First Coast Foot and Ankle Clinic

Achilles Tendonitis

The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It also is the most frequently ruptured tendon, usually as a result of a sports injury. Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon. Treatment normally includes: A bandage specifically designed to restrict motion of the tendon. Taking nonsteroidal anti-inflammatory medication for a period of time. Note: Please consult your physician before taking any medication. Orthotics, which are corrective shoe inserts designed to help support the muscle and relieve stress on the tendon. Both nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescribed custom orthotics may be recommended depending on the length and severity of the problem. Rest and switching to exercises that do not stress the tendon (such as swimming). Stretching and exercises to strengthen the weak muscle group in front of the leg, calf, and the upward foot flexors, as well as massage and ultrasound. In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.

Ankle Sprains

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems. Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising. Treatment includes resting and elevating the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments. To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercise and stretching, and wearing well-fitted shoes.

Arthritic Foot & Ankle Care

Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. Although the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence. However, early diagnosis and proper medical care can limit or slow the damage. Symptoms of arthritis in the foot and ankle include: Early morning stiffness. Limitation in motion of joint. Recurring pain or tenderness in any joint. Redness or heat in a joint. Skin changes, including rashes and growths. Swelling in one or more joints. Forms of Arthritis Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or wear and tear arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe. Dull, throbbing nighttime pain is characteristic, and may be accompanied by muscle weakness or deterioration. Many of these symptoms can be relieved with rest. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs. Rheumatoid arthritis is a major crippling disorder and the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course. In the foot, it frequently affects both ankles and toes. Arthritis of the foot and ankle can be treated in many ways, including: Physical therapy and exercise. Anti-inflammatory medication and/or steroid injections into the affected joint. Note: Please consult your physician before taking any medications. Orthotics or specially prescribed shoes.

Athletes Foot

Athlete's Foot, also known as tinea pedis, is a skin disease caused by a fungus that usually occurs between the toes. The fungus attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth. Warm, damp areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi. Symptoms of Athlete's Foot include drying skin, itching, scaling, inflammation, and blisters on and between the toes. Athlete's Foot can spread to the soles of the feet and to the toenails as well as other parts of the body, which is why timely treatment is so important. You can prevent Athlete's Foot by: Not walking barefoot, particularly in public pools and locker rooms. Reducing foot perspiration by using talcum powder. Wearing light and airy shoes. Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily. While fungicidal and fungistatic chemicals are usually used to treat Athlete's Foot problems, they often fail to contact the fungi in the lower layers of the skin. For persistent Athlete's Foot, a prescription topical or oral antifungal drug may be needed. Note: Please consult your physician before taking any medications.

Video: Athletes Foot

Bunions

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe (metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoe. Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult—all contributing to chronic pain. Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries. Treatment for Bunions Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain cause by irritations, and second to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include: The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems. Removal of corns and calluses on the foot. Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth. Orthotic devices—both over-the-counter and custom made—to help stabilize the joint and place the foot in the correct position for walking and standing. Exercises to maintain joint mobility and prevent stiffness or arthritis. Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable. Surgical Treatment Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe.

