Our Services
Other Conditions and Services We Provide
Along with the advanced treatments mentioned in the pages before, we also see patients with more general foot complaints such as:
Athlete's Foot
Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus usually attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth.
The warmth and dampness of areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi. Not all fungus conditions lead to Athlete's foot, however. Other conditions, such as malfunctions of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic Athlete's foot.
Symptoms of athlete's feet include drying skin, itching scaling, inflammation, and blisters. Athlete's foot may spread to the soles of the feet and to the toenails, and can spread to other parts of the body, including the groin and underarms.
You can prevent Athlete's foot by:
- Avoiding walking barefoot. Use shower shoes.
- Reducing perspiration by using talcum powder.
- Wearing light and airy shoes.
- Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.
While fungicidal and fungistatic chemicals are usually used to treat Athlete's foot problems, they often fail to contact the fungi in the lower layers of the skin. Instead, our practice may prescribe topical or oral antifungal drugs.
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Callous
A callus is an area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe. While many consider them a skin problem, they actually are systemic of a problem with the bone.
Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness.
They form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus.
If you need assistance relieving calluses, contact our office. Calluses can be trimmed and comfortable padding applied to these painful areas. In addition to medication to relieve inflammation, cortisone may be injected into the underlying bursal sac to rapidly reduce pain and swelling.
A plantar callus forms when one metatarsal bone is longer or lower than the others, and it hits the ground first-and with more force than it is equipped to handle-at every step. As a result, the skin under this bone thickens like a rock in your shoe. Plantar calluses that are recurring are sometimes removed surgically in a procedure called an osteotomy, which relieves pressure on the bone.
A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a "dropped metatarsal," which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form.
How to prevent calluses:
- Switch to better shoes, or even an orthotic device.
- Buy socks with double-thick toes and heels and nylon hose with a woven cotton sole on the bottom of the foot.
Corn
Corns are calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other.
Improperly fitting shoes are a leading cause of corns. Toe deformities, such as hammertoe or claw toe, also can lead to corns. In a visit to our office, your corns can be shaved with a scalpel. Self care includes soaking your feet regularly and using a pumice stone or callus file to soften and reduce the size of the corn. Special over-the-counter non-medicated donut-shaped foam pads also can help relieve the pressure.
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Flat Feet (Over Pronation)
Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when the person stands on his or her toes. The arch develops in childhood, and by adulthood most people have developed normal arches.
Most flat feet usually do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).
Foot pain, ankle pain or lower leg pain, especially in children, may be a result of flat feet and should be evaluated.
Painful progressive flatfoot, otherwise known as Tibialis Posterior Tendonitis, is caused by inflammation of the tendon of the tibialis posterior. The tendon then becomes inflamed, stretched or suffers a partial or total tear. If left untreated, this condition may lead to severe disability and chronic pain. Some people are predisposed to this condition if they have flatfeet or an abnormal attachment of the tendon to the bones in the midfoot.
Nonsteroidal anti-inflammatory medications, ice, physical therapy, supportive taping and bracing, or orthotic devices are the common ways of treating painful progressive flatfoot. Contact your physician before taking any medication. In some cases, a surgical operation may need to be performed to repair the torn or damaged tendon and restore normal function. To prevent reinjury, orthotic devices may be recommended. In severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.
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Footwear
Some serious foot disorders, and even more common conditions, can be linked to one avoidable thing: inappropriate, poor quality or ill-fitting shoes. Any podiatrist will tell you that a good quality, properly fitting shoe pays big dividends for your feet down the road. Shoes that do not fit properly can cause bunions, corns, calluses, hammertoes and other disabling foot disorders.
The most important quality to look for in shoes is durable construction that will protect your feet and keep them comfortable. Here are some tips to help reduce the risk of foot problems. Use this guide when you shop for shoes:
- Fit new shoes to your largest foot. Most people have one foot larger than the other.
- Have both feet measured every time you purchase shoes. Your foot size increases as you get older.
