Patient Education Articles

Arthritis

Arthritis

What is Arthritis?

Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes; just as a sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are associated with many different illnesses.

Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable 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.

Arthritis is a disabling and occasionally crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are most prone to arthritis.

Arthritic feet can result in loss of mobility and independence, but early diagnosis and proper medical care can help significantly.

Causes

Besides heredity, arthritic symptoms may arise in a number of ways:
Through injuries, notably in athletes and industrial workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
Through bacterial and viral infections that strike the joints. The same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
In conjunction with bowel disorders such as colitis and ileitis, frequently resulting in arthritic conditions in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from arthritis, but treating them can relieve arthritic pain.
Using drugs, both prescription drugs and illegal street drugs, can induce arthritis.
As part of a congenital autoimmune disease syndrome of undetermined origin. Recent research has suggested, for instance, that a defective gene may play a role in osteoarthritis.

Types and Symptoms

Osteoarthritis: Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or “wear and tear” arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging 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. Walking may become erratic. It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

Rheumatoid arthritis (RA): RA is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern—both ankles, or the index fingers of both hands, for example. It is often accompanied by signs and symptoms—lengthy morning stiffness, fatigue, and weight loss—and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men to suffer RA.

RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute RA. However, the disease system has been known to be active for months, or years, then abate, sometimes permanently.

Gout (gouty arthritis): Gout 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, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.

Psoriatic arthritis: Psoriasis is often thought of as a skin disorder, but it can affect the joints as well. On the skin, psoriasis appears as dry, scaly patches. Not all people with psoriasis of the skin will develop joint symptoms—about one in twenty people with psoriasis will develop associated arthritis. The arthritis may be mild and involve only a few joints, particularly those at the ends of the fingers or toes. People who also have arthritis usually have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis.

Traumatic arthritis: Traumatic arthritis is a form of arthritis that is caused by blunt, penetrating, or repeated trauma or from forced inappropriate motion of a joint or ligament. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. This damage to the cartilage eventually leads to arthritic changes in the joint.

When to Visit a Podiatrist

Because arthritis can affect the structure and function of the feet, it is important to see a doctor of podiatric medicine if any of the following symptoms occur in the feet:

Swelling in one or more joints
Recurring pain or tenderness in any joint
Redness or heat in a joint
Limitation in motion of joint
Early morning stiffness
Skin changes, including rashes and growths

Diagnosis and Treatment

Different forms of arthritis affect the body in different ways; many have distinct systemic effects that are not common to other forms. Early diagnosis is important to effective treatment of any form. Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn't treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most forms of arthritis cannot be cured but can be controlled or brought into remission; perhaps only five percent of the most serious cases, usually of rheumatoid arthritis, result in such severe disability that walking aids or wheelchairs are required.

The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if possible. Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints—inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.

Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by medication. In such a complex disease system, it is no wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line drug of choice for most forms of arthritis and the benchmark against which other therapies are measured.

The control of foot functions with shoe inserts called orthotics, or with braces or specially prescribed shoes, may be recommended. Surgical intervention is a last resort in arthritis, as it is with most disease conditions. Damaged joints can be replaced surgically with artificial joints.

Prevention

Not all types of arthritis are preventable. Osteoarthritis may be helped by correcting any faulty mechanics that lead to the joint not moving properly. Custom orthotics from your podiatrist will make sure that the foot and ankle joints are properly aligned. Controlling the uric acid level in people prone to gout helps to prevent gouty attacks and thereby reduces the chance of the associated arthritis.

More information is available from the Arthritis Foundation.

Source: "Arthritis | Foot Health | Learn About Feet | APMA." Arthritis | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Athlete's Foot

Athlete's Foot

What is Athlete's Foot?

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth. Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.

Causes

The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.

Symptoms

The signs of athlete's foot, singly or combined, include the following:

Dry skin
Itching and burning, which may increase as the infection spreads
Scaling
Inflammation
Blisters, which often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling.

Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.

When to Visit a Podiatrist

If an apparent fungus condition does not respond to proper foot hygiene and there is no improvement within two weeks, consult a podiatrist.

Diagnosis and Treatment

Your podiatrist will determine if a fungus is the cause of the problem. If it is, a specific treatment plan, including the prescription of antifungal medication, applied topically or taken by mouth, will usually be suggested. Such a treatment appears to provide better resolution of the problem when the patient observes the course of treatment prescribed by the podiatrist; if it's shortened, failure of the treatment is common.

Fungicidal and fungistatic chemicals, used for athlete's foot treatment, frequently fail to contact the fungi in the horny layers of the skin. Topical or oral antifungal drugs are prescribed with growing frequency. If the infection is caused by bacteria, antibiotics that are effective against a broad spectrum of bacteria, such as penicillin, may be prescribed.

It is important to keep the feet dry by dusting foot powder in shoes and hose. The feet should be bathed frequently and all areas around the toes dried thoroughly. If someone in your family develops athlete’s foot, disinfect home showers and tubs after each use to discourage transmission of infection.

Prevention

It is not easy to prevent athlete's foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene:

Wash feet daily with soap and water; dry carefully, especially between the toes
Avoid walking barefoot; use shower shoes in public showers.
Reduce perspiration by using talcum powder
Wear light and airy shoes
Change shoes and hose regularly to decrease moisture
Wear socks that keep your feet dry, and change them frequently if you perspire heavily

Source: "Athlete's Foot| Foot Health | Learn About Feet | APMA." Athlete's Foot | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Bunions

Bunions

What Is a Bunion?

A bunion is a “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion—from the Latin "bunio," meaning enlargement—can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion".

Causes

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.

Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

Symptoms

The symptoms of a bunion include the following:
Development of a firm bump on the outside edge of the foot, at the base of the big toe
Redness, swelling, or pain at or near the MTP joint
Corns or other irritations caused by the overlap of the first and second toes
Restricted or painful motion of the big toe

Home Treatment

What can you do for relief?
Apply a commercial, non-medicated bunion pad around the bony prominence
Wear shoes with a wide and deep toe box
If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling
Avoid high-heeled shoes over two inches tall

When to Visit a Podiatrist

If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less of an option.

Diagnosis and Treatment

Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.

A podiatrist may recommend these treatments:

Padding and Taping: Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
Medication: Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.
Physical Therapy: Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Orthotics: Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
Surgical Options: When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatrist. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatrist.

Prevention

There are some steps that may help prevent, or at least slow, the progression of bunions:
Avoid shoes with a narrow toe box
If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, get custom orthotics from your podiatrist
See your podiatrist at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.

Source: "Bunions | Foot Health | Learn About Feet | APMA." Bunions | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Callus & Corns

Corns and Calluses

What is a Corn? What is a Callus?

