Foot and Ankle Academy > Foot and Ankle Conditions

Equinus (Tight Achilles Tendon) Overview

What is Equinus?

Achilles equinus or “tight Achilles tendon” is a condition in which the upward bending of the ankle joint is limited. Someone with equinus lacks the flexibility and can occur in one or both feet.  People with equinus develop ways to “compensate” for their limited ankle motion. Individuals can compensate by picking up the heel early when walking (early heel off) leading to “toe walking”, picking up the heel early when walking, and this often leads to other foot, leg, or back problems.

 

Causes of Achilles Equinus (Tight Achilles Tendon):

  • Tightness of gastrocnemius muscle (calf muscle)
  • Tightness of soleus muscle
  • Congenital (present at birth)
  • Long cast immobilization
  • Use of crutches
  • Wearing high heel shoes
  • Lack of stretching exercises
  • Neurological (spastic) disorder

 

Foot Problems Related to Achilles Equinus:

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Achilles Tendonitis
  • Metatarsalgia (pain on the ball of the foot)
  • Callus formation on the ball of the foot
  • Flatfoot deformity
  • Midfoot arthritis
  • Ulcer (pressure sore) to the ball of the foot
  • Bunions
  • Hammertoes
  • Shin Splints

 

Diagnosis of Achilles Equinus:

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened).  Less than 10 degrees of ankle dorsiflexion is considered tight Achilles tendon (equinus)

 

Non-Surgical Treatment of Achilles Equinus:

  • stretching exercises that lengthen Achilles tendon
  • Night Splints shopping cart
  • Physical therapy
  • Topical pain relieving gel shopping cart

 

When is Surgery Needed for a Symptomatic Tight Achilles Tendon?

In some cases, surgery such as Achilles tendon lengthening or gastrocnemius recession may be needed to correct the cause of equinus.

 

Accessory Navicular Bone Overview and Image

What is Accessory Navicular Bone?

An accessory navicular bone is an accessory bone of the foot that occasionally develops inside of the foot. This bone is usually asymptomatic and may be present in approximately 2-14% of the general population.  When it does become symptomatic, surgery may be necessary to remove the bone.

Symptoms of an accessory navicular bone may include pain and swelling to inside part of the foot at the level of insertion of posterior tibial tendon.

 

Accessory Navicular Bone is Also Known As:

  • Os Tibiale Externum
  • Os Naviculare Accessorium

 

Image of Accessory Navicular Bone:

Accessory Navicular Bone, Os Tibiale Externum, Os Naviculare Accessorium
Accessory Navicular Bone, Os Tibiale Externum, Os Naviculare Accessorium

Fungal Toenail (Onychomycosis)

Toenail Fungus Overview


Fungal nail
infection (onychomycosis)  is a common foot condition that affects people of all ages.  It is commonly seen in older individuals or in individuals who have decreased immune system.

Fungi are a group of organism that like to live in dark, warm, moist areas and fungal skin infection (Tinea Pedis) is known to be a predisposing factor to fungal nail infection.

You may see:

  • White, yellow or brown discoloration under the nail plate
  • Nail plate may be discolored
  • Nail plate may be thickened
  • May have debris build up under the nail plate
  • Nail plate may be brittle, flaky and have crumbling edges
  • As the nail becomes thicker, it may become painful with shoe gear

Causes of Toenail Fungus:

A fungus that belongs to a group of fungi called dermatophytes typically causes fungal nails infections.

Conservative Treatment of fungal nail infection:

  • Over the counter or prescription topical medications (solutions, cream)
  • Laser nail treatment (in office treatment)
  • Anti fungal medications by mouth

Surgical Treatment of Toenail Fungus:

Rarely invasive / surgical intervention is indicated for fungal nail infection.  Surgical treatment / removal of nail plates are usually reserved for painful / symptomatic fungal toenails.

toenail fungus

 

Foot Pain: Symptoms and Treatment

Foot Pain Overview

Foot is made up of 26 bones, 33 joints, 107 ligaments, 19 muscles, and numerous tendons. Complex foot 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 pain

Foot Pain Causes May Include:

  • Mechanical (tight fitting shoes)
  • Biomechanical ( i.e. flatfeet, high arch foot)
  • Musculoskeletal (bone, tendon, ligament)
  • Metabolic (i.e. Gout)
  • Autoimmune (i.e. Rheumatoid Arthritis, Psoriatic arthritis)
  • Infectious (i.e. ulcers, ingrown toe nail, residual foreign body)

*** Please refer to our comprehensive foot and ankle symptom checker to learn more about your foot pain.

 

When should you seek medical treatment for you foot pain?

  • Seek immediate medical attention if you had an injury which led to numbness of your foot / toes
  • Seek immediate medical attention if you had an injury which led to swelling, coolness and color changes your foot / toes
  • Seek immediate medical attention if you believe you have an infection.
  • Seek immediate medical attention if you had trauma to the foot and the area looks deformed
  • Seek immediate medical attention if you have loss of function of your foot / toes
  • Seek immediate medical attention if the area of concern is exquisitely tender to touch
  • If your foot pain interferes with you daily living or if you are unable to perform your desired activities without pain

 

Foot Pain Symptom Checker: Check Your Symptoms

Foot and ankle symptom checker is intended for informational purposes only

Footandankleacademy.com and foot and ankle symptom checker does not provide medical advice. It is intended for informational purposes only. Information obtained on footandankleacademy.com and through foot and ankle symtom checker is not and should not be a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the footandankleacademy.com. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Foot and Ankle Symptom Checker

Foot Ganglion Cyst Treatment

Foot Ganglion Cyst Overview

A Ganglion cyst is a benign, fluid filled sac that often appears on or around tendons or joints.  Most often it occurs in the hand or foot.  Ganglion cysts are also known as “Bible cyst” derived from a common treatment in the past that consisted of hitting the cyst with a Bible or a large book, hoping to burst the sack. The size of the ganglion cyst may vary over time and it is not uncommon for the size to change day to day.

 

What are the Symptoms of Ganglion Cyst in the Foot?

  • A large or small bump on top of the foot
  • bump may feel soft or spongy
  • bump may be mobile

 

Possible Treatments of Ganglion Cyst in the Foot

  • Needle aspiration (putting a needle into the cyst and remove the fluid)
  • Needle aspiration of the cyst with injection of corticosteroid into the cyst
  • Surgical excision (surgical removal) of the cyst

 

Possible Risks Involved with Treatment of a Ganglion Cyst

  • Infection of the surgical site
  • Infection at the needle aspiration site
  • Nerve and Artery damage along the incision site
  • there’s no guarantee that a ganglion cyst won’t recur, even after surgical removal of the cyst

 

 

 

foot ganglion cyst

foot ganglion cyst treatment

foot ganglion cyst treatment

foot ganglion cyst treatment

Foot Ganglion Cyst

Foot Ganglion Cyst Overview

A Ganglion cyst is a benign, fluid filled sac that often appears on or around tendons or joints.  Most often it occurs in the hand or foot.  Ganglion cysts are also known as “Bible cyst” derived from a common treatment in the past that consisted of hitting the cyst with a Bible or a large book, hoping to burst the sack. The size of the ganglion cyst may vary over time and it is not uncommon for the size to change day to day.

 

 

 

What are the Symptoms of Ganglion Cyst in the Foot?

  • A large or small bump on top of the foot
  • bump may feel soft or spongy
  • bump may be mobile

 

Possible Treatments of Ganglion Cyst in the Foot

  • Needle aspiration (putting a needle into the cyst and remove the fluid)
  • Needle aspiration of the cyst with injection of corticosteroid into the cyst
  • Surgical excision (surgical removal) of the cyst

 

Possible Risks Involved with Treatment of a Ganglion Cyst

  • Infection of the surgical site
  • Infection at the needle aspiration site
  • Nerve and Artery damage along the incision site
  • there’s no guarantee that a ganglion cyst won’t recur, even after surgical removal of the cyst

 

 

 

foot ganglion cyst

Foot Arthritis Symptoms and Treatment

What is Foot Arthritis?

Arthritis refers to painful inflammation and stiffness of joints which as time can be very painful and disabling.  The most common form is osteoarthritis (breakdown of cartilage in the joints, leading to bone to bone contact). Foot arthritis can produce ankle swelling and pain and in severe cases it can cause loss of function.

Other causes of foot arthritis are:

  • Rheumatological conditions such as Rheumatoid Arthritis
  • Traumatic (due to fracture that affected the joint)
  • Gouty arthropathy (Gout attack)

Flat Feet Causes and Treatment

Flat Feet Causes and Treatment

Flat feet, medically known as flexible pes planus is a foot deformity where the individual lacks or has decreased foot arch when they stand on their feet and arches recreate when not standing hence the term “Flexible”.  It is most often noted in childhood and continues into adulthood. It is a complex deformity with varying degree of deformity and symptoms.  In general, patient’s pain and symptoms correlate to the amount of deformity.  The more the deformity, the more patients’ symptoms and disability will be. If left untreated, it can lead to arthritis and limited function.

Flat Feet Causes:

  • It is congenital (patient inherits the deformity from mom and/or dad)

 

Findings of having Flat Feet:

  • Partial or complete collapse of the arch of the foot 
  • Tight Achilles tendon (Ankle Equinus)
  • Patient may have bunions and/ or hammertoes as a result of a flatfoot
  • Pain in the ball of the foot as the result of tight Achilles tendon
  • Front part of the foot / toes may be pointing outward
  • The heel tilts toward the outside and the ankle appears to turn in (Calcaneal valgus)

Symptoms of Flat Feet:

  • Pain in the arch, ankle region
  • Pain along the shin bone (shin splint)
  • General aching or fatigue in the foot or leg
  • Ankle, knee, hip or lower back

Imaging:

  • X-ray is helpful in assessing the severing of deformity and to rule out arthritis

 

Flat Feet Treatment (Conservative):

  • Activity modifications. Avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches will aggravate your symptoms.
  • Orthotic devices. Use orthotic devices in your shoes to support to the arches.
  • Immobilization. In severe cases, it may be necessary to immobilize the foot to decrease pain and symptoms.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot (Please refer to our comprehensive shoe list to find the appropriate shoe based on you foot type)

 

When is Surgery Necessary for Flat Feet?

In some patients whose pain is not adequately relieved by other treatments, surgery may be considered. A variety of surgical techniques is available to correct flexible flatfoot and one or a combination of procedures may be required to relieve the symptoms and improve foot function.

Flat Feet (Pes Planus)

Flat Feet Causes, Symptoms and Treatment

Flat feet medically known as flexible pes planus is a foot deformity where the individual lacks or has decreased foot arch when they stand on their feet and arches recreate when not standing hence the term “Flexible”.  It is most often noted in childhood and continues into adulthood. It is a complex deformity with varying degree of deformity and symptoms.  In general, patient’s pain and symptoms correlate to the amount of deformity.  The more the deformity, the more patients’ symptoms and disability will be. If left untreated, it can lead to arthritis and limited function.

 

What Causes to Have Flat Feet?

