Common foot and ankle conditions - MCR Health

Common foot and ankle conditions

  • Achilles tendinitis
    • Inflammation of the Achilles tendon
  • Achilles tendinosis
    • Degeneration of the Achilles tendon
  • Causes
    • Overuse syndrome (Sudden increase in a repetitive activity)
    • This sudden increase in activity causes abnormal stress on the tendon which will lead to micro tearing of the tendon fibers Resulting in inflammation and pain.
  • Symptoms
    • Pain in the back of the heel
    • Pain when walking
    • Large nodule on the back of the ankle.
  • Treatment options
    • Immobilization, ice, anti-inflammatories, physical therapy
  • Pain should never be ignored. Please not hesitate to contact our foot and ankle specialist for a thorough evaluation and treatment plan.  If caught early majority of the conditions are treatable without surgery.
  • An Achilles tendon rupture is a tear of the Achilles tendon. This could be a partial tear or complete tear.
  • Causes
    • Majority of the cases are due to forceful jumping or sudden acceleration of running which can cause overstretching of the Achilles tendon.
    • Injury from a sharp object which cuts the tendon.
    • Medications such as steroids and antibiotics which could weaken the tendon causing the ruptures.
  • Symptoms
    • A sudden pain the back of the ankle which feels like if someone kicks you or hits to with a stick.
    • A tearing or popping sensation.
    • Difficult to walking and particularly going upstairs.
  • Treatment
    • There are surgical and nonsurgical approaches.  This depends on the severity of the tear.  If you think you may have an Achilles tendon rupture, please not hesitate to contact our foot and ankle specialist for a thorough evaluation and treatment plan.
  • A fracture is a break in the bone.
  • Causes
    • Injury
  • Symptoms
    • There is pain on site of fracture with swelling.
    • Unable to walk
    • Abnormal shape of the foot or ankle.
    • In open fractures patient may have bone protruding through the skin.
  • Treatment
    • Patient will need x-rays or even advanced imaging such as MRI or CT scan to fully evaluate the fracture.  Depending on  severity of the injury and findings were surgeon may treat conservatively with  immobilization such as a splint or cast.  If  the fracture is very unstable and not in alignment your surgeon may recommend surgical repair of the fracture.
    • Pain should never be ignored. Please not hesitate to contact our foot and ankle specialist for a thorough evaluation and treatment plan. 
  • Athlete’s foot is a fungal infection of the skin located on foot.
  • Causes
    • Fungus thrives in dark, moist and warm environments such as a shoe.
  • Symptoms
    • Dry, itchy and scaly type with skin
    • It is commonly seen in between the toes and on the soles of the feet.
  • Treatment
    • The foot should be kept dry as possible.  Wash foot daily with soap and water thoroughly and dry in between the toes particularly.
    • Antifungal powders and creams.  With severe cases patient may need antifungal pills.
  • A bunion is a bump on the inside of the foot. Also, the big toe tends to lean towards the second toe rather than being straight.  Unfortunately this is a progressive disorder and the condition worsens over time and the  bump gets bigger.     
  • Causes
    • Hereditary
  • Symptoms
    • Pain or tenderness
    • Inflammation
    • Burning sensation in the area
    • Normally symptoms worsen in closed toe type  of shoe gear.
  • Treatment
    • Nonsurgical treatment will help treat this symptom only. This will not fix the bunion.
      • Wider toe box type shoes
      • Padding to help cushion the areas of irritation
      • Avoid activities that may cause the bunion to become painful.
      • Anti-inflammatories such as ibuprofen to help reduce the pain and inflammation.
      • Icing to help reduce inflammation and pain
      • Steroid injections this will help locally reduce inflammation and pain.
      • Orthotics will help with stabilizing the foot hopefully this may prevent worsening of the deformity over time.
    • The only truly way to correct a bunion deformity is surgical intervention.
      • There are multiple types of procedures that can be done depending on the type of bunion one has. Please take the first step to become pain-free and contact our foot and ankle specialist for a thorough evaluation and treatment plan. 
