Encinitas Podiatry Group
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Corns and Calluses      Ingrown Toenails Arthritis What is a Podiatrist?
Hammertoes Bunions Nail Fungus Links and Websites
Wart Diabetic Foot Problems       Athlete's Foot Patient Education Links
Heel and Arch Pain Pain in the Ball of the Foot      Sports Injuries Common Disorder Videos
Children's Heel Pain Hallux Limitus-Rigidus More Information

Corns and Calluses

Definition:
These are areas of hard, dense skin. Calluses are wider and flatter and found on the soles of the feet. Corns are smaller and usually found on the tops of toes, or between them.

Cause: Too much pressure upon the skin causes Corns and calluses. The skin's response to this pressure is to grow thick and hard, creating the corn. Most corns are seen on the tops of contracted, hammered toes or frequently between toes. Here the knuckle is causing too much pressure, or sometimes, a spur between the toes projects out and creates the corn.

Treatment: There are a number of treatment options. Trimming the corn or callus and applying a felt or moleskin pad will give temporary relief. Purchasing wider shoes to decrease the pressure will help. An orthotic support with a depression to relieve the pressure on the ball of the foot will help a callus. Corns can be eliminated permanently if the toe is straightened and the pressure from the bone beneath the corn is eliminated.


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Hammertoes

Definition:
Toes that are contracted are called hammertoes.

Cause: Toes are meant to be straight. However, with time and wearing of shoes that are frequently too tight, toes can become contracted so that the knuckles become very prominent. These are painful in themselves or can cause painful corns and occasionally ulcers that cause even more pain.

Treatment: Buying wider shoes can relieve pressure and make the toes more comfortable. Hammertoes can be corrected with a minor procedure to straighten the toes.

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Warts

Definition: These are small, hard painful areas of skin, usually found on the balls of the feet, but can be anywhere on the skin of the feet. They may be solitary or found in clusters, called "mosaic warts".


Cause:This is a viral infection of the outer layout of the skin and they are quite contagious. If picked at, they can be easily spread to your hands, friends or family.


Treatment: There are many treatments for warts, but they are usually grouped as topical or surgical. Topical treatments include application of acid preparations or freezing the wart. Warts on the bottoms of the feet are often best treated by removal under local anesthesia and cauterizing the bases of the wart so that the viruses are killed. There is usually little discomfort with this procedure and patients are able to walk immediately afterwards.



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Heel and Arch Pain - Visit our Heel Pain Center


Definition
: pain in the bottoms of the heels, extending into the arch is most often defined as "plantar fasciitis" or "plantar fasciosis" - inflammation or disease of the plantar fascia ligament, which runs from the ball of the foot to the heel.

This is an ultrasound image of plantar fasciitis on the right window. The image is looking at the bottom of the heel (the sole of the foot is up). The thick white lines are the bottom of the heel bones and the outline of tissue entering from the right side is the plantar fascia. If there is inflammation, the tissue becomes thicker and darker at the insertion into the heel bone. The thickness can be measured on the ultrasound screen.



This is an X-ray of the bottom of the heel bone, the calcaneus, showing a heel spur.

Think of the arch being like a bow and this ligament being like a bowstring. When the foot bears weight, the arch elongates and puts tremendous tension on the ligament. The ligament pulls off on the bottom of the heel and this causes the pain. This can also cause heel spurs. The spurs, by themselves, are frequently not the cause of the pain, but are often more a result of the pulling of the ligament, which becomes inflamed. The ligament inflammation can be viewed directly using an imaging ultrasound machine. The thickness of the ligament is proportional to the inflammation. Pain is frequently seen in people whose feet pronate, or flatten out, too much. If the pain and inflammation is present for a prolonged period of time, there can be degeneration or disease of the ligament which is termed "Plantar Fasciosis" which is more chronic in nature.

Treatment: People often begin treatment before they come to the office by using anti-inflammatory medications, over-the-counter supports and exercises to stretch the Achilles tendon and the plantar fascia ligament.

There are many treatment options for heel pain. The good news is that open surgery is rarely necessary. These conditions are often successfully treated with orthotic supports that prevent the foot from pronating. These supports are easily transferred from shoe to shoe. Occasionally a cortisone injection is beneficial to relieve acute symptoms. If a spur is present, occasionally it may require surgical removal.

In recent years, a number of new techniques have become available that allow for definitive pain relief without having to proceed to open surgical release of the ligament or removal of the heel spur.

CRYOSURGERY can eliminate plantar fascial pain with a procedure that lasts only about 7 minutes. This is done under local anesthesia. EXTRACORPOREAL SHOCK WAVE THERAPY can also give good relief for heel pain. For more information visit:

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Heel Pain in Children

Definition:
This is frequently referred to as "Sever's Disease" or "Calcaneal Appophysitis". This is an inflammation of the growth plate at the back of heels.

