Achilles Tendonitis

Ankle sprains are about as common as shopping carts at the grocery store. Take a wrong step, walk on uneven ground, or be active in athletics, and sooner or later, you will probably have an ankle sprain. By definition, an ankle sprain is a type of injury involving some degree of ligamentous trauma, be it over stretching, partial rupture, or total tear. Along with this ligament injury is some level of ankle joint instability, which can become an invitation for future reinjury and weakness. Ankle sprains usually involve either the inside or outside aspects with the outer variety being the much more prevalent type due to its weaker structures and greater tendency for injury. The typical presentation of an ankle injury is acute pain, swelling, bluish-black bruising or discoloration, loss of motion, and one’s inability to weight-bear without discomfort. A thorough examination by a specialist is recommended in order to rule out other problems such as fractures, tendon ruptures, and discolorations.

The actual cause of an ankle sprain is trauma that creates excessive strain, stretching or tension on the inherent ligamentous structures resulting in subsequent injuries and disability. The ankle joint will only move so far and then something has to give. In certain isolated cases, a bone will fracture but in the vast majority of cases, a ligament is over stretched, partially tears, or totally ruptures. Pain is the unmistakable common denominator with simple weight-bearing often becoming an impossible task. The trained specialist in his or her examination will be able to largely assess the degree of injury, the probable mechanism of injury, and the chances for partial to total recovery.

The treatment approach to a sprained ankle is largely determined by how soon after the injury it is seen. Assuming that we are dealing with a fresh injury seen within hours to a few days of the trauma, our first line of treatment should be directed at reducing the soft tissue swelling. Immobilizing the injury site is used to limit unnecessary motion along with rest, elevation, ice, and compression to reduce the pain. Physical therapy and rehabilitation are then used to reestablish ankle joint stability and strength. Orthotics and braces are sometimes used for the purpose of supporting the foot and ankle while reducing any allowable abnormal range of motion. Surgery is occasionally used to strengthen the ankle joint ligaments in those cases involving chronic instability and a frequent history of sprains. Too often under addressed ankle sprains lead to a laxity of the ankle anatomy and recurrence of these ankle sprains can become more frequent.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Probably one of the most missed diagnosis of the foot I see is Chronic Dermatophytosis, aka Athlete’s Foot. We all seem to recognize the acute form many get in high school where the feet itch excessively and the skin between the toes is wet and has turned white, aka maceration, but we often mistake the chronic type of dermatophytosis as dry skin. Patients say, “Doc I keep putting moisturizing cream on my skin but they still look dry”. Well that’s because their problem is a fungus, not dry skin.

You do not have to be a member of a sports team to get athlete’s foot. In fact, believe it or not, you don’t even have to play a sport. The condition itself usually results from an overgrowth of a particular fungus organism. In most cases, the areas between the toes and the arch of the foot are most often involved. Athlete’s foot may appear in different stages, each with its own presentation. For instance, the acute stage may have blisters or have intense itching. In addition, there may be maceration between the toes and occasional drainage. The chronic condition is characterized more by a dry and scaly appearance and rarely itches. My favorite description of chronic dermatophytosis (yes I have a favorite!) is “a moccasin distribution of dry ruptured vesicles”. There is some confusion as to how this skin condition can be transmitted but at the present time, the consensus of opinion is that there is a contagious capacity. In short, you might be able to catch it from the next guy or gal, so watch your barefoot walking! Also, it can come from fungal toenails if you have those.

Occasionally, an athlete’s foot condition will become infected and require more extensive therapy. In actuality, the threat of subsequent infection is probably a prime reason for treating more aggressively the earlier stage of the condition. After all, one might ask, what is really so bad about a little itching between the toes. Well, by itself, probably not a whole lot. But in those cases where that little itching develops into a more involved complication, then we might be facing a more serious problem.

At the first sign of an athlete’s foot condition, I would recommend a short trial period of a medicinal preparation available at the pharmacy in spray or cream varieties. Following several days use, if the condition persists, I would recommend a visit to the foot specialist. One thing is for sure, do not give up your athletic status in the hopes of relinquishing your athlete’s foot!

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A bunion is a bony lump on the side of your foot, which develops when your big toe starts to angle towards your second toe. The bunion eventually causes discomfort and pain. The skin over the lump can become red, blistered or infected. A fluid-filled space called a bursa may also develop under your skin in this area and this can be painful if it becomes inflamed. This is called bursitis. You can also get a bunion deformity concerning your little toe this is often called a “tailor’s bunion”. Bunions are typically progressive and usually get worse over time. Symptoms include pain, stiffness, redness, difficulty walking and difficulty wearing shoes.

A bunion occurs as a result of a problem with your big toe known as hallux valgus. Hallux means the big toe and valgus means that it’s pointing outwards towards the other toes. In hallux valgus the bone in your foot at the base of your big toe, called the first metatarsal, moves out at the side of your foot. Your big toe angles towards your other toes. There is evidence that people can inherit a tendency to develop bunions. However, it doesn’t always follow that if your parents or grandparents have bunions, you will have them too.

