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In most cases, foot surgery is often chosen as the last available option for conditions that have otherwise been unsuccessfully treated. Surgery may be necessary for several reasons, including the removal of foot deformities (e.g. bone spurs or bunions), arthritis problems, reconstruction due to injury, and congenital malformations (e.g. club foot or flat feet). Regardless of one’s age, foot surgery may be the only successful option for treatment for certain conditions.
The type of surgery one undergoes depends on the type of foot condition the patient has. For the removal of a bunion growth, a bunionectomy is necessary. If the bones in the feet need to be realigned or fused together, a surgical fusion of the foot is needed. For pain or nerve issues, a patient may require surgery in which the tissues surrounding the painful nerve are removed. Initially, less invasive treatments are generally attempted; surgery is often the last measure taken if other treatments are unsuccessful.
While in many cases surgery is often deemed as the final resort, choosing surgery comes with certain benefits. The associated pain experienced in relation to the particular condition is often relieved with surgery, allowing patients to quickly resume daily activities. The greatest benefit, however, is that surgery generally eliminates the problem immediately.
Podiatry history has shown that foot treatments continue to evolve over time. In the field of foot surgery, endoscopic surgery is just one of the many advanced forms of surgery. As technology vastly improves so too will the various techniques in foot surgery, which already require smaller and smaller incisions with the use of better and more efficient tools. Thanks to such innovations, surgery is no longer as invasive as it was in the past, allowing for faster and easier recoveries.
The branch of medicine that is focused on the treatment, diagnosis, and study of disorders of the lower leg, ankle and foot is referred to as podiatry. Because people often spend a great deal of their time on their feet, many problems in this area can occur. A person seeks help from the field of podiatry when they need treatment for heel spurs, bunions, arch problems, deformities, ingrown toenails, corns, foot and ankle problems, infections, and problems with the foot that are related to diabetes and additional diseases.
To treat problems of the foot, ankle or lower leg, a podiatrist may prescribe physical therapy, drugs, perform surgery, or set fractures. Individuals may also be recommended to wear corrective shoe inserts, custom-made shoes, plaster casts and strappings in order to correct deformities.
When trying to gather information on a patient problem, a scanner or force plate may be used in order to design orthotics. During this procedure, patients are told to walk across a plate that is connected to a computer; the computer then takes a scan of the foot and indicates weight distribution and pressure points. The computer readouts will give the podiatrist information to help them determine the correct treatment plans.
Diagnosis is also provided through laboratory tests and x-rays. Through the foot, the first signs of serious problems such as heart disease, diabetes and arthritis can show up. For example, individuals that have diabetes may frequently have problems such as infections and foot ulcers because they experience poor circulation in the foot area. A podiatrist can then have consultations with patients when symptoms arise. Referrals will then be made to specialists that handle the greater health problems.
Some podiatrists have their own independent, private practices or clinics where they have a small staff and administrative personnel. Many podiatrists work within group practices. They usually spend time performing surgery in ambulatory surgical centers or hospitals, or visit patients in nursing homes. Podiatrists typically spend between 30 to 60 hours of week working. Some podiatrists specialize in public health, orthopedics, surgery, or primary care. Other fields include specialties in geriatrics, dermatology, pediatrics, diabetic foot care and sports medicine.
Some podiatrist specialists complete extra training in the area of foot and ankle reconstruction that results from the effects of physical trauma or diabetes. There are also surgeons that perform surgery of a cosmetic nature to correct bunions and hammertoes.
Ankles are joints that connect bones in the feet with bones in the lower leg. They are comprised of bones, ligaments, muscles, tendons, blood vessels, and nerves. The ankle joint allows the foot to move side-to-side, as well as up-and-down.
Ankle pain can be caused by a variety of conditions, but is most commonly due to soft tissue injuries such as ankle sprains and strains.
An ankle sprain occurs when one or more of the strong ligaments that support and stabilize the ankle become overly stretched or even torn if the ankle rolls, turns, or twists awkwardly. Depending on the grade of sprain (mild-moderate-severe), there will be varying degrees of pain, swelling, and restricted range of motion, along with tenderness, bruising, and ankle instability. There may even be an audible popping noise at the moment of injury.
