Tag Archives: arch pain

Lump On Your Foot or Ankle? It Might Be A Ganglion Cyst

12 Aug

A soft, painful lump has appeared on the top of your foot. Or maybe the side of your foot. Or maybe somewhere around your ankle. The lump changes size with activity. It might be sore, or it might just… be there.

ganglion cyst foot, lump on foot

This ganglion cyst has appeared along the path of the tendons on the side of the foot.

If these symptoms match a lump on your foot or ankle, chances are you have a ganglion cyst, a noncancerous, round or oval lump that develops along a tendon or joint. Most are less than an inch in diameter, although some are so small they can hardly be felt. The size of the cyst can vary however, especially as the joint is used.

Normally, a ganglion cyst is painless and requires no treatment. But if it happens to be pressing on a nerve, it can cause pain, tingling, numbness, muscle weakness, or interfere with joint movement.

What causes a ganglion cyst?

Repeated irritation can weaken the lining of a joint or tendon, causing the tissue to bulge, which is then referred to as a ganglion cyst. Inside the cyst is a thick fluid similar to the lubricating fluid found in joints or around tendons.

People who wear boots, especially women between 20 and 30, are more likely to develop ganglion cysts, as this type of footwear puts stress on the foot and ankle. Bone spurs may also cause ganglion cysts by irritating the joints and tendons, and joints or tendons that have been injured, even long ago, are more likely to develop ganglion cysts.

Treatment for ganglion cysts:

**Because ganglion cysts may be mistaken for tumors, it’s essential to have a complete exam performed by a podiatrist, and if necessary, tests to confirm the diagnosis.

If your ganglion cyst is causing you no pain, your podiatrist may recommend a wait and see approach, as the cyst may go away on its own. If it’s causing you discomfort, she may suggest one of the following treatments:

Aspiration: In an exam room, your podiatrist will use a needle to drain the fluid from the cyst.

Immobilization: If it’s clear that activity is causing the cyst to enlarge, your doctor may recommend an air boot or similar device to immobilize your foot or ankle. As the cyst shrinks, pain and other symptoms may be relieved.

Padding: Soft pads placed around the ganglion cyst to ease pressure and friction.

Medication: If swelling and pain are severe, your podiatrist may recommend prescription medication.

Surgery: In some instances, surgery may be recommended to remove the cysts and its surrounding tissue, which is attached to a joint or tendon.

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What Your Feet Tell You About Your Health

28 May

foot health

Seems to us that every general physician should ask you to take your socks off. Even if you’ve gone to see your doctor complaining of a chest cold, an inspection of your feet might inform them of the early symptoms of many conditions.

Our feet are farthest from our hearts and spine, so in many cases they’re the first area to indicate problems with the nerves or circulatory disorders. The brain and internal organs receive blood before our toes and feet do, so our appendages are the first to suffer.

Nine health problems which first show up in your feet

1.Always cold feet could be a sign of hypothyroidism, a condition in which your thyroid gland is underperforming. Most common as we approach middle age, hypothyroidism can also cause hair loss, fatigue, weight gain, and depression. A simple blood test ordered by your doctor can confirm this condition, and daily oral medication can get your thyroid gland functioning properly.

2. Suddenly hairless toes and feet could be a sign of a circulatory disorder, as your feet may not be receiving enough blood flow to sustain hair growth. Your doctor should check for a pulse in your feet, and if she has any doubts, should order a thorough cardiovascular screen.

3. Foot cramps that won’t quit may indicate a nutritional deficiency or dehydration. Sure, everybody’s feet cramp up now and then, but what matters is how often and how severe. If you exercise a lot, make sure you drink plenty of water to hydrate your muscles. You also should eat a balanced diet with plenty of potassium, magnesium, and calcium, as a lack of these nutrients can also cause cramping (good sources are nuts, leafy greens, and dairy). To relieve cramps in your feet, stretch your toes up, not down. If the cramping in your feet just won’t let up, see your podiatrist so that he or she can test for circulation issues or nerve damage.

4. Yellowing toenails is a sign of aging, but may also indicate a fungal infection. Yellowing can also occur when you wear nail polish for months without a break. If your toenails are flaky or brittle, you probably have a fungal infection and should see a podiatrist for treatment.

