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YOUR PODIATRY RESOURCE AND FOOT DOCTOR IN NEW JERSEY.

240 Williamson St.
Suite 200
Elizabeth, NJ, 07202

(908) 353-1777

"SPECIALIZED TREATMENT WITH A PERSONAL TOUCH".

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Elizabeth Foot and Ankle

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Abnormal Gait

Please view Custom Orthotics section.

Achilles Tendon Ruptures

Your Achilles tendon that is a strong fibrous cord, joins your calf muscle to your heel bone or calcaneus. You can tear your Achilles tendon if you land hard on your heel during sports, from a jump, when accelerating, or when stepping into a hole. It mainly occurs in people playing recreational sports, but it can happen to anyone. If your Achilles tendon ruptures, you might hear a pop, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often performed to repair the rupture. For many people, however, there are available nonsurgical treatment that work very well.

Surgery to repair the Achilles tendon is done if your Achilles tendon has been torn into 2 complete pieces that are completely separated with some amount of gap between the ends. Proper diagnosis is needed using a MRI to provide crucial data if surgical or non-surgical approach is appropriate.

Surgical and non-surgical options involves extended amount of time of casting, immobilization, and/or bracing.

Achilles Tendonitis

Achilles tendinitis is an overuse injury/inflammation of the Achilles tendon. It occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful at the back of your heel. The Achilles tendon allows you to push your foot down and is used for walking, running, and jumping.

Causes
The Achilles tendon connects two large muscles in the calf to the heel bone or calcaneus. This tendon creates the power needed to push off with the foot or go up on the toes. Heel pain is most often due to overuse of the foot. It can also be caused by an injury, but it less common. Achilles tendinitis due to overuse is most common in younger people but can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:
• Sudden increase in the amount or intensity of an activity.
• Your calf muscles are very tight or poor flexibility of the ankle joint.
• Running on hard surfaces such as concrete.
• Aggressive running.
• Flat feet. (increased tension)
• Participating in jumping sport, such as basketball.
• Shoes with improper support.
• Spraining your ankle

Symptoms
Symptoms can include pain in a specific spot along the tendon such as in the heel or along the entire length of the tendon. Pain is usually exacerbated with walking or running. Your Achilles tendon may be too painful to touch or move. You may experience warmth and swelling. Many shoes you typically find comfortable will irritate you.
Commonly, having Achilles tendonitis can result in a bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Exams and Tests
Diagnosis of Achilles tendinitis may include physical exam, X-rays, MRI to rule out any partial tears or ruptures, which would require surgery.

Treatment
The main treatments for Achilles tendinitis:
• Ice
• Changes in activities, including decreasing activities that cause pain
• Run on smoother/softer surfaces
• Reduce high impact sports
• Physical therapy
• PRP/Stem Cell injections
• Bracing or immobilizing
• Heel lift
• NSAIDs

Ankle Foot Orthotics

Ankle Foot Orthotics (AFO) or orthosis are made from high temperature thermoplastic material. They are used to combat a variety of factors and biomechanically assist muscle weakness, joint instability, excessive tripping, and supporting paralyzed or weak muscles.

AFOs are fitted with a variety of purposes to control alignment, increase mobility and independence, assist rehabilitation and/or to reduce pain. AFOs are also provided with the intention of preventing deformity from occurring. Depending on your needs they may be hinged (made to bend at the ankle) or solid (no movement at the ankle) and fitted on either one or both legs.

Reasons to get an AFO:

  • Ankle pain
  • Excessive tripping
  • Muscle loss/tone
  • Weakness
  • Paralysis
  • Drop foot
  • Instability
  • Falling
  • Arthritis
  • Certain ankle joint tendinitis
Ankle Sprains

An ankle sprain occurs when you twist your ankle in an abnormal position or degree. Your ankle is supported by many ligaments, which can get stretched and torn resulting in an ankle that is swollen and painful.

Ankle sprains may take several weeks to several months to heal. Usually, the more pain and swelling you have, the more severe your ankle sprain is and the longer it will take to heal. It is very important to give your ankle time to heal completely, so that you do not easily hurt your ankle again. Ankle sprains are more likely to occur if you have a history of spraining your ankles.

Proper evaluation is key to healing as you need to be further evaluated for further injury including ankle fractures, occasional 5th metatarsal fractures, torn ligaments, ruptured tendons, OCD lesions, and even hematomas. Depending on the extent of secondary injuries, surgical intervention is needed, although uncommon.

There are three grades for ankle:

  • Grade 1: Stretching or slight tearing of ankle ligament.
    •  Symptoms include mild tenderness, swelling and stiffness.
    • Ability to bear weight with minimal pain
  • Grade 2: Severe sprain with incomplete tear
    • Moderate pain with swelling and bruising.
    • Very difficult to walk due to the pain
  • Grade 3: Complete tear of the affected ankle ligament or ligaments
    • severe swelling and bruising
    • Your ankle is very unstable and walking not possible due to the severe amount of pain.

Poorly treated ankle sprains can lead to future ankle sprains, ankle instability, undiagnosed OCD lesion (damage of the cartilage), reduced activity, and unresolved ankle pain

Arthritis

Osteoarthritis

Osteoarthritis is the most common form of arthritis. It causes pain, swelling, and reduced motion in your joints. It can occur in any joint in the foot and is somewhat common in the joints of the foot and ankle.

Osteoarthritis breaks down the cartilage in your joints from wear and tear over the years. Typically, osteoarthritis occurs mostly in the aged population but can occur prematurely for different reasons. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage absorbs the shock of movement. When you lose cartilage, your bones rub together. Over time, this rubbing can permanently damage the joint.

Risk factors for osteoarthritis include:
• Being overweight
• Getting older
• Injuring a joint

There is no specific test for osteoarthritis. Most doctors use several methods, including medical history, a physical exam, x-rays, or lab tests.
Treatments include exercise, medicines, and sometimes surgery. If joints are beyond salvage, there are foot surgeries that include joint replacement or fusion of the joint. Each type of surgery has their own unique risks and benefits.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in your joints. It can affect any joint but is common in the wrist and fingers. Many patients do show signs of RA in their feet as well. RA has a signature appearance when your toes and fingers begin to deviate and point away from the midline of your body. In the foot particularly, it is called fibular deviation.
RA is more common in women than men. It often starts in middle age and is most common in older people. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime.
Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body’s own tissues.
Treatment of RA is very difficult and may include medicine, lifestyle changes, and surgery. Foot surgery for RA can include fusion or joint resection. Joint replacement is typically not performed for RA. These can slow or stop joint damage and reduce pain and swelling.

Psoriatic Arthritis
Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get them on your elbows, knees, scalp, back, face, palms and feet, but they can show up on other parts of your body.
Some people with psoriasis have psoriatic arthritis. It causes pain, stiffness, and swelling of the joints. It is often mild, but can sometimes be serious and affect many joints. The joint and skin problems don’t always happen at the same time. Upon evaluation of the joints on X-rays, Psoriatic arthritis has a signature “pencil in cup” deformity.

