Common Issues in Podiatry

Achilles Tendonitis

Able to withstand forces of 1,000 pounds or more, the Achilles tendon is the strongest and largest tendon in the body. However, ruptured Achilles tendons are common among professional and amateur athletes.

Common symptoms include:

• Recurring pain in the calf while or after running
• Tenderness or stiffness, especially in the morning, located between an inch and two inches above the heel
• Weakness or tightness in the lower leg
• Swelling in the lower leg or ankle

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Ankle Sprains

Sprained ankles are extremely common. According to the American Orthopedic Foot and Ankle Society, over 25,000 people sprain their ankles daily.

Ankle sprains are caused by awkward ankle twisting and can cause moderate to severe pain at the site. While many patients ignore the discomfort and expect it to resolve on its own, when not evaluated by a medical professional and treated early, ankle sprains can lead to chronic instability and arthritis of the joint.

• Swelling, bruising, and pain near the ankle should be treated promptly.

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Bunions (Hallux Valgus or Hallux Limitus)

Bunions are characterized by a misaligned big toe that slants inward toward the other toes.

Common symptoms include:

• A bulge or bump near the base of the big toe
• Redness, swelling, and tenderness around the joint of your big toe
• Corns and calluses between the first and second toes caused by repeated friction
• Chronic pain in the joint of the big toe
• Reduced mobility in your big toe

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Burning Feet

Painful, red, burning feet are a common sign of peripheral neuropathy, primarily affecting those with diabetes, a history of HIV, or are over 50.

Some of the other underlying causes of burning feet include:

• Alcoholism
• Anemia
• Athlete’s foot
• Charcot-Marie-tooth disease
• Chemotherapy treatment
• Kidney disease
• CRPS (complex regional pain syndrome)
• Hypothyroidism
• Tarsal tunnel syndrome
• Vitamin deficiencies

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Corns and Calluses

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or an irregularity in a shoe.

The following habits and conditions can lead to the development of corns and calluses:

• Bunions
• Hammertoes
• Bone spurs
• Enlarged, swollen arthritic joints
• Wearing shoes without socks
• Wearing tight shoes
• Smoking

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Diabetes and Your Feet

With diabetes, a small wound can turn into a huge problem and cause extensive damage. Men and women with this condition are at a high risk of developing chronic foot problems, including:

• Nail issues
• Redness
• Blisters
• Bruises
• Warmth
• Scratches
• Pressure sores
• Ulcers
• Slow or non-healing wounds

These problems pose a considerable risk for diabetic feet, which must be monitored regularly as they are likely not to feel them due to reduced sensitivity from nerve damage. Otherwise, these patients can face severe consequences like an amputation.

As a part of the disease, diabetes decreases blood flow to the extremities causing superficial injuries to heal more slowly. When a wound does not heal in a normal amount of time, it places you at a greater risk for infection.

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Facts About Fitting Shoes

Poorly fitting shoes can cause bunions, corns, calluses, hammertoes, and other disabling and/or painful foot problems. According to the American Academy of Orthopedic Surgeons, one in six persons or 43.1 million people in the U.S. have foot problems.

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Flat Feet

Flat feet are defined by limited flexibility and the absence of an arch. While flat feet may not cause pain directly, they can encourage pronation and stress from the inward leaning of ankle joints and lead to posterior tibial tendon dysfunction (PTTD), a progressive and painful condition caused by inflammation.

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Foot Odor and Smelly Feet

The feet and hands are rich with sweat glands (about 3,000 per square inch), making them highly conducive to the growth of smelly bacteria.

To reduce foot odor, clean your feet by soaking them in Epsom salt or vinegar and water for about 10 to 20 minutes.

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Foot Fractures (Broken Bones)

Almost one-quarter of your body’s bones are in your feet. Fortunately, when fractures occur in the foot, they can often be managed conservatively without surgery.

Stress fractures are common and tend to affect the bones that extend from your toes to the middle of your feet.

A Jones fracture can result from an ankle injury that tears the tendon and chips away tiny pieces of bone. A Jones fracture may require surgery and includes symptoms such as pain, swelling, and occasionally bruising.

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Gout (Gouty Arthritis)

Gout is caused by high levels of uric acid (from diet or underlying illness) in the blood. The big toe joint is the most commonly affected area and can be very painful, with men more likely to experience gout than women.

Red meat, sauces, cheeses, shellfish, liver, lentils, beans, and alcohol have been linked to gout. Throbbing pain in the big toe, especially at night (while sleeping), is a typical gout symptom.

