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What is a Podiatrist?


Podiatry is a field of medicine that aims to improve the overall health of patients by focusing on preventing, diagnosing, and treating conditions associated with the foot and ankle. They must have a Doctor of Podiatric Medicine (D.P.M.) degree from a college of podiatric medicine. Podiatrists are sometimes referred to as foot doctors, foot and ankle surgeons, or podiatric surgeons.

Most Podiatrists have a solo practice. However, more are forming group practices with other Podiatrists or healthcare providers. Some specialize in surgery, orthopedics (treatment of bones and joints), primary care, or public health. Podiatrists may also practice a subspecialty. Examples include sports medicine, geriatrics (elder treatment), or diabetic foot care.

In addition to private practice, Podiatrists may serve on the staffs of hospitals and long-term care facilities, on the faculties of schools of medicine, as commissioned officers in the Armed Forces, and the US Public Health. Many Podiatrists today are also members of group medical practices.

The skills of podiatric physicians are in increasing demand because disorders of the foot and ankle are among the most widespread and neglected health problems.


What do Podiatrists do?


Podiatrists diagnose and treat disorders and injuries of the foot and lower leg. The human foot is a complex structure; it contains 26 bones, in addition to muscles, nerves, ligaments, and blood vessels. The bones in your feet make up about 25% of all of the bones in your body. The foot is designed for balance and mobility; healthy feet are necessary for a healthy body. Podiatrists treat problems that keep the feet and lower legs from working properly, which can make walking painful or create other problems in the body.

Podiatrists provide treatment for corns, bunions, ingrown toenails, heel spurs, and poor arches. They also treat ankle and foot injuries, such as sprained ankles or a broken toes. They treat deformities of the foot that cause problems with walking, as well as foot problems related to diseases, such as diabetes.

Podiatrists sometimes prescribe drugs to treat podiatric problems. They can also set broken bones, perform surgery, and order physical therapy. They often fit patients for shoe inserts, called orthotics, and also design casts or special shoes to correct foot deformities. For example, for a patient with a heel spur, a Podiatrist might fit an orthotic for the arch, which would take pressure off the heel. The Podiatrist might also give the patient foot exercises. These would stretch and strengthen the arch. If the patient still feels a lot of pain after these changes, the doctor might inject the heel with medication to relieve the swelling.

Podiatrists may use x-rays or lab tests to diagnose foot problems. They may use an x-ray to diagnose a broken bone, while a lab test is done to diagnose serious conditions such as diabetes. Diabetics are prone to foot ulcers and infections due to poor circulation, so a lab test would be done to confirm any findings.

Finding a Podiatrist


Choosing a Podiatrist is an important decision. Thus, our goal is to assist you in making that decision.

First of all, when selecting a Podiatrist, you may want to begin your search in several different ways:

   Ask someone who has been treated by a Podiatrist whom was satisfied with the treatment and care. Ask family, friends, neighbors and/or co-workers.
Contact your local Chamber of Commerce or Better Business Bureau for reputable Podiatrists in your area.
Contact your city, county or state medical agencies for names of qualified Podiatrists.
Contact and ask for referrals from podiatric associations. Many are listed in this publication. (click here)

We recommend that you interview the Podiatrist and ask the following:

 

Is the staff friendly and accommodating?
What specific treatment do they recommend to treat your condition?
Do they take walk-in patients or is it by appointment only? How long to get an appointment?
Do they have an associate that covers for them when they are not available?
Do they have more than one office and, if so, how is their time divided between offices?
What kind of continuing education do they utilize?
Do they accept phone calls during office hours?
What types of insurance coverage do they accept?
How do they handle billing? Do they require payment at time of the visit?
Discuss your medical history and any particular problems you are concerned about.

Communication and being able to talk freely with your potential Podiatrist is of paramount importance. The Podiatrist should listen to your needs and concerns, and formulate a tailor-made program for your particular condition. After you have consulted a few Podiatrists, you should have a good idea about which one you felt most comfortable with and who best answered your questions.


