Achilles Tendon Disorders

The Achilles tendon is a flexible cord of tissue that connects the heel bone to the calf muscle. Overuse, especially resulting from repetitive activity, can cause inflammation of the tendon ("tendonitis") or actual tearing and degeneration ("tendonosis").

Symptoms: The symptoms of Achilles tendonitis and tendonosis include:

  • Pain anywhere from the heel up to the calf muscle. The discomfort often lessens with mild activity, but too little or too much activity can worsen it.
  • Noticeable tenderness upon pressing the sides of the tendon.


Diagnosis: Achilles tendon disorders are mainly diagnosed by the doctor's examination of the foot and ankle, analyzing the location of the discomfort and the range of comfortable motion. X-rays are occasionally used as well.

Treatment: Treatment options depend on how long the problem has existed and whether there is actual damage to the tendon. While surgery is used as a last resort, in most instances non-surgical treatments resolve the problem. These include:

  • Immobilization, through a cast or special boot.
  • Ice
  • Oral anti-inflammatory medications
  • Night Splints
  • Physical Therapy
  • Custom orthotic devices


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Achilles Tendon Rupture

The Achilles tendon is a flexible cord of tissue that connects the heel bone to the calf muscle. It aids walking by helping to lift the heel from the ground. When very sudden or forceful activity causes this tendon to tear, the injury is called a rupture.

Symptoms:

  • Immediate pain in the area between heel and calf
  • Sensation of popping or snapping
  • Swelling in the lower back of the leg
  • Difficulty walking, especially rising up on toes

Diagnosis: The doctor will ask about how the injury occurred, and whether the patient has ever had the problem before. The foot and ankle will be examined, and range of motion evaluated. The diagnosis is usually obvious, but in some cases an MRI is ordered.

Treatment

  • Non-surgical: Less active patients or those with medical conditions precluding surgery may simply have the area immobilized and allowed to heal naturally
  • Surgical: Surgery is the usual treatment, offering better prognosis for future mobility
  • Physical Therapy is always included in treatment after the initial rupture has healed


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Ankle Sprain

A sprained ankle is an injury to one or more of the stretchy ligaments which bind the ankle joint together and normally limit its side-to-side motion. They are typically the result of a fall or abrupt twisting motion. Ankle sprains have a wide range of severity, depending on whether the ligaments are torn or merely stretched.

Symptoms:

  • Pain
  • Bruising
  • Swelling
  • Difficulty walking
  • Unusual wobble or stiffness in ankle joint


Diagnosis: The doctor will examine the ankle and will ask for a history of the incident. X-rays are typically ordered as well.

Treatment: Some sprained ankles cause a sensation of instability rather than of pain, but treatment is crucial for all sprains. Even minor ones, left untreated, can lead to a permanent tendency for ankles to "give way".

Non-surgical treatments typically include the following:

  • Rest (Staying off ankle)
  • Ice
  • Elastic compression bandage
  • Elevating the ankle when sitting, to avoid swelling
  • Oral anti-inflammatory pain medication
  • Physical therapy, beginning soon after injury.


In more severe sprains, ligaments may need to be repaired through surgery.


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Bunions

Bunions are a foot deformity caused by an inherited problem in the foot's mechanical structure. They appear as a bump on the outside of the big toe, but the bump is only an outward sign of changes in the bones' alignment. The disorder is progressive, and can be worsened by certain types of shoes.

Symptoms: The following symptoms at the site of the bunion may become worse with tight shoes or long periods of standing:

  • Pain
  • Inflammation and skin reddening
  • Burning sensation
  • Numbness

Diagnosis: Visual evaluation is sufficient to diagnose the existence of bunions, but x-rays are often ordered so as to determine the degree of bone deformity.

Treatment:

  • Non-surgical treatments: Monitoring the progress of the bunion periodically and wearing wide shoes. Extra padding in the shoe or custom orthotic devices are often recommended. Occasionally anti-inflammatory oral pain medication and ice packs are prescribed.
  • Surgery: Recommended if the bunion interferes with normal activity. The surgery is done to reduce pain, and will remove the bump as well as make changes to the foot's bone structure.


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Calcaneal Apophysitis (Sever's Disease)

Calcaneal Apophysitis, sometimes called "Sever's disease," is not actually a disease. It's the most common cause of heel pain in young people between the ages of 8 and 14, and it's due to the repeated pull of the Achilles tendon on the growth plate of the heel bone. After the bones mature, this sensitivity disappears.

Symptoms:

  • Pain in the back or bottom of the heel, on one or both sides
  • Difficulty in running, jumping, etc.
  • Limping
  • Walking on toes
  • Soreness when sides of heel are squeezed

Diagnosis: The doctor will want to rule out more serious causes of heel pain, so a full medical history will be taken and the foot and leg will be examined. X-rays or other imaging studies may be ordered as well.