- If the shoes feel too tight, don't buy them. There is no such thing as a "break-in period."
- Most high heeled-shoes have a pointed or narrow toe box that crowds the toes and forces them into an unnatural triangular shape. As heel height increases, the pressure under the ball of the foot may double, placing greater pressure on the forefoot as it is forced into the pointed toe box.
- Shoes should be fitted carefully to your heel as well as your toes.
- Sizes vary among shoe brands and styles. Judge a shoe by how it fits on your foot - not by the marked size.
- There should be a half-inch of space from the end of your longest toe to the end of the shoe.
- Try on both shoes.
- Try on new shoes at the end of the day. Your feet normally swell and become larger after standing or sitting during the day.
- Walk around in the shoes to make sure they fit well and feel comfortable.
- When the shoe is on your foot, you should be able to freely wiggle all of your toes
- Women should not wear a shoe with a heel higher than 2 1/4 inches.
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Gout
Gout (gouty arthritis) is a condition caused by a buildup of the salts of uric acid - a normal byproduct of the diet-in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women. Some research suggests that diet heavy in red meat, rich sauces, shellfish, and brandy is popularly associated with gout. However, other protein compounds in foods such as lentils and beans may play a role.
The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. Usually only one of the big toes is affected. The pain lasts for around three or four hours and will then subside and usually not return for a few months. It can be controlled by prescribed medications. The application of ice or cooling lotions will help during an acute phase.
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Haglund's Deformity (Retrocalcaneal Exostosis)
Haglund Deformity (also known as "pump bump" or "retrocalcaneal bursitis") is a painful enlargement of the back of the heel bone that becomes irritated by shoes. It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of the irritation from rigid heel counters of shoes rubbing up and down on the back of the heel bone.
Changing shoes, soaking feet, and anti-inflammatory medications often mitigate the symptoms of this problem. Consult your physician before taking any medication.
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Heel Cracks
Heel fissures, or cracking of the skin of the heels, are an often painful condition that can cause bleeding. Open-backed sandals or shoes, which allow more slippage around the heel while walking, are often the culprits. The skin thickens as a result of the friction. Skin lotions can help with reducing the dryness associated with the condition.
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Sweaty Feet (Hyperhidrosis)
The feet and hands contain more sweat glands than any other part of the body (about 3,000 glands per square inch). Feet smell for two reasons: you wear shoes and your feet sweat. The interaction between your perspiration and the bacteria that thrive in your shoes and socks generates the odor. Any attempt to reduce foot odor has to address both your sweating and your footwear.
Smelly feet can also be caused by an inherited condition called hyperhidrosis, or excessive sweating, which primarily affects males. Stress, some medications, fluid intake and hormonal changes also can increase the amount of perspiration your body produces.
Nail Problems
Black Toenails
Black toenails can result from a variety of things. Athletes will often encounter a problem with their toenails turning dark. Darkened nails often occur from the toe hitting the end or the top of the shoe toe area. The darkened nail is essentially a bruised nail. Sometimes, the bruise can lead to a fungal nail infection. If you are a diabetic, any change in the color of your toenail should be evaluated. Contact our office to set up an appointment. The pressure, which caused the bruising of the nail, can cause a small sore under the toenail, and the sore can become infected.
Treatment may include trimming the loose nail back and applying a topical anti-fungal medication. If the skin under the nail is ulcerated, a topical antibiotic ointment should be applied. Patients with diabetes should not treat this condition themselves and should contact our office.
Ingrown Toenails
Ingrown toenails often are the result of trimming your toenails too short, particularly on the sides of your big toes. While they are common, ingrown toenails can be painful. When trimming your nails, avoid tapering the corners so that the nail curves with the shape of your toe. The sides of the nail will curl down and dig into your skin. Shoes that are too tight or short also may cause ingrown toenails.