How Podiatrists Were Selected


Consumers' Research Council of America has compiled a list of Top Podiatrists throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining top health care professionals.

The criteria that was used and assessed a point value is as follows:

Experience:

Each year the Podiatrist has been in practice

Training:

Education and Continuing Education

Professional Associations:

Membership in Podiatric Associations

Board Certification:

Completing an approved residency program and
passing a rigid examination on that specialty

Simply put, Podiatrists that have accumulated a certain amount of points qualified for the list. This does not mean that Podiatrists that did not accumulate enough points are not good health care practioners; they merely did not qualify for this list because of the points needed for qualification.

Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals who they would recommend. We found this method to be more of a popularity contest. For instance, professionals who work in a large office have much more of a chance of being mentioned as opposed to a professional who has a small private practice. In addition, many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.

Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients of a particular Podiatrist on their level of satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.

We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that the more years in practice is better than less years in practice; more education is better than less education, being board certified is better than not being certified, etc.

The Top Podiatrist list that we have compiled is current as of a certain date and other doctors may have qualified since that date. Nonetheless, we feel that the list of top Podiatrists is a good starting point for you to find a qualified family health care specialist.

No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to, ensuring an unbiased selection.


Education and Licensing


Admission to a college of podiatric medicine requires completion of at least 90 semester units of undergraduate study, an acceptable grade point average, and acceptable scores on the Medical College Admission Test (MCAT). Required courses include biology, organic chemistry, inorganic chemistry, and physics. Students are also evaluated on the basis of letters of recommendation, interviews, and extracurricular activities.

Colleges of podiatric medicine offer 4-year programs similar to other medical schools. During the first 2 years, students take courses in anatomy, chemistry, pathology, and pharmacology. During the last 2 years, students perform clinical rotations in private practices, hospitals, and clinics. During clinical rotations, students take patient histories, perform physical examinations, interpret diagnostic tests, make diagnoses, and provide treatment. Graduates receive a Doctor of Podiatric Medicine (D.P.M.) degree.

Each state has its own licensing requirements, but many honor Podiatrists licensed in other states. In most cases, an applicant must be a graduate of an accredited college of podiatric medicine, and must pass written and oral examinations.

Most states require completion of a 1 to 3-year postdoctoral residency program and continuing medical education for license renewal. Residents receive advanced training in podiatric medicine and surgery and perform clinical rotations in the following:

                   Anesthesiology
Emergency Medicine
Internal Medicine
Orthopedic and General Surgery
Pathology
Radiology

Certification Requirements

Board certification in Podiatry requires advanced training, written and oral examinations, and practice experience. Podiatrists may be board-certified in orthopedics, primary medicine, or surgery.

Certification by the American Board of Podiatric Surgery requires graduation form podiatric medical school, completion of an approved podiatric surgical residency, and practice experience, including surgical case submissions, and written and oral examinations.

 


Common Foot Disorders


Ingrown Toenails

If you trim your toenails too short, you may set the stage for an ingrown toenail, a common disorder. Like many people, you may narrow the corners of your toenails when you trim them so that the nail curves with the shape of your toe. Unfortunately, this causes the sides of the nail to curl down and dig into your skin. An ingrown toenail may also occur if you wear shoes that are too tight or too small. Any of your toenails can get ingrown, but it's most common with the big toes.

An ingrown toenail is caused by the penetration of the edges of the nail into the soft tissue of the toe. It begins with a painful irritation that often becomes infected. Combined with bacterial invasion, the nail margin becomes red and swollen, often showing pus. In cases with diabetes or poor circulation, this relatively minor problem can be become quite severe.

There are several causes for an ingrown toenail. Firstly, if your family has a history of ingrown toenails, it is more likely that you will have them too. Secondly, improper cutting of the toenails, either cutting them too short or cutting into the side of the nail, may cause an ingrown toenail. Lastly, very tight shoes can also cause this malady.

