FAQ Category: Foot

When the foot rolls inward and the natural arch flattens out, it’s called pronation. If your foot pronates too much and it’s noticeable, you may be called by the more common term of flatfooted. Mild pronation usually isn’t a problem. When bone on the inside edge of the arch (the navicular bone) drops 10 mm or more, it’s considered severe pronation.

Severe pronation can lead to changes in the foot. The foot can become unstable. Ligaments and muscles can get stretched out. Painful conditions of the lower leg can occur. Most cases of flat foot don’t cause any symptoms. More people seek help for how it looks than for how it feels.

There are some times when orthotics or special shoe inserts offer foot comfort for people with flat feet. Many people do just fine with just a good arch support in the shoe. It
depends somewhat on the type of flat foot you have and how severe it is.

There are some taping methods that can be used temporarily to see what effect support has on the arch. If taping the arch improves your symptoms, then it’s likely the orthotic
will have a positive effect.

Taping has been shown in studies to reduce the pressure through the bottom of the feet.
It also distributes the weight more evenly from front to back and side to side under the foot. This is especially true when the flat foot is accompanied by a significant (10 mm or more) drop of the navicular bone.

The navicular bone is on top of the foot about where your shoe laces tie. There’s a bump on the bottom of this bone on the inside of the foot just above the highest part of your arch. In many people with flat feet, the navicular bone has dropped down. Taping the foot so the navicular bone is in a neutral position will help guide your orthotic decision.

Repeat steroid injections for tendonitis are usually only given if the patient shows some improvement. There may be some continued mild pain and swelling after the first injection, but the patient reports a big change from before the injection. In such cases
a second injection may be given.

There are some drawbacks to steroid injections. This is why they aren’t used more routinely or without question. For example, the soft tissue can get thin. This puts the tendon at increased risk for rupture. Deep infection is also possible.

If the skin changes color, it may be a sign that the injection didn’t reach its intended site. Injection of steroid drugs under the skin can cause depigmentation. This may be what you are describing. Doctors can use a special imaging tool called fluoroscopy to guide their injections to the right place. This also helps them avoid using too much drug.

A four-week wait is usually a minimum needed for the Achilles tendon to heal. You are putting your entire body weight on a very small, but powerful tendon. Excessive loading of the tendon from sporting activities is the most common factor in causing further damage to the tendon.

The tendon can rupture from mechanical stress and overuse. Rehab and recovery for that type of injury can take up to a year. Surgery may be needed.

Poor running technique and improper shoes can be important factors in Achilles tendonitis. This is true both for the healing phase and in the case of re-injury. Talk with your coach or athletic trainer about these two factors as they relate to your event.
You may need some changes in your training patterns, too.

A rehab program for this problem is based on rest of the tendon. This means avoiding any activity that makes your symptoms worse. Sometimes a heel wedge is placed in the shoe. This unloads the calf muscles that attach to the Achilles tendon.

Exercise is a key part of the rehab program. This includes stretching for flexibility. Stretching also helps with tendon healing. Strengthening is important, especially starting with the muscle in a contracted position and lengthening it against resistance.

The use of steroid injections for tendonitis is hotly debated. There is a risk of tendon rupture with this treatment. Some doctors have tried injecting the drug around the tendon rather than into the tendon. This hasn’t been shown to work well.

A new approach is being tried using a skin patch with topical nitric oxide (NO). NO is a gas present in the body at all times. It’s released during soft tissue injury to help open blood vessels and bring more blood to the area. Early studies show good results in three-fourths of the patients with tendinopathy who used these skin patches.

Glyceryl trinitrate (GTN) is a prescription drug used on skin patches to promote healing. Scientists are finding many uses for GTN. It has been (and still is) being used for chest
pain from heart disease.

It’s also being used for cracked and bleeding skin, torn tendons

Up to one-third of people using GTN ointment have throbbing headaches. These headaches often go away after two to three days even if you continue to use the ointment. If you get these headaches it could be that you are applying too much cream. Check with your doctor about this. Sometimes just using less cream is all that’s needed, but your doctor
must make this decision.

Other patients get a skin rash from the cream. They may have an allergic sensitivity and can’t use the cream. Patients who use GTN for other conditions may have other side
effects. Headaches and skin rash are the two most common problems with GTN for tendon problems.

Call your doctor right away if you have any new symptoms that start after using GTN. You may not have to quit using the ointment, just change the way you’re using it.

The Achilles tendon is attached to the large calf muscle behind your lower leg. The tendon attaches or inserts (thus the word insertional) to the heel bone (calcaneus) in your foot. Tendinopathy usually means a tear or some other type of damage to the tendon.

