Foot Pain :: Mountain Podiatry

Skin and Nail Care

Fungus Infections

The fungal problems seen most often are athlete’s foot and fungus nails. A fungus is common mold that thrives in the three D’s: dark, damp and dirty. On the feet, it can grow on and between the toes, as well as soles and toenails. Chronic fungal infections are most common in adults, while acute fungal infections are seen more in children.

The risk is low, but athlete’s foot is a contagious infection. This fungus can make your feet itch, burn, and the skin on the bottom of your feet crack, blister, or peel. Athletes aren’t the only one who can get this as anyone who has feet that perspire heavily or if your work shoe creates a most environment, may get a fungal infection. Most environments are perfect place for fungi to thrive. You don’t hear of athlete’s hands!

Fungal toenail infections usually start underneath the tip of your toenail, and then spread back toward the cuticle and to other nails. Your nail may thicken and become so brittle that trimming crumbles the nail. It can become brown, green, and black and may even fall off. As the fungal nail thickens, it may become painful as it hits your shoe. The nail may become ingrown. As the fungus grows, foul smelling, moist debris can be seen.

Treatment is best begun at early stages of infection. Both skin and nail infections can be treated with oral and topical medications. Dependent on the extent and state of your infection, the safest, most effective treatment will be started. Fungal infections don’t happen overnight and consequently aren’t cured overnight. Effective nail treatment requires the good healthy nail to “push” the infected fungal nail as it grows out, which may take 6 to 12 months. Medications may or may not completely eliminate the fungus, but early treatment is imperative for good results.

Ingrown or Sore Toenails

Ingrown toenails most often effect the big toe. The symptoms occur because the skin around the nail is forced so close against the nail that the nail appears to be “growing” into the skin. Soft skin tissues react to the nail as if it’s a foreign body. Inflammation, pain and infection often result. It is important to seek prompt care especially if you are in a high-risk health group (have diabetes or poor circulation) or if it becomes infected. Ingrown toenails rarely respond long term to “bathroom surgery.”

Treatment for a painful ingrown nail consists of removing the ingrown portion of the nail for fast relief of pain and infection. For bad or recurrent problems, we can chemically treat the root of the ingrown nail so that the painful part of the nail should not grow back. This is done in the office, with local anesthesia and you can normally return to your normal activities with very little, if any, discomfort. You will need to bandage the area for several weeks to facilitate healing but your normal activities are encouraged. This procedure usually produces nice long-term relief for a very aggravating and recurring problem.

Plantar Warts

A wart is an infection caused by a virus most commonly seen in children, teenagers and young adults. The virus invades the skin through small cuts or breaks. Because they are commonly on the bottom, or plantar portion of your foot, the wart can grow deep into your foot, making walking painful.

The virus can be picked up anywhere and just like colds (which are also caused by viruses) warts can be “caught” by contact with other people who have warts. This is especially true in public places like showers, gyms and locker rooms where you go barefoot

Warts may appear hard or spongy with tiny red, brown or black spots. They can grow up to an inch or more across, occurring alone (solitary) or with smaller warts clustered together (mosaic). They can persist for years and recur in the same spot even after successful treatment. It is imperative that a correct diagnosis be made as a wart could actually be something more serious. If left untreated, warts may spread to other parts of the body, especially the hands.

Treatment for warts is varied dependent on the size, number, location and duration of time the warts have been present.

Mountain Podiatry has been using the new CryoProbe treatment for resistant, painful warts. This method allows precise destruction of the wart with minimal blistering and pain following treatment. Regular activities, including sports, are resumed the same day as treatment and the patient is seen every two weeks to continue painless eradication of the wart as needed. Length of treatment time is dependent on the depth of the wart, but pain usually decreases after the first treatment. The CryoProbe is the latest advancement in painless cauterization of warts, eliminating surgical anesthesia and disability. It is imperative that the whole wart virus be eradicated to decrease the chance of recurrence and the CryoProbe has become a wonderful tool in treating this stubborn virus. Call today for a consultation with us to see if this modality can help you relieve a painful problem.