The treatment of an ingrown toenail is relatively painless. Injection of an anesthetic will cause a little discomfort, of course; but if you go to a skilled doctor, they will minimize the pain. Once the toe is numb, the nail margin is removed and the nail root in this area is destroyed. Most commonly, the doctor will use an acid to kill the root of the nail, but other techniques are also available. It may take a few weeks for the nail margin to completely heal. Once the numbness wears off, there may be some very mild discomfort, but rarely does this require pain medication. There are a few complications associated with this procedure: Reoccurrence of the ingrown toenail can arise a small percentage of the time. Continuation of the infection is possible, but can be easily controlled with oral antibiotics. On occasion, the remaining nail may become loose from the nail bed and fall off, being replaced by a new nail over several months of growth.

You can lower the risk of developing an ingrown toenail by trimming the toenails straight across with no rounded corners. The length of your toenail should extend out past the skin. The top of each nail should form a straight line across, level with the top of the toe. Some additional guidelines for preventing ingrown toenails include the following:

                   Don't pick at your toenails or tear them off.
Make sure your shoes and socks are not too tight.
Keep your feet clean at all times.

 

Smelly Feet

Throughout the average day, the body naturally perspires to regulate heat in the body. In some individuals, natural perspiration is excessive in the feet, which results in sweaty feet. This condition is known as Hyperhidrosis and is defined as the production of perspiration beyond what is necessary to cool the body. Hyperhidrosis is a disorder characterized by excessive sweating that occurs in up to 1% of the population. Although nobody understands the exact cause of this excessive sweating in specific individuals, it is known that the sweating is controlled by the sympathetic nervous system.

Sweaty feet can result in very smelly feet. This condition can be a very embarrassing for the affected person. Some runners that have excessively smelly feet may also have sweaty feet, which can result in painful blisters.

A person who suffers from smelly feet should change socks daily or if necessary twice daily, and wear cotton socks to absorb perspiration. They should wear footwear that allows air to circulate around the feet- sandals and certain types of trainers can be ideal. Salt water foot baths may also be of some benefit.

Sweaty and smelly feet can be embarrassing conditions that cause distress to your family, your friends (especially after a long run), and affects your self-confidence. There are some different treatments for hyperhidrosis that a Podiatrist might prescribe; There are ointments and salves available, such as Drysol, that are astringents that tend to dry up the sweat glands. Another treatment is iontopheresis. This consists of a treatment of electrical stimulation, usually in the hands. Patients place their hands in a bath through which an electrical current is passed. This treatment tends to stun the sweat glands and can decrease the secretion of sweat for periods of 6 hours to one week. One of the most recent treatments proposed is the injection of botulinum toxin (Botox) into the area of excessive sweating. This is a toxin that affects nerve endings and decreases the transmission of the nerve impulses to the sweat glands, thus resulting in decreased sweating. It generally requires several injections and it remains effective from one to six months. Repeated injections are nearly always required to maintain an adequate level of dryness.

 

Running Injuries

Running is an enjoyable and healthy activity for people to engage in. however, whenever a person runs, they put their body through tremendous stress. Each time a runner's foot hits the ground, it generates forces equivalent to at least three times the body's weight. Running and jogging can lead to serious injuries that affect the legs, ankles, and feet, including heel pain, Achilles tendonitis, sesamoiditis, and tarsal tunnel syndrome. It is important to do everything possible to protect the feet, ankles, knees, hips, and lower back vertebrae.

With proper technique and the right equipment, running can actually help relieve pain in the joints. Good running shoes are essential. The best running shoes have excellent cushioning and provide stability and support to the arch of the foot. These shoes should be replaced every 3 to 6 months.

 

Lateral Compartment Syndrome (LCS)

The pain associated with lateral compartment syndrome occurs on the outside of the leg and in the ankle and results when the foot is too flexible, causing the arch to flatten excessively. It can be treated with orthotics that stabilize the arch, providing necessary support.

