Stephan J. LaPointe, DPM, PhD, FACFAS
Gout, typically found in diabetic patients, is an unusually painful form of arthritis caused by elevated levels of uric acid in the bloodstream. The condition typically strikes the big joint on the big toe. It has also been known to strike the knees, elbows, fingers, ankles and wrists—generally anywhere that has a functioning, moving joint.
The high level of uric acid in a person’s bloodstream creates the condition known as hyperuricema—the main cause of gout. Genetic predisposition occurs in nine out of ten sufferers. The children of parents who suffer gout will have a two in ten chance of developing the condition as well.
This form of arthritis, being particularly painful, is the leftover uric acid crystallizing in the blood stream. The crystallized uric acid then travels to the space between joints where they rub, causing friction when the patient moves. Symptoms include: pain, redness, swelling, and inflammation. Additional side effects may include fatigue and fever, although reports of these effects are very rare. Some patients have reported that pain may intensify when the temperature drops, such as when you sleep.
Most cases of gout are easily diagnosed by a podiatrist’s assessment of the various symptoms. Defined tests can also be performed. A blood test to detect elevated levels of uric acid is often used as well as an x-ray to diagnose visible and chronic gout.
Treatment for gout simply means eliminating symptoms. Non-steroid anti-inflammatory drugs or NSAIDs (Colchicine and other corticosteroid drugs, etc.) will quell the redness, the swelling, and the inflammation. However, managing your diet, lifestyle changes, and using preventative drugs are all helpful toward fully combating the most severe cases.
Those that lead an inactive lifestyle are at a higher risk for gout. Any amount of exercise decreases the probability of repeat encounters with the condition. Reducing your consumption of red meat, sea food, and fructose-sweetened drinks also reduces the likelihood of chronic gout as well.
Ingesting Vitamin C, coffee, and particular dairy products can help with maintaining a healthy lifestyle. There are new drugs out on the market that inhibit the body’s production of uric acid-producing enzymes. However, reducing or eliminating your overall levels of uric acid is the best remedy to ensuring you lead a gout-free life.
Trauma to the foot, especially the toes, can occur in many ways. Banging them, stubbing them, or dropping something on them are a few different ways this trauma can occur. Given the fact that toes are positioned in front of the feet, they typically sustain the brunt of such trauma. When trauma occurs to a toe, the result can be a painful break or fracture. Another type of trauma that can break a toe is repeated activity that places stress on the toe for prolonged periods of time.
Broken toes can be categorized as either minor or severe fractures. Symptoms of minor toe fractures include throbbing pain, swelling, bruising on the skin and toenail, and the inability to move the toe with ease. Severe toe fractures require medical attention and are indicated when the broken toe appears crooked or disfigured, when there is tingling or numbness in the toe, or when there is an open, bleeding wound present on the toe.
Generally, a minor toe break will heal without long-term complications. However, it is important to discontinue activities that put pressure on the toe. It is best to stay off of the injured toe and immediately get a splint or cast to prevent any more additional movement of the toe bones. You can also immobilize your toe by placing a small cotton ball between the injured toe and the toe beside it. Then, tape the two toes together with medical tape. Swelling can be alleviated by placing an ice pack on the broken toe directly as well as elevating your feet above your head.
Severe toe fractures may be treated with a splint, cast, and in some cases, minor surgery, especially when the big toe has been broken. Due to its position and the pressure the big toe endures with daily activity, future complications can occur if it is not properly treated. Pain associated with minor toe fractures can be managed with over-the-counter pain medications. Prescription pain killers may be necessary for severe toe fractures.
The healing time for a broken toe is approximately four to six weeks. In severe cases where the toe becomes infected or requires surgery, healing time can take up to eight weeks or more. While complications associated with a broken toe are immediately apparent, it is important to note that there are rare cases when additional complications, such as osteoarthritis, can develop over time. You should immediately speak with your podiatrist if you think you have broken your toe due to trauma. They will be able to diagnose the injury and recommend the appropriate treatment options.
In most cases, foot surgery is often chosen as the last available option for conditions that have otherwise been unsuccessfully treated. Surgery may be necessary for several reasons, including the removal of foot deformities (e.g. bone spurs or bunions), arthritis problems, reconstruction due to injury, and congenital malformations (e.g. club foot or flat feet). Regardless of one’s age, foot surgery may be the only successful option for treatment for certain conditions.
