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About Common Mid-foot Conditions and Injuries... |
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| Tendonitis
Pain and or swelling along the tendon, usually from irritation as a result of overuse.
Cause:
Overwork or strain of any tendon-including sprains (partial tears). Certain medications and or tendon diseases-such as rheumatoid disease or contractures
Symptoms:
Pain and or swelling along the tendon with or without an area of hard swelling indicative of a tear. Pain with movement first thing in the morning with movement that may or may not improve with activity
Treatment:
Protect tendon. RICE (rest, ice, compression, elevation) treatment for the first 2-3 days after injury-then you may apply heat for soreness. Oral anti-inflammatories such as Advil or Tylenol for two to three weeks. Physical therapy. Biomechanical analysis and/or computerized orthotics .Brace or surgery for unstable or badly sprained tendon- Early treatment prevents arthritis of the joint and tightness of the tendon |
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Posterior Tibial Tendonitis
Posterior tibial tendonitis causes pain along the inner side of the lower leg, ankle or foot. Tendons are strong bands of connective tissue which attach muscles to bones. The posterior tibial tendon helps point the foot down and in. Tendonitis is inflammation of a tendon.
Cause:
Posterior tibial tendonitis occurs from overuse of the tendon. This tendon attaches to a bone in the foot called the navicular and helps stabilize your arch. If your arch flattens out more than normal when you walk or run it is called over-pronation. When you over-pronate you strain your tendon and are more likely to get posterior tibial tendonitis.
Symptoms include:
- Pain or tenderness on the inner side of the shin, ankle or foot
- Pain with lifting up your foot
- Pain walking or running
Treatment may include:
- Applying ice packs to your foot for 10 minutes on, 10 minutes off and then 10 minutes on again every 3 to 4 hours for the first 2 to 3 days or until the pain goes away. Thereafter, ice your foot at least once a day until the other symptoms are gone.
- Doing ice massage. Freeze water in a cup and then peel back the top of the cup. Massage the ice into the painful tendon for 5 to 10 minutes.
- Elevating your lower leg and foot by placing a pillow underneath it. Try to keep your foot above the level of your heart.
- Your provider may recommend special arch supports or inserts for your shoes called orthotics, either custom-made or off the shelf.
- Taping your foot to give extra support to your arch, the navicular bone and the attachment of the posterior tibial tendon.
- Sometimes a cast is needed for a few weeks until the pain and inflammation go away.
- Using crutches until you can walk without pain.
- Taking anti-inflammatory medication or other pain medication prescribed by your provider.
- Doing exercises will help you return to your normal activity or sports.
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Make an appointment for more information or to hear back from our board-certified doctors. |
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Frequently Asked Questions |
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Select your category, then click the question to reveal the answer...
| Q: I am 52 yr old male...after exercising my lower body (cross trainer, stair master, and weights) my left ankle hurts the next day. I was diagnosed with flat foot on the left side as a child and I wear custom orthotics. However, it seems to have gotten worse over the years. What could be the cause and how can I prevent it in future? |
| A: There are a few possible causes and treatment options:
1. You may have some wear & tear arthritis (osteoarthritis or degenerative joint disease) of the ankle, which may be treated with Advil, Aleve, aspirin or Tylenol, if you do not have contraindications to these meds.
2. You may need new orthotics or an adjustment to your current ones.
3. You may be overtraining (improper technique)
4. Weight changes could also be a factor
You can also try RICE therapy: Rest, Ice, Compression, Elevation following your exercise regimen for minor aches & pains following exercise. A good exam from your local specialist is necessary to provide a proper diagnosis and treatment. At the Ankle N Foot Centers we offer digital x-rays to pinpoint these kinds of problems. We also offer a unique SportsMotion video gait analysis system. |
| Q: I have a foot problem that is so embarassing! I can't take my shoes off if any one is in the room because my feet smell so bad. Is there anything I can do? |
A: There are a variety of causes for excessive foot odor. One of the most common is a condition called hyperhidrosis which simply means "too much moisture."
Another cause for abnormal foot odor is an "occult" or hidden infection. This is especially common in the diabetic or those who have compromised immune systems. This type of infection may not be immediately painful but can spread quickly and often requires emergency treatment.
