Tag Archives: Foot Numbness

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.

A Question From India: Can Charcot Foot Be Cured?

6 Aug charcot foot diabetes

The PA Foot and Ankle Associates blog gets questions from all over the world about foot and ankle health. Today we received this one from Manohar in Bangalore City, India.

“Hello sir. This is Manohar from India, Bangalore City. My father is suffering with charcot joint disease and also a diabetic neuropathy. In the last month his leg is completely swelling. An orthopedic surgeon has suggested amputation. My question is how can it be cured?”

Thanks for your question, Manohar. The doctors at PA Foot and Ankle Associates, and particularly Dr. Thomas Rocchio, are one of the United States’ foremost experts on Charcot foot disorder.

Charcot foot disorder is a side effect of diabetes and is accompanied by diabetic peripheral neuropathy. Diabetes damages blood vessels, causing a decrease in blood flow to the feet. Poor circulation weakens bones, resulting in a disintegration of bones and joints in the foot and ankle. This puts the bones at high risk of fracture. Unfortunately, a diabetic who has nerve damage from DPN has a loss of sensation in their feet, and will be unaware of the bones fracturing. They continue to walk on the foot, causing the joints to eventually collapse and the foot to change shape, most notably to a rocker-bottom appearance. Sharp edges of bone may put pressure on the skin, creating the risk of chronic skin sores. It’s this end result – a combination of bone disintegration and trauma – which is known as Charcot foot disorder. It’s one of the most serious complications of diabetes.

charcot foot diagramcharcot foot disorder

Charcot is a very dangerous disease, as it is in many cases accompanied by bone infection. In highly advanced cases, sometimes amputation is the only realistic treatment. However, it is far from the only treatment.

“There are reconstruction options for many Charcot patients, but there needs to be circulation in the foot for it to heal.”, according to Dr. Rocchio. “Infection can affect the result as well. The remaining reconstructed bone must be free from infection and there must be enough healthy soft tissue to close the incisions. Usually an aggressive external fixation is needed to stabilize the reconstruction. Unfortunately, no complete answer can be given without an exam of the patient.”

Dr. Adam Teichman adds, “There are treatments to stabilize, correct, and prevent Charcot and the breakdown of the foot. For instance, if  ulcers can be healed, infection can be cured, which allows a number of options to save the foot. Amputation is not a therapy, it’s a last resort.”

Read more about Charcot foot disorder

Early diagnosis of Charcot is key to saving the foot, which is why every diabetic should have their feet checked regularly by a podiatrist. Manohar, we’d be happy to examine your father and give you a complete diagnosis and treatment plan if you and he can travel to the States.

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.

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.

Diabetic Nerve Pain Treatment Options and Symptoms

23 Jan
Diabetic Nerve Pain, also known as neuropathy or Diabetic Peripheral Neuropathy, is a nerve disorder common in those who have diabetes. Some people with this nerve damage show no symptoms, while others may feel pain, tingling, or numbness in the hands, arms, feet, toes, or legs.
peripheral neuropathy diabetic nerve pain

Courtesy of NIH

Diabetes is not the only cause of neuropathies – they may also result from vitamin deficiencies (B-12 and Folate), chemical exposures, pressure on nerves, or certain medications, especially those used in AIDS therapies and chemotherapy.

Roughly 70% of people with diabetes will develop some form of neuropathy, including Diabetic Nerve Pain. It can appear at any time during the progression of the disease, but the risk increases with age and the duration of the illness. According to the U.S. Department of Health and Human Services,  The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.

The early symptoms of diabetic nerve pain are a slight tingling or numbness in the extremities. As the disease progresses, and nerves are further damaged, the tingling or numbness becomes painful and may be quite severe. When these symptoms appear in the feet, hands, or legs, it’s known as Peripheral Neuropathy, and when caused by diabetes, Diabetic Peripheral Neuropathy.

