REV SUSAN BRANDT
HIV and Your Feet
Definition:There are thousands of people who become infected with HIV each day. HIV stands for the Human Immunodeficiency Virus. This virus weakens the body’s immune system so it is unable to do its job effectively. During the late stage of the HIV infection, AIDS (Acquired Immunodeficiency Syndrome) develops. People who are infected with HIV may not develop AIDS for many years. This means that people with HIV can appear to be healthy and normal but their health will eventually decline. It is important for people to understand that they can pass the virus to other people even though they have not developed AIDS at that point in time.
Different illnesses that affect AIDS patients include severe diarrhea, pneumonia, tuberculosis, skin cancer, fever and skin infections. Due to the body’s weakened immune system, people infected with the AIDS virus are unable to fight off infections. In addition to these illnesses, people with AIDS often develop peripheral neuropathy. Peripheral neuropathy is a disease that affects the nerves located outside the central nervous system. Neuropathy leads to insensitivity, stiffness, and numbness in the feet. These problems can also lead to foot deformities such as Bunions, Hammer Toes, Metatarsalgia, and many others. These complications should be taken care of immediately to prevent more serious problems such as the development of ulcers and possibly even amputation.
Cause:AIDS develops from the virus HIV. Scientists have traced the origin of the HIV virus to an African primate, specifically to a subspecies of the chimpanzee.
The HIV virus is found in fluids such as: blood, vaginal secretion, semen, and breast milk.
Therefore the virus can be passed on by the following:
· Sex with an infected person
· Passed from a mother to her unborn child
· Blood transfusions with infected blood
· Injections with nonsterilized equipment
One of the highest growing age groups infected with the HIV virus is young adults under the age of 25. They account for about half of all new HIV infections in the United States alone. AIDS is the second leading cause of death among people between the ages of 25 and 44.
Approximately 30% of those infected with AIDS develop a condition called peripheral neuropathy. Peripheral neuropathy is a disease of the nerves. These nerves are located outside the central nervous system. Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. People suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to their inability to sense pain. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause foot deformities such as Bunions, Hammer Toes, Metatarsalgia, and Charcot Feet.
It is very important for people with AIDS to take the necessary precautions to prevent all foot-related injuries. Due to the consequences of neuropathy, daily observation of the feet is critical. By following the necessary preventative foot care measures, you can reduce the risk of developing serious foot conditions.
Treatment and Prevention:There is no vaccine or cure for the HIV virus that causes AIDS.
HIV is most frequently transmitted sexually. Because of this, the key to prevention is education. The best way for people to prevent the disease from spreading among the population is to know how to protect themselves from becoming infected.
People with AIDS are at high risk for developing neuropathy and other serious foot complications. Because of this fact, special attention must be focused on foot health management. Footwear and orthotics play an important role in footcare.
Footwear for people with AIDS should also provide the following protective benefits:
· High, wide toe box (high and wide space in the toe area)
· Removable insoles for fitting flexibility and the option to insert orthotics if necessary.
· Rocker Soles designed to reduce pressure in the areas of the foot
· most susceptible to pain, most notably the ball-of-the-foot.
· Firm Heel Counters for support and stability. If you have AIDS and are experiencing a foot problem, immediately consult with your foot doctor.
Artho means joint and itis means inflammation. There are approximately 38 causes of arthritis and most of these conditions affect the human foot. The most common of these conditions is osteoarthritis. This is the simple wearing and tearing away of the cartilage of the joints. Age, excessive weight, ill-fitting shoes and trauma (injury) are the basic causes of osteoarthritis. Fortunately, this condition is very treatable.
The first step in the diagnosis of arthritis is a good complete history. The second step is an x-ray evaluation to view the bone structure of the foot. In more advanced cases of arthritis an MRI (magnetic resonance imaging) or CT scan (computerized axial tomography) are extremely helpful. In more complicated cases of arthritis, blood tests are used to differentiate between one arthritis type and the next.
