Foot Disorders & Injuries

Each of your feet has 26 bones, 33 joints, and more than 100 tendons, muscles and ligaments. No wonder a lot of things can go wrong. Here are a few common problems:

Bunions - hard, painful bumps on the big toe joint Hammertoes - toes that curl downward into a claw-like position Calluses and corns - thickened skin from friction or pressure Plantar warts - warts on the soles of your feet Fallen arches - also called flat feet Neuromas Gout Arthritis Heel Pain Arch Pain

Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

Bunions

A bunion is when your big toe points toward the second toe. This causes a bump on the inside edge of your toe.

Causes

Bunions occur more commonly in women and can sometimes run in families. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion. The condition may become painful as extra bone and a fluid-filled sac grow at the base of the big toe.

Symptoms

• Red, calloused skin along the inside edge of the big toe
  
• A bony bump at this site
  
• Pain over the joint, aggravated by pressure from shoes
  
• Big toe turned toward the other toes

Exams and Tests

A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

Treatment

When a bunion first begins to develop, take good care of your feet and wear wide-toed shoes. This can often solve the problem and prevent the need for any further treatment. It may help to wear felt or foam pads on the foot to protect the bunion, or devices called spacers to separate the first and second toes at night. These are available at drugstores. You can also try cutting a hole in a pair of old, comfortable shoes to wear around the house.

If the bunion gets worse -- resulting in severe deformity or pain -- surgery to realign the toe and remove the bony bump (bunionectomy) can be effective. There are over 100 different surgical techniques that have been described to treat this condition.

Outlook (Prognosis)

The outlook depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

Call for an appointment with your doctor if the bunion:

• Continues to cause pain even after self care, such as wearing wide-toed shoes
  
• Prevents you from doing your usual activities
  
• Has any signs of infection (like redness or swelling), especially if you have diabetes

Prevention

Avoid compressing the toes of your foot with narrow, poor-fitting shoes.

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Hammertoe

Hammer toe is a deformity of the toe, in which the end of the toe is bent downward.

Causes

Hammer toe usually affects the second toe, although it may also affect the other toes. The toe goes into a claw-like position. The condition may occur as a result of pressure from a bunion. A corn on the top of a toe and a callus on the sole of the foot develop, which makes walking painful.

The condition may be present at birth (congenital) or develop from wearing short, narrow shoes. Hammer toe also occurs in children who continue to wear shoes they have outgrown.

The rare case in which all toes seem to be involved may indicate a problem with the nerves or spinal cord.

Symptoms

• Callus forms on the sole of the foot
  
• Claw-like deformity of a toe
  
• Corn forms on the top of a toe
  
• Foot pain -- pain in the joint where the great toe joins the foot

Exams and Tests

A physical examination of the foot confirms hammer toe.

Treatment

Mild hammer toe in children can be treated with foot manipulation and splinting the affected toe. Wear the right size shoes or shoes with wide toe boxes for comfort and to avoid aggravating hammer toes.

Protect the protruding joint with corn pads or felt pads, corrective footwear, or other foot devices. Exercises may be helpful.

Severe hammer toe requires an operation to straighten the joint. The surgery may involve cutting or moving tendons, or fusing the joints of the toe together.

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Calluses & Corns

Corns and calluses are thickened layers of skin caused by repeated pressure or friction.

Causes

Corns and calluses are caused by pressure or friction on skin. A corn is thickened skin on the top or side of a toe, usually from shoes that do not fit properly. A callus is thickened skin on your hands or the soles of your feet.

The thickening of the skin is a protective reaction. For example, farmers and rowers get callused hands that prevent them from getting painful blisters. People with bunions often develop a callus over the bunion because it rubs against the shoe.

Neither corns nor calluses are serious conditions.

Symptoms

• Skin is thick and hardened.
  
• Skin may be flaky and dry.
  
• Hardened, thick skin areas are found on hands, feet, or other areas that may be rubbed or pressed.

Exams and Tests

Your health care provider will make the diagnosis after observing the skin. In most cases tests are not necessary.

Usually, preventing friction is the only treatment needed. If a corn is the result of a poor-fitting shoe, changing to shoes that fit properly will usually eliminate the corn within a couple of weeks. Until then, protect the skin with donut-shaped corn pads, available in pharmacies. If desired, use a pumice stone to gently wear down the corn.

Calluses on the hands can be treated by wearing gloves during activities that cause friction, such as gardening and weight lifting.