Treatment: Since calcaneal apophysitis is typically caused by running and jumping on hard pavement, the first treatment is to stop the activity that caused the pain. Other treatments include:

  • Oral anti-inflammatory medications
  • Well-cushioned footwear
  • Temporary shoe inserts
  • Physical therapy
  • Immobilization by means of a cast in severe cases.


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Capsulitis

Capsulitis is an inflammation of the ligaments which form a "capsule" around one of the middle toes, usually the second one. This condition can be the result of various structural and mechanical problems including severe bunions, unstable arch, and tight calf muscles.

Symptoms: Early-stage symptoms of capsulitis include:

  • Pain and swelling in ball of foot
  • Pain when walking barefoot
  • Difficulty wearing shoes

A later symptom is the tendency of the second toe to lie on top of the big toe.

Diagnosis: A diagnosis must differentiate between capsulitis and a condition called "Morton's neuroma." The doctor will examine the foot and ankle, test the stability of joints, and possibly order X-rays or other imaging studies.

Treatment: Capsulitis is a progressive disorder and if left untreated can lead to increased pain and dislocation of the toe. Treatments include:

  • Oral anti-flammatory pain medication
  • Rest and ice
  • Taping or splinting the toe
  • Stretching exercises
  • Shoe modifications
  • Orthotic devices in the shoe

Advanced cases of capsulitis may require surgery to reposition the second toe.


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Cavus Foot

Cavus foot refers to a condition in which the arch is abnormally high, often due to a neurological disorder, stroke, disease, or inherited structural problem. Cavus foot becomes progressively worse if it's the result of neurological causes, but otherwise it usually does not change.

Symptoms: Cavus foot can develop at any age, causing the arch to be so high it will be obvious even when the person is standing. Other symptoms may include:

  • Bent or clenched toes
  • Calluses on the ball, heel, or side of foot
  • Pain when using the foot
  • Unstable foot and heel tilting inwards


Diagnosis: The diagnosis begins with a visual examination of the arch, and an evaluation of callouses and walking pattern. The patient may be referred for a complete neurological evaluation and X-rays may be ordered as well.

Treatment: In most cases, treatments for cavus foot are non-surgical and typically include:

  • Orthotic devices that fit in the shoe
  • Modified shoes
  • Bracing, to keep foot and ankle steady

Surgical treatment is occasionally needed to improve foot stability and decrease pain.


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Charcot Foot

Charcot foot is a serious condition which results from nerve damage, causing the foot bones to weaken and break. Since nerve damage decreases sensation, patients may not realize their foot bones have fractured, and may cause severe secondary damage by continuing to walk around.

Symptoms: In the early stages, symptoms of Charcot foot resemble those of certain other foot disorders. Symptoms include:

  • Redness in the foot
  • One foot warmer than the other
  • Swelling
  • Pain
  • Deformed appearance, such as a "rockerbottom" appearance

Diagnosis: Early diagnosis is important for treatment to be successful. The doctor will examine the foot and ankle, take a medical history, and order X-rays and other imaging studies. Periodic X-rays are important to monitor progress.

Treatment: Left untreated, Charcot foot can cause the loss of a toe, foot, leg, or even a life, so the following treatments must be carefully adhered to:

  • Complete immobilization and non-weightbearing
  • Custom shoes and bracing
  • Activity modification, often to prevent problems in the other foot
  • Surgery may be needed if deformity becomes severe


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Deep Vein Thrombosis

Deep Vein Thrombosis, or DVT, is a dangerous condition in which a blood clot forms deep in the veins, usually in the leg. DVT is a medical emergency because if the clot breaks loose it can travel to the lungs and become life-threatening.

Symptoms: The symptoms of DVT may include:

  • Leg swelling
  • Unexplained pain in the leg
  • Redness or unusual warmth in the leg


Diagnosis: Diagnosing DVT is a challenge because the symptoms resemble those of simple muscle injuries or less dangerous superficial clots. If a doctor suspects DVT, the patient will be immediately sent to a lab for a test of blood circulation such as an angiogram, venogram, ultrasound or MRI.

Treatment: Because of the risk inherent in DVT, initial treatment generally takes place in the hospital. Depending on the location of the clot, treatment will include:

  • Medication to break up the clot or help prevent new clots from forming
  • Compression stockings, to assist circulation and prevent swelling
  • Surgery (typically only in cases of very large clots).


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Diabetic Complications

There are two side effects of diabetes which can give rise to foot problems: nerve damage ("neuropathy") and poor circulation. Neuropathy reduces sensation in the feet, so that wounds and other foot problems can go unnoticed. Poor circulation means that when problems do arise, they don't heal very well.

