleats are also known to aggravate the condition.

Treatment includes calf muscle stretching exercises, heel cushions in the shoes, and/or anti-inflammatory medications. Consult your physician before taking any medications.

Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or trauma. This condition is most common in children ages 10 to 15 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone (calcaneus).

Treatment includes cutting back on sports activities, calf muscle stretching exercises, heel cushions in the shoes, icing, and/or anti-inflammatory medications. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Athlete's Foot and fungal nails are the most common fungal problems with feet. A fungus is a common mold that thrives in dark, warm moist areas. On the feet, it can grow on and between toes, as well as on soles and toenails. Fungal problems can be a result of the environment (socks, shoes, heat, and humidity) or weakened immunity from disorders such as diabetes.

Chronic fungal infections are most common in adults, while acute fungal infections are seen more often in children.

Athlete's Foot, also known as tinea pedis, is a skin disease caused by a fungus that usually occurs between the toes. The fungus attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth. Warm, damp areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi.

Symptoms of Athlete's Foot include drying skin, itching, scaling, inflammation, and blisters on and between the toes. Athlete's Foot can spread to the soles of the feet and to the toenails as well as other parts of the body, which is why timely treatment is so important.

You Can Prevent Athlete's Foot By:

• Not walking barefoot, particularly in public pools and locker rooms.
• Reducing foot perspiration by using talcum powder.
• Wearing light and airy shoes.
• Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.

While fungicidal and fungistatic chemicals are usually used to treat Athlete's Foot problems, they often fail to contact the fungi in the lower layers of the skin. For persistent Athlete's Foot, a prescription topical or oral antifungal drug may be needed. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Fungal nails refer to any number of fungal nail infections that can occur on the foot. Since fungal nails are usually more resistant and more difficult to treat than Athlete's Foot, topical or oral antifungal medications may be prescribed. NOTE: PLEASE CONSULT A PHYSICIAN BEFORE TAKING ANY MEDICATIONS. Permanent nail removal is another possible form of treatment for tenacious fungal nails.

Preventing Fungal Nail Infections

After a fungal nail infection has cleared up, take steps to prevent the infection from recurring. Keeping fungi at bay will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a nonprescription antifungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.

Other Suggestions for Preventing Fungal Nails Include:

• Don't share nail clippers or nail files with others.
• Don't share shoes or socks with others.
• Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).
• Wear dry cotton socks and change them two or three times a day if necessary.
• Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
• Wear shower sandals or shower shoes when you are at a public pool or shower.

Prevention

Follow basic foot care guidelines and, more than likely, you can head off most common foot fungus problems.

Haglund's Deformity (also known as pump bump or retrocalcaneal bursitis) is a painful enlargement on the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of irritation from rigid heel counters in shoes that rub up and down on the back of the heel bone.

Changing shoes, soaking feet, and anti-inflammatory medications often mitigate the symptoms of this problem. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Heel calluses, also called plantar calluses, develop when one metatarsal bone is longer or lower than the others and it hits the ground with more force than it is equipped to handle. As a result, the skin under this bone thickens. The resulting callus causes irritation and pain.

In most cases, heel calluses can be treated without surgery. In severe cases, however, a surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone. The procedure involves cutting the metatarsal bone in a "V" shape, lifting the bone and aligning it with the other bones. This alleviates the pressure and prevents formation of a heel callus.

Heel fissures is the term for cracking of the skin of the heels. This can be a painful condition that can cause bleeding. Open-backed sandals or shoes that allow more slippage around the heel while walking are often culprits that cause heel fissures. Skin conditions, such as eczema and psoriasis, can also lead to heel fissures. The skin thickens as a result of the friction. Wearing proper shoes and the use of deep skin moisturizers and lotions can reduce the dryness associated with the condition and allow the foot to heal.

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.

Black or darkened toenails are essentially bruised nails and can result from a variety injuries or problems. Darkened nails may occur as a result of the toe hitting the end or the top of the shoe toe area. Sometimes, the bruise can lead to a fungal nail infection.

Treatment may include trimming the nail back and applying a topical antifungal medication. If the skin under the nail is ulcerated, a topical antibiotic ointment should be applied.

Diabetic patients should contact our office for evaluation if they experience any change in the color of toenails. The pressure causing the bruised nail may lead to a small sore under the toenail, which can lead to infection.

Ingrown toenails, also known as onychocryptosis, is usually caused by trimming toenails too short, particularly on the sides of the big toes. They may also be caused by shoe pressure (from shoes that are too tight or short), injury, fungus infection, heredity, or poor foot structure. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection. A common ailment, ingrown toenails can be painful. Ingrown toenails start out hard, swollen, and tender. Left untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.

In most cases, treating ingrown toenails is simple: soak the foot in warm, soapy water several times each day. Avoid wearing tight shoes or socks. Antibiotics are sometimes prescribed if an infection is present. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS. In severe cases, if an acute infection occurs, surgical removal of part of the ingrown toenail may be needed. Known as partial nail plate avulsion, the procedure involves injecting the toe with an anesthetic and cutting out the ingrown part of the toenail.

Ingrown Toenails Can Be Prevented By:

• Trimming toenails straight across with no rounded corners.
• Ensuring that shoes and socks are not too tight.
• Keeping feet clean at all times.

Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage.

Symptoms of Arthritis in the Foot and Ankle Include:

• Early morning stiffness.
• Limitation in motion of joint.
• Recurring pain or tenderness in any joint.
• Redness or heat in a joint.
• Skin changes, including rashes and growths.
• Swelling in one or more joints.

Forms of Arthritis

Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or wear and tear arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe. Dull, throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Many of these symptoms can be relieved with rest. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

Rheumatoid arthritis is a major crippling disorder and the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course. In the foot, it frequently affects both ankles and toes.

Arthritis of the foot and ankle can be treated in many ways, including:

• Physical therapy and exercise.
• Anti-inflammatory medication and/or steroid injections into the affected joint. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.
• Orthotics or specially prescribed shoes.

Many people don't realize they have a fungal nail problem and, therefore, don't seek treatment. Yet, fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish. Left untreated, however, it can present serious problems.

Also referred to as onychomycosis, fungal nails are infections underneath the surface of the nail, which may also penetrate the nail. Fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate, which ultimately can lead to difficulty and pain when walking or running. Symptoms may include discoloration, brittleness, loosening, thickening, or crumbling of the nail.

A group of fungi, called dermophytes, easily attack the nail and thrive on keratin, the nail's protein substance. In some cases, when these tiny organisms take hold, the nail may become thicker, yellowish-brown, or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks may frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete's Foot or excessive perspiration.

You Can Prevent Fungal Nail Infections by Taking These Simple Precautions:

• Exercise proper hygiene and regularly inspect your feet and toes.
• Keep your feet clean and dry.
• Wear shower shoes in public facilities whenever possible.
• Clip nails straight across so that the nail does not extend beyond the tip of the toe.
• Use a quality foot powder (talcum, not cornstarch) in conjunction with shoes that fit well and are made of materials that breathe.
• Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active lifestyles.
• Disinfect home pedicure tools and don't apply polish to nails suspected of infection.

Depending on the type of infection you have, over-the-counter liquid antifungal agents may not prevent a fungal infection from recurring. A topical or oral medication may need to be prescribed, and the diseased nail matter and debris removed, a process called debridement. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

In severe cases, surgical treatment may be required to remove the infected nail. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured and prevents the return of a deformed nail.

Two kinds of skin allergies, or dermatitis, are caused by substances coming in contact with the skin: primary irritant dermatitis and allergic contact dermatitis. Primary irritant dermatitis is a non-allergic reaction of the skin resulting from exposure to an irritating substance. Allergic contact dermatitis is an allergic sensitization to various substances.

People who work in areas where their feet are exposed to repeated or prolonged contact to hot water, chemicals, oils, or wet cement can develop primary irritant dermatitis. Some solutions are safe if used properly. However, improper use can lead to a serious contact dermatitis. This is particularly dangerous for diabetics. For primary irritant dermatitis, soaking feet in solutions, such as bleach, vinegar, salt water, or Betadine, can be beneficial as long as excessive amounts are not used.

Allergic contact dermatitis is the result of exposure to substances that sensitize the skin. Each time the foot is exposed to the substance, an inflammatory reaction occurs. Some people are allergic to the substances in sock dyes or certain shoe materials. Adhesive tapes can cause an allergic reaction with blisters or a rash developing beneath the tape. Because of the heat and the accumulation of moisture beneath the tape, an acute Athlete's Foot infection can also be caused by an allergic reaction to the adhesive. Treatments include the use of cool compresses, topical steroid compounds (like hydrocortisone creams), and antifungal creams.

Athlete's Foot, also known as tinea pedis, is a skin disease caused by a fungus that usually occurs between the toes. The fungus attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth. Warm, damp areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi.

Symptoms of Athlete's Foot include drying skin, itching, scaling, inflammation, and blisters on and between the toes. Athlete's Foot can spread to the soles of the feet and to the toenails as well as other parts of the body, which is why timely treatment is so important.

You Can Prevent Athlete's Foot By:

• Not walking barefoot, particularly in public pools and locker rooms.
• Reducing foot perspiration by using talcum powder.
• Wearing light and airy shoes.
• Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.

While fungicidal and fungistatic chemicals are usually used to treat Athlete's Foot problems, they often fail to contact the fungi in the lower layers of the skin. For persistent Athlete's Foot, a prescription topical or oral antifungal drug may be needed. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Most blisters on the feet are caused by friction and do not require medical attention. New skin will form underneath the affected area and the fluid built up in the blister is simply absorbed back into the tissue. You can soothe ordinary blisters with vitamin E ointment or an aloe-based cream.

Do not puncture a blister unless it is large, painful, or likely to be further irritated. If you have to pop a blister, use a sterilized needle or razor blade. Wash the area thoroughly, then make a small hole and gently squeeze out the clear fluid. Apply a dab of hydrogen peroxide to help protect against infection. Do not remove the skin over a broken blister. The new skin underneath needs this protective cover. Cover the area with a bandage and mild compression.

If the fluid is white or yellow, the blister is infected and needs medical attention.

Preventing Blisters

You can prevent blisters by breaking in new shoes gradually, and putting petroleum jelly or an adhesive bandage on areas that take the rub—before the blister happens. Wear socks that have heels instead of tube socks (they bunch up and cause blisters). Acrylic and other synthetic-fiber socks are good choices. Be sure to wash and dry your feet daily to prevent bacterial infections, such as Athlete's Foot.

Burning feet refers to a foot sensation that is most frequently experienced by adults over age 50 and those who are diabetic. Thyroid dysfunction, gastric restriction in morbidly obese people, and heavy use of alcohol also have been linked with burning feet. Nerve problems, such as neuromas and tarsal tunnel syndrome, may also be associated with the sensation of burning feet.

It is not unusual for feet to ache or burn at the end of a long day. However, on an ongoing basis, burning feet can be a symptom of a more serious health problem. Please consult our office and schedule an appointment if you experience persistent burning feet.

There are some simple ways to mitigate burning feet:

• Make sure you wear shoes that fit properly and provide support for your unique foot structure.
• Take foot baths daily to treat hot and sweaty feet.
• Wear socks of cotton, versus synthetic, fibers as they are lighter and cooler.
• Avoid long periods of standing.
• Try cushioned or shock-absorbing insoles in your shoes to make standing more comfortable.
• In some cases, orthotics may be helpful to correct any underlying mechanical imbalances which may be responsible for your burning feet.

A callus, also known as hyperkeratosis, is an area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe. Although many consider them a skin problem, they are indicative of a problem with the bone.

Calluses form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus. A great deal of friction or pressure over shorter periods of time can cause blisters or open sores. Calluses typically develop under a metatarsal head (the long bone that forms the ball of the foot). Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness.

Calluses can be treated with over-the-counter callus removers, which use strong acids to peel this excess skin away after repeated application. Be careful using these products as they can cause chemical burns when misapplied or used in excess. Alternatively, treat calluses as follows: Begin by soaking the foot or feet in warm soapy water and gently rubbing away any dead skin that loosens. Next, use a pumice stone or emery board to file away the thickened skin. Apply a good moisturizer to the hardened areas to keep them softer and relieve pain. Nonmedicated corn pads or moleskin (a thin fuzzy sheet of fabric with an adhesive back) are available in stores and can relieve pain caused by calluses. However, use caution removing pads or moleskins to avoid tearing the skin.

If you need assistance relieving calluses, please contact our office. We can trim and apply comfortable padding to the painful areas. In more severe cases, we may prescribe medication to relieve inflammation, or inject cortisone into the underlying bursal sac to rapidly reduce pain and swelling.

A plantar callus forms on the bottom of the heel over time where one metatarsal bone is longer or lower than the others. This structure causes the one metatarsal to hit the ground first and with more force than it is equipped to handle. As a result, the skin under this bone thickens. In most cases, plantar calluses can be treated without surgery. In some recurring cases, however, a surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone.

A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a "dropped metatarsal," which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form. A dropped metatarsal can either be a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time.

You Can Prevent Calluses By:

• Switching to better-fitting shoes or using an orthotic device to correct an underlying cause.
• Buying socks with double-thick toes and heels or nylon hose with woven cotton soles on the bottom of the foot.

Corns are calluses that form on the toes because of bones that push up against shoes and build up pressure on the skin. The surface layer of the skin thickens, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other.

Improperly fitting shoes are a leading cause of corns. Toe deformities, such as hammertoe or claw toe, also can lead to corns. Self-care for corns includes soaking feet regularly and using a pumice stone or callus file to reduce the size of the corn. Special over-the-counter, non-medicated, donut-shaped foam pads can be worn to help relieve the pressure and discomfort. For large or lasting corns, please contact our office. We can shave off the corns using a scalpel.

Cysts are fluid-filled masses under the skin. Common cysts of the feet include synovial cysts, ganglia, and cutaneous mucoid cysts.