A good understanding of foot biomechanics is required if you wish to address the cause of the bunion. The anatomy involved can be quite complex and if the forces that are causing the bunion can be reversed it is possible to keep the bunion from worsening. Proper shoe gear and arch control also plays an important role.

The best conservative care will not reverse a bunion. If you have severe pain or discomfort from a bunion, you will typically need to have an operation to correct it. Dr. Sowell is a podiatrist who is specifically trained to treat the bones and joints in the foot. There are over 130 different operations that can be carried out to treat bunions. Most of these procedures will aim to narrow your foot by straightening out your big toe joint as much as possible. An operation won’t return your foot back to normal, but most people find that surgery reduces their symptoms and improves the shape of their foot. The operation you have will depend on how severe your bunion is and whether or not you have arthritis.

One of the most common operations is called a metatarsal osteotomy. Your surgeon will cut one or more of the bones in your foot and then reset them so they are in line. He or she will also cut away the part of your big toe joint that is sticking out. Your surgeon may also correct the ligaments and tendons inside your foot by making them looser or tighter.

Another simpler operation that you may have is called an exostectomy (also sometimes called bunionectomy). In this procedure, your surgeon shaves off the part of the bone that is sticking out (ie the bunion). However, the bones aren’t straightened out. As this operation doesn’t correct the position of the bones, your bunion is more likely to return.

As with all surgery there are risks associated with these procedures. It’s likely that you will find the condition is much improved, but you may still have some pain and your big toe may feel stiffer. It’s also possible that in time the bunion will develop again.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Burning/tingling feet are a common complaint in a podiatry office. Patients rarely have any sense of why they are experiencing burning so I thought I would discuss, very quickly, the basic concept of burning feet because it can be caused by a myriad of problems:

• Neuropathy – Injury to a nerve or loss of nerve function are common causes of burning and tingling in the feet. Often, this type of nerve pain is experienced more at rest and with feet bare than when being active and wearing shoes. Many patients begin to have difficulty falling asleep due to their nerve pain and this can impact their quality of living. Proper assessment of nerve changes should be performed first and then there many treatment options to reduce the symptoms. Topical creams, oral medications, padding of the foot and surgery are just a few of the more common. Patient’s with a history of back problems, sciatica, diabetes and alcoholism often fall into this category.
• Circulatory – Loss of arterial circulation in the legs often leads to burning in the feet. Typically starting with burning while walking (intermittent claudication) patients will sit down and wait for the burning pain to pass and the return to their walk. This can progress to burning pain in the feet while trying to fall asleep (rest pain). A vascular examination can quickly determine if arterial circulation is the cause of your burning and Dr. Sowell has invested in the SensiLase non-invasive vascular testing system to quickly determine if blood flow is the problem.
• Nerve impingements – There are many anatomical situations in the foot where a nerve can get entrapped by the surrounding anatomy and begin to burn. Typically these conditions are worse when walking and when wearing shoes but the effects of the injury done while working may be experienced when resting if the injury is progressed. A thorough understanding of anatomy and how it functions (biomechanics) is required to properly treat any nerve entrapment or injury.

Burning in the feet is not normal and anyone experiencing this pain should seek help. These conditions typically persist and progress. Ignoring them will not help them resolve and the effects of treatment can be dramatic. Consider calling Dr. Sowell for a consultation and hopefully he can help reduce your pain.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. The disease is named for the three physicians who first identified it in 1886 – Jean-Martin Charcot and Pierre Marie in Paris, France, and Howard Henry Tooth in Cambridge, England. 

CMT, also known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy, comprises a group of disorders that affect peripheral nerves. The peripheral nerves lie outside the brain and spinal cord and supply the muscles and sensory organs in the limbs. Disorders that affect the peripheral nerves are called peripheral neuropathies.

The neuropathy of CMT affects both motor and sensory nerves. (Motor nerves cause muscles to contract and control voluntary muscle activity such as speaking, walking, breathing, and swallowing.) A typical feature includes weakness of the foot and lower leg muscles, which may result in foot drop and a high-stepped gait with frequent tripping or falls. Foot deformities, such as high arches and hammertoes (a condition in which the middle joint of a toe bends upwards) are also characteristic due to weakness of the small muscles in the feet. In addition, the lower legs may take on an “inverted champagne bottle” appearance due to the loss of muscle bulk. Later in the disease, weakness and muscle atrophy may occur in the hands, resulting in difficulty with carrying out fine motor skills (the coordination of small movements usually in the fingers, hands, wrists, feet, and tongue).

Onset of symptoms is most often in adolescence or early adulthood, but some individuals develop symptoms in mid-adulthood. The severity of symptoms varies greatly among individuals and even among family members with the disease. Progression of symptoms is gradual. Pain can range from mild to severe, and some people may need to rely on foot or leg braces or other orthopedic devices to maintain mobility. Although in rare cases, individuals may have respiratory muscle weakness, CMT is not considered a fatal disease and people with most forms of CMT have a normal life expectancy. 