  • It is congenital (patient inherits the deformity from mom and/or dad)

 

Findings of having Flat Feet:

  • Partial or complete collapse of the arch of the foot 
  • Tight Achilles tendon (Ankle Equinus)
  • Patient may have bunions and/ or hammertoes as a result of a flatfoot
  • Pain in the ball of the foot as the result of tight Achilles tendon
  • Front part of the foot / toes may be pointing outward
  • The heel tilts toward the outside and the ankle appears to turn in (Calcaneal valgus)

 

What are Some Symptoms of Having Flat Feet:

  • Pain in the arch, ankle region
  • Pain along the shin bone (shin splint)
  • General aching or fatigue in the foot or leg
  • Ankle, knee, hip or lower back

 

Diagnostic Imaging for Flat Feet:

  • X-ray is helpful in assessing the severing of deformity and to rule out arthritis

 

What are Some Conservative Treatments for Symptomatic Flat Feet? 

  • Activity modifications. Avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches will aggravate your symptoms.
  • Orthotic devices. Use orthotic devices in your shoes to support to the arches Abductor hallucis muscle strain
  • Immobilization. In severe cases, it may be necessary to immobilize the foot to decrease pain and symptoms.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot (Please refer to our comprehensive shoe list to find the appropriate shoe based on you foot type)
  • Topical pain relieving gel Abductor hallucis muscle strain

 

When is Surgery Necessary for Flat Feet?

In some patients whose pain is not adequately relieved by other treatments, surgery may be considered. A variety of surgical techniques is available to correct flexible flatfoot and one or a combination of procedures may be required to relieve the symptoms and improve foot function.

 

Diabetic Peripheral Neuropathy Symptoms

About Diabetic Peripheral Neuropathy Symptoms

Peripheral neuropathy is nerve damage affecting the arms, hands, legs or feet.  Peripheral neuropathy is most commonly seen in people with diabetes.  Its is also referred to as diabetic peripheral neuropathy.

Three different groups of nerves can be affected by peripheral neuropathy:

  • Sensory nerves: enable people to feel pain, temperature, and other sensations
  • Motor nerves:  control the muscles and gives them their strength and muscle tone
  • Autonomic nerves: allow the body to perform certain involuntary functions, such as sweating.

Peripheral neuropathy is not a sudden disease unless there is trauma involved.  It is usually slow and worsens with time.  Sometimes patients have this condition long before they are diagnosed with diabetes or other systemic diseases.

The biggest risk for patients with peripheral neuropathy is complete loss of sensation and development of foot ulcers (sores).  Since patients have no sensation they can develop a blister which may become an ulcer and ultimately become infected.  This is a serious complication in diabetics, immunocompromised patients and in patients with peripheral arterial disease (PAD), which can ultimately lead to life threatening infections and limb loss (amputations)

Causes of Diabetic Peripheral Neuropathy

There are many causes of peripheral neuropathy.  Here are the most common ones:

  • Diabetes
  • Trauma
  • Syphilis
  • Radiculopathy (spinal problems)
  • Alcoholisms
  • Vitamin B deficiency
  • Exposure to certain toxic chemical
  • Chemotherapy medications
  • The use of some medications can also lead to peripheral neuropathy

Diabetic Peripheral Neuropathy Symptoms

This depends on the type of nerve that is affected. Patients with peripheral neuropathy may experience one or more of the following symptoms.

For sensory neuropathy:

  • Numbness or tingling
  • Sharp pain
  • burning feet
  • pins and needles sensation
  • having crawling sensation
  • hot / cold temperature change

For motor neuropathy:

  • Muscle weakness
  • Loss of muscle tone
  • Loss of balance

For autonomic neuropathy:

  • Dry feet
  • Cracked skin

Diagnosis of Diabetic Peripheral Neuropathy

To diagnose peripheral neuropathy, your foot and ankle specialist will obtain the patient’s history of symptoms and may perform simple in-office tests.  These clinical evaluations may include the patient’s:

  • Reflexes
  • Strength
  • Sensation to light touch
  • Vibratory sensation
  •  Nerve Conduction Velocity (NCV)

Treatment of Diabetic Peripheral Neuropathy

This all depends on the underlying cause of the peripheral neuropathy.

  • In diabetic patients, the control of their blood sugar is the key
  • Topical ointments
  • Physical therapy
  • Medications

Diabetic Peripheral Neuropathy Overview and Treatment

What Diabetic Peripheral Neuropathy?

Peripheral neuropathy is nerve damage affecting the arms, hands, legs or feet.  Peripheral neuropathy is most commonly seen in people with diabetes.  Its is also referred to as diabetic peripheral neuropathy.

Three different groups of nerves can be affected by peripheral neuropathy:

  • Sensory nerves: enable people to feel pain, temperature, and other sensations
  • Motor nerves:  control the muscles and gives them their strength and muscle tone
  • Autonomic nerves: allow the body to perform certain involuntary functions, such as sweating.

Peripheral neuropathy is not a sudden disease unless there is trauma involved.  It is usually slow and worsens with time.  Sometimes patients have this condition long before they are diagnosed with diabetes or other systemic diseases.

The biggest risk for patients with peripheral neuropathy is complete loss of sensation and development of foot ulcers (sores).  Since patients have no sensation they can develop a blister which may become an ulcer and ultimately become infected.  This is a serious complication in diabetics, immunocompromised patients and in patients with peripheral arterial disease (PAD), which can ultimately lead to life threatening infections and limb loss (amputations)

What are Some Causes?

There are many causes of peripheral neuropathy.  Here are the most common ones:

  • Diabetes (diabetic peripheral neuropathy)
  • Trauma
  • Syphilis
  • Radiculopathy (spinal problems)
  • Alcoholisms
  • Vitamin B deficiency
  • Exposure to certain toxic chemical
  • Chemotherapy medications
  • The use of some medications can also lead to peripheral neuropathy

Symptoms of Diabetic Peripheral Neuropathy

This depends on the type of nerve that is affected. Patients with peripheral neuropathy may experience one or more of the following symptoms.

For sensory neuropathy:

  • Numbness or tingling
  • Sharp pain
  • burning feet
  • pins and needles sensation
  • having crawling sensation
  • hot / cold temperature change

For motor neuropathy:

  • Muscle weakness
  • Loss of muscle tone
  • Loss of balance

For autonomic neuropathy:

  • Dry feet
  • Cracked skin

Diagnosis of Diabetic Peripheral Neuropathy

To diagnose peripheral neuropathy, your foot and ankle specialist will obtain the patient’s history of symptoms and may perform simple in-office tests.  These clinical evaluations may include the patient’s:

  • Reflexes
  • Strength
  • Sensation to light touch
  • Vibratory sensation
  •  Nerve Conduction Velocity (NCV)

Conservative Treatment of Diabetic Peripheral Neuropathy

This all depends on the underlying cause of the peripheral neuropathy.

  • In diabetic patients, the control of their blood sugar is the key
  • Topical ointments
  • Physical therapy
  • Medications

 

Diabetic Foot Ulcer Overview and Treatment

 

Diabetic Foot Ulcer Overview

 

People with diabetes are prone to develop foot ulcers (open sores) often because of several complications of diabetes: immmunocompromise (weak immune system), nerve damage / numbness (peripheral neuropathy) and poor circulation (peripheral arterial disease).  Peripheral neuropathy takes away your ability to feel pain or discomfort, so you may not detect an injury to your foot. Peripheral arterial disease reduces your ability to heal, making it hard for even a tiny cut to heal.  A weak immune system cannot fight infections properly, which may lead to a life threatening infection.

Having diabetes increases the risk of developing a wide range of foot problems and life threatening infections and / or foot amputation. In addition, with diabetes, small foot problems can turn into serious complications.

Causes of Diabetic Foot Ulcer:

  • Poorly controlled diabetes mellitus
  • Peripheral neuropathy (nerve damage that leads to foot numbness)
  • Peripheral arterial disease (Poor circulation)
  • Callus to the bottom of the foot
  • Poor fitting footwear

Symptoms of Diabetic Foot Ulcer:

  • Open sore / wound to the foot

Imaging

X-ray: Usually does not show anything, unless there is a severe infection of the soft tissue or infection of bone.

MRI: Can be used to determine if there is an area of abscess (collection of puss) or bone infection.

Conservative Treatment of Diabetic Foot Ulcer:

In early stages of foot ulcers, local wound care and offloading is recommended.

  • Debridement (removing unhealthy tissue) by a physician only
  • Local wound care with topical antibiotic cream or ointment
  • Take pressure off the area (offload) with padding
  • You physician may prescribe antibiotic pills if infection sets
  • Use of negative pressure wound therapy system (V.A.C) to stimulate new tissue growth

Surgical Treatment:

If the ulcer has become infected surgery may be indicated.  Surgery can include: removing death tissue, amputation of bone or applying synthetic skin grafts.

A diabetic foot ulcer is a serious complication and can become a life threatening emergency; people with this condition should be seeing a doctor on regular basis.

We encourage you to consult with a foot and ankle specialist for a complete assessment of your condition.

 

For more information about negative pressure wound therapy system V.A.C. please visit http://www.kci1.com

 

diabetic foot ulcer

 

Diabetic Foot Care Guidelines

 

Diabetic Foot Care Guidelines

Do you want to avoid serious foot problems that can lead to a toe, foot or leg amputation?  Keeping your blood glucose (sugar) in good control and taking care of your feet every day can help you avoid serious foot problems.

Foot care is very important for each person with diabetes, but especially if you have:

• Loss of feeling in your feet (Diabetic Peripheral Neuropathy)
• Changes in the shape of your feet
• Foot ulcers or sores that do not heal
Nerve damage can cause you to lose feeling in your feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers, which may lead to amputation.

There is a lot you can do to prevent serious problems with your feet. Here’s how:

Take Care of Your Diabetes

• Make healthy lifestyle choices to help keep your blood glucose (sugar),  blood pressure and cholesterol close to normal. Doing so may help prevent or delay diabetes-related foot problems as well as eye and kidney disease.

• Work with your health care team to make a diabetes plan that fits your lifestyle. The team may include your doctor, a diabetes educator, a nurse, a dietitian, a foot care doctor called a podiatrist and other specialists. This team will help you to:

• Know when to get checks of your A1C*, blood pressure and cholesterol
• Know how and when to test your blood glucose
• Take your medicines as prescribed
• Eat regular meals that contain a variety of healthy, low-fat, high-fiber foods including fruits and vegetables each day
• Get physical activity each day
• Stop smoking
• Follow your foot care plan
• Keep your doctor’s visits and have your feet, eye and kidneys checked at least once a year
• Visit your dentist twice a year

*A1C is a measure of your blood glucose over a three-month period.

Check Your Feet every Day

• You may have serious foot problems, but feel no pain. Check your feet for cuts, sores, red spots, swelling and infected toenails. Find a time (evening is best) to check your feet each day. Make checking your feet part of your every day routine.
If you have trouble bending over to see your feet, use a plastic mirror to help. You also can ask a family member or caregiver to help you.

Make sure to call your doctor right away if a cut, sore, blister or bruise on your foot does not begin to heal after one day.

Wash Your Feet Every day

• Wash your feet in warm, not hot, water. Do not soak your feet, because your skin will get dry. Before bathing or showering, test the water with your fingers to make sure it is not too hot. You can also use a thermometer (90° to 95° F is safe) or your elbow.
• Dry your feet well. Be sure to dry between your toes. Use talcum powder or cornstarch to keep the skin between your toes dry.

keep the Skin Soft and Smooth

• Rub a thin coat of skin lotion, cream or petroleum jelly on the tops and bottoms of your feet.
• Do not put lotion or cream between your toes, because this might cause an infection.