5. Flaky, itchy, or peeling skin between your toes is a sure sign of athlete’s foot. Even if you’re not an athlete, it’s easy to pick up a case of athlete’s foot if your feet are crammed in shoes all day or you walk barefoot in common areas like a sauna or swimming pool. Use an over the counter creme to relieve the symptoms, but if your flaking, itching, or peeling continues, you may have psoriasis or eczema. Your podiatrist can determine which is which and suggest a course of treatment.

6. Your big toe suddenly becomes swollen and painful. This is an almost sure sign that you have gout, a condition that inflames the joint. But it might also indicate inflammatory arthritis or infection. If it’s due to trauma, like someone landing on your foot after a jump shot, well, you’ll probably figure that one out.

7. A sore on your foot that won’t heal is a common side effect of diabetes, skin cancer, or circulatory disorders. In the case of diabetes, blood glucose levels that have raged out of control for long periods lead to nerve damage and small blood vessel damage, which in many cases appears first in your feet.  If the sore gets infected, it can lead to an amputation. But a sore on your foot – even between your toes – can also indicate certain kinds of skin cancer, so be sure to have it checked out by your podiatrist as soon as you discover it.

8. A slowly enlarging “growth” aside your big toe is probably a bunion. Faulty, inherited foot structure leads to this common foot deformity, which can be exacerbated by poor choices in footwear like high heels and flip flops. Unfortunately, bunions rarely stop growing, so that small, slightly sore bump today may be quite large and painful years from now. The only sure way to correct a bunion is with surgery. Splints, toe separators, and the like are temporary measures which will relieve symptoms, but won’t stop the deformity from becoming worse.

9. Pain in your heel may indicate plantar fasciitis, an inflammation of the tissue which connects your heel to your arch. If you have a sharp pain in your heel when you get out of bed in the morning, which slowly subsides as you move around, you probably have PF. There are many causes of plantar fasciitis, but primarily poor footwear, obesity, or working out too aggressively are to blame. To relieve minor symptoms of plantar fasciitis, ease up on your exercise program, lose weight, or wear shoes which support your feet properly. If symptoms persist, see your podiatrist for treatment.

Landscaping: How To Protect Your Feet From Injuries

15 May

Which would you rather say to your podiatrist?

“I got this monumental ankle sprain when I was pushing my lawnmower and rolled my foot in a gopher hole.”
or
“I got this monumental ankle sprain when I rolled my foot AFTER THE MOST SPECTACULAR JUMP SHOT EVER!

If you picked “gopher hole”, you’re in the minority.

Landscaping – and even gardening – cause their share of foot and ankle injuries, especially in spring when we’re out of shape. We tend to jump right in where we left off in October, and our bodies just aren’t up to it. Bending, twisting, and lifting or pushing heavy and sharp equipment can cause an injury quite quickly if you don’t take a few precautions.

chainsaw

We hope he’s wearing a good pair of work boots

Wear proper footwear.

It may have been fine when you were a teenager to wear worn-out sneakers when you cut the lawn. As an adult, you should wear athletic shoes which support your feet well and will protect them if you step on a rock you didn’t expect to be there. Or in the groundhog hole which magically appeared overnight.

If your ankles or feet have been subject to injuries in the past, or if you’re landscaping with sharp equipment, wear a quality pair of work boots (not garden boots, which offer little protection beyond moisture). If you’re a landscaper, work boots with good support and metal-tipped toes should always be on your feet. Work boots will also protect your feet in the event you accidentally drop any equipment with sharp blades or heavy bottoms (like a tamper).

Don’t work on a wet lawn.

When grass is even a little wet, it can be very slippery. If you have a slope or hill on your lawn, cutting it when wet can be especially dangerous. Wait to mow your lawn until the turf is completely dry.

Use equipment with safety shutoffs.

Decades ago, equipment with sharp blades only stopped turning when you intentionally shut it off, which allowed chainsaws to run out of control, and feet to slide under lawnmowers while the blades were still turning. Fortunately, most modern lawnmowers, edgers, tillers, cultivators, post hole diggers, chain saws, and other equipment with high speed, rotating blades or teeth, stop as soon as you let go of the handle or trigger. If you’re still using decades-old equipment which doesn’t have a shutoff feature, it’s time to upgrade.

Shovels and other step-on equipment can cause surprising damage to your feet.