Corns and calluses are areas of thickened skin that develop to protect that area from irritation. They occur when something rubs against the foot repeatedly or causes excess pressure against part of the foot. If the thickening of skin occurs on the bottom of the foot, it's called a callus. If it occurs on the top of the foot (or toe), it's called a corn.
Corns and calluses are not contagious but may become painful if they get too thick. In people with diabetes or decreased circulation, they can lead to more serious foot problems.

Causes

Corns often occur where a toe rubs against the interior of a shoe. Excessive pressure at the balls of the feet—common in women who regularly wear high heels—may cause calluses to develop on the balls of the feet.
People with certain deformities of the foot, such as hammer toes, are prone to corns and calluses.

Symptoms

Corns and calluses typically have a rough, dull appearance. They may be raised or rounded, and they can be hard to differentiate from warts. Corns or calluses sometimes cause pain.

Home Care

Mild corns and calluses may not require treatment. If the corn or callus isn't bothering you, it can probably be left alone. It's a good idea, though, to investigate possible causes of the corn or callus. If your footwear is contributing to the development of a corn or callus, it's time to look for other shoes.

When to Visit a Podiatrist

If corns or calluses are causing pain and discomfort or inhibiting your daily life in any way, see a podiatrist. Also, people with diabetes, poor circulation, or other serious illnesses should have their feet checked.

Diagnosis and Treatment

The podiatrist will conduct a complete examination of your feet. X-rays may be taken; your podiatrist may also want to inspect your shoes and watch you walk. He or she will also take a complete medical history. Corns and calluses are diagnosed based on appearance and history.

If you have mild corns or calluses, your podiatrist may suggest changing your shoes and/or adding padding to your shoes. Larger corns and calluses are most effectively reduced (made smaller) with a surgical blade. A podiatrist can use the blade to carefully shave away the thickened, dead skin—right in the office. The procedure is painless because the skin is already dead. Additional treatments may be needed if the corn or callus recurs.

Cortisone injections into the foot or toe may be given if the corn or callus is causing significant pain. Surgery may be necessary in cases that do not respond to conservative treatment.

Prevention

Wear properly fitted shoes. If you have any deformities of the toe or foot, talk to your podiatrist to find out what shoes are best for you.
Gel pad inserts may decrease friction points and pressure. Your podiatrist can help you determine where pads might be useful.

Source: "Corns and Calluses | Foot Health | Learn About Feet | APMA." Corns and Calluses | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Diabetes

Diabetes

What Is Diabetes?

Diabetes is the inability to manufacture or properly use insulin, and it impairs the body's ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) can lead to serious damage to the eyes, heart, kidney, nerves, and feet. Diabetes affects the lives of nearly 26 million people in the United States and nearly seven million don't even know they have the disease yet.
While there is no cure for diabetes, there is hope. With proper diet, exercise, medical care, and careful management at home, a person with diabetes can avoid the most serious complications and enjoy a full and active life. Today's podiatrist plays a key role in helping patients manage diabetes successfully and avoid foot-related complications.

Symptoms

Diabetes warning signs include the following:
Skin color changes
Swelling of the foot or ankle
Numbness in the feet or toes
Pain in the legs
Open sores on the feet that are slow to heal
Ingrown and fungal toenails
Bleeding corns and calluses
Dry cracks in the skin, especially around the heel

Because diabetes is a disease affecting many parts of the body, successful management requires a team approach. Today's podiatrist is an integral part of the treatment team and has documented success in preventing amputations:
More than 65,000 lower limbs are amputated annually due to complications from diabetes.
After an amputation, the chance of another amputation within three to five years is as high as 50 percent.
Including a podiatrist in your diabetes care can reduce the risk of lower limb amputation up to 85 percent and lowers the risk of hospitalization by 24 percent.

The keys to amputation prevention are early recognition and regular foot screenings performed by a podiatrist, the foot and ankle expert.

Take Action

If you have diabetes, follow these foot care tips:
Inspect feet daily. Check your feet and toes every day for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration.
Wear thick, soft socks. Avoid socks with seams, which could rub and cause blisters or other skin injuries.
Exercise. Walking can keep weight down and improve circulation. Be sure to wear appropriate athletic shoes when exercising.
Have new shoes properly measured and fitted. Foot size and shape may change over time. Shoes that fit properly are important to those with diabetes.
Don't go barefoot. Don't go without shoes, even in your own home. The risk of cuts and infection is too great for those with diabetes.
Never try to remove calluses, corns, or warts by yourself. Over-the-counter products can burn the skin and cause irreparable damage to the foot for people with diabetes.
See today's podiatrist. Regular checkups by a podiatrist—at least annually—are the best way to ensure that your feet remain healthy.
Additional information is available from the American Diabetes Association.

Source: "Diabetes | Foot Health | Learn About Feet | APMA." Diabetes | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Diabetes Wound Care

Diabetic Wound Care

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.
Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.

Causes

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body's ability to fight off a potential infection and also slow healing.

Symptoms

Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

When to Visit a Podiatrist

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.

Diagnosis and Treatment

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Prevention of infection
Taking the pressure off the area, called “off-loading”
Removing dead skin and tissue, called “debridement”
Applying medication or dressings to the ulcer
Managing blood glucose and other health problems

Not all ulcers are infected; however, if your podiatrist diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To keep an ulcer from becoming infected, it is important to:
keep blood glucose levels under tight control;
keep the ulcer clean and bandaged;
cleanse the wound daily, using a wound dressing or bandage; and
avoid walking barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal, there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.
Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:
Neuropathy
Poor circulation
A foot deformity (e.g., bunion, hammer toe)
Wear inappropriate shoes
Uncontrolled blood sugar
History of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day—especially the sole and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible; no matter how simple they may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:
Lowering blood sugar
Appropriate debridement of wounds
Treating any infection
Reducing friction and pressure
Restoring adequate blood flow

Additional information is available from the American Diabetes Association.

Source: "Diabetic Wound Care | Foot Health | Learn About Feet | APMA." Diabetic Wound Care | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Haglunds Deformity

Haglund's Deformity

What is Haglund's Deformity?

Haglund's Deformity is a bony enlargement of the back of the heel bone. Sometimes it's called “pump bump” because the deformity often occurs in women who wears pumps.

Causes

The shape of your foot can contribute to the development of Haglund's Deformity. If you have high arches, a tight Achilles tendon, or a tendency to walk on the outside of your feet, you're more likely to develop Haglund's Deformity than other people. Wearing shoes with a firm, rigid back may also contribute to the development of Haglund's Deformity.

Symptoms

The primary symptoms of Haglund's Deformity are an enlarged bony prominence on the back of the heel and heel pain. You might also develop blisters on your heels as a result of your shoes rubbing against the bump.

Home Care

Heel pads placed in the backs of your shoes may relieve and redistribute some of the pressure. Applying ice to the area after removing your shoes may ease some of the pain and discomfort. Switching shoes can help, too. If you have an otherwise normal foot, wearing open-heeled shoes may provide relief. Open-heeled shoes are not a good idea, though, if you have tendinitis, bunions, foot pain, or a structural deformity of the foot.