The condition known as hyperhidrosis, though not truly dangerous, can produce significant discomfort, both physical and emotional. This overproduction of moisure may cause the skin to break down, often leading to infection. Successful treament is often obtained with the regular use of one to several medications. It isn't necessary to "just live with it"; see a foot specialist and get relief. |
| Q: I have been treated conservatively for Morton's Neuroma for the past 6 months with 2 cortisone injections (which helped) and orthotics (which also helped) but I still have pain and I am interested in learning more about the Koby method for intermetatarsal ligament release. Do you perform this procedure and if so, what have your clinical outcomes looked like? |
| A: First, the diagnosis would be confirmed, as there other possibilities of what could be causing the pain. Since you initially responded to an injection, there is a possibility that it could be a capsulitis, which is an irritation of the metatarsal heads. A neuroma occupies space between the bones, so it generally does not respond to cortisone injections. The specific procedure you are inquiring about is not performed in this practice due to the lack of evidence-based studies on the efficacy of the procedure, as well as, because of the inherent risk in transecting the ligament, which may cause splaying of the metatarsals. We can not recommend a procedure with a lower success rate. Our technique leaves minimal scarring, the incision is not placed in a conspicuous place and it heals quickly. Keep in mind that surgery is surgery, and one will always have some pain and mild swelling. |
| Q: I'm only 16 years old, but I think I'm getting a bunion. What should I do? |
A: A bunion is a fairly common condition in which the bone leading to the big toe is pushed out producing a bump on the inner side of the foot. It is likely that some member of your family had a bunion, since it rarely develops in one so young without a strong hereditary influence. The consequences of a bunion in the juvenile are quite serious. The bone will often adapt into an abnormal position, producing feet and legs that function incorrectly. This, in turn, can cause other far-reaching developments.
When a teenager develops a bunion, it is rare that a custom, in-shoe orthotic can prevent the deveopment and consequences that often occur. Surgical realignment usually works best and now, new techniques and equipment allow relatively painless repair and make it a simple, outpatient affair with door-to-door delivery. Don't let the individual with juvenile bunions suffer the deformities which can result. Get professional help from your foot and ankle specialist. |
| Q: Why am I growing a bump on the outside of my big toe joint? It doesn't really hurt, but why is it so red? |
| A: This is a fairly common condition known to most people as a bunion. Typically, a bunion is caused by a hereditary foot type where the bone leading to the big toe is pushed out, producing a bump. The consequences of this deformity may be severe. The redness often develops into an ulcer which can become infected. Arthritis in the joint can lead to severe stiffness and pain. Also, as the big toe drifts sideways, the other toes are slowly pushed out of the way. If caught early, it is usually possible to slow or prevent the development of the bunion with prescription in-shoe orthopedic appliances. However, surgical realignment works best and there are now new techniques using microsurgical equipment which allows relatively painless repair of the bunion. Many other advances in podiatric medicine make bunion repair a simple, outpatient affair with door-to-door delivery and usually, a return to normal foot gear in about 3 weeks. |
| Q: Can you soak and file away a corn or does it require surgery? |
| A: Soaking and filing down a corn helps to remove the skin that is building up in the area. By decreasing the pressure in the area, it is going to feel better, but it is not going to take the corn away. In order to take the corn away, you have to take care of the pressure that is causing it in the first place. Depending on the situation, it may require a change in shoes, additional padding to the area or possible surgery. Each person's problem is unique to them, so I would urge you to seek a professional opinion from a doctor in your area. |
| Q: My 10 month old baby's feet point inward, but my pediatrician says he'll grow out of it. Should we do anything or just wait and see? |
A: Many changes occur in the positioning of the foot and leg during the normal development of a child. Yet, often, pediatricians don't see the long term consequences of untreated childhood deformities. However, the in-toeing you see may be more than nature can reduce. A child that is too "pigeon-toed", flatfooted, or has some other deformity and is not diagnosed in time, may have to endure a life of pain and inactivity.
Many pediatric foot problems can be treated conservatively, without surgery, when caught early. We recommend that you seek the aid of a foot specialist with training in the development of the foot and leg and the treatment of these problems. |
| Q: I broke my foot (5th metatarsal) a few years back and now have grown a small hard lump under the skin near my arch. It is painful when I touch it. Could this be related to the break? Could this be serious? |
| A: It is probably bone growth at the area of the fracture. It could also be that the fracture never healed completely. An x-ray may be needed to give a good diagnosis, which is the beginning of successful treatment. Although it may be only pain from an injury that has not fully healed, since pain is not normal, our podiatrists recommend you at least have it diagnosed & then you can decide with the doctor if treatment may help. |
| Q: My heel has been really painful and getting worse for several months, especially in the morning. What would help this situation? |
A: This sounds like it could be Heel Spur Syndrome, which is a common problem that affects many people. Other causes may be a stress fracture to the heel bone, inflammation of a nerve which runs under the heel, or bursitis. An x-ray and a physical examination usually is required to determine the cause of the problem.