Athlete’s Foot

Athlete’s foot is a common fungal infection. Athlete’s foot usually begins between the toes. It commonly occurs in people whose feet have become very sweaty while confined within tightfitting shoes.

Signs and symptoms of athlete’s foot include a scaly rash that usually causes itching, stinging, cracked skin, and burning. Athlete’s foot is contagious and can be spread via contaminated floors, towels or clothing. You can get athlete’s foot from damp surfaces, such as showers, swimming pools, and locker room floors.

Prevention
• Keep your feet clean, dry, and cool
• Wear clean socks and do not reuse socks
• Don’t walk barefoot in public areas and wear flip-flops in locker room showers
• Keep your toenails clean and clipped short
Treatments include over-the-counter antifungal creams for most cases and prescription medicines for more serious infections. These usually clear up the infection, but it can come re-occur

Erythrasma
Erythrasma is a long-term skin infection caused by bacteria and can be commonly misunderstood for athlete’s foot that is a fungal infection. It commonly occurs in skin folds all over the body but commonly occurs in the interspace of your toes, most commonly seen in the 4th interspace.

Causes
Erythrasma is caused by the bacteria Corynebacterium minutissimum.
Erythrasma is more common in warm climates that results in excessive sweating. You are more likely to develop this condition if you are overweight, older, or have diabetes.

Treatment
Treatment of erythrasma is simple with a prescription topical antibiotic, drying between the toes after showering, and good hygiene practices.

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Bunion

A bunion is a deformity characterized by a bump on the outside of the joint at the bottom of your big toe. It can cause pain and swelling in the big toe. A bunion forms when bone or tissue around the joint becomes swollen from too much pressure. You also can have a bunionette, or tailor’s bunion, which forms on the joint of the little toe (5th toe) . It is common for the big toe to shift towards your other toes and this is called displacement. It can lead to problems with the other toes and causing subluxation (overlapping) of your 1st and 2nd toes.

There are several reasons why you can get bunions:

  • You can get a bunion from having an unusual walking style
  • Flatfeet
  • wearing tight-fitting shoes
  • high heels

You can treat most bunions at home with a few simple steps such as wider shoes and NSAIDs. If you have a lot of pain, you may need an injection of medicine into the bunion to reduce the swelling. If you still continue to have pain, you may need to have surgery.

A bunionectomy is surgery to remove the lump/bump of the big toe joint (medial eminence). This lump is called a bunion. The bunion forms on the joint where your big toe joins your foot. Bunion surgery will also straighten your big toe. Bunion surgery usually involve 1 or 2 incisions over the joint depending how severe the deformity is. The doctor will remove small pieces of bone and may need to perform a complete osteotomy with hardware to straighten your toe. Your toe may be held in place with pins, screws, wires, or staples. The surgery will leave scars that fade with time.

The surgery may make walking easier. It may reduce stiffness, pain, or swelling in your toe joint. It may also improve the way your toe looks.

Bunion surgery is not for everyone.  Feel free to make an appointment with us to discuss whether or not bunion surgery is for you.

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Charcot Foot

Charcot foot is a condition that affects the bones, joints, and soft tissue in the feet and ankles. Charcot foot is a disease that can happen in people who have nerve damage and some form of neuropathy. Most common cause of Charcot foot is from diabetes. When blood sugar levels are high over a long time, both nerve and blood vessel damage occurs in the feet. In rare cases, it is caused by other health problems.

Neuropathy secondary to nerve damage in the foot or ankle leads to numbness, pain, redness, and swelling. The symptomatic foot may feel hotter than the other foot. Typically, micro-trauma over time increases the chance that you could break bones in your foot or have another injury and not feel it. When your foot gets injured a lot, the joints can break down, and the foot can become deformed. Patients are typically not aware of this condition as it goes through acute phases simply because they cannot feel pain. Nerve damage makes it harder to notice the amount of pressure on the foot or if it is being stressed. The result is ongoing small injuries to the bones and ligaments that support the foot.

If you have severe Charcot foot, you may not be able to walk normally. The problem also increases the risk of foot ulcers and infections.

To prevent Charcot foot you need protect your feet as much as possible to keep them from being injured. If you already have Charcot foot, you may need to wear specials shoes, casts, walkers, or braces.

Causes

  • You may develop bone stress fractures in your feet, yet never know it.
  • Continuing to walk on the fractured bone often leads to further bone and joint damage.

Other factors leading to foot damage include:

  • Blood vessel damage from diabetes that can increase or change blood flow to the feet. This can lead to bone loss. Weakened bones in the feet increase the risk of fracture.
  • Injury to the foot signals the body to produce more inflammation-causing chemicals. This contributes to swelling and bone loss.

Symptoms

Early foot symptoms may include:

  • Mild pain and discomfort
  • Redness
  • Swelling
  • Warmth in the affected foot (noticeably warmer than the other foot)

At later stages, bones in the foot break and move out of place, causing the foot or ankle to become deformed.

  • A classic sign of Charcot is rocker-bottom foot. This occurs when the bones in middle of the foot collapse. This causes the arch of the foot to collapse and bow downward.
  • The toes may curl downward.

Bones that stick out at odd angles can lead to pressure sores and foot ulcers.

  • Because the feet are numb, these sores may grow wider or deeper before they are noticed.
  • High blood sugar also makes it hard for the body to fight infection. As a result, these foot ulcers become infected.

It is important to manage Charcot foot early on in the acute phases. In the chronic phase, patients may develop a rocker bottom type of foot. Rocker bottom shaped feet have a large chance of developing pressure ulcers. They typically occur in the mid arch region. These pressure ulcers are difficult to heal and may lead to soft tissue or bone infections. Treatment from a podiatrist is necessary and time sensitive.

Conservative Care

What types of Conservative care is available?

Most podiatry illness does not require surgical intervention. Surgery is always the last thought process and treatment plant. Surgeries do have risks inherently and should always be avoided unless medically necessary. Surgery should is right for you the symptoms/pain outweigh the surgical risks.

Some conservative managements are but not limited to:

  • Ankle Bracing
  • Compression dressing/Unna boot
  • Custom shoes
  • Exercises/Stretching
  • Laser
  • Injection
  • NSAIDs
  • Strapping/padding
  • Oral Medication
  • Orthotics
  • Physical Therapy
  • Topical Medication
  • Walking boot
Corns & Calluses

Corns and calluses are thick/hardened layers of skin. They develop naturally when your skin tries to protect itself against friction and pressure. They often appear on feet where the bony parts of your feet rub against your shoes. Corns usually appear on the tops or sides of toes while calluses form on the soles of feet. Corns and calluses can be unsightly.

If you are healthy with minimum comorbidities, treatment may only be necessary for corns and calluses if they cause significant discomfort. For most people, simply eliminating the source of friction or pressure makes corns and calluses disappear. Hammer toes, bunion, or other bony deformity can cause uncomfortable corns and surgical correction of a deformity can eliminate a corn.