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Hammer Toes

A hammer toe develops when ligaments and tendons tighten unnaturally because of a muscle imbalance in the foot. Friction from wearing shoes causes the ligaments and tendons to tighten, making the toe joints curl downwards. Hammer toes affect the PIP joint (the first “knuckle” joint in the toe). While these start painlessly, they can lead to significant pain without treatment. Pain is typically felt on top of the knuckle and sometimes on the sides of the toes.

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Heel Pain / Plantar Fasciitis

Pain at the bottom and inner part of the heel, which can come on suddenly when bearing weight on the foot, is a common symptom of Plantar Fasciitis.

Some of the factors that can predispose one to this condition include:

• Weight loss
• Weight gain
• Wearing high heels
• Standing on hard surfaces for long periods
• Activities that can cause the calf muscles or Achilles tendon to tightness and contract

Post-static dyskinesia describes severe pain when standing after long periods of rest that slowly subsides after walking and is a tell-tale sign of Plantar Fasciitis.

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Ingrown Toenails

Ingrown toenails can cause minor to extreme pain and are most often caused in the following ways:

• Shoes that are too small
• Trimming toenails too short
• Cutting toenails incorrectly, such as tapering the corners to match the toe’s natural contours:
  • When trimmed in a curve, growing toenails will curl down and dig into the skin. Cut your toenails straight across and gently file (without rounding them) to remove any rough edges.

Avoid trying to cut an ingrown toenail that is hard, tender, and swollen, as this can trigger a painful infection. Instead, soak the foot in clean, warm, soapy water frequently throughout the day to soften an ingrown toenail.

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Peripheral Neuropathy

Painful feet may have many causes. Peripheral neuropathy is caused when nerves throughout the body malfunction simultaneously and can be caused by a variety of conditions, including:

• Exposure to toxins
• Poor nutrition
• Vitamin B deficiency
• Autoimmune disorders
• Kidney failure
• Cancer
• Diabetes

Addressing the underlying causes of peripheral neuropathy is the only way to effectively manage the tingling, numbness, and burning associated with this painful condition.

In some cases, the loss of sensation accompanying this condition can make individuals unaware of injuries to their feet and deep sores that develop from prolonged pressure.

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Orthotics

Unlike the over-the-counter shoe inserts that many people buy, orthotics are custom molded foot inserts that are designed for the specific needs of your right and left foot, respectively. There are many reasons someone might need to wear an orthotic.

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Sports Injuries to the Feet

Running, aerobics, martial arts, kickboxing, and other sports can cause various foot and ankle injuries, including plantar fasciitis, Achilles tendonitis, and ankle sprains.

Taking the time to warm up before engaging in athletic activities and using the right foot gear can reduce your chances of suffering these injuries.

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Swelling / Edema

An abnormal build-up of fluids in the ankles and lower legs can cause severe swelling (edema) and may be related to serious health issues, such as heart, kidney, or liver failure.

If your legs and feet are swollen and retain an impression when firmly touched, call Chelsea Foot and Ankle or your primary physician.

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Toenail Fungus (Onychomycosis)

The chances of developing toenail fungus (another common foot ailment) increase with age, with more than 50% of those over 70 affected.

Small cracks in the toenail allow common fungi to enter the nail, and the moist, warm, dark environment inside our shoes can cause an infection that spreads to adjacent nails.

Avoiding damp areas like public showers, gyms, swimming pools, saunas, steam rooms, and yoga studios or applying preventative antifungals to your feet before entering these areas can help protect your feet and toenails. Toenail fungus can be transmitted between people who live together.

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Turf Toe

Turf toe is an injury of the big toe caused by a tear or rupture from hyper-extending the big toe joint when raising the heel off the ground (standing on the tips of your big toes).

Pain, swelling, and tenderness of varying degrees, often with an acute onset during the initial push-off when running, is a hallmark of turf toe. Because the pain is not normally intense enough to keep the runner or athlete from completing the game, further injury to the big toe can occur and increase recovery time.

Treatment for turf toe can include pain relief with non-steroidal anti-inflammatory drugs (NSAIDs), rest, compression, ice, and modifying any gear that may contribute to the condition.

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Warts / Plantar Warts

While they may sometimes be painful, most foot warts are harmless and can be mistaken for corns or calluses. However, all warts are caused by the Human Papilloma Virus (HPV) and can invade the skin through tiny cracks in dry skin or abrasions in thicker plantar skin.

Warts can emerge anywhere on the skin, but those that develop on the soles of feet are called plantar warts, and these arise much in the same way that toenail fungus does.

Over-the-counter wart treatments are often ineffective. Chelsea Foot and Ankle provides relief from plantar warts with Swift® Microwave therapy for warts.

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