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PODIATRY The medical care and treatment of the human foot. For an appointment with Dr. Ellis or another specialist, ask your doctor or call 320-243-7712. Information on common foot problems Bunions | Corns | Blisters | Neuroma | Diabetes | Heel Spurs What is a podiatrist? A podiatrist is a doctor of podiatric medicine (D.P.M.) or a "foot and ankle specialist." A podiatrist is a medical specialist who has received extensive training in the diagnosis, prevention, and treatment of human foot and ankle disorders. Podiatrists complete four years of undergraduate college followed by four years of extensive training in an accredidted podiatric medical school. Podiatrists are further required to complete one to three years of post-graduate education in an accredited hospital residency or surgical preceptorship program. Podiatrists are licensed to provide specialized care of the lower leg and goot through both medical an dsurfical methods. These services are provided in private offices, hospitals, surgical centers, and nursing facilities. Although the podisatrist is primarily concerned with responsibilities of foot and ankle care, he is also mindful of patients total health needs. in diagnosing, he is constantly alert to symptoms of systemic disease which manifest themselves in the foot or lower leg. Among these are: diabetes, arthritis or circulation conditions When detected, these conditions are closely managed in conjunction with the patient's established medical doctor. Together both doctors provide for total and comprehensive are of the patient. Conditions, podiatrist commonly treat: Thick, painful nails Corns and callouses Bunions Hammer toes Entrapped nerves Heel spurs Sprained ankles Sore arches Arthritic and diabetic foot care. What are bunions? Definition: A bunion is a lay term which describes and often painful swelling of the big toe joint. This condition in medical terms is called "Hallux Abducto Valgus." Bunions result through a progressive dislocation of the joint, causing the big tow to drift toward the second toe. As bunions progress, arthritis develops when the drifting big toe no longer moves freely upon the bone which supports it. This arthritis usually produces the classic "bump" seen on the inside of this joint. This region often becomes irritated with shoe pressure and excessive movement of the misaligned joint. Swelling, redness and painful movement are not uncommon with this condition. Treatment: People who suffer from bunions can sometimes reduce symptoms by wearing shoes constructed of soft, pliable materials that stretch to reduce pressure on the bump. Your local shoe shop may be able to stretch this region to give added comfort. Your doctor may suggest an anti-inflammatory medication, the application of ice or local cortisone injection for temporary relief. It is not advisable to utilize over the counter pads or bunion splints as these devices are poorly regulated and may actually worsen symptoms. If these remedies fail, as is often the case, surgical correction of bunions is possible, providing the patients general health is compromised. Bunion surgery is performed on an "outpatient" basis and patients are often able to walk comfortably immediately following the procedure. It is advisable to consult your family physician and your foot specialist to discuss all aspects of treatment for bunion problems. Care should be taken to select a doctor who specialized in foot surgery as these techniques are technically demanding. What are corns and calluses? Definition: Corns and calluses are lay terms which describe "hyper keratotic tissue," a build-up of highly compacted dead skin cells of the outer layer of skin. This form of tissue develops in response to repeated friction and pressure from rubbing against bony areas or from areas of irregularity in the shoe. Often, this condition is a direct result of poorly aligned bones in the foot or of poorly chosen shoes. Despite different names, corns and calluses are composed of exactly the same tissue. Corns usually refer to callus tissue on or between the toes, whereas calluses are on the bottom or sides of the foot. Bunions, hammer toes, and low and high-arched feet commonly lead to corns and calluses. In many instances, callus formation serves the very useful function of protecting the region of friction or pressure. Unfortunately, callus tissue can become too thick and can lose its protective qualities. It may actually create additional pressure and/or ulceration. Callus tissue can also develop a "nucleus" which causes pain upon direction pressure, almost as if there were a pebble or seed imbedded within the callus tissue. Treatment: Corns and calluses may require improved stockings, wider, softer-soled shoes, or over-the-counter sole cushions. Often times, treatment requires trimming. It is not advisable to perform this yourself as this can cause cuts and infections. This also holds true for the use of medicated corn pads, or "disks." Acid solutions in these products often produce small ulcerations which can become infected. Your podiatrist can offer many alternative forms of treatment for callus tissue. These may include trimming, mod skin padding, custom arch supports, and in extremely difficult situation, minor surgery can be performed. How do blisters form? Definition: Blisters form due to excessive sheeting forces and pressure. They usually occur in response to an increase in activity or ill-fitting shoe gear. Blisters are a common occurrence and can be prevented provided a few precautionary measures are taken: 1) Shoes should fit snugly (not tightly). Insure that shoes are comfortable and fit especially well in the heel. 2) The front part (toe box) of the shoe should be deep enough to allow freedom for the toes. 3) Use cotton, wool, or blend socks. If socks are thinning with use, try wearing 2 pairs. Wearing shoes without socks is a primary cause of blister formation. 4) Ordinary foot powder can be applied to feet and toes to reduce irritation and potential for lister formation. 