Video: Bunions

Calluses

A callus, also known as hyperkeratosis, is an area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe. Although many consider them a skin problem, they are indicative of a problem with the bone. Calluses form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus. A great deal of friction or pressure over shorter periods of time can cause blisters or open sores. Calluses typically develop under a metatarsal head (the long bone that forms the ball of the foot). Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness. Calluses can be treated with over-the-counter callus removers, which use strong acids to peel this excess skin away after repeated application. Be careful using these products as they can cause chemical burns when misapplied or used in excess. Alternatively, treat calluses as follows: Begin by soaking the foot or feet in warm soapy water and gently rubbing away any dead skin that loosens. Next, use a pumice stone or emery board to file away the thickened skin. Apply a good moisturizer to the hardened areas to keep them softer and relieve pain. Nonmedicated corn pads or moleskin (a thin fuzzy sheet of fabric with an adhesive back) are available in stores and can relieve pain caused by calluses. However, use caution removing pads or moleskins to avoid tearing the skin. If you need assistance relieving calluses, please contact our office. We can trim and apply comfortable padding to the painful areas. In more severe cases, we may prescribe medication to relieve inflammation, or inject cortisone into the underlying bursal sac to rapidly reduce pain and swelling. A plantar callus forms on the bottom of the heel over time where one metatarsal bone is longer or lower than the others. This structure causes the one metatarsal to hit the ground first and with more force than it is equipped to handle. As a result, the skin under this bone thickens. In most cases, plantar calluses can be treated without surgery. In some recurring cases, however, a surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone. A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a "dropped metatarsal," which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form. A dropped metatarsal can either be a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time. You can prevent calluses by: Switching to better-fitting shoes or using an orthotic device to correct an underlying cause. Buying socks with double-thick toes and heels or nylon hose with woven cotton soles on the bottom of the foot.

Corns

Corns are calluses that form on the toes because of bones that push up against shoes and build up pressure on the skin. The surface layer of the skin thickens, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other. Improperly fitting shoes are a leading cause of corns. Toe deformities, such as hammertoe or claw toe, also can lead to corns. Self-care for corns includes soaking feet regularly and using a pumice stone or callus file to reduce the size of the corn. Special over-the-counter, non-medicated, donut-shaped foam pads can be worn to help relieve the pressure and discomfort. For large or lasting corns, please contact our office. We can shave off the corns using a scalpel.

Diabetic Foot Care

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands. Diabetes is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease your body's ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur. With damage to your nervous system, you may not be able to feel your feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes sores to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen. Here's some basic advice for taking care of your feet: Always keep your feet warm. Don't get your feet wet in snow or rain. Keep feet away from heat (heating pads, hot water pads, electric blankets, radiators, fireplaces). You can burn your feet without knowing it. Water temperature should be less than 92 degrees. Estimate with your elbow or bath thermometer (you can get one in any store that sells infant products). Avoid smoking or sitting cross-legged. Both reduce blood flow to your feet. Avoid soaking feet. Don't use antiseptic solutions (such as iodine or salicylic acid) or over-the-counter treatments for corns or calluses. Don't use any tape or sticky products, such as corn plasters, on your feet. They can rip your skin. Use a nail file or emery board to shape toenails straight across. Avoid cutting the corners. If you find an ingrown toenail, contact our office for treatment. Use lotion to moisturize feet, keeping skin soft and moist - ensuring not to put any lotion between your toes. Wash your feet daily with mild soap and warm water. Wear loose socks overnight. When drying your feet, pat each foot with a towel and be careful between your toes. Purchase shoes that are comfortable and do not need to be "broken-in" . Be sure to thoroughly check how the shoe fits - in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Look for shoes with leather upper material and ample room for toes. Use new shoes for minimal time periods - two hours or less at a time. Don't wear the same pair of shoes everyday. Examine the inside of each shoe looking for foreign objects, protruding nails, or any rough spots inside before putting them on. Be sure not to lace shoes too tight or loose. Be sure to wear clean, dry socks everyday and always wear socks with shoes. Avoid torn or wrinkled socks. Look for thin, cotton socks in the summer as they are more absorbent. Look for socks with square-toes as they will not squeeze toes. Avoid stockings with elastic tops or garters. Never wear sandals or thongs (flip-flops) and never go barefoot, indoors or out. In the winter, wear warm socks and protective outer footwear. Avoid getting your feet wet in the snow and rain and avoid letting your toes get cold. Don't file down, remove, or shave off corns or calluses yourself. Normal nerves allow people to sense if their shoes are too tight or if their shoes are rubbing on the feet too much. With diabetes, you may not be able to properly sense minor injuries, such as cuts, scrapes and blisters-all signs of abnormal wear, tear, and foot strain. Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot, or leg by following proper prevention techniques offered by your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.

Video: Diabetic Foot Care

Flat Feet

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches. Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated. Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot. Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.