Most foot cysts are located under the skin, although occasionally they appear in tendon or bone. Synovial or ganglionic cysts are connected to a nearby joint or tendon, which makes them harder to treat. Mucoid cysts are not connected to a joint. Most cysts lead to mild pain as a result of the pressure created by wearing shoes. When any of these cysts enclose or press on a nerve, they can cause a sharp pain. X-rays, ultrasound, MRI, or CT scans are common methods for diagnosing cysts in the feet.

The best way to prevent cysts from forming is to wear well-fitted, comfortable shoes and avoid repeated foot injuries. Persistent ganglion cysts can be treated by numbing the area and extracting the fluid inside. A steroid or hardening agent may then be injected into the cyst to try to prevent it from filling again.

Extreme exposure of your feet to cold for a prolonged period can lead to a serious condition called frostbite. Frostbite starts by producing pain and a burning sensation in the exposed areas. This is followed by numbness in toes or feet and changes in skin color, from pale or red to bluish-gray or black. People with a history of frostbite often get it again in the same place.

Superficial frostbite injuries refer to those that involve the skin and subcutaneous tissue. When the damage goes more deeply, beyond the subcutaneous tissue and into muscles, nerves, tendons, or bones, they are classified as deep frostbite injuries. The extent of the injury impacts the prognosis for healing and long-term complications.

Children, the elderly, and diabetics are more prone to frostbite because of the size of their extremities or poor circulation. People who live or work outdoors also have a higher likelihood of contracting frostbite because of their increased exposure to the cold.

If you suspect that you have frostbite, SEEK EMERGENCY MEDICAL CARE AS SOON AS POSSIBLE. Get out of the cold and into a warm environment as quickly as possible. Keep the feet dry and warm. Do not expose the flesh to extremely warm or hot temperatures (such as a fire or portable heater). A gradual and steady warming procedure should be followed.

Many people don't realize they have a fungal nail problem and, therefore, don't seek treatment. Yet, fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish. Left untreated, however, it can present serious problems.

Also referred to as onychomycosis, fungal nails are infections underneath the surface of the nail, which may also penetrate the nail. Fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate, which ultimately can lead to difficulty and pain when walking or running. Symptoms may include discoloration, brittleness, loosening, thickening, or crumbling of the nail.

A group of fungi, called dermophytes, easily attack the nail and thrive on keratin, the nail's protein substance. In some cases, when these tiny organisms take hold, the nail may become thicker, yellowish-brown, or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete's Foot or excessive perspiration.

You Can Prevent Fungal Nail Infections by Taking These Simple Precautions:

• Exercise proper hygiene and regularly inspect your feet and toes.
• Keep your feet clean and dry.
• Wear shower shoes in public facilities whenever possible.
• Clip nails straight across so that the nail does not extend beyond the tip of the toe.
• Use a quality foot powder (talcum, not cornstarch) in conjunction with shoes that fit well and are made of materials that breathe.
• Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active lifestyles.
• Disinfect home pedicure tools and don't apply polish to nails suspected of infection.

Depending on the type of infection you have, over-the-counter liquid antifungal agents may not prevent a fungal infection from recurring. A topical or oral medication may need to be prescribed, and the diseased nail matter and debris removed, a process called debridement. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

In severe cases, surgical treatment may be required to remove the infected nail. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured and prevents the return of a deformed nail.

Gangrene is caused by lost blood supply to the foot or bacterial infections that result from open sores or ulcers. Diabetics are most prone to foot gangrene because they typically have poor circulation or nerve damage, which can lead to loss of blood supply.

Any sudden onset of foot or leg pain accompanied by lower skin temperature and skin color changes may indicate a sudden blockage of blood flow to the legs.

Gangrene is a serious condition, particularly when it is caused by an infection, which can spread throughout the body. Gangrenous tissue must be surgically removed, followed by oxygen treatment and intravenous antibiotics to kill any infection. If you suspect gangrene, please contact our office or seek other immediate medical attention.

Skin lesions refer to any variation in skin color or texture anywhere on the body. Some skin lesions are present at birth, such as moles, freckles, or birthmarks. Others are acquired over time, such as acne, warts, allergies, sunburn, or abrasions. Most skin lesions are harmless. However, it is important to keep an eye on them because they can change over time, which may be indicative of a serious problem. For example, one pigmented lesion that can occur on the foot and lower extremity is malignant melanoma.

A condition called actinic keratosis is another cancer-causing lesion that can occur on the feet. It is most commonly found in sun-exposed areas, such as the top of the foot. Treatment consists of freezing the lesions with liquid nitrogen or sharp excision.

Kaposi's Sarcoma is another cancerous lesion that may appear on the soles of the feet of people with HIV infection or AIDS. Kaposi's Sarcoma lesions are irregular in shape and have a purplish, reddish, or bluish-black appearance. They tend to spread and form large plaques or become nodular. The nodular lesions have a firm, rubbery appearance.

Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin characterized by round, reddish, dry scaley patches covered by grayish-white or silvery-white scales. Lesions are most commonly found on the nails, scalp, elbows, shins and feet. In the foot, psoriasis can be difficult to distinguish from Athlete's Foot, or the nail appearance may be confused with fungal infections of the toenails.

Psoriasis can cause a characteristic pitting appearance on the nails. Pustular psoriasis is a form of the disease characterized by small pustules or blisters filled with clear or cloudy fluid.

Psoriasis can affect the joints of the feet and lower extremities, leading to painful arthritis. Anti-inflammatory medications, steroids, and other medications are common treatment for psoriasis. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

The feet and hands contain more sweat glands than any other part of the body, with roughly 3,000 glands per square inch. Smelly feet are not only embarrassing, but can be physically uncomfortable as well.

Feet Smell for Two Reasons: 1) shoe wear, and 2) sweating of the feet. The interaction between the perspiration and the bacteria that thrive in shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both sweating and footwear.

Smelly feet or excessive sweating can also be caused by an inherited condition, called hyperhidrosis, which primarily affects men. Stress, some medications, fluid intake, and hormonal changes also can increase the amount of perspiration our bodies produce.

In general, smelly feet can be controlled with a few preventive measures:

• Always wear socks with closed shoes.
• Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh, or other materials that let your feet breathe.
• Bathe feet daily in lukewarm water, using a mild soap. Dry thoroughly.
• Change socks and shoes at least once a day.
• Check for fungal infections between toes and on the bottoms of your feet. If any redness or dry, patchy skin is observed, get treatment right away.
• Don't wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn't go away, discard the shoes.
• Dust your feet frequently with a nonmedicated baby powder or foot powder. Applying antibacterial ointment also may help.
• Practice good foot hygiene to keep bacteria levels at a minimum.
• Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.

Treating Foot Odor

The best home remedy for foot odor is to soak feet in strong black tea for 30 minutes a day for a week. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.

Persistent foot odor can indicate a low-grade infection or a severe case of hereditary sweating. In these cases, a prescription ointment may be required to treat the problem.

Treating Excessive Sweating

A form of electrolysis, called iontophoresis, has been shown to reduce excessive sweating of the feet. However, it is more difficult to administer. In the worst cases of hyperhidrosis, a surgeon can cut the nerve that controls sweating. Recent advances in technology have made this surgery much safer, but may increase sweating in other areas of the body.

Swelling of the feet, ankles and legs, also known as edema, is often caused by an abnormal build-up of fluids in ankle and leg tissues. Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs, including the calves and/or thighs. Because of gravity, swelling is particularly noticeable in the lower legs. Swelling in the legs and feet may also be a symptom of other, more serious health issues, such as heart failure, renal failure, or liver failure.

Common Causes of Foot, Ankle, and Leg Edema Include:

• Blood pressure-lowering drugs.
• Body fluid overload.
• Burns.
• Certain antidepressants.
• Congestive heart failure.
• Diagnostic tests.
• Environment.
• Estrogens and progestin oral contraceptives.
• Extremity surgery.
• Generalized allergy.
• Glomerulonephritis or other kinds of kidney disorders.
• Infiltration of an intravenous site.
• Injury or trauma to the ankle or foot.
• Insect bite or sting.
• Long airplane flights or automobile rides.
• Long-term corticosteroid therapy.
• Medical treatments.
• Medications.
• Menstrual periods (for some women).
• Pregnancy (mild to severe swelling).
• Prolonged standing.
• Starvation or malnutrition.
• Sunburn.
• Testosterone.
• Venogram.
• Venous insufficiency (varicose veins).

You can mitigate swelling by elevating your legs above the heart while lying down. Avoid sitting or standing without moving for prolonged periods of time. Avoid putting anything directly under the knees when lying down, and don't wear constricting clothing or garters on the upper legs.

Exercising the legs causes the fluid to work back into the veins and lymphatic channels so that the swelling goes down. Mild pressure applied by elastic bandages or support stockings can help reduce ankle swelling. A low-salt diet may also help reduce fluid retention and decrease the ankle swelling.

Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot) are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.

Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.

The Four Stages of Ulcers Are:

• Stage 1—Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved.
• Stage 2—Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.
• Stage 3—Characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)
• Stage 4—Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis).

These Are Also Four Major Cause of Foot Ulcers:

• Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
• Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
• Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal.
• Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.

Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.

Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. A wart, however, is caused by a viral infection which invades the skin through small or invisible cuts and abrasions. Foot warts are generally raised and fleshy and can appear anywhere on the foot or toes. Occasionally, warts can spontaneously disappear after a short time, and then, just as frequently, they recur in the same location. If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Children, especially teenagers, tend to be more susceptible to warts than adults.

Plantar warts, also known as verrucas, appear on the soles of the feet and are one of several soft tissue conditions that can be quite painful. Unlike other foot warts, plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries. They are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. Plantar warts are often contracted by walking barefoot on dirty surfaces or littered ground. The virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public pools and locker rooms.

Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading. Plantar warts that develop on the weight-bearing areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

To prevent the spread of warts, follow these tips:

Avoid direct contact with warts, both from other persons or from other parts of the body.

• Avoid walking barefoot, except on sandy beaches.
• Change your shoes and socks daily.
• Check your children's feet periodically.
• Keep your feet clean and dry.

It is important to note that warts can be very resistant to treatment and have a tendency to reoccur. Over-the-counter foot wart treatments are usually ineffective because their use can inadvertently destroy surrounding healthy tissue. Please contact our office for help in effectively treating warts. Our practice is expert in recommending the best treatment for each patient, ranging from prescription ointments or medications to, in the most severe cases, laser cautery.

Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from inherited to acquired.

Toe deformities in adults result mainly from an imbalance of the tendons, causing them to stretch or tighten abnormally. People with abnormally long toes, flat feet, or high arches have a greater tendency to develop toe deformities. Arthritis is another major cause of discomfort and deformity. Toe deformities also can be aggravated by poorly fitting footwear, or if a fractured toe heals in a poor position.

The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, and overlapping and underlapping toes.

In-toeing and out-toeing occur when the feet are positioned too far inward or outward when walking. Both conditions may be observed in young children as they are learning to walk. By the age of two, most children outgrow these problems on their own. Beyond this age, verbal reminders and reassurance may be advised to make the child aware of the proper position of the foot. In persistent cases, children may be required to wear special shoes or foot supports to help train them to place their feet in the right position. These interventions are designed to reduce abnormal pressures on the foot structure and function while still in their formative development.

Subungal exostosis is more commonly referred to as a bone spur under the toenail. This condition is generally caused by toe trauma, which results in the formation of a bony irregularity or prominence. The normal treatment for subungal exostosis is surgical removal. Other small tumors, called osteochondromas and enchondromas, can also form in the bone beneath the toenail.

Big toe injuries, known as turf toe, result from hyperextension of the big toe joint as the heel is raised off the ground. An external force is placed on the big toe, and the soft tissue structures that support the big toe on the top are torn or ruptured.

Turf toe often arises from participation in team sports. Symptoms include pain, tenderness, and swelling of the toe joint. There is often a sudden acute onset of pain during a push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and can dramatically increase the healing time required.

Treatment includes rest, icing, compression, and equipment modification or change. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Acrocyanosis is a painless disorder that affects the arteries supplying blood to the skin of the hands and feet. These small arteries carry oxygen and nutrients through the blood to the skin of the extremities. Spasms in the arteries block blood flow in people with this condition. Without adequate blood supply, the skin lacks oxygen, which changes the skin color to a dark blue to purple color. This characteristic color is called cyanosis.

Acrocyanosis is generally a benign condition, but can be indicative of a serious medical illness elsewhere in the body, such as cardiovascular or connective tissue disease. It occurs more frequently in women than in men. Symptoms include feet that are persistently cold in temperature, blue skin discoloration, sweaty or moist skin, and swelling.

Treatment focuses on keeping the foot warm and the blood circulating normally. It may include wearing insulated boots, thin polypropylene liner socks to wick the moisture away from the skin, and/or use of an insulated sock to maintain normal skin temperature. The disorder itself cannot be remedied, but does not worsen over time.

Alcoholic peripheral neuropathy is a nerve loss condition in the foot caused by the prolonged use of alcoholic beverages. Ethanol, the alcoholic component of these beverages, is toxic to nerve tissue. Over time, the nerves in the feet and hands can become damaged resulting in the same loss of sensation as that seen in diabetic peripheral neuropathy. The damage to these nerves is permanent. A person with this condition is at the same risk, and should take the same precautions as people with diabetic peripheral neuropathy. Another form of peripheral neuropathy is caused by exposure to toxins, such as pesticides and heavy metals, and is equally detrimental to health.

Treatment for alcoholic peripheral neuropathy may include Vitamin B-12 injections, certain oral medications to ease any burning pain, topical ointments, magnetic therapy, and galvanic stimulation (which is the therapeutic use of electric current, particularly for stimulation of nerves and muscle). NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Chilblains are caused by the skin's abnormal reaction to cold. Circulation is a determining factor for chilblains; people with poor circulation in the feet are more susceptible.