 

Stress fractures

Stress fractures are incomplete cracks in bone. They occur during high-impact repetitive activity, such as running when muscles tire and cannot absorb shock. The muscles transfer the overload of stress to the bone, causing it to crack.

 

Anterior Compartment Syndrome (ACS)

When walking, the muscles in the front of the leg help slow the forefoot after the heel strikes the ground. If these muscles are weak, the foot slaps the ground with too much force because the forefoot is not slowly lowered. When a person is running or jogging, these muscles have to work harder to prevent the forefoot from hitting the ground with excessive speed and force. These muscles can become overworked, leading to pain.

This pain, which occurs in the front of the leg, may be incorrectly referred to as shin-splints. It occurs when the muscles in the front of the leg are overtaxed. It is common in people who run on hills or uneven surfaces. The swelling and pain of anterior compartment syndrome is treated with ice, stretching, and proper footwear.

 

Shin-splints

The term "shin-splints" is often incorrectly used to describe any pain in the leg between the knee and the ankle. In actuality, shin-splints occur a few inches below the knee on the medial (inner) side of the leg. The pain is located in the posterior tibial muscle/tendon. This muscle starts below the knee on the tibia, wraps around the inside of the ankle, and attaches to the underside of the foot. This route causes a pulley-like action that generates considerable force at either end. If a person runs too much, or if the feet are not working correctly, the muscle can become overstretched and pull excessively at the point where it attaches to the tibia.

In most cases, the cause of this excessive muscle stretching is hyperpronation, or a flattened arch. This causes the foot to lengthen and the posterior tibial muscle/tendon to stretch. A custom-molded orthotic device can be placed inside the shoe to support and stabilize the foot and prevent the arch from flattening too much.

Plantar Fasciitis

Plantar fasciitis is the most common cause of interior heel pain. Pain on the bottom of the heel, most prominent with the first steps that one takes in the morning, is the hallmark of this disorder. Pain also occurs with the onset of activity such as walking and running. This pain may decrease as activity progresses, but it usually returns after resting and then resuming activity. In severe cases, the pain may occur with any weight bearing. Although the pain usually occurs in the heel, it can radiate throughout the bottom of the foot toward the toes.

Considered a chronic inflammatory syndrome, plantar fasciitis is common in runners and dancers who use repetitive, maximal plantar flexion of the ankle and dorsiflexion of the metatarsophalangeal joints. You are more likely to get the condition if you are female, if you are overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and the back because of the way plantar fasciitis changes the way you walk.

There are several things you can do to aid the healing process:

                   Give your feet a rest. Reduce your activity to a level that lets you avoid pain. If possible, don't run or walk on hard surfaces.
You may be able to reduce inflammation and relieve pain by putting ice on your heel or taking an anti-inflammatory drug such as ibuprofen.
Do simple exercises such as calf stretches several times a day, especially when you first get up in the morning. These can help your ligaments become more flexible and strengthen the muscles that support your arch.
Wear shoes with good shock absorption and the correct arch support for your foot. Athletic shoes or shoes with a well-cushioned sole are usually good choices.
Put on your shoes as soon as you get out of bed. Going barefoot or wearing slippers may make your pain worse.
Try heel cups or shoe inserts ("orthotics") to help cushion your heel. You can buy these at many athletic shoe stores.
 

Your doctor may give you corticosteroid shots to reduce inflammation. While the shots can relieve pain quickly, they do carry some risks, they can be painful, and the relief is only temporary.

Surgery is rarely necessary. Doctors usually only consider it for people who have severe pain after trying other treatments for 6 to 12 months.

Most cases of plantar fasciitis are the result of small injuries that have occurred over time. The healing process also takes time—from a few months to a year—although you should begin to improve within weeks of starting treatment. Don't just ignore the pain and hope it will go away-- The longer you wait to begin treatment, the longer it will take for your feet to stop hurting.