The type of surgery one undergoes depends on the type of foot condition the patient has. For the removal of a bunion growth, a bunionectomy is necessary. If the bones in the feet need to be realigned or fused together, a surgical fusion of the foot is needed. For pain or nerve issues, a patient may require surgery in which the tissues surrounding the painful nerve are removed. Initially, less invasive treatments are generally attempted; surgery is often the last measure taken if other treatments are unsuccessful.
While in many cases surgery is often deemed as the final resort, choosing surgery comes with certain benefits. The associated pain experienced in relation to the particular condition is often relieved with surgery, allowing patients to quickly resume daily activities. The greatest benefit, however, is that surgery generally eliminates the problem immediately.
Podiatry history has shown that foot treatments continue to evolve over time. In the field of foot surgery, endoscopic surgery is just one of the many advanced forms of surgery. As technology vastly improves so too will the various techniques in foot surgery, which already require smaller and smaller incisions with the use of better and more efficient tools. Thanks to such innovations, surgery is no longer as invasive as it was in the past, allowing for faster and easier recoveries.
Orthotics are shoe inserts that are meant to correct an irregular walking gait or provide cushioning to the feet. Orthotics come in a variety of different models and sizes, including over-the-counter and customizable variants. Customizable orthotics can be shaped and contoured to fit inside a specific shoe and are typically prescribed through a podiatrist who specializes in customized footwear and orthotics design and management.
Orthotics are beneficial because they can help prevent injuries from occurring and provide cushioning to keep pain levels down to a minimum. They also allow for the correct positioning of the feet. Orthotics can act as shock absorbers to help remove pressure from the foot and ankle. Therefore, orthotics can make bodily movements, such as walking and running, become more comfortable as well as help prevent the development of certain foot conditions.
Orthotics alleviate pain and make the foot more comfortable by slightly altering the angle at which the foot strikes the ground surface, therefore controlling the movement of the foot and ankle. Orthotics come in different variants and can be made of various materials. To determine what type of orthotic is most suited to your feet and your needs, it is best to consult your podiatrist. He or she will be able to recommend a type of orthotic that can help improve your foot function or prescribe a custom orthotic to best fit your feet.
Debilitating foot pain is a problem for many people. But just as stretching the torso can help alleviate back pain, stretching the feet can also help mend existing foot problems and prevent future ones.
The feet, as the body’s foundation, carry the body’s entire weight and can get easily strained from overexertion. Persistent sharp pain and cramping in the feet are often common concerns. Foot pain and foot problems can be due to any number of causes, and in many cases pain may be eased without medication or doctor visits. It is always a good idea, however, to first rule out any serious medical issues with a physician.
Stretching can help relax the feet and alleviate pain, but is especially important before heavy aerobic exercise. Stretching before such activities can help you avoid experiencing painful cramps or strained foot muscles. Stretches should be performed slowly and deliberately without forceful pulling. The stretch should be held for several seconds before relaxing.
A great way to stretch out and loosen up the foot muscles while sitting is to cross one leg over the other and pull the toes carefully back without overextending. Start by resting the left ankle on the right knee. With the left hand, gently flex the left foot by pulling back on the toes. Do not pull too hard; just hard enough to feel the stretch in the arch of the foot. Then point the toes of the left foot as far as you can. Rotate the motion of pointing with pulling back on the toes. This should relax and stretch the muscles on the bottom and the top of the foot. Doing this stretch ten to twenty times should bring relief. Repeat the whole process for the other foot by resting the right ankle on the left knee.
A stretch that focuses on the often injured Achilles tendon involves standing and facing a wall with your arms out and hands flat against the wall. Step back with one foot, keeping it flat against the floor. Move the other leg forward and lean toward the wall. You should feel a stretch through the back of your leg and your Achilles tendon, but do not push yourself too much. Stop when you feel a stretching sensation, and hold for 30 seconds. Ten repetitions may be done for each foot.
Stretching the feet is important for athletes or those performing aerobic exercise, but it can also help anyone with foot pain caused by poor footwear, plantar fasciitis, or long hours standing and walking. Individuals who tend to their feet by regularly stretching every day should be able to minimize foot pain and prevent new problems from arising.
The plantar fascia is a connective tissue in the heel that stretches across the bottom length of your foot. Plantar fasciitis occurs when the connective tissue becomes inflamed, causing heel pain and discomfort during physical activity. Although the condition is completely treatable, traditional methods can take up to a year to start becoming effective.