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Our bodies have a wonderful ability to protect us from injury. For example, reflexes help us avoid many bumps and bruises. Another protective ability we don’t often think about is the skin’s ability to avoid ulceration. When the foot is getting a large amount of pressure focused in a relatively small area the skin adds layers to protect itself. These extra layers of keratin make the skin less vulnerable to puncture and reduces its ability to break. These added layers are known as callus.

If callus is allowed to collect unchecked it can become very painful, can change how you walk and can lead to open wounds on your feet. This increases your risk of infection.
Callus goes by many names depending upon its location on the foot:

• “Corns” are usually on top of the small joints of the toes.
• “Soft corns” are usually between the toes at pressure points.
• Calluses on the bottom of the feet are usually just called “calluses” but podiatrists typically call them tylomas.
• “seed corns” are painful focused calluses found on pressure spots typically on the bottom of the foot.

Calluses of all types can lead to severe pain and should be addressed with treatment as well as prevention. Typically, trimming the callus will reduce your discomfort but determining why the callus is there will help us prevent its recurrence. Shoes and how we walk in them are often the culprits and modifications of them can lead to the calluses going away due to the reduction in pressure. Shoe adjustments, pads, inserts and orthotics are just a few conservative approaches that can prevent callus formation.

If conservative measures are unsuccessful, surgery might be recommended to help you walk without painful corns and calluses in the future. Contact Dr. Sowell and see if he can make each step less painful.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A common diabetes myth is that because diabetes is so prevalent it must not be that serious. I beg to differ. Every day I meet new patients who suffer greatly due to their diabetes. Blindness, amputations and a shorter lif are just a few complications from the disease. Diabetic care is a core value of Sowell Podiatry. Please control your blood sugar and get regular check ups. If we can be of any help, please give us a call.

If you are diabetic the best way to know how to care for your feet is to see a podiatrist and after he has determined your level and type of foot risk, follow his instructions. In my office, diabetic foot evaluations end with each patient getting specific instructions on how to care for their feet.

General Care and Hygiene

• Never go barefoot either indoors. Your feet may be numb and you will not feel an injury as it occurs.
• Inspect your feet daily. You may use a mirror to help see the soles of your feet and between toes. Check for breaks in skin, dryness and redness. Ask a friend or family member for help if needed.
• Wash your feet daily and be sure to dry between your toes. Water should be warm, test with your elbow to see if it is too hot.
• For dry feet you may apply a thin coat of moisturizing cream but do not put any between your toes.
• If your feet are cold you may wear loose socks to bed. If your feet are hot DO NOT ice them down. Avoid extreme temperatures.
• Cut toenails straight across and do not cut down into the corners.
• Never cut corns or calluses yourself and do not use commercial corn or callus removers.
• Do not use adhesive tape on your feet.
• Avoid any tight clothing or under garments that might constricts feet, legs or hips.

Physician Communication

• Be sure to see your doctor every 3-4 months. Make sure every doctor you see knows you are diabetic.
• See your podiatrist annually, if you are at higher risk you will need to see your podiatrist more often.
• See your podiatrist promptly if you develop a blister, puncture wound, sore, corn, callus or ingrown toenail. Any bleeding, pus or redness are reasons to see your podiatrist.

Footwear

• Buy only comfortable well fitting shoes. Get help with the fitting and be sure to walk around in them before you buy. Buy shoes late in the day when swelling is more likely to be present.
• Softer leather uppers with plenty of width and toe depth make a good choice.
• Avoid open toes or heels and inspect shoes for rough areas, protruding nails and foreign objects before buying.
• Break in new shoes by wearing them for less than two at a time until you know they will not cause blisters.
• Never wear socks or hosiery with seams. Seams can cause pressure areas and cause skin to break down.
• Wear only clean socks and change them daily. Inspect them before putting them on.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Diabetic neuropathy is a peripheral nerve disorder caused by diabetes or poor blood sugar control. The most common types of diabetic neuropathy result in problems with sensation in the feet. It can develop slowly after many years of diabetes or may occur early in the disease. The symptoms are numbness, pain, or tingling in the feet or lower legs. The pain can be intense and require treatment to relieve the discomfort. The loss of sensation in the feet may also increase the possibility that foot injuries will go unnoticed and develop into ulcers or lesions that become infected. In some cases, diabetic neuropathy can be associated with difficulty walking and some weakness in the foot muscles. Diabetic neuropathy affects all systems and has an enormous impact on every patient.

The goal of treating diabetic neuropathy is to prevent further tissue damage and relieve discomfort. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet by wearing proper fitting shoes and routinely checking the feet for cuts and infections. Analgesics, low doses of antidepressants, and some anticonvulsant medications may be prescribed for relief of pain, burning, or tingling. Some individuals find that walking regularly, taking warm baths, or using elastic stockings may help relieve leg pain.

The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. Treating diabetes may halt progression and improve symptoms of the neuropathy, but recovery is slow. The painful sensations of diabetic neuropathy may become severe enough to cause depression in some patients.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A podiatrist, like myself, is trained to handle almost all conditions concerning the foot. Not a week goes by in my office that someone does not come in with some sort of broken bone. If you feel you have broken a bone in your foot please seek medical attention immediately.