Smooth Corns and Calluses Gently

• If you have corns and calluses, check with your doctor or foot care specialist about the best way to care for them.
• If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.
• Do not cut corns and calluses. Don’t use razor blades, corn plasters, or liquid corn and callus removers — they can damage / burn your skin, leading to infection.

Trim Your Toenails Each Week or When Needed

• Trim your toenails with clippers after you wash and dry your feet.
• Trim toenails straight across and smooth them with an emery board or nail file.
• Don’t cut into the corners of the toenail.
If you can’t see well, if your toenails are thick or yellowed, or if your nails curve and grow into the skin, have a foot care doctor trim them.

Wear Shoes and Socks at all Times

• Wear shoes and socks at all times. Do not walk barefoot — not even indoors — because it is easy to step on something and hurt your feet.
• Always wear socks, stockings or nylons with your shoes to help avoid blisters and sores.
• Choose clean, white color, lightly padded socks that fit well. Socks that have no seams are best.
• Check the insides of your shoes before you put them on to be sure the lining is smooth and that there are no objects in them.
• Wear shoes that fit well and protect your feet.  Avoid wearing open toe shoes.

Protect Your Feet From Hot and Cold

• Wear shoes at the beach or on hot pavement.
• Put sunscreen on the top of your feet to prevent sunburn.
• Keep your feet away from radiators and open fires.
• Do not put hot water bottles or heating pads on your feet.
• Wear socks at night if your feet get cold. Lined boots are good in winter to keep your feet warm.
Check your feet often in cold weather to avoid frostbite.

keep the Blood Flowing to Your Feet

• Wiggle your toes for five minutes, two or three times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs.
• Don’t cross your legs for long periods of time.
• Don’t wear tight socks, elastic or rubber bands, or garters around your legs.
• Don’t smoke. Smoking reduces blood flow to your feet. Ask for help to stop smoking.
Work with your health care team to control your A1C (blood glucose), blood pressure and cholesterol.

Be More Active

• Ask your doctor to help you plan a daily activity program that is right for you.
• Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet.
• Avoid activities that are hard on the feet, such as running and jumping.
• Always include a short warm-up and cool-down period.

Be Sure to Ask Your Doctor To:

• Check the sense of feeling and pulses in your feet at least once a year.
• Tell you if you are likely to have serious foot problems. If you have serious foot problems, your feet should be checked at every visit to your doctor.
• Show you how to care for your feet.
• Refer you to a foot care doctor if needed.
• Decide if special shoes would help your feet stay healthy.

Tips for Proper Footwear

Proper footwear is very important for preventing serious foot problems.
• Athletic or walking shoes are good for daily wear. They support your feet and allow them to “breathe.”
• Never wear vinyl or plastic shoes, because they don’t stretch or “breathe.”
• When buying shoes, make sure they are comfortable from the start and have enough room for your toes.
• Don’t buy shoes with pointed toes or high heels. They put too much pressure on your toes.
Ask your doctor about Medicare or other insurance coverage for special footwear.

You may need special shoes or shoe inserts to prevent serious foot problems. If you have Medicare, you may be able to get some of the cost of special shoes or inserts paid for. Ask your doctor whether you qualify for:

• 1 pair of depth shoes* and 3 pairs of inserts, or
• 1 pair of custom molded shoes (including inserts) and 2 additional pairs of inserts

If you qualify for Medicare or other insurance coverage, your doctor or podiatrist will tell you how to get your special shoes.

* Depth shoes look like athletic or walking shoes, but have more room in them. The extra room allows for different shaped feet and toes, or for special inserts made to fit your feet.

Sources:

American Association of Diabetes Educators
1-800-TEAM-UP-4

American Diabetes Association
1-800-DIABETES

American Podiatric Medical Association
1-800-FOOTCARE

National Diabetes Education Program
1-800-438-5383

National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse (NDIC)
1-800-860-8747

Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Cuboid Syndrome Treatment

what is Cuboid Syndrome?

Cuboid syndrome is a condition that is characterized by pain along the outside border oh hindfoot (back of the foot). The pain may be acute, constant and dull in nature, and is more pronounced when pushing off the foot while walking, running, or jumping. The pain can also be produced manually by pressing on the cuboid bone from the top or bottom of the foot. Though it can affect anyone, it most often occurs in athletes. It can be a difficult diagnosis to make, as there are many bones, tendons, and ligaments that make up the foot. Once diagnosed, though, cuboid syndrome does respond very well to treatment.

Where is the Cuboid Bone?

The cuboid is a bone located on the lateral (outside) aspect of your foot. It sits between the heel bone (calcaneus) and fourth and fifth metatarsals (long bones that articulate with the toes). The cuboid bone, together with the calcaneus, forms the calcaneocuboid joint which acts to lock the foot position for stability while pushing off.

 

What Causes Cuboid Syndrome?

Cuboid syndrome occurs when the cuboid bone moves out of place in relation to the calcaneus, causing pain when walking or pushing off the ball of the foot. With cuboid syndrome, the cuboid bone has been dislocated or subluxated from the calcaneus (heel bone). When this happens, the joint can no longer function to properly stabilize the foot, causing pain during walking and / or running.

Cuboid syndrome can be caused either by an direct injury or by repetitive use. Over-pronation (flat foot) is sometimes suspected to cause cuboid syndrome. It is common in athletes and ballet dancers, both male and female alike. In male dancers, it is primarily caused by landing after jumps. In female dancers the primary cause is repeatedly going back and forth between flat foot and toe point positions. Cuboid syndrome can also develop after an ankle injury due to the uneven distribution of weight while favoring the injured side of the foot.

 

Cuboid Syndrome treatment:

  •  Manual manipulation of the cuboid bone to move it back into place. (must be done by a professional)
  • Custom orthotics (inserts) with Cuboid pad to hold the cuboid in place and to prevent over pronation
  • Ice the area
  • Taping and strapping
  • Supportive shoes
  • Non-steroidal anti-inflammatory medications such as Ibuprofen

 

Cuboid Syndrome

 

what is Cuboid Syndrome?

Cuboid syndrome is a condition that is characterized by pain along the ouside border oh hindfoot (back of the foot). The pain may be acute, constant and dull in nature, and is more pronounced when pushing off the foot while walking, running, or jumping. The pain can also be produced manually by pressing on the cuboid bone from the top or bottom of the foot. Though it can affect anyone, it most often occurs in athletes. It can be a difficult diagnosis to make, as there are many bones, tendons, and ligaments that make up the foot. Once diagnosed, though, cuboid syndrome does respond very well to treatment.

Where is the Cuboid Bone?

The cuboid is a bone located on the lateral (outside) aspect of your foot. It sits between the heel bone (calcaneus) and fourth and fifth metatarsals (long bones that articulate with the toes). The cuboid bone, together with the calcaneus, forms the calcaneocuboid joint which acts to lock the foot position for stability while pushing off.

 

What Causes Cuboid Syndrome?

Cuboid syndrome occurs when the cuboid bone moves out of place in relation to the calcaneus, causing pain when walking or pushing off the ball of the foot. With cuboid syndrome, the cuboid bone has been dislocated or subluxated from the calcaneus (heel bone). When this happens, the joint can no longer function to properly stabilize the foot, causing pain during walking and / or running.

Cuboid syndrome can be caused either by an direct injury or by repetitive use. Over-pronation (flat foot) is sometimes suspected to cause cuboid syndrome. It is common in athletes and ballet dancers, both male and female alike. In male dancers, it is primarily caused by landing after jumps. In female dancers the primary cause is repeatedly going back and forth between flat foot and toe point positions. Cuboid syndrome can also develop after an ankle injury due to the uneven distribution of weight while favoring the injured side of the foot.

 

Cuboid Syndrome treatment:

  •  Manual manipulation of the cuboid bone to move it back into place. (must be done by a professional)
  • Custom orthotics (inserts) with Cuboid pad to hold the cuboid in place and to prevent over pronation
  • Ice the area
  • Taping and strapping
  • Supportive shoes
  • Non-steroidal anti-inflammatory medications such as Ibuprofen

 

Corn – Callus

Corn / Callus

A “corn” or a “callus” is a thickened area of skin (hyperkeratosis) on the foot caused by pressure or repeated rubbing on the skin.  Over time, the repetitive friction and irritation causes the skin to produce a protective skin which may vary in size and symptom.

Terminology:

In general, thickened skins on top of the toes are called “corns” and on bottom of the foot are called “calluses”. Soft corn can develops between toes (Heloma Mole) and is kept soft by the moisture in the area

 

Causes of Corn-callus:

  • Ill fitting shoes are the primary cause of corns and/or calluses.
  • People with toe deformities such as hammertoe, claw toe or mallet toe, often suffer from corns because the top of the bent toe rubs against the shoe, causing pain and irritation.
  • Usually, soft corn between the toes are developed due to bony prominences

Symptoms of corns-callus:

  • Thickened skin on top of the toe, between the toes or on the bottom of the foot
  • Pain and redness  over the site of friction or irritation

Conservative Treatment of Corns and Calluses:

  • Proper fitting of footwear
  • Routine reduction of callus by a healthcare professional, especially in patient with diabetes, peripheral arterial disease (PAD) or  immunocompromised
  • Padding to decrease friction on the skin
  • We advise against the use of medicated corn removal pads of any kind in any patient, especially in patients with diabetes, peripheral arterial disease (PAD) or immunocompromisedThe use of “medicated corn removal pads” in those who are at risk can cause infections which can lead to amputation.

Surgical Treatment of Corns and Callus:

Surgical intervention is recommended only if patient has failed conservative treatment options.  The specific type of surgical intervention depends on clinical findings of your condition.

Cavus Foot Treatment

Cavus Foot Treatment Overview

Cavus foot is also known as Pes Cavus and consists of a higher than normal arch. The arch, or instep, runs from the base of the toes to the heel. High arched foot construct lowers the foot’s ability to absorb shock and it leads to an excessive amount of pressure being placed on the ball of the foot and heel. Pes cavus is the opposite of pes planus (flat foot). Pes cavus (high arched foot) are much less common than flat feet (pes planus).

What are some Causes of Cavus Foot?

There are many causes for pes cavus (High Arch Foot). It may be present as an inherited trait since birth (Genetic) or patient may have an underlying neurological disorder.

Some medical condition which can cause a cavus foot are:

  • Cerebral palsy
  • Charcot-Marie-Tooth disease
  • spina bifida
  • Freidereich’s Ataxia
  • Polio
  • Muscular dystrophy.

The need for a full work up of the underlying cause is necessary since it determines the treatment plan.

In the absence of neurological, congenital or traumatic causes of pes cavus, the remaining cases are classified as being ‘idiopathic’, since their cause is unknown.

Symptoms Associated with Cavus Foot?

  • Higher than normal arch (instep) 
  • Contracture of the toes. (Hammer or claw toes) 
  • Painful callus formation in the ball of the foot 
  • Heel pain and/or pain is the ball of the foot when standing or walking 
  • History of recurrent ankle sprain or feeling that the ankle is unstable 
  • Difficulty fitting in shoes
  • Muscle weakness 

 

Cavus Foot Treatment (Conservative):

  • Orthotic / shoe insert
  • Callus care and maintenance
  • Ankle brace for unstable ankle
  • Custom bracing (Ankle Foot Orthosis) in cases of neuromuscular disorders

 

Cavus Foot Treatment (Surgical):

Surgical treatment should be considered after a failed conservative management. The operations can be difficult with long recovery time. The surgical plan may consist of a combination of soft tissue and bone work. A complete evaluation and work-up will be needed prior to the selection of the surgical plan.

