Foot Problems. General Statistics

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1 General Statistics Foot Problems 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, 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.

2 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. Achilles Problems 1. Tendonitis The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. But it also the most frequently ruptured tendon. Both professional and weekend athletes can suffer from Achilles tendinitis, a common overuse injury and inflammation of the tendon. Events that can cause Achilles tendinitis may include: Hill running or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing mileage or speed. Starting up too quickly after a layoff. Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort such as in a final sprint. Achilles tendinitis 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. Non-steroidal anti-inflammatory medication. Orthoses, which are devices to help support the muscle and relieve stress on the tendon such as a heel pad or shoe insert. Rest, and switching to another exercise, such as swimming, that does not stress the tendon. Stretching, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors. In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears. 2. Peroneal Tendon Dislocation / Dysfunction The Peroneal tendons are two tendons whose 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 the foot

3 while standing. Also called "stirrup" tendons because they help hold up the arch of the foot, the muscles are held in place by a band of tissue called the peroneal retinaculum. Injury to the retinaculum can cause it to stretch or even 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, damaging the tendons. Snow skiing, football, basketball, and soccer are the most common sports activities that can result in peroneal tendon dislocation. Ankle sprains have also known to lead to the condition. Patients usually have to use crutches after such an injury, in order to allow the strain to heal. Sometimes, a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice also supplement treatment. Consult your physician before taking any medications. Surgery can be prescribed with moderate to severe injuries that cause the peroneal retinaculum to be torn or severely stretched to a point that the peroneal tendons will easily dislocate. 3. Xanthomas of the Achilles Tendon Small lumps in the Achilles tendon are sometimes caused by high cholesterol levels, resulting in cholesterol deposits in the tendon itself. Aside from treating cholesterol itself, treatment for Xanthomas involves taking a biopsy of the lesion but leaving the nodules intact. Ankle Problems 1. Ankle Sprain More than 25,000 people sprain their ankles every day, according to the American Orthopaedic Foot and Ankle Society. Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, often resulting in one or more ligaments on the outside of the ankle to be stretched or torn. If not properly treated, ankle sprains could develop into long-term problems. Treatment includes resting the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury. More serious ankle sprains, particularly in competitive athletes, may require surgery to repair to tighten the ligaments. 2. Chronic Lateral Ankle Pain Chronic lateral ankle pain is recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle. Other conditions, however, may also cause chronic ankle pain. Signs and symptoms include: Ankle instability. Difficulty walking on uneven ground or in high heels. Pain, sometimes intense, on the outer side of the ankle. Repeated ankle sprains. Stiffness.

4 Swelling. Tenderness. While ankle sprains are the most common cause of chronic lateral ankle pain, other causes may include: A fracture in one of the bones that make up the ankle joint. Arthritis of the ankle joint. Inflammation of the joint lining. Injury to the nerves that pass through the ankle. In this case, the nerves become stretched, torn, injured by a direct blow, or pinched under pressure. Scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, putting pressure on the ligaments. Torn or inflamed tendon. Treatments for chronic lateral ankle pain include: Over the counter or prescription anti-inflammatory medications to reduce swelling. Consult your physician before taking any medications. Physical therapy, including tilt-board exercises, directed at strengthening the muscles, restoring range of motion, and increasing your perception of joint position. Ankle braces or other supports. Steroid medication. Immobilization to allow the bone to heal (in cases of fractures). 3. Osteochondritis Osteochondritis Dessicans are lesions that usually cause pain and stiffness of the ankle joint and affects all age groups. Often, Osteochondritis usually follow a twisting type injury to the ankle. Osteochondritis may cause swelling and ankle pain. When immobilization of the injury doesn't alleviate the problem, surgery is sometimes prescribed. The procedures usually involve removing the loose fragment of cartilage and bone from the ankle joint and placing small drill holes in the defect. The drill holes stimulate new blood vessels to fill the area and help form scar tissue to fill the defect. Arch and Ball Problems 1. Flat Feet (over pronation) Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when the person stands on his or her toes. The arch develops in childhood, and by adulthood most people have developed normal arches. Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated. Painful progressive flatfoot, otherwise known as Tibialis Posterior Tendinitis, is caused by inflammation of the tendon of the tibialis posterior. The tendon then becomes inflamed, stretched or suffers a partial or total tear. If left untreated, this condition may lead to severe disability and chronic pain. Some people are predisposed to this condition if they have flatfeet or an abnormal