Problems: The main foot and leg problems associated with diabetes are:

  • Infections and sores that don't heal
  • Cracked, dry skin
  • Corns and calluses
  • Bunions and hammertoes
  • Charcot foot (complications from an untreated broken foot bone)
  • Tissue death due to poor blood flow

Self-treatment: Here are some simple, low-tech methods that diabetics can use to maintain foot health:

  • Inspect feet daily, using a hand mirror if necessary
  • Don't ignore leg pain
  • Don't try to cut off calluses or corns yourself
  • Don't go barefoot
  • Make sure socks aren't bunched up
  • Report any swelling, redness, warmth or pain to the doctor immediately
  • Have the doctor periodically check circulation and sensation in feet

Medical treatment: Surgical technology continues to improve, and many techniques are available for joint reconstruction and wound healing. Regular checkups can usually head off the most severe problems.


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Diabetic Foot Care Guidelines

Nerve damage caused by diabetes can lead to loss of sensation and lowered blood flow to the feet. Small injuries may not be noticed due to the absence of pain, and wounds take longer to heal because of reduced circulation. In order to avoid serious complications, it's important for people with diabetes to follow these guidelines for foot care:

Daily inspection: Using a magnifying hand mirror when necessary, check all sides of the feet for any redness, swelling, blisters, cuts or nail problems.

Daily washing in lukewarm water: Be careful to check the temperature carefully so as not to cause burns.

Bathe feet gently: Use a soft washcloth and dry by blotting, especially between the toes.

Moisturize feet: Daily moisturizing helps prevent dry skin problems, but don't put moisturizer between the toes.

Cut nails carefully: Cut straight across, filing the edges smooth. Do not cut too short.

Do not treat corns or calluses at home: See your doctor for help with these conditions.

Put on fresh dry socks each day.


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Diabetic Peripheral Neuropathy

Diabetes can cause nerve damage ("neuropathy") in the legs and feet, resulting in numbness, skin ulcers, and infection. This condition progresses slowly, but it can lead to serious complications.

Symptoms: The symptoms of diabetic peripheral neuropathy depend on which types of nerves have suffered damage. Sensory neuropathy symptoms include:

  • Numbness in feet
  • Tingling or burning sensations in feet
  • Pain in feet or legs

Symptoms of neuropathy in the motor nerves include:

  • Muscle weakness in feet and lower legs
  • Changes in foot shape
  • Loss of balance

Autonomic neuropathy symptoms include:

  • Cracked skin
  • Dry feet

Diagnosis: The doctor will take a medical history and examine the feet and legs, testing reflexes and sensitivity to touch. Occasionally additional neurological tests are ordered as well.

Treatment: The primary treatment consists of ensuring that the patient's blood sugar levels are under control. Further treatments include:

  • Oral medication to relieve tingling, burning, or pain
  • Well-fitted shoes
  • Careful inspection of the feet every day
  • Physical therapy to improve balance problems


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Equinus

Equinus is a condition in which the foot's ability to bend upward (bringing the toes closer to the front of the leg) is very limited. The condition can result from a variety of causes, including congenital muscle tightness, diabetes, neurological disorders, ankle injury, or having been immobilized in a cast.

Symptoms: As people try to compensate for equinus, secondary foot problems often develop, and these are typically what cause people to seek medical help. These problems include:

  • Cramps in the calf
  • Inflamed Achilles tendon
  • Pain in the ball of the foot
  • Flatfoot
  • Arthritis of the midfoot
  • Plantar fasciitis (arch or heel pain)

Diagnosis: The doctor will evaluate the ankle's range of motion. X-rays or neurological testing may also be ordered.

Treatment: It's necessary to focus treatment on the secondary problems caused by equinus, as well as on the condition itself. Treatments for equinus include:

  • Night splints, to reduce calf muscle tightness
  • Heel-lifts inside shoes
  • Arch supports
  • Physical therapy to stretch calf muscles
  • Surgery to correct structural bone and tendon problems


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Flexible Flatfoot

Flatfoot refers to a number of related disorders, all characterized by some degree of collapse in the arch. Flexible flatfoot is the most common of these disorders, typically beginning in childhood and worsening with time. Other characteristics of flatfoot include "Toe drift," meaning that toes point outward, and tight Achilles tendon, causing the heel to lift off the ground too early.

Symptoms: Not everyone with flexible flatfoot will experience all of these symptoms:

  • Pain in heel, arch, ankle, outside of foot, or low back
  • Overall fatigue or aching in the legs
  • Pain along the shin-bone
  • "Rolled-in" ankles

Diagnosis: The doctor will observe the function and position of the foot and ankle. X-rays are usually taken.

Treatment: Most treatments for flexible flatfoot are non-surgical. They include:

  • Modifying activity, to give arches a rest
  • Losing weight
  • Immobilization
  • Orthotic devices
  • Oral anti-inflammatory medication
  • Physical therapy, sometimes including ultrasound therapy
  • Shoe modifications

Occasionally surgery is necessary to relieve pain when other treatment methods are not sufficient. The surgical procedure depends on the extent of the damage present.