When to Visit a Podiatrist

If the pain persists despite your home remedies, or if the bump continues to enlarge, it's time to see a podiatrist. A podiatrist can carefully evaluate your feet and create a treatment plan tailored to your feet.

Diagnosis and Treatment

A podiatrist will begin by carefully examining your feet and taking a thorough medical history. X-rays may be ordered to get a good look at the structure of your feet. Sometimes, an MRI or ultrasound might be ordered as well.

Treatment will depend on the severity of the condition. Options include:
Shoe modification. Your podiatrist can recommend over-the-counter heel pads, heel lifts, or arch supports, or create custom orthotic supports to change the position of your feet in your shoes to relieve pressure on the back of your foot.
Medication. Topical anti-inflammatory medication, applied directly to the heel, may provide pain relief. Oral anti-inflammatory medication (such as ibuprofen) can help as well.
Immobilization. If the area is extremely inflamed, a custom-made soft cast or walking boot may be used to immobilize the area and allow it to heal.
Surgery. If none of the non-surgical methods provide adequate relief, your podiatrist may recommend surgery to correct the deformity. Podiatrists are specially-trained foot and ankle surgeons who can surgically re-shape the heel bone.
Prevention

Avoid shoes with rigid backs. If you have a high arch or tight Achilles tendon, wearing appropriate shoe inserts and/or adequately stretching the Achilles tendon can help prevent the development of Haglund's Deformity.

Source: "Haglund's Deformity | Foot Health | Learn About Feet | APMA." Haglund's Deformity | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Hammer Toes

Hammer Toes

What is a Hammer Toe?

A hammer toe is a contracture, or bending, of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammer toes are more common in females than males.
There are two different types:
Flexible Hammer Toes: These hammer toes are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammer toes because they are still moveable at the joint.
Rigid Hammer Toes: This variety is more developed and more serious than the flexible condition. Rigid hammer toes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammer toe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

Causes

A hammer toe develops because of an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammer toe. Arthritis is another factor, because the balance around the toe in people with arthritis is disrupted. Wearing shoes that are too tight and cause the toes to squeeze can also cause a hammer toe to form.

Symptoms

The symptoms of a hammer toe include the following:
Pain at the top of the bent toe upon pressure from footwear
Formation of corns on the top of the joint
Redness and swelling at the joint contracture
Restricted or painful motion of the toe joint
Pain in the ball of the foot at the base of the affected toe

Home Treatment

What can you do for relief?
Apply a commercial, non-medicated hammer toe pad around the bony prominence of the hammer toe to decrease pressure on the area.
Wear a shoe with a deep toe box.
If the hammer toe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid heels more than two inches tall.
A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. While this treatment will make the hammer toe feel better, it is important to remember that it does not cure the condition. A trip to the podiatrist's office will be necessary to repair the toe to allow for normal foot function.
Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.

When to Visit a Podiatrist

If pain persists, see a podiatrist. If left untreated, hammer toes tend to become rigid, making nonsurgical treatment less of an option.

Diagnosis and Treatment

The treatment options vary with the type and severity of each hammer toe, although identifying the deformity early in its development is important to avoid surgery. Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Padding and Taping: Often padding and taping are the first steps in a treatment plan. Padding the hammer toe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.

Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.

Orthotic Devices: Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammer toe deformity.

Surgical Options: Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammer toes, which are not fully reducible, may require more complex surgical procedures.

Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatrist.

Prevention

There are several things you can do to help prevent hammer toes from forming or progressing:
Wear supportive shoes to help prevent deformities. Hammer toes are often related to faulty foot mechanics, especially foot flattening.
Wear custom orthotics prescribed by your podiatrist. Orthotics may slow the progression or prevent the development of hammer toes.
Avoid shoes with narrow or pointed toe boxes that can compress the toes.

Source: "Hammer Toes | Foot Health | Learn About Feet | APMA." Hammer Toes | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Heel Pain

Heel Pain

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Causes

Heel pain has many causes. Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear (such as flimsy flip-flops); or being overweight.

Common causes of heel pain include:
Heel Spurs: A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. It is common among athletes who run and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation: Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Achilles Tendinitis: Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.

Other possible causes of heel pain include:
rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint;
an inflamed bursa (bursitis), a small, irritated sac of fluid; a neuroma (a nerve growth); or other softtissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur;
Haglund's deformity ("pump bump"), a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe;
a bone bruise or contusion, which is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

When to Visit a Podiatrist

If pain and other symptoms of inflammation—redness, swelling, heat—persist, limit normal daily activities and contact a doctor of podiatric medicine.

Diagnosis and Treatment

The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.
Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions:
Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters
Wear the proper shoes for each activity
Do not wear shoes with excessive wear on heels or soles
Prepare properly before exercising. Warm up and do stretching exercises before and after running.
Pace yourself when you participate in athletic activities
Don't underestimate your body's need for rest and good nutrition
If obese, lose weight

Source: "Heel Pain | Foot Health | Learn About Feet | APMA." Heel Pain | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

High Blood Pressure

High Blood Pressure

What Is High Blood Pressure?

High blood pressure is also known as hypertension. Blood pressure refers to the force of blood pushing against the walls of the arteries as your heart pumps out blood. Hypertension occurs when your blood pressure rises and stays above normal over a period of time.

Hypertension is often related to atherosclerosis, which is the buildup of plaque in blood vessels. This condition leads to decreased circulation and peripheral arterial disease (PAD). People with decreased circulation in their legs and feet may develop ulcerations (open wounds on the skin) that can lead to amputations.

As a member of the health-care team, your podiatrist is vitally concerned about hypertension and vascular disease (heart and circulatory problems). Make sure you tell your podiatrist if you have high blood pressure and any medications that you may be taking for treatment.

Symptoms

Symptoms of poor circulation in the feet and legs may include:
Cramping in the feet and legs, particularly with exercise
Sores on the feet or legs that do not heal or take a long time to heal
Changes in color to the feet
Changes in temperature to the feet
Loss of hair on the feet and legs

Uncontrolled hypertension can also lead to heart disease, which may present as swelling in your feet and legs.

When to Visit a Podiatrist

If you experience any of the above symptoms, it is important to visit a podiatrist. And if you have been diagnosed with hypertension, it is important to tell your podiatrist, because medications that may be prescribed for a foot or ankle condition could interact with your blood pressure medications. Also, if you need to have foot or ankle surgery, it is important that your blood pressure is under control prior to any surgical procedures.

Diagnosis and Treatment

As part of your visit, your podiatrist may check your vital signs—height, weight, and blood pressure. Your podiatrist will conduct a careful examination to determine if there is lower than normal temperature in any of the extremities, absence of normal skin color, or diminished pulse in the feet. Your podiatrist will also ask you about increased or periodic swelling in the lower extremities.