If you have diabetes or another condition that causes poor blood flow to your feet, you’re at greater risk of complications from corns and calluses. Common problems include the formation diabetic foot ulcers. Seek your doctor’s advice on proper care for corns and calluses if you have such a condition.

Intractable plantar keratosis (IPK) can typically be misunderstood for a painful callous or corn. They are usually less than 1 cm, on the plantar aspect of the forefoot. Typically, IPKs develop beneath one of the lesser metatarsal heads or under another area of pressure. They tend to form a core that can be very painful like a thorn in the skin and can significantly impair gait. They can be removed without anesthesia in an office setting. They should not be confused with plantar warts and epidermal inclusion cysts.

Custom Orthotics

Custom Foot Orthotics
Orthotics are devices that are inserted into your shoes designed to relieve or prevent pain associated from the foot and ankle. Orthotics are made to support deformities, delay and possible prevent surgery. They are individually customized to each patient. There is over the counter inserts that are significantly less expensive and may suite some patient needs
We measure our orthotics using state of the art 3D technology we strive to give you the PERFECT fit to get you to go the extra mile.

Who should use orthotics?
Prescription Custom-made orthotics can offer relief for many different foot conditions. Among these include (but are many more):
• Heel pain
• Plantar fasciitis
• Arch pain
• High or low arched feet
• Diabetes-related pain
• Morton’s neuroma
• Pain due to injury or bunion
• In-toe, Out-toe
• Pain caused by running, walking, or any other sports
There are several categories of orthotics, here are some of the more common types:

High Endurance Athletes
In order to prevent foot and ankle injuries, we recommend a pair of athletic insoles for your sneakers. Orthotics for high endurance athletes tend to be more rigid and stiff to prevent deformation under large amount of stress. We make different orthotics designed for basketball, running, walking, golf, etc.
These custom athletic orthotics will take stress away from your feet, ankles, and even knees by absorbing the shock of impact during your athletic activity.

Accommodative Orthotics
These orthotics are designed for the average working day for 8+ hours. They tend to be made with a softer shell but still strong enough to support your arch under pressure. Accommodative orthotics are typically made with memory foam. For individuals that sweat a lot, an open cell foam is preferred for better moisture wicking and flow of air to help evaporate extra moisture. Everyone has experienced some sort of aching from standing on our feet all day.

Diabetic Orthotics
Proper shoes and diabetic orthotics are essential to diabetic foot care. Diabetic orthotics are designed with plastizote top covers, which is a memory foam that will disperse high pressure points or “hot spots”. Because of your changing chemistry and foot type, we highly recommend specific shoe gear and diabetic orthotics in order to accommodate your functional lifestyle.

Cost
Over the counter orthotics are very economical but may not serve everyone needs. Custom orthotics may range in the hundreds of dollars. Fortunately, most insurance plans do cover them with little to no out of pocket cost (varies by insurance). For example, Medicare B does NOT cover orthotics.
Feel free to give us a call for your options or coverage.

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Diabetic Foot Care

People with diabetes are very vulnerable to developing foot related problems. People who suffer from diabetes can have problems with circulation, nerves, immunity, and deformity. One in five people with diabetes who seek hospital care do so for foot problems. By taking proper care of your feet, many serious health problems associated with diabetes can be prevented.

Occasionally one or more of these may exist as an isolated issue but often people suffer from more than one at the same time.

• Circulation: People with circulation problems don’t have as much oxygenated blood supplying their feet as other individuals and therefore have difficulty healing any wounds.
• Nerves: Those who have nerve problems can develop a blister and often times not even know it is there until they take off their shoes.
• Immunity: Some individuals with diabetes have a diminished response of their immune system. Because of this, they can get an infection from a cut or blister more easily and have more difficulty treating it.
• Deformity: People who suffer from diabetes can have collapse of the arch of their foot or other deformities which makes the foot more difficult to place into off-the-shelf shoes because of the risk of blisters developing over areas of high pressure.

How can you care for yourself at home?
• Keep your blood sugar close to normal
• Do not smoke
• Eat a diet that is low in fats.
• Inspect your feet daily for blisters, cuts, cracks, or sores.
• Wash your feet every day.
• Dry your feet well.
• Keep your skin soft.
• Clean underneath your toenails carefully.
• It is not recommended for diabetic patients to cut their toe nails.
• Change socks daily
• Look inside your shoes every day.
• Buy shoes that fit well
• Break in new shoes slowly
• Do not go barefoot. Do not wear sandals.
• Have your doctor check your feet during each visit.
Always get early treatment for foot problems. A minor irritation can lead to a major problem if not properly cared for early.

When should you call for help?
• You have a foot sore, an ulcer or break in the skin that is not healing after 4 days, bleeding corns or calluses, or an ingrown toenail.
• You have blue or black areas, which can mean bruising or blood flow problems.
• You have peeling skin or tiny blisters between your toes or cracking or oozing of the skin.
• You have a fever for more than 24 hours and a foot sore.
• You have new numbness or tingling in your feet that does not go away after you move your feet or change positions.
• You have unexplained or unusual swelling of the foot or ankle.
• You cannot do proper foot care.

Diabetic neuropathy

When you have diabetes, your feet need extra care and attention due to complications such as diabetic neuropathy. Diabetes can damage the nerve endings and blood vessels in your feet preventing you from noticing when your feet are injured. Diabetes also limits your body’s ability to fight infection and get blood to areas that need it. If you get a minor foot injury, it could become an ulcer or a serious infection. With good foot care, you can prevent most of these problems.

Diabetic neuropathy can be very uncomfortable for many patients. There are many ways to manage the symptoms and prevent them from becoming worse. Consulting with a foot and ankle specialist can help treat Diabetic Neuropathy.

Diabetic Foot Ulcer

Diabetic Foot Ulcer (DFU)

Diabetes can damage the nerve endings and blood vessels in your feet and severely impair your sense of feeling. Meaning you are much less likely to notice when your feet have an injury. Typical skin problem on the feet like a callus, blister, or cracked skin can turn into a larger sore, called a diabetic foot ulcer. DFU mostly form on the forefoot but can form anywhere on the foot or ankle if there is a deformity present. You can also develop an ulcer at any boney prominences, such as at the top of the toe if there is a hammer toe.

DFUs can easily become infected as they are open wounds. Severe infections can lead to gangrene with amputation typically being necessary. The level of amputation, i.e. toes, foot or leg, varies depending on amount of infection, blood flow, and dead tissue.

DFUs are managed on a weekly basis to evaluate change or serial wound debridement. Wound debridement is necessary to continue to remove dead tissue to allow healthy tissue to grow in. While having a DFU, your foot wound should always be wrapped in a protective bandage. It is very important to keep your weight off your injured foot. After a foot ulcer has formed, it will not heal as long as you keep putting weight on the area.

Always get early treatment for foot problems. A minor irritation can lead to a major problem if it’s not taken care of soon.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments.