Ankle strains can sometimes produce similar symptoms of pain, swelling, and loss of motion, however, they are due to overly stretched muscles and tendons—not ligaments. Ankle strains may also cause muscle cramps in the feet, calves and shins.
Ankle fractures are another common source of ankle pain and occur one or more of the three bones in the ankle become fractured (broken). These breaks can be stress fractures (due to repetitive stress) or traumatic fractures (due to an acute injury). Depending on where and how severe the fracture is, symptoms can include pain and swelling that can sometimes spread up to the knee, bruising or discoloration, and an inability to bear weight. A visible deformity or exposed bone may occur in severe fractures.
Various forms of arthritis may also cause ankle pain. Rheumatoid arthritis (RA) causes the immune system to attack healthy joints, like the ankle joint, by mistake, causing stiffness and swelling in both ankles. Osteoarthritis occurs when cartilage covering the ends of bones wears down, causing the bones to rub against each other. This results in pain, stiffness, and reduced range of motion in the ankle. Gout is a form of arthritis where excess amounts of uric acid in the bloodstream crystallize and build up on joints, causing severe pain and swelling. Reactive arthritis causes joint pain and swelling in the ankle in response to an infection in another part of the body.
Other forms of ankle pain include bursitis (an inflammation of a cushioning bursa sac between tendons and bone), scleroderma (a thickening of connective tissues), chronic ankle instability (caused by improperly healed ankle sprains), Achilles tendon injuries, flat feet, or an infection in the ankle.
Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia is the thick band of tissue that connects the heel bone to the toes. When this band of connective tissue becomes inflamed, plantar fasciitis occurs. Fortunately, this condition is treatable.
There are several factors that may put you at a greater risk for developing plantar fasciitis. One of the biggest factors is age; plantar fasciitis is common in those between the ages of 40 to 60. People who have jobs that require them to be on their feet are also likely to develop plantar fasciitis. This includes factory workers, teachers, and others who spend a large portion of their day walking around on hard surfaces. Another risk factor is obesity because excess weight can result in extra stress being placed on the plantar fascia.
People with plantar fasciitis often experience a stabbing pain in the heel area. This pain is usually at its worst in the morning, but can also be triggered by periods of standing or sitting. Plantar fasciitis may make it hard to run and walk. It may also make the foot feel stiff and sensitive, which consequently makes walking barefoot difficult.
Treatment for plantar fasciitis depends on the severity of the specific case of the condition. Ice massage applications may be used to reduce pain and inflammation. Physical therapy is often used to treat plantar fasciitis, and this may include stretching exercises. Another treatment option is anti-inflammatory medication, such as ibuprofen.
If you suspect that you have plantar fasciitis, meet with your podiatrist immediately. If left untreated, symptoms may lead to tearing and overstretching of the plantar fascia. The solution is early detection and treatment. Be sure to speak with your podiatrist if you are experiencing heel pain.
Have you ever gotten up from a chair or out of bed in the morning, and upon taking that first step, feel like your heel has stepped on a tack? Many people experience a feeling of sharp pain which radiates into their arch from their heel and which does not allow them to put their heel on the floor. Sometimes they need to sit back down, stand only on their toes and use the wall for balance. If you can take a few steps, it seems to go away and lessen, allowing you to then resume your activity. Later, throughout your day and after a period of rest, it can happen again. If this sounds familiar you may be suffering from your first attack of heel pain.
Heel pain is a debilitating condition that affects day to day activities. Running and walking both causes stress on the heel because the heel is the part of the foot that hits the ground first. This means that the heel is taking on your entire weight. Diagnosis and treatments for heel pain can be easily found through your podiatrist.
Plantar Fasciitis
One of the main causes of heel pain is a condition known as plantar fasciitis. The plantar fascia is a band of tissue that extends along the bottom of the foot, from the toe to the bottom of the heel. A rip or tear in this ligament can cause inflammation of these tissues, resulting in heel pain. People who do not wear proper fitting shoes are often at risk of developing problems such as plantar fasciitis. Unnecessary stress from ill-fitting shoes, weight change, excessive running, and wearing non-supportive shoes on hard surfaces are all causes of plantar fasciitis.