Gout, which is also classified under arthritis and rheumatoid arthritis are the two most crippling kinds of arthritis. In most cases, simple aches and pains of the feet are usually biomechanical, in that the bone structure of the feet are not being supported as well as they should be. The first line of defense for painful feet is to get a well-supported shoe. The second line of defense is a custom made orthotic. over-the-counter medications such as Advil, Tylenol, and Aspirin are good medications that supply anti-inflammatory relief. Ice packs, massage, and foot soaks/paraffin baths are also good first-aid measures. And there are now pain relievers available, to aid arthritis sufferers.
A twisted ankle, ankle sprain, inversion sprain or an ankle that rolls over are all terms for injuries to the human ankle. 90% of ankle injuries usually occur on the outside (lateral side) of the ankle. Medial or inside ankle injuries occur in 10% of the cases. The following is regarding a lateral ankle sprain.
An ankle sprain or a simple turning of the ankle results in pain, ecyhmosis (bruising) and tenderness over the outside portion of the foot and ankle. Mild sprains can be treated with RICE (Rest, Ice, Compression and Elevation). These conditions are usually self-limiting and clear up in a few days
Conservative measures include ice, wraps, ace bandages, and/or braces
More serious ankle sprains are usually characterized by difficulty in walking after the injury and require medical treatment which includes x-rays to rule out a fracture to the foot or ankle. An MRI is another test used to determine soft tissue ligament damage. Cast walkers such as the Cast Walking Boot are most beneficial in the treatment of severe sprains. If the ligament is ruptured, surgery is indicated. Pro-stretch and foot massagers / spas are also available for therapy and arch and foot support for better stability of the ankle.
Diabetes is probably the most damaging disease that a patient can encounter with regards to their feet. Diabetes comes in two basic types;
type 1 and type 2.
Type 1 is usually associated with juvenile diabetes and is usually a hereditary type of disease.
Type 2, commonly referred to as adult onset diabetes, is usually characterized by elevated blood sugars by people who are overweight and have not attended to their diet as they should.
Diabetes can be controlled with medications, diet and exercise. But a serious condition occurs if the sugars are out of control and a lesion (sore or ulcer) develops on the plantar (bottom) of the foot. The goal and treatment of diabetics with foot ulcers is to relieve the pressure, prevent infection and ultimately ensure the patient does not lose their limb. It is important that a patient with a foot ulcer consult their podiatrist, vascular surgeon, orthopedist or family doctor.
Many tests are employed to maintain diabetic good health, including blood tests, MRI’s,
x-rays, and constant supervision of the patient. Neuropathy is the number one disease that affects a diabetic that leads to loss of limb. Neuropathy is the loss of sensation, and the patient is not aware that he/she is developing sores on the bottom of his/her foot. It is the podiatrist who usually treats these lesions. He will treat the lesions by debridement (peeling away of the ulceration), padding to relieve pressures of the ulceration, fabrication of orthotics, a diabetic shoe, antibiotic medications, foot soaks and good diabetic hygiene.
Burning feet is a common complaint among many groups of people, most commonly in the older group over 50 years of age. It has a multi-factorial etiology (many different causes for the formation of the symptom of burning feet). This symptom is most prevalent in diabetics who present with a symptom of mixed neuropathy with loss of sensation on the plantar aspect (bottom of the feet).
However, there are many other causes for this symptom. Alcohol is high on the index of suspicion for this complaint. Neuropathy and loss of sensation secondary to alcohol ingestion over long periods of time. Other causes include thyroid dysfunction and gastric restriction in morbid obesity produce symptoms of burning feet.
Some of the infectious diseases, such as leishmaniasis, a rarely reported neurologic change secondary to a bacteria, also cause these symptoms. Thrombocytopenia also produces this symptom. However, the most common denominator for burning foot syndrome is usually a diabetic who has been insulin dependent for many years, producing a variety of secondary complaints such as vitamin deficiency to include thiamin.
