Resources

ACHILLES SURGERY

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

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

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

ANKLE SPRAINS

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

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

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

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

ANKLE SURGERY

Ankle surgery may be required to correct a serious deformity of the ankle and its bone structure. Injury (such as a fracture), birth defects, or changes throughout the course of life are the usual culprits. Diseases, such as diabetes, rheumatoid arthritis, and neuromuscular conditions, may cause severe foot and ankle deformities that over time, cause pain and difficulty in walking. Ankle surgeries emphasize the realignment of the structure either around or after removal of the deformity. Various kinds of internal and external fixation devices; some temporary, others permanent; are often required to maintain the appropriate alignment during and beyond the healing process.

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

ARTHRITIS

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

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

Symptoms of arthritis in the foot and ankle include:

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

Forms of Arthritis

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

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

Arthritis of the foot and ankle can be treated in many ways, including physical therapy and exercise. Anti-inflammatory medication and or steroid injections into the affected joint but always consult your physician before taking any medications. Orthotics or specially prescribed shoes can be used by your physician to treat the condition.

ARTHRITIS SURGERY

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

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

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

Such instances may include:

  • Chronic deformity with increased plantar pressures and risk of ulcers
  • Chronic deformity with significant instability that cannot be corrected by braces
  • Significant deformity that may include ulcers that don't heal or respond to therapy
  • Surgical procedures used to treat arthritis include:
  • Hind foot and ankle realignment-this kind of procedure is usually prescribed when there is significant instability resulting in a patient being unable to walk. Various types of internal fixation are placed within the foot during this kind of procedures.
  • Midfoot realignment-this kind of procedure is usually prescribed when there is significant instability of the middle portion of the foot. During a Midfoot realignment, various types of internal fixation are placed within the foot.
  • Ostectomy-in this procedure, a portion of bone is removed from the bottom of the foot. It is usually performed for a wound on the bottom of the foot that is secondary to pressure from a bony prominence.

ARTHOSCOPY

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

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

BLACK TOENAILS

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

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

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

BUNIONS

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

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

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

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain 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
  • Removal of corns and calluses on the foot
  • Changing to carefully fitted footwear designed to accommodate the bunion and not contribute toward its growth
  • Orthotic devices, a custom made device to help stabilize the joint and place the foot in the correct position for walking and standing
  • Exercises to maintain joint mobility and prevent stiffness or arthritis
  • Surgical Treatment
  • Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

CALLUSES

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

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

Use caution removing any type of pads or moleskins to avoid tearing the skin.

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

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

COMPUTED TOMOGRAPHY

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

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

CORNS

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

Improperly fitting shoes are a leading cause of pain. Toe deformities, such as hammertoe or claw toe,also can lead to corns. For large or lasting corns, please contact our office. We can reduce the cornsusing a scalpel and in some instances surgical correction is indicated.

CORN REMOVAL

Removal of corns is typically performed during an office visit. During the procedure, the corn is trimmed by shaving the dead layers of skin off with a scalpel. People with poor circulation or eyesight are discouraged from performing this kind of procedure themselves.

CYST REMOVAL

Ganglion masses, or cysts, are normally removed through surgery. Most cyst removal surgeries are performed on an outpatient basis. Contact our office to have the procedure performed.
During the procedure, the cyst is dissected from the surrounding soft tissues and removed. The recovery period depends on the location of the ganglion and the amount of dissection required during surgery. In many cases, patients receive a splint or below the knee cast. The surgeon may require thepatient to use crutches for several days to up to three weeks. This level of protection may be necessary if the ganglion is near the ankle joint.

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

DIABETES AND YOUR FEET

According to the American Diabetes Association, about 15.7 million people (5 .9 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 big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause lot damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it's a risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look, for punctures wounds bruises, pressure areas, redness, warmth,ulcers, scratches, cuts, and nail problems. Get someone to help you, or use a mirror.

