How do you treat it ?
The treatment of a ganglionic cyst, like that of many other clinical conditions, includes both conservative and surgical approaches. A good initial treatment option is to drain the cyst and inject an anti-inflammatory medication followed by a compression dressing to prevent refilling of the growth. Two or three injections might be necessary over a several week period to accomplish the desired effect. Proper shoe selection and modifications are also carefully monitored during this initial period in order to reduce the soft tissue irritation. Physical therapy on a scheduled basis, in some instances, can also be beneficial. Surgical removal of the cyst is usually suggested when the conservative therapies have failed in resolving the problem.

Acute Gout Attack
What is it ?
An acute gout attack is an inflammatory process that occurs in a joint secondary to a high concentration of uric acid in the blood. It is most commonly seen in the middle age, the elderly, and is much more common in men. Theoretically, it can occur in any joint in the body but is most common in the big toe joint followed by the knee and the ankle. It is extremely painful and is characterized by a red, hot, swollen joint. Patients who are undergoing acute gout attacks are usually in extreme pain and find it most difficult to even bear weight during normal walking.

What causes it ?
An acute gout attack results when elevated levels of uric acid in the blood cause crystals to settle into certain joints. The body’s defense mechanism tries to fight the foreign material and an inflammatory process is initiated. Uric acid is a metabolic end product that is normally found in certain foods. People that experience “gouty attacks” have increased levels of uric acid for a variety of reasons. Very rich foods like alcohol, chocolate, seafood, and meats can precipitate attacks. The uric acid crystals settle in joints in one’s arms and legs because of the decreased temperature seen in the extremities. The crystals are recognized as foreign material and the body fights it like an infection. The area becomes swollen, red, hot and extremely painful. Often times, a person in an acute gout attack cannot even tolerate the bed sheets touching the affected area.

How do you treat it ?,/b>
Acute gout attacks are usually treated with a combination of therapies. Oral medications such as anti-inflammatories, analgesics, and/or colchicine are most commonly used to treat this disorder. Often times, local injections into the affected joint will help relieve symptoms. Various other treatments include warm compresses, elevation of the involved area, physical therapy, and the use of pain relievers such as narcotics. The goal of treatment in acute gout attacks is to end the “flare up” and convert the patient's condition to the chronic state. Certain oral medications are available on a long-term basis to help prevent recurrent attacks and possible systemic damage. One should consult his or her family physician or internist for information on these medications.

Gout
What is it ?
Gout is a disorder that involves elevated levels of uric acid in the blood. The crystals from the uric acid then settle from the blood stream into various joints of the body, and most commonly, the big toe joint. Gout is a chronic disease that begins with recurring attacks. When an attack develops, it can last several days and the joint becomes swollen, red, and extremely painful. Patients often complain of not being able to tolerate a sheet resting on their big toes or other parts of their feet such as their heels or even their ankles. The foot is commonly affected because it is subjected to continued pressure in walking, increased exposure to trauma, and its greater tendency for anatomic blood pooling to occur.

What causes it ?
Gout is a metabolic condition that is somewhat common in the general population. Men in their 4th to 5th decades of life suffer from gout seven to eight times more often then women. There is also genetics involved with this certain disease and if someone in your family suffers from this condition, you are at an increased risk for developing this disease. Alcohol tends to worsen this condition and trigger more frequent attacks. The use of diuretics or “water pills” can also trigger the settling of uric acid in the blood and can lead to frequent episodes of painful gouty attacks.

How is it treated ?
The treatment of gout usually begins with reducing the pain and swelling by keeping the patient off weight bearing and to elevate and rest the affected area. Anti-inflammatory medications help to reduce the pain and swelling and also help to remove the uric acid from the body. Steroid injections into the joint also aid in the reduction of pain and swelling. The avoidance of alcohol and foods that contain high levels of protein is advisable to prevent gouty flare-ups. Drinking a lot of water is also suggested to dilute the levels of uric acid in the body. Once a patient develops gout and has had recurrent episodes, preventive oral medications can be taken to prevent and/or minimize future attacks. Surgery should be considered only when all other forms of treatment have failed. The surgery itself, would involve a remodeling of the affected joint or joints.

