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Pain in the ball of your foot could be Morton’s Neuroma

30 Jul

Does it feel like you have a pebble in your shoe between your 3rd and 4th toes?

Perhaps you have occasional shooting or burning pain in the bottom of your foot?

Do your 3rd or 4th toes occasionally sting or feel numb?

Any of these could be symptoms of Morton’s Neuroma, a painful thickening of the tissue around the nerves that lead to your toes.

mortons neuroma

Morton’s Neuroma is also known as Morton’s metatarsalgia, Morton’s neuralgia, plantar neuroma, or intermetatarsal neuroma. It typically has no outward signs, such as an obvious lump – only discomfort and pain on the bottom forefront of your foot or toes. Technically, a neuroma is a benign tumor of a nerve. Fortunately, a Morton’s neuroma isn’t a true tumor, but simply a thickening of fibrous tissue. If left untreated however, the neuroma can lead to permanent nerve damage.

How Morton’s Neuroma forms

Abnormalities in the anatomy of the foot, aggravated by injury, irritation, or wearing pointy shoes or high heels, compress and irritate the nerve that passes under the ligament connecting the toe bones in the forefoot. In response, the nerve enlarges and develops a nasty lump. It most commonly develops between the 3rd and 4th toes, and appears in women 10 times more often than in men. Those people who have bunions, flat feet, hammer toes, or unusually high arches, are prime candidates for developing Morton’s Neuroma. So are those athletes who perform on courts or hard surfaces – runners will notably feel the pain when they push off from the starting line.

Symptoms of Morton’s Neuroma

  • Feeling of having a pebble in your shoe
  • Burning or stinging pain and numbness in the area between the 3rd and 4th toes
  • Pain intensifies with activity and subsides with rest
  • Symptoms rarely appear at night

Causes of Morton’s Neuroma

Abnormality in foot biomechanics, aggravated by:

  • High heels, shoes that are too tight, or shoes that don’t fit correctly. This footwear can put pressure on the toes and ball of you foot, aggravating the nerve.
  • Sports that put unusual stress on your toes, like rock climbing, or snow skiing, or high impact aerobic sports like running or basketball.

Treatment of Morton’s Neuroma

  • Change your footwear. Swap high heels for flats, and wear shoes with a square toe box which will not constrict the movement of your toes. This lets the bones spread out, taking pressure off the nerve, and allowing it to heal.
  • Custom orthotics or pads may be worn inside your shoes. A podiatrist at PA Foot and Ankle Associates will customize an orthotic for you which will take pressure off of the sensitive area. This speeds healing by lifting and separating the toes, taking pressure off the nerve.
  • Steroidal injections can be used to reduce pain and inflammation in the affected area.
  • Over the counter anti inflammatory medicine like advil or aleve can be used to control pain, along with ice and rest.
  • If these treatments fail to relieve your symptoms, surgery may be recommended.
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Getting a Pedicure? Watch out for foot and toenail infections

24 Jul

Sure, you want your toenails to look pretty, especially during sandal season. But any podiatrist will tell you that they see patients nearly every week with foot and toenail infections acquired at a nail salon – viral infections, warts, and athlete’s foot being the main players. Before your next pedicure, you can take a few precautions which will protect you from picking up any hitchhiking bacteria, virus, or fungus that may turn into a serious foot or toenail infection.

PEDICURE HOW TO AVOID INFECTIONS

Don’t mess with the cuticles

Even the most experienced pedicurist will occasionally cut into the cuticles, and that’s a mistake. The cuticle helps anchor the nail to the skin, and should never be pushed back or cut during a pedicure, as that’s when bacteria may enter.

You want your toenails cut into what shape?

If toenails are cut a little too aggressively on the sides, it can lead to ingrown toenails, which as anyone who’s ever had one knows, are absolutely miserable and will certainly not match your other toenails. Pedicurists should cut the nails straight or at a slight curve, along the contour of the toenail, and not down into the corners.

Clean tools, clean surfaces

There’s a chance of acquiring fungus at a salon, too, if the owners aren’t fastidious about disinfecting surfaces and tools. Pumice and emery boards shouldn’t be used more than once, and tools should always be sterilized in between clients, preferably in an autoclave, which uses high pressure steam to kill bacteria and fungus. Non-metal tools cannot be sterilized, so if they aren’t thrown away after one use, every client that follows is at risk.

