Overview of Foot and Ankle Problems
Foot and ankle problems usually fall into the following categories:
- Acquired from improper footwear, physical stress, or small mechanical changes within the foot.
- Arthritic foot problems, which typically involve one or more joints.
- Congenital foot problems, which occur at birth and are generally inherited.
- Infectious foot problems, which are caused by bacterial, viral, or fungal problems.
- Neoplastic disorders, also known as tumors, which are the result of abnormal growth of tissue anywhere on the foot and may be benign or malignant.
- Traumatic foot problems, which are associated with foot and ankle injuries, such as fractures.
Leading foot problems are:
- Bunions — A bunion is a bony bump that forms on the joint at the base of the big toe. It forms when the big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore. A bunion is a deformity that forms gradually, and once it starts it will continue to progress slowly. A shoe size that was previously always comfortable may begin to feel narrow. The tendency for bunions is inherited, but stress on the foot can accelerate the formation. Other medical conditions such as certain types of arthritis can also lead to bunions. Smaller bunions (bunionettes) can develop on the joint of the little toe. Initially, a change in shoes will reduce irritation, but frequently surgery is required to correct the problem.
- Hammertoes—usually stemming from a muscle imbalance, this condition occurs when the toe is bent into a claw-like position. Hammertoe can affect any toe, but most frequently occurs to the second toe first. Initially, selecting shoes which are deeper or roomier in the front may help alleviate discomfort. If shoe changes are not feasible, or no longer effective, the toes can be surgically straightened.
- Heel spurs, and plantar fasciitis -- are two conditions that have to be discussed together. Typically, the problem begins with inflammation where the arch ligament (plantar fascia) connects to the underside of the heel bone. This can be precipitated by a variety of foot injuries or improper foot mechanics. The painful inflammation in the ligament is referred to as plantar fasciitis, and is one of the most common problems seen by the podiatrist. Sometimes, a patient will have episodes of low grade inflammation at this attachment point, prior to the onset of an acute episode. Over time, this will result in a spur-like calcification (heel spur) that will grow from the heel bone and into the ligament. Many people are susceptible to this condition, but not everyone. For those that are susceptible, prevention entails proper stretching of the foot and ankle prior to exercise, use of arch supports, and avoidance of going barefoot on hard surfaces. Treatments range from icing and foot exercises to use of arch supports or prescription of custom orthotics. Sometimes oral, or injectable anti-inflammatory medications are necessary. On rare occasions, surgery is required.
- Ingrown Toenails—toenails with corners or sides that dig painfully into the skin. If not addressed promptly, ingrown toenails frequently become infected. This is a very very common condition that podiatrists treat every day. Ingrown toenails can result from various issues including improper clipping of the toenails, injuries, fungus infections, hereditary tendency, and improperly fitting shoes. Most of the time, ingrown toenails are preventable, but not always, especially if there is a hereditary tendency. If the condition is persistent, or recurs frequently, there are simple and reliable in-office procedures, that can resolve the problem permanently.
- Neuroma—Is an enlarged benign growth of nerve, most commonly between the third and fourth toes. A neuroma is caused by pinching or rubbing of a nerve between the surrounding bones or ligaments. Pressure from ill-fitting shoes or abnormal bone structure can lead to this condition. Depending on the severity, treatments may include wider shoes, orthotics(custom shoe inserts), cortisone injections, and, inpersistent cases, surgical removal of the growth.
- Flatfeet - is a common condition, it is estimated that approximately one quarter of the population has flatfeet. Flatfeet are normal in infants, but after approximately age 3 a normal arch should be visible. Not all flatfeet are painful. But, if there is no pain, it doesn't mean that this will remain so. Over time, and during periods of heavy use, a flatfoot over stretches, and overuses its own ligaments and tendons, resulting in pain and fatigue, and sometimes leading to accumulated permanent damage. A child with flatfeet may not initially have pain, but may complain of fatigue in the feet, and sometimes display reluctance to participate in athletic activities. In such a case, the condition will become more symptomatic as an adult, and may lead to foot deformities, and sometimes knee and low back pain. Once identified as the problem, initial treatment consists of arch supports, or custom-made orthotics. More severe cases, may require surgery. A discussion in greater detail, can be found under the separate topic: flatfeet (over pronation).
- Sesamoiditis—an inflammation or fracture of the two small bones (known as sesamoids) under the big toe joint. Proper shoe selection, avoidance of certain aggravating activities, and especially modified insoles can help.
- Stress Fractures—incomplete cracks in bone caused by overuse. With rest and reduction of weight on the affected foot, stress fractures can heal quickly. Extra padding in shoes, or special insoles, can prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and complete immobilization.