 |
 General Orthopedics, Trauma, Sports Medicine, Hand Surgery, Foot and Ankle Surgery & Total Joint Replacement Shoulder & Elbow Surgery |
Parents anxiously await their child's first steps. All eyes and video recorders are positioned to catch this momentous occasion, but according to the doctors of Cumberland Orthopedics, all the steps a child takes after that are equally important.
"Unless there is an obvious major foot health problem, parents tend to ignore their children's foot care," says Dr. Jay, who practices at Cumberland Orthopedics and is a Professor of Orthopedics at Temple University School of Podiatric Medicine. "There seem to be so many other concerns - general health issues, proper development and just daily care - that parents overlook their children's feet, just as they do their own."
Dr. Jay recommends that parents observe their child's walking and shoe wear patterns. Things to watch out for include:
Walking with the toes pointed inward or outward is a common cause for parental concern. In some cases, these types of walking are normal, but excessive out-toeing or in-toeing needs to be evaluated.
Excessively flat feet is a common finding when infants first begin to walk. As they become older, this becomes less of an issue. Excessively flat feet may become painful with time, and may need to be treated for this reason.
High arches are not a part of normal development, and need to be investigated to be sure that it is not a sign of a bigger problem.
Nighttime leg cramps have many causes. Overuse is a common cause. Simple things, like rubbing, massage and heat, usually help. If they occur frequently, an examination is in order.
Deformities of the toes are never normal. Deviations and crossing over of toes are the beginning symptoms in ongoing problems that plague adults. Early evaluation and treatment may prevent years of discomfort.
Pain and infection in the heels can quickly become serious, and they need prompt attention to get them resolved.
Lumps and bumps that shouldn't be there -- their causes can range from warts to bone growths. These are not normal and should be checked out.
If the child makes a thumping noise with his heels and wears out the inner edges of his sole, it could be a sign of a flat foot that once was a tight Achilles tendon. Raise his heels slightly with a supportive insert (approximately 1/2 inch) and make sure he gets regular stretching exercise.
Bowleggedness is normal for the first two years of life. If it persists, though, it could signal abnormal bone growth. Knock knees are normal for 3-7 year olds and usually correct by adulthood.
Abnormal shoe wear usually signals a walking problem. In addition to being an expense, abnormal or excessive shoe wear may be the only clue to a child's foot problem.
All that can be said for the best architecture - solid stability, designed and built to bear great stress, and the ability to stand the test of time - can be said for the foot according to the doctors of Cumberland Orthopedics.
The foot is an amazing network of 26 bones, 33 joints and 107 ligments, 31 tendons and yards of nerves and blood vessels - together the feet comprise one-quarter of the bones in the body.
People take an average of 10,000 steps in a day, adding up to about 115,000 miles in a lifetime - enough to go around the planet more than four times.
The feet of a person weighing 130 pounds absorb 500 pounds of pressure with every step. This impact reaches about five million pounds of pressure each day.
Feet may come in pairs, but they are frequently unmatched, sometimes differing as much as a full shoe size. Unfortunately, shoes are sold in pairs, not mix-n-match.
According to a recent American College of Foot and Ankle Surgeons survey, 66% of Americans reported that their feet hurt on a regular basis, and their top self-treatment is changing shoes or taking shoes off. Doing nothing or just living with the pain was the choice of 18% of the respondents and only 7% sought the care of a doctor.
Shoes are important to women since they generally average 10 miles a day, outdistancing men who average only seven miles a day.
Feet and ankles provide an amazing range of motions from a baby's first wobbly steps and a ballerina's toe-dancing, to an Olympic hurdler's hard landings and a basketball players quick turns.
Feet are said to be the "mirror" of an individual's health. Arthritis and circulatory disorders often reveal their initial symptoms in the lower extremities. The foot also gives clues about a person - height, weight and gait. Sherlock Holmes was the master of discerning limps, gender, social standing and foot disorders from footprints. Podiatric surgeons are much like Holmes in determining foot problems based on the wear of a shoe. Excessive wear on the inside heel could mean the shoe is too small or excessive wear in the toe area could indicate a short Achilles tendon. Wearing on the outside of the sole may be bowleggedness, common among children.
Arthritis, characterized by inflammation and swelling of the soft tissues and lining of the joints, afflicts almost 40 million Americans. Although every joint in the body is susceptible to arthritis, the foot and its composition of 33 joints is a common target, according to Dr. Richard Jay of Cumberland Orthopedics in Vineland, New Jersey.
Arthritic feet can interfere with active lifestyles, limiting mobility and independence. The disabling effects of arthritis can often be avoided through early diagnosis and appropriate medical care.