Plantar fasciitis is caused by a number of everyday activities, so understanding the condition is important for managing and treating it. One of the most common causes of plantar fasciitis is excessive running, especially with improper fitting or non-supportive shoes. Too much exercise can lead to the plantar fascia being overworked and overstretched, which can cause tears in the tissue. Along with improper fitting shoes, pronation, the rolling of the feet inward, is a common cause of plantar fasciitis. If not treated properly, the plantar fascia becomes overstretched and starts to tear, causing inflammation.
Despite the common causes of plantar fasciitis, there are many different treatment options. For less severe cases, conservative home remedies include taking anti-inflammatory drugs to alleviate pain, applying ice packs to the bottom of your foot and heel, slowly stretching and exercising your feet to re-strengthen the tissue, and using orthotic devices are all ways to help manage your plantar fasciitis.
For more severe cases, shockwave therapy has become a common solution for plantar fasciitis. Shockwave therapy can effectively break up the tissue on the bottom of your foot which facilitates healing and regeneration. This fights the chronic pain caused by plantar fasciitis. Even if this doesn’t work, surgery is always a final option. Surgery on the tissue itself can be done to permanently correct the issue and stop the inflammation and pain in your heels.
No matter what the case may be, consulting your podiatrist is the first and best step to recovery. Even the slightest amount of heel pain could be the first stage of plantar fasciitis. Untreated symptoms can lead to the tearing and overstretching of tissue. Because the tearing of tissue can be compounded if it remains ignored, it can evolve into a severe case. The solution is early detection and early treatment. Talk to your podiatrist about the possibilities of plantar fasciitis if you’re experiencing heel pain.
Tarsal tunnel syndrome is a condition in which there is a compression of the posterior tibial nerve. The posterior tibial nerve runs along the inside of the ankle into the foot. Tarsal tunnel syndrome is named for the tarsal tunnel, which is a thin space along the inside of the ankle beside the ankle bones. This space contains various nerves, arteries, and tendons, and includes the posterior tibial nerve. The tibial nerve is the peripheral nerve in the leg responsible for sensation and movement of the foot and calf muscles. In tarsal tunnel syndrome the tibial nerve is compressed, causing tingling or burning, numbness, and pain.
Common causes of tarsal tunnel syndrome involve pressure or an injury. Injuries that produce inflammation and swelling in or around the tunnel may place pressure on the posterior tibial nerve. Direct pressure on the tibial nerve for an extended period of time, sometimes caused by other body structures close by or trauma to the tibial nerve, can result in tarsal tunnel syndrome. Diseases that damage nerves, such as diabetes or arthritis, may cause tarsal tunnel syndrome. Those with flat feet are at risk for developing the condition, as the extra pressure and strain placed on the foot may compress the posterior tibial nerve.
Feeling different sensations in the foot at different times is a common symptom of tarsal tunnel syndrome. An afflicted person may experience pain, tingling, burning or other unusual sensations in the foot of the affected leg. Symptoms are primarily felt on bottom of the foot and/or the inside of the ankle. Symptoms can appear suddenly and may occur due to overuse of the foot.
To diagnose tarsal tunnel syndrome, your podiatrist may examine the foot and tap the posterior tibial nerve to see if symptoms surface. He or she may also order an MRI to determine if a mass is present.
Treating tarsal tunnel syndrome will depend on the decision of your podiatrist. Multiple options are available, however, and can include rest, ice, immobilization, oral medications such as anti-inflammatory drugs (NSAIDS), physical therapy, injection therapy, orthotics, supportive shoes, braces, and surgery.
Sesamoiditis is a condition that affects the joint that is just behind the big toe in the area known as the ball of the foot. It is most common in younger people and people who have just begun an exercise program. Since the sesamoid bones are like a pulley controlling the big toe, they can rub against each other and cause a gradual onset of pain. Pain may also be caused by the inflammation of tendons surrounding the bones. If ignored, sesamoiditis can lead to other, more serious problems such as severe irritation and fractures of the bones.
The cause of sesamoiditis is sudden increase in activity. The ball of your foot acts as a springboard to help you lift off when you are jogging or running. Sudden increase in the use of these bones or the tendon that controls them can cause irritation. The tendon then begins to develop inflammation and the joint begins to swell. People with smaller, bonier feet or those with a high arch are typically more susceptible to this condition.
Sesamoiditis is fairly simple to diagnose since the symptoms have a gradual onset rather than a sudden impact. The symptoms begin with slight irritation around the joint shortly after the increase in activity. The discomfort eventually turns to pain with light swelling and possibly redness. Although redness or bruising are rare, this may be a symptom. After each session of exercising, the aggravated joint becomes more irritated and increases into a very intense throbbing.