Symptoms of Diabetic Peripheral Neuropathy include

  • Numbness or insensitivity to pain or temperature
  • A tingling or burning sensation
  • Pains or cramping
  • Extreme sensitivity to touch
  • Loss of balance or coordination

How are nerves damaged by diabetes?

Vascular and neural diseases are closely related. Blood vessels depend on nerves, and nerves depend on blood vessels. Scientists know that prolonged exposure to high blood sugar damages nerve fibers, but exactly how that happens is still a matter of debate. What they know for sure is that high blood glucose interferes with the ability of nerves to transmit signals, and weakens the walls of capillaries (tiny blood vessels) that supply nerves with nutrients. When nerves don’t receive enough oxygen and nutrients from blood vessels, cells begin to die, and nerves don’t function properly. Other risk factors for nerve damage of this type are smoking, alcohol abuse, and certain genetic factors unrelated to diabetes.

What you can do to avoid DPN

The best way to avoid DPN or to minimize nerve damage once it begins, is to keep your blood sugar under control, exercise regularly, and see your physician on a regular basis to test you for symptoms. According to John Hare, MD, Medical Director of Joslin Diabetes Center’s Affiliated Centers program, “people who keep their blood sugars consistently in [a] healthful range can decrease their risk of nerve damage by more than 50%. Getting diabetes under better control also may help limit the amount of damage caused by neuropathy once it’s developed.” 

In addition to a diabetes specialist, a podiatrist should also be a member of your diabetes health team. Early symptoms of DPN typically appear first in the feet, and may go unnoticed by the patient. Podiatrists are experts at detecting these symptoms, and early intervention can avoid further damage to the blood vessels and nerves.

Treatments for Diabetic Peripheral Neuropathy

Early in its development, the pain and tingling of DPN can be managed with over the counter pain medicine like acetaminophen (tylenol), aspirin, or ibuprofen (advil, motrin). Some also find relief with over the counter pain creams which contain capsaicin, an extract of hot peppers like cayenne and tabasco peppers. It’s believed that these creams block pain signals, but they’re not effective for everyone. As the disease progresses and pain intensifies, your physician may prescribe narcotic pain killers, medicines such as Lyrica, or anti-depressants such as Cymbalta, which are also approved to relieve some types of severe pain.

A highly effective treatment used by the podiatrists at PA Foot and Ankle Associates is MicroVas, originally developed by the U.S. military to treat hypothermia in Navy SEALS. This non-invasive, pain-free therapy uses electronic impulses to cause muscle contraction and relaxation cycles which stimulate circulation. The increased blood flow raises the oxygen level in the tissues, which promotes healing in the nerves and muscles which have been damaged. MicroVas is successful in over 85% of the patients treated, who report reduced pain and improved sensation.


MicroVas Therapy Heals Diabetic Peripheral Neuropathy

28 Nov


MicroVas, also known as Micro Vascular Therapy or MVT,  is one of the treatments used by PA Foot and Ankle Associates to relieve the symptoms of Peripheral Neuropathy in the feet. In most cases, but not all, this condition results from diabetes.

What is Diabetic Peripheral Neuropathy?
diabetic peripheral neuropathy microvas

click for larger image

Neuropathies are the most common side affect of diabetes, occurring in up to 50% of patients. A neuropathy can appear in any part of the body, affecting any organ, the muscles, or sensation, but most often affects the feet and legs, followed by the hands and arms. Symptoms may appear suddenly or may develop slowly over a period of years.

Symptoms of diabetic peripheral neuropathy include:

  • Tingling or burning sensation
  • Sharp pain which may be worse at night
  • Difficulty or pain when running or walking
  • A “heavy” feeling in your legs
  • Numbness in the extremities
  • Reduced ability to feel pain
  • Reduced ability to feel changes in temperature
  • Extreme sensitivity to touch
  • Lack of sensation when touching an object
  • Muscle weakness
  • Ulcers, infections, deformities, bone pain, joint pain in the foot
  • Feeling of wearing stockings or slippers when feet are bare

Peripheral Neuropathy may take years to develop in a diabetic patient, or it may be present at the time of diagnosis. If you’ve been diagnosed with Type 1 or Type 2 diabetes, it’s essential that you’re tested regularly for symptoms of Peripheral Neuropathy to avoid the additional complications which can develop.