Cavus Foot X-ray

Cavus Foot (High Arched Foot) Signs, Symptoms and Tratment

What is Cavus Foot?

Cavus foot is also known as Pes Cavus.  Cavus foot is a foot type that consists of a higher than normal arch. The arch, or instep, runs from the base of the toes to the heel. High arched foot construct lowers the foot’s ability to absorb shock and it leads to an excessive amount of pressure being placed on the ball of the foot and heel. Pes cavus is the opposite of pes planus (flat foot). Pes cavus are much less common than flat feet (pes planus).

What are some Causes of Cavus Foot?

There are many causes for pes cavus (High Arch Foot). It may be present as an inherited trait since birth (Genetic) or patient may have an underlying neurological disorder.

Some medical condition which can cause high arches are:

  • Cerebral palsy
  • Charcot-Marie-Tooth disease
  • spina bifida
  • Freidereich’s Ataxia
  • Polio
  • Muscular dystrophy.

The need for a full work up of the underlying cause is necessary since it determines the treatment plan.

In the absence of neurological, congenital or traumatic causes of pes cavus, the remaining cases are classified as being ‘idiopathic’, since their cause is unknown.

Symptoms Associated with Cavus Foot?

  • Higher than normal arch (instep) 
  • Contracture of the toes. (Hammer or claw toes) 
  • Painful callus formation in the ball of the foot 
  • Heel pain and/or pain is the ball of the foot when standing or walking 
  • History of recurrent ankle sprain or feeling that the ankle is unstable 
  • Difficulty fitting in shoes
  • Muscle weakness 

 

Conservative Treatments of Cavus Foot:

  • Orthotic / shoe insert
  • Callus care and maintenance
  • Ankle brace for unstable ankle
  • Custom bracing (Ankle Foot Orthosis) in cases of neuromuscular disorders

 

Surgical Treatments of Cavus Foot:

Surgical treatment should be considered after a failed conservative management. The operations can be difficult with long recovery time. The surgical plan may consist of a combination of soft tissue and bone work. A complete evaluation and work-up of the cause of cavus foot will be needed prior to the selection of the surgical plan.

High Arch foot X-ray

 

High Arch Foot X-ray
High Arch Foot X-ray

Causes of Heel Pain, Symptoms and Treatment

 

 

Causes of Heel Pain

Heel pain may be due to many causes, such as: stress fracture, tendonitis, arthritis, systemic arthritis, neuritis (nerve irritation), skin pathology (callus, Porokeratosis), or bone tumors . Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome (image).  Because there are several potential causes of heel pain, it is important to seek medical attention to properly be diagnosed. A foot and ankle specialist is able to determine the cause of your symptoms.

What are Some Causes of Heel Pain

 

What are Some Symptoms of heel pain

  • Heel pain in morning (post static dyskinesia)
  • Pain after activities or walking
  • Deep pain
  • Achy pain
  • Sharp pain
  • Shooting pain

 

Imaging:

Imaging modalities to evaluate heel pain can include:

  • X-rays
  • MRI
  • Ultrasound
  • Bone scan

 

What are Some Conservative Treatment of Heel Pain

This all depends on the cause of the heel pain. A foot and ankle specialist will determine the cause of the heel pain. The treatment plan may include:

  • Stretching shopping cart
  • Night splint shopping cart
  • Padding and strapping shopping cart
  • Orthotics (shoe inserts) shopping cart
  • Supportive shoe gear
  • Braces shopping cart
  • Walking boots shopping cart
  • Topical Creams shopping cart
  • Injections
  • Physical therapy
  • Anti-inflammatory medications
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Surgical Treatment

Surgical intervention is recommended if a patient has failed conservative treatment options.  The specific type of surgical intervention depends on clinical findings of your condition.

 

Image:

 

Causes of Flat Feet, Symptoms and Treatment

 

Causes of Flat Feet Overview

Flat feet, medically known as flexible pes planus, is a foot deformity where the individual lacks or has decreased foot arch when they stand on their feet and arches recreate when not standing hence the term “Flexible”.  Flat feet most often noted in childhood and continues into adulthood. It is a complex deformity with varying degree of deformity and symptoms.  In general, patient’s pain and symptoms correlate to the amount of deformity.  The more the deformity, the more patients’ symptoms and disability will be. If left untreated, it can lead to arthritis and limited function.

 

Causes of Flat Feet

  • It is congenital (patient inherits the deformity from mom and/or dad)

 

Findings of having Flat Feet

  • Partial or complete collapse of the arch of the foot 
  • Tight Achilles tendon (Ankle Equinus)
  • Patient may have bunions and/ or hammertoes as a result of a flatfoot
  • Pain in the ball of the foot as the result of tight Achilles tendon
  • Front part of the foot / toes may be pointing outward
  • The heel tilts toward the outside and the ankle appears to turn in (Calcaneal valgus)

 

Symptoms of Flat Feet

  • Pain in the arch, ankle region
  • Pain along the shin bone (shin splint)
  • General aching or fatigue in the foot or leg
  • Ankle, knee, hip or lower back

 

Imaging

  • X-ray is helpful in assessing the severing of deformity and to rule out arthritis

 

Flat Feet Treatment (Conservative)

  • Activity modifications. Avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches will aggravate your symptoms.
  • Orthotic devices. Use orthotic devices in your shoes to support to the arches shopping cart
  • Immobilization. In severe cases, it may be necessary to immobilize the foot to decrease pain and symptoms shopping cart
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot (Please refer to our comprehensive shoe list to find the appropriate shoe based on you foot type)
  • Topical pain relieving gel Abductor hallucis muscle strain

 

When is Surgery Necessary for Flat Feet?

In some patients whose pain is not adequately relieved by other treatments, surgery may be considered. A variety of surgical techniques is available to correct flexible flatfoot and one or a combination of procedures may be required to relieve the symptoms and improve foot function.

 

We encourage you to consult with a  specialist for a complete assessment of your condition.

Causes of Flat Feet

Capsulitis of the Second Toe Symptoms and Treatment

 

Capsulitis of the Second Toe Overview

 

What is Capsulitis of the Second Toe?

The joint where the toe meets the foot is referred to as the metatarsophalangeal joint.  This joint is surrounded by a membrane and a set of ligaments called a “capsule”, which helps the joint to function properly. Capsulitis is a condition in which these ligaments and the surrounding tissue have become inflamed.  Although capsulitis can occur in the joints of the 1st through 5th toes, it most commonly affects the second toe.

Metatarsophalangeal joint capsulitis can cause considerable discomfort and if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe.

Metatarsophalangeal joint capsulitis  is also referred to as “predislocation syndrome”, a common condition that can occur at any age.

 

What Causes Capsulitis of the Second Toe?

 

What Are Some Symptoms of Capsulitis of the Second Toe?

Symptoms may include:

    • Pain on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up
    • Swelling and pain at the base of the toes (underneath the toe)
    • Difficulty wearing shoes
    • Ladie may have difficulty wearing high heel shoes
    • Pain when walking barefoot
    • Unstable toe where the toe drifts toward the big toe and eventually crosses over the big toe “crossover toe”

 

Capsulitis of the Second Toe Diagnosis

An thorough physical exam in essential to diagnose metatarsophalangeal joint capsulitis.  Symptoms of capsulitis can be similar to those of a condition called Morton’s neuroma, which is treated differently from capsulitis.

  • X-rays are usually ordered, and other imaging studies such as MRI are sometimes needed.

 

Non-surgical Treatment of Capsulitis of the Second Toe

The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe.

The following treatments options are for early treatment of capsulitis:

    • Rest and ice the area
    • Oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen.
    • Taping/splinting the toe Abductor hallucis muscle strain
    • Stretching exercises for patients who have tight calf muscles Abductor hallucis muscle strain
    • Supportive shoes with stiff soles to lessen the amount of pressure on the ball of the foot.
    • Orthotic / Custom shoe inserts to distributes the weight away from the joint Abductor hallucis muscle strain
    • Topical pain relieving gel Abductor hallucis muscle strain

 

When is Surgery Needed for Capsulitis of the Second Toe

Once the second toe starts moving toward the big toe “crossover toe”, surgery is needed to reduce the deformity

Capsulitis of Foot Symptoms and Treatment

Capsulitis Overview

 

What is Capsulitis?

Every joint is surrounded by a membrane and a set of ligaments called a “capsule”, which helps the joint to function properly. Capsulitis is a condition in which these ligaments and the surrounding tissue have become inflamed.  Although capsulitis can occur in the joints of the foot, it most commonly affects the second toe.

Capsulitis can cause considerable discomfort and if left untreated.

 

What Causes Capsulitis of the Second Toe?

 

What Are Some Symptoms of Capsulitis of the Second Toe?

Symptoms may include:

    • Pain on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up
    • Swelling and pain at the base of the toes (underneath the toe)
    • Difficulty wearing shoes
    • Ladie may have difficulty wearing high heel shoes
    • Pain when walking barefoot
    • Unstable toe where the toe drifts toward the big toe and eventually crosses over the big toe “crossover toe”

 

Capsulitis of the Second Toe Diagnosis

An thorough physical exam in essential to diagnose metatarsophalangeal joint capsulitis.  Symptoms of capsulitis can be similar to those of a condition called Morton’s neuroma, which is treated differently from capsulitis.

  • X-rays are usually ordered, and other imaging studies such as MRI are sometimes needed.

 

Non-surgical Treatment of Capsulitis of the Second Toe

The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe.

The following treatments options are for early treatment of capsulitis:

    • Rest and ice the area
    • Oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen.
    • Taping/splinting the toe Abductor hallucis muscle strain
    • Stretching exercises for patients who have tight calf muscles Abductor hallucis muscle strain
    • Supportive shoes with stiff soles to lessen the amount of pressure on the ball of the foot.
    • Orthotic / Custom shoe inserts to distributes the weight away from the joint Abductor hallucis muscle strain
    • Topical pain relieving gel Abductor hallucis muscle strain

 

When is Surgery Needed for Capsulitis of the Second Toe

Once the second toe starts moving toward the big toe “crossover toe”, surgery is needed to reduce the deformity

Bursitis

What is Bursitis?

A bursa is a small fluid-filled sac found near a joint or tendon.  The function of a bursa is to protect the area from pressure or friction.  Bursitis is an inflammation of the small fluid-filled sac.  Usually, a bursa can become inflamed because of constant pressure and friction from footwear.  Common areas of bursitis in the foot is over a bunion, tailors bunion (bunionette), back of the heel (retrocalcaneal bursitis) or under the heel bone (infracalcaneal bursitis).

 

What are Symptoms of Bursitis?

  • Localized pain and swelling
  • Localized redness

 

How is Bursitis Diagnosed?

  • Bursitis is usually diagnosed by palpation and range of motion of the affected area.
  • If bursitis has been chronic, X-ray may show localized calcification in the bursa
  • Although unnecessary, MRI can also be used as a diagnostic study.

 

How is Bursitis Treated?

Treatment of bursitis may include:

  • Ice the affected area
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen
  • Padding the affected area to prevent pressure and friction on the area
  • Corticosteroid injection may be used to help reduce pain and inflammation
  • If conservative treatment fails, surgery may be needed to address the problem

 

Bursa

What is a bursa?