Call your doctor now or seek immediate medical care if:

• You have symptoms of infection
• Increased pain, swelling, warmth, or redness, Red streaks leading from the area.
• Pus draining from the area.
• A fever.

Watch closely for changes in your health, and be sure to contact your doctor if you have a new problem with your feet, such as:
• A new sore or ulcer.
• A break in the skin that is not healing after several days.
• Bleeding corns or calluses.
• An ingrown toenail.
• You do not get better as expected.

Diabetic Shoes

People with diabetes are more vulnerable to foot problems because diabetes can damage nerves and reduce blood flow to the feet. One in five people with diabetes who seek hospital care do so for foot problems. By taking proper care of your feet, many serious health problems associated with diabetes can be prevented.

Ensuring proper footwear is very important for diabetic patients. Fortunately diabetic shoes are covered by most insurances including Medicare B.

The shoes often need to be prescribed and fitted by foot and ankle specialist. Occasionally, an orthotist will be needed for custom shoes needed to accommodate deformities and partial amputations.
Diabetic shoes may be vary by design to have either a very stiff sole to a rocker bottom shape. Shoe are also designed to prevent seams are any prominent material to prevent blisters or diabetic ulcers.

There can be many benefits to wearing custom diabetic shoes:
• Relieve areas of increased pressure. This will prevent too much pressure in a specific area to prevent skin ulcerations.
• Reduce shock and shear. It is ideal to reduce shock vertically and reduce shearing of the foot which has an increased chance of developing blisters.
• Accommodate, stabilize and support deformities. Diabetic shoes will support your arch better as your arch may have collapsed over time and the shoes can help stabilize any other deformities.
 Limit motion of joints to prevent pain and to have a more stable foot for a natural gait.

F

Flat Feet

Flatfoot is defined when the arches of your feet are flattened and do not have a usual arch. This deformity causes the entire sole of your foot to touch the floor when you stand up. This issue is typically symmetrical in both feet, but can occur in only one foot in some adults. Most children have flatfeet until the age of 4, which is normal; a normal arch usually will start to develop after this age. So you should not be alarmed if your child’s foot is flat in a normal standing position. If your child has an in-toe or out toe, you should seek evaluation. If your child continue to have flatfeet after 4-5 years old, they most likely have inherited flat feet.

Flatfeet develop after an injury or from the simple wear-and-tear stresses of age. Having an injury, being very overweight, or having a condition such as rheumatoid arthritis or diabetes also can cause the arch to flatten.

Flatfoot usually is not a serious problem and can be painless in many patients. But some people do have pain if they gain weight or stand a lot. You or your child can have pain when walking or running. You or your child can do exercises and wear pads and roomy shoes to help support their feet.

Having flatfeet can sometimes contribute to problems in your ankles and knees because the condition can alter the alignment of your legs. When your feet are flat, the position of the joints of your foot and ankle become poorly aligned. Poorly aligned joints can lead to spurring, arthritis, muscle aches, tendonitis, plantar fasciitis, and generalized pain.

Watch closely for changes in your feet, and be sure to make an appointment if:
Watch closely for changes in your feet, and be sure to make an appointment if:
• You have pain in the feet or legs
• Your flatfoot appears to become worse
• You want help to find orthotics that are right for you.
Orthotics encourage a heathy positional alignment of the joints of your foot and ankle. They may help prevent pain and abnormal stress on your joints, tendons, and muscles.

Foot Fractures

Foot Fractures

A broken foot, or foot fracture, is a break in one or more of the bones in your foot. There are numerous causes of fractures including a sports injury, a fall, or other accident. A compound, or open, fracture occurs when a bone breaks through the skin. A break that does not poke through the skin is a closed fracture. Your treatment depends on the location and type of break in your foot.
You may need a splint, a cast, or an orthopedic shoe. Certain kinds of injuries may need surgery at some time depending on the amount of displacement or instability. Whatever your treatment, you can ease symptoms and help your foot heal with care at home. Depending on the type of fracture it may be necessary to be non-weight bearing or partial weight bearing with use of a crutches or walker. You may need 6 to 8 weeks or more to fully heal.
Noncompliance with fracture care can lead to non-unions which is incomplete healing of fractures. Treatment of non-unions may include surgery, additional immobilization, and bone stimulators.

Stress Fracture

A stress fracture is a thin, or hairline, crack in a bone. A stress fracture usually happens from repeated pressure on the foot, like running or jumping. You may need 6 to 8 weeks to heal.
Treatment depends on where the fracture is and how much pain it causes. Do not return to your usual exercises until your doctor says you can. Continued use of an injured foot can make the break worse or keep it from healing.

Compartment Syndrome
Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow. Compartment syndrome typically secondary to traumatic fractures and is considered a medical emergency.
Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, similar to the way in which insulation covers wires.
Fascia do not expand. Any swelling in a compartment will lead to increased pressure in that area. This raised pressure, presses the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the arm or leg will no longer be functional. Surgery or even amputation may be done to correct the problem.
Acute compartment syndrome may be caused by:
• Trauma, such as a crush injury or surgery
• Broken bone
• Very bruised muscle
• Severe sprain
• A cast or bandage that is too tight
• Loss of blood supply due to the use of a tourniquet or positioning during surgery
Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running. The pressure in a compartment only increases during that activity and goes down after the activity is stopped. This condition is usually less limiting and does not lead to loss of function or limb. However, the pain can limit activity and endurance.

Foot Surgery

Many foot problems do not respond to “conservative” management. We can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

What are the different types of foot surgery?

• Fusions
• Tendon Surgery
• Metatarsal Surgery
• Bunion Surgery
• Hammer Toe Surgery
• Neuroma Surgery
• Heel Surgery
• Reconstructive Surgery

G

Gout

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. Gout is a complex form of arthritis caused by a buildup of uric acid crystals in a joint. It causes sudden attacks of pain, swelling, redness, and stiffness in any joint but usually in the big toe.

Gout can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable. Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

Gout usually comes on without a cause. But it can be brought on by drinking alcohol or eating seafood and red meat. Taking certain medicines, such as diuretics or aspirin, also can bring on an attack of gout.

Taking your medicines as prescribed and following up with your doctor regularly can help you avoid gout attacks in the future.

Treatment
If the joint is swollen during an acute attack, put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. Do not apply ice if you are not having an attack as it make increase the amount of gouty crystal formation.

Prop up the sore limb on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.
Rest sore joints. Avoid activities that put weight or strain on the joints for a few days. Take short rest breaks from your regular activities during the day.

Take your medicines exactly as prescribed. Chronic medications for management of gout include Allopurinol.

Take pain medicines exactly as directed. Some medications to manage acute gout attacks include Colchicine and Indomethacin.

Follow up with us within the first 48 hours of attack as a local site injection may significantly improve acute attacks and improve your recovery.

Prevention
Eat less seafood, red meat, aged cheese and reduce or cease alcohol consumption.
Losing weight, if you are overweight, may help reduce attacks of gout. But do not go on a “crash diet.” Losing a lot of weight in a short amount of time can cause a gout attack.

