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Common Issues


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Common Issues


What is a Podiatrist?

A podiatrist is a specialist who provides medical evaluation and treatment of foot and ankle problems. In addition to undergraduate medical school training, podiatrists attend podiatric medical school for a doctorate degree in podiatry (Doctor of Podiatric Medicine or DPM). Podiatrists take the same courses and hospital rotations during their training as general medical doctors, often side-by-side with them. However, podiatrists are required to take additional courses and hospital rotation that are specific to their area of specialization. Like all other doctors, podiatrists are required to take state and national licensing exams, as well as be licensed by the state in which they practice. According to theAmerican Podiatric Medical Association, there are more than 18,000 practicing podiatrists in the United States. Podiatrists are in demand more than ever today because of a rapidly aging and active population. In addition, according to the association, foot disorders are among the most widespread and neglected health problems affecting people in this country.

We treat the full range of foot and ankle issues. Here are some of the most common ones we see.

+ Achilles Tendonitis

The Achilles tendon is the largest and the strongest tendon in the human body. It can withstand forces of in excess of 1,000 pounds. Even so, it one of the most frequently ruptured tendons.

Both professional and “weekend-warrior” athletes can suffer from Achilles Tendinitis or Tendinosis; A common overuse injury and inflammation of the tendon.

Contributing Causes for Achilles Tendinitis / Tendinosis:

  • An inherent natural lack of flexibility in the calf muscles.
  • Hill running or stair climbing.
  • Starting exercising too quickly/vigorously after a layoff period.
  • Increasing your mileage or speed too rapidly.
  • Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort such as in a final sprint.

Achilles Tendinitis often begins with mild pain after exercise or running that gradually worsens. Other symptoms include:

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

Treatment normally includes:

  • A bandage specifically designed to restrict motion of the tendon.
  • Non-steroidal anti-inflammatory medication (NSAIDS). These can be over-the-counter ones like Ibuprofen or Alieve, or prescription strength ones.
  • Orthotics, which are devices put into your shoes to help support the muscle and relieve stress on the tendon.
  • Rest, and switching to a different exercise (like swimming) that does not stress or overuse the tendon.
  • Massage, ultrasound, stertching and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors.

In severe cases, a short course of physical therapy may be extremely beneficial. In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.

+ Ankle Sprains

More than 25,000 people sprain their ankles every day, according to the American Orthopedic Foot and Ankle Society.

Ankle sprains are caused by an unnatural twisting. These forces on the ankle bones and the bones of the foot often result in one or more ligaments on the outside of the ankle to be stretched or torn. Ankle sprains are often minimized and subsequently ignored. If not properly treated, ankle sprains could develop into serious, painful, long-term problems.

Initial treatment is R.I.C.E. (Rest, Ice, Compress, Elevate). Resting the ankle and applying ice to reduce swelling is very important in the initial 24-72 hours. Compressive bandages also may be used to immobilize and support the injury, though many of the store-bought, over-the-counter wraps are too compressive and do more harm than good. Serious ankle sprains, especially in competitive athletes, may require surgery to repair or tighten the ligaments.

+ Bunions (Hallux Valgus or Hallux Limitus)

Bunions are malaigned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by poorly-fitting shoes that are too narrow in the forefoot and toe. Surgery by a podiatric physician is frequently recommended to correct the problem.

Bunions

More than half the women in America have bunions, a common deformity. Most bunions are the result of a muscle imbalance within your foot, causing the foot to flatten too much and the base of your big toe (Metatarsophalangeal Joint) to enlarge and protrude over time. The skin over it may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take, hence the pain. The bigger your bunion gets, the more it hurts to walk. As this deformity progresses, your big toe may lean toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful.

Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. As bunions become more severe it is often difficult to walk without pain. If this goes on for a long time you can develop arthritis at this joint.

Many bunions can be treated without surgery by wearing protective pads to cushion the painful area, and of course, avoiding ill-fitting shoes in the first place.

Bunion surgery (a bunionectomy) realigns the bone, ligaments, and tendons so your big toe can be brought back to its correct position. Almost all bunion surgeries are performed on a same-day basis (no hospital stay) using sedation and a local ankle-block for anesthesia. Recovery is commonly 4-6 weeks long and persistent swelling and stiffness can last longer.