Early diagnosis as key to effective treatment of arthritis. If the inflammation of arthritic disease isn't treated, both soft tissue and cartilage can be damaged and destruction of the cartilage may be irreversible.
Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of a joint, early morning stiffness, and skin changes, including rashes.
Symptoms do vary according to the form of arthritis and there are more than 100 different forms. Each form affects the body differently. Among the most recognized forms are:
Osteoarthritis or degenerative joint disease (wear and tear), the most common form.
Rheumatoid arthritis, a complex, chronic inflammatory disease that can be crippling.
Gouty arthritis, a condition caused by elevation of uric acid levels -sometimes a by product of diet - in the joints.
Septic arthritis or infectious arthritis, caused when bacteria spread from an infection through the bloodstream to a joint.
Psoriatic arthritis, an inflammatory arthritis associated with psoriasis.
Most forms of arthritis cannot be cured, but can be controlled and brought into remission. Arthritis treatment involves controlling inflammation and preserving joint function (or restoring it). Surgery is indicated in end-stage arthritic condition.
Traditional treatment methods include anti-inflammatories, pain medication, shoe inserts called orthoses that help with off-loading the joints affected, and physical therapy and exercise.
In addition to the traditional treatments, there are new advancements in treatment for arthritis. A whole new class of anti-inflammatories are being introduced that are as effective as those currently available, but they have less side effects such as gastrointestinal distress. There has also been preliminary success with different types of injections into the joints to repair the cartilage and joint structures.
Another critical aspect to the treatment of arthritis is patient education and involvement. Recognizing the symptoms and following the prescribed treatment regimen including appropriate medication, modifications in diet and appropriate professional follow-up are of equal importance."
Definition of plantar warts (plantar verruca)
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but, technically, only those on the sole are properly called plantar warts.
Children, especially teenagers, are often more susceptible to warts than adults; some people seem to be immune.
Identification problems
Most 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. The wart, however, is a viral infection.
It is also possible for a variety of more serious lesions to appear on the foot, including melanomas. Although rare, these conditions can sometime be misidentified as a wart. It is wise to consult a podiatrist when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.
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 centre that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have tendency to reoccur.
Sources of virus
The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic 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 which is another route for spreading.
Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
When plantar warts develop on the weight-bearing areas of the foot – the ball of the foot, or the heel, for example – they can be the source of 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.
What can you do?
Avoid walking barefoot, except on the sandy beaches
Change shoes and socks daily
Keep feet clean and dry
Check children’s feet periodically
Avoid direct contact with warts – from other persons or from other parts of the body
Do not ignore growths on, or changes in, your skin
Visit your Podiatric Physician as part of your annual health checkup
Self-treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. People with diabetes and those with cardiovascular or circulatory disorders especially should avoid self-treatment with such medications. NEVER use them in the presence of an active infection.
What might the podiatrist do?
It is possible that your podiatrist will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.
Lasers have become a common and effective treatment. A procedure known as C02 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.
Definition
A stress facture in an incomplete crack in the bone caused by overuse. A foot that is not structurally sound is prone to developing stress fractures. Even a normal foot can easily develop a stress fracture from repetitive use; symptoms may include pain, redness, and swelling.
Statistics
0.7%-15% of athletic injuries are stress fractures
Track athletes have the highest amount of stress fractures
The first metatarsal accounts for 10% of metatarsal stress fractures
The second, third and fourth metatarsals account for 90% of the metatarsal injuries
There is a decrease in the incidence of stress fractures in men with lean body mass
8.8% of stress fractures occur in the metatarsals
25.3% of stress fractures occur in the tarsal bones
0.9% of stress fractures occur in the sesamoids
28% of stress fractures occur in the calcaneus
Causes
Overuse or strain of the foot
Medical conditions such as osteoporosis
Medications such as steroids
Sudden increased activity level
What Can You Do ?
Use cold compresses or ice
Get complete rest
Elevate the feet
Stay off your feet
What Might the Podiatrist Do ?
Perform X-ray evaluation and future exams as needed
Immobilize or cast the foot/leg
Prescribe custom orthotics for long term control and prevention
Prescribe medications when indicated
When a woman is pregnant, the excessive weight gain combined with hormonal release relaxes certain ligaments in the body. As the fetus grows larger, the centre of gravity changes from the lower back to the front of the body. In the later stages of pregnancy, the woman tends to turn out her feet for stability. This puts undue stress on the tendons, muscles, and ligaments of the foot, which may cause pain or mechanical problems such as bunions, tendonitis, ingrown toenails, and other inflammatory conditions. A pregnant woman’s foot can also swell or enlarge anywhere from one to two sizes, causing discomfort. Other common complications include swelling of the legs, varicose veins, leg fatigue, and cramps.
