C o. Neal A. Marks, D.P.M., FACFAS Heather A. Craig, D.P.M. i t i o

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1 Foot C o nd Neal A. Marks, D.P.M., FACFAS Heather A. Craig, D.P.M. i t i o n s

2 Doctors Neal A. Marks and Heather A. Craig, both board certified by The American Board of Podiatric Surgery, provide complete foot care and treatment for a variety of problems related to the feet and ankles, many of which are explained in this booklet. Additional information about these problems can be found at Yourfootdoctors.com, with a link to The American College of Foot and Ankle Surgeons for even more detail. The foot and ankle contain about a quarter of the body s bones and an unusually complex network of muscles and connective tissue. Unfortunately, many people neglect their foot disorders because they feel their feet are supposed to hurt. It is estimated that more than 75% of Americans will experience foot problems of varying degrees of seriousness at one time in their lives. Many of those problems and their treatment can be resolved by professional podiatrists such as Doctors Marks and Craig. Dr. Neal A. Marks Dr. Heather A. Craig 1

3 Table Of Contents Bunions/Hammertoes...3 Corns/Calluses/Gout... 4 Warts/Nail Problems... 5 Nail Fungus/Laser...6 Neuromas...7 Heel Pain (Plantar Fasciitis)...8 Achilles Tendonitis/Ankle Pain...9 Conditions We Treat

4 Bunions (Hallux Valgus) Bunions can affect men, women and children! Every time your foot pushes off the ground your big toe supports most of your body s weight. And, if you have a bunion, an abnormal bump on the joint at the base of your big toe, it will push against your other toes. Although a bunion can be inherited, the condition can be accelerated by the shoes you wear. Your podiatrist may recommend you wear a different style of shoe or may prescribe custom-made shoe inserts to control the toe s stabilization. If the bunion is painful or severe, outpatient surgery may be recommended. Bunion surgery can reduce pain and improve the appearance of your feet. The doctor can review x-rays to determine the best procedure for your situation. Hammertoes The smaller toes on your foot could be part of a problem called hammertoes which also can be aggravated by the shoes you wear. A muscle imbalance or tight tendons may cause hammered toes, toes that buckle or curl under. It s also possible they may be caused by shoes that don t fit properly, an earlier trauma or in some cases, inherited. If your symptoms are mild, changing shoes may help. Using a pad to hold your toes straight may also help by alleviating pressure. X-rays may be taken to determine the amount of deformity. If your symptoms are severe, surgery may be required. Hammertoe surgeries are outpatient procedures that straighten the toes and alleviate the pain. 3

5 Corns and Calluses These are thickenings of the outer layer of skin on your foot and are a response to pressure or friction against the skin. Corns usually grow on top of the foot and calluses spread on the bottom of the foot or on the outer edge of a toe or the foot. In some cases, the doctor may trim away the outer layers of skin that make up the corn or callus. Pads or accommodative insoles may be used to alleviate pressure to the affected areas. If your corns or calluses are mild, reducing friction may help. Different shoes, moleskin patches or soft pads may be all the treatment needed. Surgery may be needed to alleviate the pressure causing the corn/callus to occur. Gout Gout is a form of degenerative arthritis that can cause exquisite pain and is the result of excess uric acid in the body. Signs of gout include redness, heat and swelling, with associated acute pain. Left untreated, it can lead to chronic, painful foot deformity. Initial treatment of gout includes: Prescription medications or corticosteroid injections Dietary restrictions, avoiding food and beverages high in purines Fluids drink plenty of water and other liquids, avoiding alcohol Immobilize and elevate the foot 4

6 Warts A wart is an infection caused by a virus. Over time, it develops into a hard, rough growth on the surface of the skin. Although sometimes nonpainful, warts can spread to other areas of the body. They are highly contagious through direct or indirect contact, but are not sexually transmitted. There are many ways to treat warts, depending on their size and location. Medication, surgical removal or both, may be effective treatments. Freezing or burning the growth may also be used. Even after warts are removed, they may recur. Refrain from sharing shoes. Thoroughly clean showers and shoes with appropriate cleaning products. Nail Problems Ingrown nails thickened nails black and blue nails. These are all common nail problems that Doctors Marks and Craig can treat. An ingrown nail is the result of a nail growing into the skin around it. Abnormally thick nails may be caused by injuries, pressure from shoes, fungal infections or several other causes. Black and blue nails usually are the result of sudden or repetitive injury to a toe, known as subungual hematoma, which can be painful. 5