H

Hallux Rigidus

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time, it gets increasingly harder to bend the toe. Hallux refers to the big toe, while rigidus indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.

This disorder can be very disabling since we use the big toe whenever we walk, stoop down, climb up or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called hallux limitus. But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of rigidus, in which the big toe becomes stiff or what is sometimes called a frozen joint.

Causes
Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from wear and tear—often develops in people who have defects that change the way their foot and big toe functions.

Symptoms
Early signs and symptoms include:
• Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
• Pain and stiffness aggravated by cold, damp weather
• Difficulty with certain activities (running, squatting)
• Swelling and inflammation around the joint

As the disorder gets more serious, additional symptoms may develop, including:
• Pain, even during rest
• Difficulty wearing shoes because bone spurs (overgrowths) develop
• Dull pain in the hip, knee or lower back due to changes in the way you walk
• Limping (in severe cases)

Conservative measures
In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include:
 Shoe modificationsOrthotic devices. Custom orthotic devices may improve foot function.
• Medications.
• Injection therapy.
• Physical therapy.

Surgery:
In some cases, surgery is the only way to eliminate or reduce pain. Several types of surgery are available for treatment of hallux rigidus. A comprehensive surgical plan would be made based on clinical exam, x-rays, bone quality, lifestyle, and age. Feel free to discuss options with your doctor!

Hammer Toes

Hammertoe is a deformity of any toe that bends at the middle or distal joint. With this condition, the toe is bent at the middle joint, resembling a hammer. Deformities can slightly vary from each toe. The contracture can happen at either of the small joints in the toe. A hammer toe can hurt a lot, especially as the toe rubs against your shoe when you walk. Shoes that are too tight can cause hammer toes. If a shoe forces a toe to stay bent for a long time, the muscles in your toe get tight and the tendons that connect the muscles to the bone get shorter. Over time, the muscles cannot straighten your toe. Sometimes, diseases such as rheumatoid arthritis also can cause hammer toes.

Early treatment can help your toe straighten before it gets badly bent. You can wear roomy shoes and use pads to keep the toe from rubbing against your shoes. If your toe is badly bent, you may need surgery to straighten it.

Hammer toe surgery straightens a curled toe that causes problems and does not get better with other treatment. The surgery consists of one or more small cuts or incisions on your deformed toe joint. During the surgery, the tendons may be lengthened, shorted, cut, or change position to help correct the deformity. A piece of bone is typically removed, the joint is either left alone (arthroplasty) or your small toe joint may be held together with a screw or pin to fuse the joint. A pin or wire may stay in your toe, or it may be removed after about 3 to 6 weeks. Sometimes a pin is placed so that it sticks out the end of your toe. Then it can be removed without another surgery.

Hammer toe surgery is typically is a quick recovery with little complications.

Heel Spurs

heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as “heel spur syndrome.”

I

Ingrown Nail

An ingrown toenail often occurs because a nail is not trimmed correctly or because shoes are too tight. An ingrown nail can cause an infection. It is a very common issue involving the pediatric population, but can still occur in the adult population. The issue usually arises due to poor nail trimming habits. You should trim toenails straight across, so the ends of the nail grow over the skin and not into it. When trimming your nails you should easily be able to see both corners of you nail.

Good nail care can prevent ingrown toenails.

• Trim the nails straight across. Leave the corners a little longer so they do not cut into the skin.
• Do not use manicure scissors to dig under the ingrown nail. You might stab your toe, which could get infected.
• Do not trim your toenails too short.
• Check with your doctor before trimming your own toenails if you have been diagnosed with diabetes or peripheral arterial disease. These conditions increase the risk of an infection, because you may have decreased sensation in your toes and cut yourself without knowing it.
• Wear roomy, comfortable shoes.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

When should you call us for help?

You have signs of infection, such as:
• Increased pain, swelling, warmth, or redness.
• Red streaks leading from the toe.
• Pus draining from the toe.
• A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected

Treatment

Some ingrown toenails can be treated at home with soaking your toe in warm water for roughly 15 minutes and allowing the nail to grow out naturally. Trim your nail straight across without trying to dig out the corners. Allow the nail to grow out until you are able to visualize the corners of you nail. If your toe becomes infected, you may need to be prescribed antibiotics.

Nail avulsion is the most common surgical procedure performed on the nail unit. It is the excision of the body of the nail plate from its primary attachments. Avulsion of the nail plate may be initially performed to allow full exposure of the nail matrix before chemical or surgical matricectomy. Other indications for performing nail avulsion are to treat recalcitrant onychocryptosis

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems.

L

Leg Pain

Shin Splints

The term “shin splints” refers to pain along the shin bone or Tibia. The tibia is the large bone in the front of your lower leg. The pain of shin splints is from the inflammation of the muscles, tendons, and bone tissue around your shin. Shin splints are common in runners, dancers and military recruits. Shin splints often occur in athletes who have recently intensified or changed their training routines. Shin splints are more common with athletes who run on harder surfaces such as concrete vs grass. The increased activity overworks the muscles, tendons and bone tissue.

Common activities that cause shin splints are:

• Running, especially on hills. If you are a new runner, you are at greater risk for shin splints.
• Increasing your days of training.
• Increasing the intensity of training, or going a longer distance.
• Doing exercise that has frequent stops and starts, such as dancing, basketball, or military training.
Most cases of shin splints can be treated with rest, ice and other self-care measures. Wearing proper footwear and modifying your exercise routine can help prevent shin splints from recurring.

Varicose Veins

Varicose veins are swollen, twisted veins that you can see just under the skin. They are most common in the legs, but also can form in other parts of the body. Your veins are comprised of one-way valves that help keep blood flowing toward your heart. If the valves are damaged or weakened, blood can back up and pool in your veins. This causes the veins to swell, which can lead to varicose veins. Varicose veins are common to be quite painful.

Varicose veins are very common and have higher risk if you are older, female, obesity, don’t exercise, or have a family history of varicose veins. They can also be more common in pregnancy.

Exercising, losing weight, elevating your legs when resting, and not crossing them when sitting can help keep varicose veins from becoming worse. Compression socks manage varicose veins very well. If varicose veins become too painful, you may want to consider removing them with a vascular surgeon.

Cellulitis

Cellulitis of your lower extremity is an infection of the skin and deep underlying tissues. Group A strep (streptococcal) bacteria are the most common cause of cellulitis. The bacteria typically enter your body through an injury such as a bruise, burn, surgical cut, or wound.

Symptoms include
• Fever and chills
• Swollen glands or lymph nodes
• A rash with painful, red, tender skin. The skin may blister and scab over.
Cellulitis is managed with antibiotics and may require admission if they become severe.

Blood Clots

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein clots occur in the lower leg or thigh, but can occur anywhere. A deep vein thrombosis can break loose and cause a serious problem in the lung, called a pulmonary embolism.

Sitting still for a long time can make you more likely to get a DVT. Some medicines and disorders that increase your risk for blood clots can also lead to DVTs.