If an infection or ulcer occurs in an area of a callus or corn, unhealthy tissue may need to be removed by a health care provider and treatment with antibiotics may be necessary.

Calluses often reflect undue pressure placed on the skin because of an underlying problem such as bunions. Proper treatment of any underlying condition should prevent the calluses from returning.

Outlook (Prognosis)

Corns and calluses are rarely serious. If treated properly, they should improve without causing long-term problems.

DIABETICS SHOULD NOT CUT THEIR OWN CORNS OR CALLOUSES NOR SHOULD THEY USE MEDICATED CORN PAD REMOVERS AS THESE CAN CAUSE INFECTIONS AND POTENTIAL FOR AMPUTATIONS.

Possible Complications

Complications of corns and calluses are rare. People with diabetes are prone to ulcers and infections and should regularly examine their feet to identify any problems right away. Such foot injuries need medical attention.

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Plantar Warts

Warts are small, usually painless growths on the skin caused by a virus. They are generally harmless. However, warts can be disfiguring and embarrassing, and occasionally they itch or hurt (particularly on the feet).

The different types of warts include:

• Common warts usually appear on the hands, but can appear anywhere.
  
• Flat warts are generally found on the face and forehead. They are common in children, less so in teens, and rare in adults.
  
• Plantar warts are found on the soles of the feet.
  
• Subungual and periungual warts appear under and around the fingernails or toenails.

Causes

The typical wart is a raised round or oval growth on the skin with a rough surface. Compared with the surrounding normal skin, warts may appear light, dark, or black (rare). Most adults are familiar with the look of a typical wart and have little trouble recognizing them. Unusual warts with smooth surfaces or flat warts in children may be more difficult for parents to recognize.

Common warts tend to cause no discomfort unless they are in areas of repeated friction or pressure. Plantar warts, for example, can become extremely painful. Large numbers of plantar warts on the foot may cause difficulty running and even walking.

Warts around and under your nails are much more difficult to cure than warts elsewhere.

Warts should be treated as they are a virus and can enlarge and spread. Left alone the size and amount of warts can become severe and painful when they are in a weight bearing area. Genital warts are contagious, while common, flat, and plantar warts are much less likely to spread from person to person. All warts can spread from one part of your own body to another.

Because people generally consider warts unsightly and there is often a social stigma, treatment is often sought.

Symptoms

• Abnormally dark or light skin surrounding the lesion
  
• Numerous small, smooth, flat (pinhead sized) lesions on forehead, cheeks, arms, or legs
  
• Rough growths around or under fingernails or toenails
  
• Rough, round, or oval lesions on soles of feet -- flat to slightly raised -- painful to pressure
  
• Small, hard, flat or raised skin lesion or lump

Exams and Tests

Warts can generally be diagnosed simply by their location and appearance. Your doctor may want to cut into a wart (called a biopsy) to confirm that it is not a corn, callous, or other similar-appearing growth.

Treatment

Over-the-counter medications can remove warts. These are applied to the wart every day for several weeks. DO NOT use these medications on your face or genitals. It helps to file the wart down when damp (for example, after a bath or shower) before applying these medications.

Special cushions are available at drugstores for plantar warts. These pads help relieve any pressure and pain from the warts.

Stronger (prescription) medications may be required for removal of persistent warts. Surgical removal or removal by freezing (cryotherapy), burning (electrocautery), or laser treatment may be needed.

DO NOT attempt to remove a wart yourself by burning, cutting, tearing, picking, or any other method.

Outlook (Prognosis)

Warts are generally harmless growths that often go away on their own within two years. They can be contagious, but transmission from person to person is uncommon. Warts may be unsightly or cause discomfort, especially on the feet.

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Neuromas - Morton's Neuroma

Morton's neuroma is a thickening of nerve tissue between the toes. It commonly affects the nerve that travels between the third and fourth toes.

Causes

Morton's neuroma is more common in women than men.

The exact cause is unknown. However, some experts believe the following may play a role in the development of this condition:

• Abnormal positioning of toes
  
• Flat feet
  
• Forefoot problems, including bunions and hammer toes
  
• High foot arches
  
• Tight shoes and high heels

Symptoms

Symptoms of Morton's neuroma include:

• Tingling in the space between the third and fourth toes
  
• Toe cramping
  
• Sharp, shooting, or burning pains in the ball of your foot (and sometimes toes)
  
• Pain that increases when wearing shoes or pressing on the area
  
• Pain that gets worse over time

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

Exams and Tests

A foot x-ray may be done to rule out bone problems. MRI or high-resolution ultrasound can successfully diagnose Morton's neuroma.