Haglund’s Bump
What is it ?
A Haglund's bump is an enlargement or lump of bone, which forms on the back of the heel. This can become a very painful condition due to unavoidable shoe pressure and accessibility to injury. It is not uncommon that this condition also involves Achilles tendon discomfort since the tendon has fibrous attachments into that area of the heel. There may or may not be soft tissue swelling around the bump itself but regardless, pressure on the area itself produces significant discomfort. This condition is also referred to as a “pump bump” for it was originally found most frequently in women wearing dress pumps. Today however, we find these problems in both males and females and of various age groups.

What causes it ?
There is some confusion as to the particular cause of a Haglund's bump. Some authorities believe that it is the result of an internal bone spur or calcium deposit on the heel, which then enlarges in response to pressure and friction. Another theory that is more widely accepted today is that certain rotational motions of the heel during walking cause the bump to form as a protective mechanism. In other words, the way one walks causes the heel bone to move with each step eventually causing a thickening of the bone to form. As the individual continues to walk and the rear counter of the shoe continues to irritate the heel, the bump gets bigger and the pain and disability worsens.

How do you treat it ?
The treatment of a Haglund's bump is directed at relieving the shoe pressure, stabilizing the heel or reducing its motion in the shoe and relieving any soft tissue swelling or skin irritation if present. Protective padding, shoe modifications, occasional injection therapy, physical therapy, and orthotics are effective in the management of this annoying problem. In some cases, immobilization or casting is beneficial while in certain instances where the condition seems resistant to care, surgery can be an effective approach.

Hammer Toes
Definition
A hammer toe is a toe that is contracted, or bent, at one of its joints. This deformity can lead to pressure and pain, usually at the top part of the toe as it rubs against the shoe. Hammer toes are flexible in their early stages, and they can be straightened manually. This condition usually gets worse over time, however. As the deformity progresses, toe joints lose their ability to move and the crooked toe becomes rigid. Painful corns and calluses often result from pressure and friction against the shoe. In diabetic patients with poor sensation, hammer toes can lead to ulcers and infection.

Causes
Hammer toes are caused by an imbalance in the foot’s ligaments and muscle tendons. Some of the ligaments and tendons become overpowering, and they pull the toe joints downward. The toe then becomes more bent. Shoes that do not fit properly can aggravate the condition. Different types of arthritis may also cause forefoot deformities such as hammer toes. Your podiatrist may perform a biomechanical exam to identify the specific cause of the muscle imbalance that led to the hammer toes.

Treatment Wearing the proper shoes is the most important step in the treatment of hammer toes. A shoe with a high, wide toe box area will provide enough room so that the shoe does not rub against the toes. Your podiatrist can provide other conservative treatments for hammer toes, such as pads or splints, toe shields or caps. Orthotic devices can help to correct the structural imbalance in the foot, to prevent the progression of hammer toes. Surgery can straighten the toes and remove painful corns or treat arthritic toe joints. Heel Spur Syndrome / Plantar Fasciitis
Definition
Plantar fasciitis is a fairly common condition involving pain in the bottom of the heel. The plantar fascia is a broad band of fibrous tissue that attaches to the heel bone and extends to the toes. When this ligament is excessively stretched, it can become inflamed and very painful. A heel spur may or may not be present. A spur is a bony growth near the attachment of the plantar fascia. Chronic abnormal stretching of the plantar fascia irritates the heel bone, which produces a bone spur as a protective mechanism. Patients usually complain of heel pain with the first steps in the morning, slight relief with activity, but worsening pain after extended standing or walking.

Causes
There are several possible causes of excessive stretching of the plantar fascia. These include over-pronation (flat feet which result in the arch collapsing when weight bearing), high arches, sudden increases in activity, weight gain, standing for long periods on hard surfaces, or wearing non-supportive shoes.

Treatment
Many different treatment methods are available. Patients can avoid going barefoot and avoid non-supportive shoes. Patients may stretch the heels, apply ice or take an anti-inflammatory medication. If pain persists, see your doctor. Your podiatrist may take x-rays and perform an examination with gait analysis to find out the specific cause of your heel pain. Padding or strapping, injections, physical therapy, or night splints can all help. The mainstay of conservative treatment of plantar fasciitis is orthotic therapy; these devices help control the function of the foot to treat the underlying biomechanical cause of plantar fasciitis. If conservative treatment fails, your doctor may consider ESWT (Extracorporeal Shockwave Therapy), a non-invasive procedure that uses high-energy shock waves to treat pain and inflammation. Surgery is also an option; this involves releasing the tight plantar fascia to eliminate the stress and strain on the heel.