What Can You Do ?
Wear comfortable, supportive shoes
Use over-the-counter arch supports
Elevate and rest legs often
Stretch
Begin a supervised exercise program
What Might the Podiatrist Do ?
Perform a physical examination
Prescribe support hose
Prescribe orthotics
Evaluate and treat associated foot problems
Definition of Plantar fasciitis is an inflammation of the long band of connective tissue running from the heel to the ball of the foot. Heel spur syndrome is a bony overgrowth on the heel bone. Plantar fasciitis and heel spur syndrome affect women more than men. They can cause the bottom of the heel and arch to become painful.
Statistics
Plantar fasciitis and heel spur syndrome are the most common causes of plantar heel pain.
73% of patients with heel pain are diagnosed with either plantar fasciitis or heel spur syndrome.
15% of patients who see a podiatrist complain of heel pain.
90% of those who suffer from plantar faciitis or heel spur syndrome respond to non-surgical care.
83.5% of the patients with plantar fasciitis or heel spur experience pain with first steps in the morning.
Plantar fasciitis can occur with or without a heel spur present.
Causes
Stretching the long band of tissue that connects the heel and the ball of the foot
Muscle imbalance
Bone deformity
Obesity
Trauma
Tightness of the muscles on the back of the leg
What Can You Do ?
Warm up and stretch properly before exercise
Wear appropriate shoe gear
RICE – rest, ice, compression and elevation
What Might the Podiatrist Do ?
Perform a physical examination
Perform X-ray evaluation
Perform taping and strapping
Prescribe orthotics
Prescribe appropriate medication
Administer injections
Perform surgery if necessary
Instruct in appropriate exercise
Contrary to conventional wisdom, plantar fasciitis and heel pain is not an inflammatory disorder. Rather, it is a degenerative process and should be treated as such. This course discusses the causes and differential diagnosis of plantar fasciitis, summarizes the diagnostic workup, and outlines his three-phase approach to treatment. Further, he warns of the erroneous premise of surgical procedures that involve the removal of too large a portion of the plantar fascia.
Plantar fasciitis is one of the most common causes of heel pain, which accounts for approximately 15% of all foot-related complaints. The condition occurs in a wide variety of individuals. Most often, age at onset is in the mid-40s, but plantar fasciitis can develop at any age. Many studies have shown a female-male predominance of 3:1. Sixty-five percent of patients are overweight. Unilateral involvement is common, occurring in 70% of patients. About 22% of all patients with plantar fasciitis have moderate pronation; about 15% have a high-arched, rigid foot; and the remainder have an anatomically normal or nonaffected foot.1 Only 45% of patients who undergo radiography for suspected plantar fasciitis are found to have a subcalcaneal spur.
Causes
In almost every case, the primary anatomic cause of plantar fasciitis is some degree of microtrauma and tearing at the site of plantar fascia insertion. These abnormalities, which may also be present at the origin of the plantar fascia, result from repetitive trauma and lead to collagen degeneration and angiofibroblastic hyperplasia.
Being overweight or obese places significant stress on the area and thus may be an important causative factor. Inflammation of the subcalcaneal bursa may also cause plantar fasciitis, as may compression of the median calcaneal nerve or the nerve to the abductor digiti quinti. In addition, systemic inflammatory disorders, such as rheumatoid arthritis, Reiter's syndrome, and psoriasis, may produce plantar fasciitis.
Differential diagnosis
Before plantar fasciitis can be definitively diagnosed, several other conditions must be excluded.
CALCANEAL STRESS FRACTURE - A calcaneal stress fracture may cause pain similar to that produced by plantar fasciitis.
SUBCALCANEAL DISEASE - In subcalcaneal disease, the area surrounding the site of plantar fascia insertion is not painful. Unlike the pain of plantar fasciitis, which is located in the middle of the heel, subcalcaneal pain is present on the plantar surface of the heel. Subcalcaneal pain is most likely related to bursa formation and inflammation.
HAGLUND SYNDROME - Trauma to the superior angle of the calcaneus produces inflammatory enthesopathy of the Achilles tendon. Patients who have Haglund syndrome usually experience pain during stair climbing and other activities that involve heavy use of the Achilles tendon. Rarely do they have pain on arising in the morning, which is characteristic of plantar fasciitis.
ACHILLES' TENDINITIS - In this condition, pain and swelling are generally localized to the Achilles tendon. The swelling and crepitus caused by peritendinous edema can besignificant. Patients with Achilles' tendinitis have pain during activity.
TARSAL TUNNEL SYNDROME - Compression of the median plantar or lateral plantar nerve at the median of the calcaneus causes tarsal tunnel syndrome. Often, Tinel's sign is elicited by percussion of the nerve. In many cases, electromyographic findings are inconclusive.
