Inflammation is a normal process which occurs after an injury, irritation, or surgery. This helps bring blood to the area. In the short term, it is expected and is an important part of the healing process. As time passes it should reduce and return to normal. Occasionally disorders which include arthritis, rheumatoid conditions, infections, or other long term medical conditions can cause the inflammation to last longer than usual. This can cause severe pain, swelling, redness, and changes in walking. Treatments are usually based on correcting or treating the causing disorder. When this is not possible, medications, bracing, orthotics, injections, therapy or surgery may be required to manage this condition. As a general rule rest, ice, elevation and compression are best to treat inflammation.
Arthritis is a generic term for joint pain and destruction. Osteoarthritis is the type which is caused by “wear and tear”. Other types may include inflammatory or autoimmune conditions like rheumatoid arthritis. This can also occur after an injury. This can happen in any joint. The pain can range from very mild to disabling. Symptoms often include stiffness, limitation in motion, pain at a joint, redness and swelling. Treatments vary greatly and can include medications, res, ice, injections, bracing, orthotics, and walking in a surgical boot. Occasionally surgery is required to clean out, replace, or fuse the joint. X-rays and occasionally MRI or CT is required to evaluate the condition of the joint. In some cases, labs or referral to a rheumatoid specialist are also required to help differentiate the type of arthritis.
Peripheral neuropathy is a condition which is characterized by dysfunction of the nerves in the legs or arms. Most people associate this with diabetes but it is not always the case. Neuropathy places the foot and leg at great risk for injury and infection. There is an extremely long list of causes and it is important to attempt to discover why the nerve or nerves are misfiring. Most people experience burning, pressure, pain, or an odd sensation which is hard to describe. This is most often more severe at night and improves with activity. A nerve conduction study or EMG performed by a neurologist is common as it can help identify the cause. Labs and x-rays are also very helpful. Some conditions are treatable and others require long term medications to keep symptoms at bay.
There are many types of cancers and some can occur in the foot. Most types of cysts and lesions are non-malignant (non-cancerous) but there are some cases in which cancer can occur in the foot and spread to other parts of the body. Malignant melanoma and basal cell skin cancer can occur in the foot, especially in areas prone to sun damage. Bone tumors and bone cancer are rare. Cancer is not always painful and often requires surgical treatment. If cancer does occur in the foot, referral to oncology and other cancer specialist is very important to reduce the spread and expedite treatment.
Capsulitis is an inflammatory condition of the ligaments that surround the joints. This happens most often at the second toe joint on the bottom of the foot. This can happen in other joints of the foot. The ligaments attach the bones together and create a balloon like structure which protects and stabilizes the joints. Pain, swelling, and redness are common. It is often mistaken for a Morton’s neuroma as it causes similar symptoms. This can often be treated with strapping, taping, and padding of the toes or foot. Orthotics and shoe modifications are also very common. Rarely surgical repair of the ligaments is required to reduce pain.
Neuroma is a swelling of one or more of the nerves in the foot. The nerves of the toes travel deep within the foot and can become scared, injured or swollen. When this happens, they become compressed by the surrounding bones of the foot. This can cause pain, swelling, a clicking sensation, numbness, or burning of the toes. X-ray, ultrasound, or MRI is sometimes required to help diagnose a neuroma. Treatments include shoes, pads, orthotics and injections. Commonly injections of steroids are recommended. In chronic cases, a series of sclerosing injections are recommended. Finally, surgery is sometimes required to remove the neuroma. Recurrence is sometimes seen.
Club foot is a condition which occurs at birth where there is severe deformity of one or both of the foot which make the foot appear similar to a golf club. This is best treated in infancy with casting or occasionally surgery. In some instances, this does not happen and a residual deformity persists into adulthood. Treatment in these cases often includes bracing, orthotics, and specialized shoes. Surgical correction may also be necessary to improve alignment of the foot and ankle.
