Foot and ankle problems usually fall into the following categories:
- Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
- Arthritic foot problems, which typically involve one or more joint.
- Congenital foot problems, which occur at birth and are generally inherited.
- Infectious foot problems, which are caused by bacterial, viral, or fungal disorders.
- Neoplastic disorders usually called tumors, which are the result of abnormal growth of tissue and may be benign or malignant.
- Traumatic foot problems, which are associated with foot and ankle injuries.
The top foot problems are:
- Bunions - misaligned big toe joints that can become swollen and tender, causing the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to be hereditary, but can be aggravated by shoes that are too narrow in the forefoot and toe. Surgery is frequently performed to correct the problem.
- Hammertoe - a condition, usually stemming from muscle imbalance, in which the toe is bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Selecting shoes and socks that do not cramp the toes will alleviate aggravation.
- Heel spurs - growths of bone on the underside, forepart of the heel bone. Heel spurs occur when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. With proper warm-up and the use of appropriate athletic shoes, strain to the ligament can be reduced.
- Ingrown nails - toenails whose corners or sides dig painfully into the skin. Ingrown toenails are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity and poor foot structure. Women are much more likely to have ingrown toenails than men. Ingrown nails can be prevented by trimming toenails straight across, selecting proper shoe style and size - not too tapered or shallow - and paying special attention to foot pain.
- Neuromas - enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. Pressure from ill-fitting shoes or abnormal bone structure can also lead to this condition. Treatments include orthoses (shoe inserts) and/or cortisone injections, but surgical removal of the growth is sometimes necessary.
- Plantar fasciitis (heel pain) - usually caused by an inflammation on the bottom of the foot. Our practice can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
- Sesamoiditis - inflammation or rupture of the two small bones (sesamoids) under the first metatarsal bones. Proper shoe selection and orthoses can help.
- Shin splints - pain to either side of the leg bone, caused by muscle or tendon inflammation. It is commonly related to excessive foot pronation (collapsing arch) but may be related to a muscle imbalance between opposing muscle groups in the leg. Proper stretching and corrective orthoses (shoe inserts) for pronation can help prevent shin splints.
- Stress fractures - incomplete cracks in bone caused by overuse. With complete rest, stress fractures heal quickly. Extra padding in shoes helps prevent the condition. Stress fractures left untreated may become complete fractures, which require casting and immobilization.
The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It also is the most frequently ruptured tendon, usually as a result of a sports injury. Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.
Events that can cause Achilles tendonitis may include:
- Hill running or stair climbing.
- Overuse, stemming from the natural lack of flexibility in the calf muscles.
- Rapidly increasing mileage or speed when walking, jogging, or running.
- Starting up too quickly after a layoff in exercise or sports activity, without adequately stretching and warming up the foot.
- Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort, such as in a sprint.
- Improper footwear and/or a tendency toward overpronation.
Achilles tendonitis often begins with mild pain after exercise or running that gradually worsens. Other symptoms include:
- Recurring localized pain, sometimes severe, along the tendon during or a few hours after running.
- Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone.
- Sluggishness in your leg.
- Mild or severe swelling.
- Stiffness that generally diminishes as the tendon warms up with use.
Treatment normally includes:
- A bandage specifically designed to restrict motion of the tendon.
- Taking nonsteroidal anti-inflammatory medication for a period of time. Note: Please consult your physician before taking any medication.
- Orthotics, which are corrective shoe inserts designed to help support the muscle and relieve stress on the tendon. Both nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescribed custom orthotics may be recommended depending on the length and severity of the problem.
- Rest and switching to exercises that do not stress the tendon (such as swimming).
- Stretching and exercises to strengthen the weak muscle group in front of the leg, calf, and the upward foot flexors, as well as massage and ultrasound.
In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.
Peroneal Tendon Dislocation/Dysfunction
Peroneal tendons support two important foot muscles (Peroneus Brevis and Peroneus Longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of your foot while standing.
Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.
Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains also have caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment. Note: Please consult your physician before taking any medications.
In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.
Xanthomas of the Achilles Tendon
Xanthomas are cholesterol deposits that appear in the Achilles tendon. High cholesterol levels can cause the formation of these cholesterol deposits, which appear as small lumps. Aside from treating the underlying cholesterol problem, treatment for xanthomas may require taking a biopsy of the lesion but leaving the nodules intact.