Chilblains are characterized by small itchy, red swellings on the skin, which become increasingly painful, swell, and dry out, leaving cracks in the skin and exposing the foot to the risk of infection. They occur on the extremities the toes (particularly the smaller ones), fingers, the face (especially the nose), and the ear lobes. They can also occur on areas of the feet exposed to pressure, such as on a bunion or where the second toe is squeezed by tight shoes. Symptoms include burning and itching, swelling or redness, breaks in the skin, and ulcers.

Treatment includes keeping the body, legs, and feet warm, especially for individuals who have poor circulation and/or limited mobility.

Calamine lotion will take away most of the skin discomfort. If chilblains become ulcerated, application of an antiseptic dressing is the recommended form of treatment.

Erythromelalgia is a rare disorder that results from enlarged blood vessels in the feet. Because the blood vessels are open or dilated, oxygen and heat from the blood is discharged into the tissues, making the feet turn red and feel hot all the time. Prescription medications that restrict the opening of the blood vessels is the typical treatment. NOTE: PLEASE CONSULT YOUR PHYSICIAN BEFORE TAKING ANY MEDICATIONS.

Ischemic foot refers to a lack of adequate arterial blood flow from the heart to the foot. There are a wide variety of possible causes, including arterial blockage from cholesterol deposits, arterial blood clots, arterial spasms, or arterial injury. With ischemic foot, the person suffers from an inadequate blood supply reaching the foot to provide the oxygen and nutrient needs required for the cells to continue to function.

Symptoms typically include cold feet, discoloration in the toes, muscle cramping, and, over time, ulcers and pain.

Treatment includes walking exercises to increase blood flow, wearing protective shoes, and medications. NOTE: PLEASE CONSULT WITH YOUR PHYSICIAN BEFORE TAKING ANY MEDICATION.

A neuroma is an enlarged, benign growth of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from poorly fitting shoes or an abnormal bone structure can also lead to this condition. Symptoms may include sensations of thickness, burning, numbness, tingling, or pain in the ball of the foot. Treatments generally include wearing corrective shoes or orthotics and/or receiving cortisone injections. In severe cases, surgical removal of the growth may be necessary.

Morton's neuroma is a thickening of tissues around the nerve that leads to the toes. Morton's neuroma usually develops between the third and fourth toes in response to irritation, such as that caused by wearing high-heeled or narrow shoes, or from trauma. Symptoms may include a burning pain that radiates from the ball of the foot to the toes or numbness in the toes. Conservative treatments usually resolve the pain or progressions of the condition, and range from wearing roomier, lower-heeled footwear or using orthotics to reduce the pressure on the nerve, to injections of corticosteroid medication to reduce swelling and inflammation.

Spasms are contractions of the hands, thumbs, feet, or toes and are sometimes seen with muscle cramps, twitching, and convulsions. The contractions of the muscles can be violent.

Carpopedal spasms, or spasms in the feet or toes, are usually accompanied by numbness, tingling, or a "pins-and-needles" feeling; muscle weakness; fatigue; cramping; twitching; and uncontrolled, purposeless, rapid motions.

Common Causes of Spasms Include:

• Vitamin D deficiency.
• Hyperventilation (calcium becomes temporarily unavailable to the body during hyperventilation).
• Hypocalcemia.
• Muscle cramps, usually caused by sports or occupational muscle injury.
• Parkinson's disease and other neuromuscular conditions.

Spasms of the hands or feet can be an important early warning sign of other serious health problems, so it is important to seek medical attention. Treatments may include calcium and Vitamin D supplements (if you have a deficiency).

Venous stasis is a loss of proper function in the leg veins that normally carry blood back toward the heart. This may occur following injury to the veins, which may lead to blood clots in the superficial veins (known as superficial phlebitis) or blood clots in the deep veins (known as deep venous thrombosis).

Individuals with this condition usually exhibit swelling of the legs and ankles. The superficial veins in the legs may be varicose, causing the veins to be enlarged and appear as a cord or a bunch of grapes. Patients often complain of a feeling of fullness, aching, or tiredness in their legs. These symptoms worsen with standing, and are relieved when the legs are elevated. As the condition progresses the blood continues to collect in the feet, ankles, and legs.

Rest, elevation, and compression stockings are the most common forms of treatment.

Computed tomography (CT) examination (also known as a CAT scan) is used in podiatry to help diagnose and treat foot or ankle problems. A CT is a kind of X-ray device that takes cross sectional images of a part of the body, giving the physician a three-dimensional image. CT scans are often superior to conventional X-rays because they can more accurately pinpoint a suspected problem. Common foot problems a CT exam can help diagnose include: arthritis, deformities, flat feet, foreign bodies, fractures, infection, and tumors.

Pregnant women, especially those in their first trimester, are advised against having a CT exam or any X-ray examination because the radiation may harm the unborn child.

Magnetic resonance imaging (MRI) is sophisticated diagnostic equipment used to diagnose an array of health problems or conditions, including:

• Arthritis
• Fractures
• Infections
• Injuries of the tendons, ligaments, or cartilage
• Tumors

MRIs use no radiation like conventional X-rays or CT scans. They employ large magnet and radio waves to produce three-dimensional images. MRIs are very good at portraying soft tissues and bones in your feet and ankles.

People with the following conditions may not be good candidates for a MRI:

• Conditions that requires a heart pacemaker.
• Artificial heart valves.
• Electronic inner ear implants.
• Electronic stimulators.
• Implanted pumps.
• Metal fragments in eyes.
• Surgical clips in the head (particularly aneurysm clips).

Individuals with dental fillings or bridges, a replacement hip or knee, or tubal ligation clips are generally safe to have a MRI.

In most cases, a full exam of the foot and ankle via MRI lasts between 60 and 90 minutes.

Ultrasound is a very effective tool for diagnosing a wide variety of foot and ankle problems, particularly soft tissue problems. Ultrasound uses sound waves on the body in a way much like radar uses sound waves. The waves hit a targeted area and are bounced back to a recording device, which produces an image. Ultrasound is a completely safe, noninvasive, and painless diagnostic procedure.

Common problems for which ultrasound may be prescribed include:

• Bursitis
• Heel spurs or plantar fasciitis
• Injuries of the ligaments, tendons, or cartilage
• Morton's neuroma
• Presence of foreign bodies
• Soft tissue masses
• Tarsal tunnel syndrome
• Tendonitis or tears in a tendon

X-rays help determine whether a bone has been fractured or damaged by conditions such as an infection, arthritis, or other disease.

Other reasons for conventional X-rays on your feet are to:

• Evaluate changes in the bones from infections, arthritis, or other bone disease.
• Assess whether a child's bones are growing normally.
• Locate foreign objects (such as pieces of glass or metal) in a wound.
• Determine whether bones are properly set after treating a fracture.

Pregnant women, especially those in their first trimester, are advised against having X-rays because the radiation may harm the unborn child.

Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotics are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure.

Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthotics

Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.

Soft Orthotics

Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.

Semi-Rigid Orthotics

Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.

Most individuals will experience foot pain at some point in time during their lives. Foot pain is caused by a wide variety of injuries, health problems or disorders, including (but not limited to):

• Arthritis
• Bone spurs
• Bunions
• Calluses
• Corns
• Flat Feet
• Gout
• Ingrown toenails
• Plantar fasciitis
• Sprains
• Stress fractures
• Warts
• Wearing improper shoes or extensive use of the feet.

According to an American Podiatric Medical Association survey, 76 percent of Americans said they spend more than four hours each day on their feet. The same percentage said they had foot problems in the last 12 months.

Surgery on the foot, ankle, or lower leg is usually performed by podiatric surgeons and orthopedic surgeons specializing in the foot and ankle.

Foot and ankle surgeries address a wide variety of foot problems, including:

• Sprains and fractures.
• Arthritis and joint disease.
• Benign and malignant tumors.
• Birth deformities.
• Bunions.
• Calluses and warts.
• Corns and hammertoes.
• Flatfeet.
• Heel or toe spurs.
• Neuromas (nerve tumors).

Many foot and ankle surgeries today can be performed in the doctor's office or a surgical center on an outpatient basis. They frequently can be performed using local anesthesia, in some cases combined with sedation. Most foot surgeries require a period of immobilization after the procedures with protective devices, such as a bandages, splints, surgical shoes, casts, or open sandals.

Limited weight bearing, elevating and icing the foot, and keeping the area dry are commonly required for the first two weeks following surgery until sutures are removed. Most surgeons will encourage post-operative exercise of the foot and legs to speed recovery. In addition, many patients need additional therapy or treatments after surgery in order to aid in the healing and recovery process. These may include physiotherapy, orthotic devices, and special footwear. After sufficient healing time, which varies from procedure to procedure, most patients can resume wearing their usual footwear.

Surgery to repair a torn (ruptured) Achilles tendon is conducted on an outpatient basis using a local anesthetic. It involves making an incision or cut in the back of the leg above the heel to access the torn tendon. The tendon is then sewn back together. Surgery may be delayed for about one week after the rupture to let the swelling go down.

After surgery, a cast or walking boot is usually worn for six to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down).

Specific gentle exercises (restricted motion) after surgery can shorten the time needed in rehabilitation.

Ankle surgery may be required to correct a serious deformity of the ankle and its bone structure. Injury (such as a fracture), birth defects, or changes throughout the course of life are the usual culprits. Diseases, such as diabetes, rheumatoid arthritis, and neuromuscular conditions, may cause severe foot and ankle deformities that, over time, cause pain and difficulty in walking.

Ankle surgeries emphasize the realignment of the structure either around or after removal of the deformity. Various kinds of internal and external fixation devices—some temporary, others permanent—are often required to maintain the appropriate alignment during, and beyond, the healing process.

Ankle surgeries vary in complexity, length, and severity, yet many of them today are conducted on a same-day, outpatient basis. Patients need to arrange for another person to take them home afterwards and stay with them for the first 24 hours following the surgery. Post-operative instructions, provided by your surgeon, will give you the information needed to care for your recovering ankle following surgery.

Patients who undergo surgery to correct arthritis in the foot are often diabetics with a type of arthritis known as Charcot Foot. The average age of patients developing a Charcot foot is 40 years. About one-third of patients develop a Charcot foot in both feet and/or ankles. This form of arthritis can develop suddenly and without pain. Quite suddenly, the bones in the foot and/or ankle can spontaneously fracture and fragment, often causing a severe deformity.

The arch of the foot often collapses, and pressure areas develop on the bottom of the foot, leading to open sores or ulcers.

While many of these deformities can be treated with nonsurgical care, surgery may be required. Such instances may include:

• Chronic deformity with increased plantar pressures and risk of ulcers.
• Chronic deformity with significant instability that cannot be corrected by braces.
• Significant deformity that may include ulcers that don't heal or respond to therapy.

Surgical Procedures Used to Treat Arthritis Include:

• Hindfoot and Ankle Realignment - This kind of procedure is usually prescribed when there is significant instability resulting in a patient being unable to walk. Various types of internal fixation are placed within the foot during this kind of procedures.
• Midfoot Realignment - This kind of procedure is usually prescribed when there is significant instability of the middle portion of the foot. During a midfoot realignment, various types of internal fixation are placed within the foot.
• Ostectomy - In this procedure, a portion of bone is removed from the bottom of the foot. It is usually performed for a wound on the bottom of the foot that is secondary to pressure from a bony prominence.

Arthroscopic surgery on the foot and ankle may be used as a diagnostic or treatment procedure, or both. A small instrument, called an arthroscope, penetrates the skin through small incisions.Tiny cameras can be inserted through the arthroscope, allowing the surgeon to accurately see the area and/or damage. Other small instruments can also be inserted through the arthroscope to make surgical corrections.

Because arthroscopy is less-invasive and traumatic than traditional surgery, it reduces the risk of infection and swelling, and allows for significantly speedier healing and recovery. Most arthroscopic surgeries of the foot and ankle are performed on a same-day, outpatient basis using a local anesthetic.

Bunions are progressive bone deformities of the foot that often cause recurring or chronic inflammation, irritation, and pain that require surgical correction. Surgical removal of a bunion is called a bunionectomy. However, there are multiple types of bunionectomies, each designed to resolve different structural changes caused by the deformity.

Bunion surgeries fall into two major categories:

• Head procedures that treat the big toe joint. In a head procedure bunionectomy, the bone is cut just behind the joint, moved into its proper position, and fixed in place with a screw or pin. Head procedures are often used for patients who cannot be immobilized for long periods of time.
• Base procedures concentrate on the bone near or behind the big toe joint. Different types of base procedures are conducted depending on the nature of the deformity. These range from cutting a wedge out of the bone and splitting it so that it can be moved into its proper position; making a semi-circular cut and rotating the bone into its correct position; or fusing the joint. Ligaments inside and outside the toe may also be treated during a base procedure.

There are three important factors that impact the success of bunion surgery:

1. Choose a surgeon with extensive experience with bunionectomies. Because a deep understanding of the biomechanics of each patient's foot as well as the intricacies of each surgical option is needed, surgeons with more experience at doing bunionectomies are better able to help each patient achieve the best outcome.
2. Be realistic in your expectation about what a bunionectomy can accomplish. No physician can guarantee that a bunion won't recur or that a patient will be absolutely pain free. Additionally, because of the complexity of the foot structures impacted by a bunion, patients may never be able to wear normal or slender shoes. Bunion surgery can reduce or eliminate the bone deformity, improve foot alignment and function, and prevent damage to other toes, but it does have its limitations. Be sure you understand all the possibilities before opting for this surgery.
3. Bunion surgery is not a magic bullet. Surgery alone may not be all that is needed to achieve your best outcome. After surgery, many patients experience long healing and recovery times and often have to spend time in physical therapy. Additionally, you may need a corrective orthotic device on an ongoing basis.

What to Expect

Most bunions surgeries today are performed on an outpatient basis at a surgical center or hospital. Set aside the entire day for the surgery, although you may only be at the facility for a half day.