Mechanical causes include nerve entrapment syndrome such as tarsal tunnel syndrome, which causes compression of the never as it enters the foot from the ankle. Neuroma pain, a pinched nerve between the 3rd-4th toes has been implicated in the symptom of burning feet.
Treatments vary, depending on the cause of the burning foot syndrome. The most important aspect of this symptom is accurate diagnosis. The diagnostic modalities employed in diagnosis are nerve conduction velocity testing, x-ray evaluation, and MRI is helpful in establishing the underlying cause. Blood tests to determine blood dyscrasias (changes) can be helpful. The most important tool for establishment of an accurate diagnosis is adequate history and physical examination by a physician trained in these area. The best physician for this malady is a neurologist, internist, or podiatrist.
Haglund’s Deformity is a condition of pain and discomfort on the posterior (back) aspect of the heel at the area of the insertion of the Achilles tendon. The typical patient with Haglund’s Deformity that is symptomatic is usually a female who wears high-heeled shoes. In mild cases, this inflammation and projection of bone at the back of the heel can be relieved with ice, compression, change of shoe gear, Achilles Heel pads, heel grip pads and orthotics. But in many cases where the bone is enlarged surgical excision is required. Cortisone injections in this area are not recommended because the chance of rupture of the Achilles tendon is high. Immobilization (such as with a cast walking boot) for acute symptoms is a much more effective measure, along with oral anti-inflammatory medications. Surgery, although successful, has a long post-operative recovery period, and needs cast immobilization.
· Are your toes and or feet cold or numb? Do they burn? · When walking do you get pains in your calf or thigh? · Do you have sores on your toes, feet, or legs that won’t heal? · Do you notice a loss of hair on your feet or toes, or legs? · Do you have some black or blue marks on your feet or toes? · Do muscle cramps bother you especially at night or restingYou may have Peripheral Vascular Disease if the answer to any of the above was yes.WHAT IS P.V.D?Peripheral vascular disease is the medical name of the group of medical problems that causes poor circulation to the toes, feet and legs. One of the major diseases in this group is called arteriosclerosis.Arteriosclerosis, more commonly known as “hardening of the arteries” is a condition in which there is a gradual thickening, hardening, and loss of elasticity in the walls of the arteries. The arteries are the blood vessels that brings the blood from the heart, down to the feet and legs. Arterial insufficiency may also be caused by an obstruction in the artery wall, by the narrowing of arteries or by a spasm of the vessel. This disease is most common in men past fifty years of age.Diabetes is a major cause of peripheral vascular disease. The diabetic lacks the ability to make proper use of the sugar they ingests. As a result, of this sugar builds up, they have many changes in their blood vessels, causing them to have circulation problems, more often than the average person.Besides diabetes other risk factors for circulatory disorders are heart disease, high blood pressure, smoking, family history of vascular disease, obesity, and elevated cholesterol levels.Exercise can help circulatory problems. The muscles of the legs have a massaging effect on the blood vessels and help maintain normal passage of the blood. Adequate exercise which is appropriate to a person’s general health and age will do much to benefit the entire circulatory system.There are many highly successful non-surgical treatments for peripheral vascular disease that gives relief by increasing the circulation, to the feet and leg. This is done as always in the comfort and privacy of our clinic.
Corns, Calluses, IPK
Corns and calluses are the most common conditions on the skin of the foot. A corn, which is a thickening of the outer layer of skin, usually occurs on the tops of the toes. Calluses, which are the same condition on the bottom of the feet, are caused by sheering pressures. Corns and calluses are the foots defense against friction and pressure. These conditions are usually painful but can respond to conservative care.
The first line of defense for this condition is a good supporting shoe that has a wide toe box and a low heel.
Over the counter items such as pads, lotions/creams, pumice stones and callus removers, foot baths, and scrub brushes are also helpful for these conditions.
Other useful treatments for corns and calluses are orthotics, a device to realign the mechanical disturbance of the foot. Although you can purchase orthotics over-the-counter, this device is usually made from a cast of the foot and is prescribed by a Podiatrist.
