Frequently Asked Questions

Why are my toenails becoming thick and discolored?

Thick and discolored toenails are often caused by a fungus that invades the nail. It is the same type of fungus that causes athletes foot. Sometimes this problem can be caused from trauma to the nails. Treatment for fungus to toenails is best using an oral medicine, but sometimes can be treated with topical medications. Sometimes thick nails are not fungus at all but are due to trauma either from something dropping onto the toenail or shoes that are too tight.

What Causes Heel Pain?

Heel pain can have multiple causes, but the most common causes include the following:

  • Calcific Achilles Tendinosis
  • Plantar Fasciitis: Most common cause in adults
  • Haglund’s Disease
  • Fracture Calcaneus (even a Stress Fracture)

What is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the plantar fascia, a ligament on the bottom of the foot. It is usually caused by abnormal motion of the foot and can lead to severe pain to the heel with first step in the morning (post static dyskinesia) or after sitting for a period of time. This pain initially will resolve with some walking, but then returns as you go throughout the day.

Plantar FasciitisThis injury can be further exacerbated by a tight Achilles tendon or by wearing poor shoes or going barefoot. Although it is often felt shoes don’t cause the problem, they may permit the initial injury that causes the plantar fascia to swell.

Once swollen, the plantar fascia is relatively difficult to treat and usually doesn’t resolve without some treatment. Treatment options vary from stretching of the Achilles tendon, ice massage, orthotics, night splints, cortisone shots, physical therapy and even surgery. Evaluation by a specialist in the foot and ankle can often allow you to be diagnosed with this condition while ruling out other causes. An ultrasound of the plantar fascia may even be taken to ensure this truly is the problem.

Although Plantar Fasciitis is a difficult problem, treatments do exist to improve and often resolve the problem.

What does an Achilles Tendon (Achilles Tendonitis) Injury Feel Like?

Symptoms of Achilles Tendonitis:

Achilles Tendonitis

  • Pain along the back of your foot and above your heel, especially when stretching your ankle or standing on your toes. In tendinitis, pain may be mild and worsen gradually. If you rupture the tendon, pain can be abrupt and severe.
  • Tenderness
  • Swelling
  • Stiffness
  • Hearing a snapping or popping noise during the injury
  • Difficulty flexing your foot or pointing your toes (in complete tears of the tendon)

To diagnose an Achilles tendon injury, your Podiatrist will give you a thorough physical exam. She may want to see you walk or run to look for problems that might have contributed to your Achilles tendon injury.

What's the treatment for Achilles Tendonitis?

Most minor Achilles tendon injuries should heal on their own. You just need to give them time. For severe cases immediately call your health care provider.

To speed the healing, you can:

  • Rest your leg. Avoid putting weight on your leg as best you can. You may need crutches.
  • Ice your leg. To reduce pain and swelling, ice your injury for 20 to 30 minutes, every three to four hours for two to three days, or until the pain is gone.
  • Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling.
  • Elevate your leg. Prop you leg up on a pillow when you’re sitting or lying down.
  • Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil, Aleve, or Motrin, will help with pain and swelling. Warning these drugs have side effects, such as an increased risk of bleeding and ulcers. They should be used only occasionally unless your health care provider says otherwise and should be taken with food.
  • Use a heel lift. Your Podiatrist may recommend that you wear an insert in your shoe while you recover. It will protect your Achilles tendon from further stretching.
  • Practice stretching and strengthening exercises as recommended by your Podiatrist.

Usually, these techniques will do the trick. But in severe cases of Achilles tendon injury, you may need a cast for six to 10 weeks, or even surgery to repair the tendon or remove excess tissue.

What is Haglund’s Deformity?

Haglund’s DeformityHaglund’s Deformity is a bony enlargement on the back of the heal that most often leads to painful bursitis, which is an inflammation of the bursa(fluid filled sac).

In Haglund’s Deformity, the soft tissue near the Achilles Tendon becomes irritated when the bony enlargement rubs against shoes. Haglund’s Deformity is often called “pump bump” because of the rigid back of pump style shoes can create pressure that aggravates the enlargement when walking.

Symptoms:

  • A bump on the back of the heel
  • Pain in the area where the Achilles tendon attaches to the heel
  • Swelling in the back of the heel
  • Redness near the inflamed tissue

Treatment
Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the bony protrusion. Non-surgical treatment:

  • Medication – Anti-inflammatory medications may help reduce the pain and inflammation. Warning these drugs have side effects, such as an increased risk of bleeding and ulcers. They should be used only occasionally unless your health care provider says otherwise and should be taken with food.
  • Ice – To reduce swelling, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
  • Heel lifts – Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.
  • Heel pads – Placing pads inside the shoe cushions the heel and may help reduce irritation when walking.
  • Shoe modification. Wearing shoes that are backless or have soft backs will avoid or minimize irritation.
  • Physical therapy – A physical therapist can help identify biomechanical abnormalities that may be contributing to inflammation and recommend appropriate strengthening and stretching exercises to help decrease discomfort and prevent the need for surgery.
  • Orthotics – These custom arch supports are helpful because they control the motion in the foot, which can aggravate symptoms.
  • Immobilization – In some cases, casting may be necessary to reduce symptoms.