At the very least, make sure you can see the pedicure tools soaking in that blue liquid called Barbicide, which barbers have used since… well, since at least your grandfather’s first haircut. There’s a required minimum of at least a 10 minute soak in a bacteriacide, according to Environmental Protection Agency guidelines. And UV lights? Not to be trusted for sanitizing. Some salons allow you to bring your own pedicure tools, which is your best protection.

No bubbles, please

Glass bowls for soaking your feet are preferred over fiberglass or plastic – any porous material allows bacteria to hide out. Whirlpool foot baths should be verboten, as the piping feeding the baths can harbor all kinds of bacteria and fungus, which love the warm, but not too-warm temperatures.

Shaved legs and pedicures demand distance

Wait on getting a pedicure for 2 days after you shave your legs. A razor creates microtears in the skin, which bacteria can easily enter, directly introducing them into the legs. This can lead to an infection called cellulitis, which is very serious and may require hospitalization.

And some should never show up for a pedicure

If you’re diabetic, you should think twice about getting a pedicure. One of the unfortunate side effects of diabetes is that sores don’t heal quickly, especially in the feet. Persistently open wounds, even nicks, invite all kinds of bacteria to take up residence, which can lead to a nasty infection in a diabetic foot.

Other people at high risk include those with HIV, those going through chemotherapy, and those who have circulatory disorders or vascular disease. And if you already have an ingrown toenail, avoid pedicures entirely and see your podiatrist for treatment.

We can send toenail fungus on its way with only a few treatments.

If you had a choice, would you request an amputation? This guy did.

18 Jul

Joseph Phleban of Fredericksburg, Virginia is a guy who likes adventure. Soccer, competitive swimming, football, wakeboarding, snowboarding, rugby, he did it all in his 23 years.

ankle amputation

Joe Phleban’s “Please Cut Here” tattoo.

In 2008, the day after he graduated from college, Phleban injured his ankle for the umpteenth time while wakeboarding. He wasn’t too concerned about it, was quite used to it in fact, as he’d been plagued with painful ankle problems for 6 years –  a side effect of being a daredevil.

He expected the surgery to repair his ankle to be routine, but surgeons discovered that Phleban had developed a rare disease called Pigmented Villonodular Synovitis. PVS usually affects the knee, but in about 2 percent of cases it appears in the ankle, causing inflammation and tumors in the joint lining. Phleban’s PVS was far advanced, with tumors, dangerous inflammation, and extensive bone and tissue damage.

Pigmented Villonodular Synovitis produces malignant non-cancerous tumors which damage cartilage, causing painful, degenerative arthritis.

ankle amputation

Phleban uses mirror therapy to adjust to his amputation

Doctors performed a second operation to remove the tumors in Joe’s ankle, but they reappeared inside of six months. In 2010, Phleban underwent surgery yet again to remove more tumors, followed by radiation therapy. At that point, Joe’s doctors informed him that because his ankle had been so badly damaged, playing sports would be impossible. Phleban was crushed.

In March of this year, doctors ordered an MRI, which revealed that tumors had once again returned. His doctors recommended that they fuse the bones of the ankle, which would have meant periodic lifelong surgery and limited activity. Phleban didn’t care for that prospect, so he asked his doctors to amputate his lower leg. He figured he’d wear a prosthetic device and be able to do some sports afterward, and not be resigned to a life of surgeries, recoveries, walking boots, and canes.

ankle amputation

Phleban goes skydiving, checking one more thing off his bucket list.

In an interview with the U.K.’s Daily Mail Online, Pleban said, “Over six years I had to give up all of the sports I loved. Although taking my ankle away was a big sacrifice, the chance to regain the ability to play those sports again meant it was a no-brainer. It came down to either going through surgeries for a good portion of my life or have one surgery to end them all and be as active as I want on a prosthetic.”

And then he made a bucket list. A one-last-time run at unfulfilled adventures. All of it chronicled, from the point of view of his soon-to-not-be-there appendage, on a Facebook page called The Last Adventures of Joe’s Left Foot. Paintballing, go-karting, watersliding, a Caribbean vacation with his girlfriend, skydiving, and concerts. He even got a tattoo – a dotted line that wrapped around his intended amputation, with the words, Please Cut Here. Which he emailed to his surgeon.

