Podiatry

A bunion forms when your big toe points toward the second toe. This causes a bump to appear on the inside edge of your toe.

Bunions are more common in women than men. The problem can run in families. People born with abnormal bones in their feet are more likely to form a bunion.

Wearing narrow-toed, high-heeled shoes may lead to the development of a bunion.

The condition may become painful as the bump gets worse. Extra bone and a fluid-filled sac grow at the base of the big toe.

Symptoms include:

• Red, thickened skin along the inside edge of the big toe
• A bony bump at this site
• Pain over the joint, which pressure from shoes makes worse
• Big toe turned toward the other toes and may cross over the second toe

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients with diabetes—a disease often associated with neuropathy—take preventive measures and seek immediate care if signs or symptoms appear.

People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.

Symptoms of Charcot foot may include:

• Warmth to the touch (the affected foot feels warmer than the other)
• Redness in the foot
• Swelling in the area
• Pain or soreness

Flat feet (pes planus) refers to a change in foot shape in which the foot does not have a normal arch when standing.

Flat feet are a common condition. The condition is normal in infants and toddlers. Flat feet occur because the tissues holding the joints in the foot together (called tendons) are loose. The tissues tighten and form an arch as children grow older. This will take place by the time the child is two or three years old. Most people have normal arches by the time they are adults. However, the arch may never form in some people.

Aging, injuries or illness may harm the tendons and cause flat feet to develop in a person who has already formed arches. This type of flat foot may occur only on one side. Rarely, painful flat feet in children may be caused by a condition in which two or more of the bones in the foot grow or fuse together. This condition is called tarsal coalition.

Most flat feet do not cause pain or other problems. Symptoms in adults may include tired or achy feet after long periods of standing or playing sports.

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Symptoms of a fracture are:

• Out-of-place or misshapen limb or joint
• Swelling, bruising or bleeding
• Intense pain
• Numbness and tingling
• Limited mobility or inability to move a limb

You need to get medical care right away for any fracture. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.

Hammertoe is a bending of one or both joints of the second, third, fourth or fifth toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment. Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from structural changes in the foot that occur over time in some people.

Hammertoes may be aggravated by shoes that don’t fit properly. A hammertoe may result if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

Common symptoms of hammertoes include:

• Pain or irritation of the affected toe when wearing shoes
• Corns and calluses on the toe, between two toes or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
• Inflammation, redness or a burning sensation
• In more severe cases of hammertoe, open sores may form 

Morton’s neuroma is an injury to the nerve between the toes, which causes thickening and pain. It commonly affects the nerve that travels between the third and fourth toes.

Morton’s neuroma is more common in women than in men.

The exact cause is unknown. However, some experts believe the following may play a role in the development of this condition:

• Abnormal positioning of toes
• Flat feet
• Forefoot problems, including bunions and hammertoes
• High foot arches
• Tight shoes and high heels

Symptoms of Morton's neuroma include:

• Tingling in the space between the third and fourth toes
• Toe cramping
• Sharp, shooting, or burning pains in the ball of your foot (and sometimes toes)
• Pain that increases when wearing shoes or pressing on the area
• Pain that gets worse over time

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

Nail abnormalities are problems with the color, shape, texture or thickness of the fingernails or toenails.

Causes of nail deformities include:

• Disease
• Infection
• Injury
• Medication
• Poison

The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis.

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.

You are more likely to get plantar fasciitis if you:

• Have foot arch problems (both flat feet and high arches)
• Run long distances, downhill or on uneven surfaces
• Are obese or gain weight suddenly
• Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel)
• Wear shoes with poor arch support or soft soles
• Change your activities

Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 - 70. It is one of the most common orthopedic foot complaints.

The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

The pain is often worse:

• In the morning when you take your first steps
• After standing or sitting for awhile
• When climbing stairs
• After intense activity

The pain may develop slowly over time, or come on suddenly after intense activity.

Warts are growths on your skin caused by an infection with humanpapilloma virus, or HPV. Plantar warts show up on the soles of your feet. If they hurt or bother you, or if they multiply, you can remove them. Chemical skin treatments usually work. If not, various freezing, surgical and laser treatments can remove warts.

Feet and ankles are especially vulnerable to everyday injuries that can cause damage to tendons and ligaments.

Tendons and ligaments are the soft tissues that support the joints and connect one bone to another.

Soft-tissue injuries include:

• Bursitis
• Contusions
• Sprains
• Strains
• Stress injuries
• Tendonitis

Any of these can happen as a result of an acute event, such as a fall, a sudden twist, direct blow or repetitive use.

While it may be tempting to self-treat this type of pain, injuries to the ligaments and tendons require proper diagnosis, treatment and sometimes prolonged healing.