Although it is true that some fractures do not require much care, it is also true that patients who put off the care of a fracture could have trouble getting the fracture to heal. The process is usually as simple as getting xrays (in office), diagnosis and treatment for the particular type of fracture present. Treatments range from splinting, protective shoe, walking cast and sometimes surgery. Yes, sometimes a fracture requires fixation using screw, pins and plates!
Signs of a possible broken bone in the foot are:

• Pain when walking.
• Bruising.
• Swelling.
• A change in foot or toe shape.

Occasionally, I have a patient come into my office with some of these signs but with no history of an injury or fall. Many times x-ray reveals that they have a fracture in their foot and they were not suffering with much pain. This particularly happens in patients with weak bones or osteoporosis. Please take these signs seriously and hopefully we can get you on the road to recovery as quickly as possible.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

“Flat feet” or pes planus is a term we hear thrown around quite a bit. Many patients plop down in my podiatry chair each day and proclaim “I have flat feet”. What they are describing is a foot that has no arch and sometimes the whole bottom of the foot touches the floor when walking. Well, “flat feet” by itself is not much of a diagnosis, it is more of a description of the foot’s position. Additionally, a foot that is flattened has often been considered a foot that is prone to problems and this is likely why many years ago the military avoided recruits with flat feet. It should be noted that people with overly high arches are more prone to problems as well.

A foot that appears flat when standing and walking may actually have an arch when the foot is at rest and off of the ground. This is called a functionally flat foot and this simply describes how the foot moves when walking. Many children appear to have flat feet because they have not developed their bone structure enough to have an arch and for a few children this can lead to pain. (If your child is having arch or heel pain, please see a podiatrist for evaluation.)

Some great athletes have flat feet and it is possible to get through life with flat feet and little problems. However, there are some common complications that occur when walking in this foot position:

• Hammertoes
• Bunions
• Neuromas
• Heel pain
• Tendonitis

It is my recommendation, as a podiatrist, that if you have flat feet you should at least get an assessment of your feet before you have problems.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Gouty arthritis, or hyperuricemia is a common type of arthritis that occurs when uric acid builds up in blood and causes joint inflammation. In my practice, the most common descriptors patients present with are a painful, hot, swollen and red joint in the foot. The pain often times wakes the patient at night. The first metatarsal phalangeal joint (big toe joint) is the most frequent joint involved but it may be the ankle or any other joint in the foot that becomes attacked.

Basically, we ingest chemicals in our foods called purines. These purines are broken down into uric acid and the uric acid is mostly removed from our systems though the kidneys. Gout is caused by having higher-than-normal levels of uric acid in your body. This may occur if your body makes too much uric acid (over producer) or your body has a hard time getting rid of uric acid through the kidneys (under secretor).

Like too much sugar in your iced tea, if uric acid is too concentrated in your blood it will settle out. In the case of gout it typically settles out in the form of uric acid crystals in a cool joint which makes the foot the most likely location. These crystals cause the joint to swell up and become inflamed.

The exact cause is unknown. Gout may run in families. It is more common in men, in women after menopause, and those who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in the blood. This is often over looked.
After a first gouty attack, people will have no symptoms. Half of patients have another attack. In my practice every patient is allowed one gouty attack. Typically Dr. Sowell will give an injection, prescribe medications and they generally resolve in a few days. However, some people may develop chronic gout. Those with chronic arthritis develop joint damage and loss of motion in the joints. They will have joint pain and other symptoms most of the time. Therefore, more than one gouty attack requires extensive workup to determine the ongoing cause of elevated uric acid in the blood.

Some diet and lifestyle changes may help prevent gouty attacks:

• Avoid alcohol
• Reduce how many purine-rich foods you eat, especially anchovies, sardines, oils, herring, organ meat (liver, kidney, and sweetbreads), legumes (dried beans and peas), gravies, mushrooms, spinach, asparagus, cauliflower, consommé, and baking or brewer’s yeast.
• Limit how much meat you eat at each meal.
• Avoid fatty foods such as salad dressings, ice cream, and fried foods.
• Eat enough carbohydrates.
• If you are losing weight, lose it slowly. Quick weight loss may cause uric acid kidney stones to form.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation.

To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:

• A high-arched foot
• A tight Achilles tendon
• A tendency to walk on the outside of the heel.

Symptoms

Haglund’s deformity can occur in one or both feet. The symptoms include:

• A noticeable bump on the back of the heel
• Pain in the area where the Achilles tendon attaches to the heel
• Swelling in the back of the heel
• Redness near the inflamed tissue

Diagnosis

After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone.