In June, Phleban’s foot was amputated at Georgetown University Hospital in Washington, D.C. “Right before the surgery, I was definitely freaking out a bit,” he said. “It was such a ‘no turning back’ decision. But as soon as I woke up from the surgery and looked down, I knew I had done the right thing.”

exercising after ankle amputation

Phleban exercising with his girlfirend after his amputation

Phleban shared at least one plan for the future. This Halloween, he’s planning to dress up “as a surfer, my girlfriend as a shark.”

Which physician is best to treat foot and ankle pain?

25 Jun

We sure take our feet and ankles for granted, don’t we?

best doctor for foot pain ankle pain toe pain

That is, until the Millenium Falcon breaks our ankle, or a foul ball clips our right foot. Ouch.

When your feet are painful, you’re miserable. Your lifestyle is instantly affected – pain forces you to dial back or give up walking, running, dancing, standing, or your favorite sports. Prolonged pain might even cause you to go from star athlete to couch potato.

It’s appropriate to visit the ER if you have an unusual amount of pain in your feet or ankles, especially if the pain is sudden and intense, is accompanied by bleeding or swelling, or if your foot and ankle have been involved in a trauma like a fall down the stairs. Or if you tried to break a cement block in half with absolutely no martial arts training.

For less painful events, like a suspected fracture, or wounds that won’t heal, many people choose to see their primary physician, which may or may not be a good choice, depending on that  physician’s field of expertise.

And for even less worrisome injuries, like a minor sprain, or minor heel pain, some seek no medical attention at all – which is never a good idea, as both injuries can develop into more complicated conditions, especially for athletes.

Which doctor is expert in treating foot and ankle problems?

When you have trouble with your ears, you should see an ENT. Trouble with your knees, an orthopedist. When you have pain or discomfort in your feet, toes, or ankles, you should see a podiatrist.

Podiatrists and podiatric surgeons are trained exclusively in the treatment of foot and ankle disorders – they do nothing but study the foot and ankle, it’s diseases and deformities. After all, 1/4 of all of the bones in your body are in your feet, and there are many conditions unique to this area of the body. That’s a lot of ground to cover in med school. If they choose to be a podiatric surgeon, they complete further schooling to study surgical techniques to correct these problems.

In 99% of cases, a podiatrist can resolve your ankle, toe, or foot problem much faster than a general physician. Podiatrists are also expert at spotting the early signs of diseases you can easily overlook, like diabetic foot disorders, rheumatoid arthritis and cardiovascular disease.

Without your feet in good working order, your life can be…. well, challenging. Don’t take them for granted.

Giants’ Jon Beason Sidelined With Sesamoid Injury

16 Jun

Here’s some potentially bad news for Giants fans: Middle linebacker Jon Beason injured his right foot during off season training Friday. It appears he suffered a ligament tear and a fracture of the sesamoid bone.

jon beason foot injury

Beason at work against the Redskins in 2013

“You have freak injuries,” Beason said. “I was just changing directions… the movement was a little unorthodox, I was flexing with the big toe in the ground and then I pivoted on it all the way around. It’s a movement that I often do… I literally felt like I stepped in like a sprinkler head hole. I just felt it give right away.

“I really felt that I that I had torn the extensor, which is the tendon with the muscle, it’s how your big toe functions. That would have been season-ending.”

After limping to the sidelines and huddling with the training staff, Beason was carted off the field and taken to the Hospital for Special Surgery where he underwent an array of tests: MRI, CT, and x-rays. A definitive treatment plan has yet to be announced, but Beason’s status for the Giants’ regular season opener in Detroit is up in the air, as an injury like his typically requires a 12 week recovery period.

Beason, a 3-time Pro Bowler, was drafted by the Carolina Panthers in 2007. He played only one game for the Panthers in the 2011 season when he ruptured his left achilles tendon, and in 2012, played in just four games before suffering a microfracture in his right knee, requiring surgery.

Beason was traded to the Giants in October of 2013, and played in all 12 remaining games. At the end of the season, he was second on the team with 93 tackles. The Giants re-signed him in March and expected him to be a cornerstone of their defense this year.

So what’s a sesamoid anyway?

Most bones in our bodies are connected at joints, but not the sesamoids, which are connected only to tendons or embedded in muscle. Your kneecap is the largest sesamoid in your body, and the smallest are those found in the foot, two tiny, pea-shaped bones in the front of each foot that most people are unfamiliar with until they’re injured.

