Diabetes
When you have diabetes, daily wear and
tear can take its toll on your feet, especially in the areas that
absorb the most pressure. Because of poor blood circulation, or
loss of feeling in your feet, even a minor problem such as a tiny crack
in your skin, may develop into a serious infection. Diabetic
patients can develop what we call neuropathy which is a damaging effect
to the nerves making it difficult to feel pain, pressure, heat and
cold. You may notice irritated skin, pain, or pressure caused by
collapsing joints. As the disease progresses in diabetic patients,
blocked blood vessels will bring fewer nutrients to your feet.
Without this nourishment, sores and pressure areas on the foot may not
heal. Additionally, diabetic patients may develop weakened bones,
that can slowly shift causing your feet to become deformed, changing the
way your foot distributes pressure. We perform a
thorough podiatric evaluation including: a detailed medical history,
foot examination, evaluation of the skin and blood supply, diagnostic
testing, which can be very important, including doppler or ABI studies,
to evaluate blood flow. We also do a simple test, called the
Semmes-Weinstein test, that is done in the office with a tuning fork in
order to check the level of feeling in the foot. X-rays and other
tests, such as bone scans and MRI, might also be utilized.
Often the best treatment, for our
diabetic patients, is prevention. This may be accomplished by the
education of our patients in the care and treatment of their feet.
We train all our diabetic patients to examine their feet on a regular
basis, with a regular schedule of podiatric care to help identify and
prevent problems that can become long term. Dr. Kosova, and Dr.
Reid will examine your feet regularly, teach you about self-care, provide
foot maintenance and might even recommend special footware.
For additional information on diabetic
foot visit:
www.apma.org/topics/diabetes.htm
Reconstructive
Foot Surgery
Pain and discomfort in your
feet and ankles can be helped with podiatric surgery.
Conservative treatment, such as a protective pad or cushion, only
alleviates your pain temporarily.
Reconstructive foot surgery
can correct conditions that are caused because of the following:
- Inherited at
Birth
- Improper
Footwear
- Physical Stress
- Accident
- Infection
- Neoplastic
Disorders
- Arthritic
Disorders
Surgery can help alleviate
pain from sprains, fractures, bunions, warts, corns, flatfeet and other
common problems. Foot surgery is performed on an outpatient basis
and your recovery time varies depending upon the condition being
corrected.
For additional information on
reconstructive foot surgery visit:
www.acfas.org/brftankl.html
Arthroscopic
& Laser Surgery
Problems that occur within the
joints of the foot and ankle will require surgical repair. Arthroscopy allows our doctors to inspect, examine and correct problems in
the joints with the use of needle-like probes. Since arthroscopy
uses smaller instruments and requires only small openings to be made, your
recovery time is shortened and causes less damage to the joints and
surrounding areas.
For additional information on
arthroscopic foot surgery visit:
www.acfas.org/brarthfa.html
Problems and
Disorders
Bunions
"Bunion" is a lay term
describing a painful swelling of the soft tissue overlying the big toe
of the foot. The deformity arises when a progressive dislocation
of the joint causes the big toe to drift toward the second toe.
Simultaneously, the first metatarsal bone separates or spreads in the
opposite direction, creating a bony enlargement on the inside of the
foot. The pain and swelling you experience with a bunion are a
result of shoe pressure against the bony prominence.
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Illustration
shows a foot with
both a bunion and hammertoe. |
There are two ways to treat
bunions, live with the problem and avoid excessive shoe pressure or correct the problem with surgery. Bunion surgery is categorized
into three category types which depends upon the type of bunion
deformity. Surgery is performed as an outpatient procedure.
Most patients will be able to return to full activity in three
months.
For additional information on bunions
visit:
www.apma.org/topics/bunions.htm
Hammertoes
A hammertoe is a term used to
describe a crooked, deviated, or contracted toe. Although the
condition usually stems from muscle imbalance, it is often aggravated by
poor-fitting shoes or socks that cramp the toes. Over a period of
years, the tendons that move the toe up and down begin to pull the toe
with unequal tension, and the toe then begins to buckle or become
contracted. Normally hammertoes by themselves are not painful, but
with foot wear the prominent knuckle of the toe rubs the shoe, producing
an area of irritation which eventually forms a corn.