If corns and calluses persist then professional treatment by a podiatrist and/or an orthopedist who is trained in these areas is indicated. A severe form of callus is considered an IPK (Intractable Plantar Keratosis)and may need surgery.
Usually a doctor will obtain x-rays to ascertain whether or not there is an underlining bone spur. If the condition is painful enough and non-responsive to topical medications and debridement, then surgical correction is indicated.
Foot ulcers are generally a breakdown of the skin on the plantar aspect (bottom) of the foot. They have many causes, but the most common are diabetes, and vascular insufficiency. Diabetes or vascular insufficiency should be taken very seriously as a good warning sign of impending loss of limb.
Self-treatment is not recommended for this serious condition. Consultation with a podiatrist, orthopedist, vascular surgeon, or family doctor is recommended. Some of the things that these physicians will do are:
· Ascertain whether or not there is diabetes through a blood test and/or
· Obtain x-rays to determine if there is any bone involvement
If the pulses are diminished then a doppler is indicated to determine the extent of the circulation. If there is a decrease in circulation then referral to a vascular surgeon is indicated.
The next step is to determine the level of the blockage of the artery. If the artery is blocked in a specific point, then various surgical procedures can be employed. Balloon Angioplasty, laser Angioplasty and stents are employed to open up the blood flow to the foot. But again, any break of the skin on the plantar (bottom) of the foot is a serious condition and can result in loss of the limb. Immediate referral to a professional is indicated.
Flat feet of themselves are not necessarily a problem. But people with a flat foot or the opposite condition, a highly arched foot, that are painful, are certainly in need of treatment. Flat feet and high arches that are associated with ankle, knee or low back pain are also in need of treatment.
The causes of flat feet are many, but in the older age group decreased exercise and increased weight add to the mechanical disturbances of the foot. Flat feet can also produce conditions known as heel spurs and/or plantar fascitis.
The best and first line of defense for a flat foot condition is a good supportive shoe (Nike, New Balance,) but usually some type of arch support is beneficial. The over-the-counter items such as Dr. Scholls are beneficial in treating this condition. But the most effective means of controlling flat foot or a high arched foot are custom molded orthotics.
CornsDefinition:Corns like calluses develop from an accumulation of dead skin cells on the foot, forming thick, hardened areas. They contain a cone-shaped core with a point that can press on a nerve below, causing pain. Corns are a very common ailment that usually form on the tops, sides and tips of the toes. Corns can become inflamed due to constant friction and pressure from footwear. Corns that form between the toes are sometimes referred to as soft corns.Cause:Some of the common causes of corn development are tight fitting footwear, high heeled footwear, tight fitting stockings and socks, deformed toes, or the foot sliding forward in a shoe that fits too loosely. Soft corns result from bony prominences and are located between the toes. They become soft due to perspiration in the forefoot area.Complications that can arise from corns include bursitis and the development of an ulcer.Treatment and Prevention:There are very simple ways to prevent and treat the corns. You should wear properly fitted footwear with extra room in the toe box (toe area). Avoid shoes that are too tight or too loose. Use an orthotic or shoe insert made with materials that will absorb shock and shear forces. Also avoid tight socks and stockings to provide a healthier environment for the foot.Try to steer away from corn removing solutions and medicated pads. These solutions can sometimes increase irritation and discomfort. Diabetics and all other individuals with poor circulation should never use any chemical agents to remove corns.If the problem persists, consult your foot doctor.
Morton’s Toe is a common forefoot disorder where the second toe is longer than the Big Toe (the Hallux).
Cause:Morton’s toe leads to excessive pressure on the second metatarsal head (behind the second toe at the ball- of-the-foot) resulting in pain similar to the discomfort associated with metatarsalgia. The constant pressure placed on the longer second toe while walking or standing can lead to callus formation under the second metatarsal head due to this excessive pressure.