Cause: A boney growth plate is present at the back of the heels between the ages of 8 to 14. It is attached by soft cartilage to the main portion of the heel. The Achilles tendon inserts into the back of it, coming from the calf muscle, and a strong ligament inserts into it from the bottom. Pulling of these structures on the growth plate causes pain and inflammation. This is especially true in people whose feet pronate (arches flatten out) excessively. Common sports associated with this condition include tennis, soccer, football, basketball, baseball, and skateboarding.

Treatment: Stretching the Achilles tendon prior to running and wearing a cushioned heel lift can help prevent this condition. Sever's disease usually responds very nicely to an orthotic support to control the pronation and cushion the foot.

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Ingrown Toenails

Definition:
An ingrown nail is present when the side of the nail curves down into the flesh and causes pain, and frequently infection.

Cause: Ingrown nails often run in families or can be the result of an injury to the root cells at the base of the nail. Nail fungal infections make the nails more thick and curved and can also contribute to this condition.

Treatment: These can be treated temporarily or permanently. A wedge of nail can be removed from the ingrown portion to relieve the pressure and this usually makes the toe comfortable for a few months. However the ingrown nail frequently returns. For permanent relief, the toe is anesthetized with local anesthesia. The ingrown portion of the nail is removed, leaving the top, flat part alone. Once the root cells are exposed, they are cauterized with a chemical so that the ingrown part will no longer grow back. People are usually able to return to normal activities immediately.

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Bunions

Definition:
Bunions are a boney bump on the first metatarsal bone, at the base of the big toe.

Cause: This portion of the foot bone becomes prominent when the first metatarsal and big toe shift out of alignment, most often as a result of tight shoes or excessive pronation.

Treatment: Purchasing wide shoes can relieve pressure on the bump. Bunions can be corrected with a minor surgical procedure where the bump is removed and the bones are shifted back into alignment. This is done on an outpatient basis and usually people are able to walk on the foot that day and return to an athletic shoe within a few weeks.




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Diabetic Foot Problems

Definition:
Diabetes is a medical condition that effects many areas of the body including the feet, eyes, kidneys, nerves and arteries. Some of the more dangerous problems involve the feet. Problems that might be considered minor in non-diabetics, like thick nails, corns or callouses, are dangerous with diabetics. Some diabetics lose sensation in their feet so they can't feel if they have a problem. Diabetics are more prone to infections and ulcerations (forming holes through the skin). How significant is this? Approximately 86,000 amputations are performed each year on diabetics in the United States (American Public Health Association). Comprehensive podiatric care and good control of the diabetes is the best treatment for prevention of diabetic foot problems.

Cause: Diabetes causes heightened levels of sugar in the blood which goes on to effects many areas and tissues of the body. Nerves begin to lose their function, beginning in the toe tips. The arteries can become occluded so that inadequate blood flow to the feet. Skin becomes dry, cracked and brittle. Corns, calluses and ingrown nails that put pressure on the skin can go on to cause infection and ulceration.

Treatment: Regular foot care is essential for prevention of diabetic complications, including testing for loss of sensation and ongoing education for home care. Debridement of corns, calluses, ingrown nails that could cause skin breakdown at regular intervals is essential. A prescription for protective shoes is given if necessary.

The Medicare Therapeutic Shoe Program: Medicare will provide a pair of therapeutic shoes and protective innersoles each year to qualified diabetic patients.

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Pain in the Ball of the Foot

Definition: Pain in the ball of the foot is caused by excessive pressure on the bones, joints and adjacent nerves. These include a number of different conditions. Pain beneath the joints is called "Capsulitis" or inflammation of the ligamentous capsule that surrounds the joint. Nerves that are located between the metatarsal bones where they join the toes can become pinched, swollen and inflamed. This is called a "Morton's Neuroma". Neuroma means tumor, but this is not a cancer-type tumor, but rather just a swollen, inflamed nerve. Pain beneath the base of the big toe may be from irritation to two small bones called "sesamoid bones". This is referred to as "Sesamoiditis". These are floating bones that everyone has that are similar to miniature knee caps. They can become bruised, crushed or fractured.

Cause: Any of the above conditions can become painful with injury. Some people just have a foot structure where the bones are too long, too low or out of alignment creating abnormal pressure at a specific location. Additional stress is caused by abnormal foot function during gait: excess pronation or supination (flattening of the arch or an unusual high arch). Sports that require being on the balls of the feet, like tennis, volleyball or basketball can contribute to these conditions.

Treatment: Often, these problems respond to conservative treatment with shoe changes, orthotic supports. Cortisone injection may give relief to a neuroma condition or joint inflammation. For neuromas that do not respond to orthotics or injections, cryosurgery (see cryosurgery section) has been found to be effective. Occasionally, open surgery will be necessary to correct these problems. This is done on an out patient basis.

