FAQ Category: Foot

Wounds that fail to heal in the feet of patients with diabetes are a serious problem. Treatment begins with prevention. Daily inspection of the feet is essential. When even the smallest problem shows up, patients are advised to contact their doctor or other health care provider.

Quick and early intervention can sometimes make the difference between saving and losing toes and limbs. But even early and appropriate wound care can fail. Patients who smoke are more likely to experience delayed wound healing.

Those individuals who have loss of sensation called diabetic neuropathy are also at increased risk of wounds that don’t heal. The patient may not feel the sore until it has become infected or deep. Treatment takes much longer in these cases. A positive result can also be prevented by the presence of poor circulation, a common problem in this patient population.

Amputation is suggested for one of the following five reasons:

Plantar fasciitis (PF) is an inflammatory condition that affects the fibrous tissue along the bottom of the foot. It causes severe pain when the person stands for the first time after a long rest period or upon awakening in the morning.

The pain can last for months, causes limping, and may require surgery before it goes away. The exact cause of this problem remains a mystery. Many studies have been done to find out what’s going on. Some scientists have measured the blood flow to the foot.

Others have used ultrasound to measure the thickness of the fascia. They tried to relate thickness to arch angles and pain levels. It’s clear that the arch angle has something to do with it. The ratio of height-to-length is known to be a factor.

People with low arches seem to be at risk, too. This position of the foot may put increased load on the fascia causing microdamage and the resulting pain. But the fact that not everyone with low arches develops plantar fasciitis suggests some other factors.

Women do seem more prone to PF so maybe there are hormonal factors. And women going through menopause have an increased incidence of this problem. It may be more likely gender-linked than hereditary but this has not been proven one way or the other yet.

Probably both. Increased body mass index (being overweight) is linked with chronic plantar fasciitis (PF). But so is having a flat or low arch. These two factors together are enough to result in plantar fasciitis.

Nerve damage from diabetes called diabetic neuropathy has also been linked with PF. It’s not clear if the increased rate of PF in patients with diabetes is caused by a systemic change from the diabetes or a local change from mechanical factors. Perhaps it’s a combination of both.

The fact that thin people without diabetes can develop PF suggests other factors as well. There may be differences in the thickness of the fascia that we are born with that contribute to the problem. Most likely it’s a multifactorial problem meaning that many things come together either over time or at the same time to result in this condition.

Probably not. There is still much debate about the best way to treat Achilles’ tendon ruptures. Some patients opt to avoid surgery and wear a brace or a cast for six weeks. Surgery has improved over the years so recovery is faster than it used to be and with fewer complications.

But the final outcome between conservative treatment and surgical repair remains about the same for many people. In both methods, a semifunctional rehab program begins two weeks after the injury or repair. A special walking boot is used for about eight weeks.

At first, patients can put partial weight on that side when walking. The ankle is kept in a plantar flexed position (toes pointing down) to avoid overstretching the healing tendon.

Stationary cycling is allowed during the third week. By the fourth week, the foot and ankle are brought back up to a neutral position. Neutral means the ankle isn’t dorsiflexed (toes up toward the face) or plantar flexed. Active foot and ankle motion are started in the fourth week and slowly progressed to full motion.

Around the sixth week, the amount of weight-bearing (load) allowed is increased. The patient can continue to gradually increase the amount of weight placed through the foot and ankle until full load is reached. At this point (usually around eight weeks), the brace or cast can be removed. Rehab can progress at a full pace to restore muscle length and strength.

In general, more and more people are suffering from this exact injury. Men between the ages of 30 and 50 are the most likely to sustain an Achilles’ tendon rupture. Both of these statistics are related to the fact that more people than ever before are now involved in sports.

Many people ask the Why me? question. The exact answer remains unknown. There may be some anatomical reasons. Perhaps a certain shape or length of the Achilles’ puts some people at a higher risk of rupture. Those changes along with increased sports activities may be the right mix for injury.

There are some known predisposing factors. This means those individuals who fall into any of these categories is at increased risk of tendon rupture. It does not mean it is going to happen no matter what. These factors include history of diabetes or rheumatoid arthritis.

Anyone who has had Achilles’ tendon problems in the past is at increase risk for rerupture. Certain medications can increase the risk of Achilles’ tendon rupture. Corticosteroids and fluoroquinolone antibiotics fall into this category.