Hammertoes can be treated with
protective pads, orthotic devices, specially fitted shoes, medication
and also surgically.
For additional information on hammertoes,
visit:
www.apma.org/topics/fsurgery.htm
Fractures
A fracture (break) of your ankle
usually happens due to a fall, an accident or hard blow. There are
different types of fractures that occur depending upon the severity of
the injury. Spiral, hairline, open, crushed bones are names used
to describe fractures.
Our doctors are experts in
fracture care and will perform x-rays to determine the type fracture you
have. We sometimes need to realign the bones, this is done
through a process called reduction. Casting of the fracture, a
walking boot, brace or splint are used to hold the bone in place during
healing.
For additional information on
fractures, visit:
www.apma.org/topics/fsurgery.htm
Sprains
If an injury to your ankle
doesn't result in a fracture, then it is likely sprained. An ankle
sprain is a common injury, especially during sporting activities, and
results in the stretching or tearing of the ligaments in the
ankle. Usually all sprains occur on the outside of the ankle
joints. Ankle sprains commonly happen from twisting your ankle,
but some people are more prone to them due to their bone structure.
Our doctors will examine your
ankle and x-rays might be taken to see if their might be other injuries
or problems with your ankle.
For additional information on sprains visit:
www.acfas.org/brankltr.html
Neuromas
Commonly called a Morton's neuroma, this
problem begins when the outer coating of a nerve in your foot thickens.
This condition has a number of different symptoms and side
effects. The most common symptoms are:
- Burning and stinging between the toes
radiating toward the ball of the foot
- An acute stabbing pain in the foot
that comes and goes
- Numbness and tingling of the toes
- Sudden cramps or pain in the forefoot
Some of the side symptoms associated with
these neuromas are leg aches, low back pain with muscle spasm, chronic
fatigue, a feeling of nervous tension, and cramps in the arch.
Although medication, physical therapy,
injections, and arch supports may offer a temporary decrease in
symptoms, the only permanent relief is minor outpatient surgery.
For additional information on neuromas,
visit:
www.apma.org/topics/fsurgery.htm
Heel
Pain & Plantar Fasciitis
Plantar fasciitis is an inflammation of the
ligament running from your heel to the ball of your foot, which is called
the plantar fascia. The bottom, or inside, of your heel may hurt
when you stand. The pain usually decreases after you walk a few
steps, but it may return with prolonged movement. Plantar fasciitis
can occur in patients whose foot flattens too much, or whose foot doesn't
flatten enough.
An additional source of heel pain can be
tendonitis around the ankle, which is an inflammation of the tendon or
tissue, that surround it. This is called tendonitis. You may
feel pain when you move your ankle or when your heel shifts from
side-to-side. The Achilles and peroneal tendons are common sites for
this problem.
A heel spur is a bony outgrowth at the base
of the heel bone near the plantar fascia. A spur may cause pain on
the bottom of the heel when you stand. As with plantar fasciitis,
the pain may decrease after standing or walking a short time. The
pain you feel is not from the spur itself. Your heel hurts because
the inflammation from the irritation of the plantar fascia, near the spur
is irritating a nerve or pressing against a plantar bursa. If the
bursa becomes inflamed, a secondary bursitis can also develop.
A source of heel pain in children is called
Sever's disease, or calcaneal apophysitis. This is an inflammation
of the area between the sections of the bone that make up the heel.
It occurs in young people whose bones have not yet fused and
matured. The back of the heel may hurt on walking, forcing the
patient to limp.
Haglund's deformity or bony outgrowth on
the upper part of the back of the heel may cause pain and irritation with
shoes. Rubbing the back of the bone against the Achilles tendon
causes redness and irritation.
A final possible source of heel pain is a
stress fracture. A stress fracture is a crack in the heel bone, usually
behind or below the subtalar joint, which is the last bone of the foot
beneath the ankle. You may feel pain during extended activity and
when you touch the area.
For additional information on heel pain
& plantar fasciitis, visit:
www.apma.org/topics/heel.htm
Corns
& Calluses
Painful corns have probably caused more
foot pain and misery than any other single problem. The cause is usually
a bone enlargement or a spur. Sometimes the toe will not lie down
because of a contracted tendon: this is known as hammertoe. The shoe
cannot fit comfortably over the toe and the patient suffers the agony of
a viselike squeeze of the skin between a prominent bone and the shoe.