Prior to the surgery, patients will need to make some preparatory arrangements. These include:

• Seeing your Primary Care Physician (PCP) to make sure any other health conditions are stabilized prior to surgery and to document your complete medical history, which can then be given to the foot surgeon.
• Arranging your schedule to make sure you don't need to take any long trips for at least two to three weeks following the surgery.
• Lining up another person to drive you home and stay with you for the first 24 hours after the surgery.
• Stopping the use of any anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen, for five to seven days before the surgery.

The night before the surgery, you will not be able to eat or drink anything after midnight. You should also wash your foot the night before and morning of the procedure to help reduce surrounding bacteria and prevent infection.

Bunion surgery is usually performed with a local anesthetic and is administered by an anesthesiologist. This may be combined with sedation medication to put you into "twilight" so that you are fully relaxed. After the surgery, patients are often given a long-acting anesthetic and pain medication, which is why someone else must drive the patient home.

The type of procedure you have will determine the degree to which you can put weight on the foot immediately after the surgery. Some patients, particularly those having base procedures, may have to use crutches; others may be sent home wearing a surgical shoe. The foot will be covered in a dressing, which you will need to keep dry for up to two weeks or until the sutures are removed.

During the first week after surgery, you will need to keep the foot elevated as much as possible. Ice packs also should be applied for the first three to four days to reduce swelling. Limited ambulation or walking is required over the first two weeks to promote healing. Most patients also are instructed on some basic exercises that need to be performed daily.

Sutures are generally removed about two weeks after the surgery in the doctor’s office. Once the sutures are removed, you can bathe and shower normally, but will still need to wear a dressing over the wound to keep it clean and prevent infection.

By the third or fourth week post surgery, swelling generally subsides enough for the patient to begin wearing a wide athletic shoe. It is important to continue daily exercises. If recommended, physical therapy may be initiated at this time. Once the wound has completely closed, you can use lotions to soften the skin in the surgical area.

By week five after the surgery, you will be able to walk short distances and do mild fitness activities. Continue following your surgeons instructions for increasing exercise and activities until you are back to normal.

Ganglion masses, or cysts, are normally removed through surgery. Most cyst removal surgeries are performed on an outpatient basis. Contact our office to have this procedure performed.

During the procedure, the cyst is dissected from the surrounding soft tissues and removed. The recovery period depends on the location of the ganglion and the amount of dissection required during surgery. In many cases, patients receive a splint or below-the-knee cast. The surgeon may require the patient to use crutches for several days to up to three weeks. This level of protection may be necessary if the ganglion is near the ankle joint.

Possible complications from cyst removal surgery include infection, excessive swelling, and nerve damage.

Adult-acquired flatfoot or posterior tibial tendon dysfunction usually leads to a gradual loss of the arch. The posterior tibial muscle is a deep muscle in the back of the calf and has a long tendon that extends from above the ankle and attaches into several sites around the arch of the foot. The muscle acts like a stirrup on the inside of the foot to help support the arch. The posterior tibial muscle stabilizes the arch and creates a rigid platform for walking and running. If the posterior tibial tendon becomes damaged or tears, the arch loses its stability and as a result, collapses, causing a flatfoot.

Surgery is often performed to give the patient a more functional and stable foot. Several procedures may be required to correct a flatfoot deformity, depending on the severity of the problem. These may include:

• Tenosynovectomy - a procedure to clean away (debridement) and remove any of the inflamed tissue around the tendon.
• Osteotomy - removal of a portion of the heel bone (calcaneus) to move the foot structure back into alignment.
• Tendon Transfer - in which replacement fibers from another tendon are inserted to help repair damage.
• Lateral Column Lengthening - A procedure that implants a small piece of bone, usually removed from the hip, outside of the heel bone to create the proper bone alignment and rebuild the arch.
• Arthrodesis - Fusing of one or more bones together to eliminate any joint movement, which stabilizes the foot and prevents any further deterioration or damage.

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and painful, requiring surgery.

Hammertoe surgery can be done on an outpatient basis in the doctor's office or a surgery center using a local anesthetic, sometimes combined with sedation. The surgery takes about 15 minutes to perform. Up to four small incisions are made and the tendons are rebalanced around the toe so that it no longer curls. Patients usually can walk immediately after the surgery wearing a special surgical shoe. Minimal or no pain medication is needed following the surgery.

Icing and elevation of the foot is recommended during the first week following the procedure to prevent excessive swelling and promote healing. It is also important that the dressing be kept clean and dry to prevent infection. Two weeks after the surgery, the sutures are removed and a wide athletic shoe can replace the post-operative surgical shoe. Patients can then gradually increase their walking and other physical activities.

Many conditions can affect the rear part of the foot and ankle. Two common conditions can cause pain to the bottom of the heel and lead to surgical intervention: plantar fasciitis (an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes) and heel spurs (often the result of stress on the muscles and fascia of the foot).

There are many causes of heel pain and most cases can be effectively treated without surgery. Chronic heel pain, however, often can be corrected only through surgery.

A surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone from heel calluses. The procedure involves cutting the metatarsal bone in a "V" shape, lifting the bone and aligning it with the other bones. This alleviates the pressure and prevents formation of a heel callus.

Painful calluses on the ball of the foot are caused by an abnormal alignment of the metatarsal bones. There are five metatarsal bones in each foot, each consisting of the long bones behind each toe. The metatarsal bone behind the big toe is called the first metatarsal, and so on.

The most common metatarsal surgery is performed on the first metatarsal for the correction of bunions.

Surgery on the second through fifth metatarsal bones is performed infrequently, and is usually done to treat painful calluses on the bottom of the foot or non-healing ulcers on the ball of the foot. Patients with rheumatoid arthritis may also need metatarsal surgery.

During surgery, the metatarsal bone is cut just behind the toe. Generally, the bone is cut all the way through, and then manually raised and held in its corrected position with a metal pin or screw. Following the surgery, the patient's foot may be placed in a cast.

In some instances, a surgeon will also cut out the painful callous on the bottom of the foot, but most prefer to do the procedure in an outpatient setting.

A neuroma is an abnormality of a nerve that has been damaged either by trauma or as a result of an abnormality of the foot. Neuromas occur most often in the ball of the foot, causing a pinched and inflamed nerve. In cases of chronic nerve pain from neuromas, surgery may be recommended.

During neuroma procedures, an incision is made on the top of the foot in the location of the neuroma, usually between the second and third toes or between the third and fourth toes. After the nerve is located, the surgeon cuts and removes it.

Neuroma surgery is generally performed on a same-day outpatient basis in the doctor's office or a surgery center using a local anesthetic. The incision will be covered with a dressing after the surgery, which must be kept dry until the sutures are removed, usually within 10 to 14 days after the surgery. Most patients are sent home with a surgical shoe, although crutches may be recommended in cases where the incision must be made on the bottom of the foot. Elevation and icing are important in the first few days following surgery to reduce swelling. Patients are generally restricted to limited walking until the sutures are removed. Generally, patients can return to normal shoe wear in about three weeks. The overall recovery time is usually four to six weeks.

There are many kinds of toe problems requiring surgery. These include removal of:

• Bunions, an enlargement of the bone and tissue around the joint of the big toe.
• Hammertoes, which are frequently caused by an imbalance in the tendon or joints of the toes.
• Neuromas, an irritation of a nerve between the third and fourth toes.
• Bone spurs, an overgrowth of bone under the toenail plate, causing nail deformity and pain.

If untreated, skin blisters and cracks caused by Athlete's Foot can cause serious bacterial infections. The treatment of Athlete's Foot depends on the type and extent of the fungal infection, so it is important to consult our practice before choosing a therapy.

Athlete's Foot can usually be treated with antifungal creams. Re-infection is common, so it is important to continue the therapy as prescribed, even if the fungus appears to have gone away. Lasting cases of Athlete's Foot may require foot soaks before applying antifungal creams. Severe infections that appear suddenly (acute) usually respond well to treatment. Toenail infections that develop with Athlete's Foot tend to be more difficult to cure than fungal skin infections.

Cryotherapy is a standard treatment for warts that uses a very cold substance (usually liquid nitrogen) to freeze and deaden the tissue. Cryotherapy can be done in a doctor's office and takes less than a minute.

During the procedure, the doctor applies the liquid nitrogen to the wart using a probe or a cotton swab. Liquid nitrogen can also be sprayed directly on the wart. The freezing liquid can cause discomfort or pain, which is why a numbing drug (local anesthetic) is sometimes used.

Most cryotherapy treatment requires return visits to ensure that the wart is completely removed.

Studies show that cryotherapy is successful about two-thirds of the time, and when combined with salicylic acid treatment, up to 78% of the time.

Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body." During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.

Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time -- six months or more -- and have not benefited from other conservative treatments. The brief procedure lasts about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed on an outpatient basis. Although there are no bandages, someone will need to drive the patient home.

People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).

This therapy is a safe and effective alternative treatment for heel pain and only requires a short recovery time. Clinical studies show a 70 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.

Iontophoresis is a procedure used to treat excessive sweating in the hands or feet. The procedure involves one or a series of short, 10- to 20-minute sessions in the doctor's office during which a light electrical current is passed through water into the feet. The current is gradually increased until the patient experiences a slight tingling sensation. It is believed, although not clinically proven, that this process plugs up the sweat glands.

Physical therapy can often help decrease the pain and swelling in a painful area of the foot or ankle. Heel spurs, bursitis, plantar fasciitis, bunions, corns and calluses, as well as many post-operative surgical conditions, respond well to physical therapy.

Common kinds of physical therapy may include hot packs, massage, paraffin baths, electrical stimulation, ultrasound, and diathermy (deep heating of tissues through use of electric current) to relieve pain and swelling, increase range of motion, prevent joint stiffening, rebuild muscle strength, and support the proper alignment of foot structures.

Neurolysis is a therapeutic procedure used to treat neuromas. During this nonsurgical procedure, the affected nerve is chemically destroyed via seven weekly injections of ethanol mixed with a local anesthetic. Because nerve tissue has an affinity for ethanol, it absorbs the substance, which, after repeated exposure, becomes toxic and destroys the pain-causing nerve. Neurolysis has a success rate of more than 60 percent. However, this treatment modality is not widely accepted by insurance companies.

More than 24 million people participate in some kind of aerobic exercise, which offers a host of health benefits, including increased cardiopulmonary efficiency, strengthened heart and lungs, improved circulation, lowered cholesterol levels, and stress and anxiety reduction.

Because aerobic exercise involves quick lateral movements, jumping, and leaping for extended periods of time, proper foot care plays a vital part in keeping the entire body fit. Common injuries from aerobics often involve the foot, ankle, and lower leg. Improper shoes, surfaces, or routines, and straining muscles by too vigorous a routine can lead to foot problems. Experts say that hardwood floors, especially with padded mats, are the best surfaces for your feet during aerobic exercise. And don't forget to stretch all the muscles, tendons, and ligaments in the leg, ankle, foot, and toes in a warm-up and cool-down periods before and after aerobics.

Aerobic Shoes

Proper shoes are crucial to successful, injury-free aerobics. Old sneakers in your closet are not the proper shoes for aerobics. Major shoe companies today have designed special shoes for aerobics, which provide the necessary arch and side support; they also have soles that allow for the twisting and turning of an aerobics regimen. Be aware that running shoes lack the necessary lateral stability and lift the heel too high to support aerobic activity. They also often have an acute outside flare that may put the athlete at greater risk of injury from the side-by-side motion in aerobics.

Aerobic shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot.

Because of the many side-to-side motions, aerobic shoes need an arch design that will compensate for these forces. Look for shoes with sufficiently thick upper leather or strap support to provide forefoot stability and prevent slippage of the foot and lateral shoe "breakup." Make sure shoes have a toe box that is high enough to prevent irritation of your toes and nails.

Two other tips: buy your aerobics shoes in the afternoon, when your feet swell slightly and wear the same socks (preferably made of an acrylic blend) that you will wear during aerobics.

Your feet are one of the most overlooked body parts when it comes to exercise. As you exercise, pay attention to what your feet are telling you.

Consult your physician before beginning any fitness program. This includes a complete physical and foot exam. This is especially important for those who are overweight, smoke, or haven't had a physical exam in a long time.

Proper fitness requires wearing the right clothes and shoes. Wear loose-fitting, light-colored and loosely woven clothing in hot weather and several layers of warm clothing in cold weather.

The American Podiatric Medical Association stresses the importance of foot care in exercising. People don't realize the tremendous pressure that is put on their feet while exercising. For example, a 150-pound jogger puts more than 150 tons of impact on his feet when running three miles.

Improper foot care during exercise is a contributing factor to some of the more than 300 foot ailments, according to the APMA.

The following are common ailments caused by improper foot care during exercise:

• Athlete's foot;
• Blisters;
• Corns and calluses; and
• Heel pain (including heel spurs).

Baseball is the national pastime in America. From kids to adults, playing baseball is one of the most enjoyable team sports. But as with other sports, its important that you keep yourself in good condition and have the right equipment to play safely and enjoy the health benefits of the game. Baseball players are advised to condition their entire bodies and be sure to stretch the leg, ankle, and foot muscles before, during, and after play to avoid injuries.

Baseball can be characterized by lots of stops and starts, lots of running, and, of course sliding. Practice and technique can enhance your competency and enjoyment of the game, but they are also crucial for building up the muscles needed in baseball. The rapid and changing movements associated with the sport place many pressures on your feet and ankles. Inadequate stretching, improper shoes, and repeated motions lead to the most common foot problems that occur among baseball players, such as Achilles tendonitis, plantar fasciitis, shin splints, stress fractures, ankle sprains, and bone fractures.

Baseball Shoes and Cleats

As with most athletic shoes, comfort is the most important element in choosing the right baseball shoe for you. Look for shoes with a roomy toe box that give your toes enough room to wiggle. The widest part of your foot should fit comfortably into the shoe without stretching the upper. Look for a snug heel to help keep your foot stable. Most importantly, remember to replace your baseball shoes after 70 to 75 hours of active wear.