Non-Surgical Treatment

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:

• Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation.
• Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
• Exercises. Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
• Heel lifts. Patients with high arches may find that heel lifts placed inside the shoe decrease the pressure on the heel. This tends to reduce the tension on the back of the heel.
• Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

The term Hallux Rigidus describes a limited motion of the big toe joint. The hallux, or big toe, becomes rigid and will no longer move up and down freely. Also known as a dorsal bunion or Hallux Limitius, the condition is most commonly caused by every day wear and tear of the joint and is characterized by an extensive dorsal spurs and arthritic changes in the top half of the joint. As hallux limitus continues to worsen the joint will move less and less. Eventually, we might call it hallux rigidus. Hallux rigidus can be very painful and will often cause patients to change how they walk, leading to more difficulties. Patients with limited motion of their big toes will often have a callus on their big toe as well.

A thorough biomechanical exam will reveal the severity of joint changes and will consider the motion of the first ray of the foot. The first ray includes the metatarsal (see anatomy page) and its motion plays a large role in the motion of the big toe joint. Also, xrays are typically taken to determine the location and severity of the bone spurs on top of the joint and arthritic changes within the joint.

Conservative treatment of hallux limitus might include physical therapy, shoe modifications and often custom made orthotics. With orthotics we can change how the joint and first ray move and possibly avoid surgery. However, if surgery is required the procedure can remove the spurs around the joint that are limiting its motion and may allow a patient to regain much of the range of motion that has been lost.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A hammertoe is a change in toe position due to contracture of tendons, laxity of ligaments or arthritic change in joints. These generally progress over time and have many causes and presentations. Hammertoes, one of the most painful foot ailments, can often be traced directly to the wearing of narrow, pointed-toe shoes. Women most often are the victims of hammertoes. Most of the time, female footwear is not much wider at the front than at the heel, and the outline of the normal foot is rounded. The combination of narrow shoe and wide foot, of pointed shoe and rounded foot, causes, predictably enough, painful foot problems such as hammertoes.

Additionally, there are certain foot shapes that are generally unstable while walking. Overtime this instability can cause the toes to flex to provide additional foot support. The toes contracture over an extended period of time can lead to contracture.

The tip of a hammertoe can strike the ground with a thud at every step and become flat and squat. A hard corn can form on top, and a distal corn can form at the hammering portion. The nail might split or grow inward. A corn or callused nail groove might develop where the flesh is caught between the nail and the toe bone or where the toe is angulated. A soft corn can prove especially annoying when it is between the hammertoe and the adjacent toe that is overlapped. Although any toe may be affected, the second toe suffers most often. It is longer than the other toes and therefore more likely to be deformed by small footgear. The effects of a hammertoe are not limited to the toe. The toe bones, forced back against the metatarsals, exert pressure against the center of the foot. The ball of the foot suffers, calluses form, and muscular cramps develop.

Wearing tight-fitting stockings, short footgear, tapered-toe shoes, pointed-toe shoes, tight leotards, or really snug pantyhose for long periods of time can produce a hammertoe. Because these articles of apparel are necessarily worn on each foot, there can be two hammertoes, one on each foot.

Surgery is sometimes required for this condition. There are many techniques that can be used to correct hammertoes and often times it is fairly simple. Patients almost always walk after surgery and minimal incision techniques greatly reduce discomfort and healing times.

<h4>PLEASE NOTE:</h4>
The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A few quick misconceptions about heel spurs:

• That they have to be cut out for the pain to go away.
• That they are digging into your flesh.
• That they are due to a “stone bruise”.

In fact, if we took one hundred people off the street and took x-rays ten would have heels spurs with no pain. This should tell us that heel spurs are fairly common and are not always painful. At Sowell, Podiatry we are very good at ending your heel pain without surgery.

The band that runs along the bottom of the foot from your heel to the ball of the foot is called the plantar fascia. To find your plantar fascia, simply lift your big toe and the plantar fascia will typically “pooch” out along the arch on the bottom of your foot. The swelling of this band is our focus in this article and is called plantar fasciitis. Patients with plantar fasciitis often have pain upon rising from a chair, getting out of the car or during the first few steps of the day.

Plantar fasciitis is often caused by poor foot mechanics. If your foot flattens out too much the fascia may overstretch and swell and if your foot is very high arched the fascia may be too tight and ache. Additionally, many activities can injure your plantar fascia leading to irritation along it. Chronic pulling of the plantar fascia with concurrent swelling can lead to the condition commonly known as a heel spur.

Physical examination of the foot can reveal if plantar fasciitis and a good understanding of foot mechanics will often lead to a determination as to why it is present. X-rays are required to diagnose a heel spur. The presence of a heel spur is a good indicator that the plantar fascia has been under increased tension for an extended period.

Reducing the symptoms of plantar fasciitis and heel spurs can include many things:

• Ice. We recommend rolling a frozen water bottle under the bottom of the foot.
• Anti-inflammatory medications.
• Controlling foot motion with insoles and shoes.
• Starting a stretching program to reduce tension on the area.

Occasionally plantar fasciitis and heel spurs require surgery but typically they can be addressed with conservative measures. We are very successful in treating this condition and we can often return patients back to a pain free active lifestyle in just a few visits.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

An ingrown toenail is a result of a nail growing into the skin that surrounds it. The big toe is the most common location but it may occur in any digit. At Sowell Podiatry, ingrown toes nails are very common. Too often these ingrown toenails are not cared for quickly enough and infection has typically set in when they arrive in our office. Ingrown toenails may cause pain at the tip of the toe or all the way down to the base of the toe and are usually more painful when walking and when wearing shoes.