Bunion Prevention

Because bunions develop over time, taking care of your feet during childhood and early adulthood is the key to prevention. Keep track of the shape of your feet as they develop over time, especially if foot problems run in your family.

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

+ Burning Feet

Burning feet are a common complaint among many groups of people. Most commonly, this happens in persons over 50 years of age, in diabetics and in patients with a longstanding history of HIV. There are many causes for burning feet. Neuropathy is the greatest cause. Poor circulation is another cause of burning, particularly when the feet are elevated. Other causes include thyroid dysfunction and gastric restriction in obesity. Some infectious diseases, such as Leishmaniasis, a rarely reported neurologic change secondary to a bacterial infection, also may cause burning feet.

Treatments vary, depending on the underlying cause of the burning foot syndrome. Diagnostic tests often are performed before employing a treatment regimen.

+ 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 against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas.

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

+ Diabetes and Your Feet

According to the American Diabetes Association, over 16 million people (greater than 6% percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a huge risk for diabetics. Diabetics must constantly monitor their feet for changes that they no longer can feel or they face severe consequences including amputation.

With a diabetic foot, a wound such as a small blister from wearing a tight, ill-fitting shoe can cause a lot of damage. As a part of the disease, diabetes decreases blood flow to the extremities causing simple injuries to heal more slowly. When a wound does not healing in a normal amount of time it places you at a greater risk for infection. As a diabetic, you are inherently immune-suppressed, causing your infections spread more rapidly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. If you cannot see the bottom of your feet due to arthritis or obesity, you MUST get someone to help you, or use a mirror.

Some basic advice for Diabetics in caring for your feet:

  • Try to keep your feet warm.
  • Don’t get your feet wet in snow or rain.
  • Don’t put your feet on radiators or in front of the fireplace.
  • Don’t smoke or sit cross-legged. Both dramatically decrease blood supply to your feet.
  • Don’t soak your feet.
  • Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
  • Trim your toenails straight across. Avoid cutting the corners.
  • Use a nail file or emery board. If you find an ingrown toenail, contact our office. Do not attempt to cut this yourself.
  • Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
  • Wash your feet every day with mild soap and warm water and dry them well afterwards.
  • Wear loose socks to bed.
  • Wear warm socks and shoes in winter.
  • When drying your feet, pat each foot with a towel and be careful between your toes.
  • Use your hands to inspect the inside of each shoe before putting it on. Shake the shoe to remove an debris or items that may have gotten in (such as loose change or a pebble.
  • Don’t lace your shoes too tightly or loosely.
  • Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.

If your feet become numb from diabetes, they are at risk for becoming deformed. One way this happens is through a loss of protective sensation. You walk on pressure points that normally would hurt, signaling you to stop walking on the painful bony prominence. If you have diabetic neuropathy and you don’t regularly check your feet, these pressure points can eventually break through the skin and cause ulcers, or open sores. Often, these may become infected. Another way your feet may become deformed in diabetes is a bone condition called Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face as a diabetic. It warps the shape of your foot by causing your bones fracture and disintegrate, yet you continue to walk on it because you don’t feel it. Diabetic foot ulcers and the early phases of Charcot fractures can be treated successfully managed by a number of conservative (non-surgical) modalities.

+ 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. Thirty-six percent regard their foot problems as serious enough to warrant medical attention.

The cost of foot surgery to correct foot problems from tight-fitting shoes is $2 billion a year, according to the AAOS. If time off from work for the surgery and recovery is included, the cost is $3.5 billion.

General Tips on Selecting The Right Shoe for You

Some serious foot disorders, and even more common conditions, can be linked to one avoidable thing: Low quality or poorly-fitting shoes. Any podiatrist will tell you that a higher-quality, properly fitting shoe pays for itself in terms of better long-term foot health.

When shopping for shoes, always make sure to not force your feet in order to conform to the shape of a pair of shoes. Rather, the shoe should always be roomy enough to fit your foot.