5 attachment of the tendon to the bones in the midfoot. Nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing, or orthotic devices are the common ways of treating painful progressive flatfoot. Contact your physician before taking any medication. In some cases, a surgical operation may need to be performed to repair the torn or damaged tendon and restore normal function. To prevent reinjury, orthotic devices may be recommended. In severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition. 2. Metatarsalgia (foot pain in ball) Foot pain in the "ball of your foot," the area between your arch and the toes, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this midportion of the foot. Also known as "dropped metatarsal heads," metatarsalgia can cause abnormal weight distribution due to over-pronation. Metatarsalgia causes one of metatarsal joints to become painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia can also be caused by arthritis, foot injury (sports, car accidents, repeated stress), hard surfaces (cement or tile floors) and specific footwear (rigid soled work boots). Inappropriate shoes will only aggravate the condition. A simple change of shoes may solve the problem. In more severe cases, full-length custom-molded foot inserts may need to be prescribed. 3. Plantar Fibromas (lumps in the arch of the foot) A plantar fibroma is a benign tissue tumor or growth on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. When non-surgical measures for treating plantar fibromas, such as orthotics, have failed to provide adequate relief of symptoms, surgical removal is a reasonable option. 4. Sesamoiditis There are a few bones in the human body that are connected only to tendons or are embedded in muscle. These are the sesamoids. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the great toe - one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weight-bearing and help elevate the bones of the great toe. Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis, and is common among ballet dancers, runners and baseball catchers. Symptoms include: Pain under the big toe or on the ball of the foot. Swelling and bruising. Difficulty and pain in bending and straightening the big toe.

6 Surgery is usually not required to treat sesamoiditis. Over-the-counter anti-inflammatory medications, as well as rest and ice the sole of your feet, usually relieve the pain. Consult your physician before taking any medications. Common Foot Injuries 1. Ankle Sprain On a daily basis, approximately 25,000 people sprain their ankles, according to the American Orthopaedic Foot and Ankle Society. Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, often resulting in one or more ligaments on the outside of the ankle to be stretched or torn. If not properly treated, ankle sprains could develop into long-term problems. Treatment includes resting the ankle and applying ice to reduce swelling. Compressive bandages also may be used to immobilize and support the injury. More serious ankle sprains, particularly in competitive athletes, may require surgery to repair to tighten the ligaments. 2. Broken Ankle During the past 30 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of "baby boomers," according to the American Academy of Orthopedic Surgeons. The ankle has two joints, one on top of the other. A broken ankle can involve one or more bones, as well as injuring the surrounding connecting tissues or ligaments. Any one of the three bones that make up the ankle joint could break as the result of a fall, an automobile accident or some other trauma to the ankle. A broken ankle may also cause damage to the ligaments. Because a severe sprain can often mask the symptoms of a broken ankle, every injury to the ankle should be examined. Symptoms of a broken ankle include: Bruising. Deformity, particularly if there is a dislocation as well as a fracture. Immediate and severe pain. Inability to put any weight on the injured foot. Swelling. Tender to the touch. Treatment options include a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to "fix" the bones together so they will heal properly. 3. Fractures