A bursa is a small fluid-filled sac found near joints, bones or tendons.  The function of a bursa is to protect the area from pressure or friction.

Bunionette (Tailor’s Bunion) Symptoms and Treatment

 

Bunionette (Tailor’s Bunion) Overview

 

The term tailor’s bunion comes from the position of a tailor sitting in a cross-legged position.  Bunionette form when the fifth toe (smallest toe) moves out of alignment and towards the fourth toe, usually there is an bony enlargement of the fifth metatarsophalangeal joint. Friction between the bony prominence and shoe gear can cause discomfort and develop callus, inflammation and pain.  Over time, the movement of the fifth toe can lead to irritation of other toes which may cause deformity of other toes such as hammertoes and deviations of toes. Females are three times more like

 

Causes of a Bunionette

Bunionettes can be caused by:

  • Friction and irritation from tight fitting shoes
  • Increased separation between the fourth and fifth metatarsals
  • Enlarged fifth metatarsal head
  • Lateral deviation of the fifth metatarsal
  • Bursa (fluid filled sack) formation over the area
  • Trauma to the area

 

Symptoms of a Bunionette

Many people with bunionette suffer from discomfort and pain from the constant irritation, rubbing and friction of the enlargement against shoes gear. The skin over the toe becomes red, tender, achy and uncomfortable to wear shoes.  Over time corn, callus, bursitis and arthritis may develop.

 

Imaging

  • X-ray: May be needed to determine the size, severity of the deformity and to determine if there is any arthritis.

 

Conservative Treatments of a Bunionette

The goal for bunionette treatment is twofold: first, to relieve the pressure and pain cause by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunionette includes:

  • The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems. shopping cart
  • Removal of corns and calluses on the foot.
  • Changing to carefully-fitted / wider footwear designed to accommodate the bunionette 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. shopping cart
  • Exercises to maintain joint mobility and prevent stiffness or arthritis.
  • Toe Splints for nighttime wear to help the toes and joint align properly. This is often recommended for pediatric and adolescents with bunionette, because their bone development may still be adaptable. shopping cart
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Surgical Treatment of a Bunionette

Depending on the size of the enlargement of the bunionette, malalignment of the fifth toe and amount of pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunionette.  In these cases, bunionette surgery known as a tailor’s bunionectomy may be advised to remove the bunionette and realign the toe.

 

Bunion Treatment (Conservative and Surgical)

Bunion Treatment Overview

A bunion also known as (hallux abducto-valgus) is a bony deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunion forms when the big 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 (known as Hallux Abductus). 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 Hallux Abducto-Valgus. Bunions can also lead to other toe deformities, such as hammertoes and deviation of other toes as well.

Many people with bunion 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 and contributing to chronic pain.

 

Bunion Treatment (Conservative):

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

  • The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems Abductor hallucis muscle strain
  • Removal of corns and calluses on the foot.
  • Changing to carefully-fitted / wider 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 Abductor hallucis muscle strain
  • 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 Abductor hallucis muscle strain
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Imaging:

  • X-ray: May be needed to evaluate for possible arthritis to the big toe joint.

 

Bunion Treatment (Surgical):

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

 

Bunion X-ray Image:

Bunion picture - foot and ankle academy
Bunion X-ray

 

 

Bunion Symptoms and Treatment

Bunion Overview

Bunion also known as (hallux abducto-valgus) is a bony deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunion forms when the big 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 (known as Hallux Abductus). 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 Hallux Abducto-Valgus. Bunions can also lead to other toe deformities, such as hammertoes and deviation of other toes as well.

Many people with bunion 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 and contributing to chronic pain.

 

Bunion Treatment (Conservative):

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

  • The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems Abductor hallucis muscle strain
  • Removal of corns and calluses on the foot.
  • Changing to carefully-fitted / wider 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 Abductor hallucis muscle strain
  • 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 Abductor hallucis muscle strain
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Imaging:

  • X-ray: May be needed to evaluate for possible arthritis to the big toe joint.

 

Bunion Treatment (Surgical):

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

 

Bunion X-ray Image:

Bunion picture - foot and ankle academy
Bunion X-ray

 

 

 

Big Toe Joint Arthritis Symptoms, Treatment and Pictures

 

Big Toe Joint Arthritis Overview

Arthritis of the big toe joint is a common condition that causes stiffness, swelling and pain. The medical term for the big toe is “hallux” and hallux rigidus is common medical terms that is associated with end stage arthritis of this joint.  For normal function of this joint, approximately 60-90 degrees of upward motion (Dorsifiexion) is needed.  Limited motion of this joint is termed “hallux limitus” and with limited motion, the foot does not propel the body forward properly, leading to jamming of the joint and end stage arthritis or hallux rigidus.

 

Symptoms of Big Toe Joint Arthritis

  • Pain with movement (achy / sharp pain)
  • Bone spur development
  • Bump on top of the joint
  • limited motion to the joint

 

Causes of Big Toe Joint Arthritis

  • Genetic or Overuse
  • Trauma
  • Gout
  • Rheumatoid Arthritis
  • Flatfoot

 

Diagnosis of Big Toe Joint Arthritis

  • Clinical evaluation / range of motion testing
  • X-ray (Bone spur formation around the joint)

 

Treatment of Big Toe Joint Arthritis

  • Shoe gear modification (to take off pressure from the area) shopping cart
  • Rocker bottom shoes shopping cart
  • Stiff soled shoes (to limit motion to the joint) shopping cart
  • Custom orthotics (with Morton extension / reverse Morton extension) shopping cart
  • Cortisone injection (decrease inflammation)
  • Hyaluronic Acid injection (to lubricate the joint)
  • Physical Therapy
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Surgical Treatment of Big Toe Joint Arthritis

  • Cheilectomy ( clean up the joint)
  • Decompression osteotomy of the joint (decompress the joint / increase joint space)
  • Implant arthroplasty ( partial / complete implant of the joint)
  • Fusion of the joint

 

Picture of Big Toe Joint Arthritis

 

Ball of Foot Pain: Symptoms and Treatment

 

Ball of Foot Pain Overview

Metatarsalgia is a general term that refers to any painful condition that affects the ball of the foot. Many different foot conditions can cause metatarsalgia.  The most common cause of metatarsalgia is due to biomechanical conditions.  It is important that specialist to determine the exact underlying pathology in order to receive the proper treatment.

 

Causes of Pain on the Ball of the Foot

  • Pes Planus (having a low arch)
  • Pes Cavus (high arch foot)
  • Bunion
  • Hammertoe
  • Tailors Bunion
  • Osteoarthritis
  • Capsulitis
  • Bursitis
  • Peripheral Arterial Disease (PAD)
  • Systemic Arthritis
  • Ankle equines (tight Achilles tendon)
  • Neuritis
  • Trauma
  • Bone Tumor
  • Soft Tissue Mass
  • Peripheral Neuropathy
  • Skin conditions: ulcer, corns, infection, warts or blister

 

Imaging for Ball of Foot Pain

Your foot and ankle specialist will determine if imaging is needed based on your physical exam findings. Imaging may include:

  • X-ray
  • MRI
  • CT scan
  • Ultrasound
  • Bone scan
  • Nerve Conduction Velocity (NCV)

 

Ball of Foot Pain Treatment (Conservative)

This depends on the underlying problem.  Your foot and ankle specialist will determine your treatment plan. It may include:

  • Protective padding shopping cart
  • Orthotics (shoe inserts) shopping cart
  • Toe taping shopping cart
  • Braces shopping cart
  • Splints shopping cart
  • Supportive shoes gear
  • Topical creams shopping cart
  • Injections
  • Physical therapy
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Ball of Foot Pain (Surgical)

This depends on the underlying problem.  Your foot and ankle surgeon will determine your surgical treatment plan.

 

We encourage you to consult with a specialist for a complete assessment of your condition

 

ball of foot pain - foot and ankle academy

Athlete’s Foot (Tinea Pedis)

Athlete’s Foot Symptoms and Treatments

Athlete’s foot, medically known as Tinea Pedis is a common fungal infection to the bottom of the foot or between the toes (Interdigital Tinea Pedis).  Trichophytom is the most common type of fungus that causes the infection.  Despite its name, athlete’s foot can affect anyone who comes in contact with the organism.  Fungal infection can occur almost in part of the body but in particular areas where stay moist and warm can become vulnerable to fungal infection. Fungus that causes athletes foot can be found in many locations, especially in gym floors, locker rooms, swimming pools, nail salons, airport security lines, inside shoes and bath / shower tubs.  Walking barefoot in areas where someone with infection had previously walked will increase your chance infection. Individuals with decreased immune system are more vulnerable to athlete’s foot. Rarely, athlete’s foot can cause blisters called (bullous tinea pedis or vesicular tinea pedis). Athletes foot in contagious and

If not treated, it can lead to more serious bacterial infection of the skin (cellulitis or erythrasma), especially in elderly, individuals with diabetes and in individuals with impaired function of the immune system (immunosupressed)

Types of athletes foot:

  • Interdigital tinea pedis (between toes)
  • (Moccasin tinea pedis) infection to the sole of the foot
  • (Bullous type) blistering / inflammatory tinea pedis

What are the Symptoms of Athletes foot:

  • Dry skin to the bottom of the
  • Skin cracking and peeling off
  • Moisture (skin maceration) in between the toe
  • Itching to the bottom of the foot or between the toes
  • Blistering to the bottom / side of the foot
  • Foul smell

How is Athlete’s  Foot Treated:

  • Apply anti-fungal medication / cream to the area shopping cart
  • Use anti-fungal powder for Interdigital tinea pedis to keep the area dry shopping cart
  • Spray inside your shoes with antifungal spray / powder shopping cart
  • Wear sandals / do not walk barefoot in public area
  • Change you socks to synthetic material socks. They wick moisture away from your skin and keep your feet dry shopping cart
  • Change your socks daily
  • In severe cases of athlete’s foot, you may have to go on oral anti-fungal medication.

 

Arch Pain Symptoms and Treatment

 

Arch Pain Overview

 

Arch of the foot is the anatomical area between the heel and the ball of the foot. Pain across the bottom of the foot between the ball of the foot and the heel area if often referred to as “arch pain“. This term is very non-specific as there are specific foot conditions that causes pain and symptoms in this area.

What Causes Arch Pain?

 

arch pain

Anterior Ankle Impingement Symptoms and Treatment

 

Anterior Ankle Impingement Overview

 

What is Anterior Ankle Impingement?

Anterior impingement syndrome is a condition where bone spurs or osteophytes form in the front (anterior) of the ankle joint leading to chronic ankle pain. Bone spur can form to the front end of the tibia (shin bone), on top of the ankle bone (talus) or both. When foot is push upward (dorsiflexed), the bone spurs pinch the soft tissue, causing pain and inflammation. Anterior impingement syndrome is also knows as “footballer’s ankle” or “Athlete’s Ankle”.

 

What Causes Anterior Impingement Syndrome?

Anterior ankle impingement syndrome is thought to be caused by repetitive micro-trauma where the ankle goes thought extreme up motion (dorsoflexion) or extreme down (plantarflexion) motion. Typical sports would be American football, basketball, soccer, ballet and runners.

 

Anterior Impingement Syndrome Symptoms

  • Pain over the front of the joint
  • Pain is reproduced when the foot is pushed upwards towards the shin.
  • Front of the ankle joint is often tender
  • Bone spur may or may not be felt over the front of the joint

 

How is Anterior Impingement Syndrome Diagnosed?