The Different Parts of A Shoe

A shoe has many different components. If you understand basic shoe construction, you can make a more informed and better decision for yourself.

The sole consists of an insole and an outsole. The insole is inside the shoe; the outsole contacts the ground. The softer the material used for the sole, the greater the shoe`s ability to absorb shock.

The heel is the bottom part of the rear of the shoe that provides elevation. The higher the heel, the greater the pressure on the front of the foot. Longterm use of higher heels may also result in contracture/ shortening of the Achilles Tendon.

The toe box is the tip of the shoe that provides space for the toes. Toe boxes are either rounded or pointed and will determine the amount of space provided for the toes.

The vamp is the upper middle part of the shoe where the laces are commonly placed. Nowadays, you will sometimes see Velcro used instead of laces.

The last is the part of the shoe that curves in slightly near the arch of the foot to conform to the average foot shape. This reflects the curvature that helps you to tell the right shoe from the left one.

The material from which a shoe is made can affect fit and comfort. Softer materials decrease the amount of pressure the shoe places on the foot. Stiff materials can cause blisters and calluses.

A counter may be used to stiffen the material around the heel and give support to the foot.

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

The fitting

Here are some tips to help reduce the risk of foot problems. Use this guide when you shop for shoes:

  • Fit new shoes to the larger of your feet. Almost everyone has one foot larger than the other.
  • Have both feet measured every time you purchase shoes. Your foot size increases and changes as you get older, even throughout adulthood.
  • If the shoes feel too tight, don’t buy them! There should never be a “break-in period” with new shoes that results in discomfort and blistering. This usually means that the shoe is “breaking-in” your foot!
  • The majority of high heeled-shoes have a pointed or narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box. This is very harmful.
  • Always fit your shoes to your heel as well as your toes.
  • Don’t get hung up on a number: Like dress sizes and pants sizes, shoe sizes vary widely from brand to brand. Judge each shoe individually based on how it fits on your foot – not by the based on the size they say it is.
  • There should be a half-inch of space from the end of your longest toe to the end of the shoe.
  • Try on both shoes.
  • Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day.
  • Walk around the store in the shoes to make sure they fit well and feel comfortable before buying them.
  • With the shoe, you should be able to freely wiggle all of your toes within the toe box. If you can’t, it’s too tight and you should go up a size.
  • Nobody, reagardless of height, age or sex, should ever wear a shoe with a heel higher than 2 1/4 inches.

+ Flat Feet

Flat feet are a common condition. In infants and toddlers, the arch of your foot is not developed and flat feet are normal to have. Most feet are flexible and an arch appears when the person stands on his or her toes. The arch develops in childhood, and by adulthood most people have developed normal arches. Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.

Most flat feet usually do not cause pain in and of themselves. Flat feet may be associated with pronation, a leaning inward of the ankle bones. Painful progressive flatfoot, otherwise known as Posterior Tibial Tendon Dysfunction, is caused by inflammation of the tendon of the tibialis posterior. When the tendon becomes inflamed, gets stretched or suffers a partial or total tear, this painful condition sets in. If left untreated, this condition may lead to severe disability and chronic pain. Some people are predisposed to this condition if they have flatfeet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory drugs (NSAIDS), ice, physical therapy, supportive taping and bracing, or orthotic devices are the first line of treatment in managing the painful progressive flatfoot. Contact your physician before taking any medication. In some cases, a surgical procedure may need to be performed to repair the torn or damaged tendon and restore normal function. To prevent recurrence of this injury, orthotics may be recommended. In severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

+ Foot Odor and Smelly Feet

The feet and hands contain more sweat glands than any other part of the body (about 3,000 glands per square inch). Feet smell for two reasons: you wear shoes and your feet sweat. The interaction between your perspiration and the bacteria that thrive in your shoes and socks generates the odor. Any attempt to reduce foot odor has to address both your sweating and your footwear.

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

+ Fractures (Broken Bones)

Close to 1 in 4 of all the bones in your body is in your feet. A broken (fractured) bone in your forefoot or in one of your toes, while often painful, is rarely disabling. Most of the time, these injuries heal without the need for surgical intervention. Types of fractures include stress fractures and general bone fractures.