If any abnormalities in your blood pressure are noted, your podiatrist will notify you and may refer you to your primary care physician for further evaluation and treatment.

Source: "High Blood Pressure | Foot Health | Learn About Feet | APMA." High Blood Pressure | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Ingrown Toenails

Ingrown Toenails

What Are Ingrown Toenails?

Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is the most common location for this condition, but other toes can also become affected.

Causes

Ingrown toenails may be caused by the following:
Improperly trimmed nails
Heredity
Shoe pressure; crowding of toes
Repeated trauma to the feet from normal activities

Symptoms

The following symptoms may be present with ingrown toenails:
Pain
Redness and swelling
Drainage
Odor
Prominent skin tissue (proud flesh)

Home Treatment

If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water, then apply an antiseptic and bandage the area.
People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self-treatment and seek podiatric medical care as soon as possible.
Other “do-it-yourself” treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications, should be avoided. Nail problems should be evaluated and treated by your podiatrist, who can diagnose the ailment, and then prescribe medication or another appropriate treatment.

When to Visit a Podiatrist

You should see a podiatrist immediately if any drainage or excessive redness is present around the toenail. Also, if a short trial of home treatment has not resulted in improvement of the condition, see your podiatrist. If you have diabetes or poor circulation, you should seek immediate treatment at the first signs of an ingrown toenail, as it can lead to more severe complications.

Diagnosis and Treatment

A podiatrist will remove the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a chemical, a laser, or other methods.

Prevention

Trim toenails properly: cut them straight across, not longer than the tip of the toes. Do not dig into corners and only gently round off corners with a nail file. Use toenail clippers.
Avoid shoes with pointy or narrow toe boxes.
Never rip or tear edges of nails.

Source: "Ingrown Toenails | Foot Health | Learn About Feet | APMA." Ingrown Toenails | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Neuromas

Neuromas

What is a Neuroma?

A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

The principal symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women.

Causes

Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma:
Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.
Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.
Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.
Repeated stress, common to many occupations, can create or aggravate a neuroma.

Symptoms

The symptoms of a neuroma include the following:
Pain in the forefoot and between the toes
Tingling and numbness in the ball of the foot
Swelling between the toes
Pain in the ball of the foot when weight is placed on it

Home Treatment

What can you do for relief?
Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
Wear shoes with thick, shock-absorbent soles, as well as proper insoles that are designed to keep excessive pressure off of the foot.
High-heeled shoes over two inches tall should be avoided whenever possible because they place undue strain on the forefoot.
Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.

When to Visit a Podiatrist

Podiatric medical care should be sought at the first sign of pain or discomfort. If left untreated, neuromas tend to get worse.

Diagnosis and Treatment

Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction.

For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, additional treatment or surgery may be necessary to remove the tumor.

The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case.

Padding and Taping: Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.

Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.

Orthotics: Custom shoe inserts made by your podiatrist may be useful in controlling foot function. Orthotics may reduce symptoms and prevent the worsening of the condition.

Surgical Options: When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

Prevention

Although the exact causes of neuromas are not completely known, the following preventive steps may help:
Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
Wear shoes with adequate padding in the ball of the foot.
Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).

Source: "Neuromas | Foot Health | Learn About Feet | APMA." Neuromas | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Peripheral Arterial Disease

Peripheral Arterial Disease

What Is PAD?

PAD is short for Peripheral Arterial Disease. PAD is caused by a blockage or narrowing of the arteries in the legs when fatty deposits called plaque buildup. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. This results in a reduction of blood flow to the legs and feet. This is commonly referred to as poor circulation.

PAD occurs most often in the arteries in the legs, but it can also affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys, and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

PAD affects 8 to 12 million Americans, and one in every five people over the age of 70 has the disease. People with PAD have a two-to-six times' greater chance of death from a heart attack or stroke. PAD and diabetes are the leading causes of foot or leg amputations in the United States.

Causes/Risk Factors

Risk factors for PAD and other conditions that may complicate PAD include the following:
Smoking
High Cholesterol
High Blood Pressure
Physical inactivity
Obesity
Diabetes

Symptoms

The symptoms of PAD include the following:
Fatigue, tiredness, or pain in your legs, thighs, or buttocks that always happens when you walk but goes away when you rest.
Foot or toe pain at rest that often disturbs your sleep.
Skin wounds or ulcers on your feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks)

However, many individuals with PAD do not experience typical leg symptoms such as cramping, pain, or fatigue known as claudication.

When to Visit a Podiatrist

Do not ignore leg pain. It is important to discuss any leg or thigh pain that you are having with your podiatric physician since it could be a warning sign of a serious disease such as PAD. Early detection of PAD can offer an opportunity to treat risk factors that can slow the progression of the disease and decrease the chance of heart attack and stroke.

Diagnosis and Treatment

Your podiatric physician can do a simple test to determine if you have PAD. The test is called an ABI, or ankle-brachial index. It compares the blood pressure in your ankles with the blood pressure in your arm. If your ABI is abnormal, your podiatric physician may order other tests to determine the extent of your PAD.

PAD can be treated with lifestyle changes, medicines, and surgical procedures if necessary. Medical treatment options include:
Programs to stop smoking
Blood pressure control
Lowering cholesterol
Manage high blood sugar (diabetes)
Medications to prevent clotting
Healthy diet
Exercise program

A variety of surgical treatment options are available depending on the location and severity of the artery blockage. Your podiatric physician can refer you to the appropriate specialist for these procedures.

Source: "Peripheral Arterial Disease | Foot Health | Learn About Feet | APMA." Peripheral Arterial Disease | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016

Peripheral Neuropathy

Peripheral Neuropathy

What is Peripheral Neuropathy?

Peripheral neuropathy is damage of the peripheral nerves. Your peripheral nerves—the nerves in your toes and fingertips—are the ones on the periphery of your body. When the nerves are damaged, they don't function properly. People with peripheral neuropathy have decreased or abnormal sensation in their toes and fingers. Sometimes, they develop problems moving these parts of the body as well.

Causes

In the United States, the most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy within their lifetime.

Other causes of peripheral neuropathy include:
Certain medications, including some chemotherapy drugs.
Heredity. Some people have a family history of peripheral neuropathy.
Advanced age. Peripheral neuropathy is more common as people age.
Arthritis. Certain type of arthritis can cause peripheral neuropathy.
Alcoholism. According to the US National Library of Medicine, up to half of all long-term heavy alcohol users develop peripheral neuropathy.
Neurological disorders. Certain neurological disorders, including spina bifida and fibromyalgia, are associated with peripheral neuropathy.
Injury. Acute injury to the peripheral nerves may also cause peripheral neuropathy.

Symptoms

The most common symptoms of peripheral neuropathy include burning, numbness, tingling, or shooting or stabbing pain in the toes and/or fingertips. Any change in sensation in the fingers or toes may be a symptom of peripheral neuropathy. Be sure to report any abnormal sensations to your doctor. Those sensations may be the first sign of another problem, such as diabetes.