For league play, cleats may be recommended to give you the traction needed for the surface in the diamond. Baseball cleats come in a variety of materials ranging from leather and synthetic materials (plastics) to rubber and metal. Be sure to follow the regulations of your league regarding the material allowed; many leagues no longer permit the use of metal spikes or cleats, particularly on artificial turf. Be sure to give yourself time to adjust to cleats by wearing them on the designated surface.

With all its running, twisting, turning, and jumping, basketball is one of the hardest games on feet. Different movements put all the areas of the foot at risk. That is why proper conditioning, stretching, and well-fitted shoes are critical to a healthy enjoyment of the sport.

Ankle sprain is a particularly common injury in basketball. But the repeated shock and pressures on the foot can also lead to inflammations, including Achilles tendonitis, plantar fasciitis, and sesamoiditis.

Basketball Shoes

Foot and ankle stability, shock absorption, and traction are the most important qualities for basketball shoes. If you are susceptible to ankle injuries, consider a high-top or three-quarter shoe that provides added support to key foot structures during play. Look for shoes that offer the following:

• A wide toe box with plenty of room for your toes to move around. Not enough room can lead to blisters, corns, and calluses.
• Lightweight, breathable material for uppers; generally, leather is recommended.
• Dense, abrasion-resistant soles that are low to the ground for better traction and support.
• A well-cushioned midsole for a shock-absorbing layer. An EVA or EVA-compressed layer is lightweight but not as durable or stable. A polyurethane layer has greater stability, but it is often heavier, too.
• Bend in the forefoot of the shoe, which is at the ball of the foot near the toes. Be sure there is less bend in the arch where you need the added support to keep the foot stable.
• A firm heel counter that fits snugly.
• Laces as the form of closure give you the ability to adjust for the support you need throughout the foot.

When buying basketball shoes, be sure to take the socks you plan to wear with them to ensure a proper fit. Have your feet measured standing up and fit the shoes to your larger foot. Walk around, turn, twist, and jump in each pair on a hard surface to see how your foot feels during each of these movements. Most importantly, make your choice based on comfort.

Since the bicycle's invention in the early 1900s, it has been a favorite form of recreation and sport in the U.S. More than 100 million Americans enjoy biking, either for recreation or, increasingly, for commuting to work each day. While a great workout for most of the body, feet play a vital role in cycling. They are responsible for the transfer of energy from the body to the pedals, which makes the bicycle move.

Keeping the alignment between the hips, knees, and feet is the most efficient way to operate a bicycle. Lack of proper body alignment and overactivity are responsible for the most common foot problems related to biking: Achilles tendonitis, sesamoiditis, shin splints, and foot numbness or pain.

Cycling Shoes

For the casual or recreational cyclist, a typical athletic shoe used for running, walking, or cross-training is perfectly fine for biking. Just be sure that the sole is firm and not worn down so that it grips the pedal to avoid slipping.

For more serious cyclists, next to bicycles themselves. proper shoes are the most important piece of cycling equipment. In general, cycling shoes should have a stiff sole and fit snugly around the bridge of the foot and heel. The more stable and less movement inside the shoe, the more power can be transferred through the entire foot to the pedal. Also look for shoes with ventilated uppers to keep feet more comfortable. Closure systems vary, including lacing, buckles, straps, and Velcro -- or some combination. You can choose whichever feel most comfortable to you. However, be careful that any loose ends (from straps or laces) and buckles don't hang over, as they can pose a safety hazard if you elect to use toe clips.

The type of biking you do can impact your choice of shoes as well. For road cycling and racing, shoes that have stiff soles, a narrow heel, and snug fit are best. For mountain biking, the shoes also need a decent tread for better grip and a more rugged sole.

Many serious cyclists use some form of a toe clip system. These allow the rider to transfer power from the body to the pedal in both the up and down motions of the leg. Simple toe clips have metal or plastic clips that attach to any type of shoe with strapping. However, they are not as efficient at energy transfer because they allow the foot to bend. Additionally, hanging straps can pose a danger. Clipless systems use metal or plastic cleats in the sole of a shoe that attach to bindings on the pedal. These are a good choice for road or race cycling, but they do take some adjusting to initially. Also, the cleats make the shoes unwearable for walking. Clips are generally not advised for mountain biking since the foot comes off the pedal frequently.

Remember to take the socks you plan to wear with you when trying on cycling shoes to make sure the fit is right.

A large part of the attraction of golf is the time spent outdoors. During an 18-hole round of golf, the typical player walks four-to-five miles over the course of three-to-five hours. That's a lot of time spent on your feet. At the same time, the biomechanics of golf make your feet as important to the success of your swing as any other part of the body. Getting and keeping your feet in the right position to help carry the force of the swing through properly can be impacted by the shoes you wear.

Common foot injuries and problems associated with golf are related to overdoing it, particularly if an underlying structural problem exists in your feet. This includes tendonitis, capsulitis, and ligament sprains and pulls, which can keep a golf enthusiast off the green. Improper shoes can bring on blisters, neuromas, and other pain in the feet. Podiatrists see these problems daily and can treat them conservatively to allow for a quick return to the sport.

Golf Shoes

Remember that you'll spend a lot of time on your feet standing and walking during golf, so look for shoes that are comfortable. Golf shoes come in a variety of types, from the traditional oxford-style to sandals and even boots. Whichever style you choose, look for shoes that are lightweight, well-cushioned in the soles and heels, made from a breathable material, water resistant and offer traction. The middle of the shoe should feel a little tighter than your everyday shoes to support your swing. Be sure to try on golf shoes with the socks you will normally wear to make sure to get the right fit.

More serious golfers may be interested in purchasing spikes. Just give yourself time to adjust to walking wearing spikes and make sure you know the policy for wearing them on each golf course. Spikes give added traction and help stabilize the foot during play. Spikes are made from different materials. Soft, polyurethane spikes that are less damaging to the green and lightweight, but don't offer as much traction as a heavier material. Carbide or ceramic spikes are for serious golfers who spend a lot of time on the greens. They are made of durable materials that often outlast the shoe's upper. Metal spikes often last the life of the shoe, are very durable, give good traction but must be carefully maintained to prevent rust.

Jogging gained enormous popularity in the 1970s as a great form of cardiovascular fitness. Since then running has become one of the most popular form of physical fitness in America. Whether you run on an indoor track or outdoors, you can enjoy this activity year-round and fit it comfortably into your daily routine.

During jogging or running, the 26 bones, 33 joints, 112 ligaments, and a network of tendons, nerves, and blood vessels that make up the foot all work together. That's why you need to condition your body, build up to a routine, and stretch your muscles, tendons, and ligaments before and after each run. Debilitating muscle strain or more serious injury can result when runners or joggers don't build up their routines and allow their bodies to strengthen over time.

The most common foot problems associated with jogging or running are blisters, corns, calluses, Athlete's Foot, shin splints, Achilles tendonitis, and plantar fasciitis. You can prevent many simple foot problems by using proper foot hygiene. Keep your feet powdered and dry. Wear clean socks every time you run. Make sure your shoes fit properly. Most importantly, let your body be your guide so that you don't overstrain your legs, ankles, and feet. If you develop recurring and/or increasing aches and pains from jogging or running, please contact our office and we'll help you pinpoint the problem and prevent more serious injury or long-term damage to your feet.

Jogging/Running Shoes

Because of the force placed on your legs, ankles, and feet, jogging/running shoes need to provide cushioning for shock absorption. Like walking shoes, you need to select a pair designed for the shape of your foot and your natural foot structure or inclination.

There are three basic foot types:

• Pronators are people with relatively flat feet, caused by low arches, which generally leads to overpronation, or a gait in which the ankle rolls inward excessively. People with this foot type need motion control shoes that offer support for mid-foot. Motion-control shoes are more rigid and built on a straight last. These are generally board-lasted shoes, which have a piece of cardboard running the length of the shoe for greater stability. Look for sturdy uppers for added stability and avoid shoes with a lot of cushioning or highly curved toes. Also look for a reinforced heel counter to maintain foot support and stability.
• Supinators are people with high arches, which can lead to underpronation that places too much weight on the outsides of the feet. People with this foot type need stability shoes designed for extra shock absorption and often having a curved or semi-curved last. A slip-lasted shoe is also recommended, because the sewn seam runs the length of the shoe giving it greater flexibility. Also look for shoes that are reinforced around the ankle and heel to stabilize the foot and extra cushioning under the ball of the foot.
• People with normal feet can wear any type of running shoe, although a curved last is generally preferred.

When you run, your foot rolls quickly from the heel to the toe, with your foot bending at the ball on each step. That's why it is important for running shoes to have enough flexibility in just the right places. However, to help with shock absorption, you need a little more rigidity to support the middle of the foot. Make sure the heel is low, but slightly wider than a walking shoe to help absorb the initial shock when your heel strikes the ground.

Here are some other important tips for buying a good pair of running shoes:

• Shop at the end of the day when your feet are slightly swollen to get a good fit.
• Try on shoes with the socks you will wear when walking. If you use an orthotic, bring that to the store when you try on shoes as well.
• Have your feet measured standing up and fit your shoes to the larger of your two feet.
• Be sure there is enough room in the toe box for your toes to wiggle and about a half inch between your toes and the end of the shoe.
• Take time when shopping to try on different brands and walk around the store in each pair. Be sure to walk on a hard surface, not just on carpeting. Let your foot be the guide to the fit, not the shoe size or style.
• Look for lightweight, breathable materials for greater comfort.
• Run your hand all over and inside the shoes to feel for any seams or catches that might irritate your foot.
• Choose shoes that lace for better foot stability and control.
• Make sure your heel fits snugly and does not tend toward slipping out of the shoe.
• Consider buying two pairs and rotating your wear to give each pair time to breath between runs and extend the life of each pair.
• Replace running or jogging shoes twice year or about every 400 miles.

Quick starts and stops and lots of movements from side to side are the characteristics that make tennis challenging -- and stressful on your feet. Amateur and professional tennis players alike are prone to injuries of the foot and ankle, primarily from repeated lateral motions and quick stopping and starting. Clay and crushed stone courts help players slide better, and are considered the safest surfaces on which to play. Asphalt, concrete, rubberized, or carpeted courts don't allow sliding, and are not as healthy for your feet.

Common tennis injuries include ankle sprains, stress fractures, plantar fasciitis, and tennis toe. If you experience recurring or persistent pain, please contact our office for an evaluation.

The best way to prevent foot injuries from tennis is to make sure you condition yourself. This includes building all-around body strength and flexibility; stretching the muscles (particularly in your calves) before, during and after play; drinking lots of water; and wearing the right shoes.

Tennis Shoes

Tennis shoes need lots of cushioning and shock absorption to deal with all the forces placed on your feet during play and to keep your foot and ankle stable. Be sure to choose shoes specifically for racquet sports; running shoes, for example, don't have the support needed for the side-to-side movements common to tennis. Look for tennis shoes that have a reinforced toe, wiggle room in the toe box, padding at the ball of the foot, sturdy sides, a low, well-cushioned heel that is not flared, and a firm heel counter for support.

When shopping for tennis shoes, follow these tips:

• Try on shoes with the socks you normally wear to make sure the fit is right.
• Go shopping at the end of the day when your feet are larger and fit your shoes to the larger of your two feet.
• Let your feet be your guide to fit. Choose only shoes that are comfortable in the store -- don't expect a wear-in period. The shoes should feel supportive, cushioned, and flexible, with some resistance in the heel for greater stability.
• Walk around the store in each pair you try on. Be sure to walk on a hard-surface, not just a carpeted floor. Emulate tennis play by jumping up and down in the shoes and making some fast turns to see how the shoes will really perform.

Before beginning any exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced.

Stretching exercises should take 5 to 10 minutes and ought to be conducted in a stretch/hold/relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior) as well as the anterior muscles.

Some effective stretching exercises to prepare the foot and ankle for exercise include:

• The wall push-up. Face a wall from three feet away, with feet flat on the floor, and knees locked. Lean into the wall, keeping feet on the floor and hold for 10 seconds as the calf muscle stretches, then relax. Do not bounce. Repeat five times.
• The hamstring stretch. Put your foot, with knee straight and locked, on a chair or table. Keep the other leg straight with knee locked. Lower your head toward the raised knee until the muscles tighten. Hold to a count of 10 then relax. Repeat five times, then switch to the other leg.
• Lower back stretch. In a standing position, keep both legs straight, feet spread slightly. Bend over at the waist and attempt to touch the palms of your hands to the floor. Hold the stretch for 10 seconds and repeat 10 times. Do not bounce.

Excessive tightness of the calf muscles can contribute to many foot and some knee problems. A key point of injury is the Achilles tendon, which attaches the calf muscle to the back of the heel. When the calf muscle tightens up, it limits the movement of the ankle joint. 

Calf muscle stretching is very useful in the prevention and treatment of many foot problems. Two typical methods for stretching your calf muscles include the wall push-up (described above) and this technique: Standing approximately two feet from a wall. While facing the wall, turn your feet inward ("pigeon toed") and lean forward into the wall, keeping your heels on the floor and the knees extended. Keep your back straight and don't bend at the hips. Hold the stretch for 10 seconds and do the stretch 10 times in a row.

About 67 million adults in this country have discovered that walking is one of the most fun, natural, and inexpensive ways of keeping your health—and your feet—in top shape. Walking can be enjoyed almost anywhere, any time, and year around. It's also a good way to get exercise, particularly for people who are out-of-shape.

