Foot and Ankle Solutions

 Achilles Tendinitis  "The pain in the back of my leg has been increasing the last few months. I can feel a bump along my achilles." Achilles Tendinitis-Non-Insertional The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Non-insertional tendinitis involves the middle portion of your achilles. It can feel like a bump in the middle of your calf. The leg typically hurts when you move your ankle in an upward position(dorsiflex). Causes   There is not one cause of achilles tendinitis. Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon . Systemic conditions such as sarcoidosis, RA, MS, SLE can also contribute. Symptoms Common symptoms of Achilles tendinitis include: Pain and stiffness along the Achilles tendon in the morning Pain along the tendon or back of the heel that worsens with activity...

Treatment of Swollen Legs(Varicose Veins)?   Venous insufficiency(most common cause of swollen legs) Swelling of the ankles and feet is often an early symptom of venous insufficiency, a condition in which blood inadequately moves up the veins from the legs and feet back to the heart. Normally, the veins keep blood flowing in the correct direction with the help of one-way valves. When valves become insufficient, they allow leaking of fluid from the vein to the soft tissues Chronic venous insufficiency can lead to skin changes, skin ulcers and infection. If you experience signs of venous insufficiency you should seek medical advice. Elevation Compression Topical treatments Treatment of secondary infection, when present Elevating the leg above the level of the heart decreases venous hypertension and edema, is appropriate for all patients, and should be done a minimum...

What is a Hammertoe "Crooked Toe"? Causes: Hammertoe is a common foot deformity that occurs most often in women who wear high heels or shoes with a narrow toe box. These types of footwear may force your toes against the front of the shoe, causing an unnatural bending. What is it? A hammertoe has an abnormal bend in the middle joint of a toe. Moving the affected toe may be difficult or painful. Corns and calluses can result from the toe rubbing against the inside of your shoes. These corns often present on the top of the toe or in between the toes(interspace). Treatment: There are few conservative options for hammertoes. Over the counter corn pads may help alleviate the symptoms and allow you to perform your daily activities. Custom molded orthotics can help control the biomechanics of your feet which can slow down the progression of the hammertoe. Surgery should be considered once all conservative options have failed and your daily activities are becoming a...

Toenail Fungus Fungal nail infection is a fungus growing in and around your fingernail or toenail. Causes Fungi can live on the dead tissues of the hair, nails, and outer skin layers. You can get fungal infections anywhere on your body. Nails, scalp, jock itch, athletes foot. Fungal nail infections often start after a fungal infection on the feet. They occur more often in toenails than in fingernails. And they are most often seen in adults as they age. You are at higher risk of getting a fungal nail infection if you: Have minor skin or nail injuries Have a deformed nail or nail disease Have moist skin for a long time Have immune system problems Wear footwear that does not allow air to reach your feet Symptoms Symptoms include nail changes on one or more nails (usually toenails), such as: Brittleness Change in nail shape Crumbling of the outside edges of the nail Debris trapped under the nail Loosening or lifting up...

Posterior Tibial Tendon Dysfunction What is Posterior Tibial Tendon Dysfunction(AKA PTTD?)   PTTD occurs when the posterior tibial tendon becomes inflamed or torn. Flatfoot can be a result of or contribute to PTTD. The job of the PT tendon is to support your arch. If you have a tendency to over-pronate then this tendon can become overworked and incompetent.  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. PT inflammation or overuse is usually the cough, not the pneumonia, so-to-speak. PTTD can be a result of abnormality biomechanics and may need more complicated surgery to correct these abnormalities. Anatomy The posterior tibial tendon is one of the most important tendons of the leg. A tendon attaches muscles to bones, and the pos...