Home Care

If you have peripheral neuropathy, it is important to inspect your feet regularly. Because decreased sensation may develop eventually, you might not notice an injury or infection. Someone who has diabetes and peripheral neuropathy with loss of protective sensation, for instance, could step on a tack without noticing it. Regularly inspect your feet so you can note any injuries or infections and seek appropriate medical attention as needed.

If you're unable to properly inspect your own feet, enlist a family member or friend to help you. It's absolutely essential that any injuries are caught and treated promptly. Otherwise, an infection can develop and progress.
People with peripheral neuropathy should wear properly fitted shoes and avoid walking barefoot to prevent injury. If you have diabetes, it's important to control your blood sugar as well, because out-ofcontrol blood sugar leads to increased nerve damage. Take your insulin or medication as prescribed and follow the recommended diet.

When to Visit a Podiatrist

Everyone with peripheral neuropathy of the feet should see a podiatrist. Podiatrists are doctors who are specially trained to preserve the health of the feet.

Diagnosis and Treatment

A podiatrist, family physician, internist, or physician who specializes in diabetes can diagnose peripheral neuropathy. The diagnosis is made on the basis of a physical exam, health history, and your reporting of symptoms. The doctor may order a blood test to check your blood sugar level because high blood sugar levels and diabetes are an important cause of peripheral neuropathy.
There is no known cure for peripheral neuropathy. The goal of treatments are to slow the progression of the disease, to maintain foot health, and to decrease pain (if present) and improve the quality of life.
The podiatrist may prescribe oral medication to help with pain. He or she will also perform a thorough foot check to look for any injuries or infections and will teach you how to do the same. Your podiatrist will also show you how to take care of your feet at home. People who have peripheral neuropathy should have their feet examined by a podiatrist at least once per year.
If you also have diabetes, the podiatrist will work closely with you and other health-care professionals. Controlling the patient's blood sugar levels with diet, exercise, and medication (if needed) can slow the progression of peripheral neuropathy and maintain foot health.

Prevention

The best thing you can do to prevent peripheral neuropathy is to keep your blood sugar levels under control. Peripheral neuropathy is common in people with diabetes, but the degree of neuropathy generally corresponds to the degree of blood sugar control. Someone whose blood sugar is kept under tight control will usually have much better sensation in their fingers and toes than someone with poorly controlled diabetes.

Source: "Peripheral Neuropathy | Foot Health | Learn About Feet | APMA." Peripheral Neuropathy | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Psoriasis

Psoriasis

What is Psoriasis?

Psoriasis is a skin condition caused by faster-than-normal turnover of skin cells. Normally, new skin cells rise to the surface of the skin once a month; the old surface skin cells die and slough off while the new cells are moving to the surface. In people who have psoriasis, the new cells move to the surface so rapidly that the dead cells build up on the surface in dry, whitish-silver patches. Some people have mild cases of psoriasis. Others have extensive cases that affect multiple parts of the body.

Causes

Psoriasis is an autoimmune disease and seems to run in families. Psoriasis tends to be more severe in people with weakened immune systems, including those with AIDS and those undergoing treatment for cancer. Stress also seems to make psoriasis worse.

Symptoms

People with psoriasis typically have areas of thick, reddened skin with dry, whitish-silver patches. The dry patches are called psoriatic plaques. The skin may feel itchy.
Psoriasis is most commonly found on the elbows, knees, and bottoms of the feet. It can also affect the fingernails, toenails, and joints of the body.

Home Care

Keep the skin well-moisturized to maintain skin health and ease the discomfort of psoriasis. Oatmeal baths can soothe the skin. Hypoallergenic moisturizer, applied on a regular basis, also helps.
Phototherapy, or light therapy—which involves exposing the skin to UV-B light—may be helpful as well. Some people use UV-B lights at home under a doctor's direction. Other patients carefully time their exposure to sunlight. Talk to your doctor to see if phototherapy may be helpful for you.

When to Visit a Podiatrist

If you have psoriasis on your feet, see a podiatrist. A podiatrist can also help determine the cause of reddened, itchy feet. (Psoriasis can mimic severe athlete's foot or contact dermatitis.) If you have red, irritated feet that haven't responded to home or medical treatment, see a podiatrist.

Diagnosis and Treatment

A podiatrist will carefully examine your feet and take a thorough medical history. He or she may also take a tiny sample (biopsy) of the affected area to confirm a diagnosis of psoriasis.

Treatment depends on the severity of the disease. Mild cases of psoriasis can be treated with topical steroid creams, applied directly to the area. More severe cases of psoriasis may need systemic (whole body) treatment. Drugs that depress the immune system, including methotrexate and cyclosporine, help some people with psoriasis. Certain biologic drugs, including Humera® and Enbrel®, are also useful for psoriasis. If you have severe psoriasis, you may work with a variety of medical specialists to get your psoriasis under control.

Prevention

You can't prevent the development of psoriasis, but you can avoid things that make your psoriasis worse. Stress management techniques may help some people with psoriasis. Alcohol, dry air, and too much or too little sunlight seems to trigger psoriasis for some people, so controlling your exposure to things that irritate your psoriasis may help. Talk to your doctor to find out what you can do to control your psoriasis at home.

Source: "Psoriasis | Foot Health | Learn About Feet | APMA." Psoriasis | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Shoe Inserts and Orthotics

Shoe Inserts and Prescription Custom Orthotics

What are Shoe Inserts?

You've seen them at the grocery store and at the mall. You've probably even seen them on TV and online. Shoe inserts are any kind of non-prescription foot support designed to be worn inside a shoe. Pre-packaged arch supports are shoe inserts. So are the “custom-made” insoles and foot supports that you can order online or at retail stores. Unless the device has been prescribed by a doctor and crafted for your specific foot, it's a shoe insert, not a custom orthotic device—despite what the ads might say.

Shoe inserts can be very helpful for a variety of foot ailments, including flat arches and foot and leg pain. They can cushion your feet, provide comfort, and support your arches, but they can't correct biomechanical foot problems or cure long-standing foot issues.

The most common types of shoe inserts are:
Arch supports: Some people have high arches. Others have low arches or flat feet. Arch supports generally have a “bumped-up” appearance and are designed to support the foot's natural arch.
Insoles: Insoles slip into your shoe to provide extra cushioning and support. Insoles are often made of gel, foam, or plastic.
Heel liners: Heel liners, sometimes called heel pads or heel cups, provide extra cushioning in the heel region. They may be especially useful for patients who have foot pain caused by age-related thinning of the heels' natural fat pads.
Foot cushions: Do your shoes rub against your heel or your toes? Foot cushions come in many different shapes and sizes and can be used as a barrier between you and your shoe.