Achilles Tendonitis
Achilles tendonitis is another cause of heel pain. Similar to plantar fasciitis, inflammation of the Achilles tendon will cause heel pain due to stress fractures and muscle tearing. A lack of flexibility of the ankle and heel is an indicator of Achilles tendonitis. If left untreated, this condition can lead to plantar fasciitis and cause even more pain on your heel.
Heel Spur
A third cause of heel pain is a heel spur. A heel spur occurs when the tissues of the plantar fascia undergo a great deal of stress, leading to a separation of the ligament from the heel bone entirely. This results in a pointed fragment of bone on the ball of the foot, known as a heel spur.
Fungal infection of the toenail, or onychomycosis, typically appears as a gradual change in a toenail’s texture and color that involves brittleness and darkening. The fungal infection itself occurs beneath the surface of the nail. Aside from discoloration, other symptoms include the collection of debris beneath the nail plate, white marks on the nail plate, and a foul odor emanating from the nail. If ignored, the infection can spread into other nails and the skin; in severe cases, it can hinder one’s ability to work or walk.
The toenails are particularly vulnerable to contracting infection in moist environments where people are likely to be walking barefoot, such as around swimming pools, public showers, and locker rooms. Fungal infection may also be more likely to occur in nail beds that have been injured, and sufferers of chronic diseases such as diabetes, circulatory problems, or immunodeficiency conditions are particularly prone to developing fungal nails.
Fungal nails can be primarily prevented by practicing proper hygiene and regularly examining the feet and toes. Carefully washing the feet with soap and water and thoroughly drying the feet afterwards are essential. Other tips include wearing shower shoes in public areas, changing shoes and socks daily, keeping toenails clipped at a short length, wearing breathable shoes that fit properly, wearing moisture-wicking socks, and disinfecting home pedicure tools and instruments used to cut nails.
Fungal nail treatment may vary between patients and the severity of the condition. Your podiatrist may suggest a daily routine of cleansing that spans over a period of time to ease mild infections. Over-the-counter or prescription antifungal agents may also be prescribed, including topical and/or oral medications. Debridement, or the removal of diseased nail matter and debris, may also be performed. In more severe cases, surgical treatment may be needed. In some instances, the temporary removal of the fungal nail allows for the direct application of a topical antifungal to the nail bed. In other cases, a chronically painful fungal nail that has not responded to other treatments may be permanently removed; this allows the infection to be cured and avoids the growth of a deformed nail.
One out of ten broken bones is reported to be in the feet. When an object crushes, bends, or stretches the bone beyond acceptable ranges, bones break. A break in the foot is either a fracture or a straight break.
The location of any break can tell you how the break happened. Toes, for instance, break typically as a result of something being kicked hard and with great force. Heel breaks almost always are a result of an improper landing from a tall height. Twists or sprains are the other two frequent occurrences. As with all usual breaks, they result from unexpected accident or sudden injury. As with stress fractures, breaks form as a process over time from repeated stress on already present cracks. Runners, dancers, and gymnasts are the usual athletes who receive this type of break. Stress fractures result from incredible pressure on the feet. It is no surprise these athletes bear the majority of reported fractures.
Pain, swelling, bruising, and redness are all indicative of the typical symptoms from a broken foot. Severe pain—to the point of not being able to walk—usually depends on the location of the break in the foot. Toes are on the lower scale of pain threshold, but heels are high, as are a few other particular bones. As the severity of the broken foot increases, symptoms like blueness, numbness, misshaping of the foot, cuts, or deformities will become apparent. These symptoms indicate the need to see a medical professional with access to an x-ray facility.
Prior to seeing a specialist, precautions should be taken to reduce pain and swelling. Elevate and stabilize the foot, and refrain from moving it. Immobilization of the foot is the next priority, so creating a homemade splint is acceptable. Keep in mind that while creating a splint, any increase of pain or cutting off blood circulation means that the splint should be removed immediately. Use ice to decrease swelling and relieve pain symptoms.