If you’re doing a project that requires a lot of digging, or using equipment like manual aerators for your lawn, wear quality work boots at all times. The repeated stepping-on-with-force required with these tools can cause injuries like sesamoiditis, plantar fasciitis, sprains and fractures.

If you have ankle, foot, leg, or back issues, stretch before you start.

In gardening and landscaping, lots of bending, squatting, twisting and turning is required, sometimes while holding or moving heavy equipment. Injuries happen remarkably quickly when your body isn’t prepared for them. We recommend that those who have previous injuries of the back, hip, legs, feet, or ankles, or are over 50, stretch before they begin their activities.

Taking these precautions and wearing work boots when you garden or landscape may not make you look like the coolest guy or girl on the block, but they’ll keep you out of the podiatrist’s office. Or the ER.

 

What is Plantar Fasciitis?

4 Dec
plantar fasciitis

Kobe Bryant famously suffered with Plantar Fasciitis

Plantar Fasciitis is the leading cause of heel pain. In medicine, the suffix itis refers to irritation or inflammation of an organ, and in this case, to the plantar fascia, a band of tissue which connects your heel bone (calcaneus) to the ball of your foot. Pain can be felt anywhere along this path.

The classic sign of plantar fasciitis comes in the morning, when you step out of bed – a sharp pain in your heel. Gradually, as the tissue warms up and becomes flexible, the pain fades – maybe not completely, but substantially. It may then return if you stand on your feet all day or exercise, especially if you run or exercise strenuously.

What causes the heel pain of plantar fasciitis? When the plantar fascia is constantly stressed, small tears occur in the tissue. The tears make the plantar fascia weaker, less able to do its job of support and shock absorption. This offloading of the work causes stress on the surrounding tissues, which is the actual cause of the pain.

Plantar fasciitis also makes itself known to those who are carrying more body weight than normal, like pregnant women or obese individuals. You might also develop plantar fasciitis if you made a poor choice in shoes and wear a style which doesn’t support your feet correctly. People with flat feet also frequently suffer from plantar fasciitis, as do long distance runners .

Symptoms of Plantar Fasciitis
  • A sharp pain at the back of your heel, sometimes described as “knife-like”
  • Pain is most common with your first few steps in the morning, but may also occur after physical activity, or climbing stairs
  • In most cases, pain increases gradually
  • Usually appears in one foot, but occasionally both
  • Foot may be stiff and difficult to bend
heel pain plantar fasciitis

Click for larger view

The Plantar Fascia acts like a shock absorber for your foot, and also supports your arch. If the plantar fascia receives repetitive stress, such as from exercising on hard surfaces, unsupportive footwear, or too much pressure from weight, small tears form in the tissue. These tears cause irritation in the surrounding tissue, which triggers pain.

If plantar fasciitis is left untreated, the condition may get substantially worse. Knee pain is also frequently reported in patients with plantar fasciitis, due to their change in gait to compensate for the heel pain.

Treatment for Plantar Fasciitis
  • Custom orthotics (not off the shelf) prescribed by your podiatrist
  • Physical therapy
  • Rest, elevate, and ice the heel
  • Over the counter anti inflammatory pain medicine such as Ibuprofen (Advil) or Naproxen (Aleve)
  • Athletic shoes which provide excellent arch support and padding at the heel
  • If exercising, train on soft surfaces instead of hard surfaces
  • If overweight, start a weight management program

If these methods aren’t successful in relieving your pain, your podiatrist may recommend steroid injections, PRP injections, EPAT (shockwave) therapy, Radiofrequency Ablation (RFA), or in extreme cases, surgery.

Help! The Arches In My Feet Are Falling!

6 Aug
adult aquired flat foot

In a normal foot, only the smallest toe is visible when viewed from behind.

A common problem among the elderly and increasingly middle aged patients is collapsing arches, medically known as Adult Acquired Flat Foot Syndrome (AAF), or Posterior Tibial Tendon Dysfunction (PTTD). This is a progressive condition in which the arch of the foot collapses and the bones of the ankle and foot fall out of proper alignment.

A magnitude of foot problems develop as we age and many of these complaints begin about the age of 60. Among the most serious from a biomechanical standpoint is Adult Acquired Flat Foot Syndrome (AAF).  Treated early enough, symptoms can be arrested or at least slowed. Untreated however, AAF becomes an extremely painful condition which ultimately affects the entire body and the patient’s lifestyle, as gait is significantly altered by the out-of-line foot and ankle. This malalignment can create pain, fatigue, and discomfort throughout the entire body.