Choosing an Over-the-Counter Shoe Insert

Selecting a shoe insert from the wide variety of devices on the market can be overwhelming. Here are some podiatrist-tested tips to help you find the insert that best meets your needs:
Consider your health. Do you have diabetes? Problems with circulation? An over-the-counter insert may not be your best bet. Diabetes and poor circulation increase your risk of foot ulcers and infections, so schedule an appointment with a podiatrist. He or she can help you select a solution that won't cause additional health problems.
Think about the purpose. Are you planning to run a marathon, or do you just need a little arch support in your work shoes? Look for a product that fits your planned level of activity.
Bring your shoes. For the insert to be effective, it has to fit into your shoes. So bring your sneakers, dress shoes, or work boots—whatever you plan to wear with your insert. Look for an insert that will fit the contours of your shoe.
Try them on. If all possible, slip the insert into your shoe and try it out. Walk around a little. How does it feel? Don't assume that feelings of pressure will go away with continued wear. (If you can't try the inserts at the store, ask about the store's return policy and hold on to your receipt.)

What are Prescription Custom Orthotics?

Custom orthotics are specially-made devices designed to support and comfort your feet. Prescription orthotics are crafted for you and no one else. They match the contours of your feet precisely and are designed for the way you move. Orthotics are only manufactured after a podiatrist has conducted a complete evaluation of your feet, ankles, and legs, so the orthotic can accommodate your unique foot structure and pathology.

Prescription orthotics are divided into two categories:
Functional orthotics are designed to control abnormal motion. They may be used to treat foot pain caused by abnormal motion; they can also be used to treat injuries such as shin splints or tendinitis. Functional orthotics are usually crafted of a semi-rigid material such as plastic or graphite.
Accommodative orthotics are softer and meant to provide additional cushioning and support. They can be used to treat diabetic foot ulcers, painful calluses on the bottom of the foot, and other uncomfortable conditions.
Podiatrists use orthotics to treat foot problems such as plantar fasciitis, bursitis, tendinitis, diabetic foot ulcers, and foot, ankle, and heel pain. Clinical research studies have shown that podiatrist-prescribed foot orthotics decrease foot pain and improve function.

Orthotics typically cost more than shoe inserts purchased in a retail store, but the additional cost is usually well worth it. Unlike shoe inserts, orthotics are molded to fit each individual foot, so you can be sure that your orthotics fit and do what they're supposed to do. Prescription orthotics are also made of top-notch materials and last many years when cared for properly. Insurance often helps pay for prescription orthotics.

When to Visit a Podiatrist

If you are simply looking for extra cushioning or support, you may wish to try an over-the-counter shoe insert first. If you have serious pain or discomfort, however, schedule an appointment with a podiatrist. He or she will assess your overall health and look for any other contributing factors. Today's podiatrists are specially trained to evaluate the biomechanics of the lower extremity.

Your podiatrist will examine your feet and how you walk. He or she will listen carefully to your complaints and concerns and assess the movement and function of your lower extremities. Some also use advanced technology to see how your feet function when walking or running.

The information gathered during the exam will help your podiatrist determine if shoe inserts might be helpful or if you need prescription orthotics. If orthotics are needed, your podiatrist will capture a threedimensional image of each foot. Those images, as well as any measurements obtained by your podiatrist, are used to create a set of unique foot supports that will improve your foot movement and lead to more comfort and mobility. Your podiatrist might also suggest additional treatments to improve the comfort and function of your feet.

Source: "Shoe Inserts and Prescription Custom Orthotics | Foot Health | Learn About Feet | APMA." Shoe Inserts and Prescription Custom Orthotics | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Skin Cancers

Skin Cancers of the Feet

What Are Skin Cancers of the Feet?

Skin cancer can develop anywhere on the body, including in the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.

Causes

We often view the sun's harmful rays as the primary cause of skin cancer; the condition is often found on parts of the body that receive the most sun exposure. Skin cancers of the feet, however, are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities that might indicate evolving skin cancer.

Types and Symptoms

Some of the most common cancers of the feet are:
Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body. It will cause local damage but only rarely spreads beyond the skin. Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and look like an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble noncancerous skin tumors or benign ulcers.

Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally it begins as a hard projecting callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common skin conditions of the foot.

Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Non-surgical treatments are rarely effective, and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.

Malignant melanoma has many potential appearances, leading to its nickname, “The Great Masquerader.” This skin cancer commonly begins as a small brown-black spot or bump; however, roughly one third of cases lack brown pigment and thus appear pink or red. These tumors may resemble common moles; however, close inspection will usually demonstrate asymmetry, irregular borders, alterations in color, and/or a diameter greater than 6 mm. Melanomas may resemble benign moles, blood blisters, ingrown nails, plantar warts, ulcers caused by poor circulation, foreign bodies, or bruises.

When to Visit a Podiatrist

Podiatrists are uniquely trained as lower extremity specialists to recognize and treat abnormal conditions on the skin of the lower legs and feet. Skin cancers affecting the feet may have a very different appearance from those arising on the rest of the body. For this reason, a podiatrist's knowledge and clinical training is of extreme importance for patients for the early detection of both benign and malignant skin tumors.

Learn the ABCDs of melanoma. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:
Asymmetry - If the lesion is divided in half, the sides don't match.
Borders - Borders look scalloped, uneven, or ragged.
Color - There may be more than one color. These colors may have an uneven distribution.
Diameter – The lesion is wider than a pencil eraser (greater than 6 mm).

To detect other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or “donut-shaped” edges, or scaly areas.

Diagnosis and Treatment

Your podiatrist will investigate the possibility of skin cancer both through a clinical examination and with the use of a skin biopsy. A skin biopsy is a simple procedure in which a small sample of the skin lesion is obtained and sent to a specialized laboratory where a skin pathologist will examine the tissue in greater detail. If a lesion is determined to be cancerous, your podiatrist will recommend the best course of treatment for your condition.

Prevention

Prevention of skin cancer on the feet and ankles is similar to any other body part. Limit sun exposure, and make sure to apply appropriate sunscreen when you are outdoors and your feet and ankles are exposed.

Source: "Skin Cancers of the Feet | Foot Health | Learn About Feet | APMA." Skin Cancers of the Feet | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Sprain and Fractures

Sprains, Strains & Fractures

What is a Foot or Ankle Sprain or Fracture?

The feet and ankles work together to provide support and mobility to the body. A foot or ankle sprain is a soft tissue injury. Most often, a sprain occurs when an injury pulls, stretches, or tears the ligaments that connect bone to bone. A fracture is actually a break in the bone.

Causes

Injuries are the most common causes of foot and ankle sprains and fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ankle sprains and fractures. Basketball players are prone to ankle sprains, and runners may develop stress fractures of the ankle or foot. Gymnasts and dancers may also develop stress fractures.
Tripping or stumbling on uneven ground is another common cause of foot and ankle sprains and fractures.