CALCANEAL APOPHYSITIS - This condition is limited to growing, active children with open apophyses. Pain is localized below the insertion of the Achilles tendon. Deep palpation of the affected area produces significant discomfort. Calcaneal apophysitis resolves on fusion of the apophyses, which occurs as these patients mature.
Diagnosis
At history taking, most patients with plantar fasciitis state that they have pain the instant their affected heel touches the floor in the morning. The pain lessens with time and activity. However, if they sit for some time during the day, they experience "restart" pain when they stand. Most patients experience activity-related discomfort intermittently throughout the day.
Physical examination often reveals that the range of motion of the ankle on the affected side is less--usually by no more than 5 degrees--than that of the contralateral ankle. By pressing a thumb against the middle of the affected heel, the physician can delineate the area of plantar fascial pain. Pressure similarly applied underneath the calcaneus reveals the area of subcalcaneal pain.
Radiographic findings are not specific. As already stated, the correlation between plantar fasciitis and subcalcaneal spurs is not significant. Anteroposterior and lateral views are used to rule out calcaneal stress fracture or other bone abnormalities. Fat pad atrophy can be demonstrated radiographically in some older patients.
Electromyography is rarely helpful diagnostically. In some cases of plantar fasciitis, ultrasonography shows a thickened fascia at the tip of the heel. Often, a technetium Tc 99m bone scan reveals increased isotope uptake at the site of plantar fascia insertion.
Treatment
Conservative treatment resolves plantar fasciitis in 85% of patients. In the 15% of patients in whom this approach fails, surgery is indicated.
CONSERVATIVE TREATMENT - I use a sequentially phased regimen to treat patients with plantar fasciitis.
PHASE 1 - During this phase, an exercise program that involves stretching of the plantar fascia and Achilles tendon and strengthening of the anterior tibial muscle is instituted. In addition, a fiberglass splint fabricated to extend the foot to its full length and place the heel at a 90-degree angle is worn during sleep. A semiflexible orthotic device with additional longitudinal arch support is constructed for use during the day. The patient wears these devices and continues the exercise program for 6 to 8 weeks; if absolutely no improvement is noted at the end of this period, a follow-up visit is scheduled.
PHASE 2 - At the follow-up visit, blockade of the medial calcaneal nerve or the nerve to the abductor digiti quinti with lidocaine is carried out to determine whether nervecompression exists. Corticosteroid administration is helpful only in decreasing the inflammatory response. Although one or two injections of a corticosteroid may provide prolonged symptomatic relief, permanent relief is possible only if such therapy is combined with phase 1 measures. Use of nonsteroidal anti-inflammatory drugs results in short-term pain relief.
PHASE 3 - After the follow-up visit, a short walking cast or a fiberglass ankle brace is worn for 3 weeks. If the patient is then pain-free, maintenance physiotherapy is beneficial.
SURGERY - For patients who are not pain-free after completion of 9 to 11 months of nonsurgical treatment, direct or endoscopically guided surgical release of the plantar fascia or the nerve to the abductor digiti quinti is warranted. Surgical techniques that involve partial or complete resection of the plantar fascia are based on the erroneous premise that total release of the plantar fascia is necessary. Currently, removal of only a small (one third) portion of the plantar fascia is recommended.
Comment
Plantar fasciitis is not an inflammatory but rather a degenerative process. Nonetheless, a great number of inappropriate therapeutic procedures and orthotic devices have been used in response to the erroneous belief that inflammation is the problem. Usually, the use of corticosteroids, nonsteroidal anti-inflammatory drugs, and heel cups is ineffective in the long run. Clearly, treatment of plantar fasciitis must focus on resolving the fasciosis or tendinosis present and thus should consist of rest, stretching exercises, muscle strengthening, and pressure relief.
What is a foot orthotic ?
Orthotics are custom-made shoe inserts, made from an electronic scanning or a plaster cast of the foot, which is form, fitted to the foot when not bearing weight. There are different types of orthotics designed for different activities, various shoe gear and various foot ailments. Its purpose is to prevent abnormal motion of the foot while allowing for normal motion and function.
An orthotic is designed to control the mechanics of the foot to a precise degree – from the heel contact phase of walking through mid stance and toe-off phases.
Different types of orthotics
Orthotics fall into three broad categories: rigid, soft and semi-rigid. Rigid orthotics are designed to control function. They may be made of a firm material, such as plastic or graphite. Soft orthotics help absorb shock and take pressure off uncomfortable or sore spots. Semi-rigid orthotics provide dynamic balance of the foot while walking or participating in sports. Orthotics help guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently.
What about orthotics and children ?