Flat feet are a common problem and has countless variations. Symptoms can vary widely based on the foot type and associated problems. Most people who have flat feet and have no pain or problems. There are instances where the shape of the foot causes stress, strain, and changes that cause pain and difficulty walking. Associated problems include tendonitis, hammertoe, arthritis, equinus, etc. X-ray and evaluation is always important to help determine the best course of treatment. There are two broad types of flat feet which include flexible and rigid deformity. Each has its own treatment recommendations. In general treatment often begins with non-surgical treatments such as orthotics, shoe changes, bracing, and padding. In some cases, surgery is required to repair or reconstruct the foot to improve alignment and function.
Foot odor can be stressful and unpleasant. There are two factors which contribute to foot odor. Sweat and bacteria. Bacteria produces the odor and they are most active in dark, moist, and warm environments. The inside of a shoe is the perfect environment to for bacteria to live and thrive. In general, good foot care which includes choosing shoes which breath, wearing cotton socks, and using moisture absorbent powders can control this problem. In some cases, this may be caused by hyperhidrosis (excessive sweating) which is inherited. Special medications and topical solutions are most common to treat this.
Diabetes is a very complex disorder which can cause severe problems in the foot. Every system is affected. Problems associated with diabetes, if not well managed, can lead to severe consequences including ulcers, infection and possible amputation. Neuropathy and circulatory problems are most well-known but changes in the skin, tendons, and muscles can occur. Changes can be subtle and non-painful. Prevention, tight control of blood sugars, regular checks with your primary care physician, and frequent foot checks are important in reducing risks associated with diabetes.
Ulcers and Wounds
Wounds, ulcers, sores, skin lesions...They go by many names. Ulcers, wounds and sores are complex problems. Many medical problems slow the healing process. The foot and ankle are prone to ulceration of breakdown of the skin. This is a very common problem and can be very dangerous! Normally our bodies heal at a rapid rate but blood flow, neuropathy, illness, and other conditions can block this process and lead to a chronic wound which may or may not be painful. The focus of proper wound care is understanding and managing the reasons the ulceration is not healing. It is routine to have labs, ultrasound, culture, and x-ray ordered on the initial visit to help focus treatment for the best result. The largest risk with ulceration is infection as the skin provides protection from bacteria and an ulceration has disrupted this barrier. There are hundreds of types and brands of dressings. There are also various skin substitutes. Your wound care specialist will help choose which is most appropriate for the type of wound. Also, pressure relief is generally critical in improving the healing potential of foot ulcers. This can be accomplished in several ways with crutches, boots, casts and pads. If you or a loved one has a foot or leg wound which is slow to heal or has been a problem for a month or more, please contact us. Dr. Corey Blackburn has had extensive training and experience in wound care and management. Ulcerations can be complicated and risky don't delay any longer.
Frost bite is a condition which occurs when the skin has been exposed to cold too long and has caused tissue death. Sometimes the damage takes a few weeks to develop and is usually painful. There are several treatments for this depending on the extent. In cases where the damage is superficial, care can remain non-surgical. In severe or extensive cases surgery may be required to reduce the risk of infection or further skin loss. In any case seek medical care immediately.
Gangrene is a serious condition in which skin muscle and bone has died. This most often caused by lack of blood flow, severe infection, or both. This may appear as dark black tissue. It often occurs rapidly and may or may not be painful. In any case, immediate medical attention is required to prevent loss of the foot, leg, or life!
Gout is an extremely painful condition in which uric acid collects in joints. This can happen in any joint but is most common in the big toe. Most people with gout have difficulty removing uric acid through the kidney causing it to collect in the blood until it begins to form crystals. This causes severe pain, redness and swelling. It often starts at night. Lab testing, and occasionally a joint aspiration is required to diagnose and confirm. Treatments include medications, injections, and steroids to control the pain. Long term medications to prevent further attacks is sometimes required. Your primary care physician is will help determine if this is necessary.