Symptoms

Pain, swelling, bruising, and difficulty walking on the affected foot or ankle are the most common symptoms of a sprained or fractured foot or ankle.

Home Care

If you've hurt your foot or ankle, it's best to err on the side of caution. The acronym RICE can help you remember what to do:
Rest—Rest the affected area. Stay off the injured foot or ankle until it can be fully evaluated. Walking, running, or playing sports on an injured foot or ankle may make the injury worse.
Ice—Apply ice to the affected area as soon as possible, and reapply it for 15–20 minutes every three or four hours for the first 48 hours after injury. Ice can decrease inflammation.

Compression—Wrap an elastic bandage (such as an Ace® wrap) around the affected foot or ankle. The wrapping should be snug, but not so tight as to cut off circulation.
Elevation—Elevate the affected extremity on a couple of pillows; ideally, your foot or ankle should be higher than your heart. Keeping your foot or ankle elevated also decreases swelling.

When to Visit a Podiatrist

Podiatrists are doctors who specialize in the care and treatment of the lower extremities. If you've injured your foot or ankle, see a podiatrist. He or she can determine the extent of the injury and develop a plan of care to get you back in the game (or back to your everyday life) as soon as possible.
Increased pain, swelling, bruising, redness, or difficulty walking after an injury are definite signs that it's time to see a podiatrist.

Diagnosis and Treatment

A podiatrist will carefully examine your feet and ankles and take a complete medical history. He or she will also order tests, including an X-ray, ultrasound, or MRI, to determine the extent of your injury. If you have a fracture that's clearly visible on X-ray, you may not need additional testing. Ultrasounds and MRIs are useful for finding soft issue injuries (including torn ligaments) and stress fractures.

Treatment will depend on your injury. If you have a broken bone, your podiatrist may attempt to “reduce” the fracture, which means lining up the ends of the bones so they can heal properly. (You'll be given a local anesthetic to numb the area first.) If the fracture is “unstable,” meaning that the ends of the bone do not stay in place after a reduction, surgery may be needed. Podiatrists can use metal plates and screws to fix broken bones.

Stress fractures are treated with rest and immobilization. You will be instructed to stay off the affected area until healing is complete. Crutches and/or a special “boot” or cast may be used to immobilize the area.

Sprains are also treated with a period of immobilization. Depending on the extent of your sprain, you may be able to resume activity fairly quickly, or you may need to wear a soft cast or special “boot” and use crutches for a period of weeks.
Professional athletes may undergo surgery to repair torn ligaments.
Oral anti-inflammatory medication, such as ibuprofen, can be used to decrease pain, swelling, and inflammation.

Prevention

Warming up prior to physical activity can prevent ankle sprains and fractures. So can wearing proper shoes. If you're an athlete, talk to your podiatrist to determine which shoes are best for your sport, and read APMA's footwear selection tips on our Tips for Healthy Feet page for more information. Athletic shoes should be replaced yearly; running shoes should be replaced every 300–400 miles or so.
Avoid running or walking on uneven surfaces.

Source: "Sprains, Strains & Fractures | Foot Health | Learn About Feet | APMA." Sprains, Strains & Fractures | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Surgery

Surgery

When is Foot Surgery Necessary?

Many foot problems do not respond to “conservative” management. Your podiatrist can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

Types of Foot Surgery
Fusions: Fusions are usually performed to treat arthritic conditions of the foot and ankle. A fusion involves removing all cartilage from a joint and then joining two or more bones together so that they do not move. Fusions can be done with screws, plates or pins or a combination of these.

Tendon Surgery: Surgery on the tendons can be performed for acute injuries such as ruptures but is also commonly done to lengthen or shorten the tendon, depending on the problem. In some cases, tendons may be re-routed to improve foot and ankle function.
Metatarsal Surgery: Surgery on the lesser metatarsals is performed for a variety of reasons but is commonly done to redistribute the weight bearing on the ball of the foot. In some severe cases, such as rheumatoid arthritis, surgery may involve removing the metatarsal heads (the bones in the ball of the foot area).

Bunion Surgery: There are many different types of bunion surgery depending on the severity of the bunion and the joint involvement. Your podiatrist can explain the bunion procedure that is most appropriate for your bunion. Depending on the surgery necessary, the recovery time can be very different—particularly if you need to be on crutches after the surgery or in a cast.
Hammer Toe Surgery: Hammer toe surgery may involve removing a portion of the toe bone to realign the toe or could involve fusing the toe joint (see Fusions, above). In some cases, it may involve placing an implant in the toe to maintain realignment.

Neuroma Surgery: Neuroma surgery involves removing a benign enlargement of a nerve, usually between the metatarsal heads in the ball of the foot. This soft tissue surgery tends to have a shorter recovery time than bone procedures, but it leaves some residual numbness related to the removal of the piece of nerve tissue.

Heel Surgery: Based on the condition and the chronic nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Your podiatrist will determine which method is best suited for you.

Reconstructive Surgery: Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation, and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.

Preoperative Testing and Care

As with anyone preparing for any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatrist will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by your podiatrist, such as blood studies, urinalysis, EKG, X-rays, a blood flow study (to better evaluate the circulatory status of the foot and legs), and a biomechanical examination. A consultation with another medical specialist may be advised by a podiatrist, depending on your test results or a specific medical condition.

Postoperative Care

The type of foot surgery performed determines the length and kind of aftercare required to assure that your recovery from surgery is rapid and uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. Your podiatric surgeon will also determine if and when you can bear weight on your foot after the operation. A satisfactory recovery can be hastened by carefully following instructions from your podiatrist.

Source: "Surgery | Foot Health | Learn About Feet | APMA." Surgery | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Sweaty Feet

Sweaty Feet

What are Sweaty Feet?

Excessive sweating of the feet is called hyperhidrosis. It's more common in men than in women, and more common in young adults than older adults.
People whose feet sweat excessively often also have problems with excessive sweating of the palms. According to the International Hyperhidrosis Society, 3 percent of the population suffers from hyperhidrosis.

Causes

Excessive sweating of the feet seems to be an inherited problem. No one knows exactly why it occurs, but people who sweat excessively seem to have a different “set point” than other people. Most people sweat when it's hot out, or when they become warm. People with hyperhidrosis sweat excessively almost all the time.

Symptoms

The most obvious symptom of hyperhidrosis is feet that sweat excessively. Some people sweat so much that their feet may slip around inside their shoes.

The feet may also have a whitish, wet appearance; sometimes, foot infections are present as well. (Constant wetness breaks down the skin, allowing infection to set in.) Foot odor is common.

Those suffering from hyperhidrosis may also experience emotional stress and worry regarding foot odor. Sweat-related anxiety and isolation can be particularly severe among teens with plantar hyperhidrosis.