Mountain Podiarty also uses The Swift Treatment for stubborn plantar warts. Swift is a new technology, using microwave energy delivered through a special probe that is applied to the skin to treat the affected tissue. Swift does not break the surface of the skin and eliminates the need for bandages or dressings – leaving you to carry on your day as normal. The number of treatments depend upon how your body responds to the treatment. The vast majority of warts resolve within 3 treatments which are spaced 4 weeks apart. Call today and let Mountain Podiarty help you resolve your stubborn wart issues.

General Foot Pain

Ankle Sprains and Injuries

Ankle twists or sprains are a very common foot/ankle injury that is often ignored, tolerated and/or mistreated. Most common is the inversion sprain, when the foot goes down and in toward your other foot. Many of the sprains are mild and only result in stretching of the ankle ligaments. Rest, Ice, Elevation and Compression, known as RICE and recovery should be less than a week. If, however, your ankle sprain is more severe with swelling, bruising or inability to bear weight, your evaluation and treatment must be more in-depth. An Xray of the foot and/or ankle may be needed to rule out fracture. MRI examination is beneficial to evaluate the integrity of the ankle joint and its ligaments and tendons.

Arch Pain

Arch pain is the term used to describe symptoms that occur under the arch of the foot. When a patient has arch pain they usually have inflammation of the tissues within the midfoot. The arch of the foot is formed by a tight band of tissue that connects the heel bone to the toes. This band of tissue is important in proper foot mechanics and transfer of weight from the heel to the toes. When the tissue of the arch of the foot becomes irritated and inflamed, even simple movements can be quite painful.

The most common cause of arch pain is plantar fasciitis. Plantar fasciitis is the name that describes inflammation of the fibrous band of tissue that connects the heel to the toes. Symptoms of plantar fasciitis include pain early in the morning and pain with long walks or prolonged standing.

Arch pain early in the morning is due to the plantar fascia becoming contracted and tight as you sleep through the night. When awakening and walking in the morning, the fascia is still tight and prone to irritation when stretched. When walking or standing for long periods, the plantar fascia becomes inflamed and painful. Treatment of plantar fasciitis is best accomplished with some simple stretching exercises, anti-inflammatory medications, and inserts for your shoes.

Arthritis and Joint Pain

Joint stiffness, pain or tenderness, swelling and/or redness that persists for more than two weeks—all may signal arthritis. There are many forms of arthritis that damage our bodies, gradually wearing away protective cartilage where the bones meet to make a joint. The force our body weight generates makes the joints of the foot and ankle particularly susceptible to arthritis. Your feet will carry you the equivalent of five times around the world during your lifetime!

As cartilage erodes and bone rubs against bone, the joint can become painful. Movement may become limited as bone ends erode or thicken, sometimes developing painful outgrowths, or spurs. This is very common in the great toe joint, where motion upon walking becomes limited and eventually painful. If left untreated, damage to cartilage can seriously weaken the joint, often leading to altered gait and limited activities due to pain.

Rheumatoid arthritis and osteoarthritis are two common forms of arthritis that affect millions of Americans, especially those over age 45. Rheumatoid arthritis is a “systemic” disease that can affect the entire body. Osteoarthritis, sometimes called degenerative arthritis, or referred to as joint “wear and tear,” is isolated to the joints. Pain and stiffness caused by cartilage destruction develop slowly as a result of years of everyday living and pounding.

Arthritis of the feet is very common since 25% of the bones of your body are in your feet. Add to that the many miles that you travel daily and have traveled over your lifetime, and you can see that feet can easily show the results of the abuse. Many times the symptoms of foot arthritis can be controlled by medications, orthotics and physical therapy. In early stages, orthotics are beneficial in treating “turf toe.”