7 If the ingrown nail isn t infected, trimming it may help alleviate the symptoms. Severe infections may require antibiotics or removal of a portion of the nail. If the thickened nail isn t infected, trimming, filing or grinding may alleviate the problem. If a fungal infection is present, anti-fungal medications may be needed. If the pain is severe on the black and blue nail, it may be necessary to remove, or a hole may be drilled to allow drainage and relieve the pressure. Nail Fungus This is often caused by the spread of fungal infections like athlete s foot, or by the use of nail polish or artificial nails. options include the use of topical or oral anti-fungal medications. Removal of the nail may be an alternative to resolve the infection. Laser treatment, a quick and safe procedure performed in the offices of Doctors Marks and Craig, destroys the fungus with no damage to the nail or surrounding skin or pain to the patient. No post-treatment is necessary and normal activities can be resumed immediately. This is not typically covered by insurance. 6

8 Neuromas A neuroma is a painful growth or tumor of nerve tissue that forms when bones in the feet press together and irritate a nerve. They often form in women who wear high heels frequently or are the result of abnormal foot mechanics. If left untreated, neuromas often get worse. Reducing the symptoms may include: Shoe changes and custom-molded insoles. Padding and Taping Physical Therapy Cortisone injection to alleviate symptoms Sclerotherapy (alcohol) injections to shrink the neuroma. If symptoms are not reduced, surgery may be necessary. Surgery is performed as an outpatient procedure where the nerve is removed. 7

9 Heel Pain (Plantar Fasciitis) Heel pain is usually localized to the underside or back of your heel. It can be the result of increased activity, ill-fitting shoes, weight gain or trauma. If it is on the bottom of the foot it could be a condition known as Plantar Fasciitis/Heel Spur Syndrome which is often caused by overuse of the arch tendon (Plantar Fascia) of the foot. It is a very common condition. Early treatment is essential to resolve symptoms. Padding and strapping. Padding in the shoe softens the impact of walking. Strapping helps support the foot and reduces strain on the fascia. Exercise is essential to supporting the integrity of Plantar Fascia. Anti-inflammatory medications and ice can help offer relief. Custom-molded insoles may be needed for long-term usage. Injection therapy. Corticosteroids may be injected to help reduce inflammation and relieve pain. Removable walking cast. This will keep your foot immobilized to allow it to rest and heal. Night splint. This allows you to maintain an extended stretch of the plantar fascia while sleeping. Surgery. In a small percentage of cases, surgery may be required. Shock wave therapy is a non-surgical treatment that may be indicated if symptoms do not resolve with conservative treatment. 8

10 Achilles Tendonitis Your Achilles tendon runs down the back of your lower leg and connects the calf muscle to the heel bone. Achilles tendonitis is an inflammation of the tendon, and is usually short-lived. If not resolved, it leads to a degeneration of the tendon. s can range from immobilization to insoles and include oral medication, night splints, exercise and physical therapy. If these approaches do not work, surgery may be necessary. Ankle Pain The most common ankle injury is often due to an ankle sprain. It is most common on the outside of the ankle caused by twisting or inversion of the ankle. It also can be caused by ankle instability, arthritis, gout, tendonitis, fracture or infection. Initial treatment may consist of rest, ice, elevation and immobilization, but may also require non-steroidal antiinflammatory drugs and cortisone injections. Further testing, including an MRI, may be necessary to evaluate the problem. 9

11 We Treat: Nail Problems Including Ingrown Toenails and Nail Fungus Corns Calluses Foot and Ankle Ulcers Heel and Arch Pain Sports Injuries Involving the Foot and Ankle Bunions Hammertoes Warts Neuromas Achilles Tendonitis Bursitis Sprains/Strains Involving the Foot or Ankle We Also Treat Most Systemic Diseases Affecting the Foot: Diabetes Arthritis Gout Vascular Disease Neurological Disorders 10

12 We Are Proud To Have Provided Professional Foot Care To Greater Clevelanders Since 1990 Neal A. Marks, D.P.M., FACFAS Heather A. Craig, D.P.M Plymouth Ave. Rocky River, OH Mayfield Rd. South Euclid, OH Visit our website at yourfootdoctors.com

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