Noninsertional tendinopathy is a tear or injury to the Achilles tendon. This occurs somewhere between where it attaches or inserts to the bone and where it becomes muscle. It’s not right at the point of insertion.

Technically a tendinopathy is not the same as tendonitis. Some say it’s on a continuum or line. Tendonitis is at the beginning of the line and tendinopathy is at the other end. That’s because chronic overuse of a tendon leads to inflammation and microtears
(tendonitis). Tendonitis can later become a tendinopathy. The tendinopathy tear is large enough to show up on ultrasound imaging; tendonitis is not seen.

Both conditions have pain, but there’s often a tender bump or nodule above the insertion point with a tendinopathy.

Nonoperative treatment consists of immobilizing the lower leg with a cast. Some doctors use a cast for four weeks then switch to a removable brace. The brace or orthosis
is used for another four weeks. The advantage of the orthosis is that it allows the patient to begin a gradual rehab program sooner.

There is a danger of rerupture with either treatment choice. Open repair is reported to be linked with a lower rate of rerupture. Studies also show surgery results in earlier return of ankle movement after the cast comes off. There are other possible problems with
surgery such as infection or poor wound healing.

Either treatment approach is going to take some time for recovery and a return to dance. Ask the doctor to give you more information about your options based on your daughter’s condition. The severity of the rupture may make a difference in treatment choice.

Dropfoot (also called footdrop) means the patient can’t bend the foot upward.

This can happen when the peroneal nerve is damaged. The damage can occur at the time of the original injury. Pinching or pressure from the cast on the nerve just below the
outside edge of the knee can also cause it.

Sometimes patients don’t follow the doctor’s orders. They put weight on the foot when they aren’t supposed to. Early weight bearing can cause rerupture of the Achilles or damage to the nearby nerve.

Temporary dropfoot can go away in as little as two weeks. The average recovery rate is two to three months. In some cases it takes much longer (up to a year or more).

The “wait-and-see” approach is used most often to answer your question. Nerve conduction tests can be done but these are painful and must be repeated to see if progress has occurred.

Your choice of treatment may depend on your level of function and activity. What kind of job do you have? The physical tasks of a desk job are much different than with a more active job. Were you involved in sports or athletics before the injury? Do you want to
get back to the playing field? What kinds of leisure activities do you like?

You may be able to enter a rehab program with a physical therapist. The therapist can apply treatments to help release scar tissue and realign the connective tissue fibers. Stretching and strengthening will probably be a part of the program.

Surgery is an option even at this late date. Scar tissue can be removed and the torn tendon repaired. You’ll still likely need a rehab program afterward. Following your surgeon’s instructions is very important to prevent rupturing the tendon again.

The base of the big toe or metatarsophalangeal joint (MPJ) is a common spot for soccer injuries. Pushing off the ground, forward drives, and running put this joint at risk for sprains and strains. This can become a chronic problem, especially if it’s not treated properly.

Early rehab should include rest, ice, compression, and elevation. The doctor often prescribes antiinflammatory drugs during this phase. The joint must be kept protected. Rest helps protect the joint, but taping can also help. Special shoe inserts or shoe adaptations may work, too.

Before returning to your sport, you want to make sure there’s no swelling and you have pain free range of motion. After that, sports-specific exercises and drills can be added before returning to competitive play.

Turf toe is a sprain at the base of the big toe where it meets the foot. The toe gets jammed when running or jumping. Turf toe is ranked third as the injury most likely to cause an athlete to lose time on the field. It’s most common in football, soccer, running, and basketball.

The name “turf toe” comes from the fact that many of the players affected by this problem play on artificial turf. Artificial turf is a hard surface. Pushing off, running, and jumping combined together with the hard surface can lead to this injury.

The big toe is at risk for sprains and injury from overuse and especially from jamming the joint when pushing off the ground or running. Hallux limitus is the name given
to this condition. It’s very common, especially among running and jumping athletes.

Chronic pain and loss of motion and function are reported in at least half of all athletes with this problem. Symptoms lasting five years or more after the injury are also common. Once the toe loses its normal range of motion, the center of movement shifts. This causes even more jamming of the first toe.

The toe can start to get bone spurs, joint damage, and even become fused together. Early treatment is best, but it may not be too late for your son. Physical therapy should be tried first. If that fails to relieve symptoms, surgery may be needed. After this much time, surgery may give pain relief, but may not restore full motion.

The Achilles tendon is a large, strong fibrous cord along the back of your lower leg. It connects the calf muscles to the heel bone (calcaneus). The Achilles tendon helps you point your foot down or rise up on your toes. When you walk, the Achilles helps you push
off your foot.