ESWT What is Extracorporeal Shockwave Therapy? Extracorporeal Shockwave Therapy treatment is a highly effective treatment available for patients with chronic tendon disorders, and is used widely by Sports Physicians & Orthopaedic Surgeons.    Shockwave therapy is a non surgical treatment, and works by delivering impulses of energy(via sound waves), targeted to specific damaged tissues within the abnormal tendon. This increases the blood flow within the affected area, stimulating cell regeneration and healing, and decreasing local factors which can cause pain. How shockwave therapy works A probe is pressed on to the affected area and the shockwaves are delivered through the skin (a gel like substance is also applied to the area to promote the process)       The impulses are delivered through the skin as a shockwave that spreads inside the injured tissue as an aspherical ‘radial' wave. These radial ...

Insertional Achilles Tendinitis ​What is insertional Achilles tendinitis? Typically there is a triad-- Haglunds deformity (bone spur on back of heel), Insertional achilles tendinitis (inflammation along achilles at its insertion), and r etrocalcaneal bursitis (inflammation of bursa). What are the symptoms? Most patients report the gradual onset of pain and swelling at the Achilles tendon insertion into the back of the heel bone without specific injury. At first, the pain is noted after activity alone, but becomes more constant over time. The pain is made worse by jumping or running and especially with sports requiring short bursts of these activities. There is tenderness directly over the back of the heel bone and often there is a bone prominence at this area. Positioning the ankle above a 90 degree position is limited by pain. What causes insertional Achilles tendinitis? The cause is primarily a degeneration of the tendon. The average patient i...

 Haglunds Deformity footandanklesolution.com   Q: " Can anyone suggest a flexible neutral shoe that has a heel that doesn't dig into the achilles? Ideally would be heel drop of over 7mm, but most important is whether the shoe is flexible." A:  Cutting the heel counter allows the the hindfoot to be more mobile than normal and can cause achilles or lateral ankle issues. I wouldnt recommend it. I would recommend a heel raise pad or orthotics with heel raise. any more questions about conservative treatment or surgical procedures if pain persists just ask. Q:  It's painful to the touch, but I can still run. I'm trying to fix the problem before it becomes a bigger issue. This can be a difficult condition to treat. Is there a bump on the back of your heel at the achilles attachment(specifically more laterally or toward the outside?) is it painful mostly along the outside of your skin and achilles or is the pain on the bump or is it deeper...on the ins...

Athlete's Foot - Treatment Overview "My feet are itchy, have redness, smell and nothing seems to be working. What else can I do?" footandanklesolution.com How you treat athletes foot(tinea pedis) depends on its type and severity. Most types of athletes foot can be treated at home and with OTC creams. If itchy, redness, maceration continue please seek medial attention. If you have diabetes or neuropathy and see skin that looks red and has foul odor, please seek medical attention. Nonprescription antifungals usually are used first. These include clotrimazole (Lotrimin), miconazole (Micatin), terbinafine (Lamisil), and tolnaftate (Tinactin). Nonprescription antifungals are applied to the skin (topical medicines). Prescription antifungals may be tried if nonprescription medicines are not successful or if you have a severe infection. Some of these medicines are topical antifungals, which are put directly on the skin. Examples includ...

Dry Cracked Feet The skin on our feet is naturally dry, unlike the skin on the rest of the body. The skin on our feet has no oil glands, so it relies on hundreds of thousands of sweat glands to keep our feet moisturized. This can be problematic for people who do not properly moisturize their feet on a regular basis, or who have a medical condition—such as diabetes or athletes feet—that causes dry feet. Anyone can have dry feet, but the condition is more common among seniors and diabetics. Dry feet can range in severity from mild, temporary dry skin to severe dry skin that causes additional problems. Skin can become dry for a number of reasons, but there are ways to prevent it, such as keeping your feet moisturized and avoiding rubbing or scratching the skin. Typically cream containing Urea is optimal for dry skin on feet. OTC creams can be found at Walmart/Walgreens.  Prescription based Urea may be dispensed at 40% Urea. If you have any questions just comment or...

