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COMMON FOOT AILMENTS Heel Pain Sharp pain, aching, or stiffness on the bottom of one or both heels is very common. The pain is often worse with the first step out of bed or after prolonged periods of rest. It may take a few minutes of limping before normal walking resumes. These symptoms are typically associated with the condition known as plantar fasciitis heel spur syndrome. Treatment options include: stretching exercises, medications, night splints, cortisone injections, physical therapy, foot strapping, ice water soaks, and custom orthotics. Most cases can be resolved with conservative treatment; however, sometimes surgical intervention is needed. Bunions A bunion is a prominence of bone or tissue around the joint. The enlargement occurs either at the base of the great toe or on the outside of the foot, at the base of the little toe. This is called a "bunionette" or "tailor's bunion." Bunions are usually inherited. Individuals with flat feet or low arches are more prone to develop problems. A common misperception is that pointy shoes cause bunions. Although it is not the shoes that cause the problems, tight, pointed, confining shoes are especially stressful on the joints of the foot because all of the body's weight rests there. Treatments for bunions vary depending on the severity of pain and deformity. Early treatments may include padding, medications, physical therapy, and/or custom made orthotics. When conservative treatments do not provide satisfactory relief from symptoms, or when the condition is significant, surgery may be necessary. Ingrown Nails Painful ingrown nails may be inherited, caused by an overcurvature of the nail, or an imbalance between the width of the nail plate and the nail bed. Toe injuries that cause the nail's contour to change can also lead to an ingrown nail. Ingrown toenails can be extremely painful if left untreated. Symptoms include redness, swelling, and infection. If the problem is severe or ongoing, minor surgery to remove all or a portion of the nail may be recommended. These in-office procedures are performed very comfortably under local anesthesia, and usually are performed in less than an hour. Hammertoes A hammertoe deformity is a contracture of the toe, frequently caused by an imbalance in the tendon or joints of the toes. Due to the "buckling" effect of the toe, hammertoes may become painful secondary to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making it difficult to wear shoes. Conservative treatment includes: padding and alteration of shoe gear. If conservative treatment is not effective, surgical intervention to realign the toe may be suggested. Neuroma An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes. Several factors may contribute to the formation of a neuroma. Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just some of the conditions that may cause a neuroma. Symptoms such as burning or tingling to adjacent toes and even numbness are commonly seen with this condition. If conservative treatment does not relieve the symptoms, then based upon your symptoms, surgical treatment may be appropriate. Plantar Warts Warts are caused by a virus, which typically invades the skin through small cuts and abrasions. They are frequently called plantar warts, because they appear most often on the plantar surface, or the sole of the foot. They can appear anywhere on the skin, however, and technically, only those on the sole are properly called plantar warts. Children, especially teenagers, tend to be more susceptible to warts than adults. Warts are often mistaken for corns. Plantar warts tend to be hard and flat, rough-surfaced, with well-defined boundaries. They are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. Self treatment is generally not advisable because the chemicals destroy skin cells (warts) and it is difficult to destroy abnormal skin cells without destroying healthy tissue as well. Common treatments include: cryocautery, electrocautery, surgical excision, and topical acid treatments.
William A. Cohen, DPM
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