Foot & Ankle Services
Services Include
+ Arthritis
Artho, means joint and –itis, means inflammation. There are approximately 38 causes of arthritis and most of these conditions affect the human foot. The most common of these conditions is osteoarthritis, this is the simple wearing and tearing away of the cartilage of the joints. Age, excessive weight, ill-fitting shoes and trauma (injury) are the main causes of osteoarthritis. Fortunately, this condition is very treatable.
+ Bunions
A bunion is a common term for a medical condition known as Hallux Valgus. Hallux Valgus is the tilting of the big toe away from the mid-line of the body. It is usually characterized by a lump or bump that is red, swollen and/or painful on the inside of the foot at the big toe joint. There are many causes of bunions, but the primary one is heredity. Tight, ill-fitting shoes or shoes that constrict the forefoot over a long period of time can exacerbate your foot condition and cause progression of your bunions faster. High heels and constricting shoes are the primary causes of progression of Hallux Valgus. Treatment for bunions occurs conservatively in the form of custom shoes to reduce irritation, accommodative padding to reduce pressure to the bony prominence, arch supports or custom orthotics to control the mechanical faults causing the bunion deformity and arrest the progression or at least slow it. Surgery is the only measure to correct the deformity. Surgical correction involves the repositioning of the bone structure to re-create a more normal function of your foot and return stability to your walking pattern. Surgical repair is an outpatient surgical procedure and in many cases involves only minimal down time.
+ Calluses/Corns
Calluses are thickened skin caused from friction and pressure, they are usually caused by an underlying bony prominence rubbing against the shoe or an adjacent bone. Many calluses are also caused by mechanical problems with your foot structure causing unusual frictional irritation from your shoes during walking. Treatment can be as simple as modifications to your shoes, a prescription orthotic device to control the mechanics of your foot structure or a pad to reduce pressure. In some cases, surgical correction is necessary to completely correct the underlying deformity causing the skin irritation.
+ Cysts
Cysts are fluid filled masses under the skin. Some common cysts of the feet include synovial cysts, ganglia and cutaneous mucoid cysts. Most foot cysts are located under the skin, although occasionally they may be found in tendons or bones. The synovial or ganglionic cysts are connected to a nearby joint or tendon. Mucoid cysts are frequently connected to a joint. If they are located near the nail they may cause the nail to grow improperly. Most cysts are mildly to severely painful because of the pressure created by your shoes. When the cyst presses on a nerve it can cause severe sharp pain which many times lancinates (shoots) into the foot or up into the ankle. Some cysts form as a result of repeated injury to your foot. Ganglion cysts may be treated by numbing the area and extracting the fluid inside. A steroid may then be injected into the cyst to try to prevent it from filling again. Loose fitting comfortable shoes are likely your best preventative conservative measure. If this along with accommodative padding fail to prevent pressure irritation, surgical excision is generally warranted. Recovery from the surgical procedure is fairly short as healing is limited to soft tissues.
+ Diabetic Foot Care
Diabetes can greatly affect the feet. Small cuts or injuries can serious consequences for the diabetic patient. Diabetes affects circulation, specifically the very small blood vessels called capillaries, and can cause many changes in the feet. This reduced blood flow to the feet makes it harder to heal an injury or resist infection. Diabetes also has the potential to cause nerve damage and reduce or eliminate the feeling in your feet. Because of these problems, you may not notice a pebble in your shoe or some other source of irritation that could cause an open cut or blister. This open wound could lead to an infection which, left untreated, could result in amputations. Early detection and treatment of foot problems in diabetic patients is the key to prevention of infections and resulting surgeries. Your podiatric physician is part of a team approach to your diabetic care. A simple daily inspection program to observe your feet is critical to this early warning approach. Clean your feet daily, dry them well and examine them for simple cuts, corns, calluses, cracks in the skin, bruises, discoloration of any kind, open wounds and swelling. If improvement is not noted within a few days you should contact our office for an immediate appointment. Rapid and aggressive treatment for wounds and ulcers is the key to preventing amputation or reducing the severity of an amputation.
+ Flat Feet
The condition of flat feet is not necessarily a problem. Flat feet, however, do not allow for shock absorption while walking which can contribute to earlier arthritis in the feet as well as the ankles, knees and hips. Treatment of flat feet, especially flexible flat feet, can improve the fatigue, onset of arthritis and general foot pain associated with this condition. Treatment most frequently consists of more supportive footwear along with arch supports or prescription orthotics. These are simple devices that complement stabilizing shoes to better control your foot mechanics and prevent excessive flattening of the foot. They can also easily be moved from shoe to shoe. In some instances a surgical procedure can be performed to prevent the excessive collapse of the flexible flat foot.
+ Foot and Ankle Surgery
Foot and ankle surgery focuses on the return to full function and normal activities rather than only pain reduction. We employ the latest techniques and reconstructive foot surgery to allow you to return to full activity as soon as possible. In almost all instances, surgery is performed in an outpatient setting. Ambulation with weight-bearing is frequently possible immediately following foot surgery.