  • Calcaneal apophysitis is inflammation heels growth plate. Inflammation will cause pain area.  This condition typically affects children between the ages of 8-14.
  • Causes
    • Overuse and stress on the heel bone.
    • Most commonly this affects children that are very active in sports.
    • Flatfoot or high arch foot
    • Tight heel cord
  • Symptoms
    • Pain heel particularly in the back
    • Walking on toes
    • Limping
    • Pain when walking or running
  • Treatment
    • Rest
    • Heel lifts
    • Anti-inflammatories
    • Immobilization
    • Physical therapy
  • Pain should never be ignored. Please not hesitate to contact our foot and ankle specialist for a thorough evaluation and treatment plan. 
  • Calcaneal fracture occur when the heel bone broken.
  • Causes
    • Majority of calcaneal fractures results due to injury. The type of injury is a high impact type of injury.  Most commonly cause falling from a height, such as a ladder or motor vehicle accident.
  • Symptoms
    • Pain able to walk foot after injury
    • Swelling
    • Bruising
    • Lower back pain (due to the fact that this is a high energy type of injury that it is common that the patient may also have a lumbar fracture
  • Treatment
    • If you do have a calcaneal fracture is very important that you be evaluated by a foot and ankle specialist to determine what the best treatment.
    • Nonsurgical treatment would be immobilization such as a cast.

  Depending on the severity of the fracture patient may need surgical repair of the fracture.         

  • Charcot foot and ankle is a condition where the bones weaken to a point where it will cause fracturing of the bones and eventually changes the shape of a normal foot. This condition becomes a very debilitating.
  • Causes
    • Neuropathy (a condition where one loses sensation therefore patient cannot feel pain)
    • Due to this loss of sensation patient continues to walk causing further deformity of the foot.
  • Symptoms
    • Swelling
    • Redness
    • Warmth to touch
    • Deformity of the foot and/or ankle
  • Treatment
    • It is extremely important that once one is diagnosed or thinks that they may have Charcot to see a foot and ankle specialist right away. Charcot foot and ankle can lead to loss of foot and perhaps even the leg.
    • Nonsurgical treatment
      • Immobilization: During the early stages of this condition the bones become very soft multiple therefore it is pertinent that the patient is completely off their foot most likely will be placed in a cast as well.
      • Custom shoes and/or inserts to accommodate deformity.
    • Surgical treatment
      • If the deformity severe which causes patient to be unable to function in his or her daily activities or due to the abnormality of the foot causing ulcers a surgical reconstruction may be recommended.
  • Chronic ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually, the giving way occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability
  • People with chronic ankle instability often complain of:
    • A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
    • Persistent (chronic) discomfort and swelling
    • Pain or tenderness
    • The ankle feeling wobbly or unstable
  • Causes
    • Ankle sprain that has not adequately healed or was not rehabilitated completely
    • Repeated ankle sprains
  • Diagnosis
    • Physical exam
    • X-rays or other diagnostic imaging
  • Treatment
    • Nonsurgical
      • Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport.
      • Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains.
      • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation.
    • Surgical
      • Repair or reconstruction of the damaged ligament(s)
  • Is a deformity that is present at birth in about one in every 1,000 children. It occurs in males more often than females and can affect one or both feet.
  • It must be corrected to avoid a lifetime of disability.
  • In most cases, clubfoot can be effectively treated if it is undertaken as early as possible. Casting of the legs and feet is usually successful, but in some cases, surgery may be required.
  • Buildup of pressure within the tissue of the foot, is a painful condition that can result in tissue damage. Potential causes are injury (acute compartment syndrome) or exercise (exertional compartment syndrome).
  • After injury, immediate surgery is required to prevent damage to the nerves, blood vessels and muscles of the foot.
  • Exercise-induced compartment syndrome is a chronic condition and is usually not a medical emergency. It commonly occurs in seasoned athletes who perform repetitive motions while running, bicycling and swimming. Symptoms include aching, burning or cramping and can be confused with shin splints. The symptoms are usually relieved by discontinuing the exercise.