7 Nearly one-fourth of all the bones in your body is in your feet. A broken (fractured) bone in your forefoot or in one of your toes is often painful but rarely disabling. Most of the time, these injuries heal without operative treatment. Types of fractures include stress fractures and general bone fractures. Stress fractures frequently occur in the bones of the forefoot extending from your toes to the middle of your foot. Stress fractures are like tiny cracks in the bone surface. They can occur with sudden increases in training (such as running or walking for longer distances or times), improper training techniques or changes in training surfaces. Most other types of fractures extend through the bone. They may be stable, in which there is no shift in bone alignment, or displaced, in which the bone ends no longer line up properly. These fractures usually result from trauma, such as dropping a heavy object on your foot, or from a twisting injury. If the fractured bone does not break through the skin, it is called a closed fracture. Several types of fractures occur to the forefoot bone on the side of the little toe (fifth metatarsal). An ankle-twisting injury may tear the tendon that attaches to this bone and pull a small piece of the bone away. A more serious injury in the same area is a Jones fracture, which occurs near the base of the bone and disrupting the blood supply to the bone. This injury may take longer to heal or require surgery. Symptoms include pain, swelling, and sometimes bruising. 4. Osteochondromas Osteochondromas are benign bone tumors under the toenail. They form in the bone beneath the toenail. An osteochrondroma accounts for about half of all benign bone tumors, occurring mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not very painful. Sometimes, they can deform the toenail and cause an ingrown toenail. In some cases, they are removed surgically, but can recur even after the procedure. 5. Osteochondritis Dessicans(stiff ankle) These are lesions that usually cause pain and stiffness of the ankle joint and affects all age groups. Often, osteochondritis usually follow a twisting type injury to the ankle. Osteochondritis may cause swelling and ankle pain. When immobilization of the injury doesn't alleviate the problem, surgery is sometimes prescribed. The procedures usually involve removing the loose fragment of cartilage and bone from the ankle joint and placing small drill holes in the defect. The drill holes stimulate new blood vessels to fill the area and help form scar tissue to fill the defect. 6. Shin Splints Shin splints are pain to either side of the leg bone, caused by muscle or tendon inflammation. It is commonly related to a collapsing arch, but may be related to a muscle imbalance between opposing muscle groups in the leg. Proper stretching and corrective shoes or shoe inserts for pronation can help prevent shin splints. 7. Sports Injuries

8 Martial arts and kick boxing A variety of injuries can occur as a result of martial arts and kick boxing. These include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended for a minimum of 15 minutes before performing any kicking or punching. Aerobics Proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot. Team Sports Activities such as football, basketball, soccer, field hockey and lacrosse often lead to ankle and big toe joint injuries as a result of play on artificial surfaces. Turf toe Big toe injuries also called "turf toe," often result from hyperextension of the big toe joint as the heel is raised off the ground. An external force is placed on the great toe and the soft tissue structures that support the big toe on the top are torn or ruptured. Symptoms include pain, tenderness and swelling of the toe joint. Often there is a sudden acute onset of pain during push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and will dramatically increase the healing time. Treatment includes rest, ice, compression, and equipment modification or change. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. Consult your physician before taking any medication. Deformities 1. Amniotic Band Syndrome Amniotic band syndrome (ABS) is an uncommon, congenital fetal abnormality that causes disfigured feet. Some researchers believe that ABS is caused by early amniotic rupture, which leads to the formation of fibrous strands that entangle limbs and appendages. Contact our office to discuss treatment options, which may include surgical excision of the fibrous band and any necrotic tissue. 2. Bunions (Hallux Valgus) Bunions are 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 by a podiatric physician is frequently recommended to correct the problem. 3. Claw Toe

9 Claw toe normally is caused by nerve damage from diseases like diabetes or alcoholism, which can weaken the muscles in your foot, according to the American Orthopaedic Foot and Ankle Society. Having claw toe means your toes "claw," digging down into the soles of your shoes and creating painful calluses. Claw toe gets worse without treatment and may become a permanent deformity over time. Common symptoms include: Toes bent upward from the joints at the ball of the foot. Toes bent downward at the middle joints toward the sole of your shoe. Corns on the top of the toe or under the ball of the foot. Claw toe deformities are easier to repair when detected early, but they harden into place over time. Splint or tape is used to hold your toes in correct position. 4. Clubfoot Clubfoot is one of the most common non-life threatening major birth defects. It affects your child's foot and ankle, twisting the heel and toes inward. It may look like the top of the foot is on the bottom. The clubfoot, calf and leg are smaller and shorter than normal. Clubfoot is not painful, is correctable and your baby is probably otherwise normal. Approximately one in every 1,000 newborns has clubfoot. Of those, one in three have both feet clubbed. The exact cause is unknown. Two out of three clubfoot babies are boys. Clubfoot is twice as likely if you, your spouse or your other children also have it. Less severe infant foot problems are common and are often incorrectly called clubfoot. The goal of treating clubfoot is to make your newborn's clubfoot (or feet) functional, painless and stable by the time he or she is ready to walk. Doctors start by gently stretching your child's clubfoot toward the correct position. They put on a cast to hold it in place. One week later, they take off the cast and stretch your baby's foot a little more, always working it toward the correct position. They apply a new cast, and one week later you come back and do it again. This process (called serial casting) slowly moves the bones in the clubfoot into proper alignment. Doctors use X-rays to check the progress. Casting generally repeats for 6-12 weeks, and may take up to four months. About half the time, your child's clubfoot straightens with casting. If it does, he or she will be fitted with special shoes or braces to keep the foot straight once corrected. These holding devices are usually needed until your child has been walking for up to a year or more. Muscles often try to return to the clubfoot position. This is common when your child is 2-3 years old, but may continue up to age 7. Sometimes stretching, casting and bracing is not enough to correct your baby's clubfoot. He or she may need surgery to adjust the tendons, ligaments and joints in the foot/ankle. 5. Dysplasia (Epiphysealis Hemimelica) Dysplasia is a disorder affecting the bone joints. It is characterized by overgrowth of the cartilage on the end of one or more of the long bones (carpal or tarsal bones) in the hand or foot. Less often, the cartilage on other bones such as those in the ankle, knee or hip joint can be affected.