Common symptoms are
• Warmth and tenderness over the vein
• Pain or swelling in the part of the body affected
• Skin redness

Treatment includes medicines to ease pain and inflammation, break up clots and keep new clots from forming. Keeping the affected area raised and applying moist heat can also help. If you are taking a long car or plane trip, take a break, walk or stretch your legs and drink plenty of liquids.

DVTs require a venous duplex for definitive diagnosis. If you are unable to see your doctor, proceed to the ER for an evaluation.

M

Metatarsalgia (forefoot pain)

Metatarsalgia is a common condition of the forefoot in which the ball of your foot becomes painful and inflamed. You might develop metatarsalgia if you participate in activities that involve running and jumping. Other causes including foot deformities and poorly fitted shoes.

Properly fitted shoes with good support or insoles can help prevent metatarsalgia.

Symptoms
Symptoms of metatarsalgia can include:

• Sharp, aching or burning pain in the ball of your foot.
• Pain that worsens with any activity and improves when you rest
• Sharp or shooting pain, numbness, or tingling in your toes
• A feeling of having a pebble in your shoe

Causes
Metatarsalgia is typically caused by several issues:

 Intense training or activity. Distance runners are at risk of metatarsalgia, primarily because the front of the foot absorbs significant force when a person runs. But anyone who participates in a high-impact sport is at risk, especially if your shoes fit poorly or are worn.
• Certain foot shapes. A high arch can put extra pressure on the metatarsals. So can having a second toe that’s longer than the big toe, which causes more weight than normal to be shifted to the second metatarsal head.
 Foot deformities. Wearing too-small shoes or high heels can cause your foot to be misshapen. A downward-curling toe (hammertoe) and swollen, painful bumps at the base of your big toes (bunions) can cause metatarsalgia.
• Excess weight. Because most of your body weight transfers to your forefoot when you move, extra pounds mean more pressure on your metatarsals. Losing weight might reduce or eliminate symptoms.
• Poorly fitting shoes. High heels, which transfer extra weight to the front of your foot, are a common cause of metatarsalgia in women. Shoes with a narrow toe box or athletic shoes that lack support and padding also can contribute to the problem.
• Stress fractures. Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot.
• Morton’s neuroma. This noncancerous growth of fibrous tissue around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are similar to metatarsalgia and can also contribute to metatarsal stress.
• Fat pad atropy. Thinning of the protective fat pad of the forefoot causing direct contact of the ground and the heads of your metatarsals.

Risk factors
Almost anyone can develop metatarsalgia, but you’re at higher risk if you:

• Participate in high-impact sports that involve running and jumping
• Wear high heels, shoes that don’t fit properly or shoes with spikes, such as cleats
• Are overweight
• Have other foot problems, including hammertoe and calluses on the bottom of your feet
• Have inflammatory arthritis, such as rheumatoid arthritis or gout

Complications

Left untreated, metatarsalgia might lead to pain in other parts of the same or opposite foot and pain elsewhere in the body, such as the low back or hip, due to limping from foot pain.
Treatments usually include anti-inflammatory, high grade orthotics, or better shoe gear.

N

Nail Fungus

Onychomycosis, commonly known as a fungal nail infection, is infection of the fingernails or toenails by forms of fungi or yeast. Fungal nail infections are the most common disease of the nails and account for nearly one-half of all nail disorders. In the most common form of fungal nail infections, fungus grows under the growing portion of the nail and then along the nail bed and the grooves on the sides of the nails. A toenail that is infected by a fungus usually turns white or yellow. As the fungus spreads, the nail turns a darker color and gets thicker, and its edges start to turn ragged and crumble. A bad infection can cause toe pain, and the nail may pull away from the toe. Thickened nails can easily separate from the nail bed along to have a buildup of debris, bacteria and dead skin.

Toenails that are exposed to moisture and warmth a lot are more likely to get infected by a fungus. This can happen from wearing sweaty shoes often and from walking barefoot on shower floors.

Fungal nail infection may occur at any age but is more common in adults, particularly in older individuals. Diabetics may be more likely than other people to develop a fungal nail infection.

Fungal nails are very hard to treat, and the infection can return after it has cleared up. But medicines and treatment can sometimes get resolve of toenail fungus for good. If the infection is very bad, or if it causes a lot of pain, you may need to have the nail removed.

• In general, toenails are most commonly affected with fungal nail infection. If the fingernails are affected, the toenails are usually affected as well. Nails often become thicker and lift from the nail bed (onycholysis) starting at the growing portion of the nail. You might then see debris under the nails and discoloration of the affected area.
• In some forms of fungal nail infection, you might see black or white, powdery discoloration on the surface of the nail plate.
• In some forms of fungal nail infection, you might see these abnormal changes farther up the finger (proximally), where the nail originates.
• In fungal nail infection, one, a few, or all nails may be affected.

Treatment

  • Topical therapy with ciclopirox nail lacquer, which requires daily application for 9–12 months.\
  •  Oral antifungal treatments offer the best chance for curing fungal nail infection. The medications may cause liver problems or may affect blood cell counts. Blood tests are usually performed before starting therapy and during therapy to look for possible side effects.
  • In stubborn (refractory) fungal nail infection, surgical removal of part of the nail or the entire nail.
  • Nail Laser Therapy

Nail fungus (onychomycosis) can easily be confused with onycholysis, and dystrophic nails not caused by fungal elements.

Nail LASER Therapy

Elizabeth Foot & Ankle Associates is now offering PinPointe Laser Nail Therapy for toenail fungus to treat those stubborn fungal nails at an affordable cost! This cutting-edge technology can transform your discolored and disfigured nails into clearer, healthier looking nails. The FDA approved PinPointe Foot Laser, penetrates under the nail without damaging the nail or surrounding tissue.

Treatment is

  • Safe and effective
  • in-office toenail treatment (no anesthesia required)
  • pain free
  • no harmful side effects
  • typically takes only 45-minutes to complete
  • 85% success rate
  • Treatments are typically ONE SESSION. You may however need additional sessions 3-6 months later.

Post treatment instructions are essential to the prevention of recurrent fungal nails:

  • continuation of topical nail solutions
  • antifungal creams
  • antifungal sprays

You will see the results of the laser treatment a few months later, once the new nail grows out.

Contraindications:

  • Pregnancy is NOT a contraindication
  • Severe diabetic neuropathy (numbness)
  • Dermatological conditions that mimic fungal nails such as psoriasis
  • subungal hematoma (acute trauma to the nail)

Please contact our office to schedule your consultation.

Neuroma

Morton Neuroma

Neuroma is typically an injury to a nerve that may cause the never tissue to thicken. Anything irritation, regardless if the forces or external or internal, can lead to the development of a neuroma. The compression, will cause the nerve to enlarge with inevitable nerve damage.

The most common neuroma is a Morton’s Neuroma. Morton’s Neuroma occurs between the third and fourth toes. It commonly affects the nerve that travels between the 3rd and 4th toes. Neuromas on other parts of the foot are also possible, but less likely.