  • X-ray usually is all needed to evaluated the joint for bone spurs.
  • MRI may be used to confirm diagnosis or rule out other problems.

 

Anterior Ankle Impingement Treatment

Treatment of anterior Ankle impingement syndrome is aimed to reduced inflammation and pain. Treatment may include:

  • Icing the area
  • Anti-inflammatory medications
  • Heel lift shopping cart
  • Topical pain relieving gel shopping cart

 

If conservative treatment options fail, surgical procedure may be considered. Ankle arthroscopy is ofter utilized to remove the bone spurs.

 

Image of Anterior Ankle Impingement:

Anterior Ankle Impingement Syndrome

Source:
Definition: Dictionary of Sport and Exercise Science and Medicine by Churchill Livingstone © 2008 Elsevier Limited. All rights reserved.

Ankle Pain: Symptoms and Treatment

Ankle Pain Overview

 

What Causes Ankle Pain Symptoms?

  • Ankle Sprain or strain is the most common cause
  • Ankle arthritis
  • Infection in the ankle joint
  • Gout, Rheumatoid arthritis, Reiter Syndrome, Pseudo gout, and other types of arthritis

 

Problems in areas that can cause you to have ankle pain include:

 

Ankle Impingement Syndrome Symptoms and Treatment

What is Impingement?

Impingement is a term used in sports medicine when soft tissue is trapped, usually between bones, leading to pressure, inflammation, pain and loss of function.

 

What is Anterior Impingement Syndrome?

Anterior ankle impingement syndrome is a condition where bone spurs or osteophytes form in the front (anterior) of the ankle joint leading to chronic ankle pain. Bone spur can form to the front end of the tibia (shin bone), on top of the ankle bone (talus) or both. When foot is push upward (dorsiflexed), the bone spurs pinch the soft tissue, causing pain and inflammation. Anterior ankle impingement syndrome is also knows as “footballer’s ankle” or “Athlete’s Ankle”.

 

What Causes Anterior Impingement Syndrome?

Anterior impingement syndrome is thought to be caused by repetitive micro-trauma where the ankle goes thought extreme up motion (dorsoflexion) or extreme down (plantarflexion) motion. Typical sports would be American football, basketball, soccer, ballet and runners.

 

What are symptoms of Anterior Impingement Syndrome?

  • Pain over the front of the ankle joint
  • Pain is reproduced when the foot is pushed upwards towards the shin.
  • Front of the ankle joint is often tender
  • Bone spur may or may not be felt over the front of the ankle.

 

How is Anterior Impingement Syndrome Diagnosed?

  • X-ray usually is all needed to evaluated the ankle joint for bone spurs.
  • MRI may be used to confirm diagnosis or rule out other problems.

 

How is Anterior Impingement Syndrome Treated?

Treatment of anterior ankle impingement syndrome is aimed to reduced inflammation and pain. Treatment may include:

  • Icing the area
  • Anti-inflammatory medications
  • Heel lift shopping cart
  • Topical pain relieving gel shopping cart

 

If conservative treatment options fail, surgical procedure may be considered. Ankle arthroscopy is ofter utilized to remove the bone spurs.

 

Image of Ankle Impingement Syndrome:

Anterior Ankle Impingement Syndrome

Source:
Definition: Dictionary of Sport and Exercise Science and Medicine by Churchill Livingstone © 2008 Elsevier Limited. All rights reserved.

Ankle Fracture Overview and Treatment

Ankle Fracture Symptoms and Treatment

A fracture describes a break in one or more of the ankle bones. fractures are often thought of as a sports injury but you do not have to be an athletes to sustain an ankle fracture. Ankle fractures are categorized as unimalleolar (1 broken bone), bimalleolar (2 broken bones) or trimalleolar (3 broken bones). Simply put, the more bones that are fractured (broken), the more unstable the ankle becomes. Fractures can happen at any age.

 

Bony Anatomy of Ankle Joint:

The ankle joint is made up of 3 bones:

  • Talus – bone that sits between tibia, fibula and calcaneus
  • Tibial – shin bone
  • Fibula – bone to the outside of ankle joint

 

What are Some Causes?

  • Rolling the ankle
  • Twisting the ankle
  • Direct trauma / impact such as car accident
  • Landing awkward after a jump
  • Walking or running on uneven surfaces

 

What are Some Symptoms:

  • severe pain
  • swelling around the joint
  • Bruising around the joint
  • inability to walk or apply pressure on the injured foot
  • Ankle area is tender to touch
  • Ankle joint may feel loose
  • Ankle deformity (if the joint is dislocated)

 

Conservative Treatments:

If the fracture is stable and there is minimal displacement of the fractured bone (s), you may be placed in a blow the knee weight bearing or non-weight bearing for 6 weeks.

 

Surgical Treatments:

If the fracture is unstable and displaced, surgical intervention may be needed to reduce the fracture (reposition the fracture) into a normal alignment. In most cases screw and (or) plates will be used to hold the bone fragments together while they heal. Usually, it takes 6 weeks for the bone to heal.

 

Physical Therapy / Rehabilitation:

Physical therapy and strengthening exercises may be needed to strengthen your leg and ankle so you can get back to normal walking and physical activity.

 

Image:

Ankle fracture
Ankle Fracture (Bi-malleolar)

Ankle Arthritis Symptoms and Treatment

What is Ankle Arthritis?

Ankle arthritis refers to wearing out the articular cartilage of the joint. The most common form is osteoarthritis (breakdown of cartilage in the joints, leading to bone to bone contact). Arthritis can produce ankle swelling and pain and in severe cases it can cause loss of function.

 

What are Some Causes of Ankle Arthritis

  • Osteoarthritis ( wear and tear / degenerative joint disease / age related) (most common)
  • Rheumatological conditions such as Rheumatoid Arthritis
  • Traumatic (due to fracture that affected the joint)
  • Gouty arthropathy (Gout attack of the joint)

 

What are the Symptoms of Ankle Arthritis

  • Tenderness or pain with palpation around the joint
  • Stiffness of the ankle joint
  • swelling around the joint
  • Reduced range of motion of the joint
  • Pain with walking or bearing weight
  • Grinding of the joint (creptius)

 

How is Ankle Arthritis Diagnosed

  • Usually simple X-rays will reveal the presence of joint arthritis
  • Bone scans
  • Magnetic resonance imaging (MRI)
  • CT scan

 

What are Some Conservative Treatment Options:

  • Weight Control is very important
  • Anti-inflammatory medications to reduce swelling in the joint
  • Pain relievers to control the pain
  • Inserts / Orthotics that support the foot shopping cart
  • Brace to provide support and limit motion shopping cart
  • Rocker bottom shoes shopping cart
  • Physical therapy
  • Cane for gait stability and support shopping cart
  • Corticosteroid injection
  • Topical pain relieving gel shopping cart

 

What are Surgical Treatments Options:

Surgical intervention may be required if conservative treatments have failed. The following are some of the surgical options for ankle osteoarthritis:

  • Ankle Fusion surgery. This kind of surgery, also called ankle arthrodesis, involves fusing bones together (tibia and talus) with the use of pins, screws, plates or rods. After healing, the bones remain fused together (no more motion to ankle joint)
  • Joint replacement surgery. This kind of surgery involves replacing the ankle joint (ankle implant) with artificial implants and is used only in rare cases due to its high failure rate.

 

 

Images:

Ankle Arthritis
Ankle Arthritis

Ankle Fusion
Ankle Fusion

Total Ankle Implant
Total Ankle Implant

Acquired Adult Flatfoot Symptoms and Treatment

Acquired Adult Flatfoot Overview

Acquired adult flatfoot is also known as Posterior tibial tendon dysfunction (PTTD). The posterior tibial tendon serves a vital function in the biomechanics of the foot and pathology of this tendon can lead to debilitating pain and possibly arthritis of foot and ankle.

Acquired adult flatfoot is a condition where the tendon has gone through changes, which makes it unable to support the arch of the foot, resulting in flattening of the foot. Posterior tibial tendon dysfunction is the most common cause of flat feet in adults, hence “adult acquired flatfeet”. This condition can happen in one foot or both feet and in general it tends to be progressive in nature, especially if it is not treated early.

Signs and symptoms of acquired adult flatfoot

    • Loss of arch height
    • Swelling to medial ankle (along the course of the tendon)
    • Inability to rise on the toes (single heel raise)
    • Pain to medial ankle with weight bearing
    • Lateral foot pain (sinus tarsi pain)
    • Inward rolling of the ankle
    • Toes starting to point towards the outside

 

Causes of Acquired Adult Flatfoot

    • Overuse
    • Not wearing supportive shoes
    • Foot sprain / trauma
    • Engaging in activities that involves the tendon: running, walking, hiking and climbing

 

Imaging of Acquired Adult Flatfoot:

MRI may be a valuable tool in evaluating the integrity of the tendon

Non-surgical Treatment of Acquired Adult Flatfoot

Acquired adult flatfoot is progressive and early evaluation and treatment of this condition is strongly advised. If treated early enough, your symptoms may resolve without the need for possible surgical intervention.

In contrast, untreated acquired adult flatfoot could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases treatment can begin with non-surgical approaches that may include:

  • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while shopping cart
  • Orthotic devices or bracing. Orthotics or Ankle Foot Orthosis (AFO) to support the arch and decrease tension on the tendon. shopping cart
  • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Shoe modifications. Your foot and ankle surgeon may advise you to change your shoes to something more supportive. (Please refer to our comprehensive shoe list to find the appropriate shoe based on you foot type)
  • Topical pain relieving gel for sore feet shopping cart

 

When Is Surgery Needed Acquired Adult Flatfoot?

In advanced progression or failed conservative treatment of acquired adult flatfoot, surgical intervention may be required to address your pain and foot deformity.

We encourage you to consult with a foot and ankle specialist for a complete assessment of your condition.

 

acquired adult flat foot

Achilles Tendon Rupture Signs, Symptoms and Treatment

Achilles Tendon Rupture Signs, Symptoms and Treatment


Achilles tendon rupture
commonly occur in healthy men between the ages of 30 and 50 years who have had no previous injury to the affected leg. Those who suffer this injury are typically “weekend warriors” who are active intermittently. Most Achilles tendon tears occur in the mid-substance of the tendoachilles, approximately 2-6 cm above the calcaneal insertion of the tendon also knows as the “watershed zone”.

The most common mechanisms of injury include sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot, and violent dorsiflexion of a plantar flexed foot. Other mechanisms include direct trauma and, less frequently, attrition of the tendon as a result of longstanding peritendinitis with or without tendinosis.

 

 

What Are Symptoms of Achilles Tendon Rupture?

  • Traumatic injury that causes sudden pain behind the ankle.
  • Patients may hear a ‘pop’ or a ‘snap,’ and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them).
  • Patients have difficulty pointing their toes downward, and may have swelling and bruising around the tendon.
  • Lack of continuity of the tendon.
  • A defect in the Achilles tendon can often be felt after a tear.
  • Squeezing the calf muscle should cause the foot to point downwards, but in patients with a torn Achilles tendon, the foot will not move (this will cause positive results on the Thompson test).
  • On X-ray, disruption of Kager’s Triangle may be noted

 

Other risk factors that are associated with Achilles tendon rupture include

  • Cortisone injections into the Achilles tendon
  • Gout
  • Fluoroquinolone antibiotic use (i.e. Cipro, Levaquin)

 

Treatment of Achilles Tendon Rupture

Treatment of an Achilles tendon tear can consist of either surgery or non-surgical techniques.