Located just behind the big toe, the sesamoids act like pulleys, providing a smooth surface over which the tendons glide, increasing the leverage of the tendons controlling the big toe. The sesamoids also assist with weightbearing and elevate the bones in your biggest toe. But that’s assuming you have sesamoids – some people are born without sesamoids in their feet and experience no problems.

Read more about sesamoiditis

If you damage the sesamoid bones in your feet, you’ll feel the pain in the ball of your foot, just behind the joint of the big toe. You may simply have an irritation of the tendons around the bones – called sesamoiditis, or you may have actually broken one of the tiny bones.

If you suspect an unjury to the sesamoids, seek an evaluation from a podiatrist, the most knowledgeable physician to treat this uncommon injury. Before your appointment, stop the activity which caused the pain, take over the counter pain medicine like advil or aleve to manage the pain and soreness, and use ice to reduce swelling.

If after a diagnosis, your podiatrist confirms an injury to the sesamoid bones, she or he may recommend any of the following:

  • custom orthotics to shift your body weight off of the forefoot
  • steroid injections to relieve swelling and pain
  • immobilization with a surgical boot
  • physical therapy
  • strapping or taping the big toe
  • surgery to remove or repair the sesamoids

The podiatrists at PA Foot and Ankle Associates are experts at treating sports injuries and are the best qualified physicians to diagnose and treat uncommon injuries of the foot and ankle.

Millenium Falcon Breaks Han Solo’s Ankle

16 Jun

Harrison Ford, the original Han Solo in the Star Wars film franchise, broke his ankle Thursday while filming a scene in the series’ reboot. He’ll be off the set of “Star Wars: Episode VII” for 6-7 weeks until his ankle heals.

Harrison Ford as Han Solo in Star Wars Episode IV: A New Hope (1977).

Harrison Ford as Han Solo in the original Star Wars

harrison-ford-star-wars-episode 7 2014

Harrison Ford as Han Solo in Star Wars: Episode VII

Ford, 71, is reprising his role as Han Solo in the movie. As all things are not magical in filmmaking, a hydraulic door fell off the iconic Millenium Falcon spaceship while he was stepping from it. The injury was serious enough that Ford was air lifted from the set to a local hospital in Oxford, England. The ankle may require surgery to fixate the bones with a plate and screws.

***Yes, we noticed that too – he was airlifted to a hospital for an ankle injury – but YOU never helped save the entire universe, and he did!

You’re not a famous Hollywood actor with a helicopter at your disposal, but your broken ankle needs treatment, too.

broken ankle, also known as an ankle fracture can range in seriousness from a hairline fracture in one bone, to multiple fractures which make the ankle very unstable. In addition to the broken bones, soft tissue is usually damaged as well, most commonly the ligaments which hold the ankle bones in position. In Ford’s case, his broken ankle was caused by trauma, but an ankle can also break after a sudden, forceful twisting, rolling, or by tripping or falling. The ankle is a very complex anatomical structure with many parts and a break in one of the bones poses risk to others.

If you suffered a broken ankle, you may feel immediate and severe pain, swelling, bruising, an inability to move your toes or bear weight, and/or a cold or blue foot. Treatment by your podiatrist may include splinting the broken ankle, immobilization with a cast or walking boot, crutches, or surgical realignment of the bones if necessary. Physical therapy is always recommended to strengthen the muscles and the bones after the injury heals.

We’re excited about this movie, because Ford’s original Star Wars cohorts are in this one as well: Carrie Fisher (Princess Leia), Mark Hamill (Luke Skywalker), Anthony Daniels (C-3PO), Peter Mayhew (Chewbacca), and Kenny Baker (R2-D2).

“Episode VII,” the first installment of a brand new “Star Wars” trilogy, is scheduled to be in theaters Christmas, 2015.

If there was a report card for foot care, you’d get an F

11 Jun

Unfortunately, when it comes to foot care, most of you are failing miserably. Well maybe not YOU, because you’re reading this, but everyone else is failing…

foot pain foot health

The American Podiatric Medical Association has released a very illuminating survey on American’s attitudes and experiences concerning their foot health. The results are very surprising to us in some ways, and completely predictable in others, based on the patients we see. Unfortunately, your feet continue to rank low on the list of body parts you consider important to your well-being, and you’re paying less attention to them than you should.

The survey, released in March, shows that 8 out of 10 of you have experienced foot pain at some time in your life. Those of you who’ve experienced foot pain on a regular basis, also report regular issues with other health complications, primarily back pain, eyesight issues (probably diabetes-related), arthritis or other joint pain, weight issues, knee pain, and heart and circulatory disorders.