Ingrown toenail start out hard, swollen and tender, and later, may become sore, red and infected. Your skin may start to grow over the ingrown toenail. Soaking your foot in warm, soapy water several times each day is usually a good way to treat an ingrown nail. Please contact our office to determine the best course of treatment for your condition.
You can prevent ingrown toenails by:
- Trimming your toenails straight across with no rounded corners.
- Ensuring that your shoes and socks are not too tight.
- Keeping your feet clean at all times.
Fungal Nails
Many people don't realize they have a fungal nail problem. as infections can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish, but it can present serious problems if left untreated.
Also referred to as Onychomycosis, fungal nail infections are an infection underneath the surface of the nail, which can also penetrate the nail. In addition to causing difficulty and pain when walking or running, fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.
A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail's protein substance. When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. 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.
Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete's foot and excessive perspiration.
You can prevent fungal nail infections by taking these simple precautions:
- Exercise proper hygiene and regularly inspect your feet and toes.
- Keep your feet clean and dry.
- Wear shower shoes in public facilities whenever possible.
- Clip your nails straight across so that the nail does not extend beyond the tip of the toe.
- Use a quality foot powder - talcum, not cornstarch - in conjunction with shoes that fit well and are made of materials that breathe.
- Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles.
- Disinfect home pedicure tools and don't apply polish to nails suspected of infection.
Orthotics
Orthotics are custom made devices manufactured from a variety of different materials. They fit inside your own shoes, and are worn on a full time basis to help control the way your foot functions. Advances in technology enable your Step Lively podiatrist to prescribe a device specific to the activities that you participate in the most. From walking, running and soccer, to aerobics, skiing and basketball, orthotics can help you perform at peak efficiency. Professional orthotics are custom made from impressions of your feet. Just as contact lenses and glasses improve vision, orthotics will help improve your foot function.
Is there more than One Type of Orthotic?
There are three types of orthotics: rigid, semi-rigid or soft and flexible. Different occupations, activities and foot shapes require their own specific types of orthotics in order to provide the proper support necessary to improve foot function. Orthotics are used with children, adults, athletes, elderly patients and, very often, with patients following surgery or injury.
How Long will I need to Wear Orthotics and How Long do they Last?
Orthotics are worn in 95% of all walking or standing activities. Most people wear orthotics indefinitely, depending upon activities. Periodic changes in your prescription are required as your foot function changes.
Will I Need More Than One Pair of Orthotics?
There are patients who may need more than one pair of orthotics depending on shoe type. Often a different pair is needed for recreation and for work. Women who wear different heel heights may require an additional pair. Your Step Lively podiatrist may recommend more than one pair, depending on your individual needs.
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Wear Patterns
What are your shoes trying to tell you? Here are the basic wear patterns:
- A bulge and wear to the side of the big toe: A too-narrow fit or you have a bunion.
- Outer sole wear: You turn out. Orthotics may help.
- Toe shaped ridges on the upper: Shoes are too small or you have hammertoes.
- Wear on the ball of the foot: Your heel tendons may be too tight. Stretch with heel raises.
- Wear on the inner sole: You pronate or turn in. Inner liners or orthotic supports may help.
- Wear on the upper, above the toes: The front of your shoe is too low.
Children's Shoes
Choosing shoes for your children can play a critical role in their musculoskeletal development, including their posture in later years. In general, infants just learning to walk do not need shoes; the child may go barefooted indoors, or wear only a pair of socks. This helps the foot grow normally and develop its muscles and strength, as well as the grasping ability of toes.
Here are some tips when purchasing shoes for children:
- Both feet should be measured, and if two different sizes, shoes should be chosen that fit the larger foot best.
- Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends at the ball of the foot, not in the middle of the shoe.
- Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Feel the inside of the shoe for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot. Look for signs of irritation on the foot after the shoe is worn.
- Never try to force your child's feet to fit a pair of shoes.
- Shoes should not slip off at the heels. Children who tend to sprain their ankles will do better with high-top shoes or boots.
- The child's foot should be sized while he or she is standing up with full weight-bearing.