10 Usually only one limb is involved. The limbs may be unequal in length. 6. Enchondroma Small tumors called enchondromas can sometimes form in the bone beneath the toenail. An enchondroma is a fairly common benign tumor, which is the most common bone tumor of the hands and feet. The tumor can involve large portions of the bones, causing thinning of the cortex. This can weaken the bone and cause it to break spontaneously. When enchondromas occur in the small bone in the end of the toe, they can cause pain that may mimic the pain of ingrown toenails. Ollier's Disease, also known as enchondromatosis, frequently occurs in the small bones in the hands and toes (phalanges) and the long bones behind the phalanges called metatarsals. Maffucci's Syndrome is a very rare form of enchondromatosis associated with multiple soft tissue hemangiomas. This tumor frequently occurs in the hands and feet, and has a greater tendency toward malignant transformation than Ollier's Disease. 7. Flat Feet (over pronation) Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible or painful flat feet may be associated with other conditions and require medical attention. Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated. Painful progressive flatfoot, otherwise known as Tibialis Posterior Tendinitis, is caused by inflammation. The tendon becomes inflamed, stretched or suffers a partial or total tear. If left untreated, this condition may lead to severe disability and chronic pain. Some people are prone to this condition if they have flatfeet or an abnormal attachment of the tendon to the bones in the midfoot. Nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing, or orthotic devices are the common ways of treating painful progressive flatfoot. Consult with your physician before taking any medications. Surgical intervention involves repairing the torn or damaged tendon to restore normal function. To prevent re-injury, orthotic devices or show inserts may be recommended. In severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition. 8. Gordon Syndrome Gordon Syndrome is an extremely rare disorder that belongs to a group of genetic disorders known as the Distal Arthrogryposes. These disorders typically involve stiffness and impaired mobility of certain joints of the lower arms and legs (distal extremities) including the knees, elbows, wrists,

11 and/or ankles. These joints tend to be permanently fixed in a bent or flexed position. Gordon Syndrome is characterized by the permanent fixation of several fingers in a flexed position, abnormal bending inward of the foot, and, less often, incomplete closure of the roof of the mouth (also called cleft palate). In some cases, additional abnormalities may also be present. The range and severity of symptoms may vary from case to case. Gordon Syndrome is thought to be an inherited condition. 9. Haglund's Deformity Haglund Deformity (also known as "pump bump" or "retrocalcaneal bursitis") is a painful enlargement of the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of the irritation from rigid heel counters of shoes rubbing up and down on the back of the heel bone. Changing shoes, soaking feet, and anti-inflammatory medications often mitigate the symptoms of this problem. Consult your physician before taking any medication. 10. Hallux Rigidis (stiff big toe) When you have a stiff big toe, walking can become painful and difficult. An unmovable big toe (Hallux Rigidus) often is the most common form of arthritis in your foot. "Wear-and-tear" injuries also can wear down the articular cartilage, causing raw bone ends to rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. Symptoms may include: A bump, like a bunion or callus, that develops on the top of the foot. Pain in the joint when you are active, especially as you push-off on the toes when you walk. Stiffness in the big toe and an inability to bend it up or down. Swelling around the joint. Pain relievers and anti-inflammatory medications are often prescribed to reduce swelling and ease the pain. Applying ice packs or taking contrast baths (which use alternating cold and hot water to reduce inflammation) may also help reduce inflammation and control symptoms for a short period of time. A stiff-soled shoe with a rocker or roller bottom design and possibly even a steel shank or metal brace in the sole can alleviate the symptoms. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe. When damage is mild or moderate, a surgical procedure may be performed to remove the bone spurs, as well as a portion of the foot bone, to allow the toe more room to bend. 11. Hallux Limitus (Stiff Big Toe Joint) Hallux Limitus is a condition that results in stiffness of the big toe joint