+ Fractures
A fracture is a break in a bone. Fractures are divided into traumatic fractures (those fractures that occur as a result of an injury) and stress fractures (those fractures that occur as a result of repeated micro-trauma such as sports and exercise). Fractures take several weeks to heal properly and, in some cases, can fail to heal (developing a “non-union”). Treatment for fractures may be as simple as a below the knee walker or even a simple fracture shoe to stabilize the bone structure and allow for healing. In some instances, non-weightbearing with crutches may be necessary to prevent excessive pressure and potential displacement of the fracture fragments leading to a nonunion. If the fracture is severe or if the bone fragments are displaced far enough apart to prevent healing, surgical correction with internal fixation using pins, screws and/or surgical plates may be necessary to allow for proper stabilization and healing of the fracture. This can also most frequently be accomplished in an outpatient setting.
+ Ingrown Nails
An ingrown toenail is a condition in which the nail is cutting into the surrounding flesh. This condition is usually very painful and can be associated with infection of the toe. A nail is ingrown when one or both corners or sides of the nail grow into the skin of the toe. Irritation, redness, uncomfortable sensations of warmth as well as swelling, pain and infection can result from an ingrown toenail. A simple office procedure can be performed to permanently resolve the ingrown nail and prevent reoccurrences.
+ Geriatric Foot Care
Many older patients suffer from various symptoms including arthritis, poor circulation and simple difficulties of caring for their feet and nails due to vision problems or physical problems of reaching for their feet. Providing basic care for nails and calluses, as well as arch support therapy or prescription orthotics for arthritis in many cases keep patients mobile, healthier and allows for participation in lifes daily activities in an enjoyable way.
+ Hammertoes
Hammertoes are a result of an imbalance of the muscle structures of the toes. When the toes become crooked, bent, or buckle it causes the joints to protrude. A hammertoe is a contracture of the toe and gives the appearance of a “hammer head” and frequently can cause callus formation over the top portion of the toe due to irritation of the contracted toe from the top of the shoe. It also can cause a callus on the end of the toe. Bone spurs can occur on the sides of the toes causing pain and callus formation resulting in soft corn formation between the toes with associated pain. Treatment conservatively occurs in the form of periodic trimming of the callus production and accommodative padding along with extra-depth shoes to provide reduced irritation. If this is insufficient, then surgical correction is advised. Surgical therapy for hammertoes is a relatively straightforward procedure and return to activity is fairly quick.
+ Heel Pain
Heel pain is generally the result of faulty biomechanics (gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, a bruise incurred while performing physical activity, wearing poorly constructed footwear, or being overweight. The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel. Possible treatments include anti-inflammatories, arch supports, stretching, physical therapy, prescription orthotics, night splints and good immobilizers. These can all be used to resolve the pain. Surgery in limited cases is necessary, but most often the heel pain responds to good conservative therapy.
+ Injection Therapy
Injection therapy can be considered to treat many pathologies of the foot such as tendinitis, joint pain and swelling. Injection therapy is most often accomplished with a steroidal anti-inflammatory designed to attack the cause of your pain, which is inflammation in and/or around the affected tendon, ligament, muscle or joint. Injection therapy can also be used to complement other modalities of treatment such as physical therapy.
+ Injuries
Our clinic treats all forms of injuries from simple sprains and strains to the more complex injuries including fractures. Lacerations, puncture wounds, removal of foreign bodies such as glass and splinters are also frequently seen and treated at Family Foot Clinic.
+ Metatarsalgia
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints of the area. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads, or can be more isolated affecting just the first metatarsal head (near the big toe) which is frequently referred to as sesamoiditis. Sesamoiditis is inflammation of two small bones located underneath the big toe joint similar to the kneecap in the knee. Excessive pressure to the big toe joint frequently inflames these two small bones. Treatment for metatarsalgia or sesamoiditis frequently is anti-inflammatory in nature and is also treated with various pads, arch supports and prescription orthotics in addition to appropriate footwear. These treatments are designed to be preventative by reducing the stress that causes the pain syndrome. Many times isolated calluses will form at the site of a specific metatarsal that is out of alignment or has become less flexible due to arthritis at the joint just behind it where it attaches to the foot and therefore increases pressure in the ball of the foot due to this inflexibility. Occasionally surgical correction will be necessary to realign the metatarsal to reduce this isolated stress.
+ Nail Care
Simple primary podiatric care in the form of nail debridement (trimming) is necessary in patients who have vision problems or significant arthritis in their hands and are unable to properly care for their nails on their feet themselves. Many patients are unable to reach their feet and properly care for their nails and also require podiatric assistance to prevent complications from lack of care. While this may seen to be a simple condition to self treat, many patients have extreme difficulty and with lack of treatment can get infections and severe pain along with skin lacerations from something as simple as a long, thickened or an ingrown nail.