  • A callus is a thickened area of skin on the foot caused by pressure and repeated rubbing, such as from a shoe or sock.
  • Treatment
    • Padding, offloading, different shoe gear
    • Removal
  • A corn is a small circular thickened lesion in the skin of the foot. It usually forms due to repeated pressure on the skin, such as the rubbing of a shoe
  • Treatment
    • Padding, offloading, different shoe gear
    • Removal
  • Drop foot refers to the inability to lift the front part of one’s foot off the ground when walking, resulting in a scuffing or dragging of the foot or lifting the thigh (known as “steppage” gait). It is most often caused by nerve or muscle disorders or damage or by a central nervous system disorder.
  • Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg
  • People with equinus develop ways to compensate for their limited ankle motion, and this often leads to other foot, leg or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by toe walking, while a smaller number take steps by bending abnormally at the hip or knee
  • Causes
    • Tightness in the Achilles tendon or calf muscles (the soleus muscle and/or gastrocnemius muscle)
    • Diabetes can affect the fibers of the Achilles tendon and cause tightness
    • Bone blocking the ankle motion
    • Spasms in the calf muscle
  • Foot Problems Related to Equinus
    • Plantar fasciitis (arch/heel pain)
    • Calf cramping
    • Tendonitis (inflammation in the Achilles tendon)
    • Metatarsalgia (pain and/or callusing on the ball of the foot)
    • Flatfoot
    • Arthritis of the midfoot (middle area of the foot)
    • Pressure sores on the ball of the foot or the arch
    • Bunions and hammertoes
    • Ankle pain
    • Shin splints
  • Diagnosis
    • The foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened)
  • Treatment
    • Nonsurgical
      • Night splint: The foot may be placed in a splint at night to keep it in a position that helps reduce tightness of the calf muscle.
      • Heel lifts: Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.
      • Arch supports or orthotic devices: Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.
      • Physical therapy: To help remedy muscle tightness, exercises that stretch the calf muscle(s) are recommended
    • Surgical
      • The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.
  • Often begins as an infection in the skin called tinea pedis (also known as athlete’s foot)
  • Fungus often starts under the nail fold at the end of the nail. Over time, it grows underneath the nail and causes changes to its appearance, such as a yellow or brownish discoloration. It can also cause thickening and deformity of the toenail.
  • Treatment
    • Topical medications
    • Terbinafine (Lamisil)
  • A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means knot and is used to describe the knot-like mass or lump that forms below the surface of the skin
  • Ganglion cysts are among the most common benign soft-tissue masses
  • Causes
    • The exact cause of ganglion cysts is unknown, they may arise from trauma—whether a single event or repetitive microtrauma
  • Symptoms
    • A noticeable lump—often this is the only symptom experienced
    • Tingling or burning, if the cyst is touching a nerve
    • Dull pain or ache, which may indicate the cyst is pressing against a tendon or joint
    • Difficulty wearing shoes due to irritation between the lump and the shoe
  • Diagnosis
    • he lump will be visually apparent, and, when pressed in a certain way, it should move freely underneath the skin. Sometimes the surgeon will shine a light through the cyst or remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray, and in some cases, additional imaging studies may be ordered.
  • Treatment
    • Nonsurgical
      • Monitoring but no treatment. If the cyst causes no pain and does not interfere with walking, the surgeon may decide it is best to carefully watch the cyst over a period of time.
      • Shoe modifications. Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst.
      • Aspiration and injection. This technique involves draining the fluid and then injecting a steroid medication into the mass. More than one session may be needed. Although this approach is successful in some cases, in many others, the cyst returns.
