Heel Pain
One of the most common complaints I hear
in private practice concerns heel pain. What we in the medical
field call "heel spur syndrome" usually involves
a painful heel. Sometimes pain extends into the arch and
the back of the heel in the achilles tendon insertion. Achilles
tendon pain is at times accompanied with heel pain.
Some patients describe their heel pain as
severe in the morning and improving with activity. Others
feel that pain increases with activity. Although the symptoms
vary, the source of the problem is the same: imbalance due
to the pulling of a group of fibers (known as the plantar
fascia) which inserts in the heel bone at the area where
the heel spur is noted.
Oddly enough a person can have "heel
spur syndrome" without actually having a heel spur
on x-ray. The explanation of this finding is complicated.
One of the most beneficial and yet non-invasive types of
treatment is the orthotic device that corrects the imbalance.
This prescription device is an impression of the foot in
its corrected position. The orthotic takes the strain off
the heel spur region. This conservative treatment to decrease
heel pain has a success rate of about 98% in my practice.
However, should conservative treatment fail, I feel the
best surgical procedure is the Instep Plantar Fasciotomy
which has proven to be extremely successful. I have seen
patients years after this procedure and have been happy
to report they still remain pain free. One of the benefits
of this procedure is that patients can be in regular shoes
soon after surgery and can walk immediately after the procedure.
Click
here for Heel Spur Info/Surgery Pamphlet
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Joint Stiffness/Great Toe Implant
It's not abnormal for one or more joints
of the foot to have little or not motion. Sometimes this
occurs due to arthritic conditions such as osteoarthritis,
gout or rheumatiod arthritis. Another reason for joint stiffness
is traumatic arthritis as when a heavy object falls on your
great toe or when your toe is jammed. However, any accident
involving the great toe can cause pain and problems with
toe motion. Since we need motion in the great toe to walk
normally, pain and destruction of the joint can occur when
it can no longer bend adequately.
Implants created for the toes are now used
to allow motion and decrease pain. This is approximately
a one hour out-patient procedure. Patients can usually start
walking right after surgery (this is usually covered by
insurance companies). In some cases an orthotic
(either prescription
or non-prescription) device can provide comfort by shifting
the weight and balance of the foot. The Arthritis Foundation
is quite a propent for orthotic devices.
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Corn Between Toes
A corn between the toes is one of the most
painful kinds of problems I see in my office. Patients can
have corns between any toes in the foot, but the most common
corn is seen between the 4th and 5th toes. X-rays, taken
of the corn areas, usually represent bone spurs. Should
a patient desire any type of permanent relief, it is my
opinion that the best treatment is surgical removal of the
bone spurs by a bone-shaving technique. This technique usually
results in the complete disappearance of the corn. A small
incision is made on the top or bottom of the toe and a fine
instrument is inserted so that the bone prominence is meticulously
reduced. Patients can usually return to normal shoes in
3 days or less and have suture removal in 7 days. In my
opinion, this procedure is a breakthrough in podiatric surgery.
It has been my experience that this procedure is consistently
covered by both private insurance and Medicare as is most
surgical procedures.
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Ball of foot pain - Maybe you have a
neuroma
Patients who have a neuroma usually describe
pain between the 2nd & 3rd toes, or 3rd & 4th toes.
Pain usually starts at the base of the toes or in the web
space and continues out toward the end of the toes. Most
of the time pain is most pronounced during walking or activity,
and is described as a sensation which alternates between
aching, burning and numbness. Some patients feel the need
to remove their shoes and rub the involved area for relief.
A neuroma is a tumor which is usually benign
and is most often found between the 3rd & 4th toes often
called a Mortons Neuroma. However, a neuroma can occur in
any interspace. Treatment is usually in the form of one
or a series of cortisone injections, orthotic
devices or surgery. Cortisone injections usually produce
temporary relief. However, orthotics can actually balance
the foot and accommodate the neuroma so that the sympotms
disappear because of a special padding technique.
Should conservative treatment fail, a surgical
procedure to remove the neuroma can be performed in an outpatient
setting. This procedure does not require general anesthesia
and the patient can walk the same day. Foot surgery of this
type is usually covered by insurance companies.
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Ingrown Nail Pain
If someone asked me, "what is the most
common procedure you perform?" it would be, without
a doubt, ingrown toenail procedure. Problems with ingrown
nail borders can affect anyone of any age. I have treated
patients from 2 months old to patients over 90 years old
all plagued by this same problem. It is still unclear what
precipitates the ingrown nail. As with many medical problems,
when there is no definite cause, there are instead many
possibilities. Some of them are cutting the corners of the
nail too aggressively, narrow shoes, heredity, fungal nails
(yellow, thick brittle nails, causing the nail plate to
grow abnormally curved) and sometimes ingrown toenails appear
for no apparent reason. The good news is there's a procedure
that insures the nail border will be permanently removed,
although a small number of patients (about 2%) report re growth.
Through a special injecting technique, the toe is made numb
with little or no pain, after which the border is removed.