As we age, many of our muscles, tendons, and ligaments lose their ability to stretch and support our bones.  If you’ve ever discovered an old rubber band in the bottom of a drawer, you’ll get the idea – it’s more likely to snap than stretch. The Posterior Tibial Tendon, which attaches the calf muscle to the bones in the foot, is largely responsible for the support of your foot when walking, and to hold up the arch. With aging, overuse, or trauma, this tendon degenerates and loses its function, along with associated ligaments and joints on the inner side of the ankle and foot. Ligaments are responsible for holding bones in place, and when they fail, bones shift and deformity is the result. The deformity causes malalignment, which leads to more stress and failure of the ligaments, and a slow collapse of the arch which becomes debilitating in its later stages.

AAF is most frequently seen in women, especially those who start out with somewhat flat feet or a pronated (rolls inward) foot. These attributes place extra stress on the soft tissue structures, along with the posterior tibial tendon and the ligaments on the inner side of the foot. Other contributing factors are diabetes, obesity, rheumatoid arthritis, and hypertension. People who play high impact sports may also develop tears in the posterior tibial tendon, eventually leading to AAF.

pttd out of alignment foot ankle

The foot and ankle become malaligned as AAF progresses

Symptoms of PTTD/AAF

The symptoms of posterior tibial tendon deformity change considerably as the condition progresses. Initially, pain may be felt along the tendon’s path on the inside of the foot and ankle. This area may also be red, warm, and swollen. As the arch starts to flatten, in addition to pain, the foot and toes turn outward and the ankle rolls inward. As the arch flattens even more, the pain shifts to the outside of the foot, just below the ankle. Arthritis develops in the foot, and later may develop in the ankle, sometimes causing the ankle joint to lock.

Treatment of PTTD/AAF

Treatment of adult acquired flatfoot depends on the stage of the condition and its severity. Mild cases may only warrant rest, ice, and custom orthotics. Advanced cases may require immobilization, bracing, or even surgery. Early intervention by a podiatric surgeon is key to slowing the progression of PTTD.

At the onset of PTTD, a boot or brace is used to support the arch and relieve strain on the soft tissues, including the tendon. When pain has subsided, custom orthotics are used to reduce the stress on these tissues. However, as the arch has already fallen, the deformity may progress. If pain persists after these conservative measures, surgery to correct the deformity may be recommended.

Angels’ Albert Pujols Out With Plantar Fascia Tear

29 Jul

pujolsLos Angeles Angels slugger Albert Pujols, who has been struggling with plantar fasciitis in his left foot for seven years (that’s right, 7 years!), is most likely out for the rest of the season after tearing his plantar fascia in Friday night’s game against Oakland. Angels’ Manager Mike Scioscia said that Pujols, who hit .258 with 17 home runs and 64 RBI’s despite being hobbled all season by the troublesome foot, will be out “for a significant amount of time.”

Back in April Pujols, 33, said of his plantar fasciitis, “I’m dying. It’s hurting real bad.”  He was considering off season surgery, and he sort of got his wish Friday night when he tore the ligament, achieving a similar result. In plantar fascia surgery, a podiatric surgeon cuts part of the plantar fascia ligament to release tension and relieve inflammation. The surrounding soft tissue attaches to the plantar fascia and helps it heal. Unfortunately for Pujols, he didn’t suffer a complete tear, so off-season surgery may still be an option.

The minimum recovery period for a plantar fascia tear is six weeks, but with the Angels all but out of playoff contention and a season-high 13 games behind Oakland in the American League West, there is no need to bring Pujols back for the final two weeks of the season. Instead of having surgery in October and spending most of the winter rehabbing, Pujols  can spend the rest of the summer recovering and come back healthy in 2014.

plantar-fasciitis diagramJust goes to show what we always say – don’t play through the pain, because it will always get worse, sometimes seriously.  It’s remarkable that even with the Angels’ state of the art sports medicine, highly paid trainers, and months to rest in every off season, Pujols’ plantar fasciitis never sufficiently healed. It’s a particularly difficult injury to treat in some cases.