When dealing with a medical center, the patient should note that the treatment can vary. The treatment will depend on the severity of the fracture and the cause of the break. Crutches, splits, or casts are common treatments while surgery has been known to be used in more severe cases in order to repair the break in the bones.
A bunion is an enlargement of the base joint of the toe that connects to the foot, often formed from a bony growth or a patch of swollen tissues. It is caused by the inward shifting of the bones in the big toe, toward the other toes of the foot. This shift can cause a serious amount of pain and discomfort. The area around the big toe can become inflamed, red, and painful.
Bunions are most commonly formed in people who are already genetically predisposed to them or other kinds of bone displacements. Existing bunions can be worsened by wearing improperly fitting shoes. Trying to cram your feet into high heels or running or walking in a way that causes too much stress on the feet can exacerbate bunion development. High heels not only push the big toe inward, but shift one's body weight and center of gravity towards the edge of the feet and toes, expediting bone displacement.
A podiatrist knowledgeable in foot structure and biomechanics will be able to quickly diagnose bunions. Bunions must be distinguished from gout or arthritic conditions, so blood tests may be necessary. The podiatrist may order a radiological exam to provide an image of the bone structure. If the x-ray demonstrates an enlargement of the joint near the base of the toe and a shifting toward the smaller toes, this is indicative of a bunion.
Wearing wider shoes can reduce pressure on the bunion and minimize pain, and high heeled shoes should be eliminated for a period of time. This may be enough to eliminate the pain associated with bunions; however, if pain persists, anti-inflammatory drugs may be prescribed. Severe pain may require an injection of steroids near the bunion. Orthotics for shoes may be prescribed which, by altering the pressure on the foot, can be helpful in reducing pain. These do not correct the problem; but by eliminating the pain, they can provide relief.
For cases that do not respond to these methods of treatment, surgery can be done to reposition the toe. A surgeon may do this by taking out a section of bone or by rearranging the ligaments and tendons in the toe to help keep it properly aligned. It may be necessary even after surgery to wear more comfortable shoes that avoid placing pressure on the toe, as the big toe may move back to its former orientation toward the smaller toes.
A plantar fibroma is a knot in the arch of the foot. It can cause pain when repeated pressure is applied by walking barefoot or wearing tight shoes. While plantar fibromas can appear in anyone, men who are middle-aged or older are said to be more susceptible. The main symptom of a plantar fibroma is a firm lump on the arch of the foot. If there is pain, it can be intensified by putting pressure on the nodule. The lump can stay one size or grow larger. You may have one or more fibromas in the feet and there tends to be a high incidence of recurring plantar fibromas. Generally, a plantar fibroma can be treated without surgery. Treatment might include steroid injections to help shrink the lump, orthotics to help redistribute weight away from the nodule, plantar fascia stretching, or physical therapy to help use anti-inflammatory medication on the lump. If a lump grows larger or more painful, a podiatrist can be consulted to confirm the diagnosis. The doctor will palpate the lump and this may cause pain that can be felt all the way to the toes. An X-ray, MRI, or biopsy might be done if further evaluation is necessary. A lump in the arch of the foot might be something other than a plantar fibroma, such as cysts, nerve or fatty tumors, swollen tendons, or an infection in the foot. It is important to see a podiatrist for proper diagnosis and treatment of plantar fibromas.
A podiatrist is a Doctor of Podiatric Medicine who treats the foot, ankle, and related structures of the leg. If you are having any pain, injuries, or abnormalities in these areas, it is best that you seek help from a podiatrist.
Podiatrists complete four years of training in a podiatric medical school. Their training is like that of other physicians, and they may go on to complete a fellowship training after a residency training. Some podiatrists are board certified meaning they have advanced training, clinical experience, and have taken an exam to prove their skills. Certifying boards for podiatry are the American Board of Foot and Ankle Surgery and the American Board of Podiatric Medicine. Podiatrists may work in private practices, hospitals, clinics, or they may even become professors at colleges of podiatric medicine.