What Is E.S.W.T. ?
Extracorporeal Shock Wave Therapy (ESWT) is a newer state-of-the-art procedure used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body," and refers to this non-invasive surgical procedure in which strong sound waves are directed at the area of heel pain. The device used is similar to that currently used in non-surgical treatment of kidney stones.

Plantar Fasciitis is a painful condition that results from strain of the ligament that stretches from the heel bone to the base of the toes. It is sometimes associated with a heel spur, in which case it is called "heel spur syndrome." The condition can usually be successfully treated with conservative measures such as use of anti-inflammatory medications and ice, stretching exercises, orthotic devices, and physical therapy. If the condition does not resolve after six months of these treatments, ESWT may be considered as an alternative to invasive surgery.

ESWT is an out-patient, same-day procedure that does not require an overnight stay in the hospital. It takes about 30 minutes per foot and may sometimes be performed under local anesthesia without sedation. Strong sound waves penetrate the heel and stimulate a healing response by the body. There is no incision made in the skin. Patients should be able to return to work or school the day after the procedure with light duties. Heavy lifting, running, or sports should be avoided for four to six weeks following the procedure. Your podiatrist can advise you on whether you may be a candidate for ESWT.

High Arched Feet
Definition
A high arched foot is one where there is a marked elevation of the longitudinal arch both on and off weight bearing. This type of foot by itself is usually not a problem but tends to cause other difficulties, which frequently require treatment. For instance, the high arched foot creates excessive pressure on the ball of the foot and frequently produces thick and uncomfortable calluses. Hammertoes are also common with this foot type, which may cause problems with certain shoes. In addition, the high arched foot is notoriously known as a poor shock absorber, frequently resulting in discomfort in the heel and arch areas.

Causes
The three main causes of high arched feet include congenital development (at birth), trauma or injury (involving nerve damage), and certain neurological conditions. It is important to thoroughly evaluate a high arched foot in order to determine its probable cause. The type of therapy selected will then have a much better chance for success. It should be kept in mind that not all high arched feet require treatment. In the absence of symptoms or progressive soft tissue changes, clinical treatment may be unwarranted.

Treatment
The treatment of the high arched foot is directed at supporting the elevated mid section of the foot, providing shock absorptive benefits to those areas in need, and improving the functional mechanics of the foot and ankle.Orthotics prescribed by a foot specialist are the most effective means of accomplishing these objectives. The high arched foot usually responds well in a relatively short period of time to the use of orthotic supportive devices. In certain rare cases where the condition is excessive and defies therapeutic control, surgery might become a consideration. Ingrown Toenails
Definition An Ingrown toenail is a common, painful condition that develops when the skin on the side of a toenail grows over the nail’s edge, or when the nail itself grows into the skin. This condition can cause significant pain, and may develop into an infection if left untreated. Infection is present when the sides of the toe become red, warm, swollen, or when drainage occurs. Ingrown toenails may become a chronic, recurrent problem.

Causes
Ingrown toenails occur more frequently in people whose nails are large, thick, or excessively curved in at the edges. When an injury occurs, such as stubbing the toe or having the toe stepped on, the side of the toenail can puncture the skin and become ingrown. Improper trimming of the nail corners may cause the nail to penetrate the skin and introduce germs. Poorly fitting shoes or tight hosiery may worsen the problem.

Treatment
It is best to seek treatment early if you believe you have an ingrown toenail. This condition usually does not get better on its own, especially if the toe is already red, hot, swollen, or draining. If an infection is present, the offending portion of the toenail should be removed by your podiatrist with a minor procedure using the proper instruments; antibiotics are usually prescribed as well. Performing “bathroom surgery” on your own toe frequently makes the condition worse. Temporary relief from an ingrown toenail may be achieved with warm water or Epsom Salt soaks, drying the toe thoroughly, applying an antiseptic, bandaging the toe, and avoiding tight shoes.