Even if you’re an amateur athlete – especially you marathon runners – you may easily be exposing your feet to the same pounding an MLB player like Pujols does.  Any sign of pain – toes, heel, arch, or ankle – needs to be addressed immediately and given time to properly heal. Being out of the game temporarily, even for a full season, is much better than aggravating a minor condition into a serious injury which can sideline you for much longer.

Jenny’s story of how her terrible heel and arch pain was cured

8 May

Meet Jenny.

Jenny is an athlete – a marathon runner – and her chronic plantar fasciitis caused severe pain from her heel through her arch. Her plantar fascia tendon had developed tendinitis, causing pain with every step. She tried to push through it, but eventually had to reduce her training to a very minimal schedule.

Her podiatrist’s first treatment method was to inject the plantar fascia with cortisone to reduce the inflammation. This is a typical first approach, and is frequently successful.  The inflammation in the tendon is reduced by the cortisone, allowing the tendon to heal. Unfortunately for Jenny, the heel and arch pain returned after only a few weeks.

The second step in Jenny’s treatment was a PRP (platelet rich plasma) injection. At first, the PRP treatment reduced her pain considerably, but her tendon didn’t respond as her doctor had hoped, and her pain returned once again.

Jenny and her doctor then chose the FAST Technique to relieve her heel pain.

In her words, the procedure was “seamless”.  She had no pain at all during or after the very short procedure and her plantar fasciitis is now completely gone. Jenny has resumed her normal training schedule and is delighted that she can get back to her pre-pain level of activity.

The FAST Technique is a remarkable improvement for treating heel pain and has been found to be 95% effective in eliminating chronic pain resulting from tendinitis or tendinosis. East Penn Foot and Ankle Associates is the only podiatry practice in the Lehigh Valley to offer this innovative approach to relieving heel pain.

Read more about the FAST Technique on our website here.

Watch Jenny tell her story:

What is a Plantar Fascia Tear?

14 Feb

pau gasol plantar fascia rupture

On February 5, Los Angeles Lakers forward Pau Gasol was defending Brooklyn’s Brook Lopez when he came down on the Nets’ player’s foot. Gasol heard a “pop” in his foot and fell to the floor. He tried to stay in the game, but he ultimately exited the locker room on crutches.

The source of his foot pain? A torn (ruptured) plantar fascia, sidelining him for 6-8 weeks.

The plantar fascia is a thick ligament which extends from the heel to the ball of the foot. Its purpose is to stabilize the arch and resist arch collapse.

Tearing the plantar fascia is an extremely painful and uncommon injury. But last week, Gasol said he was playing through a pain level of eight out of 10 in his right foot. “I’ve been dealing with it for a couple months now,” Gasol said. “But I never felt anything like I did tonight.” And therein lies the most likely reason for Gasol’s more serious injury – playing with pain. He already had a sore and irritated plantar fascia, and when put under the additional strain of jumping and landing, the ligament tore. Most often the rupture occurs where the ligament attaches to the heel bone.

Athletes frequently experience plantar fasciitis, a common overuse injury that appears as heel pain or arch pain. As a matter of course, trainers inject the ligament with cortisone to kill the pain and get the player back in the game. Unfortunately this can contribute to the more traumatic and serious tearing injury.

But a torn plantar fascia is not only an athletic injury – arch problems, sudden weight gain, and obesity can contribute to the injury, too.

Video of Pau Gasol’s injury:

How do you know if you have a torn plantar fascia?

  • Pain in the heel or arch, active or resting
  • Possible swelling or bruising in the bottom of the foot
  • Tender spot or lump between the arch and heel
  • You heard or felt a “pop” in the arch when the pain started
  • Your arch feel like it’s collapsing

Treatment for a plantar fascia tear

A ruptured plantar fascia will most likely not get better on its own, and will be accompanied by excruciating pain, so medical attention is strongly advised. Surgery is usually not necessary, but your podiatrist will immobilize your foot with a cast or a walking boot and give you a pair of crutches to keep weight off the injured foot. Once the ligament heals, physical therapy will be prescribed and possibly custom orthotics to prevent re-occurrence of the tear.

In other injuries of the ligaments, steroids and cortisone are normally administered to decrease pain and inflammation. But in the case of a plantar fascia rupture, your podiatrist may avoid this treatment, as these medicines might actually delay healing.  Over the counter pain relievers will be the most likely route to reduce pain. PRP injections however, may be recommended to speed the healing process.

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