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Fractures of the Calcaneus (Heel Bone)

The calcaneus, or heel bone, forms part of the inner architecture of the foot. The calcaneus and its joint – along with the nearby talus bone -- are crucial to the foot's functioning. The heel bone has a spongy interior, so fractures can result in serious fragmentation. Calcaneal fractures are most often caused by accidents, but can occasionally result from repetitive stress.

Symptoms: The symptoms of calcaneal fractures depend on the nature of the injury, and on which related parts of the foot's structure were also damaged. Symptoms may include:

  • Sudden pain and inability to bear weight on the foot
  • Heel swelling
  • Bruising of heel and ankle
  • Pain in the heel that develops slowly over days

Diagnosis: The doctor will ask about the injury, examine the foot, and order X-rays. Typically, advanced imaging tests are also ordered.

Treatment:

  • Immobilization, by means of a cast
  • Rest, ice, compression and elevation (known as R.I.C.E. treatment)
  • Surgery, in the case of complex traumatic injury
  • Physical therapy and rehabilitation to restore function


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Ganglion Cyst

Ganglion cysts are benign masses of soft tissue, usually fluid-filled. When they occur on the foot, their location is usually (but not always) on the top of the foot. They vary in size, and may grow, shrink, disappear or recur. The cause of ganglion cysts is not fully understood, but they are sometimes linked to trauma to the area.

Symptoms:

  • A noticeable lump (this may be the only symptom)
  • Dull pain
  • Tingling or burning
  • Difficulty wearing shoes over the lump

Diagnosis: The doctor will examine the lump, using manual techniques as well as light to ascertain its nature. Occasionally a small amount of fluid is withdrawn from the cyst for evaluation, and imaging methods are sometimes used as well.

Treatment: Ganglion cysts may be treated through the following non-surgical methods:

  • Monitoring, but no treatment (if the cyst is causing no pain)
  • Differently shaped shoes (to avoid irritating the lump)
  • Aspiration of fluid (draining the fluid and injecting steroid medication)

Surgery is sometimes required if other options fail or are not feasible.


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Gout

Gout is a painful disorder that results from crystallized uric acid being deposited in joints. It most often affects the big toe because that's the joint farthest from the heart and thus the coolest in temperature. (Uric acid, which circulates in the bloodstream, is temperature-sensitive and tends to form crystals at cooler temperatures.) Risk factors for gout include high blood pressure, diabetes, obesity, stress, chemotherapy, and a diet high in meat products.

Symptoms:

  • Intense pain in big toe, especially during the night
  • Redness, swelling and warmth at big toe joint

Diagnosis: The doctor will take a medical history and examine the affected joint. Lab tests and X-rays may be ordered to rule out alternative causes for the inflammation.

Treatment: Gout symptoms and inflammation usually lessen and disappear within three days. Treatments include:

  • Immobilization and elevation to reduce swelling and rest the foot
  • Dietary restrictions, emphasizing less meat, fat and alcohol
  • Plenty of fluids (helps prevent new crystals from forming)
  • Oral anti-inflammatory pain medication

If gout recurs frequently, the primary care physician should be consulted.


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Hallux Rigidus

Hallux rigidus is a degenerative arthritic condition in the joint at the base of the big toe. This disorder worsens with time, and as the big toe loses mobility the person has difficulty walking, stooping and standing. Hallux rigidus has many causes including inherited structural abnormality, overuse, and inflammatory diseases.

Symptoms: Early signs of hallux rigidus include:

  • Pain and stiffness in big toe while walking or standing
  • Inflammation and swelling around the big toe joint
  • Difficulty running and squatting

Later symptoms may include pain even during rest, sometimes extending into the hip, knee or lower back, due to changes in walking. Bone spurs can make it difficult to wear shoes.

Diagnosis: The doctor will evaluate the range of motion in the big toe, and will use X-rays to determine the extent of arthritis.

Treatment: The following treatments during early stages of hallux rigidus may make surgery unnecessary:

  • Modified shoes
  • Orthotic devices
  • Oral anti-inflammatory pain medication
  • Injection therapy
  • Physical therapy

Surgery is sometimes the only way to relieve pain or remove bone spurs.


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Hammertoe

Hammertoe is an abnormal bending in any of the four smaller toes. It begins as a mild deformity, while the toes are still flexible, and progressively worsens until the toes become rigid and must be surgically repaired. Hammertoe is most often caused by gradual changes in the foot's structure which give rise to muscle/tendon imbalance (eventually forcing the toes to contract). The disorder can be aggravated by wearing shoes that cramp the toes.