Calluses spread across your foot or along
the outer edge of the heal or big toe. Treatment for these two
conditions usually requires a change of shoes and/or use of orthotics,
which cushion these problems. Surgery is another alternative if
corns or calluses become too severe.
Ingrown
Nails
Ingrown toenails are quite common
in all age groups. It is a result of a nail growing into the skin
that surrounds it. The improper trimming of the nails, tight shoes, or injury to
the nail can cause ingrown toenails. Often they seem to occur for no
reason at all.
If they become infected, you should soak them in warm
water and Epsom salts, apply an antibiotic ointment and make an
appointment to have them treated. Treatment is simple and painless
in most situations. You can resume normal daily activities within
a day.
For additional information on ingrown
nails of the foot
visit:
http://www.acfas.org/brnailds.html
Fungal
Nails
Fungal toenails are toenails that
have become infected with one of a group of microorganisms we call
fungus. This fungus is similar to the organism that causes
athlete's foot. As the fungus invades the nail and the nail bed, it may go
unnoticed for a period of time because it is rarely painful. It usually
appears at the nail edge and works its way under the nail, progressing
back to the root of the toenail. Once it invades the root it
begins to distort the way the nail grows and becomes more difficult to
treat.
Treatment, if performed early, might simply
be to clip away the problem portion of the nail and apply an antifungal
cream. Once the conditioned has progressed,
oral medications may be used with or without nail removal.
For additional information on fungal
nails of the foot
visit:
www.apma.org/topics/fungal.htm
Plantar
Warts
What are warts? A wart
is an infection caused by a virus which can invade your skin through small
cuts or breaks. Over time, the wart develops into a hard rough
growth on the surface of the skin. A 'plantar wart' is most commonly
seen on the bottom of the foot. It can also appear on the top of the
foot. Children, teens and people with allergies, or weakened immune
systems, are more vulnerable to the wart virus. Symptoms may appear
as a spongy type of tissue with tiny red-brown, or black spots. They
can grow to an inch or more across, occurring alone or with smaller
clusters nearby, commonly called mosaic. Warts are sometimes
mistaken for corns and calluses. They could persist for years and
re-occur in the same spot. If left untreated, they can spread to
other parts of the feet, or even to the hands or other parts of the
body. Dr. Kosova, and Dr. Reid will examine your wart carefully, determine that it is
not a corn or a callus, and then after debridement of the lesion,
prescribe the appropriate treatment. Oftentimes, the wart is treated
cryosurgically, which is a rather painless procedure to free the deep
layers of the wart. A medication will be prescribed for you to apply
at home. In certain cases, depending upon size, location and
resistance, sometimes surgical removal, using laser or electrocautery, is
utilized to remove the wart.
For more information about
plantar warts, visit:
www.apma.org/topics/Warts.htm
Other
Foot Problems
Family Podiatry Center also treats many other foot problems:
- Athlete's
Foot
- Black-And-Blue
Nails
- Tendonitis
- Thickened
Nails
- Plantar Warts
- Pressure
Ulcers
Other Foot Care
Geriatrics
Older patients have distinct foot
problems usually related to circulatory impairment or arthritis.
Routine visits help to monitor secondary foot disorders and prevent
further complications.
For additional information on geriatrics,
visit:
www.apma.org/topics/aging.htm
Pediatrics
Growth should not be a painful
process. Soreness and
cramping in the feet and legs are not normal. Often parents are told that their children may
"grow out of it." This may be true in some cases but a level
of reassurance from a specialist can go a long way in easing a parent's
concern. We encourage parents to have their children examined
annually. Childhood foot conditions like flat feet, curved feet,
toe walking, in-toeing and out-toeing, can cause the child to walk or
run in ways that are unnatural. This can lead to more serious
foot, leg and motor problems later in life.
For additional information on pediatrics,
visit:
www.apma.org/topics/child.htm
Orthotics
Orthotics are a custom-made biomechanical
device fabricated from a plaster cast of your foot. Structural
deficiencies and damaging compensatory habits can be modified with the
use of properly fitted orthotics.
Orthotics are molded right at our
facilities and take less than 30 minutes to be fitted. It
then takes a few days for the orthotics to be created from the cast.
For additional information on orthotics,
visit:
www.apma.org/topics/orthotics.htm