Achilles Tendinosis Causes and Treatment

What is Achilles Tendinosis?

Achilles tendinosis is a condition characterized by painful thickening of the Achilles tendon. There is usually no redness or warmth of the surrounding soft tissues, although the area can be painful to touch. Achilles tendinosis is a chronic problem, meaning it develops gradually and lasts a long time. When seen under a microscope, inflammatory cells are not present, although chronic damage and microscopic tears of the tendon may be seen. Thickening of the Achilles tendon is also referred to as degenerative tendinopathy and can lead weakening and rupture of Achilles tendon.

Thickening of the Achilles tendon (Achilles tendinosis) usually occurs approximately six-centimeters from the attachment on the heel bone. Because of poor blood supply, the ability to heal these microscopic tears is limited and tearing of the tendon continues. Eventually, the tendon begins to thicken and weaken, and gets quite painful.

 

Causes of Achilles Tendinosis

  • Lack of routine stretching of Achilles tendon
  • Activities that involve sudden starts and stops and repetitive jumping
  • Sudden increases in activity level
  • Decreased recovery time between exercise bouts
  • Training on poor surfaces or up hills
  • Changes in surface, i.e. running on trails vs. concrete sidewalks
  • Switching from high heel to athletic shoes
  • Poor footwear, i.e. high heels

 

Diagnosis of Achilles Tendinosis

  • Usually occurs if individuals who are between 35-45 years of age who are not necessarily athletic
  • Achilles tendon is painful when palpated
  • Pushing off with the leg is painful and/or weak
  • Achilles tendon is swollen and visibly thickened

 

Treatment of Achilles Tendonosis

It is important to note that because Achilles tendinosis lacks inflammation, treatments that are aimed at controlling inflammation are unlikely to be helpful. Therefore, while anti-inflammatory medications and ice application may be used to treat symptoms of discomfort associated with Achilles tendinosis, they are not fighting inflammation in this situation.

 

The more effective treatments for Achilles tendinosis are

  • shoe inserts (Orthotics) shopping cart
  • Stretching of Achilles Tendon shopping cart
  • Physically therapy
  • Massage therapy
  • Topical pain relieving gel shopping cart

 

Surgical Treatment of Achilles Tendinosis

Since the tendon has deteriorated, and it may not be possible to get it to heal again. The deteriorated portion of the tendon is removed (debrided), and the healthy sides of the tendon are stitched together. If the extent of the degeneration is severe, a tendon transfer is performed.

 

Achilles Tendinosis MRI:

Achilles Tendinosis MRI

Achilles Tendinitis Treatment Options (Surgical and Conservative)

Achilles Tendinitis Treatment

Achilles tendinitis is the inflammation of Achilles tendon. Achilles tendon is considered the strongest tendon in the body, which connects the back of the leg to the heel bone. Achilles tendinitis is a common injury, which tends to occur in middle-age recreational athletes (weekend warriors). Overuse of Achilles tendon causes inflammation, which leads to pain and swelling, which at times it can be debilitating. It should not be confused with Achilles tendinosis, which is the result of chronic inflammation, scarring and microscopic degenerative changes (tears) within the tendon substance.

Usually, Achilles tendonitis is divided into 2 categories:

  • Insertional tendinitis: Where the tendon inserts into the back of the heel becomes inflamed and usually is associated with a bump / swelling to the back of the heel. Usually, bone spur can develop to the back of the heel.
  • Non-insertional tendinitis: Mid-portion of the tendon becomes inflamed and is tender on palpation. If chronic, a palpable lump may be noted on palpation

 

What are Some Causes of Achilles Tendinitis:

  • Tightness of Achilles tendon (Equinus)
  • Flat Foot / Overpronation (Pes Planus)
  • High arch foot (Pes Cavus)
  • Shoe gear irritation
  • Not stretching before sports activity
  • Direct trauma
  • Some medications such as Fluoroquinolones are know to cause Achilles tendon pathology.

 

What are Some Symptoms of Achilles Tendinitis:

  • Pain to the back of the heel with ambulation, especially after sitting for a period of time. Usually, the first few steps out of the bed in the morning may be painful.
  • Pain / soreness on palpation of Achilles tendon (usually 2-4 cm above where the tendon attaches to the back of the heel. This area is called the “watershed” portion of Achilles tendon and is know to have poor blood supply and is particularly susceptible to inflammation, scarring and possible rupture)
  • Pain to the back of the heel or to Achilles tendon with range of motion of the ankle joint (Dorsiflexion / Plantarflexion)
  • Pain with pushing off or jumping during exercise.
  • Pain to Achilles tendon going up stairs / hills

 

Imaging for Achilles Tendinitis:

  • X-ray: Usually does not show anything unless there is a bone spur to the back of the heel
  • MRI: May be needed to evaluate for a possible tear within the tendon. A MRI may also be helpful for preoperative planning.

 

Achilles Tendinitis Treatment (Conservative):

(Depending on the length of your symptoms, it can take between 3-6 months for treatment to take effect)

  • Immobilization – allow the tendon to heal itself. (Walking boot for 6 weeks. Prolong use of walking boot can lead to weakening of the calf muscle)
  • Ice
  • Stretching exercises targeting Achilles tendon (Click here)
  • Non-steroidal Anti-inflammatory medication (NSAID)
  • Heel lifts – to decrease tension on achilles tendon and allowing it to heal
  • Night splint – to stretch the Achilles tendon
  • Orthotics / Inserts
  • Supportive shoes
  • Physical Therapy
  • Topical pain relieving gel

***Cortisone injection is not recommended for Achilles tendinitis, as it can weaken the tendon, leading to Achilles tendon tear / rupture.

Achilles Tendinitis Treatment (Surgical):

Surgical intervention is recommended only if patient has failed conservative treatment options. The specific type of surgical intervention depends on the location of tendonitis and the amount of damage to the tendon.

Achilles Tendinitis Images:

 

Achilles Tendinitis Treatment
Typical Area of Achilles Tendinitis
Achilles Tendinitis Treament
Typical Area of Achilles Tendinitis

Achilles Equinus Treatment Options (Non-Surgical and Surgical)

 

Achilles Equinus Treatment Overview

 

What is Equinus (Tight Achilles Tendon)?

Equinus or tight Achilles tendon is a condition in which the upward bending of the ankle joint is limited. Someone with equinus lacks the flexibility in their ankle joint and can occur in one or both feet.

People with tight Achilles tendon develop ways to “compensate” for their limited ankle motion. Individuals can compensate by picking up the heel early when walking (early heel off) leading to “toe walking”, picking up the heel early when walking, and this often leads to other foot, leg, or back problems.

 

What Causes of Tight Achilles Tendon

  • Tightness of gastrocnemius muscle (calf muscle)
  • Tightness of soleus muscle
  • Conginetal (present at birth)
  • Long cast immobilization
  • Use of crutches
  • Wearing high heel shoes
  • Lack of stretching exercises
  • Neurological (spastic) disorder

 

What Foot Problems Are Related to Equinus (Tight Achilles Tendon)

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Achilles Tendonitis
  • Metatarsalgia (pain on the ball of the foot)
  • Callus formation on the ball of the foot
  • Flatfoot deformity
  • Midfoot arthritis
  • Ulcer (pressure sore) to the ball of the foot
  • Bunions
  • Hammertoes
  • Shin Splints

 

Diagnosis of Equinus (Tight Achilles Tendon)

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened). Less than 10 degrees of ankle dorsiflexion is considered tight Achilles tendon (equinus)

 

Achilles Equinus Treatment (Non-Surgical)

  • stretching exercises that lengthen Achilles tendon
  • Night Splints shopping cart
  • Physical therapy
  • Topical pain relieving gel shopping cart

 

Achilles Equinus Treatment (Surgical)

In some cases, surgery such as Achilles tendon lengthening or gastrocnemius recession may be needed to correct the cause of equinus.

Foot and Ankle Conditions

Foot and Ankle Conditions & Related Topics

The provided list of foot and ankle conditions is for educational and informational purposes only. The content of each topic is derived from the current medical knowledge. The informational content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. This site does not provide medical advice and we encourage you to consult with a foot and ankle specialists for a thorough evaluation of your foot and ankle condition.

 


A

Arch Supports

 


B

Black Toenails
Bone Infection
Bone Tumors in  the Foot
Broken Ankle
Broken Foot

 


C

Calcaneal Apophysitis (Sever’s Disease)
Calf Pain
Compartment Syndrome
Contact Dermatitis
Cracked Heels

 


D

Deep Vein Thrombosis (DVT)
Dermatitis
Diabetic Foot Care Guidelines
Drop Foot
Dry Heels
DVT (Deep Vein Thrombosis)

 


E

 


F

Fallen Arches
Fifth Metatarsal Fracture
Flatfoot – Pediatric
Foot Drop
Foot Odor
Fracture – Ankle
Fracture – Calcaneus(Heel Bone)
Fracture – Foot
Fracture – Metatarsal
Fracture – Toe
Frostbite

G

Gangrene

H

Hallux Valgus (Bunion)
Heel Bone Fracture
Heel Fissures

I

Intermetatarsal Neuroma
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M

MRSA Infection of the Foot
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N

Nail Fungus
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Neuropathy
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O

Obesity and Foot Pain
Odor
Onychomycosis (Fungal Nails)
Orthotics (Foot Support)
Osteomyelitis (Bone Infection)
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P

P.A.D. (Peripheral Arterial Disease)
Pediatric Flatfoot
Peripheral Arterial Disease (P.A.D.)
Pigeon-Toes
Puncture Wounds of the Foot
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Q

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R

Raynauds Phenomenon
Restless Legs (Restless Leg Syndrome)
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S

Shin Splints
Sweaty Feet
Swollen Foot / Ankle
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T

Talar Dome Lesions
Tarsal Coalition
Thick Toenails
Toe Walking
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U

Ulcers / Wounds of the Foot
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V

Vitamin D Deficiency
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W

Webbed Toes
White Toenails
Wounds / Ulcers of the Foot
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X

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Y

Yellow Toenails
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Z

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Achilles Equinus (Tight Achilles Tendon)

 

Achilles Equinus (Tight Achilles Tendon) Overview

Achilles equinus or “tight achilles tendon” is a condition in which the upward bending of the ankle joint is limited. Someone with equinus lacks the flexibility and can occur in one or both feet.  People with equinus develop ways to “compensate” for their limited ankle motion. Individuals can compensate by picking up the heel early when walking (early heel off) leading to “toe walking”, picking up the heel early when walking, and this often leads to other foot, leg, or back problems.

 

Causes of Achilles Equinus (Tight Achilles Tendon):

  • Tightness of gastrocnemius muscle (calf muscle)
  • Tightness of soleus muscle
  • Congenital (present at birth)
  • Long cast immobilization
  • Use of crutches
  • Wearing high heel shoes
  • Lack of stretching exercises
  • Neurological (spastic) disorder

 

Foot Problems Related to Achilles Equinus:

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Achilles Tendonitis
  • Metatarsalgia (pain on the ball of the foot)
  • Callus formation on the ball of the foot
  • Flatfoot deformity
  • Midfoot arthritis
  • Ulcer (pressure sore) to the ball of the foot
  • Bunions
  • Hammertoes
  • Shin Splints

 

Diagnosis of Achilles Equinus:

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened).  Less than 10 degrees of ankle dorsiflexion is considered tight Achilles tendon (equinus)

 

Non-Surgical Treatment of Achilles Equinus:

  • stretching exercises that lengthen Achilles tendon
  • Night Splints shopping cart
  • Physical therapy
  • Topical pain relieving gel shopping cart

 

When is Surgery Needed for a Symptomatic Tight Achilles Tendon?