Practically all foot imbalances that podiatrists see stem from childhood. Bunions, for example, thought to be cause by poor fitting shoe gear are, in fact, primarily caused by abnormal foot mechanics and aggravated by shoes. These imbalances are recognized as early as the age of three or four. If a child has feet that flatten or “roll in” excessively (called hyper-pronation) chances are that they will experience more serious problems in later life. At an early age, structures of the foot can be repositioned to grow in proper alignment. Often, children will not complain of foot problems and so a check-up by a podiatrist is a good idea for all children.
By the age of thirty, most people are likely to have over 70,000 kilometers on their feet and in a lifetime, this figure increases to about 120,000 kilometers.
How do I know if I need an orthotic ?
If you are experiencing foot discomfort that persists, the origin may be biomechanical in nature, in which case, an orthotic would be helpful.
Many times, orthotics can help in situations of flat feet, high arched foot structure, heel pain, bunions and even callus formation. Since the foot is the foundation of the body, symptoms at the ankle, knee, hip and lower back can be related.
Since orthotics can work in a preventative fashion to avoid potential foot problems, they may be indicated in some cases even though you are not experiencing pain. An example of this is when the foot rolls in or flattens excessively. This may lead to disabling problems in the future. Arthritis and soft tissue damage can result due to the poor alignment of the foot. Have a podiatrist do an assessment of your feet in order to decrease the chance of potential future problems.
Are not orthotics just expensive arch supports ?
Absolutely not! A simple arch support is designed to push up against the arch while standing. It is not meant for ‘static stance’ or for ‘dynamic motion'. This means that an arch support is not designed to control the mechanics of foot imbalances, which are so varied that a precise prescription for each patient is often required.
Buying an arch support over-the-counter is similar to buying eye glasses off the shelf. An exact understanding of where the problem lies is required in order to obtain optimum results.
Definition
A neuroma is a painful condition often referred to as a pinched nerve, swollen nerve, or nerve tumor. It is defined more specifically as a benign growth or nerve tissue, frequently found between the third and fourth toes. This may result in pain, burning, tingling, or numbness between the toes and in the ball of the foot.
Causes
Improper or ill-fitting shoes
Trauma
High heeled shoes
Heredity
What Can You Do ?
Change to shoes with lower heels
Wear supportive shoes with a roomy toe box
User over-the-counter shoe inserts
What Might a Podiatrist Do ?
Perform a physical examination
Perform X-ray evaluation to rule out other causes
Recommend padding and taping
Prescribe custom orthotics
Prescribe anti-inflammatory medication
Administer cortisone injections
Perform surgery when indicated
Definition
An ingrown toenail is a painful condition characterized by the nail digging into the surrounding skin, leading to inflammation and possible infection of the toe. This is a serious condition for people with impaired circulation, diabetes or other systemic diseases.
Causes
Heredity
Trauma
Improper nail trimming
Shoe pressure
What Can You Do ?
Trim nails straight across as a preventive measure
Select the proper shoe style and size
What Might a Podiatrist Do ?
Perform a physical examination
Perform X-ray evaluation to rule out other causes
Remove the ingrown portion of the nail
Culture the nail
Prescribe appropriate medications, such as antibiotics
Perform surgical correction of the nail when indicated
Definition
A hammertoe is a contraction deformity, resulting in bony prominences on the feet.
Causes
Heredity
Trauma
Improper or ill-fitting shoes
High heeled shoes
What Can You Do ?
Change to shoes with lower heels
Wear supportive shoes with a roomy toe box
Soak to soften
Use non-medicated corn pads
What Might a Podiatrist Do ?
Perform a physical examination
Perform X-ray evaluation to rule out other causes
Recommend padding and taping
Prescribe custom orthotics
Prescribe anti-inflammatory medication
Administer cortisone injections
Perform surgery when indicated
Definition
A fungal nail infection is not just a cosmetic problem. It is an infection of the bed and plate underlying the surface of a nail. Fungal nail infection, a condition called onychomycosis (ON-i-ko-my-KO-sis), is caused primarily by organisms called dermatophytes. It is extraordinarily common, afflicting more than 35 million people in the United States alone. However, some 90% of them have yet to see a doctor for treatment.
Once these tiny organisms find their way under a nail, they begin to multiply. Ironically, when the fungus finds its way under the nail, the nail itself provides a protective environment for the fungus to thrive. The toenails are most vulnerable to infection, since they spend much of their day surrounded by dark, warm, and often moist shoes and socks.
Symptoms
When fungal nail infection begins to take hold, it can cause the nail to change color, often to a yellow/green or darker color. Debris may collect under the nail, causing a foul smell. The nail may thicken and become flaky. Thick toenails, in particular, may cause discomfort in shoes and may even make standing and walking uncomfortable for some people.