Here's some basic advice for taking care of your feet:

  • Always keep your feet warm.
  • Don't get your feet wet in snow or rain.
  • Don't smoke or sit cross legged. Both 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 fi le or emery board. If you find an ingrown toenail, contact our office.
  • 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.
  • Wear warm socks and shoes in winter.
  • When drying your feet, pat each foot with a towel and be careful between your toes.
  • Buy shoes that are comfortable without "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes only two hours or less at a time. Don't wear the same pair every day. Inspect the inside of each shoe before putting it on. 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 toe socks will not squeeze your toes. Avoid stocking with elastic tops.

When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate and yet you continue to walk on it because it doesn't hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.

The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact case, you need good blood flow in your foot. Thecast is changed every week or two until your foot heals. A custom walking boot is another way to treatyour Charcot foot. It supports the foot until all the swelling does down, which can take as long as a year.

Surgery is considered if your deformity is too severe for a brace or shoe.

FLATFOOT CORRECTION

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

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

These may include:

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

FRACTURES

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

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

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

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

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

GOUT

Gout (also known as gouty arthritis) is a condition caused by a buildup of the salts of uric acid (a normal byproduct of the diet) in the joints. A single big toe joint is the most commonly affected area, possibly because it is subject to so much pressure in walking. Attacks of gouty arthritis are extremely painful.

Men are more likely to be afflicted than women. Diets heavy in red meat and shellfish have been linked to gout. However, other protein compounds in foods, such as lentils and beans, may play a role.

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

Gout can be controlled by with prescription medications and diet. Note: Please consult with your physician before taking any medications. The application of ice or cooling lotions helps alleviate pain and swelling during an acute phase. In some cases, specially made shoes are prescribed to relieve the pain associated with gout.

HEEL FISSURES

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

HEEL SURGERY

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

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

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

INGROWN TOENAILS

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

In severe cases, if an acute infection occurs, surgical removal of part of the ingrown toenail may be needed. Known as partial nail plate avulsion, the procedure involves injection the toe with ananesthetic and cutting out the ingrown part of the toenail and using a laser or a chemical to prevent recurrence of that nail border.

Ingrown toenails can be prevented by:

  • Trimming toenails straight across with no rounded corners
  • Ensuring that shoes and socks are not too tight

METATARSAL SURGERY

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

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

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

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

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

NAIL FUNGUS

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

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

A group of fungi, called dermophytes, easily attack the nail and thrive e on keratin, the nail's protein substance. In some cases, when these tiny organisms take hold, the nail may become thicker, yellowish brown, or darker in color, and foul smelling. Debris may collect beneath the nail plate, as well as white marks frequently appear on the nail plate.

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

You can prevent fungal nails infections by taking these simple precautions:

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

Depending on the type of infection you have an oral medication may need to be prescribed, and the diseased nail matter and debris removed, a process called debridement. Note: Please consult your physician before taking any medications.

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

NERVE SURGERY (NEUROMA)

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

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

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

PLANTAR FASCIITIS (HEEL SPUR)

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

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat heel pain.

RAYNAUD'S DISEASE

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

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

SEVER'S DISEASE

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

Treatment includes cutting back on sports activities, heel cushions in the shoes, icing, and or anti-inflammatory medications.  Note: Please consult your physician before taking any medications.

SPURS

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

Heel spurs refer specifically to bone spurs in the heel. Heel spurs are growths of bone on the underside, forepart of the heel bone and occur when the plantar fibrous band pulls at its attachment to the heel bone. This area of the heel later calcifies to form a spur.

Anti-inflammatory medications, cortisone injections, and or orthotics (special shoe inserts) are some of the common treatments for spurs. Note: Please consult your physician before taking any medication. Surgery may be prescribed if spurring around the joint becomes severe or leads to recurrent pain from persistent corns.

TOE SURGERY

There are many kinds of toe problems requiring surgery. These include removal of Bunions, an enlargement of the bone and tissue around the joint of the big toe. Hammertoes are frequently causedby an imbalance in the tendon or joints of the toes. Neuromas are an irritation of a nerve between thethird and fourth toes. Bone spurs, an overgrowth of bone under the toenail plat, causing nail deformity and pain.

WARTS

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

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

The wart may bleed which could be a route for spreading. Plantar warts that develop on the weight bearing areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

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