Symptoms:

  • Classic bent-down position of toe
  • Corns and calluses on toe or ball of foot (from shoe rubbing on bent toe)
  • Redness or burning sensation
  • Open sores (in severe cases)

Diagnosis: Hammertoes are easily recognized, but X-rays may be taken in order to ascertain the degree of deformity.

Treatment: Treatment of hammertoes depends on how much flexibility remains. Early-stage treatments include:

  • Different shoes (roomy, comfortable, low-heeled)
  • Orthotic devices
  • Injection therapy
  • Splinting and strapping
  • Oral anti-inflammatory pain medication

Surgery is necessary if the hammertoe has become rigid, or if pain and open sores persist.


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Heel Pain

Plantar Fasciitis is the most common cause of heel pain. It's an inflammation of the band of tissue which extends from the toes to the heel, and often results from overly flat or very high arches. Obesity and long hours of standing in non-supportive footwear can also lead to this disorder.

Symptoms: The pain of plantar fasciitis is felt on the bottom of the heel. Discomfort is often greatest right after getting up in the morning or when standing up after a rest. The pain typically improves after walking a little, but then returns after too much time spent on the feet.

Diagnosis: The doctor will take a medical history and examine the foot to rule out all other possible causes of heel pain. X-rays or other imaging studies may also be used to narrow the diagnosis.

Treatment: Surgery is rarely needed for plantar fasciitis. Some treatment options include:

  • Avoiding barefoot walking
  • Ice several times a day
  • Limited activities
  • Shoe modifications
  • Oral anti-inflammatory pain medication
  • Padding and strapping
  • Removable walking cast
  • Injection therapy
  • Night splint
  • Physical therapy


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Ingrown Toenail

A toenail is ingrown when the sides of it curve down and grow into the skin. The nail digs further into the skin as it continues to grow, creating inflammation and sometimes infection. Ingrown toenails are most commonly caused by cutting the nails too short, although they can also result from trauma, heredity, toenail infections or shoes that are too tight.

Symptoms: The usual symptoms of ingrown toenails are:

  • Pain
  • Swelling and redness
  • Warmth
  • Draining liquid & foul odor (if infection is present)

Diagnosis: Ingrown toenails are readily diagnosed by an examining physician.

Treatment: Cutting toenails in a straight line and wearing shoes that fit well are the primary methods of preventing future ingrown toenails. Treatments for the disorder include:

  • Foot soak in tepid water with Epsom salts
  • Oral antibiotics (for infection, if any)
  • Minor surgery to remove part of nail

It's important to avoid home treatments such as cutting a notch in the nail or repeatedly trimming nail borders, putting cotton underneath the nail, or using over-the-counter topical medications.


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Lisfranc Injuries

The long bones that lead to the toes are connected to the foot's arch bones at the Lisfranc joint. A band of fibrous tissue called the Lisfranc ligament controls the strength and alignment of the joint. Injuries to this joint range from sprains and dislocations to serious fractures, and usually result from a heavy object striking the foot or from the foot being accidentally twisted.

Symptoms: Symptoms depend on the severity of the injury, and include:

  • Pain throughout midfoot
  • Swelling of foot
  • Inability to bear weight
  • Abnormal widening of foot
  • Bruising or blistering on arch

Diagnosis: It's important for the doctor to differentiate between a Lisfranc injury and a sprained ankle. A thorough medical history will be taken, after which a physical examination (sometimes under anesthesia) is combined with X-rays and other imaging studies.

Treatment: Nonsurgical treatments for Lisfranc injuries include:

  • Immobilization
  • No weight-bearing
  • Ice and elevation, to reduce swelling
  • Oral anti-inflammatory pain medication
  • Physical therapy, after swelling and pain have disappeared

Surgery is occasionally needed in cases of severe injury.


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Malignant Melanoma of the Foot

Melanoma is a type of skin cancer which spreads easily to other parts of the body. When it occurs on the foot or ankle, it may be overlooked in its early stages, leading to a higher mortality rate. Melanoma is often linked to excessive UV radiation, as from tanning beds or sunburn. Fair-skinned people and those prone to numerous moles are more vulnerable to melanoma.

Symptoms: Melanoma can appear anywhere on the body, and recognizing whether a mole might be abnormal follows an ABCD rule:

  • Asymmetrical (the mole or lesion is not perfectly round)
  • Border is irregular
  • Color (the mole usually has several colors rather than one single color)
  • Diameter is growing or is larger than a pencil eraser

Diagnosis: The doctor will examine the spot and take a biopsy if there is any suspicion of melanoma.

Treatment: Early detection of melanoma is crucial. An oncologist will discuss treatment options if melanoma is diagnosed. Depending on the extent of the cancer, there are many different types of treatments available.


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Neuroma

When nerves are compressed or irritated, they become enlarged and eventually suffer permanent damage. This enlargement and damage is called a neuroma. Neuromas in the foot most often appear between the third and fourth toes in the ball of the foot, although they can occur in other locations as well. Neuromas arise as secondary complications from certain foot deformities, but they can also be caused by badly fitting shoes or by injuries.