Moreover, because fungal nail infection is an infection, it can spread to other nails, and possibly to other people. Something as ordinary as an emery board can carry the fungal organisms from an infected nail to an uninfected one. That's why it is so important to seek treatment as soon as you think you have an infection.
Only your doctor can determine for sure if you have fungal nail infection. He will take a small sample of the debris under your nail, as well as possibly some nail clippings, and have them analyzed to see if fungus is present.
How do you get it?
Fungal nail infection has little to do with personal cleanliness. Something as simple as banging a toe or finger, trimming your nails too closely, or wearing tight shoes is enough to weaken the nail and expose the underlying nail bed to infection. The fungus that causes the infection resides in many common places: locker rooms, swimming pools, showers, even your garden. You can also contract the infection while getting a manicure or pedicure, from unsterilized instruments that have been used on others with the infection.
Some people have chronic disorders that make them more susceptible to fungal nail infection. People with diabetes, circulatory problems, and immunological deficiencies (such as AIDS/HIV infection) are at increased risk, as are the elderly. Moreover, fungal nail infection appears to be more prevalent in those with a history of athlete's foot (a fungal infection of the skin) and people whose feet perspire a lot.
How do you treat it?
Fungal nail infection will not go away by itself. Only your doctor can prescribe effective treatments for fungal nail infections.
What Can You Do ?
Keep your feet as clean and dry as possible; you may want to use a talcum foot powder
Use shower shoes when walking in public swimming and shower areas
Clip your toenails straight across so that the nail does not extend beyond the tip of the toe
Wear comfortable shoes that fit properly
Foot and ankle emergencies happen every day. Broken bones, dislocations, sprains, contusions, infections, and other serious injuries can occur at any time. Early attention is vitally important. Whenever you sustain a foot or ankle injury, you should seek immediate treatment from a podiatrist.
Myths
“It can’t be broken, because I can move it.” False
This widespread idea has kept many fractures from receiving proper treatment. The trust is that often you can walk with certain kinds of fractures. Some common examples: breaks of the thinner of the two leg bones; small ‘chip’ fracture of either foot or ankle bones; and the frequently neglected fracture of a toe.“If you break a toe, immediate care isn’t necessary.” False
A toe fracture needs prompt attention. If X-rays reveal it to be a simple displaced fracture, care by your podiatrist usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Many patients develop post fracture deformity of a toe, which in turn results in formation of a painfully deformed toe with a most painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.“If you have a foot or ankle injury, soak it in hot water immediately.” False
Do not use heat or hot water if you suspect a fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing effect, and prevents swelling and pain. After seeing a podiatrist, warm compresses and soaks may be used.“Applying an elastic bandage to a severely sprained ankle is adequate treatment.” False
Ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to insure a normal recovery all may be indicated. Surgery may even be necessary.“The terms ‘fracture,’ ‘break,’ and ‘crack’ are all different.” False
All of those words are proper in describing a broken bone.
Definition
A flat foot is a structural deformity resulting in the lowering of the arch of the foot. This is sometimes referred to as 'fallen arches'. A person with a flat foot or a highly arched foot that is painful is in need of treatment. People with flat feet may have ankle, knee or lower back pain.
Causes
Heredity
Arthritis
Trauma
Musculoskeletal disorders
What Can You Do ?
Wear supportive shoes
Use over-the-counter shoe inserts
What might the podiatrist do?
Perform a physical examination and gait analysis
Perform X-rays
Prescribe custom orthotics
Perform surgery when indicated
Definition
A diabetic ulcer is a breakdown of the skin on an area of the foot. An ulcer can develop quickly and may be painful and difficult to heal. Infection is a common complication. It is important to have an X-ray to determine whether there is any bone involvement when an ulcer is present.
Causes
Heredity
Uncontrolled diabetes mellitus
Trauma
Vascular insufficiency
Lack of sensation
Ill-fitting shoes
What Can You Do ?
Consult a podiatric physician immediately
Alert the doctor’s office that you are a diabetic with a foot sore
Self-treatment is not recommended for this serious condition
What might the podiatrist do?
Perform a physical examination
Perform X-rays
Perform debridement and wound care
Conduct laboratory tests
Initiate total medical team approach, which may include your family practice doctor, endocrinologist, internist, vascular surgeon, and infectious disease specialist.
Definition
The disease is marked by the inability to manufacture or properly use insulin, and impairs the body’s ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves, and blood vessels.
Statistics
Recent estimates predict that if current trends continue the numbers of persons with diabetes will more than double, from 140 million to 300 million in the next 25 years. The greater proportion of the increase is likely to occur in the developing countries, which are the communities, which can least afford it. (Source: WHO).
