Conditions & Treatments
Achilles tendinitis is a condition which causes extreme pain, swelling and stiffness to the Achilles tendon. The Achilles tendon connects the heel bone to the respective calf muscles. Achilles tendinitis is causes by repetitive small injuries to the tendon, this repeated trauma can also induce a complete rupture.
Symptoms include pain just above the heel bone, behind the heel bone or in the back of the leg. Tenderness and stiffness are present in the morning, accompanied by swelling, and difficulty flexing the foot or pointing the toes. Wearing shoes with a closed back also causes discomfort and pain. Treatment includes physical therapy, heel lifts, and sometimes use of a CAM walker boot in more severe cases. Restriction of motion and weight bearing activities is required for the improvement of the tendinitis. Should there be a full rupture of the Achilles Tendon, surgical repair is required.
An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to- side movement.
Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments. Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. Sometimes ankle sprains occur because of weak ankles, a condition that some people are born with. Previous ankle or foot injuries can also weaken the ankle and lead to sprains.
The signs and symptoms of ankle sprains may include:
Pain or soreness
Stiffness in the joint
These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains—instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if you don’t have pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain—whether it’s your first or your fifth—requires prompt medical attention.
Arthritic Foot & Ankle Care
Arthritis is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Each foot has 33 joints that can be afflicted with arthritis. Symptoms include pain and tenderness as well as “popping” of the joints. Treatment includes shoe modification, custom orthtotics, anti-inflammatory medication, application of heat, ultrasound, injections. In some instances surgical intervention may become necessary.
Athlete’s Foot is a common skin infection on the foot caused by fungus, and occurs most often between the toes. It can be caused by walking barefoot in public places as well as wearing non-moisture wicking socks. Symptoms include itching, stinging and burning between the toes; cracking and peeling skin on the feet as well as blisters on the feet that itch.
Athlete’s Foot is not a serious condition, but sometimes can be difficult to cure. In minor cases, Athlete’s Foot can be treated with over the counter antifungal medications. In more severe cases, doctors may prescribe oral and/or topical antifungal medications. In either case, when infected, keep feet dry and clean.
Brachymetatarsia (Congenital Short Toe)
Brachymetatarsia is a condition in which there is one or more abnormally short or overlapping toe bones (metatarsals). This condition may result due to a congenital defect or it may be an acquired condition. It most frequently involves the fourth metatarsal.
Dr. Khavari does corrective surgery for this deformity through distraction. This is performed by putting an external device on the bone to lengthen the bone gradually. This gives her and the patient more control of how they can and would like to lengthen the bone. The patient lengthens the bone 1/2 mm a day which is done by turning a screw at home (this process is totally pain free.
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 Hallus Abducto Valgus. 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 this joint 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 pronated 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 caused by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:
- 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—both over-the-counter and custom made—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.
- Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable.
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.
Corns & Calluses
Corns & Calluses are thickened, and hard layers of skin which form on an area of the foot, most often under pressure points. Ill fitting shoes, wearing shoes without socks, as well as areas of constant increased pressure are some of the leading causes for developing corns & calluses on the bottom of the. foot.
Symptoms include thickened, and rough skin, hard bump at the site,as well as tenderness under the skin where the corn/callus is present. Treatments include paring down the keratotic tissue and applying ointment to avoid infection of the treated area. Custom orthotics as well as shoe modification also help rid of the corn/callus. In some instances surgical intervention is required to treat the underlying biomechanical issue and bone deformity.
Diabetic foot describes the issues that occur among people who suffer from diabetes. The condition is caused by damage to the central nervous system and poor blood circulation that stems from diabetes. An insulin deficiency leads to loss of feeling in the foot, and causes other problems that can be difficult to treat.
Due to the delicate nature of these conditions, it is extremely important to pay attention to all of the warning signs, including new or lasting numbness in the foot, swelling, loss of hair on legs and feet, pain, hard skin, open wounds, and similar symptoms. Some patients with diabetes have a lack of hot, cold, or painful sensations. Other patients hurt their foot without realizing it, and the poor blood circulation makes it harder for the body to heal and fight off disease. In diabetic patients, small sores can easily turn into big infections, which is why it is crucial to constantly observe the health of the feet.