A red, swollen, painful nail margin is very common with infection of the ingrown toenail and often times there will also be bleeding and pus. Parents should be aware that children are often times slow to discuss this problem and if they get any hint that there might be a problem such as altered gait, sock stains or a grimace they should inspect the child’s toes immediately. We perform many toenail procedures and take many steps to make this as comfortable and pain-free as possible.

Ingrown toenails have many potential causes. Some of the most common are:

• Improperly fitting shoes.
• Trauma to the toe.
• Thickened toenails due to fungus or repeated trauma.
• Improper trimming of toenails.

Treatment of an ingrown toenail typically involves addressing any bacterial infection in the skin first. Surface infection may often respond to proper foot soaks or antibiotic creams and oral antibiotics may also be used depending on the severity of the infection. A removal of the offending toenail is generally required and is often performed under local anesthesia. At this point, the toenail edge may be removed and allowed to re-grow or it may be removed permanently, this is called a matrixectomy. Please call Sowell Podiatry if you are suffering with an ingrown toenail and we will help you return to an active pain free lifestyle as quickly as possible.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Morton’s Neuroma is a benign thickening or enlargement of an intermetatarsal plantar nerve. The area of the foot known as “the ball of the foot” is made up of five large joints with very little room in the spaces between the joints. When these joints bump together, the nerve passing between them can become injured and over time will become more tuberous, or thickened. This is often described as a cord-like mass. Patients typically describe this condition as being painful, shooting, electrical and the most common description in my practice is that people say “it feels like there is a hot rock in my foot”.

Typically patients have more pain when weightbearing and wearing shoes and will often relay a history of taking off their shoes and rubbing their feet for relief. Morton’s neuroma can be diagnosed with advanced imaging techniques but is typically a diagnosis made clinically by a physician familiar with the condition.

Orthotics, pads, shoe modifications and corticosteroid injections are widely used to treat Morton’s neuroma. If such interventions fail, patients are commonly offered surgery known as neurectomy, which involves removing the affected piece of nerve tissue. Occassionally neurolytic injections are used to destroy the nerve without surgery.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Neuropathy is a term that is often heard when discussing foot complications. It seems that patients generally understand that neuropathy is a change in the nervous system often times in the foot but they have a terrible time describing how it feels. “My feet tingle and burn” or “My feet are numb but they still hurt” is often said, realizing that it seems to make no sense. Neuropathy is a diagnostic term that is quite large and includes all of these descriptions along with a few hundred more! When the nerves are undergoing change a patient will feel these changes in many ways. Tingling, burning, itching, feeling wet, feeling like something is crawling on them or just sharp pain to name a few. As a podiatrist, Dr. Sowell assesses many patients with neuropathy each day. Because the foot has many different sized nerves in it and each size nerve serves different purposes the testing may range from light touch, vibration, temperature, position and sharp vs. dull to name just a few.

There are many causes of neuropathy in the lower legs. Diabetes is by far the most common followed by alcoholism, back injury, lead poisoning and even medication induced neuropathy. The most important point is to try to limit further injury of the nerves by addressing any underlying causes that are within our control. Then we must address the care of the painful condition and attempt to reduce its impact on each patient. Whether it is a loss of sleep at night, an aggravating pain while sitting still or an increased risk of foot ulcerations due to a loss of feeling Dr. Sowell is very experienced in improving his patient’s quality of life.

There are many conditions that mimic early neuropathic changes and it takes a physician that sees this condition regularly to properly recognize it. Dr. Sowell would be happy to help you through the maze of neuropathy and help you return to a healthy active lifestyle.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Peripheral Arterial Disease (PAD) is a condition that affects approximately 12 million Americans. It occurs when blood vessels become narrowed and restrict blood flow. PAD can develop in many areas of the body but is very often first seen in the lower legs and feet. This can lead to Critical Limb Ischemia (CLI) which can end in amputation of toes, feet and legs.
At Sowell Podiatry, we treat PAD very seriously. Dr. Sowell has invested in a Sensilase non-invasive vascular study system to help detect patients with PAD as early as possible.

Symptoms of PAD:

• Claudication- Dull cramping pain in hips, thighs or calves during exercise and/or rest.
• Numbness or tingling in the leg, foot or toes.
• Changes in skin temperature, quality or color.
• Weakness in legs or arms.