While in college, those who want to be podiatrists often take biology, chemistry, and physics classes in preparation for podiatry school. In podiatry school, students study how the bones, nerves, and muscles work together to help you move around. Additionally, they study injuries and how to properly diagnose and treat them. Admittance into podiatric medical school requires the completion of 90 semester hours of undergraduate study with a good grade point average, and acceptable scores on the MCAT (Medical College Admission Test)
Podiatrists treat many different conditions such as: aching feet, ankle pain, bunions, corns, hammertoes, fungus, ingrown toenails, plantar fasciitis, sprains and more. Common forms of treatment for these conditions are physical therapy, drugs, or surgery. Podiatrists may also recommend corrective shoe inserts, custom-made shoes, plaster casts, and strappings to correct deformities.
Even if you are someone whose feet are in generally good condition, you should still visit a podiatrist to have your feet properly exfoliated and maintained, or to make sure you are looking after your feet properly.
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Corns are hard and thick areas of skin that form as a result of constant rubbing, friction, or pressure on the skin. They are patches of dead skin with a small plug toward the center. They may appear on the tops and sides of toes and can make walking painful.
Soft corns are typically thinner with a white color and rubbery texture. Soft corns tend to appear between the toes. Seed corns are another type of corn that appear in clusters and can be tender if they are on a weight-bearing part of the foot. Seed corns usually appear on the bottom of the foot and are likely caused by a blockage in sweat ducts.
While corns and calluses are somewhat similar, calluses are a bit different. Calluses are a patch of dead skin that can occur anywhere on the body. In comparison to corns, calluses are usually a bit larger in size. However, both corns and calluses are caused by increased friction on the skin.
There are some risk factors that may increase your chances of developing corns and calluses. If you have bunions, hammertoe, or a bone spur, you are more likely to develop a corn or callus on your foot.
While Corns and Calluses tend to disappear when the friction to the affected area ceases, the help of a podiatrist may be useful in the removal process. It is important to remove the dead skin around the area and this may be done in a few different ways. Moisturizing creams may be helpful in softening and removing the dead skin around the callus. You should never use razors or other pedicure equipment to remove your corns. Doing this may worsen your corn or callus and cause infection.
In some cases, corns and calluses may be caused by abnormal foot structure or walking motion. In such a case, you should seek a podiatrist’s assistance in order to correct the issue.
Foot and ankle pain can be a nuisance in a person’s life, especially if it happens frequently. The best way to prevent this type of pain, is to exercise often. Regular exercise of the foot includes stretching and strength exercises. Stretching exercises can help prevent injuries such as a sprained ankle, while strength exercises can prevent ailments such as plantar fasciitis.
Stretching exercises can help improve flexibility and the foot and ankle’s range of motion. These exercises can certainly help with those who participate in high-energy activities such as sports. Many athletes routinely perform foot and ankle exercises to prevent injuries like sprained ankles, which are common injuries where the tendons in the ankle are over stretched. Strength exercises help develop foot muscles for better support and protection.
Most exercises are simple and can be done at home, either standing or sitting. One chair exercise is called “limber up”. In this exercise, a person would start by sitting down with their feet flat on the floor. Then lift one leg up so the feet are not touching the floor, then rotate your foot clockwise 15-20 times, and 15-20 times counterclockwise. Repeat the same process with the opposite leg. Another sitting exercise helps stretch the back of your heel and requires an exercise band. It begins by looping the band around a heavy piece of furniture, or something stable that will not be moved when the band is tugged or pulled. Then sit directly in front of it, and slide one foot into the loop, so that the band curves around the forefoot. Start by pulling the forefoot back and holding it for 5-10 seconds. Doing this 10-15 times on each foot, will stretch the back of your heel, increasing your flexibility.
Foot exercises that require standing are also just as easy and simple. Referred as the “Achilles Stretch”, this exercise stretches the Achilles tendon, making it more flexible, helping prevent foot, ankle, and leg pain. It begins by first standing and facing the wall, with the arms outstretched and the palms on the wall. Then place one foot behind another keeping the back leg straight, and the forward leg bending at the knee. Make sure both heels are flat on the floor and adjust your stance accordingly. With your hips, lean forward to feel the stretch, you can also adjust the distance from your feet to feel the stretch in various parts of the calf. Make sure to hold the stretch for about 30 seconds and repeat the same process 3 times with each leg. An even easier foot exercise is simply walking on sand. Walking barefoot on sand both strengthens and stretches your feet.