Prevention, early diagnosis, and proper treatment of diabetic foot is crucial for diabetic foot issues. A podiatrist can help develop a diabetic foot care program for a patient, which includes:
- Regular preventative examinations
- Regular nail and foot inspections
- Healthier lifestyle
- Proper hygiene and change in footwear to include therapeutic shoes
- Prompt wound care in order to resolve the issues before they become too big
- Custom orthotics
- Physical therapy
- Surgical care, if needed
Flatfeet are characterized by collapsing of the arch that comes into a complete or a nearly complete contact with the ground. Flatfeet be hereditary or be caused by stretched or torn tendons. Symptoms include pain in the heel and the arch of the foot. Treatment includes strengthening exercises, shoe gear modifications, and custom orthotics. In some instances, surgical intervention is required. In such situations, the surgeon evaluates the appropriate corrective procedure for the affected foot.
Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and smells foul. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair your ability to work or even walk. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.
Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where you are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed
may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete’s foot and excessive perspiration.
A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the- counter liquid antifungal agent. However, even the best over-the- counter treatments may not prevent a fungal infection from treatments may vary, depending on the nature and severity of the infection. Your foot and ankle physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail.
Geriatric Foot Care
As average lifespans increase, so does stress on the feet. Because of increased wear on elderly feet, injury and deformation that can cause pain and mobility loss becomes a greater threat to geriatrics. Preventative care and nonsurgical procedures can help lead to healthy feet and mobility as you age.
Symptoms of these health issues that can be found in feet include: dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness, and discoloration
Gout is a form of arthritis due to increased uric acid in the body, typically from dietary sources. It’s causes are certain foods, including steak, shellfish, and alcohol. It can also be caused by the inability to deplete the uric acid from the body leading to increased uric acid levels. Symptoms include inflammation and redness accompanied by intense pain in the big toe joint. This is sometimes accompanied by limited range of motion in the great toe joint as well as warmth at the joint level.
Gout may be treated with non-steroidal anti-inflammatories (ibuprofen or aspirin), or ultrasound guided cortisone injections. In some instances, doctors may prescribe prescription medications to lower uric acid. In rare cases, surgical intervention is required to debride the joint area and get rid of built up crystals at the joint level.
A Hammertoe is an imbalance of the foot muscles that causes the middle joint of the toe to bend and become stuck in the bent position. It can be hereditary or be caused by tendon imbalance, ill-fitting shoes, as well as injury. Symptoms include, pain on top of the bent toe when wearing shoes; red, swollen toe joint as well as limited range of motion in the toe joint.
Hammertoes may be treated conservatively with shoe gear modifications and ultrasound guided cortisone injections. However, often times conservative treatments are unsuccessful and surgical intervention is required. In such instances the surgeon would excise a small piece of the bone, perform a joint implant procedure or joint fusion procedure.
A heel spur is a calcium deposit that causes a bone protrusion on the heel bone. Heel spurs may be hereditary and asymptomatic or secondary plantar fasciitis. Symptoms include intense pain when rising in the morning and/or dull, aching pain in the heel throughout the day
Heel Spurs may be treated conservatively with strengthening and stretching exercises, custom orthotics and shockwave therapy. For more severe cases, Platelet Rich Plasma injections (PRP) are recommended. In some cases, conservative treatments are not effective and surgical intervention is required. In such instances, the surgeon would release the painful contracted tissue from the heel bone.
Infections may result from a variety of conditions such as an ingrown toenail, a bug or an animal bite as well as a diabetic wound. In any case, we will evaluate the patient clinically and present a suitable treatment plan. In rare occasions a surgical debridement may become necessary should a wound have been left unattended, or poor hygiene of the wound has been present.
Ingrown toenail also known as onychocryptosis, is a common condition that occurs when the sides of the toenails grow into the surrounding skin. When the edges of the nail break through the skin, the ingrown toenail can cause pain, redness, swelling, tenderness and, if not properly cared for, an infection. Most frequently, this condition affects the large toes, but it can happen on other toes as well.
There are number of risk factors and causes for ingrown toenails, such as:
- improper trimming of the toenail
- wearing shoes or socks that don’t fit
- injuring the toe
- playing certain sports such as running, tennis, soccer or basketball
- having curved toenails
- putting repetitive pressure to the feet
- not maintaining proper hygiene
- fungal infections
- excessive sweating of the feet
- genetic predisposition
There are three stages of ingrown toenails: mild, moderate, and severe. A podiatrist can diagnose the condition and its stage based on the symptoms, and with a physical examination of the nail and the surrounding skin. Depending on the severity of the symptoms, the doctor can recommend topical or oral antibiotics. If the toenail doesn’t improve, surgery may be recommended to remove a part of the toenail (partial nail removal), or the whole toenail (total nail removal). These procedures are common and performed under a local anesthetic.
To prevent this condition, it’s crucial to cut the nails straight across, wash the feet every day, wear roomy and comfortable shoes that fit properly, change socks regularly, and check the feet for signs of this or other foot problems.