    • Surgical
      • When other treatment options fail or are not appropriate, the cyst may need to be surgically removed. While the recurrence rate associated with surgery is much lower than that experienced with aspiration and injection therapy, there are nevertheless cases in which the ganglion cyst returns
  • Gangrene occurs when there is a lack of blood supply to tissue, depriving it of oxygen, and thereby causing death and decay of the tissue. The two main types of gangrene are wet (caused by bacterial infection) and dry (no infection). Your risk of gangrene is higher if you have an underlying condition that can damage your blood vessels and affect blood flow, such as diabetes or hardened arteries (atherosclerosis)
  • Causes
    • The most common causes of gangrene are diabetes, arteriosclerosis, tobacco abuse, burns and frostbite. Initiation of gangrene may result from a wound or injury that is slow to heal due to lack of blood supply to the injured area.
  • Symptoms
    • Skin discoloration — ranging from pale to blue, purple, black, bronze, or red depending on the type of gangrene you have
    • Swelling
    • Blisters
    • Sudden, severe pain followed by a feeling of numbness
    • A foul-smelling discharge leaking from a sore
    • Skin that feels cool or cold to the touch
  • Treatment
    • Nonsurgical
      • Wound care & close observation
    • Surgical
      • When other treatment options fail or are not appropriate, treatment includes surgical removal of the dead tissue, which may include a level of amputation, and use of antibiotics when infection is present. Surgical intervention to restore blood flow is often necessary as well
  • Gout is a disorder that results from the buildup of uric acid in the tissues or a joint. It most often affects the joint of the big toe
  • Causes
    • Deposits of crystallized uric acid in the joint
    • Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid
    • Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress and certain medications and vitamins
    • Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer and red meat
  • Symptoms
    • Intense pain that comes on suddenly, often in the middle of the night or upon arising
    • Signs of inflammation, such as redness, swelling and warmth over the joint
  • Treatment
    • Medications: Prescription medications or injections are used to treat the pain, swelling and inflammation.
    • Dietary restrictions: Foods and beverages that are high in purines should be avoided since purines are converted in the body to uric acid.
    • Fluids: Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
    • Immobilize and elevate the foot: Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.
  • Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone)
  • Causes
    • Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes or women’s pumps, can cause this irritation
    • A high-arched foot
    • A tight Achilles tendon
    • A tendency to walk on the outside of the heel
  • Symptoms
    • A noticeable 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
    • Nonsurgical
      • Medication: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation. Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
      • Exercises: Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
      • Heel lifts: Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel.
      • Heel pads: Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.
      • Shoe modification: Backless or soft backed shoes help avoid or minimize irritation.
      • Physical therapy: Physical therapy modalities, such as ultrasound, can help to reduce inflammation.
      • Orthotic devices: Custom arch supports control the motion in the foot.
      • Immobilization: In some cases, casting may be necessary
    • Surgical
      • If nonsurgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for postsurgical care. Hallux rigidus
  • Hammertoe is a contracture (bending) deformity of one or both joints of the second, third, fourth or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop
  • Causes
    • The most common cause of hammertoe is a muscle/tendon imbalance
    • A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.
  • Symptoms
    • Pain or irritation of the affected toe when wearing shoes.
    • Corns and calluses (a buildup of skin) on the toe, between two toes or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending on their location.
    • Inflammation, redness or a burning sensation
    • Contracture of the toe
    • In more severe cases of hammertoe, open sores may form
  • Treatment
    • Nonsurgical
      • Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over-the-counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option.
      • 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 toebox 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. 
      • Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe.
    • Surgical
      • In some cases, usually when the hammertoe has become more rigid and painful or when an open sore has developed, surgery is needed.
  • Heel pain, especially stabbing heel pain, is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst.
  • Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain
  • Causes
    • The most common cause of plantar fasciitis relates to faulty structure of the foot
    • Wearing nonsupportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis
    • Obesity and overuse may also contribute to plantar fasciitis.
  • Symptoms
    • Pain on the bottom of the heel
    • Pain in the arch of the foot
    • Pain that is usually worse upon arising
    • Pain that increases over a period of months
    • Swelling on the bottom of the heel
  • Treatment
    • Nonsurgical
      • Stretching exercises.Exercises that stretch out the calf muscles help ease pain and assist with recovery.
      • Avoid going barefoot.When you walk without shoes, you put undue strain and stress on your plantar fascia.
      • Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
      • Limit activities. Cut down on extended physical activities to give your heel a rest.
      • Shoe modifications.Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
      • Oral nonsteroidal 
      • Padding, taping and strapping. Placing pads in the shoe softens the impact of walking. Taping and strapping help support the foot and reduce strain on the fascia.
      • Orthotic devices.Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
      • Injection therapy.In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
      • Removable walking cast.A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
      • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
      • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
    • Surgical
      • Padding, taping and strapping. Placing pads in the shoe softens the impact of walking. Taping and strapping help support the foot and reduce strain on the fascia.
      • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
      • Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
      • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
      • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
      • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
  • When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This digging in of the nail irritates the skin, often creating pain, redness, swelling and warmth in the toe
  • If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe is not painful, red, swollen or warm, a nail that curves downward into the skin can progress to an infection
  • Causes
    • In many people, the tendency for ingrown toenails is inherited.
    • Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
    • Improper trimming. The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail. 
    • Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.
    • Nail conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma
  • Treatment
    • Home Care
      • If you do not have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom salt may be recommended by your doctor) and gently massage the side of the nail fold to help reduce the inflammation.
    • Physician Care
      • If an infection is present, an oral antibiotic may be prescribed.
      • Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.
      • Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.
  • Condition in which the feet point inward when walking. It is commonly seen in children and may resolve in very early childhood with no treatment or intervention
  • The child should be examined by a foot and ankle surgeon if the intoeing is causing significant tripping, difficulty with normal activity, pain, difficulty with shoes or is not resolved in early childhood.
  • A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.
  • The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, causing the symptoms of Morton’s neuroma and eventually leading to permanent nerve damage
  • Causes
    • Anything that causes compression or irritation of the nerve can lead to the development of a neuroma
    • One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box.
    • People with certain foot deformities—bunions, hammertoes, flatfeet or more flexible feet—are at higher risk for developing a neuroma
  • Symptoms
    • Tingling, burning or numbness
    • Pain
    • A feeling that something is inside the ball of the foot
    • A feeling that there is something in the shoe or a sock is bunched up
  • Treatment
    • Nonsurgical
      • Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
      • Icing: Placing an icepack on the affected area helps reduce swelling.
      • Orthotic devices: Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
      • Activity modification:. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
      • Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
      • Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
      • Injection therapy: Treatment may include injections of cortisone, local anesthetics or other agents
    • Surgical
      • Surgery may be considered in patients who have not responded adequately to nonsurgical treatments. Your foot and ankle surgeon will determine the approach that is best for your condition. The length of the recovery period will vary depending on the procedure performed.
  • Osteomyelitis (an infection of the bone) can be caused by a variety of microbial agents (bacteria, fungus), the most common of which is staphylococcus aureus.
  • This serious infection can occur from a number of sources:
    • It may enter bone through an injury, such as an open fracture with the bone ends piercing the skin.
    • It can spread from elsewhere in the body or through the bloodstream.
    • It can result from a chronic foot wound or infection, such as a diabetic ulcer.
  • Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage (the connective tissue found at the end of the bones in the joints) protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one’s ability to easily perform daily activities.
  • Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Some people refer to osteoarthritis simply as arthritis, even though there are many different types of arthritis.
  • Causes
    • A wear-and-tear disease because the cartilage in the joint wears down with repeated stress and use over time
    • As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.
    • Previous injury
    • Abnormal foot mechanics (flat feet or high arches)
  • Symptoms
    • Pain and stiffness in the joint
    • Swelling in or near the joint
    • Difficulty walking or bending the joint
  • Diagnosis
    • X-ray
    • Advanced imaging
  • Treatment
    • Nonsurgical
      • Oral medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally, a prescription for a steroid medication is needed to adequately reduce symptoms.
      • Orthotic devices: Custom orthotic devices (shoe inserts) are often prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain.
      • Bracing: Bracing, which restricts motion and supports the joint, can reduce pain during walking and can help prevent further deformity.
      • Immobilization: Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve.