12 It is normally caused by an abnormal alignment of the long bone behind the big toe joint called the first metatarsal bone. Left untreated, Hallux Limitus can cause other joint problems, calluses, and diabetic foot ulcers. Painful bone spurs also can develop on the top of the big toe joint. Anti-inflammatory medications, cortisone injections and/or functional orthotics are some of the common treatments for stiff big toe. Consult your physician before taking any medications. Surgery may be prescribed if spurring around the joint becomes severe. 12. Hallux Varus Hallux Varus is a condition in which the big toe points away from the second toe. It often is one complication from bunion surgery. The condition has been linked to a number of other causes, including congenital deformity, tight or short abductor hallucis tendons, trauma or injury, absence or surgical removal of the fibular sesamoid. Treatment may focus on stretching the abductor hallucis tendon through a specific kind of stretching exercise. Other options include toe splints and surgery, in which a small incision is made on the side of the toe. The toe is then splinted in a neutral or straight position. 13. Hammertoes Hammertoe is a deformity of the second, third or fourth toes. In this condition, the toe is bent at the middle joint, resembling a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes. Causes of hammertoe include improperly fitting shoes and muscle imbalance. Treatment for the condition typically involves shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions or non-medicated corn pads may also relieve symptoms. 14. Jackson Weiss Syndrome Jackson-Weiss Syndrome (JWS) is a rare genetic disorder characterized by foot abnormalities. Symtoms include abnormally broad big toes and/or malformation or fusion of certain bones within the feet. 15. Mallet Toes Mallet toes are often caused by bone and muscle imbalances that become exaggerated in people with active lifestyles. Arthritis can also lead to mallet toes. Mallet toes can cause extreme discomfort, and can be aggravated if restrictive or improperly fitting footwear is worn for a prolonged period of time. Treatment is designed to relieve pressure, reduce friction, and transfer forces from the sensitive areas. Shoes with a high and broad toe box (toe area) are recommended for people suffering from

13 mallet toes. This prevents further irritation on the toe area from developing. Other conservative treatments include forefoot supports such as, gel toe caps, gel toe shields and toe crests. Gel forefoot supports provide immediate comfort and relief from common forefoot disorders, without drying the skin. 16. Metatarsalgia Foot pain in the "ball of your foot," the area between your arch and the toes, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this midportion of the foot. Also known as "dropped metatarsal heads," metatarsalgia can cause abnormal weight distribution due to over pronation. Metatarsalgia causes one of metatarsal joints to become painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia can also be caused by arthritis, foot injury (sports, car accidents, repeated stress), hard surfaces (cement or tile floors) and specific footwear (rigid soled work boots). Inappropriate shoes will only aggravate the condition. A simple change of shoes may solve the problem. In more severe cases, full-length custom-molded foot orthoses may need to be prescribed. 17. Osteomyelitis (Bone Infections) Bone infections, called osteomyelitis, generally require surgery to remove the infected bone. These infections are very difficult to cure with oral or intra-venous antibiotics without also removing the infected bone. The presence of bone infection can be diagnosed with special tests such as bone scans and MRIs. 18. Overlapping or Underlapping Toes Underlapping toes usually involve the fourth and fifth toes. (A special form of underlapping toes is called congenital curly toes.) The cause of underlapping toes is generally unknown. They may be caused by an imbalance in muscle strength of the small muscles of the foot. If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery may be needed to remove a small portion of the bone in the toe. Overlapping toes are characterized by one toe lying on top of an adjacent toe. The fifth toe is the most affected. Overlapping toes may develop in the unborn fetus. Passive stretching and adhesive taping is most commonly used to correct overlapping toes in infants, but the deformity usually recurs. Such deformities can sometimes be surgically corrected by releasing the tendon and soft tissues about the joint at the base of the fifth toe. In some extreme cases, a pin may be surgically inserted to hold the toe in a straighten position. The pin, which exits the tip of the toe, may be left in place for up to three weeks.