Half of you said that foot pain has restricted your activities in some way: walking, standing for long periods, exercising, sleeping, going to work, or playing with your children or grandchildren.

You said that you understand how important foot health is, and that consistent or chronic foot pain can indicate other health problems.  You also said that you understand what a complex mechanism the foot is and that a podiatrist is best qualified to treat your foot pain.

However….

You also reported that you have little knowledge of or experience with podiatrists. When a foot problem arises, you’re more likely to visit your primary care physician for help, or try and treat it on your own. But those of you who have visited a podiatrist give them high marks for care and are more satisfied with the outcome than those of you who were treated by your primary care physician.

This last fact highlights a common misperception about the healthcare system – that your primary care physician is some kind of wizard who knows how to treat every conceivable ailment. While we respect our fellow physicians, every MD’s training is different. Primary care physicians are a sort of first line of defense and are trained to identify and treat the most common illnesses and complaints in the population. They’re also trained to flag unusual symptoms and to refer out injuries and disorders which are best treated by a specialist. Yet 60% of you say that you would talk to your PCP about a foot condition before seeking advice from a podiatrist (we understand however, that some insurance plans require this). Hello? Podiatrists know more about foot and ankle injuries and disorders than any other physician. When given the choice, always opt for a specialist.

Shame on you: Only 32% of you report doing foot, ankle, or leg exercises to keep them strong, and only 43% wear proper, supportive footwear (that explains all of the comments/questions on our blog post about why your feet hurt). Speaking of footwear, 71% of women who wear high heels experience foot pain which they directly attribute to wearing high heels. Yet they own NINE PAIR (!).

Unfortunatley, nearly 50% of you experiencing foot pain wait until it’s severe to see a podiatrist. Most of you don’t even consider a visit to a podiatrist for conditions like persistently sweaty or odorous feet, blisters, pain from high heels, hammertoes, problems with your toenails, or even diabetic wound care. Yet each of these conditions can indicate a more serious potential problem or set of problems. Treated early and properly by a podiatrist, your pain and discomfort can be relieved without further complications. In fact, 34% of you said that a podiatrist helped you identify other health issues such as diabetes, circulatory issues, or nerve damage.

But what is up with the fact that only 74% of you report keeping your toenails trimmed?  OMG! What are the other 26% of you doing? Do you have man servants to trim your toenails for you? Or extra long shoes to accommodate your lavishly long toenails?

Click here to read the entire APMA survey.

Red Sox’ Mike Carp on DL with Broken Foot

5 Jun

We’re always happy to see an athlete and clubhouse taking their foot and ankle injuries seriously and giving them time to heal.

red sox mike carp

The world champion Boston Red Sox announced that 1st baseman and outfielder Mike Carp is on the 15 day DL with a fractured right foot. Last week, Carp was struck by a pitch during a game against Atlanta when he fouled it off his foot. He continued to play (risky!) and post-game x-rays were negative. So he also started Friday’s and Saturday’s games.

But after Sunday’s game against Tampa Bay, Carp’s foot was still hurting, so he had further tests done. No surprise to us that a CT scan revealed a fracture. After all, the pitch from the Braves’ David Hale was flying at 83 mph BEFORE Carp fouled it off his right foot. After the scan, doctors immediately ordered Carp into a walking boot and he’ll be on the bench for 2-3 weeks, according to Red Sox manager John Farell.

It’s necessary to rest a fractured bone in the foot for at least a week. After that, a strict regimen of physical therapy is required for an athlete to get the bone back in shape. If Carp resumes playing before the bone is properly healed, the fracture can become much worse. Or due to weakness in the bone, the foot may be injured in another way, such as an ankle sprain, tendon rupture, or fracture elsewhere in the foot.

The Red Sox and every baseball club – or for that matter any sport organization – should move cautiously when allowing a team member to resume playing. What’s best for the team isn’t always what’s best for the player (see: concussion lawsuit/NFL).

If you’re an athlete and experience any tenderness or pain in your feet, ankles, or lower legs, it’s always best to have it checked by a podiatrist at PA Foot and Ankle Associates, even if your trainer has given you the green light. Podiatrists and podiatric surgeons are the only physicians trained exclusively to treat the diseases and conditions of the foot and ankle and are expert in diagnosing and treating minor injuries before they become big problems.

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