Metatarsalgia is a generic term referring to pain across the forefoot at the area of the metatarsals. This can be caused by several conditions including stress injury, ligament stress or tears, or direct injury. X-rays and an exam are usually required as this can take many forms.
Osteoporosis is the reduction of bone density. This can occur with age but can also be associated with other conditions such as thyroid or hormone disorders. It can also be an inherited condition. Osteoporosis can cause people to be prone to fracture, or difficulty healing bone injuries. Testing may include x-rays, lab draws, or bone density scans. In some cases, supplementation or other medications prescribed by your primary care physician may be necessary to improve bone density. Regular exercise is also an important aspect of preventing and reversing osteoporosis.
Plantar fibroma or plantar fibromatosis is a benign tumor of the plantar fascia on the bottom of the foot. These can grow quite large and can cause severe pain. This may feel like a sharp pain or sensation similar to walking on a rock. Treatments include padding, special orthotics, injections. In some cases, surgical removal is required. These are prone to recurrence.
The sesamoid bone is a small set of bones on the bottom of the big toe joint of the foot. Sesamoids act like a pulley for a tendon in the toe. This injury is a common repetitive injury of the foot. Runners and joggers are especially prone to this type of injury. When injured the bone becomes inflamed and painful. In extreme cases, the bone can break. People may experience redness, swelling, pain while bending the toe pain while up on tiptoe. Treatments include reduced weight on the foot, walking in a boot, padding, rest, icing, orthotics. Rarely surgery is required to reduce pain.
Achilles tendonitis is the inflammation of the tendon at the back of the heel and ankle. This tendon is very important to walking and can become quite painful. It commonly occurs at the attachment to the heel bone but can also happen in the middle. This can be caused by spurring, tightness of the tendon, some medications, or injury. Most people experience pain which radiates to the back of the leg. There is often swelling or bulging of the tendon. It can be uncomfortable with closed back shoes as they will rub. Treatments can include walking in a boot, shoes with a heel lift, stretching, icing, rest. In some cases, surgery is required to reduce spurring, diseased tendon, and repair the tendon. The largest risk is for tendon rupture which can cause significant problems.
Osteomyelitis is the infection of bone. In most cases this is caused by an ulcer wound or injury which has allowed infection beneath the skin. The infection has become so severe that the bone has become infected. There are two general treatment categories to treat this very serious problem. The first is antibiotics. As antibiotics do not penetrate bone as easily as other types of tissue, IV antibiotics are usually prescribed for 4-6 weeks. Surgery in which bone is removed is sometimes required to reduce the amount of rapidly growing bacteria within the bone and allow the immune system and antibiotics to work better. Supplementation with hyperbaric oxygen (pure oxygen) may also be helpful. These infections can progress quite rapidly and should be treated quickly.
This condition is a largely inherited disorder of the nerves of the arms and legs. It can cause weakness of the muscles, numbness, and deformities of the hands and feet. Changes in walking including a disorder called drop foot are common. There is also deterioration of the small muscles of the hands and feet causing very characteristic deformities of the fingers and toes. There is significant risk of ulceration/sores as the numbness of the skin progresses. Treatment is available to reduce these risks and improve walking.
Known commonly as "Charcot foot" or "rocker bottom foot". Charcot consists of fractures of a bone or joint with little or no trauma. It can occur in any bone but the bones of the foot and ankle are most likely. It often causes the arch to collapse and in some cases invert to a "rocker bottom" or round appearance. This disorder occurs in conjunction with neuropathy. Though frequently associated with diabetes, it can occur in with any type of neuropathy. Generally it begins with redness, swelling, changing shape of the arch and rarely pain. This is sometimes confused with cellulitis but a simple X-ray can often confirm the diagnosis. Treatments are aimed at reducing the damage until the fractures heal and protecting the foot from ulceration and further damage. Occasionally reconstruction is required.