Symptoms: Symptoms develop gradually, appearing intermittently at first and then worsening. They include:

  • Pain or burning
  • Numbness
  • Tingling
  • Sensation of something inside ball of foot or bunched up underneath foot

Diagnosis: The doctor will take a history of symptoms and perform manual examination of foot. Other tests or imaging studies may also be included.

Treatment: Treatment is much likelier to be successful when begun during the early stages of the problem. Treatment includes:

  • Modifying activities or shoe type
  • Padding
  • Ice
  • Orthotic devices
  • Injection therapy
  • Oral pain medication

Surgery may be necessary in severe cases. All treatments include longterm strategies for appropriate footwear and activities.


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Pediatric Flatfoot

Pediatric flatfoot is a childhood foot deformity consisting of partial or total collapse of the arch. It may be evident at birth or it may not appear until the child is older. In some instances pediatric flatfoot has no symptoms at all.

Symptoms: If pediatric flatfoot causes any symptoms, they may include:

  • Outward tilting of heel
  • Pain or cramping in foot, leg or knee
  • Awkwardness in walking
  • Difficulty with shoes
  • Reluctance to engage in physical activities

Diagnosis: The doctor will evaluate the appearance of the foot while the child stands, sits and walks. The foot's range of motion will be checked, and in some cases the doctor will also examine the child's knee and hip. (Leg problems are sometimes the cause of flatfoot.) X-rays are frequently used for diagnosis as well.

Treatment: If the child experiences no symptoms, treatment is unnecessary. When symptoms exist, treatments include:

  • Wearing different shoes
  • Physical therapy
  • Activity modification
  • Orthotic devices
  • Anti-inflammatory oral pain medication

In severe cases, surgery is necessary to relieve discomfort and repair deformities.


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Peripheral Arterial Disease (P.A.D.)

When arteries in the legs become blocked with plaque, the blood flow from the heart is reduced and the tissues of legs and feet suffer from oxygen deprivation. The presence of P.A.D. in the legs often indicates generalized circulation problems throughout the body.

Symptoms: Early stages of P.A.D. often have no symptoms, so people may not suspect a problem until there is significant arterial blockage. When symptoms are noticed, they include:

  • Leg pain and cramping
  • Numbness or weakness in legs
  • Cold legs or feet
  • Sores that won't heal on legs or feet
  • Color change in legs
  • Loss of leg hair
  • Change in appearance of toenails

Diagnosis: It's crucial to report suspected P.A.D. symptoms to the doctor. There are simple, non-invasive tests which can measure the volume of blood flow in the legs and feet.

Treatment: The doctor may refer the patient to a vascular specialist. Typically, treatment of any arterial disease includes:

  • Lifestyle changes (increased exercise, smoking cessation, heart-healthy diet)
  • Medications (to improve blood flow, prevent clots, control blood pressure or cholesterol)
  • Surgery


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Peroneal Tendon Injuries

The peroneal tendons attach the outer ankle bone to muscles in the arch and midfoot. Injuries to these tendons can result from sudden accidents or from repetitive ankle motion. High arches are an inherited condition which increases the risk of this type of injury. The four categories of tendon injuries are: tendonitis (inflammation of the tendon), acute tears, degenerative thinning and tears, and subluxation (tendons slipped out of normal position).

Symptoms: Symptoms vary with type of injury, but may include:

  • Pain
  • Swelling
  • Warmth to the touch
  • Instability or weakness in ankle
  • Increase in height of arch
  • Snapping sensation around ankle bone

Diagnosis: The doctor will use X-rays and imaging studies to differentiate peroneal tendon injuries from other related problems.

Treatment: The appropriate treatment will depend on the type of injury involved and the patient's mobility needs and lifestyle. Treatments include:

  • Immobilization in cast or splint
  • Oral anti-inflammatory pain medication
  • Physical therapy (including ice, heat, ultrasound and exercise)
  • Bracing during particular activities
  • Surgery (if tendons or supporting tissues need repair)


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Plantar Wart

Warts are small skin growths caused by the human papilloma virus (HPV), and they often occur on hands and feet. "Plantar" refers to the bottom of the foot. Plantar warts grow deep in the skin, and can occur singly or in clusters. They are more common among children and the elderly, since healthy younger adults usually have resistance to the virus.

Symptoms:

  • Thickened skin in one area on the bottom of the foot
  • Pain, especially if the sides of the wart are squeezed
  • Tiny black dots (dried blood in capillaries)


Diagnosis: The doctor will examine the skin of the foot, evaluating the appearance and sensitivity of the wart in order to distinguish it from a callus.