How do you get diabetes?
No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called non-insulin dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.
What Can You Do ?
Wash feet daily
Inspect feet and toes daily
Lose weight
Wear thick, soft socks
Stop smoking
Cut toenails straight across
Exercise
Make regular examination visits to your podiatrist
Be properly measured and fitted every time you buy new shoes
Do not go barefoot
Do not wear high heels, scandals, and shoes with pointed toes
Do not drink in excess
Do not wear anything that is too tight around the legs
Never try to remove calluses, corns or warts by yourself
What might the podiatrist do?
Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatrist, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a Podiatrist.
Definition
A callus or corn is a build up of skin that forms at points of pressure or over bony prominences. Calluses form on the bottom side of the foot. Corns form on the top of the foot and between the toes.
Statistics
65 out of 1000 people are afflicted with calluses or corns
37 out of 1000 males are afflicted
91 out of 1000 females are afflicted
Causes
Repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe
Heredity disorders
What Can You Do ?
Wear supportive shoes with a wide toe box and a low heel
Use over-the-counter creams, avoiding any acid preparations
Use pumice stone or file to treat if not a diabetic
What might the podiatrist do?
Perform a physical examination
Perform X-rays if needed
Perform trimming or padding of the lesions
Perform surgery when indicated
Definition
A bunion is an enlargement at the base of the big toe caused by a misalignment of the joint. It may be swollen, tender and painful with the wearing of footgear.
Statistics
8 out of 1000 males have a bunion
38 out of 1000 females have a bunion
55 out of 1000 people over the age of 65 or older have a bunion
63% of patients with bunions see a Podiatrist
1% of entire adult population has had a bunion
4% of people over the age of 65 have had a bunion
Causes
Biomechanical abnormalities
Heredity
Neuromuscular disorders
Inflammatory joint disease (arthritis)
Trauma
Congenital deformities
What Can You Do ?
Wear a shoe with good support and wide toe box
Apply cold compresses
Soak the foot in lukewarm water to relieve pain
Use over-the-counter foot pads
What might the podiatrist do?
Perform a physical examination of the foot
Perform X-rays
Recommend padding or taping
Prescribe orthotics as needed
Perform surgery when indicated
Definition
Blisters are painful, fluid-filled lesions, often caused by friction and pressure.
Causes
Ill-fitting shoes
Stiff shoes
Excessive moisture
Wrinkled socks against the skin
Foot deformities
What Can You Do ?
Keep your feet dry.
Always wear socks as a cushion between your feet and shoes. Wear properly fitting shoes.
If a blister does occur, do not pop it.
If a blister does occur, do not pop itCut a hole in a 1/4” piece of foam or felt and place on affected area, or cover with a soft gel-type ointment and protective soft gel dressing to prevent infection and speed up the healing process.
What might the podiatrist do?
Remove the blister surface if needed.
Prescribe appropriate medications, topical or oral.
Recommend paddings, dressings, and friction-reducing measures.
Definition
Athlete’s foot is a common infection of the skin and nails characterized by itching, scaling, redness, and the formation of small blisters. In general the lesions start between the toes and can extend to the borders and bottom of the foot. The fungus has the potential to spread to the toenails, causing them to become thickened, discolored, and painful. In this case the infection is called onychomycosis (see page 5 of this section for more details). While this infection is common among athletes, keep in mind that it can affect athletes and non-athletes alike.
Causes
The feet are vulnerable because shoes commonly create a warm, dark and humid environment that encourages fungal growth.
Athlete’s foot can also be contracted in dressing rooms, hotel and locker room showers, and swimming pool locker rooms where bare feet may come in contact with the fungus.
What Can You Do ?
Keep shoes and socks dry as a preventive measure
Practice good foot hygiene, including daily washing of the feet with soap and water; drying feet carefully, especially between the toes
Change shoes regularly and wear acrylic or cotton socks
What might the podiatrist do?
Prescribe topical anti-fungal medications
Prescribe oral anti-fungal medications (only available by prescription)
Definition
Arthritis is a disabling disease that affects nearly 40 million Americans alone. Inflammation of the cartilage and the lining of the body’s joints characterize it. Symptoms include swelling in one or more joints, recurring pain or tenderness in any joint, redness or heat in a joint, limitation in motion, early morning stiffness, and skin changes including rashes or growths. The three types of arthritis are osteoarthritis, rheumatoid arthritis, and gouty arthritis. Because each foot contains 33 joints and bears a tremendous amount of weight and pressure, feet may be more susceptible to arthritis than other parts of the body.
Causes
Heredity
Age
Viral and bacterial infections
Excessive weight
Prescription and illegal drugs
Systemic disease
Ill-fitting shoes
Trauma
What Can You Do ?