Home Care

Good foot hygiene is essential. Wash your feet daily with an antibacterial soap; be sure to wash between the toes. Dry the feet thoroughly, then apply cornstarch, foot powder, or an antifungal powder to your feet. Wear wicking socks made of natural or acrylic fiber blends that draw the moisture away from your feet instead of trapping it. Some synthetic blends are designed to wick moisture away from the skin and work best to keep the feet dry. One hundred percent cotton socks absorb moisture but do not wick it away from the skin and frequently lead to blisters, so they should be avoided.

It's also a good idea to change socks during the day. Stash an extra pair of socks at school or at work, and change socks mid-way through the day. Wear shoes that are made of breathable materials.

A technique called iontophoresis, which uses water to conduct a mild electrical current through the skin, has been found helpful for people with sweaty feet. People can purchase iontophoresis machines for athome use.

When to Visit a Podiatrist

If your feet sweat excessively, see a podiatrist. According to the US National Library of Medicine, less than 40 percent of people with excessive sweating seek medical care. A podiatrist can help you control this embarrassing condition. Patients who talk to their podiatrists about plantar excessive sweating may also have concerns regarding extreme sweating elsewhere – such as in their underarms, on their palms, or on their face or scalp.

Diagnosis and Treatment

Most often, excessive sweating of the feet is diagnosed based on your reporting of symptoms and a physical exam of the feet. A podiatrist can also do a starch-iodine test to confirm the diagnosis. First, an iodine solution is applied to the bottom of the feet. After the solution has dried, cornstarch is sprinkled over the area. The treated area turns dark blue if excessive sweat is present.

Treatment options are tailored to your symptoms. Over-the-counter or prescription roll-on antiperspirants may be applied directly to the feet. Botox injections can temporarily control excessive sweating of the feet. (The effect generally lasts for about six to nine months.) Oral prescription medications, often anticholinergics, can be used. Severe cases of sweaty feet may be treated with a surgical procedure called a sympathectomy, which interrupts the nerve signals that tell the body to sweat excessively.

Prevention

Good foot hygiene can prevent foot odor and foot infections, two common side effects of sweaty feet.

Source: "Sweaty Feet | Foot Health | Learn About Feet | APMA." Sweaty Feet | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Tendonitis

Tendinitis

What is Tendinitis?

Tendinitis is the inflammation of a tendon. Tendons are thick cords of tissue that connect muscles to bone.
Achilles tendinitis, or an inflammation of the Achilles tendon, is one of the most common causes of foot or ankle pain. Other types of foot/ankle tendinitis include posterior tibial tendinitis and peroneal tendinitis.

Causes

Tendinitis can result from an injury or over-use. Improper stretching prior to exertion or incorrect form during physical activity can also contribute to the development of tendinitis. Some people, including those with “flat feet,” tight tendons or arthritis, are particularly prone to tendinitis.

Symptoms

Pain is the most prominent symptom of tendinitis. The pain will be most noticeable when you try to move that part of your body. The involved tendon may swell.

Home Care

Rest and ice can ease the pain of tendinitis. Stay off your foot or ankle as much as possible and apply ice for up to 15 minutes at a time, three to four times a day.

When to Visit a Podiatrist

If the pain doesn't go away with ice and rest, or if the pain persists beyond a week, it's time to see a podiatrist. Don't wait! Tendinitis can become a chronic problem, and it's a lot harder to treat chronic problems than acute injuries.

Diagnosis and Treatment

Your podiatrist will ask you some questions about your pain and general health and perform a complete physical examination of your feet and ankles. X-rays or an MRI might be ordered to rule out any other problems, such as a fracture or torn tendon.
Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.

Prevention

Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon.

Gradually increasing your activity level with an appropriate training schedule—building up to a 5K run, for instance, instead of simply tackling the whole course the first day—can also help prevent tendinitis.

Source: "Tendinitis | Foot Health | Learn About Feet | APMA." Tendinitis | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Toenail Fungus

Toenail Fungus

What Is Toenail Fungus?

Toenail fungus, or onychomycosis, is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and smells foul. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair your ability to work or even walk. The resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.

Causes

Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where you are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.

Symptoms

Toenail fungus is often ignored because the infection can be present for years without causing any pain. The disease is characterized by a progressive change in a toenail's quality and color, which is often ugly and embarrassing.

Home Treatment

A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.

When to Visit a Podiatrist

You should visit a podiatrist when you notice any discoloration, thickening, or deformity of your toenails. The earlier you seek professional treatment, the greater your chance at getting your nails to clear.

Diagnosis and Treatment

Treatments may vary, depending on the nature and severity of the infection. Your podiatrist can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail.
Newer oral antifungals, approved by the Food and Drug Administration, may be the most effective treatment. They offer a shorter treatment regimen of approximately three months and improved effectiveness. Your podiatrist may also prescribe a topical treatment, which can be an effective treatment modality for fungal nails.

In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail that has not responded to any other treatment permits the fungal infection to be cured and prevents the return of a deformed nail.
Trying to solve the infection without the qualified help of a podiatrist can lead to more problems. With new technical advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.

Prevention

Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails. Clean and dry feet resist disease.
Wash your feet with soap and water, remembering to dry thoroughly.
Wear shower shoes when possible in public areas.
Change shoes, socks, or hosiery more than once daily.
Clip toenails straight across so that the nail does not extend beyond the tip of the toe.
Wear shoes that fit well and are made of materials that breathe.
Avoid wearing excessively tight hosiery to decrease moisture.
Wear socks made of synthetic fiber that “wicks” moisture away from your feet faster than cotton or wool socks do.
Disinfect instruments used to cut nails.
Disinfect home pedicure tools.
Don't apply polish to nails suspected of infection (those that are discolored, for example).

Source: "Toenail Fungus | Foot Health | Learn About Feet | APMA." Toenail Fungus | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.

Warts

Warts

What are Warts?

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus and can appear anywhere on the skin. Those that appear on the sole of the foot are called plantar warts. Children, especially teenagers, tend to be more susceptible to warts than adults. Some people seem to be immune to warts.

Causes

The virus that causes warts generally invades the skin through small or invisible cuts and abrasions. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, creating another route for spreading. Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

Symptoms/Identification

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur. When plantar warts develop on the weight-bearing areas of the foot (the ball of the foot, or the heel, for example), they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Home Care

Self-treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self-treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use these medications in the presence of an active infection.

When to Visit a Podiatrist

It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis. It is possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart.

Diagnosis and Treatment

It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.
Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia in either your podiatrist's office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

Prevention
Avoid walking barefoot
Change shoes and socks daily
Keep feet clean and dry
Check children's feet periodically
Avoid direct contact with warts from other persons or from other parts of the body
Do not ignore growths on, or changes in, your skin
Visit your podiatric physician as part of your annual health checkup

Source: "Warts | Foot Health | Learn About Feet | APMA." Warts | Foot Health | Learn About Feet | APMA. N.p., n.d. Web. 13 Nov. 2016.