Most of all, increased athletic activity is a key factor. In a recent study from Italy, out of 24 patients with acute Achilles rupture, 23 occurred during athletic activities.

You are describing a bunionette deformity. These can be very painful for some people. They don’t bother others. And many don’t like how they look and have them removed.

Before doing surgery, most surgeons will suggest a more conservative approach. Wider shoes, orthotics, toe spacers, and padding can help relieve the pressure and reduce the inflammation. Up to one-quarter of affected people aren’t helped by nonsurgical treatment. They really need surgery to take care of the problem.

There is a wide range of operations that can be done. Most of these procedures fall into one of two groups. The first is exostectomy, which just means to remove the bone. The second is an osteotomy. In this operation, a wedge-shaped piece of bone is removed and the two ends of remaining bone are moved together to close up the gap.

The surgeon decides which type of operation to perform based on several factors. The location and severity of the deformity makes a difference. X-rays are taken to help identify angles and measures important in planning the operation. If there are any other deformities in the foot, these must be addressed as well.

Yes, bunions of the fifth metatarsal head (little toe) are called bunionettes. They occur as a result of a widened angle between the fourth and fifth toes.

Narrow shoes or constant pressure alongside the edge of the foot is the usual cause of the problem. In fact, sometimes this condition is even called tailor’s bunion. Clothing tailors sitting on the floor with their legs crossed put pressure on the lateral border of the foot. The result can be a bunionette.

In some people, the cause of this deformity with the soft tissue changes is unknown. Many patients aren’t bothered by it and don’t need any treatment. Others have pain, inflammation, and swelling.

The condition is treated first with appropriate shoe wear. Narrow shoes should be avoided. A shoe with a wide enough width for the widest part of the foot should be chosen. Padding and toe spacers help some people. If these measures don’t improve the symptoms, then surgery may be needed.

The calf muscle is a very large muscle with a thick, but narrow tendon attaching it to the heel. This is called the Achilles’ tendon. The Achilles’ tendon is the most commonly ruptured tendon in the body. Middle-aged, sports enthusiasts like your husband are the most likely people to suffer this injury.

Doctors report that this injury is on the rise, too. That’s probably because more people are staying active and exercising more as they age into mid- and later life.

We don’t know what the best treatment is for this problem. Some say surgery, others advise nonoperative care. Over the past 10 years, the pendulum has swung more toward surgery with earlier mobilization.

Without surgery, the patient can be given a special mobile cast to get them up and walking sooner than later. Although re-rupture is higher for people who don’t have surgery, surgery is not without risks. Infections and wound problems can delay healing after surgery.

Achilles’ tendon rupture is a common but complex problem. We don’t have a clear treatment path that works well for everyone. Surgery may be helpful; the risk of re-rupturing the tendon is higher when surgery isn’t done.

Rehab seems to take about the same amount of time whether the patient has the tendon repaired surgically or not. You didn’t say if you have had surgery, but it sounds like you’ve at least had some physical therapy.

To answer this question, you may want to do a short inventory with yourself. Are you limited in what you can do because of weakness in the foot or ankle? Or is it fatigue, stiffness, or pain that limits you?

Just exactly what is it you can’t do that you want to be able to do? Is it jumping activities? Walking on uneven surfaces? Running a marathon? Contact your physical therapist with your list and see what she or he would suggest. You may need some direct one-on-one time with the therapist and/or you may just need to bump up your training schedule.

The standard treatment methods include heat, antiinflammatory drugs, and stretching. Physical therapy applied early can help soften the fascia along the bottom of the foot and stretch the tissue to keep it from pulling and causing chronic inflammation.

The therapist can show you how to tape your foot to help limit pressure on the heel. He or she may also fit you with an orthotic (shoe insert) to help support the foot. Some patients use a special sock at night to gently stretch the tissue.

In resistant cases, a fitted splint to maintain a gentle stretch across the sole of the foot may be worn while sleeping. Local steroid injections are often tried in persistent cases. And putting the foot in a cast for several weeks may help.

Newer treatments include FDA-approved shock wave treatment called extracorporeal shock-wave. This high-pressure, low-energy sound-wave technology has been used to treat kidney stones and may be helpful for plantar fasciitis.