There have been tremendous advances in the treatment of PAD. When I began practice at Sowell Podiatry many patients with PAD were doomed to amputation. Now with new advances in medications, testing and surgical techniques we are saving limbs that were once lost.
If you think there is any chance you are suffering with PAD, please call and get an appoint as soon as possible. We have many patients who are still walking on limbs that would have been lost

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A very common description of foot pain from my patients at Sowell Podiatry is the complaint that “my feet hurt when I get out of bed in the morning”. Now this can be caused by many things, but I would like to explain the phenomenon of post-static dyskinesia that my patients often experience. The spaces for swelling in the deeper tissues of the foot are very tight. Very small amounts of swelling can often lead to discomfort in some areas. When the foot is in motion, particularly when weight bearing, the muscles and motion of the foot squeeze any swelling in these places away and the swelling will move up into the lower leg. This “natural pump” is very efficient as long as it keeps running.

When we get off of our feet for an extended time, such as driving home from work, sitting to rest or sleeping at night the “pump” is turned off and the swelling collects. When we engage this “pump” by getting up on our feet and walking there is a build up swelling that must be moved quickly and it is painful until a few steps are taken and we begin to get the swelling moving. So often, patients think it is the first few steps that are the problem but actually it is the activity before resting that led to the swelling build up.

Most likely, the foot is not being properly supported while walking or working and this leads to continual swelling throughout the day. If you are suffering with pain upon rising, you might try icing your feet at the end of your day. Rolling a frozen water bottle on the floor underneath your foot from your heel to the ball of your foot can be very helpful. As a podiatrist I can assess the foot for lack of support and swelling and often can relieve this pain upon rising with simple shoe, insole or lifestyle modifications.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

The band that runs along the bottom of the foot from your heel to the ball of the foot is called the plantar fascia. To find your plantar fascia, simply lift your big toe and the plantar fascia will typically “pooch” out along the arch on the bottom of your foot. The swelling of this band is our focus in this article and is called plantar fasciitis.

Plantar fasciitis is often caused by poor foot mechanics. If your foot flattens out too much the fascia may overstretch and swell and if your foot is very high arched the fascia may be too tight and ache. Additionally, many activities can injure your plantar fascia leading to irritation along it. Chronic pulling of the plantar fascia with concurrent swelling can lead to the condition commonly known as a heel spur.

Physical examination of the foot can reveal if plantar fasciitis and a good understanding of foot mechanics will often lead to a determination as to why it is present. X-rays are required to diagnose a heel spur.

Reducing the symptoms of plantar fasciitis can include many things:

• Ice. We recommend rolling a frozen water bottle under the bottom of the foot.
• Anti-inflammatory medications.
• Controlling foot motion with insoles and shoes.
• Starting a stretching program to reduce tension on the area.
• Anti-inflammatory medications.
• Controlling foot motion with insoles and shoes.
• Starting a stretching program to reduce tension on the area.

Occasionally plantar fasciitis and heel spurs require surgery but typically it can be addressed with conservative measures. We are very successful in treating this condition and we can often return patients back to a pain free active lifestyle in just a few visits. However, sometimes long term support of the foot is needed and Dr. Sowell recommends custom orthotics in these situations

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (non-malignant), and usually will not go away or get smaller without treatment. Definitive causes for this condition have not been clearly identified. The characteristic sign of a plantar fibroma is a noticeable lump in the arch that feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop.

People who have a plantar fibroma may or may not have pain. When pain does occur, it is often caused by shoes pushing against the lump in the arch, although it can also arise when walking or standing barefoot. To diagnose a plantar fibroma, Dr. Sowell will examine the foot and press on the affected area. Sometimes this can produce pain that extends down to the toes. An MRI or biopsy may be performed to further evaluate the lump and aid in diagnosis.

Non-surgical treatment may help relieve the pain of a plantar fibroma, although it will not make the mass disappear. The foot and ankle surgeon may select one or more of the following non-surgical options:

• Steroid injections. Injecting corticosteroid medication into the mass may help shrink it and thereby relieve the pain that occurs when walking.
• Orthotic devices. If the fibroma is stable, meaning it is not changing in size, custom orthotic devices (shoe inserts) may relieve the pain by distributing the patient’s weight away from the fibroma.
• Physical therapy. The pain is sometimes treated through physical therapy methods that deliver anti-inflammatory medication into the fibroma without the need for injection.

Surgical treatment to remove the fibroma is considered if the patient continues to experience pain following non-surgical approaches. Orthotic devices may be prescribed to provide support to the foot. Due to the high incidence of recurrence with this condition, continued follow-up with Dr. Sowell is recommended.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Rest pain is a pain that is typically felt in the feet and legs while trying to fall asleep. Patients will describe a burning that often requires them to get up and move around or to hang their feet off of the side of the bed. Some patients will even sleep in a chair to avoid rest pain. This can be a sign of significant arterial circulation disease and should be addressed immediately. Please seek your podiatrist or primary care physician to see if your burning is due to arterial disease.

Additionally there are other symptoms concerning arterial disease that should be followed up with your doctor. Pain in your calf muscles that occurs when walking can also be a sign of circulatory disease. Some patients say my legs give out, my legs start burning or have to sit for a while and wait for the pain to go away. Then they get up and walk about the same distance before experiencing the pain again. This is called intermittent claudication and is another sign of arterial disease.