In some cases, surgery such as Achilles tendon lengthening or gastrocnemius recession may be needed to correct the cause of equinus.

 

Abductor Hallucis Muscle Strain Symptoms and Treatment

 

Abductor Hallucis Muscle Strain

The abductor hallucis muscle lies along the inside border of the foot, next to the heel bone.  Abductor hallucis muscle originates from the inside border if the heel bone (calcaneus) and inserts on the side of the big toe (hallux).  The muscle serves to move the big toe away from the other toes.  Abductor hallucis muscle strain is commonly misdiagnosed as plantar fasciitis as the cause for heel pain.

 

 What are the causes of Abductor Hallucis Strain?

 

What are the Signs and Symptoms of Abductor Hallucis Strain?

  • Pain along the inside arch of the foot
  • pain along the inside margin of the heel
  • Pain and tenderness when pressing along the course of abductor hallucis muscle or tendon

 

Treatment of Abductor Hallucis Muscle Strain

  • Rest
  • Apply ice to the area (10 -15 minutes for every 1 hour)
  • Tape the foot to take off the strain of the arch area (Low-Dye Taping) shopping cart
  • Wear orthotics (insoles) to support arch and prevent over pronation of the foot shopping cart
  • Anti-inflammatory medications such as Ibuprofen (Consult your physician before taking any medication)
  • Physical therapy can help with treatment of abductor hallucis muscle strain
  • Topical pain relieving gel shopping cart

 

Abductor hallucis muscle strain
Abductor Hallucis Muscle

What are Some Ankle Sprain Treatment Options

Ankle Sprain Treatment Overview

An ankle sprain is one of the most common injuries that one can experience throughout their lifetime.   It is reported that approximately 25,000 people experience it each day, and it can happen to athletes, non-athletes, children and adults. It can happen when one taking part in a sport or physical activity or simply stepping on an uneven surface, or stepping down at an angle.

The ankle is considered to be a very complex joint, held together by set of ligaments called the medial and lateral collateral ligaments.  These ligaments secure the ankle joint and protect the joint from abnormal movements, especially twisting, turning and rolling of the joint.

Medial collateral ligaments are located inside of the ankle joint and are considered to be the strongest and protect the ankle from abnormal eversion (rolling-out) of the ankle joint.

Lateral collateral ligaments are located outside of the ankle joint and are considered to be the weakest and protect the ankle from abnormal inversion (rolling-in) of the ankle joint.

Inversion ankle sprain (ankle rolling-in) is the most common type and with an ankle sprain (inversion or eversion) theseligaments can stretch and if severe enough the ligaments can tear leading to pain, swelling and bruising.

In case of severe ankle sprains, a “pop” can be heard or felt.

The amount of force with which the ankle was twisted along with clinical findings, determines that grade of ankle sprain.

  • Grade 1 sprain (Mild): Slight stretching and some damage to the ligaments.
  • Grade 2 sprain (Moderate): Partial tearing of the ligaments.
  • Grade 3 sprain (Severe): Complete tear of the ligament, which leads to gross instability of the ankle joint on physical exam. A severe ankle sprain can cause damage to the ankle joint surface (cartilage) leading to arthritis and chronic pain.

[table cols=”Severity, Grade – 1″ data=”Physical Examination Findings, Minimal tenderness and swelling, Impairment, Minimal, Pathophysiology, Stretched ligaments, Typical Treatment*, Weight bearing as toleratedNo splinting/casting Isometric exercises
Full range-of-motion and stretching/ strengthening exercises as tolerated”]

[table cols=”Severity, Grade – 2″ data=”Physical Examination Findings, Moderated tenderness and swellingDecreased range of motion Possible instability, Impairment, Moderated, Pathophysiology, Complete tears of some but not all collagen fibers in the ligament, Typical Treatment*, Immobilization with walking boot for 6 weeksPhysical therapy with range-of-motion and stretching/strengthening exercises”]

[table cols=”Severity, Grade – 3″ data=”Physical Examination Findings, Significant swelling tenderness andInstability, Impairment, Severe, Pathophysiology, Complete tear/rupture of ligament, Typical Treatment*, Immobilization for 6 weeks or morePhysical therapy similar to that for grade 2 sprains but over a longer period Possible surgical reconstruction in ankle joint instability noted after conservative treatment”]

X-ray: Since an ankle fracture can have similar symptoms of pain, swelling and bruising, an X-ray may be needed to make sure you do not have a ankle or foot fracture.

MRI: In case of severe ankle sprains, your doctor may need to order anMRI (Magnetic Resonance Imaging) to evaluate the extent of damage to the ligaments.  Most often, this can be helpful in pre-operative planning.

Symptoms of Ankle Sprain

  • Pain
  • Swelling
  • Bruising
  • Inability to apply pressure on foot or ankle

Ankle Sprain Treatment (Conservative)

  • Rest (Grade 1,2,3)
  • Ice (Grade 1,2,3)  (10-15 minute every 1 hour. You can ice over wrapping to decrease discomfort)
  • Elevation (Grade 1,2,3)
  • Compression (Grade 1,2,3) (wrap with Ace bandage to reduce swelling)
  • Immobilization with cam-walker (Grade 2,3) (Allows the ligaments and surrounding tissue to heal themselves)
  • Ankle brace (for preventative purposes)
  • Taping before Activity
  • Physical therapy
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to control pain and inflammation
  • Topical pain relieving gel Abductor hallucis muscle strain

Ankle Sprain Treatment (Surgical)

Surgical treatment for acute ankle sprain is rare and is usually reserved for injuries that fail to respond to nonsurgical treatment, and for persistent instability after months of rehabilitation and non-surgical treatment.

Pump Bump Causes and Treatment

Pump Bump Overview

 

What is Pump Bump

Pump bump” is medically known as “Haglund’s deformity“, which is a bony enlargement on the back of the heel. Usually shoes rubs against the area, causing skin and Achilles tendon irritation.  This often leads to bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

 

What Causes Pump Bump

Haglund’s deformity is often called “pump bump” because  the backs of high heel shoes (Pump-style shoes) rubs on the area and aggravates the enlargement when walking. Usually any rigid back shoies can cuase this irritation and pain.

The following foot condition can predispose one to have a pump bump:

  • A high-arched foot (pes cavus)
  • A tight Achilles tendon (Ankle Equines)

 

Symptoms of Pump Bump

Symptoms may include:

  • Enlarged bump on the back of the heel
  • Painful bump on the back of the heel
  • Swelling in the back of the heel
  • Redness over the bump on the back of the heel

 

How is Pump Bump Diagnosed

Usually, pump bump is diagnosed clinically but x-rays may be ordered to evaluate the structure of the heel bone and the foot.

 

Non-Surgical Treatment of Pump Bump

Non-surgical treatment is aimed at reducing the inflammation of the bursa. Non-surgical treatment can include one or more of the following:

  • Medication such as ibuprofen, may be recommended to reduce the pain and inflammation.
  • Icing the area. Use ice for 10-15 minutes for every 1 hour.
  • Stretching exercises help relieve tension from the Achilles tendon Abductor hallucis muscle strain
  • Heel lifts to decrease pressure on the area Abductor hallucis muscle strain
  • Heel pads to reduce friction and irritation on the area Abductor hallucis muscle strain
  • Shoe modification. Open back shoes to minimize irritation.
  • Physical therapy can help to reduce inflammation and pain
  • Orthotic devices (shoe inserts) Abductor hallucis muscle strain
  • Immobilization to allow the area to calm down and heal itself Abductor hallucis muscle strain
  • Topical pain relieving gel Abductor hallucis muscle strain

 

When Is Surgery Needed for Pump Bump

Usually surgery is needed if patient has failed conservative treatment options

 

Images:

Pump Bump / Posterior Heel Spur
Pump Bump / Posterior Heel Spur

 

Plantar Fasciitis Causes, Symptoms and Treatment

 

Plantar Fasciitis Overview

Plantar fasciitis is the inflammation of the ligament (plantar fascia) that runs from the heel bone to the ball of the foot.  This ligaments functions to stabilize and support the arch.

The plantar fascia is made of multilayered, fibrous aponeurosis broad band which is surrounded by fibrofatty subcutaneous tissue, intrinsic muscle and neurovascular structures. The plantar fascia originates from the calcaneus (heel bone) and fibers of fascia divide into the metatarsophalangeal (MTP) joint.

In the United states of America more than two million people receive treatment for plantar fasciitis 1. One out of ten people will develop heel pain in their lifetime 2.

Studies have shown that about 50% to 75 % of patients who have plantar fasciitis also have a heel spur 3-5.  Although the heel spur can occur with plantar fasciitis, it is not considered the cause.

 

The cause of plantar fasciitis is controversial but can include:

 

Symptoms of plantar fasciitis can include:

  • Dull, achy, sharp, throbbing and inflammation of the heel.
  • Pain on the bottom of the heel mostly when taking the first steps in the morning or after prolong period of sitting or walking.

Diagnosis of plantar fasciitis is based on medical history and clinical examination. Diagnostic imaging studies such as x-rays or other imaging modalities such as a MRI,CT scan, NCV or Bone Scan can be utilized to rule out other pathologies.

How is Plantar Fasciitis Treated?  

(90 % of the time plantar fasciitis does not require surgery and can be treated by conservative therapy)

  • Orthotics (inserts) Abductor hallucis muscle strain
  • Heel cups Abductor hallucis muscle strain
  • Padding Abductor hallucis muscle strain
  • Night splint Abductor hallucis muscle strain
  • Walking boot Abductor hallucis muscle strain
  • Supportive shoe gear
  • Icing
  • Anti–inflammatory Medications (NSAIDS)
  • Cortisone Injection
  • Physical therapy
  • Stretching exercises Abductor hallucis muscle strain
  • Decreasing activity.
  • Topical pain relieving gel Abductor hallucis muscle strain

 

Other Treatments for Plantar Fasciitis:

There are numerous surgical procedures available to treat plantar fasciitis. These procedure includes:

  • Minimal Invasive surgery (endoscopic plantar fascia release or small incision approach)
  • Percutaneous coblation of the fascia
  • Traditional open fasciotomy
  • Extracorporal shock wave therapy (ESWT)
  • Platelet Rich Plasma (PRP) injections.

 

Reference:
1. Pfeffer G, Bacchetti P, Deland J, et al: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int 20(4):214-221, 1999.
2. Crawford F, Thomson C: Interventions for treating plantar heel pain. Cochrane Database Syst Rev 3:CD000416, 2003.
3. Shmokler RL, Bravo AA, Lynch FR, et al: A new use of instrumentation in fluoroscopy controlled heel spur surgery. J Am Podiatr Med Assoc 78:194-197, 1988.
4. Snook GA, Chrisman OD: The management of subcalcaneal pain. Clin Orthop 82:163-168, 1972.
5. Williams PL, Smibert JG, Cox R, et al: Imaging study of the painful heel syndrome. Foot Ankle 7:345-349, 1987.