In more resistant cases, reconstructive surgery is needed to give improvement in joint motion and the benefit of reduced pain. The goals of surgery are different for each individual and will need to be discussed with us. While surgical care will not cure arthritis or completely restore the joint to its natural health, it will ease pain and make daily activities more manageable. Early recognition is key!

Ball of Foot Pain

Ball of foot pain or Metatarsalgia is pain that occurs in the ball (or metatarsal region) of the foot. The pain can range from mild to severe and often gets worse when you stand or move. It is sometimes described as a burning or aching sensation and you may have shooting pains, tingling or numbness in your toes. Some people also experience a ‘walking on pebbles’ sensation. Metatarsalgia is a common foot problem with a number of different causes, such as badly fitting footwear, being overweight and certain medical conditions (for example, arthritis). Older people are more susceptible.

Metatarsalgia often occurs in the area where the second, third and fourth toes meet the ball of the foot (the metatarsal heads). Large calluses can sometimes form. It can affect just one or two toes or the whole foot (or both feet).

You can try a number of simple measures to ease the pain of metatarsalgia, like using shock-absorbing insoles and taking non-steroidal anti-inflammatory painkillers such as ibuprofen. If you have more severe inflammation (swelling) and pain, consult your GP or podiatrist, who may recommend steroid injections into your foot joints. When nothing else works, you may need an operation on the foot, although this is rare.

Bunions

A bunion, from the latin “bunio” meaning enlargement, is a protuberance of bone or tissue around a joint. This enlargement occurs either at the base of the great toe or on the outside of the foot, at the base of the little toe where it is called a “bunionette” or “tailor’s bunion.” Bunions at the base of the great toe usually begin when the big toe starts moving toward the smaller toes and this crowding puts pressure on the joint, pushing it outward. Both men and women can develop bunions, although it appears that bunions are more commonly seen in women. Bunions develop from a weakness in the bone structure of your foot. Because of the instability of the bones and ligaments which form the various joints and arches in your foot, the joints have a tendency to move out of proper alignment. The deformity runs in families and people with flat feet or low arches are more prone to develop this problem.

Bunions also maybe associated with various forms of arthritis. Bunions are a progressive deformity, getting worse with time. As bunions become more severe, the joint moves further out of proper alignment and eventually arthritis will damage the joint space. As bunion deformities progress, they can become quite symptomatic and bothersome. The skin and deeper tissues around the bunion also may become swollen or inflamed from increased pressure of footwear. The other toes can be affected by a bunion, as a result of pressure from the great toe pushing against the lesser toes. Shoes which used to fit gradually become too tight and walking and everyday activities can become uncomfortable. Inactivity becomes the exercise of choice! Treatment initially is to relieve pressure on the bunion and smaller toes with larger shoes and restriction of painful activities. Given the progressive nature of the bunion, surgical correction of the bunion may be required. Due to the structural nature of the problem, the metatarsal bone needs to be cut and realigned. In addition, the surrounding tendons and ligaments may need to be repositioned to help realign the joint in a straight position.

This procedure is performed in an out-patient hospital setting with anesthesia so that you won’t feel, see or hear anything. You can generally go home within a couple hours of completing the surgery. Pain and deformity are significantly reduced in the great majority of patients who undergo bunion surgery. In addition to easing pain, the purpose of bunion surgery is to remove the enlargement and realign the join to restore normal function. This means that after surgery, the foot can carry the body’s weight properly, and that special shoes are no longer needed. As with most conditions, early diagnosis and treatment is essential before structural joint damage occurs. So that that you can return to your activities without lasting complications, make an appointment today and see what is causing your discomfort and what can be done so that your everyday pain may be reduced.

Hammertoes and Corns

A hammertoe deformity usually refers to an abnormal toe position where one or more small toes buckle or bend-under, out of their normal straight position. Many disorders can affect the joints of the toes, causing pain and preventing the foot from function as it should. People of all ages can have toe problems, from infants born with deformities, to older adults with acquired deformities. Over time, these deformities develop from being a flexible tendon deformity to one that affects the bone and therefore is rigid and non-bending.