      • Steroid injections: In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication.
      • Physical therapy: Exercises to strengthen the muscles, especially when osteoarthritis occurs in the ankle, may give the patient greater stability and may help him or her avoid injury that might worsen the condition
    • Surgical
      • When osteoarthritis has progressed substantially or has failed to improve with nonsurgical treatment, surgery may be recommended. In advanced cases, surgery may be the only option. The goal of surgery is to decrease pain and improve function
  • The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.
  • PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.
  • Causes
    • Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking or climbing stairs
  • Symptoms
    • Pain, swelling, a flattening of the arch and an inward rolling of the ankle
  • Treatment
    • Nonsurgical
      • Orthotic devices or bracing: To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe.
      • Immobilization: Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weightbearing for a while.
      • Physical therapy:Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
      • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
      • Shoe modifications: Your foot and ankle surgeon may advise changes to your shoes and may provide special inserts designed to improve arch support.
    • Surgical
      • In cases of PTTD that have progressed substantially or have failed to improve with nonsurgical treatment, surgery may be required. For some advanced cases, surgery may be the only option
  • Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints.
  • RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity and disability.
  • When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, causes swelling and damage to the joint’s cartilage and bones.
  • Symptoms
    • Rheumatoid nodules (lumps), which cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking
    • Dislocated toe joints
    • Hammertoes
    • Bunions
    • Heel pain
    • Achilles tendon pain
    • Flatfoot ankle pain
  • Diagnosis
    • Clinical examination
    • Blood tests
  • Treatment
    • Nonsurgical
      • Orthotic devices: The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking and give needed support to improve the foot’s mechanics.
      • Accommodative shoes: These are used to relieve pressure and pain and to assist with walking.
      • Aspiration of fluid:When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain.
      • Steroid injections:Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule.
    • Surgical
      • When RA produces pain and deformity in the foot that is not relieved through other treatments, surgery may be required. 
  • Stress fractures are tiny hairline breaks that can occur in the bones of the foot. They can be caused by overtraining or overuse, improper training habits or surfaces, improper shoes, flatfoot or other foot deformities and osteoporosis.
  • These tiny breaks in the bones of the feet can lead to a complete break if left untreated.
  • Pain, swelling, redness and bruising can be signs of a stress fracture. The fracture can occur almost anywhere in the foot. X-rays and other studies are used to diagnose the stress fracture. A foot and ankle surgeon should be seen as early as possible to start treatment and possibly shorten the recovery time. Possible treatments include rest and possible immobilization of the foot. In some cases, surgery may be required to stabilize the stress fracture or to repair a stress fracture that has progressed to a fracture.
  • Tailor’s bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The prominence that characterizes a tailor’s bunion occurs at the metatarsal head, located at the far end of the bone where it meets the toe. Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.
  • Causes
    • Inherited faulty mechanical structure of the foot
    • Bony spur (an outgrowth of bone) on the side of the fifth metatarsal head
  • Symptoms
    • Redness, swelling and pain at the site of the enlargement.
  • Treatment
    • Nonsurgical
      • Shoe modifications. Choose shoes that have a wide toe box, and avoid those with pointed toes or high heels.
      • Bunionette pads placed over the area may help reduce pain.
      • Oral medications.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
      • An ice pack may be applied to reduce pain and inflammation. Wrap the pack in a thin towel rather than placing ice directly on your skin.
      • Injection therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.
      • Orthotic devices.In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.
    • Surgical
      • Surgery is often considered when pain continues despite the above approaches
  • A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage or fibrous tissue, may lead to limited motion and pain in one or both feet.
  • The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid and cuneiform bones. These bones work together to provide the motion necessary for normal foot function
  • Causes
    • Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis or a previous injury to the area.
  • Symptoms
    • Pain (mild to severe) when walking or standing
    • Tired or fatigued legs
    • Muscle spasms in the leg, causing the foot to turn outward when walking
    • Flatfoot (in one or both feet)
    • Walking with a limp
    • Stiffness of the foot and ankle
  • Diagnosis
    • Obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. The findings of this examination will differ according to the severity and location of the coalition.