Treatment and Prevention:Proper treatment of Morton’s Toe starts with selecting proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating this condition. It may be necessary to buy footwear a half size to a size larger to accommodate the longer second toe.
Orthotics that feature arch support to keep the foot aligned, and a metatarsal pad to reduce stress on the ball-of-the-foot are often recommended when treating this condition. Proper footwear combined with a effective orthotic will provide relief from pain associated with Morton’s Toe.
If problem persists, consult a foot doctor.
Hammertoes / Bone Spurs
Hammertoes, bonespurs, and exostosis are all a result of an imbalance of the muscle structures of the toes, when the toes become crooked, bent, or buckle under causing joints to protrude. These are all descriptions of a biomechanical imbalance.
Although heredity can be a factor in the formation of these conditions, usually it is ill-fitting shoes that precipitate these conditions. In diabetics, or people with poor circulation, hammertoes can be a serious condition. Infections can ensue and the hammertoes can become the source of loss of limb. If a corn develops over a hammertoe, it is usually a result of the pressure between the toe and the shoe.
First aid remedies that can be tried at home; make sure the shoe is fitting adequately, massage, soaks, scrubs, pads, creams. But, if redness or infection are present the care of a podiatrist, orthopedist, or family doctor is recommended. If the deformity is permanent and causing constant pain, surgical correction utilizing a tenotomy, capsulotomy or arthroplasty (realigning the bone) is the next stage of treatment.
Usually hammertoes can be repaired without using pins or wires, but sometimes this is necessary. In some extremely deformed toes your doctor will recommend an implant to be placed inside the joint to help maintain alignment. Earlier ambulation is encouraged with the use of a post-operative shoe.
Athletes Foot and Fungus Problems
Athlete’s foot typically affects the skin on the feet between the toes, but can move anywhere on the foot and can affect the toenails.
Athlete’s foot is an infection of the skin and the nails, usually on the feet. The infection is usually found on the skin between the toes. Sometimes the fungal infection spreads to the toenails, which become thick and distorted. Fungi are plant organisms (tinea pedis) such as mold and mildew and grow best in conditions that are moist. Bacteria may thrive as a secondary infection, which worsens the symptoms of the disorder and makes it more difficult to cure. A fungal infection is one of the most difficult nail and foot conditions to treat.
It is common to catch athlete’s foot from other people who have it by walking on floors that are moist or wet (e.g. at swimming pools and in shared bathroom facilities). Athlete’s foot is also much more common in people who tend to have moist feet. Athlete’s foot can also be spread by sharing other people’s shoes or personal care items such as towels and wash cloths.
Athletes Foot and Fungus may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere.
On the skin:
· Reddened, cracked, and peeling skin
· Some bleeding
· Stinging sensation
· Development of small blisters
(Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads. In severe cases the skin may thicken, like a callus, and begin to scale.)
On the toe nail:
· Change in color (yellow or brown)
· Nail gets thicker
· Bad odor
· Debris collects beneath the nail
· White marks on the nail
Treatment may include
There are a variety of products that can be used on the foot and toe nails that kill the tinea pedis fungus.
After a period of time, if products used for athlete’s foot and fungus fail, topical or oral antifungal drugs, such as Sporonax or Lamisil, are usually prescribed by your Podiatrist.
Bathe your feet at least once a day with soap and warm water. Dry thoroughly after bathing and keep your feet dry. Change socks frequently and buy socks that absorb moisture, such as cotton and wool. Expose your feet to the air for short periods of time throughout the day (do not walk barefoot, however). Wear sandals with open toes whenever possible.
· Wear sandals or shoes when walking on moist or wet floors
· Don’t share shoes or personal care items such as towels
· Wear socks made of absorbent materials such as cotton or wool
· Change socks frequently if you perspire heavily
· Choose footwear that allows for the circulation of air
· Keep the floors in shared facilities clean and dry
· Keep your feet clean and dry by dusting Goldbond or Talc Powder in shoes and hose and feet
· Clean athletic shoes frequently
Metatarsalgia (Ball-of-foot pain)
Definition:Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).