Hammertoes are most commonly found on the second (next to the big toe) and fifth (or small) toes. Because of this abnormal toe position, the joint of the toe becomes prominent on top of the buckled toe. The tendons and ligaments then begin to contract and accelerate the problem. Skin irritation (inflamed skin areas) or even corns – (an accumulation of hard dead skin cells) may form on top of these prominent, contracted joints where shoes are likely to rub. This usually will lead to pain and inability to wear some types of shoes comfortably, especially if the pressure or corn is on the small toe. In reality, the corn is nature’s protection or “band aid” between the shoe and bone. This pressure can lead to inflammation or bursitis and the inability to wear a lot of your shoes. A bone spur, which is an overgrowth of bone, can occur within the toe joint if outside pressure continues to irritate the bone.

Any toe problem that causes pain or discomfort while walking should be evaluated. Ignoring the symptoms can aggravate the condition, and over time may lead to an infection, a breakdown of tissue or ulceration. For people with poor circulation or an underlying medical problem, prompt attention is a must to prevent even further issues.

Treatment of hammertoe pain is directly dependent on the extent of development of the deformity and level of pain. Early recognition and modification of shoe gear can give good relief. However, if structural changes have occurred in the toe and the deformity is painful, surgical correction may be recommended to relieve pain, correct the problem and provide a stable, functional toe. The type of surgery performed will depend on a thorough evaluation of the toe, the factors causing the deformity and which treatment is likely to be the most successful. The surgical correction can be performed on an outpatient basis at a local hospital.

If there are pressure calluses or corns that are causing pain in your everyday activities, it is imperative that early diagnosis be obtained and your options discussed.

Metastarsal Stress Fractures

A stress fracture is a “crack” that develops in a bone as a result of excessive or abnormal stress. Bone is a living tissue. It responds to stress by becoming stronger in a process called “remodelling”. If a large amount of stress is placed on a bone suddenly the bone will break. If small amounts of repetitive stress are placed on a bone and this repetitive stress exceeds the bone’s ability to respond, a stress fracture can result.

A metatarsal stress fracture is a stress fracture that develops in one of the metatarsal bones, the longest bones in the foot. Metatarsal stress fractures are also called “march fractures” because they were common in soldiers who did a lot of marching. The second metatarsal bone is the one that is most often affected, followed by the third then the fourth. If left untreated a metatarsal stress fracture can eventually turn into a complete fracture (broken bone).

The pain from a metatarsal stress fracture is usually felt on the top of the foot, over the affected metatarsal bone. The pain can be dull or sharp, constant or intermittent. Pain may persist at rest and may even be severe enough to prevent sleep. There may be tenderness and swelling over the stress fracture. Activities like walking or running can make the pain from a metatarsal stress fracture worse. Hopping or jumping can be particularly painful. If a metatarsal stress fracture progresses to a complete fracture there may be crepitus (a crunching noise) over the fracture site. At this point pain usually prevents weight bearing.

Neuroma

A burning, numbness or tingling sensation that radiates from the ball of the foot into the base of the toes is most likely caused by an inflamed benign nerve tumor or neuroma. The nerve of the toes passes between the metatarsal bones (long bones behind the toes) but because of trauma, tight-fitting shoes or other compression, the nerve gets squeezed between the surrounding bones. Over time it subsequently gets enlarged and often quite painful with symptoms radiating toward the tip of the toes or up to the ankle. Most neuromas occur between he third and fourth toes but can occur between any toes. Pain is usually less severe when the foot is not bearing weight.