5) Vaseline may help to reduce blister formation between the toes. 6) Tincture of Benzoin (available at your drug store) may be applied to recurrent blister sights to "toughen" skin. 7) Soft insoles (I recommend Spenco products) may help to reduce plantar foot pressure. Treatment: When blisters do occur they are best left untreated if not painful. Treatment of symptomatic blisters occurs as follows: 1) Immediately remove the cause of excessive pressure. (i.e. ill-fitting shoes, shoe inserts, a seam or defect in the shoe's construction) 2) Wipe blister with a sterilized needle, etc. A window can be created in the blister to allow drainage. Apply Betadine or Methiolate with a light dressing. Telfa is useful at helping to reduce excessive pressure and may be incorporated int the dressing. 3) Should you feel uncomfortable draining region, consult a podiatrist for treatment. Should red streaks or excessive pain in this region develop seek medical advice immediately. 4) In the most severe of cases a custom pad or orthotic can be developed to address excessive pressure. What is a neuroma? Definition: A neuroma (Mortons Neuroma) is a benign (non-life threatening) growth surrounding normal nerve tissue. This mass is usually a result of chronic irritation of the involved nerve. The feet are most commonly affected by this condition and symptoms produced include: shooting pain, numbness, tingling and burning sensations. Neuromas most commonly affect a region between the third and fourth toes, though all toes can be affected. Neuoma pain usually occurs gradually and often give the sensation of a stocking being "balled up" under the affected toes. Patients may also experience a shocking sensation between adjacent toes. Treatment:Symptoms of this condition may be relieved through wider shoes, supportive arch devices, or local cortisone injections. If these forms of treatment fail the neuroma can easily be removed surgically. How does diabetes affect feet? Statistics show that in the United States, over 12 million individuals suffer from some form of diabetes. It is well known that patients with diabetes are subject to a greater incidence of infection, circulatory, and nerve impairment. These complications result in a mutltiude of diabetic foot problems - many of which can be recognized and treated if patients are properly educated in diabetic foot care. Despite rapidly advancing research, prevention of diabetic peripheral neuopathy (nerve disorders) and diabetic peripheral vascular disease (circulation disorders) have not been accomplished. Though these conditions cannot yet be avoided, a tremendous amount of research has been developed to assist the foot specialist and primary care physician in preventing many of the complications associated with this disorder. It is imperative for those with diabetes to educate themselves on foot care through the numerous publications available through your doctors office or by attending lectures often sponsored by your local hospital or diabetic support group. Together, you and your physician can remain alert to any changes that may become potentially dangerous, and possibly prevent serious complications from occurring. What causes heel pain? Definition: Heel pain (heel spur syndrome or plantar fascitis) is a very common condition which results in a dull ache and/orsharp stiffness on the bottom of one or both heels. This pain is often initially present in the center of the heel (calcaneus) and soon increases to include the inside region of the heel. This pain, in advanced stages, may also involve both sides of the heel when "squeezed" and may cause stiffness in prolonged periods. Patientsa lso develop this condition following new job or exercise programs which place new and increased stress on the heels or arch. Development The heel bone is the largest bone in the foot. It serves as the structure which accepts extreme amounts of weight with each and every step. The heel is uniquely designed with an architecture that permits distribution of excessive am9ounts of stress, while serving as a suseful lever for the muscles of the calf. The painful heel usually occurs in those who dsiplay flat or high arched feet, a tight achilles tendon, or tight plantar fascia. These conditions do not allow the calcaneus to function properly thus not permitting this structure to adapt to the trememdous forces placed unpon it. When this occurs a microscopic fault develops in the heel bone which if not properly treated can easily develop into a "stress fracture." Bone, not unlike metal, will fail under repeateds tress if not properly supported. During episodes of repeated stress, the heel bone may develop a "spur" in response to this local trauma. This may be complicated by "plantar fascitis" - an inflammation of the tissues that help maintain our arch. Contrary to popular belief the absence, presence or size of a spur in no way correlates to the severity of your condition. Your doctors objective is to reduce the current excessive stress surrounding the heel bone, while preventing further injury and pain in this region. Many treatments exist in the management of heel pain. Your doctor will select a treatment plan that best suits your current condition. The following treatment and diagnostic descriptions will assist in the understanding of your specific treatment plan. X-rays in Heel Pain Diagnosis Your doctor will routinely order x-rays to assist in the diagnosis and treatment of plantar heel pain. Due to the complex nature of this condition, a bone scan, C.T. (Computerized Tomaography "Cat-Scan"), or M.R.I. (Magnetic Resonance Imaging) may be ordered by your doctor though your local hospital. These advanced forms of x-ray may be necessary to further evaluate your condition. These tests represent state of the art dianostic tools in stress fracture detection and heel pain management. Your doctor's office will supply you ad the hospital with necessary instructions and an appointment if these tests are required. Home Shoe Program This program strictly advises against walking (even a few steps) in bare feet, stocking feet, slippers, moccasins, dock siders, deck shoes, sandals, or thongs. This includes any type of shoe gear that has not been pre-approved