Stress fractures frequently occur in the bones of the forefoot extending from your toes to the middle of your foot. Stress fractures are like tiny cracks in the bone surface. They can occur with sudden increases in training (such as running or walking for longer distances or times), improper training techniques or changes in training surfaces.

Most other types of fractures extend through the bone. They may be stable, in which there is no shift in bone alignment, or displacement, in which the bone ends no longer line up properly. These fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. Several types of fractures occur to the forefoot bone on the side of the little toe (fifth metatarsal).

An ankle-twisting injury may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is a Jones fracture, which occurs near the base of the bone and disrupting the blood supply to the bone. This injury may take longer to heal or require surgery. Symptoms include pain, swelling, and sometimes bruising.

+ Gout (Gouty Arthritis)

Gout (or, Gouty Arthritis) is a condition caused by a buildup of the uric acid – a normal byproduct of the diet- in your joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking. Attacks of Gouty are extremely painful. Men are much more likely to be afflicted than women. Some research suggests that diet heavy in red meat, rich sauces, cheeses, shellfish, liver and brandy is commonly associated with gout. Other research implicates protein compounds in foods such as lentils and beans.

The most common symptom of an acute attack of Gout is waking up in the middle of the night with severe, throbbing pain in the big toe, which is almost always red, hot and swollen. Usually only one of the big toes is affected. This pain can be brought under control by certain prescription medications. Applying ice or cooling lotions will sometimes help during an acute attack.

Specially-made shoes can sometimes relieve the pain associated with gout.

+ Hammer Toes

Hammer toes result from a muscle imbalance in the foot wherein the ligaments and tendons to become unnaturally tight. A hammer toe is a toe that is contracted at the PIP joint (the first "knuckle" joint in the toe). Most hammer toes start off painlessly and most people don't even necessarily recognize that they have on. Eventually, many hammer toes can become extremely painful. Over time, the ligaments and tendons in the toe tighten, causing the toe’s joints to curl downwards. Most commonly, pain is felt at the top of the knuckle due to rubbing inside a shoe, though sometimes there is pain on the sides of the joints in the toes, from adjacent pressure and rubbing between toes.

Hammer toes are classified based on the mobility of the toe joints. There are two types – flexible and rigid. In a flexible hammer toe, the joint has the ability to move. This type of hammer toe can be straightened manually. A rigid hammer toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

+ Heel Pain / Plantar Fasciitis

Plantar fasciitis is the most common foot condition treated in New York City. Typical symptoms include pain at the bottom and inside of the heel, most commonly experienced only on weight bearing. This can come on suddenly and there are many different predisposing factors: weight loss, weight gain, new activities, standing for prolonged periods on hard surfaces, high heels, and anything that can cause tightness and contracture of the calf muscles and/or the Achilles tendon.

One of the hallmarks of this condition is something known as "post-static dyskinesia". This means that, after periods of rest (and non weight-bearing) there is extreme pain on weight-bearing. For instance, when getting up out of bed or standing up after a period of sitting, the pain can be most intense. It often takes a few steps, if not longer, before it begins to diminish in intensity.

There are many different ways to treat plantar fasciitis including, icing, stretching, nonsteroidal anti-inflammatory medications (NSAIDS), Cortisone injections, and physical therapy including ART, A.S.T.YM. and Graston Technique. Depending on the severity, location, and length of symptoms, our doctors recommend different approaches to treating this condition.

One thing about plantar fasciitis is for sure: it requires quick, consistent, and aggressive intervention as early as possible to have a full resolution of symptoms. Sadly, many patients put off addressing their heel pain for many months, and by the time they come to see us, they are already very far into the process of developing scar tissue and this prolongs their recovery time.

+ Ingrown Toenails

Ingrown toenails often are the result of trimming your toenails too short, particularly on the sides of your big toes.

While they are common, ingrown toenails can be very painful. When trimming your nails (or getting a pedicure) avoid tapering the corners so that the nail curves with the shape of your toe. The sides of the nail will curl down and dig into your skin. Shoes that are too tight or short also may cause ingrown toenails by exerting abnormal pressures on the sides of the nails, forcing them downward into the flesh of your toe.