According to the American Podiatric Medical Association, exercise offers a host of benefits. Walking helps control weight, blood sugar, and cholesterol levels. A brisk walk can burn up to 100 calories per mile or 300 calories per hour. Walking also improves cardiovascular fitness. As an aerobic exercise, walking gets the heart beating faster to transport oxygen-rich blood from the lungs to the muscles. The heart and lungs grow more efficient with a regular walking regimen, reducing blood pressure and the resting heart rate. Walking is also a central element of medical rehabilitation for a wide array of health problems. For example, recovery from a heart attack can be facilitated by a regular walking regimen. Additionally, walking creates an overall feeling of well-being, and can relieve depression, anxiety, and stress by producing endorphins, the body's natural tranquilizer. A brisk walk will relax you and also stimulate your thinking.

To gain the most health benefit from walking, it is important to pay attention to your feet. Shoes that don't fit properly or provide adequate support, lack of stretching, and improper gait can lead to foot injuries or pain. The most common foot problems are blisters, corns, calluses, and plantar fasciitis.

Walking Shoes

The only equipment you need to enjoy walking for fitness is a good pair of shoes. But before you can shop for the best shoe for your foot, you need to identify the natural inclination of your foot and gait. There are three basic foot types:

• Pronators are people with relatively flat feet, caused by low arches, which generally leads to overpronation, or a gait in which the ankle rolls inward excessively. People with this foot type need motion control shoes that offer support for mid-foot. Motion-control shoes are more rigid and built on a straight last. These are generally board-lasted shoes, which have a piece of cardboard running the length of the shoe for greater stability. Look for sturdy uppers for added stability and avoid shoes with a lot of cushioning or highly curved toes. Also look for a reinforced heel counter to maintain foot support and stability.
• Supinators are people with high arches, which can lead to underpronation that places too much weight on the outsides of the feet. People with this foot type need stability shoes designed for extra shock absorption and often having a curved or semi-curved last. A slip-lasted shoe is also recommended, because the sewn seam runs the length of the shoe giving it greater flexibility. Also look for shoes that are reinforced around the ankle and heel to stabilize the foot and extra cushioning under the ball of the foot.
• People with normal feet can wear any type of walking shoe, although a curved last is generally preferred.

When you walk, the natural motion of your foot rolls gradually from the heel to the toe, with your foot bending at the ball on each step. That's why it is important for walking shoes to have enough flexibility in just the right places. A good walking shoe should give a little when you twist it and bend at the ball of the foot. When you put the shoe on a flat surface and push on the toe the heel should come up off the surface. If it does, the shoe has the curvature you need to conform to your movement during walking. Make sure the heel is low and not too wide. A slight undercut in the heel will help your foot begin its roll from the heel through the step.

Here are some other important tips for buying a good pair of walking shoes:

• Shop at the end of the day when your feet are slightly swollen to get a good fit.
• Try on shoes with the socks you will wear when walking. If you use an orthotic, bring that to the store when you try on shoes as well.
• Have your feet measured standing up and fit your shoes to the larger of your two feet.
• Be sure there is enough room in the toe box for your toes to wiggle and about a half inch between your toes and the end of the shoe.
• Take time when shopping to try on different brands and walk around the store in each pair. Be sure to walk on a hard surface, not just on carpeting. Let your foot be the guide to the fit, not the shoe size or style.
• Look for lightweight, breathable materials for greater comfort.
• Run your hand all over and inside the shoes to feel for any seams or catches that might irritate your foot.
• Choose shoes that lace for better foot stability and control.
• Make sure your heel fits snugly and does not tend toward slipping out of the shoe.
• Wear your walking shoes only for walking to extend their life. Consider buying two pairs and rotating your wear to give each pair time to breath between walks.
• Replace walking shoes after every 300 to 600 miles, depending on how hard you are on your shoes.

Work shoes are available in many shapes and have unique features and materials designed for specific occupations and uses. Thick leather boots with steel toe boxes are designed to protect your feet. Boots with varying degrees of traction are also available.

The American Podiatric Medical Association offers the following guide that matches specific occupational hazards with work footwear:

Work shoes are available in many shapes and have unique features and materials designed for specific occupations and uses. Thick leather boots with steel toe boxes are designed to protect your feet. Boots with varying degrees of traction are also available.

The American Podiatric Medical Association offers the following guide that matches specific occupational hazards with work footwear:

Hazard and Protection

• Falling and rolling objects, cuts and punctures - Steel-toe safety shoes, add-on devices, such as metatarsal guards, metal foot guards, puncture-proof inserts, and shin guards.
• Chemicals, solvents - Footwear with synthetic stitching and made of rubber, vinyl, or plastic.

1. Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.

2. Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete's Foot. Any growth on the foot is not considered normal.

3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.

4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.

5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.

6. Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).

7. Alternate shoes, don't wear the same pair of shoes every day.

8. Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.

9. Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.

10. If you are a diabetic, please contact our office and schedule a check-up at least once a year.

Whether you are a professional athlete or play sports just for fun, the demands made on your feet and lower limbs can lead to a range of injuries, including blisters, sprained ankles, torn ligaments, shin splints, knee pain, lower back pain and other joint or muscle problems. Added to these are common complaints such as corns, calluses and Athlete's Foot. Your running style, quality of footwear, and even minor limb length differences can contribute to injury.

Here are some tips for athletic foot care:

• Wash your feet every day, and dry thoroughly.
• Wear only good quality, well-fitting cotton socks.
• Always use the correct shoe for each sport and surface.
• Get in shape. Being overweight or out of shape places added stress on the feet. Condition yourself gradually with stretching exercises for 15 to 20 minutes (warm-up and cool-down periods) before and after any activity.
• Wear correct shoes. Footwear should be given the same consideration as any other piece of sporting equipment. Sports shoes should protect as much as possible, be durable, and should be right for the sport and surface.

Most blisters on the feet are caused by friction and do not require medical attention. New skin will form underneath the affected area and the fluid built up in the blister is simply absorbed back into the tissue. You can soothe ordinary blisters with Vitamin E ointment or an aloe-based cream.

Do not puncture a blister unless it is large, painful, or likely to be further irritated. If you have to pop a blister, use a sterilized needle or razor blade. Wash the area thoroughly, then make a small hole and gently squeeze out the clear fluid. Apply a dab of hydrogen peroxide to help protect against infection. Do not remove the skin over a broken blister. The new skin underneath needs this protective cover. Cover the area with a bandage and mild compression.

If the fluid is white or yellow, the blister is infected and needs medical attention.

Preventing Blisters

You can prevent blisters by breaking in new shoes gradually, and putting petroleum jelly or an adhesive bandage on areas that take the rub—before the blister happens. Wear socks that have heels instead of tube socks (they bunch up and cause blisters). Acrylic and other synthetic-fiber socks are good choices. Be sure to wash and dry your feet daily to prevent bacterial infections, such as Athlete's Foot.

Children with strong, healthy feet avoid many kinds of lower extremity problems later in life. That's why it is important to inspect your children's feet periodically.

Infants

The size and shape of your baby's feet change quickly during their first year. Because a baby's feet are flexible, too much pressure or strain can affect the shape of their feet. It's important to allow baby to kick and stretch their feet freely. Also, make sure shoes and socks do not squeeze the toes.

Toddlers

Do not to force a toddler to walk before s/he is ready. Once walking begins, watch the toddler's gait. Many toddlers have a pigeon-toe gait, which is normal. Some initially learn to walk landing on their toes instead of their heels. Most children outgrow both these problems. But other conditions detected early can be treated more easily.

When Foot Care Is Needed

To help with flatfeet, special shoes or orthotics may be prescribed. To correct mild in-toeing or out-toeing, your toddler may need to sit in a different position while playing or watching TV. If your child's feet turn in or out a lot, corrective shoes, splints, or night braces may be prescribed.

The foot's bone structure is well-formed by the time your child reaches age 7 or 8, but if a growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly. With a doctor's care, however, the risk of future bone problems is reduced.

Remember to check your child's shoe size often. Make sure there is space between the toes and the end of the shoe and that the shoes are roomy enough to allow the toes to move freely. Don't let your child wear hand-me-down shoes.

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas.

Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist's instructions.

Diabetics are more prone to various foot problems than those without diabetes due to the development of painful nerve damage called peripheral neuropathy. Neuropathy can affect your entire body, but most often the legs and feet are the most prone areas to serious health complications.

The damage to your nerves can cause the loss of feeling in your feet, making it difficult to detect extreme temperatures and pain as easily, or readily, as someone who does not have diabetes. As a result, you could sustain a serious cut or wound and not even notice your foot is injured until an infection begins. Many diabetic foot problems can be prevented in some measure with improved blood sugar control and a strengthened immune system.

If you are among one of the millions of people in the United States with diabetes, it is important to visit your podiatrist for regular foot examinations in order to maintain healthy feet and a strong body.

Examine Your Feet Daily

Careful inspection of your feet on a regular basis is one of the easiest, least expensive and most effective measures for preventing foot complications. By examining your feet daily, and after every injury, you are taking a crucial step to preventing serious foot problems. Noticeable changes, such as temperature, skin color, pain, or swelling may be warning signs for poor circulation or loss of sensation that could potentially lead to something more serious.

Annual examinations by your podiatrist are also vital for anyone with diabetes. A podiatrist can provide a more thorough exam and detect any signs of changes, such as broken skin or ulcers that can be detrimental to the health of your feet and body. Your podiatrist can also check for areas of high pressure or loss of blood circulation.

Clean Your Feet

With diabetes, it is important to keep your feet clean. Wash your feet daily with warm water and mild soap. After washing, make sure you dry your feet thoroughly, especially in-between the toes. You may also apply non-irritating moisturizer to prevent cracks and to keep your feet smooth.

Be sure to also avoid ingrown toenails, which can get infected, by keeping them trimmed neatly. If you are unable to cut your toenails safely, ask your podiatrist for professional assistance. And never attempt to cut your own bunions or corns as this can lead to infection, as well. Instead, remember to visit your podiatrist for safe and pain free removal.

To further protect your feet from harm, be sure to:

• Avoid smoking, as it reduces blood flow to your feet
• Buy comfortable shoes that are not too tight or too loose
• Wear clean, dry socks and change them everyday
• Never walk barefoot in order to protect your feet from harmful objects

Diabetes is serious, especially when your feet are involved. Early detection and simple care are just a few things that can be done to control and prevent complications as they arise.

Your podiatrist plays a critical role in the prevention and management of complications of the foot in diabetics. Talk to your podiatrist today to see what you can do now to keep your feet safe, strong, and healthy.

It's normal for people to experience some foot problems as they age. But experts say that problems with feet can be the first sign of more serious medical conditions, particularly among older adults. Health problems, such as arthritis, diabetes, nerve issues, and circulatory disorders, may first be manifested in the feet. That is why it is important to pay attention to your feet and seek medical attention as soon as you notice a problem.

Here Are Some Foot Care Tips for Older Adults:

• Practice good foot care. Check your feet regularly or have a member of your family check them for you.
• Keep blood circulating to your feet as much as possible. Do this by putting your feet up when you are sitting or lying down, stretching if you've had to sit for a long while, walking, having a gentle foot massage, or taking a warm foot bath.
• Wear comfortable shoes that fit well to prevent pressures that can lead to friction and infection and keep your foot structure properly aligned.
• Avoid exposing your feet to cold temperatures.
• Don't sit for long periods of time (especially with your legs crossed).
• Don't smoke because it decreases blood supply and increases the chance of swelling and other circulatory problems.

What should you look for to make sure your feet are healthy? Here are some general guidelines:

• Balance - A good test for balance involves standing on one foot, with your arms out to the side and your eyes closed. If you are less than 30 years old, you should be able to balance for 15 seconds, 30 to 40 years old for 12 seconds, 40 to 50 years old for 10 seconds and over 50 years old for seven seconds. This can be improved with exercises.
• Circulation - Look at the color of your toes. Do they look like a normal nail color or are they leaning towards red, white, purple, or blue? Press down on the nail of your big toe until the color blanches. Now let go and allow the blood flow to return to your toe. The return of normal color should take 2 to 5 seconds in a person with average circulation.
• Flexibility - How flexible are your toes? Try to pick up a marble or a small dish towel with your toes. To test your ankle flexibility, hang your heel off of a stair. Now let the heel go below the level of the stair. If this causes pain, stop the test. If your heel goes below the level of the stair without causing strain in your calf, that is a good sign. If there is some strain, this can be improved with flexibility exercises.
• Pain - A healthy foot does not produce any pain.
• Sensation: Take a pencil eraser and lightly run it on the top, bottom, and both sides of your feet. The sensation should feel equal in all quadrants. It may tickle on the bottom of the feet. That is normal.
• Skin - Check your skin for calluses, blisters, or areas of irritation. Stand next to your shoes. Are they shaped like your feet or are they causing areas of constriction that may result in irritation? Put your hand inside your shoe. Are there seams, tacks, or rough places in the shoe that correspond to calluses or blisters on your feet?

Increased media attention has heightened awareness for the spread of infections from shared instruments and unhygienic practices in many salons. One way to avoid any exposure is to do pedicures for yourself at home. Here are some easy steps to follow that will make sure to keep your feet safe:

1. Soak your feet in warm soapy water for approximately 10 minutes. This helps soften and clean skin and nails.

2. After the foot soaking, gently rub the skin with a pumice stone or emery board. This gets rid of dead skin cells and calluses. Some body scrub products can help exfoliate dead skin. (Please contact our office if you have deep calluses or corns and need help shaving them.)

3. Push back the cuticles with an orange stick or a Hindu stone. Cuticles offer protection from bacteria and infection. Cuticles clearly overhanging the nail margins need to be carefully trimmed. Do not trim any further than the nail margin or draw blood as this can lead to infection.

4. Trim toenails straight across rather than in a curved pattern. This helps prevent ingrown toenails, allowing the straight edge of the nail to advance as one unit. Toenails should be trimmed just enough so that you can see a few millimeters of skin just beyond the nail margin. Nails should not overhang the edge of the toe.