What is the MicroVas treatment?
microvas treatment diabetic peripheral neuropathy

A patient undergoing MicroVas Therapy

MicroVas was originally developed by the U.S. military to treat hypothermia in Navy SEALS. It’s a non-invasive treatment which uses electronic impulses to cause muscle contraction and relaxation cycles to stimulate circulation in the capillaries (the tiny blood vessels near the skin surface).  This increased capillary blood flow raises the oxygen level in the tissues in order to promote healing in the nerves and muscles which have been damaged.

Blood flow in the capillaries and the tissues they feed is compromised in many diabetic patients because persistent high blood sugar causes vascular damage and nerve damage, and with the vascular damage comes decreased blood flow to the surrounding tissues. When blood flow is reduced, gas and fluid exchange is reduced, which allows toxins to build up in the tissues, causing further damage. MicroVas stimulates blood flow in these regions to remove toxins, speed healing, and restore balance and proper function.

MicroVas treatments are administered in our office, take roughly 45 minutes each and there are no complications. How many treatments are required will depend on the severity of your condition and will be determined by your podiatrist.

More information on diabetic neuropathy

More information on MicroVas treatment

Diabetes: How minor foot ulcers lead to amputation

5 Oct

Throughout the PA Foot And Ankle Associates blog we stress how important it is for diabetic patients to take proper care of their feet, especially those who’ve been diagnosed with diabetic neuropathy. We stress this because we see far too many patients in the OR requiring the amputation of a toe, a foot, or part of their lower leg in addition to a foot. This is truly a procedure we wish we performed less frequently. While amputation indeed saves the remaining limb and sometimes even the patient’s life, early care of diabetic foot ulcers and preventive treatment are the keys to keeping your legs, feet and toes intact.

Each year more than 60,000 people in the U.S. require a lower-extremity amputation due to complications from diabetes. That’s a tragic figure, considering that early intervention from a podiatrist can in most cases prevent ulcers and consequent infections from becoming serious enough to warrant amputation. The most frequent  reason for these amputations is poor treatment of infected diabetic foot wounds. Unfortunately,  about 50 percent of patients who have a foot, toe, or leg amputated die within five years – a worse mortality rate than for most cancers. Roughly half of these amputations can be prevented through proper care of foot infections.

foot with gagrene

A foot which has gangrene must be amputated

How foot ulcers lead to amputation

Because people with diabetes often have poor circulation and little or no feeling in their feet, a minor cut that goes unnoticed or a sore caused by a shoe becomes infected. If left untreated, the infection can spread, killing soft tissue and bone. Dead and infected tissue must be surgically removed, which, if the infection is extensive, can mean amputation of the toe, foot, or even part of the leg.

Nearly 80% of all nontraumatic amputations occur in people with diabetes, and 85 % of those begin with a foot ulcer.

“Lower extremity amputation takes a terrible toll on the diabetic patient,” says Benjamin A. Lipsky, MD, professor of medicine at the University of Washington and VA Puget Sound, Seattle. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible.”

Read how one diabetic patient struggled to avoid amputation

You might be surprised to learn that doctors consider even minor redness, callus, blisters, sores, or any break in the skin on the foot to be a diabetic foot ulcer. It may seem over zealous, but impairments associated with diabetes, such as a weakened immune system, nerve damage, and poor circulation, diminish the patient’s ability to fight even a minor infection. Wounds easily treated and healed in non-diabetic patients often become chronic, non-healing wounds in diabetics. As a result, when a wound becomes infected, it enters a perpetual inflammatory state and can’t move through the healing process. These infections can become systemic, infecting the entire foot, including the soft tissue and the bones. Podiatrists have many tools and specialized training at their command to properly treat foot ulcers to heal them as fast as possible.