Evaluation and correct diagnosis is important so that specific treatment can be started early. X-rays are important to rule out any bony pathology. Eliminating mechanical compression with changing of shoe gear, prescription of anti-inflammatory medication, cortisone injections, and CMOs are first line treatment options to attempt to reduce the swelling of the nerve. If this fails, then a series of sclerosing injections may be used to try and non-surgically destroy the nerve and relieve symptoms.

Heel Pain

The heel bone bears all of the body’s weight with each step and sharp pain, stiffness or aching on the bottom of your foot or in your heel is a very common ailment. The pain is often at its worst upon awakening in the morning or after resting, causing limping for a few minutes before your foot “loosens up.” As you continue your daily activities, the pain may return and not go away with activity.

Heel pain originates deep within the foot, directly on the heel bone or within the foot’s connective tissues, called the “plantar fascia.” This fibrous band extends from the heel bone, supports the arch and reaches across to the toes. Pain can result when these tissues become irritated or inflamed, eventually causing bony spurs to develop on the heel bone.Most cases of heel pain are characterized by inflammation. First, the fascia begins to pull on the bone and the tissues become irritated, then inflamed. This inflammation is called plantar fasciitis.

A projection or growth of bone may form on the heel bone when the fascia pulls over an extended period of time. Heel spurs themselves are not painful. It is the inflammation of the plantar fascia that cause the pain and thus treatment is aimed at reducing stress on the foot and decreasing inflammation. Injury, overuse or mechanical causes can bring on discomfort in the heel. A correct evaluation and diagnosis is imperative for successful treatment as most heel pain can be relieved without surgery.

Diabetic Foot Care

Non-healing wounds have many causes but it is imperative that they heal quickly and completely. Before treatment of an ulcer, the patient’s circulation must be evaluated. If there is little or no blood flow to the wound, no treatment however novel or effective, will work. Circulation must be first be established in order to have other medical treatments be effective, such as antibiotics and other wound dressings. The infection must be treated with appropriate antibiotics, either oral or intravenously, so that healing can begin.

Once circulation is found to be adequate, topical or oral antibiotics can be used to their full effectiveness. New topical wound treatments will also be effective at this time. As a podiatrist and wound care specialist, we will select appropriate wound care treatment according to the wound’s appearance, tissue quality and stage of healing. Some of the newer wound preparations can even speed wound healing.

For diabetics, proper sugar control can do a lot to prevent problems and speed healing of ulcers. For leg ulcers, addressing venous insufficiency and varicose veins with support hose can help prevent the ulcers from occurring. So just because you have a wound on your foot or leg, don’t overlook the systemic disease that may have caused or influenced the wound, as you will only set your self up for reoccurrence or further complications. Early diagnosis and treatment is essential.

Custom Made Orthotics

Many foot problems and subsequent pain are due to the misalignment of the bones in your foot. Your foot has 28 bones, 20 muscles, 33 complex joints and over 100 ligaments that work to support your body weight as you walk. Unfortunately, with time our feet begin to lose their stability and pain often results. If it is determined that pain is caused by abnormal foot function, then prescription functional orthotics are a good way of attempting to restore normal function to your foot.

Orthotics control the position of your foot, addressing many deformities that can occur. Weight bearing stress is distributed throughout your foot instead of concentrating in certain areas and the strain on soft tissue and joints is markedly decreased, therefore reducing your pain. Orthotics compensate for incorrect foot movement just like eyeglasses improve vision.

Prescription orthotics are custom made from an impression of your feet. They are usually made of a polypropylene or graphite material that flexes as your walk but still holds your foot in a corrected position. This medical device maximizes the success of your treatment, versus over-the-counter or store-front arch supports. Many insurance companies reimburse for doctor-prescribed orthotics for certain medical conditions, as prescription orthotics have been shown to be quite effective for pain relief. Orthotics are commonly used for heel pain, (fasciitis and spurs), tendonitis, bursitis and painful joint problems.

Skin and Nail Care

General Foot Pain

Heel Pain

Diabetic Foot Care

Custom Made Orthotics

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