Doing these exercises regularly can help prevent many foot and ankle problems. Other foot exercises can even relieve pain. For example, those affected with plantar fasciitis can simply sit down on a chair, and then place a tennis ball below their affected foot. By rolling the ball under the foot, and increasing or decreasing pressure, pain will be relieved. With any exercise, it is always important to do a small warmup such as walking a few laps around the house to get the blood flowing. If after doing an exercise to relieve pain such as the tennis ball exercise, or are unsure that your execution is correct, be sure to contact a podiatrist for further instruction.
Bone density loss, dry skin, poor circulation, and rough and brittle nails are some of the common problems that can occur as people age. The effect that these problems has on foot health should be of particular concern in comprehensive geriatric care.
Feet that are diseased or injured have a negative effect on overall health and safety. Painful feet limit a person’s willingness and ability to stay active. Poor foot health can also cause gait change, which can lead to falls and accidents. Even though recovery time from health problems naturally slows as we age, many foot problems can be avoided altogether with regular prophylactic care.
Feet should be thoroughly washed in warm water daily. Care must be taken to dry the feet well, making sure to dry between and under the toes. Any left-over moisture can cause problems like foot fungus. After cleaning feet carefully check for problems such as cracked skin, bruises, swelling, cuts, corns, or other irregularities.
Examine toenails for ingrown, jagged, or split nails. Long toenails should be cut straight across. Never cut toenails at an angle or down the side as this may lead to ingrown nails.
Cracked and dry feet should be treated once or twice a day with a non-greasy moisturizer. Rub the moisturizer into the skin and allow it to dry before putting on socks and shoes. Sweaty feet can be dusted with a small amount of talcum powder. Avoid putting talcum directly into shoes as this may make feet slip within the shoe and cause a serious fall.
Wear clean dry socks each day. Not only do clean socks feel better on the feet, but socks worn for longer periods may harbor disease and odor-causing bacteria. Socks should not be tight around the top as they can leave marks on the leg. Socks that are too small can bring about bruising caused by pressure against the toes.
Wear comfortable and well-fitting shoes. If possible, consult a professional footwear specialist when purchasing shoes. Do not walk around barefoot as this exposes the feet to possible injury and bacteria.
Good foot health allows a more active lifestyle, which improves blood flow. Good circulation aids in recovery from injury or illness. It is also important for maintaining overall health.
Serious health problems can manifest themselves as symptoms in the feet. The elderly should seek professional help from a podiatrist if experiencing foot problems like tingling, numbness, pain, infection, or a sore that does not heal. Taking care of these problems right away can prevent the development of severe cases.
People are constantly wearing improperly-fitting shoes. Though it isn’t hard, picking the right shoes does require keeping a few things in mind.
Shoe stores have rulers so you can get an exact measurement of your feet. Be sure to always measure your feet with your shoes on. Measuring just your foot will give you a shoe size that is 1-2 inches too small for picking the right size shoe.
To ensure that your toes won’t be cramped, make sure there is wiggle room. Approximately one inch should be between your toes and the tip of your shoe. It is easy to tell if your shoes are too tight, because you will start to experience pain, blisters, and swelling.
Additionally, do not always assume your shoe size will be the same at every store. Manufacturers sometimes run differently, and your size will vary from brand to brand. Make sure the stores you purchase from have return policies, in case there is a problem.
Rather than shoe shopping in the morning, it is advised to shop for shoes later in the day. Your feet will swell as the day passes. If shoes are purchased in the morning, they may not be as snug as they should be. Furthermore, not all two feet are the same size. Therefore, accommodations may be necessary.
An overall concern in buying shoes is making sure they are comfortable and supportive. There is no such thing as a shoe being ‘broken in’. If they are uncomfortable at the store, they likely will always be uncomfortable.
Since we do a lot of walking, it is important that we pick the right shoes. Our feet will benefit from this, and we will be happier and healthier because of it.