The matrix or root cells which lie behind the cut out nail
are chemically treated so no new nail will grow. The procedure
involves no sutures. In most cases, as the toe heals, the
skin moves closer to the nail and no detectable void is
noted. It's nice to know that not only can the ingrown nail
border be removed, but it can, in most cases, be done painlessly
and permanently.
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Permanent Removal of Fungal or Deformed
Nails
So many people are bothered by painful nails
either because they are ingrown or because they are so thick
that the nail rubs against shoes. This is especially true
with the great toenails.
In many cases the best treatment has been
permanent removal of the whole nail. Historically, the most
common method has been removal of the nail followed by the
application of a chemical used to kill root cells.
Another favorable treatment modality is non-permanent
removal of the great toenail followed by application of
anti-fungal solution called Restore or Penlac, or oral ingestion
of a medicine called Lamisil. As the new nail re grows the
penetration of Restore or Penlac usually results in a transformation
from the previously fungal nail to a new and more normal
nail plate. In my opinion, Restore or Penlac have proven
to be the most potent antifungal solutions I have ever prescribed.
If you have a fungal nail and you either
wish to remove it permanently or non-permanately, it's nice
to know that the procedure is virtually painless and the
postoperative course is such that most patients return to
work the following day in their regular shoes.
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Hammer Toes
Is there an easy solution? I often treat
patients with hammertoes, toes that are bent, buckled or
flexed at the main toe joint. A hammertoe procedure is performed
by removing a small portion of bone. Hammertoes sometimes
hurt from shoe contact or because of joint pain, indicating
at times, arthritis. It's important to realize that a consultation
concerning even conservative treatment is very important.
The patients interested in a permanent correction of their
hammertoes will be happy to know that the procedure is usually
painless, performed in less than 30 minutes and done at
an outpatient facility. Hammertoe surgery is performed with
anesthesia, with or without sedation, but general anesthesia
is rarely required. If you are not sure about doing something
definitive about your hammertoes, I or a staff member will
be happy to answer your questions.
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Arch Pain
So many people walk with arch pain as a result
of too flat an arch or too high an arch. As we get older,
the bones and ligaments that support the arch can reduce
with gravity or become aggravated by overuse. Arch abnormalities
can also cause heel or ball of the foot pain due to a shift
in body weight. To make matters worse, the aging process
causes a general thinning of the fat in the foot (especially
in the ball of the foot) which is our body's natural cushion.
In most cases a foot device called an orthotic
(prescription or non-prescription)
can be placed in the shoe which can provide support and
place the foot in a better functioning position. Cast-made
(prescription) orthotics are very often the answer for difficult
foot problems. Because an impression or a cast of the feet
is taken they can correct each foot differently and are
therefore a more specific prescription device than orthotics
made without a cast. The down side is they are often bulky
and expensive and take about 1 month to produce. The upside
is not everyone needs orthotics made from a cast of their
feet. Sometimes all the control you need is in a
non-prescription orthotic which is duped according to
the shoe size and are not made from a cast of your feet.
Non-prescription devices that I sell through my office are
feather light, wafer thin and go in all shoes (even sandals
and heels) and are not expensive--about $125 compared to
$450-$850 for cast-made orthotics.
When devices and conservative treatment fail,
some of the above mentioned problems can be successfully
resolved with surgery in most cases. Should you have arch,
ball of the foot or heel
pain, some type of orthotic
device is probably the best type of treatment.
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Corns and Callouses
Many of us think of corns and callouses as
thickened areas of skin. I think this is the case because
they usually feel so much better when the callous or corn
is shaved down. Why then do they re grow and hurt sometimes
even more than they did before? The reason usually surprises
many patients, it is because corns and callouses indicate
problems with the bone below. The body, in its wisdom, tries
to protects these bony prominences by growing thick areas
of skin. However, these thickened areas press against nerves
and other tissues and cause pain. The corn on the 5th toe
is a perfect example. When the small piece of bone is removed,
the corn and the pain usually disappear permanently.
If a corn or callous has been present for
a very short time, or noticed after the purchase of a new
pair of shoes, it may be more appropriate to approach the
problem conservatively, i.e. medically managed by shaving
down the thick skin.
If you have a condition described above,
a consultation is the first step in learning that there
are options that can lead to the elimination of pain and
discomfort and structural abnormalities.
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Children with Flat Feet-Do they need
to be treated?
Over the last decade, journals specializing
in the medical care of the foot are very definite about
the need to treat the abnormally flat-footed and pronated
foot after age 3. The term pronation refers to the angulation
below the ankle, which some parents have referred to as
a "turning out of the ankle". It has been noted
within the literature that the flatfoot and pronated feet
can produce bunions and hammertoes if left untreated. A
corrective device (orthotic--prescription
or non-prescription) cannot permanently change the structure
of the foot but can prevent certain deformities when the
child is older (in most cases) from becoming worse.
Most parents remark that after their child
wears these devices (which can be changed from shoe to shoe),
they walk straighter and play with less clumsiness and awkwardness.
In my opinion, orthotic devices are the best conservative
treatment for flat feet in children.
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