Ingrown toenails start out hard, swollen and tender, and later, may become sore, red and infected. Your skin may start to grow over the ingrown toenail. Do not attempt to cut the nail in this condition. Not only will it be extremely painful, it may make the matter worse.

Soaking your foot in warm, soapy water several times each day is usually a good initial step to try and treat an ingrown nail. Also, you can try inserting some cotton or waxed dental floss between the nail and your skin. If this fails after a few days, or the pain gets worse, please contact our office so we can help you determine the best course of treatment for your condition.

Antibiotics are sometimes prescribed if an infection is present at the site of the ingrown nail. Part of your ingrown toenail may need to be surgically removed (partial nail plate avulsion) if an acute infection occurs. The procedure involves numbing the toe with an anesthetic and cutting out the ingrown part of the toenail.

You can prevent ingrown toenails by:

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

+ Neuropathy

Peripheral Neuropathy is caused when many peripheral nerves throughout the body malfunction at the same time. It is caused by a wide variety of conditions, including exposure to certain toxins, poor nutrition (particularly vitamin B deficiency), and complications from diseases such as cancer or kidney failure. It is also very common in diabetes and prolonged HIV infection.

The neuropathy seen in diabetes is the result of poorly controlled blood sugar levels. In HIV, the mechanism of action of the neuropathy is not well understood, but thought to potentially be two-fold: Either stemming from a direct or indirect action of the HIV virus on the peripheral nerves, or as a result of some of the more common medications used to treat HIV infection.

Often, patients with neuropathy complain of tingling, numbness, pins-and-needles feeling, and/or burning pain and loss of sensation in the legs and feet. Because people with neuropathy often lose their protective sensations (their ability to sense things like temperature and pain) they can burn themselves without realizing it and develop open sores as the result of injury or prolonged pressure. Joints are particularly vulnerable to stress in people with polyneuropathy because they are often insensitive to pain.

If you have Diabetes or HIV and think you may be experiencing symptoms of Neuropathy, we are currently enrolling patients into an investigational study examining the effects of a new, promising medication that helps treat the symptoms of neuropathy. If you would like to find out more information about this study, please contact us.

+ 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. Whether is it to treat heel pain, plantar fasciitis, neuromas, hammertoes, bunions or tailor's bunions, there are specific modifications made to each orthotic that are intended to bring you feet into a more normal and functioning position.

Many chiropractors, physical therapists and orthopedists refer their patients for custom molded orthotics as they can often help tremendously with low back pain. As orthotics restore the normal anatomic functional alignment of your feet, the changes in your base of support translated up the body, putting the ankle, knee, hip, low back and spine into their more normal functioning positions as well.

Orthotics are also very helpful in non-surgically correcting congenital deformities in children. Adjusting orthotics and making modifications in them over time as children mature and grow is a very effective way of restoring normal anatomy in mild to moderate cases of such things as flatfoot, in-toeing or out-toeing. Our doctors are experts in podopediatrics and have excellent success in non-surgically correcting such inheriting conditions.

+ Shockwave Therapy

Extracorporeal shock wave therapy is used to treat chronic heel pain (plantar fasciitis/heel spur syndrome). During this non-invasive surgical procedure, sonic waves are directed at the area of pain using a device similar to that currently used in non-surgical treatment of kidney stones.

“Extracorporeal” means “outside of the body,” and refers to this non-invasive surgical procedure in which strong sound waves are directed at the area of heel pain. This usually brief procedure (approximately 30 minutes) is performed under local anesthesia and/or “twilight” anesthesia. The strong sound waves penetrate the heel area and stimulate a healing response by the body. An overnight hospital stay is not necessary since extracorporeal shock wave therapy is performed on and outpatient basis. Since the skin is never violated, there is no post-operative wound and no sutures to remove.

This therapy is a safe and effective alternative treatment for chronic heel pain (greater than 6 months that has not responsed to conventional treatment modalities). It requires a very short recovery time, mainly due to the elimination of costly and invasive surgical procedures. Contact us today to receive more information or to discuss the treatment options for extracorporeal shock wave therapy.