If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. Surgical treatment is done by debridement of affected tendon and excision of retrocalcaneal bursa and Haglund Deformity.

What is a Bunion?

bunionsA Bunion (Hallux Valgus) is a deformity involving the large big toe joint. It is a partial dislocation, or in advanced cases a complete dislocation of the joint at the base of the big toe.

Symptoms
Symptoms of a Bunion are as the joint progressively moves out of place it cause increasing pain, local swelling, and redness due to irritation from shoes. There also may be an associated burning sensation due to the fact that one of the nerves is the area gets pressed up against the prominent bone.

What is the treatment for bunions?

Good footwear is often all that is needed. Wearing good footwear does not cure the deformity but may ease symptoms of pain and discomfort.
Treatment may include:

  • Wear shoes, trainers or slippers that fit well and are roomy.
  • Don’t wear high-heeled, pointed or tight shoes.
  • You might find that shoes with laces or straps are best, as they can be adjusted to the width of your foot.
  • Padding over the bunion
  • Ice the area for 20 minutes a night.

Surgery
An operation may be advised if a change of footwear does not ease symptoms. The aim of the operation is to straighten the joint as much as possible and relieve pain.

What Are Hammertoes?

HammertoesA hammertoe occurs from a muscle and ligament imbalance around the toe joint which causes the middle joint of the toe to bend and become stuck in this position. The most common complaint with hammertoes is rubbing and irritation on the top of the bent toe.

What Causes Hammertoes?

The muscles of each toe work in pairs. When the toe muscles get out of balance, a hammertoe can form. Muscle imbalance puts a lot of pressure on the toe’s tendons and joints. This pressure forces the toe into a hammerhead shape.

Why do I have hammertoes?

  • Genes: You may have inherited a tendency to develop hammertoes because your feet are somewhat unstable — they may be flat or have a high arch.
  • Arthritis
  • Injury to the toe: Ill-fitting shoes are the main culprits. If shoes are too tight, too short, or too pointy, they push the toes out of balance. Pointy, high-heeled shoes put particularly severe pressure on the toes

How do I fix Hammertoes?

Non-surgical Treatment

The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.

A number of non-surgical measures can be undertaken:

  • Padding corns and calluses.
  • Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels – conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
  • Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance.
  • Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoe.
  • Splinting/strapping. Splints or small straps may be applied by a surgeon to realign the bent toe.

How are Hammer Toes Surgically Corrected?

Hammer toe surgery most often involves removing a portion of bone within the toe, to reduce the joint contracture.  Depending on the direction the toe is deviated, soft tissue procedures may be necessary along with pinning the toe with a surgical wire.

What causes Ingrown Toenails?

Introduction to Ingrown Toenails:

Ingrown ToenailsIngrown toenails, a problem also known as onychocryptosis, is a very common condition. Ingrown toenails occur when the corners or sides of the toenail dig into the skin, often causing infection. Ingrown toenails can be painful. Ingrown toenails can start out hard, swollen, and tender. Left untreated, they may become sore, red, and infected and the skin may start to grow over the ingrown toenail.

Causes:

  • Trimming toenails too short, particularly on the sides of the big toes. (most common!!)
  • Shoe pressure (from shoes that are too tight or short)
  • Injury to the nail
  • Fungus infection in the toenail which causes a thickening and incurvation
  • Heredity
  • Poor foot structure (certain foot types are more likely to develop an ingrown nail because of how you walk)

How to treat Ingrown Toenails?

Treatment:

  • In most cases, treating ingrown toenails is simple: soak the foot in warm, soapy water several times each day. Avoid wearing tight shoes or socks. If symptoms persist after 3 or more days, call your Podiatrist.
  • Antibiotics are sometimes prescribed by your Podiatrist if an infection is present. In severe cases or if an acute infection occurs, surgical removal of part of the ingrown toenail may be needed. Known as partial nail plate avulsion, the procedure involves injecting the toe with an anesthetic and cutting out the ingrown part of the toenail.
  • Total nail plate avulsion is removal of the whole toenail.. This will only happen if the nail is severely damaged by trauma, incurvated too much in the middle, (onychogryphosis), or too thick from a fungal infection.

What is a Plantar Wart (Verruca Plantaris)?

Plantar Wart (Verruca Plantaris)A wart is a small growth on the skin that develops when the skin is infected by a virus. The result is a small lesion on the skin that contains viral particles. Plantar warts that develop on the weight-bearing areas of the foot (the ball or heel of the foot) can cause a sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

How to treat a Plantar Wart?

Treatment options:

  • Prescription topical medication
  • Chemical ablation: acids to remove the wart
  • Surgical removal
  • Cryotherapy: Freezing off the wart