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Arthritis

Definition: Joint pain, inflammation and deteriorization, as well as deformity can be caused by many types of arthritis.

Cause: Each type of arthritis attacks the joints in a different way and at different locations. Osteoarthritis most often attacks the big toe joint ("Hallux limitus-rigidus") and midfoot joint of the arch. Rheumatoid arthritis attacks the joints across the ball of the foot, often causing dislocations. Psoriatic arthritis attacks the joints of the ball of the feet as well as the toe joints. Gout usually attacks the big toe joint, but occasionally can attack any other foot or ankle joint. Gout has some special characteristics that will lead your doctor to this diagnosis. Gout rarely attacks women.

Treatment:The good news is that almost all the conditions can be relieved or improved upon. Treatment depends upon the type of arthritis and degree of involvement. Treatments may involve oral medication, injection, orthotic supports or surgery depending upon the need. Obtaining relief of painful arthritic conditions is particularly gratifying for both the doctor and the patient.

Hallux Limitus-Rigidus: : (Stiff Big Toe Joint)

Definition: This is a condition where the big toe joint becomes arthritic, stiff and painful. The "hallux" is the Latin word for the big toe. As the joint becomes stiffer, it is referred to as "hallux limitus" and when motion stops it becomes "hallux rigidus".

Cause: This is either caused by an injury to the joint which with time causes erosion of the joint cartilage and bone spur formation or by poor foot structure and mechanics so that the joint wears out from abnormal stresses, just like the knee or hip joints do. People who pronate excessively have a higher tendency for this condition.

Treatment: If this is caught early, much of the progression of the arthritis can be halted with a proper orthotic to eliminate the pronation and relieve the stress from the joint. Anti-inflammatory medications and cortisone injections can give good temporary relief. For chronic conditions there are a number of surgical procedures that can give permanent relief.

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Nail Fungus

Definition: This is an infection of the nail plate by a fungus, the same types that cause athlete's foot. This is seen when the nail becomes thick, discolored and sometimes flaky.

Cause: The nail plate is not live tissue and is susceptible to infection. In fact, it is normal for people to get fungal infections after age 60. Some patients are at greater risk - particularly diabetics, immunosuppressed individuals and people who live or work in moist environments.

Treatment: Most of the over-the-counter medications found at sores are not effective. Nail fungus can be treated with oral or topical medications. The oral medications are the most successful and are generally quite safe, though it is necessary to inquire about the medical history and perform liver function tests during the course of the oral medication. Topical medications can be effective and minimize the side effects. No nail fungus treatment works all the time.

**Not Fungal Nails: Just because your nail may be discolored, thick or loose does not mean it is fungal. There are a number of other conditions that can cause similar appearance to a nail fungal infection. These conditions, of course, will not respond to nail fungus treatments, since they aren't fungal in the first place. Your doctor can help determine what the cause of your nail condition and advise the best course.

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Athlete's Foot

Definition:
This is a fungal infection of the skin, causing either inflammation, blisters, flaking, redness, oozing and/or itching.

Cause: Fungus is everywhere and can be acquired by anyone, infecting the skin of the feet. Some of the people are more susceptible including diabetics, individuals whose feet perspire more, and those who work in greenhouses or are from moist environments.

Treatment: Most athlete's feet infections will respond to the over-the-counter medicated powders and creams. The more severe infections will be treated with prescription medications.

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Sports Injuries

There are many kinds of sports related injuries, some more prevalent due to the stresses of specific sports. Many injuries are caused by faulty foot structure and function and aggravated by improper shoes.

Treatment: The goal when treating athletes is to get them safely back to participating in their sports as soon as possible. If the condition is severe enough that they cannot participate in their sport for a period of time, an alternative exercise can usually be found to allow the athlete to stay in shape during the rehabilitation period. Once the painful condition has resolved, steps must be taken to prevent recurrence. If poor foot structure or function is to blame, we can often correct this with a support worn in the shoe. We offer both experience an d the latest technology in the fabrication of orthotic support.

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More Information - Other Common Foot Problems

besides the information given on this section of our website, the American College of Foot and Ankle Surgeons has a very good website with in-depth information on a wide range of foot problems at:

Tobacco Cessation: Weight Managment: Diabetic Foot Care

DISCLAIMER: *MATERIAL ON THIS SITE IS BEING PROVIDED FOR EDUCATIONAL AND INFORMATION PURPOSES AND IS NOT MEANT TO REPLACE THE DIAGNOSIS OR CARE PROVIDED BY YOUR OWN MEDICAL PROFESSIONAL. This information should not be used for diagnosing or treating a health problem or disease or prescribing any medication. Visit a health care professional to proceed with any treatment for a health problem.

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