 Minimalist Shoes and Stress Fractures    We discussed stress fractures yesterday. Today well focus on one specific way they can occur, and how YOU can prevent them! I put the abstract of an article that was just published this month. The article was done by Bergstra et al in the Journal of Sports and Medicine and goes on to conclude that, " This increased pressure in the forefoot region might play a role in the occurrence of metatarsal stress fractures in runners who switched to minimalist shoes and warrants a cautious approach to transitioning to minimalist shoe use."     Keep reading below if you want to learn more.    I provided the abstract to the article below, but those that are interested, I will provide a summary of this article for your own education.    I'm not anti-minimalist shoe running but I am here to provide recent literature on certain topics. If you have a topic you would like to discuss and like me ...

Runners worst enemy---Stress Fractures   footandanklesolution.com   Stress Fracture--What is it? A stress fracture is either caused from abnormal stress in normal bone(usually case in runners) or normal stress on abnormal bone(osteoporosis). They are commonly caused by increased activity, unfamiliar surfaces, or improper shoe gear. Stress fracture is an incomplete fracture through a bone. Where are common areas for stress fractures? The most common is the 2nd metatarsal(bone that articulates with your 2nd toe. Usually your pain will be localized to the area just behind the 2nd toe. The pain for stress fractures usually presents on the TOP of your foot. Stress fractures can be localized to one area that is painful. How is it diagnosed? Xrays usually detect stress fractures. In some cases bone scans or CT scans are needed to diagnose, but this is uncommon. Treatment options? At first RICE treatment(see ). NSAIDs for pain management(motrin/ibuprofuen). Fractu...

 Common Foot and Ankle Injuries with Athletes I'm going to discuss Foot and Ankle injuries involving sports. The best treatment for a sprain or strain around the ankle or foot is the age-old RICE. I don't have products on this blog/website but I do have suggestions. Comment or email me at zbeth02@gmail.com RICE = Rest, Ice, Compression, Elevation. Rest : Motion and impact on the injured area needs to be limited in order for the body to heal itself.  Unfortunately the foot/ankle are difficult to stay off of because you need them! Ice:  Why ice? Ice can help in acute injuries mostly. Ice no more than 20 minutes at a time because it can actually hurt your skin! Ice reduces inflammation which reduces pain and swelling. A frozen bag of peas, bag of ice is all you need. Compression: This reduces swelling which reduces pain! ACE bandage, splint, air cast all work Elevation:  Keep a pillow under your foot/leg at all times to reduce swelling! It is importa...

 Diabetic Foot Care! What is the importance? If you have diabetes, it's essential to make foot care part of your daily self-care routine. Diabetics can develop foot conditions without knowing it. When feet and legs have neuropathy(nerve damage) a small cut or wound can go unnoticed. These small wounds could go on to produce terrible infections and even end with loss of limb or life. Amputations are very often preventable just from daily foot checks and foot care. That means checking your feet daily and seeing a foot doctor (podiatrist) every two or three months in order to catch problems early. "I keep hearing about Neuropathy. What is it and how does it relate to Diabetes?" Neuropathy is simple damage to nerves. There are many things other than diabetes that can cause neuropathy, however, diabetes is currently the number 1 cause. When your blood carries excess amounts of sugar consistently it reaches its limit and pours the sugar into ...

Calcaneal Apophysitis (Sever's Disease) What Is Calcaneal Apophysitis? Calcaneal apophysitis is a painful inflammation of the heel’s growth plate. It typically affects 8-14 year old who are active in sports. At this age the growth plate in the back of the heel is still open. When there is too much repetitive stress on the growth plate, inflammation can develop. Calcaneal apophysitis is also called Sever’s disease, although it is not a true “disease.” It is the most common cause of heel pain in children, and can occur in one or both feet. When people think of heel pain in adults it commonly occurs on the bottom of the heel and involves the plantar fascia. However in children, its on the back of the heel and involves the growth plate. Causes Overuse and stress on the heel bone through participation in sports is a major cause of calcaneal apophysitis. Repetitive trauma irritates the growth plate and causes inflammation. Symptoms Symptoms of calcaneal apophysitis may...