- There should be about one-half inch of space (or a thumb's width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.
A soft, pliable, roomy shoe such as a sneaker is ideal for all children. The toe box should provide enough space for growth, and should be wide enough to allow the toes to wiggle. (A finger's breadth of extra length will usually allow for about three to six months' worth of growth, though this can vary depending on your child's age and rate of growth.) Contrary to common belief, high-top shoes offer no advantages in terms of foot or ankle support over their low-cut counterparts
If your child frequently removes his or her shoes, those shoes may be uncomfortable. Check your child's feet periodically for signs of too-tight shoes, such as redness, calluses or blisters. And have your child's feet measured periodically at the shoe store to determine whether his or her feet have grown enough to warrant a larger pair of shoes.
Remember that the primary purpose of shoes is to prevent injury. Shoes seldom correct children's foot deformities or change a foot's growth pattern.. Casting, bracing or surgery are often needed if a serious deformity is present. If you notice a problem, have your child examined.
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Warts
Most foot warts are harmless, even though they may be painful. They are often mistaken for other conditions such as corns or calluses –however,a wart is a viral infection. Over 42 types of viruses are known to cause a wart.
Children, especially teenagers, tend to be more susceptible to warts than adults as the most common times for warts to occur are, puberty, emotional & physical stress, pregnancy and menopause.
Warts can appear anywhere on the skin and those which are located on the sole of the foot are called plantar warts. The virus generally invades the skin through small or invisible cuts and abrasions. When they get large enough they can be quite painful. More serious foot lesions such as malignant (cancer) lesions can sometimes be mistaken as a wart.
If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of 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, another route for spreading. Plantar warts that develop on the weight-bearing areas of the foot - the ball of the foot, or the heel, can cause 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.
Occasionally warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
Prevention:
- Avoid direct contact with warts - from other persons or from other parts of the body. Avoid walking barefoot, except on sandy beaches.
- Change your shoes and socks daily.
- Check yours & your children's feet periodically.
- Keep your feet clean and dry.
- When trying on new shoes always wear socks.
Treatment
Over-the-counter foot wart treatments are usually the first course of treatment that a person will try. The acid used can kill some warts but usually by the time the wart is discovered it is larger and the Over-the-counter medication will be ineffective. Step Lively Foot & Ankle centers can treat warts in a variety of ways, including medication and surgical removal.
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Venous Stasis
Venous stasis is a loss of proper vein function of the legs that would normally carry blood back toward the heart. This may occur following injury to the veins, which can result in blood clots in the superficial veins known as superficial phlebitis, or following blood clots in the deep veins known as deep venous thrombosis. Individuals with this condition usually exhibit swelling of the legs and ankles. The superficial veins in the legs may be varicose, causing the veins to be enlarged and appear as a cord or a bunch of grapes. Patients often complain of a feeling of fullness, aching, or tiredness in their legs. These symptoms are worse with standing, and are relieved when the legs are elevated. As the condition progresses the blood continues to collect in the feet, ankles, and legs.
Swelling in the lower legs and ankle can also occur as a result of chronic congestive heart failure and kidney disease. In some instances the cause of the swelling may not be easily identified.
Treatment includes rest, elevation, and compression stockings.
Walking
About 67 million men and women in this country have discovered how walking is one of the most fun, natural, and inexpensive ways of keeping your feet in top shape.
For those with a long history of inactivity, problems with obesity, or who just don't like strenuous activity, walking is an excellent way to begin an exercise program. Walking helps control weight, blood sugar, and cholesterol levels. A brisk walk can burn up to 100 calories per mile or 300 calories per hour.
Walking also improves cardiovascular fitness. As an aerobic exercise, walking gets the heart beating faster to transport oxygen-rich blood from the lungs to the muscles. The heart and lungs grow more efficient with a regular walking regimen, reducing blood pressure and the resting heart rate. Walking is even a central element of medical rehabilitation. Recovery from many ailments, including heart attack, is facilitated by a regular walking regimen.