Cause:With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia. Ball-of-foot pain is often caused from improper fitting footwear, most frequently by women’s dress shoes and other restrictive footwear. 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.
Other factors can cause excessive pressure in the ball-of-foot area that can result in metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also 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 and Prevention:The first step in treating metatarsalgia is to determine 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.
Unloading pressure to the ball-of-the-foot can be accomplished with a variety of footcare products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. The orthotic 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. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.
If problem persists, consult your foot doctor.
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.
· 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.
There are a variety of products that can be used on the foot and toe nails that kill the tinea pedis fungus.
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, talcum not cornstarch. Buy shoes that fit well and are made of materials that breathe.
Definition:A claw toe is a toe that is contracted at the PIP and DIP joints (middle and end joints in the toe), and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. Claw toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe.
Claw toes are classified based on the mobility of the toe joints. There are two types – flexible and rigid. In a flexible claw toe, the joint has the ability to move. This type of claw toe can be straightened manually.
A rigid claw toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.
Cause:Claw toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including claw toes.
Treatment and Prevention:Changing the type of footwear worn is a very important step in the treatment of claw toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the claw toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes.
Other conservative treatments include using forefoot products designed to relieve claw toes, such as toe crests and hammer toe splints. These devices will help hold down the claw toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.
If the problem persists, consult your foot doctor
Metatarsal Problems / Callus / IPKIn severe cases of calluses, which usually occur on the plantar aspect (bottom) of the foot, an IPK can develop. An IPK is, in medical terminology, an Intractable, meaning that it will not go away,Plantar, meaning bottom of the foot, Keretosis, meaning a deep seated painful callus that usually occurs under a weight bearing metatarsal (long bone of the foot).If orthotics, padding, massage and other conservative methods do not relieve the problem, surgical intervention is necessary. There are many types of surgeries to employ to correct this problem. A “V” osteotomy (cutting of the bone) is the most common osteotomy for the second, third and fourth metatarsal, and an oblique osteotomy for the fifth metatarsal. Sometimes internal fixation, pins or screws, are used to help stabilize the bones when surgery is indicated. These surgeries are usually done under a local block anesthesia, and the patient is usually ambulatory (walking) immediately after the surgery in a post operative Cast Walking Boot. The newer medications make this procedure safe and pain free, but your doctor needs to be consulted as to specific cause for the specific treatment.
Bunions (Hallux Valgus)
A bunion is a common term for a medical condition known as Hallux Valgus. Hallux Valgus if 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. There are many causes of bunions, but the primary one is tight, ill-fitting shoes, 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. There are many things that you can do to lessen the pain associated with this condition:
1]A good, well-supported, wide toe box shoe, along with good insoles.
2]Anti-inflammatory medications such as aspirin, Tylenol, etc.
4]Soaking the foot in Epsom salts, Johnson and Johnson foot soaks, or massage, therapy, and pads are also good palliative measures.
Of course, if you have diabetes, vascular insufficiency, arthritis or a neuropathy (where the sensation to the foot is diminished) immediate care of a podiatrist/physician is recommended. Doctors specializing in the care and treatment of the foot (Podiatrist or Orthopedist) usually will recommend x-rays to determine the exact cause and treatment of this condition. Although cortisone injections and orthotics are helpful for this condition, it is usually a surgical procedure (bunion surgery) that eradicates the pain.
Alternate Names : Beau’s Lines, Fingernail Abnormalities, Koilonychia, Leukonychia, Onycholysis, Spoon Nails
Definition:Nail abnormalities refer to abnormal color, shape, texture, or thickness of the fingernails or toenails.
Overview & Considerations:
Just like the skin, the fingernails are a telling reflection of a person’s state of health.
Pitting (the presence of small depressions on the nail surface) is often accompanied with crumbling of the nail. Detachment of the nail can also occur. (The nail becomes loose and sometimes even comes off.)