Treatment: Plantar warts may eventually disappear on their own, but most people desire treatment. Treatment methods include:

  • Laser therapy
  • Topical or oral medication
  • Cryotherapy (freezing)
  • Acid treatments
  • Surgical removal


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Posterior Tibial Tendon Dysfunction

Posterior Tibial Tendon Dysfunction, or PTTD, is a progressively worsening change in the tendon which supports the arch. PTTD is the most common cause of flatfoot in adulthood, and it's usually the result of excessive amounts of stair-climbing, running or hiking.

Symptoms: Because PTTD is progressive, early-stage symptoms are different from those in later stages. Early symptoms include:

  • Pain on inside of ankle and foot
  • Signs of inflammation (redness, swelling, warmth)

Later symptoms include:

  • Toes and foot turning outward
  • Ankle turning inward
  • Pain on the outside of foot, below ankle
  • Arthritis in ankle

Diagnosis: In an office examination, the doctor will look for tenderness or swelling of the tendon, and will evaluate the patient's ability to carry out certain foot movements. X-rays will be ordered, and MRI or ultrasound testing may be used to asses the degree of tendon damage.

Treatment: Early-stage treatment of PTTD includes:

  • Physical therapy
  • Oral anti-inflammatory pain medications
  • Modifications of shoes, providing arch supports

In later stages of PTTD, surgery may be the only option.


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Puncture Wound

Since puncture wounds have a small entry point, it's impossible to visually assess the depth of the wound or the extent of interior injury. Dirt and foreign objects can be lodged within the wound, causing infection and further problems. It's important to seek treatment for a puncture wound within the first 24 hours.

Symptoms: Puncture wounds are usually obvious when they happen, as the person has just stepped on something sharp and suffered an injury.

Diagnosis: The patient usually appears in the doctor's office with a clear self-diagnosis of a puncture wound.

Treatment: The first stage of treatment may have occurred in an emergency room, and may include a tetanus shot. Follow-up cleaning and monitoring for infection may be conducted later, under anesthetic if necessary. Antibiotics will be part of the treatment, since infection is a major concern with puncture wounds.


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Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a condition in which the immune system malfunctions, attacking the lining of healthy joints. Inflammation results, and eventually the joint lining thickens and produces excessive joint fluid. This extra fluid, together with substances released by the activated immune system, causes damage to the joint's bone structure.

Symptoms: When RA occurs in the feet, it most commonly affects the ball of the foot, but it can also affect the ankle and other areas. Symptoms of RA include:

  • Pain and stiffness in affected joint
  • Swelling and lumps
  • Achilles tendon pain
  • Hammertoes
  • Dislocated toe joints
  • Bunions
  • Flatfoot

Diagnosis: RA is usually diagnosed through a combination of physical examination and blood tests. X-rays and imaging studies may also be ordered.

Treatment: Overall treatment for RA will be handled by the patient's primary care physician, but specific foot and ankle problems resulting from RA can be treated by the following methods:

  • Steroid injections
  • Accomodative shoes
  • Orthotic devices
  • Fluid aspiration (suctioning excess fluid from joint)

Surgery is occasionally needed to correct deformity.


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Sesamoid Injuries to the Foot

Sesamoids are round bones located within the tendons of many joints. The sesamoids in the foot are beneath the big toe joint, in the ball of the foot. These small bones are important to the foot's normal functioning; they assist with weight-bearing and provide leverage when a step "pushes off" from the big toe. Sesamoids are injured during vigorous activities involving pressure on the ball of the foot, and they may also result from high arches and high-heeled shoes.

Symptoms: Symptoms depend on the exact type of injury, and on whether it was caused by abrupt trauma or by chronic overuse and inflammation. Symptoms may include:

  • Pain (sharp or dull)
  • Swelling
  • Limited motion of big toe
  • Popping sensation

Diagnosis: The doctor will take a medical history and assess the functioning of the big toe joint. X-rays and sometimes advanced imaging studies are ordered.

Treatment:

  • Immobilization
  • Taping, strapping or padding
  • Oral anti-inflammatory pain medication
  • Physical therapy
  • Steroid injections
  • Orthotic devices

Surgery may be necessary if the injury is not resolved by non-surgical treatments.


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Tailor's Bunion

Tailor's bunion is an enlargement or overgrowth of bone at the base of the little toe. As this bone becomes more prominent, the little toe turns inward, and the bump becomes irritated from rubbing on the shoe. Tailor's bunion is usually caused by an inherited structural problem, but the condition can be aggravated by wearing narrow-toed shoes.

Symptoms: The symptoms of tailor's bunion are those of inflammation: pain, swelling and redness where shoes rub against the site of the enlarged bone.

Diagnosis: Tailor's bunion is usually obvious because of the enlargement, but X-rays will often be ordered to help determine the extent of the deformity.