Athlete’s Foot

Athlete's foot is a skin infection in the foot caused by a fungus. The fungus that causes Athlete's foot is called Trichophyton. When the feet (or other areas of the body) stay moist, warm and irritated, this fungus can thrive and infect the upper layer of the skin.

Athlete's foot, also called tinea pedis, is caused by the ringworm fungus. The fungus that causes athlete's foot can be found on floors, as well as in socks and clothing. The fungus can be spread from person to person by contact with these objects. However, without proper growing conditions – a warm, moist environment – the fungus will not infect the skin. Up to 70% of the population will have athlete's foot at some time during their lives.

The symptoms of athlete's foot include itching and burning feet. The skin frequently peels and, in particularly severe cases, there may be some cracking, pain and bleeding as well.

When the skin is injured by the fungus, bacteria can also invade the skin, which can cause a bad smell. Bacterial infection of the skin and the resulting inflammation is known as cellulitis. This is especially likely to occur in the elderly, individuals with diabetes, chronic leg swelling, impaired immune systems, or individuals who have had veins removed (such as for heart bypass surgery).

The treatment of athlete's foot can be divided into two parts. The first and most important part is to make the infected area less suitable for the athlete's foot fungus to grow- this means keeping the area clean and dry. The second part of treatment is the use of antifungal creams. Many medications are available including miconazole, clotrimazole, etc. Your Podiatrist will recommend a proper cream; treatment usually continues for about 4 weeks.

People afflicted with athlete's foot should buy shoes that are leather or some other breathable material. Shoe materials such as vinyl don't let the feet breathe, which causes your feet to remain moist. This provides an excellent area for the fungus to breed. Absorbent socks such as cotton that suck water away from your feet will help. Medicated powders (containing ingredients such as miconazole or tolnaftate) can help keep your feet dry.

Finally, your feet can be soaked in a drying solution of aluminum acetate.

Achilles Tendonitis

The Achilles tendon is the cord in the back of the heel. Achilles tendons can rupture for many reasons, including age, sex (males are more susceptible), and sports. However, the Achilles tendon may also rupture secondary to medical reasons.

Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon, also called the heel cord. The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, assists in the act of walking, and Achilles tendonitis can make walking almost impossible.

Treatment for Achilles tendonitis depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued

If damage to the tendon is minor, the injury may respond to a simple course of treatment of rest, ice, compression, and elevation. Severe Achilles tendonitis, tendon rupture, or tearing away from the heel bone may require surgery and lengthy rehabilitation. Surgery involves removing the tendons inflamed outer covering and reattaching the torn tissues.

After surgery, patients undergo range of motion physical therapy and progressive strengthening exercises for 2-3 weeks. Most activities can be resumed in 6-10 weeks and competitive sports usually can be resumed after 3-6 months.

Bunions

A bunion is a common term for a medical condition known as Hallux Valgus. Hallux Valgus is the tilting of the toe away from the mid-line of the body. It is usually characterized by a lump or bump that is red, swollen and/or painful on the inside of the foot in and around the big toe joint. Bunions worsen over time and cause discomfort, difficulty walking, and skin problems such as corns and lesions. Sometimes a small fluid-filled sac near the joint becomes inflamed, causing additional swelling, redness, and pain.

There are many causes of bunions, but the primary one is tight fitting shoes – especially shoes that constrict the forefoot over a long period of time. High heels and constricting forefoot shoe gear are the primary causes of Hallux Valgus.

Bunions are one of the most common foot problems. They often run in families, which suggest that the inherited shape of the foot may predispose people to them.

Treatment for bunions includes a thorough evaluation from your Podiatrist. The only way to eliminate bunions is by surgical removal. Bunions worsen over time unless the problem that produces them is eliminated. If a bunion causes severe discomfort, a surgical procedure called a bunionectomy may be performed. Surgical techniques vary, depending on the angle of the bones in the bunion and the extent of the deformity. After surgery, your Podiatrist will prescribe the patient with fitted orthotics to maintain stable, properly aligned feet. Without this treatment, the underlying cause of the bunion continues to cause problems and the bunion can recur.