5. Refine the nail edge with an emery board, maintaining the straight edge.

6. Apply cream and moisturizing lotion to the skin and nail margins.

7. Massage the cream or lotion into the feet. A foot massage can help relieve tension and tired, aching feet. You can get a good massage at home by rolling your feet back and forth over a rolling pin or bottle. Specialists in the body's reflexes, called reflexologists, believe that points on the foot correspond to other body parts and ailments can be relieved through reflexology. They believe the ball of the foot has a connection to the lungs, the heel to the lower back, and the great toe to the head. Although no scientific research exists to back up these claims, reflexology does seem to produce positive results in some people.

8. Apply nail polish remover to the nails to gently remove excess lotion. This allows nail polish to adhere better to the nail. To apply nail polish, start with a base coat, followed by one or two coats of the nail color, and, finally, a clear topcoat.

9. Space your pedicures apart by approximately eight weeks.

The Foot Health Foundation of America offers this simple quiz to pinpoint any warning signs of foot and ankle problems: (See bottom for scoring.)

1. How much time do you spend on your feet each day?

  A. Less than 2 hours 0

  B. 2 - 4 hours 1

  C. 5 - 7 hours 2

  D. 8 hours or more 3

2. How old are you?

  A. Under 40 0

  B. Between 40 and 59 1

  C. 60 and over 2

3. How would you describe your weight?  

  A. Less than 20 pounds overweight or at ideal weight 0

  B. 20 - 39 pounds overweight 2

  C. 40 or more pounds overweights 3

4. Have problems with your feet or ankles ever prevented you from participating in:  

  - leisure/sports activities  

  A. Yes 2

  B. No 0

  - work activities?  

  A. Yes 3

  B. No 0

5. Have you ever received medical treatment for problems with your feet and/or ankles?  

  A. Yes 3

  B. No 0

6. Do you regularly wear heels two inches or higher?  

  A. Yes 2

  B. No 0

7. What types of exercise do you engage in or plan to engage in? (check all that apply)  

  A. Walking 1

  B. Field sports (e.G., softball, golf) 2

  C. Winter sports (e.G., skiing, ice skating) 2

  D. Court sports (e.G., tennis, basketball) 3

  E. Aerobics 3

  F. Running 3

  G. None (if you shose answer g, skip to question 11) 0

8. Do you have the appropriate shoes for your sport or sports?  

  A. Yes 0

  B. No 3

9. Do you experience foot or ankle pain when walking or exercising?  

  A. Rarely 1

  B. Sometimes 2

  C. Often 3

  D. Never 0

10. Do you:  

  - exercise in footwear that is more than one year old or in hand-me-down footwear?  

  A. Yes 3

  - stretch properly before and after exercising?  

  A. Yes 0

  B. No 3

11. Do you:  

  - have diabetes?  

  A. Yes 3

  B. No 0

  - experience numbness and/or burning in your feet?  

  A. Yes 3

  B. No 0

  - have a family history of diabetes?  

  A. Yes 2

  B. No 0

12. Do you: (mark all that apply)  

  - sprain your ankles frequently (once a year or more) or are your ankles weak?  

  A. Yes 2

  B. No 0

  - have flat feet or excessively high arches?  

  A. Yes 2

  B. No 0

  - experience pain in the achilles tendon or heel or have shin splints

(pain in the front lower leg)?  

  A. Yes 2

  B. No 0

  - have corns, calluses, bunions or hammertoes?  

  A. Yes 3

  B. No 0

  - have arthritis or joint pain in your feet?  

  A. Yes 3

  B. No 0

  - have poor circulation or cramping in your legs?  

  A. Yes 3

  B. No 0

Scoring

0-20 Points: Congratulations! Your feet and ankles are very healthy and you can maintain your active lifestyle and/or exercise regimen. With proper attention and care your feet and ankles should remain healthy; however, you may want to schedule an annual exam with a podiatric physician to ensure their long-term health. Furthermore, if you scored points for questions 4, 5, 9, 11 or 12 you should consider visiting a podiatric physician in the near future for a check-up.

21 - 40 Points: Pay attention. Your feet and ankles are showing signs of wear, placing you in the moderate risk category. Although you can continue your normal activities, you should strongly consider visiting a podiatric physician for a check-up. If you participate in a rigorous exercise regimen on a regular basis or plan to - or if you scored points for questions 4, 5, 9, 11 or 12 - you should visit a podiatric physician soon to safeguard your foot and ankle health.

41 Points or Higher: Caution. Your feet and ankles are at high risk for long-term medical problems and you should contact our office as soon as possible. If you exercise, you should pay particular attention to your feet and ankles until you are seen by our practice. If you have not begun exercising, it is advisable to contact our office before undertaking any type of exercise.

Now that you've assessed the health of your feet and ankles, you are armed with knowledge that will enable you to maintain their health over a lifetime.

PLEASE NOTE: EVEN IF YOU SCORED WELL, THIS SELF ASSESSMENT IS NOT A SUBSTITUTE FOR A PHYSICAL EXAM.

Women invite foot problems by wearing high heels. High heels may contribute to knee and back problems, disabling injuries in falls, shortened calf muscles, and an awkward, unnatural gait. In time, high heels may cause enough changes in the feet to impair their proper function. Most women admit high heels make their feet hurt, but they tolerate the discomfort in order to look taller, stylish, and more professional.

There are ways to relieve some of the abusive effects of high heels. Women can limit the time they wear them by alternating with good-quality, oxford-type shoes or flats for part of the day. Keep the heel height to no more than two inches and make sure the fit for the rest of the shoe is good. Varying heel heights whenever possible to wear shoes as low as possible in each situation. For example, there are comfortable and attractive "walking" pumps for women for work and social activities.

Experts Say the Best Shoes for Women May Be:

Women invite foot problems by wearing high heels. High heels may contribute to knee and back problems, disabling injuries in falls, shortened calf muscles, and an awkward, unnatural gait. In time, high heels may cause enough changes in the feet to impair their proper function. Most women admit high heels make their feet hurt, but they tolerate the discomfort in order to look taller, stylish, and more professional.

There are ways to relieve some of the abusive effects of high heels. Women can limit the time they wear them by alternating with good-quality, oxford-type shoes or flats for part of the day. Keep the heel height to no more than two inches and make sure the fit for the rest of the shoe is good. Varying heel heights whenever possible to wear shoes as low as possible in each situation. For example, there are comfortable and attractive "walking" pumps for women for work and social activities.

Experts Say the Best Shoes for Women May Be:

• A walking shoe with ties (not a slip-on).
• Shoes with a Vibram-type composition sole.
• A relatively wider heel, no more than a half or three-quarters of an inch in height.

Women who always wear nylon pantyhose expose themselves to a host of foot problems. Nylon doesn't breathe and the heat that it generates and traps can lead to excessive perspiration. A warm, damp area is an ideal place for fungal infections such as Athlete's Foot.

Inexpensive nylon pantyhose can also cause forefoot problems, because they don't allow the normal expansion of the foot when walking, and may pull the toes backward when the pantyhose ride up. The cramping and pressure of the hose can contribute to ingrown toenails and hammertoes. If you must wear pantyhose, be sure they fit properly around the foot. Limit the length of time you wear them whenever possible and, like socks, wash them after every use.

Pregnant women need to observe good foot health to prevent pain and discomfort. Since the body undergoes changes and acquires a new weight-bearing stance, women should wear shoes with broad-based heels that provide support and absorb shock. Additional body weight also calls for more support, to prevent foot "breakdown."

The expectant mother often experiences more than ordinary swelling of her feet and ankles, which can aggravate existing foot conditions and promote inflammation or irritation. Pregnancy also triggers the release of hormones that enhance loose ligaments, which can contribute to foot strain. To help overcome these problems, allow time each day to stay off your feet. Elevate the feet and legs when you are sitting to help prevent and reduce swelling. Don't sit for long periods of time. If problems do develop, please contact our office.

Older women have more trouble with their feet than younger ones, often because fat pads on the bottom of the feet tend to deteriorate in the aging process. Many foot problems for older women can be alleviated simply by wearing properly fitted, well-constructed shoes that provide cushioning and have a soft, flexible upper that will conform to the shape of their feet. Shoes made of leather that "breathes" can also reduce the possibility of skin irritation.

Soles should be lightweight, with enough flexibility and shock-absorbing quality to provide solid footing and not be slippery. Low-heeled shoes provide greater stability, more protection for the feet, and greater comfort. Because older women often have circulatory problems, they have a special need to keep their feet warm in cold weather, to prevent frostbite or chilblains. Most importantly, keep walking and moving around every day so that all the systems in the legs and feet remain stretched and circulation stays healthy.

Productive workers depend on their ability to walk and move about safely, with ease and comfort.

When your job requires you to stand on your feet for long periods, work in potentially hazardous areas or with potentially hazardous materials, you have some increased risk of foot injury. You can do a lot to prevent injuries by keeping your feet healthy and following safe work practices.

According to the National Safety Council, in any given year, there are about 120,000 job-related foot injuries, one-third of them toe injuries.

In addition to following the same basic foot care guidelines for all people, when you are on the job be sure to develop safe work habits and attitudes. This includes wearing protective footwear when appropriate. The National Safety Council also reports that only one out of four victims of job-related foot injury wear any type of safety shoe or boot. The remaining three either are unaware of the benefits of protective footwear or complain about it.

Because bunions develop slowly, taking care of your feet during childhood and early adulthood can pay off later in life. Keep track of the shape of your feet as they develop over time, especially if foot problems run in your family.

Exercising your feet can strengthen them. Learn to pick up small objects with your toes. Wear shoes that fit properly and that do not cramp or pinch your toes. Women should avoid shoes with high heels or pointed toes

Burning feet are a common complaint among many groups of people, most commonly those over 50 years of age and in diabetics. There are many causes. Heavy alcohol use may lead to the condition. Neuropathy and loss of sensation often are contributors as well. Other causes include thyroid dysfunction and gastric restriction in obesity. Some infectious diseases, such as leishmaniasis, a rarely reported neurologic change secondary to a bacteria, also may cause burning feet.

Treatment

Treatments vary, depending on the cause of the burning foot syndrome. Diagnostic tests often are performed before a diagnosis is made.

A chronic infection caused by various types of fungus, Athlete's foot is often spread in places where people go barefoot such as public showers or swimming pools. The condition ranges from mild scaling and itching to painful inflammation and blisters. It usually starts between the toes or on the arch and may spread to the bottom and sides of the foot.

General Treatments

Depending on the type of infection you have, various kinds of medication may be used in treating your fungal problem. Successful treatment usually involves a combination of medication and self-care.

If your condition is not serious, over-the-counter and prescription powders, lotions, or ointments can often help treat scaling, itching, and inflammation. Consult us before taking any medication. Foot soaks may help dry excessive perspiration, but you should contact our office first. If your Athlete's foot does not improve, we may prescribe stronger medication.

Athlete's foot and fungal nails are the most common fungal problems with feet. A fungus is a common mold that thrives in dark, warm moist areas. On the feet, it can grow on and between toes, as well as on soles and toenails. Fungal problems can be a result of the environment (socks, shoes, heat and humidity) or weakened immunity from such disorders as diabetes.

Chronic fungal infections are most common in adults, while acute fungal infections are seen more often in children.

Since fungal nails are usually more resistant and more difficult to treat than Athlete's foot, topical or oral antifungal medications may be prescribed. Permanent nail removal is another possible form of treatment for fungal nails.

After a fungal nail infection has cleared up, you can take steps to prevent the infection from coming back.

Keeping the fungus under control will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a non-prescription anti-fungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.

Other Tips:

• Don't share nail clippers or nail files with others.
• Don't share shoes or socks with others.
• Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).
• Wear dry cotton socks, and change them two or three times a day if necessary.
• Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
• Wear shower sandals or shower shoes when you are at a public pool or shower.

Prevention

Follow basic foot care guidelines and you more than likely can head off most common foot fungus problems.

• Wear dry cotton socks, and change them two or three times a day if necessary.
• Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
• Wear shower sandals or shower shoes when you are at a public pool or shower.
• Don't share shoes or socks with others.
• Don't share nail clippers or nail files with others.

Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).

Follow basic foot care guidelines and you more than likely can head off most common foot fungus problems.

Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure.

Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers.

If they become painful or infected, contact our office. We may remove the ingrown portion of the nail, and if the condition reoccurs frequently, we may permanently remove the nail.

Your feet may be one of the first places to see the effects of osteoporosis. A stress fracture in the foot is often the first sign.

There is a lot you can do throughout your life to prevent osteoporosis, slow its progression and protect yourself from fractures.

• Include adequate amounts of calcium and vitamin D in your diet.
• Exercise regularly.

Smelly feet generally can be controlled with a few preventive measures:

• Always wear socks with closed shoes.
• Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh or other materials that let your feet breathe.
• Bathe your feet daily in lukewarm water, using a mild soap. Dry thoroughly.
• Change your socks and shoes at least once a day.
• Check for fungal infections between your toes and on the bottoms of your feet. If you spot redness or dry, patchy skin, get treatment right away.
• Don't wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn't go away, discard the shoes.
• Dust your feet frequently with a non-medicated baby powder or foot powder. Applying antibacterial ointment also may help.
• Practice good foot hygiene to keep bacteria levels at a minimum.
• Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.

These preventive measures also can help prevent Athlete's foot which can flourish in the same environment as sweaty feet. However, Athlete's foot won't respond to an antibacterial agent because it's caused by a fungus infection. Use an anti-fungal powder and good foot hygiene to treat Athlete's foot.

Persistent foot odor can indicate a low-grade infection or a severe case of hereditary sweating. In these cases, our practice may prescribe a special ointment. You apply it to the feet at bedtime and then wrap your feet with an impermeable covering such as kitchen plastic wrap.

Soaking your feet in strong black tea for 30 minutes a day for a week can help. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.

A form of electrolysis called iontophoresis also can reduce excessive sweating of the feet, but requires special equipment and training to administer. In the most severe cases of hyperhidrosis, a surgeon can cut the nerve that controls sweating. Recent advances in technology have made this surgery much safer, but you may notice sweating in other areas of the body after the procedure.