With Heel Spur Syndrome, a sharp sensation on the bottom of the heel area is often most painful in the morning after a busy work day or prolonged activity. A short course of anti-inflammatory medication combined with physical therapy often acheives relief. Relapses are prevented by in-shoe prescription inserts or micro surgery. |
| Q: One of my toenails has become discolored at the tip. Why is it doing this and can it get worse? |
| A: The most likely explanation is that you have developed a fungal infection. This is not life-threatening (in fact it is incredibly common) but chances are good it will get worse and can develop some very painful consequences. The discoloration often comes to involve the entire nail, followed by a noticeable thickening. The shape of the nail may become distorted and an ingrown nail is often the result. The fungus can even infect your fingernails! An experienced podiatrist has numerous methods to treat this condition, but the success rate is much greater when the condition is caught early. |
| Q: I've been doing aerobics for 2 months, but the front of my foot has been aching badly for the last few weeks. It hurts worse after exercise. |
| A: There are many possible explanations for your discomfort. These include a nerve tumor, a torn ligament or perhaps an inflamed joint. More likely it's the diagnosis of a stress fracture, also known as a march fracture. This condition develops when excessive, repetitive stress is placed on a bone. In the foot, this usually means a metatarsal (one of the bones that run out to the ball of the foot and connects to the base of a toe). A stress fracture is not the typical break in a bone, but a more subtle, slight interruption of the hard outer edge of a bone. This type of break is not large enough to prevent activity, but does cause aching and fatigue with use. To diagnose, a podiatrist will perform a rigorous history and physical exam, then also take an x-ray. If untreated, this seemingly minor problem can lead to nonunion in which the bone can't heal itself. This may require surgery to relieve the problem. See your foot specialist early when the treatment is simple and usually very successful. |
| Q: What’s the difference between an Orthopedic Surgeon and a Podiatric Surgeon? |
A: Actually, there is a significant difference in the surgical and orthopedic training received in the residencies of these two specialties with respect to foot and ankle surgery. While the podiatric resident focuses on the foot and ankle for two to three years, the orthopedic resident’s foot and ankle training is vague and does not require specific experience or proficiency in this discipline, as revealed in the July 2003 issue of Foot and Ankle International. The study of 148 American orthopaedic surgical residencies has shown that “a large number of residency programs do not have a faculty member committed to foot and ankle education, and almost one-third have no time specifically allocated to foot and ankle education.” Out of a possible 260 weeks of residency training, the orthopedic surgeons were trained as little as six weeks and not more that 24 weeks in foot and ankle surgery, the study found. Furthermore, the orthopaedic resident might only need 12 bunion cases to pass their residency rotation, while the podiatric resident needs at least 100 bunion cases alone, not to mention other more complicated foot and ankle procedures.
Bottom line, the surgeon, whether orthopedic or podiatric, with the most surgical experience and training in a specialty should possess better skills than those without similar training. So ask your doctor how many cases he or she has done in complicated foot and ankle surgery. |
| Q: Why do my 3rd and 4th toes tingle and get numb? The only way to relieve it is to take my shoe off and rub my foot. |
A: There are many possible causes for your problem, including "wear-and-tear arthritis" or hammertoe development, but the most likely is a neuroma. This is a benign nerve tumor that develops over time, usually developing around and pressing on the nerve, which causes the feeling that you have a lump inside the bottom of your foot.
If treated early, the pain may be permanently relieved with medicine placed around the nerve along with physical therapy. Prescription, customized shoe inserts may be required to take pressure off the nerve as well. As a last resort, the nerve tumor can be removed, a simple outpatient procedure. If left untreated, the pain can become severe and make shoe wearing a painful ordeal. See a podiatrist while the simple treatments can still provide relief. |
| Q: One of my toenails has become discolored at the tip. Why is it doing this and can it get worse? |
| A: The most likely explanation is that you have developed a fungal infection. This is not life-threatening (in fact it is incredibly common) but chances are good it will get worse and can develop some very painful consequences. The discoloration often comes to involve the entire nail, followed by a noticeable thickening. The shape of the nail may become distorted and an ingrown nail is often the result. The fungus can even infect your fingernails! An experienced podiatrist has numerous methods to treat this condition, but the success rate is much greater when the condition is caught early. |
| Q: I have a lump with dark spots in it growing on the bottom of my foot. What could it be? |
A: Quite likely, you have developed a Plantars Wart. This is due to a virus which has infected your foot. This type of virus is very contagious and will often spread to cover large areas of the skin. Although a wart is the most common cause for this bump, there are many other possibilities such as a pressure callus or, in rare cases, a melanoma. A wart will usually become thickened and quite painful. It can even spread to your hands.
There exist numerous methods for treating plantars warts, but rarely are the over-the-counter medications effective. Podiatrists have experience in a variety of treatments, including some new topical medicines and relatively painless electrosurgical methods which have proven successful. Don't wait for the virus to spread; see a foot professional soon to find the treatment which fits your needs. |
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