Treatment for sesamoiditis can vary depending on the severity of the situation. However, treatment is almost always approached in a noninvasive way. For a case that is just beginning the doctor may recommend a very strict rest period that will limit the activity allowed on the joint. If you must be active, a recommendation for as modified shoe or insole, along with bandaging and immobilizing the big toe will be made to ensure that pressure is not placed on the joint. For severe cases, it is typically recommended that the joint and the big toe be completely immobilized to allow adequate time to heal. Ice and an over the counter anti-inflammatory may can help with the pain and discomfort while you are at rest.
When you return to your regular exercise activities, it is recommended that you use an insole that will allow even distribution of impact to your entire foot, rather than just the balls of your foot. This will prevent further aggravation of the injury.
Whether your feet are over-worked or under-worked, chances are they could benefit from some special attention. Even those who exercise regularly probably do not spend any time strengthening their feet. This can be just as rewarding as strengthening the rest of the body, since the health of your feet affects the health of the rest of the body as well, especially the ankles, legs, and spine.
For those who might not have any idea on how a foot-specific exercise might be conducted, there are several workouts that are fairly easy to perform in the comfort of ones’ home. One of the easiest is the toe rise, also known as the tip-toe. This exercise involves standing on the tip-toes for a count of 15 then resting the feet on the ground. This process should be repeated a minimum of three times a day in order to strengthen the feet.
Toe pick-ups strengthen the feet by working them in a very different way. In this exercise, small items are picked up using the toes in order to strengthen the muscles on the upper part of the feet. Once again three sets should be performed, with the item in question being held for 15 seconds then dropped. Items that may be picked up using the feet include marbles and even stationery, which works wonders for the toes and the surrounding muscles.
Yet another simple workout is the ankle pump. This can be done either upwards or downwards, but for the workout to be most effective both can be incorporated into the routine. As the term suggests, this involves lifting the foot off the floor and flexing the toes either towards the shin or towards the ground. This movement puts the feet and ankles through a large range of motion which works the muscles.
Last but not least, feet should be stretched so that the muscles can relax and recuperate. This can be done by placing both feet off of the floor and bracing oneself against the wall at a 45 degree angle. This ensures that the feet and ankles are adequately stretched once the workout is complete.
In short, giving the feet a good workout every now and then is important in order to avoid problems such as plantar fasciitis. It’s also important to warm-up or cool-down after running or vigorous walking. Foot exercises may be followed by a good foot massage. This encourages circulation in the feet as well as muscle relaxation.
For hundreds of years, women have been wearing various kinds of high heels for aesthetic reasons. Women who wear high heels appear to be taller and have longer and thinner legs, and the wearer’s gait and posture changes. Though high heels have had an association with femininity and have kept them popular over the years, there are definite health problems caused by wearing them too frequently.
The motion of the ankle joints is limited when heels are worn. The ankle joint is very important to the body when it comes to walking. Because of their location, these joints have a great deal of weight put on them. Thus, it is very important to keep them as healthy as possible. The Achilles tendon is the main tendon in the ankle. Wearing high heels too often, studies have shown, can cause the calf muscle and Achilles tendon to shorten and stiffen. This can cause problems when shoes without heels are worn.
By putting a great deal of pressure on the ball of the foot and by forcing the toes into a small toe box, high heels can cause or may worsen many foot problems. These include corns, hammertoe, bunions, Morton’s neuroma and plantar fasciitis.
Not only does wearing high heels regularly have negative effects on the feet, the rest of the body can suffer as well. The knees, one of the most important joints in the entire body, can be affected by wearing high heels. High heels can cause the knees to stay bent all the time. Also, it can cause them to bend slightly inward as well. Doctors believe that women can suffer from osteoarthritis later in life because of constantly walking like in high heels. By limiting the natural motion of the foot during walking, high heels also cause an increased in stress on the knees.
Similarly, high heels can cause the back to go out of alignment. If high heels are worn constantly, the spine’s ability to absorb shock can cause continued back pain. They can compress the vertebrae of the lower back, and can overuse the back muscles.
However, this is not to say that high heels can never be worn. If worn occasionally and not often, they will not cause serious problems. They should not be worn every day. It’s important to wear them modestly to avoid the long-term physical health problems of the feet, knees, ankles, and back mentioned above.