+ Neuromas
Neuromas are enlarged benign growths of peripheral nerves. They are most common between the third and fourth toes but can also be seen between other toes at the level of the metatarsal and toe joints. They are most frequently caused by injury, pressure from adjacent metatarsals or tissues such as ligaments rubbing against and irritating these nerves. Conservative treatment is centered around reducing the inflammation of the nerve through physical therapy, anti-inflammatory therapy both orally and by injectable routes and potential mechanical control using orthotic devices (sophisticated arch supports). Sclerosing therapy using an injection of a local anesthetic and a sclerosing material stops the nerves conduction and in doing so eliminates the pain without the need for surgery in many cases. This is a cost effective and non-surgical treatment for neuromas. If conservative management fails, surgical excision is the ultimate alternative and will generally resolve the pain leaving only a small area of numbness at the site of the neuroma. These nerves are sensory nerves only and do not affect the mechanics or function of the foot which means the nerve removal is pain relieving while not affecting gait or function.
+ Orthotic Therapy
Biomechanical examination of the foot and leg is an important step in determining the underlying cause of painful, foot, leg, hip and lower back pain syndromes. This examination involves both weight bearing and non-weight bearing measurements of joint alignment in the lower limb, and gait analysis. Prescription orthotics are used for a number of conditions such as: plantar fasciitis (heel pain), achilles tendinitits, ankle or foot pain, low/high arched feet, diabetic foot complications, tired or aching legs or feet, and neuroma’s. In some cases an off the shelf device (OSD) is all that is required. In other instances, custom molded orthotics are required to control/resolve the symptoms. Orthotics can be specially made to fit all types of shoes from sneakers, casual lace shoes or ski boots to narrow dress shoes. If a custom device is required, and an examination is performed to determine the foots range of motion and mechanical position and a casting is performed to capture this position. A prescription is written and sent with the castings to the lab for fabrication of a device recommended by our physician to properly control your foot’s function. The materials used to make the orthotics are dependent upon your foot condition and your desired lifestyle. When the orthotics return from the laboratory they will be dispensed after properly checking them for fit and proper fabrication. Orthotic therapy rarely fails when prescribed for appropriate conditions in which they will improve function. They are not however the panacea for all foot problems. In some instances, surgical correction will be ultimately necessary to solve related foot conditions.
+ Plantar Faciitis
Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, a bruise incurred while walking, running, or jumping on hard surfaces, wearing poorly constructed footwear, or being overweight. The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel. Possible treatments include anti-inflammatories, arch supports, stretching, physical therapy, prescription orthotics and night splints. These can all be used to resolve the pain. Surgery in limited cases is necessary, but most often the heel pain responds to good conservative therapy.
+ Sprains
A sprain is an stretch or tear of a ligament. A ligament is a strong stretch-resistant band of tissue running between two bones to help stabilize the joint and, in the case of the foot, helps to support the arch by maintaining the numerous bones in a stable position. Frequently, sprains are associated with industrial or sports injuries but can occur from stress in the home due to lack of proper footwear usage. Treatment is usually involves ice, compression, and support with an Ace bandage or elastic wrap, elevation and rest. In more severe cases, cast immobilization and even non-weightbearing with crutch gait may be necessary to allow for adequate ligament stability during the healing process. Appropriate treatment can increase post-injury ligament stability and reduce risk of injury in the future.
+ Spurs
Spurs are bony enlargements and are not “calcium deposits”. While bone is part calcium the bone spurs usually caused by ligament attachment irritation/strain or trauma are actually bone overgrowth as a result of this constant irritation. Just because bone spurs are present does not mean that they need to be removed in many cases. However, painful spurs can restrict motion at joints increasing the degeneration of the associated joint cartilage resulting in severe arthritis. Surgical removal of the spurs has the potential to prolong joint life and decrease pain. If you have bone spurs, simple x-rays will detect the severity of the condition. Consultation with our podiatric physician can determine the best course of treatment for your spurs given their current severity and your symptoms.
+ Tendinitis
Tendinitis is inflammation of a tendon which connects muscle to bone. Tendinitis can result from a sprain or strain as well as mechanical and structural faults within your foot and ankle. Treatment is usually conservative using rest, physical therapy techniques and supportive therapy such as cast immobilization or splints and elastic bandages. More severe tendinitis conditions can even impact the long-term functionality of your foot. Early intervention with orthotic therapy or arch supports may prevent the rupture of the tendon and these severe arthritic changes with early treatment. Achilles tendinitis can also be quite severe requiring surgical debridement if not treated early and aggressively.
+ Warts
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions but also can occur without any history of skin irritation. They can appear anywhere on the skin, but technically only those on the sole of the foot are properly called plantar warts as they are on the plantar surface or bottom of the foot. Children and teenagers tend to be the most susceptible to warts but they can also occur in adults. Wart treatment includes topical acid applications, removal by dissection (curettage), hyfrecation or laser removal. Treatment is most often non-disabling and allows for activity to continue through the process.
+ Wound Care/Ulcers
Ulcers are most common in patients with diabetes but can also occur in patients with poor blood flow. Early intervention or treatment can prevent more serious complications such as infections and amputation.
Nail Restoration
- Nail fungus
- Nail shape changes due to injury
- Spoon shaped nails
- Brittle and splitting nails
- Horizontal ridges
- Discolored nails