Gout

Gout is a disease that occurs throughout the body, and is caused by the buildup of uric acid in the joints. It can be a serious disease and needs medical intervention. An elevated blood level of uric occurs when the liver produces more uric acid than the body can excrete in the urine, or when you eat a diet high in rich foods produces more uric acid than the kidneys can filter from the blood.

Over time, uric acid in the blood settles in the joint spaces, causing swelling, inflammation, stiffness, and pain. Gout usually affects the joint of the big toe (hallux) or the ankle joints.

Gout is not genetic, but it is inherited. Approximately 18% of people who develop gout have a family history of the condition. Diseases and conditions that increase the risk include diabetes, obesity, kidney disease, and sickle cell anemia. Regularly drinking alcohol interferes with the removal of uric acid from the body and can increase the risk for developing gout.

Touching or moving the toe may be intensely painful and patients often say that having as much as a bed sheet over the toe increases the pain. Symptoms of gout develop quickly – sometimes in one day – and typically occur in only one joint at a time. Rarely, symptoms develop in two or three joints simultaneously.

The goal of your Podiatrist is to decrease the amount of uric acid in the joints, which helps to reduce symptoms and prevent further attacks. If left untreated, affected joints may be damaged, causing disability. In most cases, gout is not treated unless it occurs frequently. Your Podiatrist may prescribe nonsteroidal anti-inflammatories and corticosteroids. These medications usually resolve symptoms in about a week.

Corns

Corns, the most common conditions on the skin of the foot, are thickened areas of skin that form in response to excessive pressure and friction. They form to protect the skin and the structures beneath it from damage or injury. Corns are usually hard and circular, with a waxy or translucent center. They may become painful in response to persistent friction.

There are two types of corns. Hard corns, called heloma durums, are the most common type. They are caused primarily by tight fitting shoes and toe deformities. They usually develop on the tops and tips of the toes and on the sides of the feet. Soft corns, called heloma molles, usually occur as the result of bone abnormalities in the toes. They develop between the toes.

For many people, the toes curl downward and do not lie flat. Fitting curled toes into shoes with tight toe boxes is the most common cause of hard corns. The toes remain curled inside the shoe and press against the inside of the shoe, usually at the toe joints. The tip of the curled toe presses against the sole of the shoe. The skin compensates for this added pressure by thickening at the point of contact and hard corns develop to protect the underlying structure.

Soft corns are areas of white moist skin between the toes. They most commonly occur between the fourth and fifth toes. They can be very painful and if not treated can form small ulcerations or sinus tracts that can become infected. The soft corn is due to an irregularity in the shape of the bone in the fourth or fifth toes.

Since hard corns usually are caused by a combination of narrow-toed shoes and toe deformities, they can be treated in different ways. One way is to wear wider shoes or sandals. Another treatment is to fix the bone problem in the toes. If the toes are flexible and can be straightened, an orthotic or a small pad may enable the toe to return to a normal position and reduce pressure and friction.

Hard corns also may be cut or burned off with a topical acid solution. This treatment does not correct the underlying problem, so the corns often recur. People with soft corns caused by excessively wide toe bones can switch to wider shoes with more room between the toes. However, this usually does not provide adequate relief.

In some cases, surgery is performed to treat soft corns. In this procedure, the Podiatrist makes a small incision in the toe, grinds down the piece of bone that causes the irritation, and closes the incision with a couple of stitches.

 

Metatarsalgia

Metatarsalgia is a painful foot condition in the metatarsal region (the area just before the toes, more commonly referred to as the ball-of-the-foot) of the foot. This foot disorder affects the bones and joints at the ball-of-the-foot. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).