Treatment: Non-surgical treatments may be considered first. These include:

  • Oral anti-inflammatory pain medication
  • Ice
  • Padding
  • Shoe modifications
  • Injection therapy
  • Orthotic devices

Surgery is considered if the above treatments are not sufficient to resolve the pain. With surgery, the underlying bone deformity can be reduced or corrected.


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Talar Dome Lesion

A talar dome lesion is a defect or damaged area in the cartilage covering the top of the ankle bone. These lesions sometimes develop long after an injury such as a sprained ankle, and they may involve softened bits of cartilage or bone breaking loose and "floating" in the ankle. Talar dome lesions increase the risk of future arthritis in the joint.

Symptoms: These may arise months or years after an injury:

  • Intermittent ankle swelling
  • Chronic pain deep in the ankle, especially during sports
  • Clicking or "catching" sensation in ankle when walking
  • Feeling of the ankle "giving out" or "locking up"

Diagnosis: Diagnosis of talar dome lesion is challenging. The doctor will talk with the patient and conduct motion testing of the ankle, sometimes using strategically targeted anesthetic to help determine the source of pain. X-rays and other imaging studies are also helpful.

Treatment:

  • Immobilization in cast or boot
  • Oral anti-inflammatory pain medication
  • Physical therapy, including non-weight-bearing range of motion exercises
  • Surgery (sometimes necessary to remove bone and cartilage fragments)


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Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is the compression of a nerve that runs inside a narrow space (the tarsal tunnel) within the ankle. It's similar to carpal tunnel syndrome in the wrist. The nerve becomes squeezed as a result of crowding within the tarsal tunnel. This crowding can result from swollen tendons, varicose veins, swelling from arthritis or sprain, or even cysts and bone spurs. Flat feet can also put strain on the nerve.

Symptoms: Symptoms arise suddenly, and are usually felt on the inside of ankle and bottom of foot. In some cases, however, they extend to the toes, heel, or calf. Characteristic symptoms include:

  • Numbness
  • Shooting pain
  • Burning or tingling
  • Electric shock sensation

Diagnosis: The doctor will manipulate the affected area to evaluate the nerve's sensitivity. Electromyography studies may be ordered if the condition doesn't clear up.

Treatment:

  • Oral anti-inflammatory medications
  • Ice
  • Rest
  • Physical therapy
  • Immobilization
  • Injection therapy
  • Bracing
  • Supportive shoes
  • Orthotic devices

Occasionally, surgery is needed to resolve the problem.


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Toe and Metatarsal Fractures

Nineteen of the foot's 26 bones are metatarsal and toe bones. Fractures of these bones can be caused by acute trauma, such as a blow to the foot, or by repetitive stress. Hairline stress fractures can be caused by being too aggressive with increasing activity level, or by foot deformity and osteoporosis.

Symptoms: The symptoms of fracturing one of these small bones depend on the source of the injury. Acute trauma may cause:

  • A breaking sound
  • Pinpoint pain in foot, which often goes away later
  • Crooked appearance of toe
  • Bruising and swelling on the following day

Stress fractures may cause:

  • Pain with normal activity that goes away while resting
  • Swelling, but no bruising

Diagnosis: The doctor will rely primarily on X-rays to show the location of the fracture, but will also visually examine the foot and assess its functioning.

Treatment: Treatment depends on degree of severity. Some treatments include:

  • Rest
  • Avoiding stressful activities
  • Rigid shoes and immobilization
  • Surgery, if there is severe displacement of the broken bones
  • Physical therapy (after other treatments)


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Toenail Fungus

Nail fungus is a fungal infection in one or more of your nails. An infection with nail fungus may begin as a white or yellow spot under the tip of your fingernail or toenail. As the nail fungus spreads deeper into your nail, it may cause your nail to discolor, thicken and develop crumbling edges — an unsightly and potentially painful problem.

Diagnosis: An infection with nail fungus may be difficult to treat, and it may recur.

Treatment: Medications are available to help clear up nail fungus.


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  • Dr. Bier embodies everything I want in a physician; patience, kindness and expertise. He solved my problem which was long-standing. I am grateful to my friend for recommending him, and I will recommend him to others.
    ~– Lisa B, Darien, CT

  • Dr. Bier corrected a toe problem I had been living with for many years, he was able to correct my problem and for that I am very grateful. He listens to all I have to say and takes the time to answer each of my questions.
    ~– Josie C, Wilton, CT

  • Dr. Bier always makes my feet feel better; he is the best podiatrist I have ever gone to.
    ~– Dorothy W, Stamford, CT

  • Dr. Bier is everything you want in a foot and ankle doctor. He takes great care in his Diabetic patients.
    ~– Fred N, Darien, CT

  • Dr. Bier is a wonderful doctor. He’s caring and concerned. He takes the time needed to properly care for your feet. Through his arduous efforts, he has saved my foot and leg. He is pleasant and through. I would never go elsewhere.
    ~– John B, Greenwich, CT

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