14 19. Peroneal Tendon Dislocation/Dysfunction Peroneal tendons are two tendons whose muscles originate on the outside of the calves. These two muscles allow you to roll to the outside of the foot while standing. Also called "stirrup" tendons because they help hold up the arch of the foot, the muscles are held in place by a band of tissue. Injury to these tendons can cause them to stretch or even tear. When this happens, they can dislocate. Snow skiing, football, basketball, and soccer are the most common sports activities that can result in peroneal tendon dislocation. Ankle sprains have also known to lead to the condition. Patients usually have top use crutches after such an injury, in order to allow the strain to heal. Sometimes, a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice also supplement treatment. Consult your physician before taking any medications. Surgery can be prescribed with moderate to severe injuries that cause the tendon to be torn or severely stretched to a point that it easily dislocates. 20. Posterior Tibial Tendon Dysfunction The posterior tibial tendon starts in the calf, stretches down behind the inside of the ankle and attaches to bones in the middle of the foot. This tendon helps hold your arch up and provides support as you step off on your toes when walking. If it becomes inflamed, over-stretched or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot. Signs and symptoms of posterior tibial tendon dysfunction include: Gradually developing pain on the outer side of the ankle or foot. Loss of the arch and the development of a flatfoot. Pain and swelling on the inside of the ankle. Tenderness over the midfoot, especially when under stress during activity. Weakness and an inability to stand on the toes. Diabetics, overweight, and hypertensive people are particularly at risk. Left untreated, posterior tibial tendon dysfunction could lead to arthritis in the hindfoot. Pain could increases and spread to the outer side of the ankle. Treatment includes rest, over-the-counter nonsteroidal anti-inflammatory drugs, and immobilization of the foot for 6 to 8 weeks with a rigid below-knee cast or boot to prevent overuse. Consult your physician before taking any medications. 21. Sesamoiditis Sometimes known as the "ball bearings of the foot," the sesamoids are two small bones found beneath the first metatarsal bones. They can inflame or rupture under the stress of exercise. Sesamoiditis can be relieved with proper shoe selection and orthotic devices, or shoe inserts.

15 22. Spurs Bone spurs are a very common foot problem. Spurs in the feet most often occur in the heel and near the toes. 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. Painful bone spurs also can develop on the top of the big toe joint. Anti-inflammatory medications, cortisone injections and/or special shoes or inserts are some of the common treatments for stiff big toe. Consult your physician before taking any medication. Surgery may be prescribed if spurring around the joint becomes severe. 23. Tarsal Coalition A tarsal coalition is a bone condition that causes decreased motion or absence of motion in one or more of the joints in the foot. The lack of motion or absence of motion is due to abnormal bone, cartilage or fibrous tissue growth across a joint. When excess bone has grown across a joint, there is usually little or no motion in that joint. Cartilage or fibrous tissue growth can restrict motion of the affected joint to varying degrees, causing pain in the affected joint or in surrounding joints. The bones found at the top of the arch, the heel, and the ankle are referred to as the tarsal bones. A tarsal coalition is an abnormal connection between two of the tarsal bones in the back of the foot or the arch. This abnormal connection between two bones is most commonly an inherited trait and passed down from generation to generation. Symptoms usually include an aching sensation deep in the foot near the ankle or arch, accompanied by muscle spasms on the outside of the affected leg. Non-surgical treatment includes special shoes or inserts, physical therapy and anti-inflammatory medication. Consult your physician before taking any medication. Surgery sometimes is performed to allow for more normal motion between the bones, or to fuse the affected joint or surrounding joints. Diabetes and Your Feet According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands. Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation. With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes,

16 you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Here's some basic advice for taking care of your feet: Always keep your feet warm. Don't get your feet wet in snow or rain. Don't put your feet on radiators or in front of the fireplace. Don't smoke or sit cross-legged. Both decrease blood supply to your feet. Don't soak your feet. Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet. Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office. Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes. Wash your feet every day with mild soap and warm water. Wear loose socks to bed. Wear warm socks and shoes in winter. When drying your feet, pat each foot with a towel and be careful between your toes. Buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don't wear the same pair every day. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely. Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops. When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast. The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is an another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe. Diseases of the Foot 1. Arthritis Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