Nerve testing (electromyography) cannot definitely diagnose Morton's neuroma, but may be used to rule out conditions that cause similar symptoms.

Treatment

Nonsurgical treatment is tried first. Your doctor may recommend any of the following:

• Padding and taping the toe area
  
• Shoe inserts
  
• Changes to footwear (for example, shoes with wider toe boxes)
  
• Anti-inflammatory medicines taken by mouth or injected into the toe area
  
• Nerve blocking medicines injected into the toe area
  
• Other painkillers
  
• Physical therapy

Anti-inflammatories and painkillers are not recommended for long-term treatment.

In some cases, surgery may be needed to remove the thickened tissue. This can help relieve pain and improve foot function. Numbness after surgery is permanent, but should not be painful.

Outlook (Prognosis)

Nonsurgical treatment does not always improve symptoms. Surgery to remove the thickened tissue is successful in about 85% of cases.

Prevention

Avoid ill-fitting shoes. Wear shoes with a wide toe box.

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Gout

Gout is a kind of arthritis that occurs when uric acid builds up in the joints.

• Acute gout is a painful condition that typically affects one joint.
  
• Chronic gout is repeated episodes of pain and inflammation, which may involve more than one joint.

Causes

Gout is caused by having higher-than-normal levels of uric acid in your body. Your body may make too much uric acid, or have a hard time getting rid of uric acid. If too much uric acid builds up in the fluid around the joints (synovial fluid), uric acid crystals form. These crystals cause the joint to swell up and become inflamed.

Not everyone with high uric acid levels in the blood has gout.

The exact cause is unknown. Gout may run in families. It is more common in males, postmenopausal women, and people who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood.

The condition may also develop in people with:

• Diabetes
  
• Kidney disease
  
• Obesity
  
• Sickle cell anemia and other hemolytic anemias
  
• Leukemia and similar types of disorders

The condition may occur after taking medicines that interfere with the removal of uric acid from the body.

Symptoms

Symptoms of acute gouty attacks:

• Symptoms develop suddenly and usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.
  
• The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating.
  
• The joint appears warm and red. It is usually very tender (it hurts to lay a sheet or blanket over it).
  
• There may be a fever.
  
• The attack may go away in several days, but may return from time to time. Additional attacks usually last longer.

After a first gouty attack, people will have no symptoms. Some people will go months or even years between gouty attacks.

Some people may develop chronic gouty arthritis, but others may have no further attacks. Those with chronic arthritis develop joint deformities and loss of motion in the joints. They will have joint pain and other symptoms most of the time.

Tophi are lumps below the skin around joints or in other places. They may drain chalky material. Tophi usually develop only after a patient has had the disease for many years.

After one gouty attack, more than half of people will have another attack.

Exams and Tests

Tests that may be done include:

• Synovial fluid analysis (shows uric acid crystals)
  
• Uric acid - blood
  
• Joint x-rays (may be normal)
  
• Synovial biopsy
  
• Uric acid - urine

Treatment

Treatments for a sudden attack or flare-up of gout:

• Your doctor will recommend that you take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or indomethacin as soon as your symptoms begin. You will need to take prescription-strength medicines for 4 - 10 days.
  
• Your health care provider may occasionally prescribe strong painkillers such as codeine, hydrocodone, and oxycodone.
  
• A prescription medicine called colchicine helps reduce pain, swelling, and inflammation.
  
• Corticosteroids can also be very effective. Your doctor may inject the inflamed joint with steroids to relieve the pain.
  
• The pain often goes away within 12 hours of starting treatment, and is completely relieved in 48 hours.

Daily use of allopurinol or probenecid decrease uric acid levels in your blood. Your doctor may prescribe these medicines if:

• You have several attacks during the same year
  
• You have signs of gouty arthritis
  
• You have uric acid kidney stones

Some diet and lifestyle changes may help prevent gouty attacks:

• Avoid alcohol, anchovies, sardines, oils, herring, organ meat (liver, kidney, and sweetbreads), legumes (dried beans and peas), gravies, mushrooms, spinach, asparagus, cauliflower, consommé, and baking or brewer's yeast.
  
• Limit how much meat you eat at each meal.
  
• Avoid fatty foods such as salad dressings, ice cream, and fried foods.
  
• Eat enough carbohydrates.
  