Ridges (linear elevations) can develop along the nail occurring in a “lengthwise” or “crosswise” direction.
Beau’s lines are linear depressions that occur “crosswise” (transverse) in the fingernail. They can occur after illness, trauma to the nail, and with malnutrition.
Leukonychia describes white streaks or spots on the nails.
Koilonychia is an abnormal shape of the fingernail where the nail has raised ridges and is thin and concave. This disorder is associated with iron deficiency anemia
Alternate Names : Beau’s Lines, Fingernail Abnormalities, Koilonychia, Leukonychia, Onycholysis, Spoon Nails
Nail Abnormalities: Common Causes
· Crush injury to base of the nail or the nail bed may produce a permanent deformity
· Nail biting can be a sign of anxiety, chronic tension or uncontrollable compulsion
· Chronic picking or rubbing of the skin behind the visible portion of the nail can produce a washboard nail
· Chronic exposure to moisture or to nail polish can produce brittle nails with peeling of the edge of the nail
· Fungus or yeast produce changes in the color, texture, and shape of the nails
· Bacterial infection may cause a change in color (green nails with Pseudomonas) or painful pockets of infection under the nail or in skin surrounding the nail — severe infections can cause loss of the nail plate
· Viral warts may cause a change in the shape of the nail or ingrown skin under the nail
· Disorders that affect the amount of oxygen in the blood (such as abnormal heart anatomy and lung diseases including cancer or infection) may produce “clubbing” of the nail, which looks like the back of a teaspoon
· Kidney disease that causes a build-up of nitrogen waste products in the blood
· Liver disease including chronic liver failure
· Thyroid diseases including hyperthyroidism or hypothyroidism may produce brittle nails or splitting of the nail bed from the nail plate (onycholysis)
· Infection (especially of the heart valve) may produce splinter hemorrhages (red streaks in the nail bed)
· Systemic amyloidosis
· Severe illness or surgery may produce horizontal depressions in the nails (Beau’s lines)
· Vitamin deficiency can cause a loss of luster or brittle nails
· Malnutrition of any sort can affect the appearance of the nails
· Psoriasis may produce pitting, splitting of nail plate from nail bed (onycholysis), and chronic destruction of the nail plate (nail dystrophy)
· Lichen planus
Heavy metal ingestion
· Arsenic poisoning may produce white lines and horizontal ridges
· Silver intake can produce a blue nail
Heel Spur / Plantar Fasciitis
Heel spur / plantar fasciitis affects men and women equally. It is a condition in which the bottom of the heel is extremely painful. A heel spur is a bony overgrowth on the bottom of your heel bone. The heel spur is usually a result of an inflamed ligament (plantar fascia) on the bottom of the foot that attaches to the heel bone. Constant abnormal pulling of this ligament irritates the heel bone and the body lays down a bone spur as a protective mechanism. The patient usually complains of pain with the first step in the morning, some relief following activity, but returning after extended amounts of time standing or walking. This condition is a constellation of many causes; overweight, ill fitting shoes, bio-mechanical problems (mal-alignment of the heel), gout, pronation (a complex motion including outward rotation of the heel and inward rotation of the ankle) and rheumatoid arthritis are some of the causes of heel pain.
If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Ice compresses, stretching exercises, night splint for traction of the leg muscles to stretch the muscle in the back of the leg, and massage of the back of the leg, along with padding are also things that you can do at home.
Heel pain is not relieved by a soft, ill supported shoe. Shoes such as Nike, and New balance are the best shoes for this condition.
Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. Arch supports, or orthotics are the number one treatment modality for this condition. If the pain is relieved with this device, most likely an orthotic will offer a permanent solution. Physical therapy is another modality that physicians use in the treatment of this condition.
If all these conservative measures fail to relieve the pain, then surgery is indicated. The newer minimal incision surgeries such as the Endoscopic plantar fasciotomy surgery is extremely beneficial for this condition, and for earlier ambulation, the use of the newer Cast Walking Boot is recommended.