Heel Pain/Plantar Fascitis

Heel pain is usually caused by plantar fasciitis that is sometimes called heel spur syndrome since a bony is usually present coming off the calcaneus. However, pain in the heel has a differential diagnosis of many potential causes. The foot and ankle surgeon will properly diagnose the cause of heel pain ruling out stress fracture, Achilles insertional tendinitis, bony growth to the posterior calcaneus, nerve irritation, arthritis, bony cyst, or infection. In children still undergoing growth, heel pain may be due to irritation and inflammation of the growth plate within the calcaneus called apophysitis.

Plantar fasciitis is irritation and inflammation of the plantar fascia. The plantar fascia extends from the toes to the heel. It is a fibrous band of connective tissue that serves to support the plantar arch of the foot. Heel pain due to plantar fasciitis presents with sharp and achy pain to the plantar medial heel where the plantar fascia inserts onto the calcaneus. Plantar fasciitis pain may or may not present with having a heel spur. This depends on how long the condition has been going on. Heel spur formation is a sign of enthesopathy that results when the plantar fascia pulls against the calcaneus under tension over time resulting in formation of bony growth along the course of the tension. Patients with plantar fasciitis usually states a consistent history of having heel pain that is worse after taking the first step after getting up from rest. Patients with high-arched foot or flatfoot are more prone to developing plantar fasciitis.

The foot and ankle surgeon will obtain an accurate medical history and obtain imaging studies to determine if the heel pain is due to plantar fasciitis or of another differential diagnosis. Having a plantar heel spur seen on x-rays only confirms diagnosis as plantar fasciitis and provides information on the chronicity of the condition, but it is important to note that the pain is not due to presence of a spur. Spur is not present in many cases of plantar fasciitis that is diagnosed with correlation to history.

Initial treatments of plantar fasciitis include stretching exercises, icing area of the heel, topical and oral anti-inflammatories, avoid going barefoot, and wearing more supportive shoes. Biomechanical treatments such as strapping of the foot or wearing orthotics support the medial arch and decrease the traction tension and attenuation of the plantar fascia against the calcaneus. Cortisone injections may be necessary to provide immediate relief of more intense pain. Additional treatments involve physical and massage therapy of the plantar fascia. Most patients do not need surgery to relieve plantar fasciitis pain; however, a small percentage of patients will require surgery after conservative treatments have all failed to relieve pain. Surgery involves releasing the plantar fascia at its insertion site to the plantar calcaneus.

Ingrown toenails

Ingrown toenails can form when the side of a toenail begins to grow into the flesh surrounding the nail. As a result, the affected toe—most commonly the big toe—may become red, swollen, painful, and—in severe cases—infected.

There are many reasons why an ingrown toenail may develop. Improperly cutting your toenails is a major cause of ingrown toenails. If toenails aren’t cut straight across or are cut too short, the likelihood of getting an ingrown toenail may increase. Other causes include having unusually curved toenails, wearing shoes that don’t give your toes an ample amount of space, and hereditary factors. Injuring the toe by stubbing it or having an object fall on it may also lead to ingrown toenails. If left untreated, an ingrown toenail can lead to further complications with the foot.

If you are someone who has diabetes, it’s extremely important to remain mindful of ingrown toenail prevention, as minor cuts or simple scrapes can lead to serious complications. You can prevent ingrown toenails by ensuring toenails are straight across and at a moderate length, wearing shoes that fit properly, and checking feet daily for signs of foot issues.

Treatment for an ingrown toenail will vary on a case by case basis. One form of treatment requires lifting the ingrown nail and placing a splint or piece of cotton underneath. Another method for a more severe case would involve partially removing the nail. For cases that need extreme care, the nail itself and tissue would have to be removed.

If you’d like more information about ingrown toenails, we recommend you consult with a podiatrist who can give you a proper diagnosis and go over your treatment options.

Pediatric foot problems

It is never normal for a child to experience pain in his or her feet. Foot pain that lasts more than a few days and limits a child’s ability to walk should be examined by a podiatrist. Many adult foot ailments originate in childhood and may be present at birth. Common foot issues that are experienced by children are pediatric flat foot, Sever’s disease, ingrown toenails, and plantar warts.

A child’s foot grows rapidly during the first year. Consequently, foot specialists consider the first year to be the most crucial point in the foot development process. There are ways you can help ensure that your child’s feet develop properly. One way is to carefully look at your baby’s feet. If you notice any deformities, you should immediately seek professional care. You should also loosely cover your child’s foot, since tight coverings may prevent movement and inhibit normal development. Another tip is to change the baby’s positioning throughout the day. If your baby lies down in one spot for too long, it may put an excessive amount of strain on the feet and legs.

It is best that you try not to force a child to start walking. Children will begin to walk when they are both physically and emotionally capable to do so. You should also avoid comparing your child’s walking progress with other children because the age range for independent walking varies. When your child’s feet begin to develop, you may need to change both their shoe and sock size every few months to allow room for their feet to grow.

Kids are sometimes prone to splinters, cuts, and severe injuries because they tend to walk around barefoot. This also makes them more susceptible to developing plantar warts, a condition caused by a virus that invades the sole of the foot through breaks in the skin. These ailments can be avoided by making sure your child wears shoes in unsanitary environments. You should also wash any minor cuts or scrapes on your child’s feet.