Metatarsalgia is described as pain and inflammation in the ball of the foot. It is mostly caused by a lack of adequate padding in the ball of the foot. This can be as a result of ill-fitting shoes or decreased fat-pad in the ball of the foot. Overuse, often due to intense training or activity can also be a cause for metatarsalgia. Symptoms include pain in the ball of the foot as well as tingling or numbness in the toes.
Metatarsalgia may be treated conservatively with shoe gear modifications, and custom orthotics. Surgical intervention to repair the underlying biomechanical deformity is sometimes necessary.
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an inter- metatarsal neuroma.
“Intermetatarsal” describes its location—in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.
If you have a Morton’s neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring:
Tingling, burning, or numbness
A feeling that something is inside the ball of the foot, or that there’s a rise in the shoe as if a sock is bunched up
The progression of a Morton’s neuroma often follows this pattern:
The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
Over time the symptoms progressively worsen and may persist for several days or weeks.
The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities—bunions, hammertoes, flatfeet, or more flexible feet—are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racket sports. An injury or other type of trauma to the area may also lead to a neuroma.
Pediatric Foot Care
Pediatrics can suffer from a number of podiatric conditions. These may include: ingrown toenails, warts, flat feet deformities, bunions, sports injuries including ankle sprains. Haglund’s deformity is also another common condition among our young patient population.
Plantar Fasciitis is one of the most common conditions seen at a podiatric office. It can occur among a variety of our patient population. The condition is inflammation of the tissue that connects the heel bone to the toes. It can represent as a result of flat fee or fallen arches, ill-fitting shoes, repetitive overuse, pregnance and weight gain.
Symptoms are stabbing pain the bottom of the foot near the heel, pain with barefoot walking, as well as the worst pain presenting when getting out of the bed in the morning or after long periods of sitting or rest. If symptoms persist, normal weight bearing activities should be limited and patient should be assessed by a podiatrist. Sometimes an XRAY may be necessary to rule out bone spurs or stress fractures.
Plantar Fasciitis may be treated conservatively with shoe gear modifications, oral anti-inflammatory medication, cortisone injections, Medical grade or Custom orthotics, Platelet Rich Plasma injection, as well as physical therapy. In severe cases, surgical intervention is required. In such cases, the surgeon will cut a small piece of the fascia that connects to the heel bone to alleviate tension and pain.
Poor Circulation can lead to multiple issues and conditions in the lower extremity. Symptoms include cramping, numbness, burning, as well as weakness in the lower legs and feet. In diabetic patients, poor circulation, can be specially dangerous due to leading to poor wound healing and increasing the chances of an amputation. Yearly circulation studies are suggested for certain patients to rule out, blood clotting as well as the need for vascular intervention. Should poor ultrasound results be present, the patient will be referred to a vascular specialist for evaluation.
Sesamoids are Two pea-sized bones, which are embedded within the soft tissues under the main joint of the big toe. Even though small in size, the sesamoids play an important role in how the foot and big toe work. If the sesamoids are injured, they can be a source of severe pain and disability. Inflammation of the surrounding tissues can cause the condition. This can be extremely painful. The condition is mostly cause due to overuse and is often seen in dancers and runners. Resting, and Ice therapy are the gold standards of treatment along with oral anti-inflammatories. Corticosteroid injections help should primary conservative measures not resolve the issue completely. Should a displaced fracture of the sesamoid bone be present, surgical intervention may be needed.
Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome is a painful condition caused by the impingement of the posterior tibial nerve. It causes burning pain in the foot along with pins and needles and pain radiating in the arch of the foot. At times it can mistakenly be taken and represent like plantar fasciitis. Neural symptoms should help distinguish between the two conditions. It can be caused due to osteoarthritis, diabetes, overpronation of the foot, presence of a cyst/ganglion, as well as a bony coalition. Consrvative treatment includes rest, ice therapy, oral anti-inflammatories, as well as physical therapy. X-Rays, MRI, and nerve conduction studies are sometimes needed. Should conservative measures fail, a surgery to decompress the entrapped nerve or for the removal of the cyst/bony spur becomes necessary.
Caused by hyper extension of the great toe, resulting in sprain of the ligament around the big toe joint. Symptoms include swelling, pain and tenderness with weight-bearing. In severe cases, if left untreated it can lead to arthritis in the toe joint along with limited motion in the joint. Rest, Ice therapy, compression, as well as physical therapy to regain motion are conservative treatments for the condition. Should symptoms not improve, or if a full rupture of the ligament is suspected, and MRI for advanced imaging may be performed and surgical intervention may be necessary.