+ Sports Injuries

A variety of injuries can occur as a result of partaking in activites such as running, martial arts, aerobics, kick boxing and other team sports. These include, but are not limited to, plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains.

Stretching is recommended for a minimum of 15 minutes before and after performing any exercise.

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

+ Swelling / Edema

Swelling of the feet, ankles and legs, also called edema, is often caused by an abnormal build-up of fluids in ankle and leg tissues.

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity over time, swelling is particularly noticeable in the lower legs.

When squeezed, the fluid will move out of the affected area and may leave a deep impression for a few moments. Swelling of the legs is many times related to other, more serious causes (for example, heart failure, renal failure, or liver failure).

Common causes of foot, ankle, and leg edema include:

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

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

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

+ Toenail Fungus

Toenail fungus (Onychomycosis) is uncommon in children but the incidence increases with age. Nearly half of Americans age 70 and older are infected. Fungal infections occur when the organism finds it's way into the nail through small cracks in the nail. Once in, the fungus spread through the nail and to adjacent nails in the dark, warm, moist environment that is the inside of our shoes.

Toenail fungus can cause swelling of the skin adjacent to the nail, yellowing, thickening or crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. Toenail color can vary from brown or yellow to white with this condition.

Toenail fungus can be picked up in damp areas such as public gyms, showers, saunas, steam rooms or swimming pools. It can also be picked up in areas where people are barefoot such as dance and yoga studios, and fungus can be passed people who live in the same home. Athletes and people who wear tight-fitting shoes that causes trauma to the toes or keep the feet from drying out are at higher risk. The condition can also spread from one toe to another, or to other parts of the body.

Other factors that put you at risk for a fungal toenail infection include not drying off the feet thoroughly after bathing or exercise, having an abnormal pH level of the skin, and having a compromised immune system. Diabetics have an increased risk of contracting a toenail fungus because, by definition, their immune systems are compromised. This is one of the reasons that The American Podiatric Medical Association as well as the American Diabetes Association warns diabetics that they should have their nails cut and debrided by a podiatrist.

Most topical medications for onychomycosis fail to resolve the infection. The two most successful treatments are an oral anti-fungal medication, and an FDA approved laser that kills the fungus in the nails.

+ Turf Toe

Big toe injuries also called “turf toe,” often result from hyper-extension of the big toe joint as the heel is raised off the ground. An external force is placed on the great toe and the soft tissue structures that support the big toe on the top are torn or ruptured.

Symptoms include pain, tenderness and swelling of the toe joint. Often there is a sudden acute onset of pain during push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and will dramatically increase the healing time.

Treatment includes rest, ice, compression, and equipment modification or change. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. Consult your physician before taking any medication.

+ Warts / Plantar Warts

Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses. A wart, however, is caused by a viral infection from the Human Papilloma Virus or HPV. The virus generally invades the skin through small or imperceptible cut or abrasion in the thick plantar skin. While warts can appear anywhere on the skin, technically, only those on the sole are properly called plantar warts.

More serious foot lesions such as malignant lesions can sometimes be mistaken for a wart. Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune to them. At The Chelsea Foot & Ankle Center, we see a LOT of warts in the HIV population.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black or darkened blood. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

Plantar warts are often contracted by walking barefoot on infected surfaces. Like fungus, the virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public bathing facilities and gym locker rooms.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.

Occasionally, warts can spontaneously disappear after a short time. Just as frequently, they can recur in the same location.

Plantar warts that develop on the weight-bearing areas of the foot – the ball of the foot, or the heel, can cause sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

  • Avoid direct contact with warts – from other persons or from other parts of the body.
  • Avoid walking barefoot, except on sandy beaches.
  • Change your shoes and socks daily.
  • Check your children’s feet periodically.
  • Keep your feet clean and dry.

Over-the-counter foot wart treatments are usually ineffective and their use can inadvertently destroy surrounding healthy tissue. Our practice can treat warts a variety of ways, including topical prescription medications, freezing/cryosurgery and laser removal.