Kids are also prone to developing Sever’s disease, which is the inflammation of the growth plate in the heel. Typically the result of overuse, Sever’s disease often develops inactive children who are experiencing a growth spurt. When a child experiences a growth spurt, the heel bone will often grow faster than the other muscles, tendons, and ligaments in his or her lower extremities. This causes Sever’s disease.

As a parent, you should ensure that your child’s feet are developing properly and are being properly maintained. Consequently, it is important that you perform routine inspections on his or her feet to detect any injuries or deformities in their early stages. Early detection and treatment will help to ensure that your child does not develop any serious foot conditions.

BUNIONS

A bunion is a bony, painful swelling that is often formed on the first joint of the big toe. Bunions can be extremely painful due to the weight of all your body resting on it each time you take a step. Everyday activities, such as walking and wearing shoes, can cause you extreme discomfort if you have a bunion.

Reasons that a person may develop a bunion can vary. Some patients may form bunions due to genetic factors, complications with arthritis, or a weak foot structure. General aging can also play a role in the formation of a bunion.

If you have a bunion, you may notice a bony bump on your big toe, experience swelling and redness, and the area may feel tender to the touch. To help alleviate the pain that often comes with having a bunion, it’s suggested to maintain a healthy weight to help lessen the pressure on your toe, practice both heating and icing the affected area, wear wide-fitting shoes wear to leave plenty of space for your toes and to minimize rubbing, and look into shoe inserts that can help position your foot correctly.

Because bunions can result in other painful foot problems, such as hammertoes and bursitis, we recommend that you meet with a podiatrist for a professional diagnosis and for information regarding all your treatment options.

Plantar Warts

Plantar warts are small, grainy bumps that can appear on the soles of the feet due to a human papillomavirus (HPV) infection. HPV is a contagious virus that can enter the body through a small cut or scrape on the foot, infecting the skin and forming plantar warts. This condition most often affects children, teenagers, and the elderly.

Plantar warts appear as one or more small, grainy bumps of tough, thickened skin. They often have tiny black dots at their center. These are actually dried blood in the capillaries. Pressure endured by your feet while walking can cause the warts to grow inwards. The warts may be painful or tender, especially when pressure is applied to them. This can make walking or standing for prolonged periods of time painful.

There are a variety of treatment methods for plantar warts, including topical medications, laser therapy, cryotherapy, acid treatments, or removing the wart through surgery. You can prevent plantar warts by wearing shoes when walking in public spaces such as pools and locker rooms. Keeping your wart covered can help you avoid spreading it to other people.

If you notice warts on the soles of your feet, please consult with a podiatrist.

Ankle Fractures

When the foot or ankle experiences trauma, a fracture may occur. Causes of foot and ankle fractures can vary. In some cases, an obvious impact to the foot or a fall can be behind a fracture. Fractures can also occur because of increased stress on the bone over time. The location of the fracture can often give your podiatrist information on how the fracture occurred.

Pain, especially when bearing weight, is a telltale sign of a fracture. Limping due to this pain is a further sign of a foot or ankle fracture. Other symptoms include inflammation, bruising, deformity, and tenderness. A deformity may occur due to a shift in bone alignment or a joint dislocation near the fracture. While pain is a significant symptom of breakage, a patient who has nerve damage or who has diabetes may not feel this pain. In this instance, your podiatrist will look for additional signs to determine whether a fracture has occurred.

If you are experiencing severe pain, cannot walk without limping, have an open wound near the suspected break, or have numbness or tingling in the toes, you should see your podiatrist.

Sports injurie

When the foot or ankle experiences trauma, a fracture may occur. Causes of foot and ankle fractures can vary. In some cases, an obvious impact to the foot or a fall can be behind a fracture. Fractures can also occur because of increased stress on the bone over time. The location of the fracture can often give your podiatrist information on how the fracture occurred.

Pain, especially when bearing weight, is a telltale sign of a fracture. Limping due to this pain is a further sign of a foot or ankle fracture. Other symptoms include inflammation, bruising, deformity, and tenderness. A deformity may occur due to a shift in bone alignment or a joint dislocation near the fracture. While pain is a significant symptom of breakage, a patient who has nerve damage or who has diabetes may not feel this pain. In this instance, your podiatrist will look for additional signs to determine whether a fracture has occurred.

If you are experiencing severe pain, cannot walk without limping, have an open wound near the suspected break, or have numbness or tingling in the toes, you should see your podiatrist.

Fungal toenails

Onychomycosis, or fungal infection of the toenails, is a very common condition. The fungi that cause this infection live and thrive in warm and moist environments. Unfortunately, this makes the feet and toenails an ideal home for them. Toenail fungus is highly contagious and can be contracted from walking barefoot in places like public pools and communal showers, sharing personal items like towels and shoes, and coming into direct contact with an infected person.

Toenail fungus can change the appearance of the toenails. They may become thickened, brittle, or crumbly. The nails can also become discolored and turn yellow, white, or brown. They may begin to lift and separate from the nail bed and emit a foul odor. The infection is usually not painful unless it has progressed and become severe. People who have diabetes, poor circulation, a weak immune system, excessively sweaty feet, toenail injuries, or Athlete’s foot are at an increased risk of contracting toenail fungus and experiencing complications.

Toenail fungus can be treated through topical solutions, which are applied directly to the nail, oral antifungal medications, or laser treatment. In severe cases where the infection has progressed or is recurring, surgery to remove some or all of the infected nail may be necessary. If you have toenail fungus, please consult with a podiatrist who can find the right treatment for you.