• If you are losing weight, lose it slowly. Quick weight loss may cause uric acid kidney stones to form.

Outlook (Prognosis)

Proper treatment of acute attacks allows people to live a normal life. However, the acute form of the disease may progress to chronic gout.

Prevention

The disorder itself may not be preventable, but you may be able to avoid things that trigger your symptoms. Limit alcohol consumption and follow a low-purine diet.

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Arthritis

The word arthritis actually means joint inflammation. The term arthritis is used to describe more than 100 rheumatic diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern, severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Who is at risk for arthritis?

Certain factors are associated with a greater risk of arthritis. Some of these risk factors are modifiable while others are not.

Non-modifiable risk factors

• Age: The risk of developing most types of arthritis increases with age.
  
• Gender: Most types of arthritis are more common in women; 60% of the people with arthritis are women. Gout is more common in men.
  
• Genetic: Specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and ankylosing spondylitis.

Modifiable risk factors

• Overweight and Obesity: Excess weight can contribute to both the onset and progression of knee osteoarthritis.
  
• Joint Injuries: Damage to a joint can contribute to the development of osteoarthritis in that joint.
  
• Infection: Many microbial agents can infect joints and potentially cause the development of various forms of arthritis.
  
• Occupation: Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee

What causes arthritis?

• Elevated uric acid levels cause gout, and specific infections can cause certain forms of arthritis. The causes of many of the other forms of arthritis are unknown. Scientists are studying the role of factors such as genetics, lifestyle, and environment in the various types of arthritis.

What are the most common types of arthritis?

• The most common form of arthritis in the Unites States is osteoarthritis followed by gout, fibromyalgia, and rheumatoid arthritis.

What are the symptoms of arthritis?

• The pattern and location of symptoms can vary depending on the type of arthritis. Generally, people with arthritis feel pain and stiffness in and around one or more joints. The onset of arthritis symptoms can develop gradually or suddenly. Arthritis is most often a chronic disease, so symptoms may come and go, or persist over time.

What should I do if I think I have arthritis?

• If you have pain, stiffness, or swelling in or around one or more of your joints, talk to your doctor. It is important to keep in mind that there are many forms of arthritis, and a specific diagnosis of the type you have may help to direct the proper treatment. Although there is no cure for most types of arthritis, early diagnosis and appropriate management are important, especially for inflammatory types of arthritis. For example, early use of disease-modifying drugs can affect the course of rheumatoid arthritis. An early diagnosis and appropriate treatment can make a difference in pain and joint damage. The earlier you understand your arthritis, the earlier you can start managing your disease and making healthy lifestyle changes to help your arthritis.

Can I prevent arthritis?

• Depending on the form of arthritis, there are steps that can be taken to reduce your risk of arthritis. Maintaining an appropriate body weight has been shown to decrease the risk of developing osteoarthritis and gout. Protecting your joints from injuries or overuse can reduce the risk of osteoarthritis.

How is arthritis diagnosed?

• Diagnosing arthritis often requires a detailed medical history of current and past symptoms, physical examination, x-rays, and blood work. It is possible to have more than one form of arthritis at the same time.

What are the treatments for arthritis?

The focus of treatment for arthritis is to control pain, minimize joint damage, and improve or maintain function and quality of life. According to the American College of Rheumatology, the treatment of arthritis might involve the following:

• Medication
  
• Nonpharmacologic therapies
  • Splints or joint assistive aids
    
  • Patient education and support
    
  • Weight loss
• Surgery

How can I manage arthritis pain?

• Both medical treatment and self-management strategies are very important.
• Physical activity can also help reduce pain.

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Arch pain

Arch pain has often been described as a burning feeling or sensation in the long arch of the foot. There can be many causes for this, such as a strain to any one of the structures of the foot. However, the most common cause of arch pain has been found to be plantar fasciitis.

Management of arch pain

A factor in the early management of arch pain is receiving an accurate diagnosis from your physician here at Birmingham Foot. At that point, if the symptoms are generally mild Dr. Linde may consult with you about foot orthotics and stretching exercises to help the calf muscles and arch. If you report that your symptoms are more severe than Dr. Linde may use tape to support the arch and restrict movement as well as prescribe an anti-inflammitory medication, and recommend the use of orthotics. If there is no relief from those treatments, further testing may be necessary to determine whether such conditions as arthritis or a pinched nerve exist.

Arthritis information was provided by the Centers for Disease Control and Prevention

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