by your doctor. Patients that have been dispensed shoe accommodations (heel lifts, arch pads, or arch supports) are to never walk without these devices in their shoes unless given the okay by their doctor. Activity and Exercise Your doctor advises against continuing your current walking or jogging program. This also refers to the avoidance of daily activities such as walking stairs, climbing ladders, or jumping. Your doctor realizes the need to function normally at work or home, but does ask you to avoid excessive or unnecessary activity when possible. You may want to plan your day to reduce your work or shopping duties or ask others for assistance. Such activities as shopping in large malls or supermarkets should be kept to a minimum. Patients are also asked to discontinue dancing or aerobic type exercise. This includes all exercises which could produce a large amount of pressure in the heel region (stationary bike, exercise equipment designed to strengthen the lower extremity, and the treadmill). Local Steroid Injection Local steroid injection serves as a first line tool in controlling inflammation (swelling) and associated pain in the calcaneus. This injection is deposited in the region of the painful heel to alleviate symptoms and promote healing. It is not uncommon for a steroid injection to increase symptoms temporarily a day following initial therapy, but these increased symptoms rapidly diminish in a few hours. Patients need not be concerned about the effect of the particular steroid your doctor utilizes in heel pain treatment. This variety of "steroid" should not be confused with those abused by some athletes or utilized in the treatment of serious disease. Nonsteroid Anti-Inflamatory Drugs (NSAIDS) NSAIDS serve to decrease inflammation and symptoms surrounding the calcaneus and affiliated soft tissue structures. These medications are prescribed by your doctor for management of painful heel symptoms and other conditions afflicting joints and muscles. It is advisable to take these medications as prescribed. It is not advisable to take NSAIDS on an empty stomach and your do tor asks you to contact him/her if stomach upset or nausea develops following NSAIDS therapy. Orthopedic Strapping and Padding Orthopedic strapping and padding refers to temporary appliances which your doctor applies to your foot or shoe to assist in alleviating your symptoms. These may consist of modified flexible insoles, heel lifts, or a felt arch support that is temporarily applied with tape directly to the patient's feet. These forms of treatment assist the doctor in determining whether custom molded treatment assist the doctor in determining whether custom molded arch supports (orthotics) will be necessary in long-term therapy. Custom Molded Orthoses Custom mold orthoses or "orthotics" are those devices which are inserted into yoru shoes to assist in the correction of abnormal foot structure and gait. Sometimes referred to as "arch supports," these devices are extremely efficient at reducing abnormal stress throughout the entire foot, especially in the heel. They perform functions that make standing, walking, and running more comfortable by altering slightly the angles at which the foot strikes the ground. Orthotics take various forms and are constructed from a wide range of materials. Your doctor will determine the type of material used in the fabrication or your devices following a full lower extremity exam. Your doctor will then make plaster of Paris impressions of your feet, which will be sent to an outside labe facility for arthotic fabrication. It is important to follow all instructions dispensed with your new devices to assure proper initial use. Short Leg Casting Chronic heel pain in advanced stages may require total immobilization to assist in consolidation of calcaneal micro-fracture. Plaster, fibergalss, or prefabricated removable casts may be utilized by your doctor for 4-6 weeks in an attempt to promote healing in the calcaneus. Your doctor will determine the length of time the cast should be applied and whether crutch use is required. Electronic Bone Growth Stimulation Device Your doctor may implement the use of an electronic bone stimulation device to promote healing of calcaneal micro-fractures. This device is similar in appearance to a very small transistor radio and is worn on the belt. Small removable electrode patches attach to the skin surrounding the heel and receive electronic signals which are then transmitted into the heel bone. These signals assist and accelerate bone healing when directed properly. It is important to follow all instructions dispensed with his unit to assure optimum results. Surgical Treatment Chronic heel pain, not responsive to conservative treatment may be treated via surgery. Surgery will be considered only when all conservative options are exhausted. Your doctor is trained to perform such surgery on an outpatient basis in his office, hospital, or surgery center. This procedure is performed under local anesthetic and you will usually be permitted to leave later that day following the procedure. Your doctor will determine the type of surgery necessary to treat yoru condition based on type and duration of symptoms. This may include: the utilization of a screw or pin to repair the stress facture site and/or removal of the heel spur and/or release of the soft tissue structures (plantar fascia) contributing to increased stress within the calcaneus. Following surger, your doctor may or may not require a cast and use of a bone stimulation device for a predetermined amount of time. Conclusion Heel pain represents a condition that often proves frustrating and exhausting for those affected. This frustration is also often experienced by the treating physician. It is very important to closely follow all instructions discussed by your physician. Successful management of this condition will require a great amount of patience and discipline. Please follow all written and oral instructions to assist in the rapid resolution of these symptoms. Do not hesitate to contact your doctor if questions arise. 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