Cause

The pain is often caused from improper fitting footwear, most frequently by women’s dress shoes and other restrictive footwear. One or more of the metatarsal heads become painful and/or inflamed. This is usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia. Footwear with a narrow toe box (toe area) forces the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot.

There are others factors can cause excessive pressure in the ball-of-foot area that can result in metatarsalgia, which include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Additionally, as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot.

Treatment

First, we need to find the cause of the pain. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot.

A variety of footwear products can unload pressure form the ball-of-the-foot. For example, orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. It is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Also, other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.

 

What is a foot fracture?

With 38 bones in a single foot, almost any of them can be broken. Many fractures do not require surgery, or even a cast, as they will heal on their own with some support. When a foot is fractured, the site of the fracture usually is painful and swollen. The site of the fracture will determine the course of treatment, if necessary, including the following:

                   Ankle joint fractures

These fractures may be serious and require immediate medical attention. Ankle fractures usually require a cast, and some may require surgery if the bones are too separated or misaligned.

Metatarsal bone fractures

Fractures of the metatarsal bones, located in the middle of the foot, often do not require a cast. A stiff-soled shoe may be all that is needed for support as the foot heals. Sometimes, surgery is needed to correct misaligned bones or fractured segments.

Sesamoid bone fractures

The sesamoid bones are two small, round bones at the end of the metatarsal bone of the big toe. Usually, padded soles can help relieve pain. However, sometimes, the sesamoid bone may have to be surgically removed.

Toe fractures

Fractures of the middle toes can heal without a cast. Fractures of the big toe or little toe may require a cast and/or surgery.

Fungal Nails

Fungal infection of toenails, called Onychomycosis, is a common foot health problem that many people do not recognize. Fungi are simple parasitic plant organisms, such as molds and mildew that do not require sunlight for growth. They easily attack the nail, thriving off keratin, the nail's protein substance.

Onychomycosis is an infection underneath the nail that can also penetrate the nail. If it is ignored, it could impair one's ability to work or even walk because it is frequently accompanied by thickening of the nails, which then cannot be easily trimmed, and may cause pain while wearing shoes. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in/or about the nail plate.

Symptoms:

                   Change in color (yellow or brown)
Nail gets thicker
Bad odor
Debris collects beneath the nail
White marks on the nail
This infection is capable of spreading to other toenails, the skin or even the fingernails.

Toenails are especially vulnerable around damp areas where people are likely to be walking barefoot - swimming pools, locker rooms, and showers. Injury to the nail bed may make it 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.

Prevention

Clean, dry feet resist disease. Wash the feet with soap and water, and dry thoroughly. Shower shoes should be worn in public areas. Shoes, socks and hosiery should be changed daily. Use a quality foot powder. Buy shoes that fit well and are made of materials that breathe.

Seeing your Podiatrist

Your Podiatrist can detect a fungal infection early. A suitable treatment plan may include prescribing topical or oral medication (such a Lamisil or Sporonax), and debridgment (removal of diseased nail matter and debris) of an infected nail. Debridgment is one of the most common foot care procedures performed by DPMs. In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. 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.

 

Tarsal Tunnel Syndrome  

Tarsal tunnel syndrome is a condition that affects the inside of the ankle. Many structures run through that area – veins, tendons, arteries, and nerves. When the tibial nerve is compressed by another structure, the neurological impulses through it are restricted. This causes pain, a burning sensation, and tingling. In many cases, an adjacent muscle that grows too large for the area causes the compression. This can happen for a number of reasons, including, excessive pronation, rheumatoid arthritis, trauma, and obesity. 

The symptoms of tarsal tunnel syndrome are burning pain, pain that radiates down to the toes and/or up to the lower leg, and pain that is usually unremitting, in that is does not subside after weight has been removed from the foot.

Simple methods to relieve some of the symptoms are ice, anti-inflammatories, heel-aid, immobilization (such as with a cast walking boot) and cortisone injections. In some cases where the pain is unresolved after conservative measures have been employed, then surgery is utilized.


 

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