FOOTNOTES DIABETES AND YOUR FEET Diabetes is chronic disease that occurs when your body s ability to process sugars, starches, and other foods into energy is impaired. Some of the long-term effects of the elevated sugar (glucose) are damage to eyes, heart, feet, kidneys, nerves, and blood vessels. Specifically, diabetes can affect the sensation and the circulation in your feet. This can lead to numbness in your feet and decreased ability to heal injuries and wounds on the feet. A diabetic is more likely to get infections, soft tissue and bone injuries, and wounds on the feet that can lead amputation. Here are some steps you can take to try to prevent foot problems associated with diabetes: 1. Wash you feet daily with warm water and dry well, especially between the toes. Check your feet daily for cuts, cracks, swelling, or redness. Report anything unusual to your podiatrist. 2. Protect your feet with well-fitting, round toed shoes. Have your feet measured when you buy shoes for proper fit. Do not go barefoot. 3. Let your Podiatrist treat corns and calluses as well as thickened or ingrown toenails. Some home remedies can cause damage. 4. Check your blood sugar at least once daily and try to keep it within your doctors recommended range.
BUNIONS A bunion is a swelling or enlargement of the large toe joint on the side of the foot. There is a very strong hereditary tendency for development. It usually becomes larger and more painful over time and may eventually get irritated because of shoes. Bunions develop because of a weakness in the bone structure and ligaments causing instability and malalignment of the joints of the foot. This can lead to the development of a bunion which may, over time, become arthritic and painful. Shoes do not cause a bunion but can aggravate the problem. Treatment of a bunion includes early recognition and evaluation. It is important to see your Podiatrist for suggestions on controlling the cause of the bunion so that symptoms do not arise or worsen. The doctor will evaluate the cause, often taking x-rays, and make recommendations on treatment. Treatment can vary from exercises, changes in shoe gear and prescription orthotics to stabilize the condition. If conservative treatment is not successful surgical correction may be considered.
INGROWN TOENAIL An ingrown toenail is a condition where a portion of the toenail presses into the surrounding skin. Ingrown toenails are often caused by an excess curvature of the toenail but may also be caused by cutting the toenails incorrectly, trauma to a toe, or wearing tight fitting shoes. This can lead to swelling, redness, pain, and if left untreated, infections. Treatment of an ingrown toenail may include removing the painful portion of the nail, possibly with local anesthesia. Oral antibiotics may also be used if there is a severe infection. If an ingrown toenail is a recurring problem and trimming the nail only gives temporary relief a permanent procedure may be needed. This correction is performed in the office under a local anesthetic, and consists of removing the offending portion of the toenail and the nail root. Your Podiatrist will advise you on the best treatment options for your problem and will instruct you in the proper way to cut you toenails in the future. If you have difficulty cutting your nails, periodic office visits may be necessary to prevent the development of ingrown toenails.
SOFT CORNS Corns that occur between the toes are often referred to as soft corns. They are usually caused by two bones rubbing against each other and pinching the skin. The skin s normal response to the irritation is to get stronger and thicker. This process continues until there is actually a corn which is a point of pressure and often pain between the toes. Sometimes the corn is on two toes next to each other but it may be on only one of the toes. Wearing tight-fitting, or narrow shoes will exacerbate the problem. There are several ways to treat soft corns. Conservative treatment includes shaving or debriding the corn from the toe as well as proper padding in between the toes to stop the rubbing. Wearing shoes with a wider or rounded toe box is also advised. If this does not give long-lasting relief your Podiatrist may recommend surgical removal of the enlarged bone or spur. Do not use over-the-counter remedies without your doctor s recommendation as they can lead to sores in the skin and infection. If this should occur you should see your Podiatrist immediately for treatment.