In addition, walking creates an overall feeling of well-being, and can relieve depression, anxiety, and stress by producing endorphins, the body's natural tranquilizer. A brisk walk will relax you and also stimulate your thinking.
If you are more than 40 years old and have any problems with weight, respiration, blood pressure, pulse rate, or cholesterol, check with your doctor before beginning a walking regimen. The same goes for diabetics, smokers, or people with preexisting injuries or a family history of heart problems.
Walking can help you:
- Strengthen your heart and lungs, and improve circulation
- Prevent heart attacks and strokes
- Reduce obesity and high blood pressure
- Boost your metabolic rate
- Favorably alter your cholesterol
- Improve muscle tone in your legs and abdomen
- Reduce stress and tension
- Reduce arthritis pain; stop bone tissue decay
Foot care and walking
Don't neglect your feet when embarking on a walking regimen. Wear thick, absorbent socks (acrylic is preferable to cotton); dry feet well after bathing, paying special attention to the toes, and use powder before putting on shoes. Nails should be cut regularly, straight across the toe.
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Women’s Feet
Because they have traditionally played the role of homemaker, women have been on their feet a lot more than men. And today, with more women entering the workforce and wearing shoes like high heels, their foot problems are only aggravated.
High Heels
Women invite foot problems with high heels. High heels may contribute to knee and back problems, disabling injuries in falls, shortened calf muscles, and an awkward, unnatural gait. In time, high heels may cause enough changes in the feet to impair their proper function. Most women admit high heels make their feet hurt, but they tolerate the discomfort in order to look taller, stylish, and more professional.
There are ways to relieve some of the abusive effects of high heels, however. Women can limit the time they wear them by alternating with good-quality oxford-type shoes or flats for part of the day. Tight-fitting high heels only compound the abuse.
Fortunately, women have other heel-size choices. Key is wearing the right shoe for the right activity - and that means varying heel height, and determining what heel is most suitable.
For example, there are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for women for work and social activities. Several companies have also designed footwear for certain athletic activities, including aerobics, specifically for women.
Experts say the best shoes for women may be:
- A walking shoe with ties (not a slip-on).
- A Vibram type composition sole.
- A relatively wider heel, no more than a half or three-quarters of an inch in height.
Stockings
Women who always wear nylon pantyhose expose themselves to a host of foot problems. Nylon doesn't breathe and the heat that it generates and traps causes excessive perspiration. A warm, damp area is an ideal place for fungal infections such as Athlete's foot.
Inexpensive nylon pantyhose can also cause forefoot problems, because they don't allow the normal expansion of the foot when walking, and may pull the toes backward when the pantyhose ride up. The cramping and pressure of the hose can contribute to ingrown toenails and hammertoes.
Pregnancy
Pregnant women need to observe good foot health to prevent pain and discomfort. Since the body undergoes changes and acquires a new weight-bearing stance, women should wear shoes with broad-based heels that provide support and absorb shock. Additional body weight also calls for more support, to prevent foot "breakdown."
The expectant mother often experiences more than ordinary swelling of her feet and ankles, which can aggravate existing foot conditions and promote inflammation or irritation. Pregnancy also triggers the release of hormones that enhance loose ligaments, which can contribute to foot strain. If problems develop, contact our office.
Women Over 65
Older women have more trouble with their feet than younger ones; fat pads on the bottom of the feet tend to deteriorate in the aging process. They can alleviate some foot problems by wearing properly fitted, well-constructed shoes that provide cushioning and have a soft, flexible upper that will conform to the shape of their feet. They also need leather shoes that "breathe" and can reduce the possibility of skin irritation.
Soles should be lightweight, with enough flexibility and shock-absorbing quality to provide solid footing and not be slippery. Low-heeled shoes provide greater stability, more protection for the feet, and greater comfort. Because older women often have circulatory problems, they have a special need to keep their feet warm in cold weather, to prevent frostbite or chilblains.