The treatment uses noninvasive technology to break up heel spurs and ease tissue thicknening. Studies are underway to determine the best treatment frequency, duration, and intensity for PF.

All three suggestions have some merit. It is true that plantar fasciitis (PF) does get better on its own in six to 12 months for many people. But it’s also a painful condition that can be very disabling while you have it.

Studies using shoe inserts called orthotics for this condition do show they help. Pain is decreased and function improved in the first three months. When comparing patients with PF who use orthotics with patients who don’t use these inserts, there’s no difference in outcomes between the two groups at the end of 12 months.

Physical therapy can be helpful to teach you how to manage symptoms. Stretching and a particular form of massage called cross-transverse friction massage (CTFM) can help keep the connective tissue soft and pliable.

The therapist may use deep heat in the form of ultrasound followed by CTFM to stretch the fascia. The therapist can also help you find the best off-the-shelf orthotic to use to reduce pain during the interim.

There are a few ways to assess the effectiveness of orthotics. The first is just a simple before and after diary of your symptoms. For example, before you get the orthotics, you can keep track of what hurts and when it hurts. How long does it last?

Record practice and competitive times for your three mile run before and after the orthotics. Compare both the symptoms and the results after you receive the inserts.

A more sophisticated study can be done at a motion analysis lab. If you live in a university town, you might find such a gait laboratory at a physical therapy school or physiology department. Sometimes the physical therapy department at large hospitals is set up with this type of motion analysis equipment, too.

If none of that is available, there is a simple test your podiatrist or physical therapist can conduct. It’s called the Foot Posture Index (FPI-8). The original FPI had eight test items to measure foot posture.

Position of the bones, arch, and toes are assessed using this tool. A revised version of the FPI-8 with only six items (FPI-6) is now being studied. If you find someone who is familiar with this tool, it may give you a more objective set of before and after measures.

Helbing’s sign was named after the German physician (Carl Helbing) who first wrote about it in the early 1900s. It is a curving inward of the Achilles’ tendon. The Achilles’ tendon attaches the calf muscle to the large heel bone called the calcaneus.

Helbing’s sign occurs most often when the arch of the foot drops down such as occurs with flat feet. The curving of the Achilles’ can be best seen from behind when the person is standing.

Sesamoiditis is a general term used to describe inflammation of the sesamoid bones in the big toe. The sesamoid bones are two tiny sesame seed-shaped bones under the base of the big toe. Sesamoiditis is usually caused by repetitive stress such as jamming the toe or pushing off from the big toe over and over.

Ballet dancers, track athletes pushing off from the starting blocks, and runners experience this type of problem. Football, rugby, and soccer players are at risk for this problem, too. Anyone with problems with foot alignment can also develop sesamoiditis.

The treatment is usually with rest, ice, taping or orthotics (shoe inserts), and antiinflammatory drugs. With proper medical management, she should be able to recover and return to sports. Preventing recurrence of the problem may require some change in shoe wear and training techniques.

Not likely. A stress fracture (sometimes only referred to as a stress reaction of the bone) usually heals nicely in four to six weeks. The outer covering of the bone called the cortex has a slight crack but the bone is still intact. There are no bone chips. The fracture line has not widened or opened up in any way.

Treatment is usually anti-inflammatory drugs and reduced weight-bearing. The patient uses crutches and keeps the weight off that foot. The patient doesn’t usually need a cast or brace of any kind.

Your son will probably have to interrupt his active military training until the bone has healed. About the time the X-ray or MRI shows healing has occurred, the patient’s pain has gone and he or she is ready to put more weight on the foot and increase activity level.

A additional period of time is allowed for gradual progression of weight-bearing and exercise to regain strength. Most military recruits with a stress fracture of the foot are back to full duty at the end of eight weeks.

Stress fractures of the talus bone are fairly rare. Rare enough that long-term studies aren’t available for the most part. A recent study from the military may help answer some of your questions.

They reviewed the medical records of eight soldiers who had a stress fracture of the talus. Using X-rays and MRI studies, they found mild degenerative changes in the bone a year (up to six years) after the initial injury.