Understanding the basic construction of shoes will help you make more informed decisions and select shoes that fit your foot and needs.

Shoes are made up of five major components:

• The toe box is the tip of the shoe that provides space for the toes. Toe boxes are generally rounded, pointed, or squared and will determine the amount of space provided for the toes.
• The vamp is the upper middle part of the shoe where the laces are commonly placed. Sometimes Velcro is used instead of laces.
• The sole consists of an insole and an outsole. The insole is inside the shoe; the outsole contacts the ground. The softer the sole, the greater the shoe's ability to absorb shock.
• The heel is the bottom part of the rear of the shoe that provides elevation. The higher the heel, the greater the pressure on the front of the foot.
• The last is the part of the shoe that curves in slightly near the arch of the foot to conform to the average foot shape. This curve enables you to tell the right shoe from the left.

The material from which a shoe is made can affect fit and comfort. Softer materials decrease the amount of pressure the shoe places on the foot. Stiff materials can cause blisters. A counter may be used to stiffen the material around the heel and give added support to the foot.

Athletic footwear should be fitted to hold the foot in the position that's most natural to the movement involved. Athletic shoes protect your feet from stresses encountered in a given sport and to give the player more traction. The differences in design and variations in material, weight, lacing characteristics, and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress.

Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations.

Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes. Don't wear any sport or other shoes beyond their useful life.

A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. Cross training shoes are fine for a general athletic shoe, such as for physical education classes or health club exercising, such as on stair machines and weight-lifting because they provide more lateral support and less flexibility than running shoes. They also tend to be heavier than running shoes, but most people don't need light, flexible shoes for cross-training. If a child is involved more heavily in any single sport, he or she should wear shoes specifically designed for that sport.

Our practice recommends sturdy, properly fitted athletic shoes of proper width with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with acrylic fiber content so that some perspiration moisture is "wicked" away.

Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down. The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear. Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.

Choosing shoes for your children can play a critical role in their musculoskeletal development, including their posture.

In general, infants just learning to walk do not need shoes. Infants may go barefooted indoors, or wear only a pair of socks. This helps the foot grow normally and develop its muscles and strength as well as encourages the grasping ability of toes.

Once children are ready to walk as toddlers, their need for properly-fitted shoes is important. In general, a soft, pliable, roomy shoe, such as a sneaker, is ideal for all children. The toe box should provide enough space for growth and should be wide enough to allow the toes to wiggle. A finger's breadth of extra length will usually allow for about three to six months' worth of growth, though this can vary depending on your child's age and rate of growth.

Because high-top shoes tie above the ankle, they are recommended for younger children who may have trouble keeping their shoes on. Contrary to common belief, however, high-top shoes offer no advantages in terms of foot or ankle support over their low-cut counterparts.

Here are some tips when purchasing shoes for children:

• Both feet should be measured every time you shop for new shoes since those little feet are growing. If, as is common, the feet are two different sizes, shoes should be fitted to the larger foot.
• The child's foot should be sized while he or she is standing up with full weight-bearing.
• There should be about one-half inch of space (or a thumb's width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.
• Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Look for signs of irritation on the foot after the shoe is tested.
• Put your hand inside the shoe and feel around for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot.
• Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends at the ball of the foot, not in the middle of the shoe.
• Never try to force your child's feet to fit a pair of shoes.
• Shoes should not slip off at the heels. Children who have a tendency to sprain their ankles will do better with high-top shoes or boots.

Children who frequently remove shoes from their feet may be signaling some discomfort. Check your child's feet periodically for signs of too-tight shoes, such as redness, calluses or blisters, which will help you know when they've outgrown their shoes.

Remember that the primary purpose of shoes is to prevent injury. Shoes seldom correct children's foot deformities or change a foot's growth pattern. Casting, bracing, or surgery may be needed if a serious deformity is present. If you notice a problem, please contact our office to have your child's feet examined.

Proper footwear is an important part of an overall treatment program for people with diabetes, even at the earliest stages of the disease. If there is any evidence of neuropathy, wearing the right footwear is crucial.

As a general rule, people with diabetes should choose shoes that:

• Accommodate, stabilize, and support deformities, such as Charcot Foot, loss of fatty tissue, hammertoes, and amputations. Many deformities need to be stabilized to relieve pain and avoid further damage. In addition, some deformities may need to be controlled or supported to decrease further progression of the deformity.
• Limit motion of joints. Limiting the motion of certain joints in the foot can decrease inflammation, relieve pain, and result in a more stable and functional foot.
• Reduce shock and shear. A reduction in the overall amount of vertical pressure, or shock, on the bottom of the foot is desirable, as well as a reduction of horizontal movement of the foot within the shoe, or shear.
• Relieve areas of excessive pressure. Any area where there is excessive pressure on the foot can lead to skin breakdown or ulcers. Footwear should help to relieve these high pressure areas, and therefore reduce the occurrence of related problems.

Prescription Footwear

Many diabetics need special prescription footwear. The various types include:

• Custom-Made Shoes: When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.
• External Shoe Modifications: In these cases, the outside of the shoe is modified in some way, such as adjusting the shape of the sole or adding shock-absorbing or stabilizing materials.
• Healing Shoes: Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes.
• In-Depth Shoes: An in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4-inch to 1/2-inch of depth throughout the shoe. This extra volume accommodates inserts, or orthotics, as well as deformities commonly associated with a diabetic foot. In-depth shoes are usually designed to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.
• Orthoses or Shoe Inserts: Also known as orthotics, an orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthotics or shoe inserts are commonly recommended for patients with diabetes, including a special total contact orthosis, which is made from a model of the patient's foot and offers a high level of comfort and pressure relief.

• Avoid shoes that have seams over areas of pain, such as a bunion.
• Avoid shoes with heavy rubber soles that curl over the top of the toe area (such as seen on some running shoes), because they can catch on carpets and cause an accidental fall.
• Flat shoes (with a heel height of one inch or less) are the healthiest shoes for your feet. If you must wear a high heel, keep to a heel height of two inches or less, limit their wear to three hours at a time, and take them off coming to and from an activity.
• Laced, rather than slip-on shoes, provide a more secure fit and can better accommodate insoles, ORTHOTIC devices, and braces.
• Look for soles that are shock absorbing and skid resistant, such as rubber, rather than smooth leather.
• Shoes should be made of a soft material that has some give.

Everything from serious foot disorders to more common foot and ankle conditions can be exacerbated by one, avoidable cause: inappropriate, poor quality, and/or ill-fitting shoes. Any podiatrist will tell you that a quality, properly fitted shoe pays big dividends for your feet—now and in the future.

The most important quality to look for in shoes is durable construction that will protect your feet and keep them comfortable. Shoes that do not fit properly can cause bunions, corns, calluses, hammertoes and other disabling foot disorders.

The Fitting

Here are some tips to help reduce the risk of foot problems when shopping for shoes:

• Don't force your feet into a pair of shoes in order to conform to the shape of the shoe. The shoe needs to conform to the shape of your foot.
• Fit new shoes to your largest foot. Most people have one foot larger than the other.
• Have both feet measured every time you purchase shoes. Foot size increases as you get older.
• If the shoes feel too tight, don't buy them. There is no such thing as a "break-in period."
• Many high-heeled shoes have a pointed or narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box. Limit heel height to two inches or less to protect your feet.
• Shoes should be fitted carefully to your heel as well as your toes.
• Sizes vary among shoe brands and styles. Judge a shoe by how it fits on your foot, not by the marked size.
• There should be a half-inch of space from the end of your longest toe to the end of the shoe.
• Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day, which makes for a better fit.
• Be sure to try on both shoes. Walk around the shoe store in the shoes to make sure they fit well and feel comfortable.
• When the shoe is on your foot, you should be able to freely wiggle all of your toes.

Most men's shoes conform to the shape of the feet and have a roomy toe box with sufficient horizontal and vertical space and a low heel (usually about half an inch high). Soles made of either hard materials (such as leather) or soft materials (such as crepe) can be worn, but softer soles tend to be more comfortable. If you stand for extended periods of time, shoes with soft, pliable and cushioned soles will protect your feet and help keep them comfortable.

The best shoes for men are good quality oxford styles, shoes ordinarily associated with wing-tip or cap toe designs. Also suitable are slip-ons, dressy loafers, and low dress boots.

It is advisable to have three to five pairs of shoes for business so that you can alternate your shoes on a daily basis.

The best shoe for women's feet is a walking shoe with laces (not a slip-on), a composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height.

Some women inflict punishment on their feet from improper footwear that can bring about unnecessary foot problems. Some of the problems result from high-heeled shoes (generally defined as pumps with heels of more than two inches).

A study conducted by the American Orthopaedic Foot and Ankle Society found that:

• Nine out of 10 women wear shoes that are too small for their feet.
• Eight out of 10 women say their shoes are painful.
• More than 7 out of 10 women have developed a bunion, hammertoe, or other painful foot deformity.
• Women are nine times more likely to develop a foot problem because of improper fitting shoes than a man.
• Nine out of 10 women's foot deformities can be attributed to tight shoes.

High-heeled, pointed-toe shoes can cause numerous orthopedic problems, leading to discomfort or injury to the toes, ankles, knees, calves, and back. Many high-heeled-shoes also have a pointed, narrow toe box that crowds the toes and forces them into an unnatural triangular shape. These shoes distribute the body's weight unevenly, placing excess stress on the ball of the foot and on the forefoot. This uneven distribution of weight, coupled with the narrow toe box characteristic of most high heels, can lead to discomfort, bunions, hammertoes, and other deformities.

The height of the heel makes a dramatic difference in the pressure that occurs on the bottom of the foot. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.

To relieve the abusive effects of high heels, women should limit the amount of time they wear them and alternate these shoes with good quality sneakers or flats for part of the day. Look for comfortable and attractive walking pumps for work and social activities, that blend fashion appeal with athletic shoe-derived construction, reinforced heels, and wider toe room for greater comfort. Low-heeled shoes (one inch or lower) with a wide toe box are the ideal choice for women. An ample toe box that can accommodate the front part of the foot is as important as the heel in determining fit.

When you take a step, your foot typically hits the ground heel first and rolls toward your toes, flattening the arch slightly. As you push off the ball of your foot, your arch springs back and does not touch the ground. That's how normal feet are supposed to work. Unfortunately, many feet aren't normal.

Overpronation occurs if your foot rolls too much toward the inside. This can cause arch strain and pain on the inside of the knee. Underpronation occurs if your foot rolls too much to the outside. Underpronation can lead to ankle sprains and stress fractures. You can relieve foot pain by compensating for these tendencies, but first you need to determine which way your feet roll.

One method for determining which kind of pronation you have is the watermark test: Put your feet into a bucket of water, then make footprints on a piece of dark paper.

• If your footprint looks like an oblong pancake with toes, you pronate excessively or may have flat feet. Try molded-leather arch supports, which can be purchased in many drug stores. And when shopping for athletic shoes, ask a sales clerk for styles with "control" features—soles designed to halt the rolling-in motion. If arch supports or sports shoes don't help, please contact our office for a custom-molded orthotics.
• If there's little or no connection in your footprint between the front part of the foot and the heel, you under-pronate or have a high arch. This means a lot of your weight is landing on the outside edge of your foot. Ask for "stability" athletic shoes, which are built with extra cushioning to remedy this problem. If you are prone to ankle sprains, wear high-top athletic shoes that cover the foot and ankle snugly to minimize damage from twists.

Examining old shoes before buying new ones can help you evaluate your wear patterns and buy new shoes with a better fit and style that compensates for the stresses you place on shoes.

What are your shoes trying to tell you? Here is a translation of basic wear patterns:

• A bulge and wear to the side of the big toe means too-narrow fit or you have a bunion.
• Outer sole wear means you turn your foot out. orthotics may help.
• Toe-shaped ridges on the upper means your shoes are too small or you have hammertoes.
• Wear on the ball of the foot means your heel tendons may be too tight.
• Wear on the inner sole means you pronate or turn your foot inward. Inner liners or orthotics may help.
• Wear on the upper, above the toes means the front of your shoe is too low.

National Institutes of Health

http://www.nih.gov

NIHInfo@OD.NIH.GOV (e-mail)

(301) 496-4000

National Institute on Aging

http://www.nih.gov/nia

Information Center

P.O. Box 8057

Gaithersburg, Maryland 20898-8057

(800) 222-2225

(800) 222-4225 (TTY)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

http://www.niddk.nih.gov

Building 31

Room 9A04 Center Drive, MSC 2560

Bethesda, MD 20892-2560

American Diabetes Association

http://www.diabetes.org

(800) 342-2383

American Academy of Podiatric Sports Medicine

http://www.aapsm.org

(888) 854-FEET

American Academy of Orthopaedic Surgeons

http://www.aaos.org

6300 N. River Road

Rosemont, IL 60018

(847) 823-7186

American College of Foot and Ankle Surgeons

http://www.footphysicians.com and http://www.acfas.org

8725 W. Higgins Road, Sutie 555

Chicago, IL 60631-2724

(773) 693-9300

American Physical Therapy Association

http://www.apta.org

1111 N. Fairfax Street

Alexandria, VA 22314-1488

(800) 999-2782

American Podiatric Medical Association

http://www.apma.org

9312 Old Georgetown Road

Bethesda, MD 20814-1621

(301) 581-9200

American Orthopaedic Foot and Ankle Society

http://www.aofas.org

6300 N. River Road, Suite 510

Rosemont, IL 60018

(800) 235-4855

American Podiatric Medical Association

Mayo Clinic Online

http://www.mayoclinic.com

Medlineplus

http://www.nlm.nih.gov/medlineplus

A Resource of the U.S. National Library of Medicine and the National Institutes of Heatlh

Podiatryonline

http://www.podiatry-online.net

Webmd

http://www.webmd.com