FRACTURES OF THE FEET A fracture is a break in the continuity of the bone. These usually occur as a result of an injury to your foot. You can also get a stress fracture which is a more minor crack in the bone which is a result of overuse of the bone or secondary to a bone weakened by osteoporosis. Fractures can occur to any bone in your foot from a toe bone to your heel bone (calcaneus). It is a myth that there is nothing that can be done for a fracture of a toe bone. It is important to get these fractures evaluated to make sure the fractured pieces of bone are in the proper position so that they may heal properly. Your podiatric physician will make recommendations for the treatment of a fractured toe. Fractures to other bones in the foot require x-rays and most often require some form of a cast to immobilize the area. Any injury to you foot should not be treated lightly. You should immediately rest and elevate the foot and put ice on the injured area. X-rays will need to be taken to evaluate for a fracture. Your Podiatrist will advise you on the most appropriate course of treatment for your injury.
PLANTAR WART A plantar wart (verruca plantaris) is a viral infection of the skin caused by the Human Papiloma Virus (HPV), which occurs on the bottom of the foot. Normally it appears as an area of rough and thickened skin with well-defined borders. There may be darkened lines in the wart that are often mistaken for splinters. They are not always painful when touched, but if pinched the pain can be excruciating. The verruca virus is contagious. It enters through an area of damage to the skin. Swimming pools, gyms, and dressing rooms are common sources of infection. Children suffer from this condition more frequently than adults. The plantar wart can resemble other skin conditions such as corns and calluses. It must be carefully differentiated from these conditions so that the appropriate treatment can be started. If you know you have a wart, over-the-counter treatments can be tried, but if the condition does not resolve in a few weeks or if it is becoming larger and more painful an evaluation by your Podiatric physician is essential.
BABY FEET The human foot is one of the most complicated parts of the body. It is comprised of 26 bones and is laced with ligaments, muscles, blood vessels, and nerves. Because the feet of young children are soft and pliable, abnormal pressures can easily cause deformities. A child s feet grow rapidly during the first year, reaching almost half their adult size. This is why foot specialists consider the first year as the most important in the development of the feet. Here are some suggestions to help you assure that this development proceeds normally: --- - Cover the baby s feet loosely. Tight covers restrict movement and can retard normal development. - Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related movements which prepare the feet for weight bearing. - Change the baby s position several times a day. Lying too long in one spot, especially the stomach can put excessive strain of the feet and legs.
HEEL PAIN Heel pain is a very common complaint among people with foot problems. The heel bone bears all the weight of the body with each step. The stress placed on this portion of the foot and its associated tissues is tremendous. If the stresses are abnormal due to either structural or positional deformities they can lead to heel pain. Some of these deformities include flat or high arched feet, a tight Achilles tendon, or abnormal muscle or ligament pull on the bottom of the foot. In addition to poor foot function, heel pain may develop because of an increase in athletic activity and exercise, a recent weight gain of 10 pounds or more, wearing unsupportive shoes, or medical problems such as arthritis or diabetes. Heel spur or heel pain syndrome is the most common cause of heel pain. This is due to an inflammation of the soft tissue attaching to the heel bone. Taking x-rays may not show an actual spur, but will help evaluate the problem and rule out other causes of pain like stress fractures and arthritis. Treatment of heel spur syndrome usually starts with wearing a shoe with proper support and an anti-inflammatory and/or a cortisone injection. Your podiatrist may recommend custom orthotics to control the abnormal stresses in your foot. If conservative treatment does not help your Podiatrist may recommend surgery to relieve the symptoms.
NEUROMA A neruoma is an inflammation and enlargement of a nerve between the bones of your foot. It is caused by a pinching of the nerve between the metatarsals, and is most commonly between the third and fourth toes. As the irritation continues, the nerve gets larger, and may cause numbness, sharp pain, cramping, and burning. The symptoms may occur on the ball of the foot and extend up into the affected toes. Shoes that are too tight will aggravate the condition. Neuromas may also occur between any of the other toes of the foot or any place on the foot where a nerve may get irritated, either by shoes, between bones, or by stress on the soft tissue. Conservative methods of treatment may include injections, anti-inflammatoies, special padding, and change of shoe gear. If these modalities fail to alleviate the symptoms surgical removal of the painful nerve is recommended.