Only half the patients were aware of any symptoms. They reported mild tenderness after excessive activity. No one had any tenderness when examined by an orthopedic surgeon. The long-term results are unknown at this point. Over time, these arthritic changes could progress from mild to moderate to severe but there’s no way to know that without further study.

You may be referring to a position podiatrists call the Windless mechanism. This static position can also be used to stretch the plantar fascia. The plantar fascia is located along the bottom of the foot.

Sitting in a chair, cross your affected leg over your other leg. The painful foot and ankle are resting on the thigh just above your knee. Pull your toes toward the shin. Stop pulling the toes upward when you will feel the stretch, tension, and discomfort or pain.

Hold the stretch for at least 10 seconds. Repeat 10 times. This exercise can be done any time throughout the day. It is especially helpful when done right before getting out of bed or before standing up after sitting for a long time.

There is evidence from one study suggesting that results after eight weeks of stretching in this way are very positive. Patients had less pain and increased function. Improvements were still present when patients were contacted two years later.

Plantar fasciitis causes a tightness and pain of the plantar fascia along the bottom of the foot. It can make getting up in the morning a very painful process. Surgical results to release the soft tissues have mixed results.

A recent study at the Center for Foot and Ankle Research at the University of Rochester in New York focused on the treatment of plantar fasciitis. They treated two groups of patients who had plantar fasciitis for more than 10 months. Group A performed Achilles’ tendon stretches, while Group B stretched the plantar fascia.

The plantar fascia stretching group had the best result. At the end of the first phase of the study, the Achilles’ tendon group was given the plantar fascia exercise to perform every day for eight weeks. They quickly caught up with the plantar fascia group with less pain and improved function.

A night splint puts the foot and ankle in the same position used to stretch the plantar fascia. The ankle and toes are bent back toward the face in a position called dorsiflexion. The splint is as effective as the daily stretching exercise. However, the splint has a few problems.

The splint doesn’t help keep the plantar fascia stretched out during the day. The manual stretch can be done after long periods of inactivity. It’s especially helpful when the stretch is completed before getting up in the morning. The stretching exercise also costs less than the night splint.

It may be best to make an appointment with your family physician or orthopedic surgeon. A physical exam, X-rays, and possibly other imaging tests are needed to identify the problem.

Symptoms that occur with movement or action suggest a musculoskeletal problem. It could be a bone fracture, joint impingement, or muscle strain. Ligaments, tendons, joint capsule, nerves, or any other soft tissue could be part of the problem. Without specific testing, it would be difficult to say what is the problem.

The doctor can examine the foot and ankle and perform specific tests to help rule in or rule out various problems. The type of symptoms your daughter is describing may point to a condition some athletes have called tarsal tunnel syndrome (TTS). With TTS, the tibial nerve gets pinched, pressed, or stretched as it passes through a tunnel formed by the bones of the ankle.

If this is the problem, the symptoms will gradually get worse. Sometimes the pain, numbness, and tingling last even after the aggravating motion is stopped. Early diagnosis and treatment is always best. Sometimes a simple solution is possible. Waiting too long may mean less chance for full recovery.

Pain, numbness, and tingling in both the hands and feet are not likely caused by tarsal tunnel syndrome (TTS). TTS is a compression or entrapment of the tibial nerve as it passes through a small tunnel formed by the bones of the ankle. TTS is usually only on one side and can’t affect the wrist or hands.

It’s usually caused by trauma or a change in the normal anatomy. For example an extra bone or thickened muscle, old or new fracture, or cyst or tumor could be putting pressure on the nerve.

As you have experienced, sometimes a problem presents one way leading to a particular diagnosis. Over time as the symptoms progress, symptoms may spread or other symptoms may start. The doctor relies on the history, physical exam, and any tests performed to sort out one problem from another. With the addition of the same symptoms somewhere else in the body, a new exam is needed.

You may have a problem called peripheral neuropathy. The means that the nerves of the hands and feet are disturbed for some reason. The doctor will have to find out what the underlying cause or reason is for your symptoms. With both hands and feet involved, a systemic source of symptoms is most likely. This could be a change in liver function, diabetes, or tumor.

It’s good that you saw your doctor early on so that a baseline of symptoms was established. Now with a follow-up appointment, it may be clearer what direction to head to make a more definitive diagnosis.