It is not normal to have foot or leg pain while walking, resting or trying to fall asleep. Call Sowell Podiatry today if you are having these issues. We offer in office vascular testing that is easy and is non-invasive. We can help.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Throughout life there might be times when we are bothered by how our feet smell. If I had a nickel every time the mother of a teenage boy was embarrassed by his smelly feet I could travel more…just kidding. Some suffer with excessive sweating (hyperhydrosis) and bacterial skin infection that can lead to malodor. In my practice I like to start with a simple solution and if it does not work then we can try something more aggressive. In the case of “smelly feet” I recommend tea soaks. Simply boil some water (enough for a foot bath), steep a few tea bags and let the water cool to a point you could put your elbow in it without discomfort. Then soak your feet for about fifteen minutes and do this daily for two weeks. The tannic acid in tea should lower the pH enough to kill surface bacteria and should help shrink sweat glands a bit. A few puffs of Lysol in the shoe never hurt either. If this does not do the trick the call and make an appointment at Sowell Podiatry and we will get to the bottom of the problem!

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

One of the most common foot conditions Dr. Sowell sees everyday is painful onychomycosis. That is to say that fungal nails have become very common in our society today and it is estimated that over 35 million people have fungal toenails in the United States alone. Fungal toenails are characterized as being thick, yellow, crumbly and abnormal in growth. They often times become very painful and can be embarrassing for patients. At Sowell Podiatry we take this condition very seriously and address it with a protocol that should provide a higher success rate.

1. We clean and sterilize all instruments properly using autoclave and chemical baths for each instrument that touches a patient.
2. We biopsy toenails before treating the toenail to verify that the condition is in fact caused by a fungus. There are some conditions such as micro-trauma and psoriasis to name a few that mimic onychomycosis.
3. We provide in depth debridement services for fungally infected toenails to reduce their risk of spread.
4. We measure and record fungal infection to determine if the condition is getting better.
5. We offer multiple treatment options to help the patient find a treatment course that fits their goals.

At Sowell Podiatry it is our goal to reduce the spread of fungal toenails in our community and we do that one toe at a time. If your toenails look abnormal, yellow or painful please give us a call.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Venous stasis or stasis dermatitis is changes in the skin that occur when blood collects (pools) in the veins of the lower leg. Caused by venous insufficiency this is a long-term (chronic) condition in which the veins have problems sending blood from the legs back to the heart. Blood pools in the veins of the lower leg. Fluid and blood cells leak out of the veins into the skin and other tissues. This may lead to itching, which causes more skin changes.

The symptoms of venous insufficiency include a dull aching or heaviness in the leg and pain that gets worse when you stand. The skin of the ankles and lower legs may look thin or tissue-like. You may slowly get brown stains on the skin and if you scratch the area, the skin may become irritated or crack. It may also become red or swollen, crusted, or weepy.

Over time, some skin changes become permanent:

• Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
• A bumpy or cobblestone appearance of the skin
• Dark brown color

Skin sores (ulcers) may develop (called a venous ulcer or stasis ulcer). These most often form on the inside of the ankle.

The diagnosis is primarily based on the appearance of the skin. Dr. Sowell may order tests to examine the blood flow in your legs and he may use elastic or compression stockings to reduce swelling. He will work with your primary care physician to determine what additional care might be needed such as medications or surgery. This conditions greatly affects ones ability to heal wounds and often times decreases ones quality of life. Therefore, early assesment and treatment is imperative.

PLEASE NOTE:

The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

Today, we know that you don’t have to be a liar, touch a toad, or drink a witch’s evil potion to get a wart. In all probability, you can’t even grow one by touching another person’s wart. Apparently, these lesions are non-contagious but can spread within the involved area of the same individual. In actuality, warts are encapsulated or walled off growths of viral tissue. Plantar warts on the feet are frequently painful with squeezing type pressure. In the vast majority of cases, the growth of a wart is preceded by some sort of skin puncture or would defect that in all probability, allows an entry site for contamination. Whether we all have inactive or potential wart viruses circulating in our bodies or gain the virus through the wound is as of yet unclear.

An interesting and often confusing distinction must be made between certain calluses and plantar warts. The surface of the wart often looks bumpy, or papillomatous, like cauliflower while skin lines or striations can be seen passing around a wart. In addition, plantar warts, upon close examination, will often demonstrate small black dots which when trimmed will bleed. These are tiny blood vessels, which become caught in the growth itself and are absent in regular callus tissue. A final line of distinction in identifying a wart is in its response to pressure. Squeezing a wart will usually produce extreme pain as opposed to similar pain from direct pressure on calluses.

Warts that appear on the hands and fingers are usually more responsive to therapy than are those on the feet. The professional methods of treatment available for plantar warts include just about everything from chemical applications and surgery to banana peels and hypnosis. Some warts respond quickly and some do not, and that my friends, is just plain honesty. I tend to start conservatively and if not successful become more aggressive in the fight. Even though we all know those old wives tales to be ridiculous, perhaps until your appointment with your foot specialist, you should stay away from toads, telling lies, and drinking weird tasting brews.

<h4>PLEASE NOTE:</h4>
The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.