No one is exactly sure why some people spontaneously rupture the Achilles tendon.It can happen even to top athletes. If you overstretch your Achilles tendon, it can tear
(rupture). A rupture can be partial or complete. Usually it occurs just above the heel bone, but it can happen anywhere along the tendon.

Other possible causes of Achilles tendon rupture can include overuse, running on hard surfaces, or tight calf muscles. Activities that put you at risk for Achilles rupture are tennis, racquetball, or basketball. Any activity that involves sudden starts and stops can result in tendon rupture.

Sometimes injuries occur from overstretching your Achilles tendon while doing something simple like walking through your living room.

It sounds like you may have torn your Achilles tendon. The Achilles tendon is the tendon that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus). This is the tendon along the back of the ankle.

If the tendon has not ruptured, then you may have strained the tendon. This type of injury results in a stretch injury to the tendon called tendonitis. In some cases, the tendon itself doesn’t tear. Instead it pulls a piece of calcaneal bone off of the rest of the calcaneus.

You’ll need to see a medical doctor for a proper diagnosis. The tendon may heal on its own without treatment. For some conditions, early treatment is the key to success.

In the case of Achilles tendon rupture, a cast may be needed to immobilize the foot during healing. Sometimes physical therapy is advised. When conservative treatment doesn’t help, surgery is a final option.

Synvisc or Orthovisc are trade names for the generic compound: Hylan GF-20. Hylan is a thick substance like the synovial fluid that occurs naturally in the joints. Synovial fluid acts as a lubricant and shock absorber.

Hylan G-F 20 is injected into the knee joints for the treatment of pain in individuals with osteoarthritis. It has been used for other purposes besides arthritis. A recent study from Turkey used hylan in the Achilles tendons of rats. They found it had a positive healing effect on Achilles tendonitis.

Studies in humans using hylan for tendonitis haven’t been done yet. This first study may pave the way for future studies. Ask your doctor about trying this on an experimental basis.

Dancers are notorious for “working through the pain” no matter what the injury. Dancing requires rigorous training and is very competitive so this kind of decision is common. Stress fractures can heal if the stress is stopped. Most bone heals within four to six weeks.

Failure to rest the area may lead to a more serious fracture. It’s possible the stress fracture won’t heal resulting in what’s called a nonunion. So long as the bone doesn’t heal, blood and nutrients aren’t getting to the area. This can lead to death of bone cells called necrosis. Surgery to remove the bone and put a bone graft in
place may be needed if necrosis occurs.

Other injuries further up in the kinetic chain can occur when the foot is painful. The ankle, shin, knee, hip, and even the back can be affected. Talk to your doctor about your decision. If there is a physical therapist available, make an appointment. The therapist
can help you learn how to tape the foot and ankle. Strengthening the muscles around the foot and ankle can also help protect you from further injury.

Imaging studies have unique differences. For example, CT scan can be used to look for stress fractures, especially if the bone doesn’t heal. Fractures that don’t heal are called nonunion.

MRIs help the doctor see if there is inflammation of the joints. The symptoms can be very much like fracture but the treatment is different.

Talk to your doctor about the need to narrow down imaging choices. Visit the
radiologist’s finance office. Explain your situation as a self-paying patient. Special plans can be made to help you pay off what you owe over a longer period of time.

Isolated foot pain isn’t usually a sign of growing pains, although it is possible. Some males don’t finish growing until well past adolescence.

Dancers are often subjected to pain and injuries from overuse. Male dancers dance up on toes (called demi-pointe) and also perform many leaps and jumps. Those activities
added together can cause an injury called a stress reaction or stress fracture.

Stress fractures don’t always show up on X-ray, especially during the first six to eight weeks. An MRI or CT scan may be needed. Sometimes the doctor will order a bone scan, which shows increased uptake of a radioactive substance at the area of bone injury.

Your best next step may be to make an appointment with an orthopedic surgeon. Find out of there are any doctors in your area who specialize in dance injuries.

It’s very similar but not exactly the same. Lithotripsy is a way to break up stones inside the body using shockwaves. The stones are crushed to sand-like particles and then pass from the body. The patient can avoid open surgery with this treatment.

A similar high or low-energy shockwave treatment can be used for plantar fasciitis. Several studies have been published on this. It’s been shown to be safe and effective. Doctors advise trying regular treatment (e.g., antiinflammatory drugs, ultrasound,
stretching, heel cup) first. If you still have painful symptoms then consider this new shock wave therapy.

Right now sedation is needed, especially with high-energy shock wave treatment. Both feet can be done at the same time and the patient is back to work the next day. In the future this treatment will likely be done in the doctor’s office.