17 Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. It is often a part of complex diseases that may involve more than 100 disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence, but that may be avoided with early diagnosis and proper medical care. Symptoms: Early morning stiffness. Limitation in motion of joint. Recurring pain or tenderness in any joint. Redness or heat in a joint. Skin changes, including rashes and growths. Swelling in one or more joints. Forms of arthritis Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or "wear and tear" arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs. Rheumatoid arthritis is a major crippling disorder, and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course, and frequently in both ankles, or the index fingers of both hands. Arthritis can be treated in many ways, including: Physical therapy and exercise. Medication. Orthoses or specially prescribed shoes. 2. Cancer There are many kinds of cancers of the foot; some take the form of cysts and lesions, while others are more widespread. Malignant melanoma is a skin cancer that is very curable if caught early. Although it makes up only 1 percent of skin cancers, malignant melanoma accounts for over 60 percent of skin cancer deaths. It is estimated that approximately 30% of melanomas occur in the lower extremities, and that 3% occur in the feet. Neoplastic disorders, usually called tumors, are the result of abnormal growth of tissue and may be benign or malignant.

18 Osteochondromas are benign bone tumors under the toenail. They form in the bone beneath the toenail. An osteochrondroma accounts for about half of all benign bone tumors, occurring mostly in children and young adults. Unless they cause irritation to the surrounding tissue, they are generally not very painful. Sometimes, they can deform the toenail and cause an ingrown toenail. In some cases, they are removed surgically, but can recur even after the procedure. A plantar fibroma is a benign tissue tumor or growth on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band called the plantar fascia. When non-surgical measures for treating plantar fibromas, such as orthotics, have failed to provide adequate relief of symptoms, surgical removal is a reasonable option. Giant cell tumors are usually benign non-cancerous tumors of the tendon sheath. These masses are generally found on the toes, top of the foot or sides of the foot. They can also occur deep inside the foot. They are firm irregular masses that are commonly painful. 3. Freiberg's Disease Freiberg's Disease usually begins as a pain in the ball of a child's foot; its onset is often linked to an injury to the growth plate of one of the long bones behind the toes called metatarsals. This disorder is most frequently seen in the adolescent between the ages of years of age. It is three times as likely to occur in females as compared to males. The pain is a result of a loss of blood flow to the growth plate in the bone. Treatment consists of reducing pressure under the affected bone. This may consist of anything from using crutches to a custom insole for the shoe called an orthotic. 4. Gout Gout (gouty arthritis) is a condition caused by a buildup of the salts of uric acid - a normal byproduct of the diet-in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women. Some research suggests that diet heavy in red meat, rich sauces, shellfish, and brandy is popularly associated with gout. However, other protein compounds in foods such as lentils and beans may play a role. The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. Usually only one of the big toes is affected. The pain lasts for around three or four hours and will then subside and usually not return for a few months. It can be controlled by prescribed medications. The application of ice or cooling lotions will help during an acute phase. Specially-made shoes can sometimes relieve the pain associated with gout. 5. Arthritis Arthritis is a disabling and occasionally crippling disease afflicting almost 40 million Americans. In some forms, it appears to be hereditary. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

19 Arthritis is an inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. It is often a part of complex diseases that may involve more than 100 disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet. Arthritic feet can result in loss of mobility and independence, but that may be avoided with early diagnosis and proper medical care. Symptoms: Early morning stiffness. Limitation in motion of joint. Recurring pain or tenderness in any joint. Redness or heat in a joint. Skin changes, including rashes and growths. Swelling in one or more joints. Forms of arthritis Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or "wear and tear" arthritis. Aging usually brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Overweight people are particularly susceptible to osteoarthritis. The additional weight contributes to the deterioration of cartilage and the development of bone spurs. Rheumatoid arthritis is a major crippling disorder, and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory group of diseases, often affecting more than a dozen smaller joints during its course, and frequently in both ankles, or the index fingers of both hands. Arthritis can be treated in many ways, including: Physical therapy and exercise. Medication. Orthoses or specially prescribed shoes. 6. Karposi's Sarcoma (AIDS related) Kaposi's Sarcoma is a cancerous lesion that can occur on the soles of the feet. The lesion is irregular in shape and has a purplish, reddish or bluish black appearance. Kaposi's Sarcoma lesions tend to spread and form large plaques or become nodular. The nodular lesions have a firm rubbery appearance. The disease is usually associated with AIDS infection. It can occur without the concurrent AIDS infection, but this is very rare. 7. Kohler's Disease