What you can do to avoid diabetic foot ulcers

The most important thing any diabetic patient can do is to effectively manage their blood glucose levels from the onset of their disease. If you’ve recently been diagnosed with diabetes, take your blood glucose levels seriously by eating correctly and monitoring levels as prescribed by your doctor. You should also be visiting a podiatrist on a regular schedule so he or she can create a baseline against which to measure any effects of diabetes on your feet or ankles.

Read about diet guidelines for diabetics

A word about preventive surgery: If you have diabetic neuropathy and you develop a bunion, hammertoe, charcot foot, or corns, you may want to consider surgery as soon as the abnormality is discovered. Because these conditions create areas of great pressure in your foot, if you have a loss of sensation, or if your blood circulation is poor, this pressure can lead to a non-healing wound. Eliminating the abnormality in the foot may deter a future ulcer which leads to an amputation. These surgeries are rather routine for podiatric surgeons and are usually performed on an outpatient basis.

How diabetes causes Neuropathy and other foot problems

5 Sep

obesity and diabetesAccording to figures from 2010, an estimated 285 million people globally had diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double.

The remarkable takeaway from that fact is that type 2 diabetes is caused by what we call a “western diet” – too much sugar, too much starch (mostly white flour and white rice products), and too much meat. As countries in the developing world become wealthier and adopt more of the American diet, they also exhibit more cases of type 2 diabetes.

Read about how to avoid diabetes with a healthy diet

What is diabetes?

Diabetes is defined as a “group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces symptoms of frequent urination, increased thirst, and increased hunger.” Diabetes carries the risk of long-term complications, which typically develop after ten to twenty years. These complications are most typically cardiovascular disease, stroke, and peripheral vascular disease.

A long term complication of diabetes, Peripheral Neuropathy, is a nerve condition which causes numbness, tingling and pain in the feet, and increases the risk of skin damage due to reduced sensation. When combined with diabetes related vascular damage (small blood vessel damage), problems with the lower legs and feet can be quite serious and may sometimes lead to partial or complete amputation of the foot, leg, or toes.

Up to 70 percent of people with diabetes will develop some type of neuropathy, making it one of the most common side effects of this disease.

How nerves are affected by diabeteshow diabetes affects nerves

“Theories abound as to why exactly neuropathy occurs in people with diabetes”, says Dr. John Hare, M.D., of the Joslin Diabetes Center, the world’s preeminent diabetes research and clinical care organization. “[It]… is thought to be a result of chronic nerve damage caused by high blood sugars… One theory suggests that excess sugar circulating throughout the body interacts with an enzyme in [nerve] … cells. This enzyme… transforms the sugar into sorbitol, which in turn draws water into the [nerve] cells, causing them to swell. This in turn pinches the nerves themselves, causing damage and in many cases pain. Unless the process is stopped and reversed, the nerves die.”

Recent studies have suggested that decreased blood flow to the nerves can also contribute to the development of diabetic neuropathy. Over time excess blood glucose can injure the walls of tiny blood vessels that nourish your nerves, especially in the legs. Nerves send messages to and from your brain about pain, temperature and touch. They tell your muscles when and how to move. They also control body systems that digest food and pass urine. When the nerves aren’t fed properly by the blood vessels, they cease to do their job.

While diabetes is a frequent cause of neuropathy, it is not the only cause. Nutritional deficiencies, chemical exposures, pressure on nerves, or medications (such as some of those used for chemotherapy or to treat AIDS), can also cause neuropathy.

If you have been diagnosed with diabetes, take great care to stick to the diet recommended by your physician and watch for signs of any tingling or pain in your legs or feet. We encourage you to make an appointment with PA Foot and Ankle Associates’ Diabetic Foot Center where you can learn about the symptoms of peripheral neuropathy and how to take proper care of your feet.

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