WHAT ARE ORTHOTICS Foot orthoses (orthotics) are devices that sit inside your shoe and are used to help an individual stand, walk, and run in a more normal, well-aligned, efficient and comfortable manner. The use of orthotics is a conservative approach to many foot problems including heel pain, tendonitis, instability, bunions, and even knee and back pain. It is a highly successful and practical form of treatment. Orthotics are fabricated either from a mold of your foot or by computer evaluation of your foot. They take various forms and are constructed of various materials depending on what condition they are being used to treat. All orthotics are concerned with improving foot function and minimizing abnormal stress forces that could ultimately lead to foot deformity and pain. Orthotics fall into 3 main categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine both control and protection. Your podiatrist will evaluate your condition and foot function and will prescribe and fit you for a custom orthotic that is appropriate for you.
ATHLETE S FOOT Athlete s foot or tinea pedis is a skin infection caused by a fungus. It can occur between the toes or on the soles of the feet. It can be associated with blisters, itching, burning, cracking, oozing, excess moisture, scaling, and even a bad odor. Wearing shoes creates an ideal environment for fungus to grow. It is dark, moist, and warm which promotes the growth of fungus. Some people have a predisposition to catching fungal infections. These fungal infections, if left untreated, can spread to skin on other areas of the body, or even to the nails causing an infection called onychomycosis. Prevention starts with good foot hygiene. Daily washing with soap and water and drying well, especially between the toes can help prevent the problem. Changing the socks and shoes several times a day and not wearing the same shoes daily is important if sweaty feet are the factor. Treatment can start with over-the-counter antifungal medications but any skin condition that does not begin to respond within a week should be evaluated by a podiatric physician for a proper diagnosis and treatment.
MELANOMA The feet can be a site for birthmarks. They can come in a variety of shapes, sizes, and colors. Some of these marks can develop later on in life. Pigmented or colored moles are fairly common on the feet and although these have a very small chance of becoming malignant, the risk is increased on the sole, the toes, and beneath the nails. The possibility of malignant melanoma must be considered if a pre-existing mole grows, rapidly, changes color, begins to bleed, or show evidence of surrounding inflammatory reaction. Any suspicious mole should be excised without delay and examined by a Pathologist. Malignant melanoma is classified according to the level of severity. Certain lesions can be removed easily due to their superficial nature while others may metastasize and need more aggressive treatment. Your podiatrist can help you decide if a mole is suspicious and remove it if necessary.
FOOT ODOR Foot odor is often joked about, but to those who suffer with it, it is a very real problem. It is usually due to the breakdown of skin components and possibly bacteria growth in the event of excess sweating of the feet. This may be visible as superficial pits or a worm-eaten appearance around the toes and the weight bearing surface of the feet. A secondary fungal infection may worsen the condition. Measures to reduce sweat production and to control secondary infection will help alleviate the condition. Talc, spray deodorants, and absorbent insoles are remedies which a person may try before seeking the advice of a Podiatrist. Regular washing and the avoidance of occlusive foot wear are extremely important. If over-the-counter remedies do not help, a Podiatrist can prescribe medication and make recommendations about appropriate foot wear to treat the condition.
ONYCHOMYCOSIS Onychomycosis is an infection of a toenail, usually caused by a fungus. It may appear as a discolored, lifted, or thickened toenail. Fungus can begin to develop in a toenail after a minor trauma to the nail. Some people, like diabetics, are more prone to getting a fungal infection of the toenail. Fungal infections of the toenails can be associated with fungal infections of the skin on the foot or Athlete s foot. There are other conditions of the nail which can cause an abnormal appearance. Some of these are nail trauma and psoriasis. There are various treatment options for fungal infections of the toenail, including topical and oral medications, and sometimes surgery. Your Podiatrist can do a test on the toenail to identify the cause of the discoloration or change in appearance of the toenail. Appropriate treatment will then be recommended. Early diagnosis and treatment often makes it easier to get rid of the infection.