Wear supportive shoes on a daily basis
Begin a program of physical therapy, exercise or massage, use ice packs or hot packs
Soak feet in lukewarm water
Wear shock retarding insoles
Tips for adults and children - Become informed. Footwear specialists recommend that shoppers discuss size, fit, and material with store sales personnel to become better informed. Your shoe size is not a static measurement – sizes vary with style and manufacturer.
Getting the right fit
Have your feet measured while standing. It is a good idea to shop for shoes after you have been on your feet for a few hours. Even healthy, normal, feet tend to swell slightly during the day
Shoe experts and podiatrists advise having both feet measured, since feet are seldom precisely the same size. Always buy for the larger foot
Beware of shoes which need a ‘break-in’ period – proper shoes should be comfortable immediately. Have both shoes fitted and then take a good walk around the store
Select shoes that provide good comfortable fit and which give you a psychological lift. Podiatrists feel the feet, classic examples of durability and grace, can look good too
Purchase with function in mind
The shoe industry provides styling versatility for everyone – men, women and children. You should select footwear based on its appropriateness, both in appearance, support, and comfort. A good rule of thumb: buy footwear for function – for work, leisure time, or special activities.
For work: Working men and women should earmark at least three pairs of shoes for business hours. People who spend most of their working day on their feet should wear cushioned-soled shoes.
Workers in heavy industry should always wear shoes with toe protection.
For play: For casual wear, men and women can choose from a wide variety of casual slip-on and tied shoe and boot styles as well as a wide variety of sport shoes and boots.
For walking: Support is critical, and a lightweight, tie shoe is recommended. Specialists also advise that you look for cushioned heels and soles for bounce on hard surfaces and traction on slippery ones.
For children: Though fit is the most important consideration in children’s shoes, function applies here, too. For every day, crepe or rubber-soled shoes help cushion impact on growing feet better than dressier shoes with thinner soles. Buckled and tied shoes stay on the foot well and are best for active, daily wear.
A child’s shoe size should be measured regularly.
Measure children’s feet as follows:
Up to 6 years Every 2-3 months
6 – 10 years Every 3-4 months
10-12 years Every 4 months
12-15 years Every 5 months
16 years + Every 6 months
Look for shoes that are straight-laced, have a firm, rigid heel counter and flex at the toe.
Make sure there is room for the child to wiggle his or her toes, that the heel isn’t slipping out of the shoe and that there is at least 1/2 inch from the tip of the child’s toe to the end of the shoe.
Taking care of your shoes
Once you have a shoe that fits and flatters, you have to maintain it. Specialists recommend that you make it a habit to examine your shoes every time you put them on, for comfort, health reasons, and appearance.
First, look for signs of wear. If the heel lifts are low, you are 'down at heel' and asking for trouble. Run-down heels put uneven pressure on your heel bone, which supports 25% of your body weight, and adds to uneven walking patterns, which can translate to pains throughout the body.
Thin and worn soles provide little protection from the shocks of hard surfaces and put unnecessary strains on the metatarsal joints.
Ideas for good foot health when travelling:
Before traveling, visit a podiatric physician if you ARE experiencing any pain, problems, or discomfort with your feet or ankles. Foot pain is NOT normal.
To condition your feet and legs, begin a regular walking program wearing the shoes you plan to travel with – include inclines if your destination has hilly terrain – at least four weeks before your trip.
Review your travel itinerary and the activities planned to determine the kinds of shoes you will need (should pack).
Take a few pairs of supportive, comfortable shoes and plenty of appropriate socks so they can be changed frequently. Try not to take new shoes that have never been worn.
When traveling, periodically flex feet at the ankles, wiggle toes, unlace shoes if feet swell, keep legs uncrossed, and move around if possible (especially during airplane travel – get up and move around once for every hour on the plane).
Be prepared: in case of a minor foot problem, pack adhesive bandages, talcum powder, antibiotic or first aid cream, tweezers, and nail clippers in your toiletry bag.
If you injure your foot or ankle whilst away, seek professional attention from a podiatrist. People often assume that if a toe is broken, that it doesn’t require immediate attention. That is not true. When traveling abroad, use the Internet and contact a FIP member association at www.fipnet.org/.
Limit walking barefoot to safe, sandy beaches or close to the pool. Walking barefoot exposes feet to sunburn, as well as the plantar warts virus, athlete’s foot and other infections.
Regularly apply sunscreen to the tops of your feet.
Treat your feet well after a long day of sightseeing, shopping, or hiking: massage them and keep them elevated.
Copyright 2006 - Cumberland Orthopedic Professional Association
www.copabones.com