Causes

People with foot deformities such as bunion, hammer toes, flat feet, and flexible feet are more likely to have neuromas form. Also, people who wear very tight or tapered shoes may have a high incidence of neuromas. Other causes can include high endurance sports such as runners and generic trauma. Morton’s neuroma is more common in women than men.

Symptoms

• Tingling in the space between the 3rd and 4th toes
• Toe cramping
• Sharp, shooting, or burning pain in the ball of the foot and sometimes toes
• Pain that increases when wearing tight shoes, high heels, or pressing on the area
• Pain that gets worse over time

Diagnosis

Although, many doctors can diagnosis Morton’s neuroma in a clinical setting, MRI is the gold standard for diagnosis.

Treatment

• Injection of the neuroma
• Padding and taping the toe area
• Shoe inserts (orthotics)
• Changes to footwear, such as wearing shoes with wider toe boxes or flat heels
• Anti-inflammatory medicines taken by mouth or injected into the toe area
• Nerve blocking medicines injected into the toe area
• Other painkillers

If conservative therapy fails, there are surgical options to remove the neuroma.

P

Pediatric Care

Growing pains

Severs

Sever’s disease is a pediatric condition that consists of swelling and irritation of the growth plate in the heel. The growth plate consist of cartilage and is located in the back of the heel bone in regards to the calcaneus. The growth plate is typically weaker and more at risk for injury than the rest of the bone.

Sever’s disease symptoms

– swelling and redness in the back of the heel
– stiffness in the feet in the morning
– limping and toe walking
– pain when the heel when squeezed

Symptoms are usually worse during activity and improve with rest. Sever’s disease can only occur during the growth spurt of puberty. During a growth spurt, the bones, muscles, and tendons grow at different rates. The muscles and tendons pull excessive force on the growth plate in the heel as a result of the long bones of the legs growing too quickly. This injury leads to the pain of Sever’s disease.

Sever’s disease typically happens in kids who are:

– in their growth spurt
– activity in sports or activities that involve a lot of running or jumping, especially on hard surfaces

Treatment includes NSAIDS and limitation in physical activity for a few weeks.

Ingrown nails
– Very common pediatric condition typically caused by improper management of toe nail trimming.
– See ingrown nail description

In-toe/Out-toe
In-toeing is referred to as a tendency for feet to turn inward or “pigeon-toed”, while out-toeing is the tendency for feet to point outward.

Causes

– Tibial torsion
– metatarsus adductus
– femoral anteversion

In-toe and out-toe can sometimes be addressed with bracing or orthotics with a gait plate at a young age.

Toe walking
Toe walking is a condition when children walk on the balls/forefoot of their feet. Toe walking is a fairly common in many children in early stages of walking. Typically children outgrow this condition.

If toe walking continues after toddler years, it should be addressed. Toe walking sometimes can result from certain conditions, including cerebral palsy, muscular dystrophy and autism spectrum disorder. Other conditions that are occur with normal development include tight leg muscles, stiffness in the Achilles tendon or a lack of muscle coordination.

In a few cases, toe walking is caused by an underlying condition, such as:
– A short Achilles tendon
– Cerebral palsy
– Muscular dystrophy
– Autism

Plantar Fasciitis

Plantar fasciitis

 Plantar fasciitis is pain and inflammation of the plantar fascia. Plantar fascia is comprised of tissue at the bottom of your foot that connects the heel bone to the toes. The plantar fascia is a thick fascial band and is a significant contributor to supporting your arch. Plantar fasciitis is one of the most common causes of heel pain.

Plantar fasciitis commonly causes stabbing/sharp pain that usually occurs with your first steps in the morning. As you day progresses, the pain typically decreases. Attacks may re-occur after long periods of standing or after rising from sitting.

The pain is often worse:

  • In the morning when you take your first steps
  • After standing or sitting for awhile
  • When climbing stairs
  • After intense activity
  • During walking, running, and jumping sports

 Plantar fasciitis is common in athletes and can be caused by running or other sports. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis. You may get plantar fasciitis if you walk or stand for long periods, or have a tight Achilles tendon or calf muscles. Plantar fasciitis is seen in both men and women.

You are more likely to get plantar fasciitis if you:

  • Have foot arch problems (both flat feetand high arches)
  • Run long distances, downhill or on uneven surfaces
  • Are obese or gain weight suddenly
  • Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel)
  • Wear shoes with poor arch support or soft soles
  • Change your activities

 You can improve your foot pain with rest and other care at home. It might take a few weeks to a few months for your foot to heal completely.

When the pain becomes significant, further treatment and proper diagnosis may be necessary with x-rays and MRI. Occasionally, people may have partial or complete tears of the plantar fascia that can be easily confused for plantar fasciitis.

Heel spurs can typically occur after experiencing chronic plantar fasciitis. They are boney ingrowth from the heel bone (calcaneus) into the plantar fascia. Heel spurs are typically a secondary response to inflammation and pain and are not a contributing factors to pain.

Plantar Wart

A plantar wart is a viral infection that results in a harmless skin growth. Plantar warts are a specific type of wart that occurs on the bottom of your feet. Plantar warts are typically very painful when you walk. A virus makes the top layer of skin grow quickly, causing a wart. Plantar warts are caused by direct contact with the human papilloma virus (HPV) and is in the same family of warts on other areas of the body. Warts sometimes go away on their own in months or even years.

There are two types of plantar warts:

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional satellite warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

The symptoms of a plantar wart may include:

 Thickened skin. A plantar wart often resembles a callus because of its tough, thick tissue.
• Pain. Walking and standing may be painful. Squeezing the sides of the wart may also cause pain.
• Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the capillaries (tiny blood vessels). Plantar warts grow deep into the skin. Usually, this growth occurs slowly with the wart starting small and becoming larger over time.

Treatment includes over-the-counter medication like salicylic acid or even duct tape. Stronger medicine or treatment maybe indicated effectively eliminating warts in a short amount of time and include inject them with medicine, removing warts through surgery, or by freezing them.

Warts are spread easily. You can infect yourself again by touching the wart and then touching another part of your body. You also can infect others by sharing towels, razors, or other personal items.

Poor Circulation

PAD/PVD
Peripheral artery disease (PAD) is poorly functioning blood vessels that supply the legs and feet. PAD occurs due to narrowing of the arteries in the legs resulting in decreased blood flow, which can injure nerves and other tissues.

PAD is caused by atherosclerosis that occurs when fatty material or plaques builds up on the walls of your arteries and makes them narrower. As a result, the walls of the arteries also become stiffer and cannot widen. Poor delivery of oxygen rich blood and the oxygen demand of the tissue cannot be supplied. Muscles cannot be adequately supplied and requires much more work, resulting in pain and other symptoms.

PAD is a common disorder. It most often affects men over age 50, but women can have it as well.