    • X-rays or advanced imaging
  • Treatment
    • Nonsurgical
      • Oral medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
      • Physical therapy: Physical therapy may include massage, range-of-motion exercises and ultrasound therapy.
      • Steroid injections:An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.
      • Orthotic devices: Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
      • Immobilization: Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot.
      • Injection of an anesthetic agent: Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization.
    • Surgical
      • If the patient’s symptoms are not adequately relieved with nonsurgical treatment, surgery is an option
  • A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage.
  • Signs and Symptoms
    • Chronic pain deep in the ankle—typically worse when bearing weight on the foot (especially during sports) and less when resting
    • An occasional clicking or catching feeling in the ankle when walking
    • A sensation of the ankle locking or giving out
    • Episodes of swelling of the ankle—occurring when bearing weight and subsiding when at rest
  • Diagnosis
    • A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. To diagnose this injury, the foot and ankle surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking or limited motion within that joint.
    • Sometimes the surgeon will inject the joint with an anesthetic (pain-relieving medication) to see if the pain goes away for a while, indicating that the pain is coming from inside the joint. X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury.
  • Treatment
    • Nonsurgical
      • Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended.
      • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
      • Physical therapy.Range-of-motion and strengthening exercises are beneficial once the lesion is adequately healed. Physical therapy may also include techniques to reduce pain and swelling.
      • Ankle brace.Wearing an ankle brace may help protect the patient from reinjury if the ankle is unstable.
    • Surgical
      • If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing
  • Toe walking, a condition in which a person walks on the toes or ball of the foot, is most often seen in young children learning to walk
  • Toe walking may be idiopathic (habitual) or it can be caused by a shortened Achilles tendon (equinus deformity) often associated with a neurological or muscular disorder.
  • Turf toe is a sprain of the big toe joint resulting from injury during sports activities. The injury usually results from excessive upward bending of the big toe joint. The condition can be caused from either jamming the toe or from repetitive injury when pushing off repeatedly when running or jumping
  • Causes
    • The name “turf toe” comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf, the foot can stick to the hard surface, resulting in jamming of the big toe joint. There has been some indication that less-supportive flexible shoes worn on artificial turf are also to blame.
  • Symptoms
    • The signs and symptoms of turf toe can include pain, swelling and limited joint movement
  • Diagnosis
    • X-rays are typically ordered to rule out any broken bone. Other advanced imaging studies may also be helpful for proper diagnosis.
  • Treatment
    • Rest, ice, compression, and elevation. (RICE)
    • Less-flexible footwear
    • Operative treatment is reserved for individuals with severe cases and prolonged pain.
  • Ulcers, which are open sores in the skin, occur when the outer layers of the skin are injured and the deeper tissues become exposed. They can be caused by excess pressure due to ill-fitting shoes, long periods in bed or after an injury that breaks the skin. Ulcers are commonly seen in patients living with diabetes, neuropathy or vascular disease. Open wounds can put patients at increased risk of developing infection in the skin and bone.
  • Signs and Symptoms
    • drainage, odor or red, inflamed, thickened tissue. Pain may or may not be present.
  • Treatment
    • Removal of unhealth tissue
    • Local wound care
    • Special shoes or padding
    • If infection present, antibiotics will be necessary
  • A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but they typically appear on the bottom (plantar side) of the foot
  • Types
    • 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.
  • Causes
    • Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body
  • Symptoms
    • Thickened skin. A plantar wart often resembles a callus because of its tough, thick tissue.
    • 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
    • Topical or oral treatments, laser therapy, cryotherapy (freezing), acid treatments or surgery to remove the wart.
  • Varicose veins are usually due to improperly functioning valves within the veins. The veins typically appear prominent or look raised. The condition can cause swelling of the legs, ankles and feet. The skin may become discolored due to leakage of blood into the surrounding tissues, and ulcers may form on the skin. The foot and ankle surgeon may advise use of compression stockings or other treatments

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