People are at higher risk if they have a history of:

• Abnormal cholesterol
• Diabetes
• Heart disease
• High blood pressure
• Kidney disease
• Smoking
• Stroke

Lymphedema

Lymphedema is a type of swelling that occurs in your body’s soft tissue. Lymph is a fluid that comprised of white blood cells that defend against germs. It can build up when the lymph system is damaged or blocked. It usually happens in the arms or legs.

Causes of lymphedema include
• Infection
• Cancer
• Age
• Poor valves in the veins
• Liver disease
• Kidney disease

Treatment can help control symptoms. It includes exercise, compression devices, compressive dressings, skin care, and massage. Many insurances insurance cover lymphedema pumps but require a physician to prescribe the devices.

ABI PVR

Pulse Volume Recording (PVR) is a vascular test that is non-invasive, pain free, and can be done in an outpatient setting. PVR uses and ultrasound device and blood pressure cuffs to obtain information about the arterial blood flow in the arms and legs. Other names include vascular study or Doppler segmental pressure study.
The ankle brachial index (ABI) is a measurement of the blood pressure in the lower leg relative to the blood pressure in the arm. Blood pressure cuffs are placed on the arm and leg and inflated, while the Doppler is used to listen to the blood flow in the leg and arm. Normally, the blood pressures in your ankle and arm should be about equal. But if the pressure in your lower extremities is lower than of your arms, it could be a sign of PVD.

We perform this service at our Elizabeth location.

Gangrene

Gangrene is the death of tissues in your body. Gangrene occurs when a part of your body loses its blood supply and dies. Gangrene can occur anywhere but is common in the toes and feet.

Causes include:
• Trauma
• Poor circulation
• Diabetes

Skin symptoms may start with blue or black color changes followed by pain, numbness, and sores. Eventually the area will become black and may produce a foul-smelling discharge.

Gangrene is a serious condition and requires immediate attention and it may become infected. Treatment includes surgery, antibiotics, and hyperbaric oxygen therapy. In severe cases an amputation may be necessary.

Hyperbaric Medicine
During Hyperbaric oxygen therapy, the amount of oxygen in your body is increased, thus increasing the blood oxygen levels. These increased levels can help promote healing and fight infection.

We perform hyperbaric oxygen therapy at our Elizabeth location.

Posterior Tibial Tendonitis

Posterior tibial tendon dysfunction or PTTD is one of the most common problems of the foot and ankle. PTTD occurs when the posterior tibial tendon becomes inflamed, partially torn or even ruptured. As a result, the tendon may not be able to provide stability and support for the arch of the foot, resulting in flatfoot. The posterior tibial (PT) tendon serves as one of the major structures for walking. The PT tendon provides strength, stability and supports the arch of the foot.

PTTD typically affected middle age adults and female more than men. It is also called adult acquired flat foot. PTTD is the most common cause of acquired flat feet during adulthood. The disease is usually progressive and worsens over the years.

The major cause of PTTD is overuse of the PT tendon or pronation. Overweight and trauma can be a major contributor as well. Symptoms include pain, swelling, inward rolling of your ankle, and flatfoot. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. Due to the poor position of the foot and ankle joints, you are prone to developing arthritis as well.

Most patients can be treated without surgery, using orthotics and braces. If orthotics and braces do not provide relief, surgery can be an effective way to help with the pain. Surgery might be as simple as removing the inflamed tissue or repairing a simple tear. Advanced tissue grafts can significantly reduce swelling and increase healing as well. Patients will require aggressive physical therapy with or without surgery to improve function and recover.

PRP Injections

Platelet Rich Plasma injection is a type treatment used to treat injuries that occur to tendons, ligaments muscles and joints. Injuries can be from sports to every day wear and tear pain.

Plasma is the liquid part of your blood and provides a medium for you red/white blood cells and platelets to move throughout your circulatory system. Platelets are a type of blood cell that forms blood clots and play a role in healing. PRP is product produced from the blood collected from yourself and spun down in a centrifuge. The end product (serum) is very high concentrate of platelets and other positive growth factors. The serum is then injected into the site of injury. Growth factors are released to will help the site of injury repair with renewed tissue while also triggering your body’s healing process. PRP has a positive effect on damaged ligaments, tendons, muscle and other soft tissue structures, but preventing more invasive surgery.

Treatment may be one injection or you may require a series of injection depending on the extent of the injury.

S

Stem Cell Injection

Stem Cell Therapy/Injection

Stem cell therapy or Bone marrow aspirate works similar to Platelet Rich Plasma (PRP). It can be used to treat tendonitis, sprained ankles, inflamed ligaments, joint diseases and several other diseases. Stems cells are considered to be the body’s raw material and are cells that can differentiate to any type of cells. Stem cells can be replicated and differentiated to any specialized cell to serve a more specific function. Stem cells can become muscle cells, nerve cells, tendons or muscle. Certain structures have a difficult time healing due to poor circulation or extent of the injury and Stem cell injection can help aid the recovery of these structures. Stem Cells are collected from yourself in the operating room, processed, and re-injected to the area of injury. Stem Cell Injection helps the body have a natural speedy recovery preventing the patient from having a more invasive surgery.

Treatment may be one injection or you may require a series of injections depending on the extent of the injury; However, in general, stem cell therapy is a single injection treatment. Not all patients are candidates for stem cell injection, so they would consider PRP instead.

Sweaty-Dry Feet

Hyperhydrosis

Hyperhidrosis is a medical condition due to excessive sweating. Sweating is a natural condition for our body to prevent overheating. Occasionally, this system is poorly regulated. Major areas often affected are the palms, soles and armpits. Excessive sweating of the feet can lead to serious discomfort and skin changes as well as paving the road for opportunistic infections such as athlete’s foot and erythrasma. Patients with hyperhidrosis may need to change their socks several times a day.

Hyperhyosis can be medically managed several ways including over the counter medications, prescription medication and even serial injections.

Xerosis

Xerosis is a dry skin condition when your skin does not produce enough sweat and oil. This issue can affect anyone at any age. Diabetics are especially vulnerable to xerosis.

Symptoms:
• Scaling, flaking or peeling skin
• Rough skin
• Tightness
• Itching
• Crack of the skin, especially the heel

Dry skin can be caused by:

• Cold/dry winter air
• Excessive washing
• Soaps
• Other skin diseases
• Secondary to medication
• Diabetes
• Aging

T

Tendinitis

Tendons are flexible bands of tissue that connect muscles to bones. They help your muscles move your bones. Tendinitis is the severe swelling of a tendon. Tendinitis is inflammation of a tendon caused by overuse or injury of a tendon. It causes pain and soreness around a joint. Tendinitis can occur at any age but are more common in older individuals due to the loss of elasticity and overall structure. There are several types of tendinitis in the foot and ankle but the two most common are: Achilles tendinitis and posterior tibial tendinitis.

Tendinitis depending on its severity and location can be treated with a variety of stretching/exercises, injections, orthotics, and even surgery.

Tendonosis is similar to tendinitis and is sometimes referred to chronic tendinitis. Tendonosis is the breakdown of the tendons at the cellular level without any obvious inflammation.