In-toe Gait
What is it ?
In-toe gait is a very common problem among children and even adults. Fortunately, most in-toeing that is seen in children is a growth and developmental condition and will correct itself without medical or surgical intervention. Not all bony foot structures are present at birth and in fact, most of the structures at birth are made of a very soft cartilage. Therefore, a child’s foot growth is a gradual process and it may go through many phases until the final structure is achieved. Parents may complain that their child frequently trips over his or her feet and runs in a funny or awkward fashion. If this applies to your child or even to you, your foot specialist should conduct a proper physical exam of your feet and legs.

What causes it ?
There are many possible causes to an “in-toe gait”. An infant’s first environment is the uterus. Often times, this area is very cramped as the baby grows in size. The baby’s legs are usually curled up as the intra-uterine development occurs. Once the baby is born, the foot may appear flat but as the baby begins walking, a more normal appearing foot develops. If the child’s hips or lower legs are affected, it usually corrects itself. However, at times, the torsion on the hips and legs is severe enough that it won’t correct itself and will produce an in-toe gait pattern. A small amount of in-toeing should not affect one's daily activities. However, if the in-toeing is severe, proper treatment should be instituted to prevent further deformities.

How is it treated ?
There are many ways to treat an “in-toe gait”. If your child walks with his/her feet turned in, there are certain things you can do to prevent the condition from worsening. Positioning your child’s feet when he/she is sleeping so that the feet are pointing outward is one form of treatment. Encouraging your child to sit Indian style rather than reverse Indian style also helps. If this condition is caught early enough, there are other forms of treatment that can be instituted. These treatment modalities include special shoes, stretching exercises, and even special bars to positionally affect the feet and lower legs. It is important to remember that many “in-toe” deformities correct themselves. However, if you are concerned or worried about a persistent pigeon toe or in-toe gait pattern, your podiatrist should be consulted.

Limb Length Discrepancy
What is it ?
A limb length discrepancy is a condition in which one leg is longer than the other. Some people have this condition and are completely unaware of it, while others experience a great deal of pain and discomfort. This condition can alter the way you walk, can affect weight distribution during gait, and can in some cases, cause knee and hip problems. It is normal to have slight variations in the length of the lower limbs. However, in certain cases, this variation can and will produce clinical symptoms. Foot specialists deal with and treat limb length discrepancies on a regular basis and are specialized in this area of dysfunction.

What causes it ?
Limb length discrepancy may be caused by a number of factors. Developmental alterations in the womb can affect how the legs are formed. Persistent resting and sleeping positions of the growing child can result in limb length variations. Trauma can also cause a difference in the length of one’s legs. If a bone breaks in the lower leg, this may be enough to stop the growth of normal bone and cause a limb length discrepancy. Hereditary factors may also lead to this deformity. If limb length discrepancies run in the family, this may also increase one's risk of developing this condition.

How is it treated ?
Limb length discrepancies can be treated by a number of methods. If the dysfunction does not cause any pain or symptoms, it may go untreated. However, if this dysfunction causes pain, discomfort, or difficulties with ambulation, the condition should be treated. A thorough examination by a trained specialist should be the first step in any treatment plan. After a thorough examination, special orthotics or shoe modifications may be made to reestablish limb length equality and improved function. The orthotics may consist of a simple heel lift or may be customized to the patient’s foot. These modifications should help to effectively treat the deformity as well as to decrease the compensatory discomfort.

Lister’s Corn
What is it ?
A corn is a hardening of the skin that is formed as a result of persistent pressure or friction. The skin becomes hardened to protect all of the delicate structures beneath the surface. A Lister’s corn is a particular type of lesion that develops along the outer portion of the nail groove. The patient will frequently complain of pain while wearing shoes and will often identify the skin build-up as part of an ingrown toenail.

What causes them ?
A Lister’s corn is caused by abnormal pressure to the nail groove. This can be from a structural deformity within the toe such as a bone spur, a contracted digit (hammertoe), or abnormal biomechanics (the way one walks). A Lister’s corn also can be caused from pressure from tight or improper shoe gear. It is important to recognize a lister’s corn because it can lead to an ingrown toenail, infection or ulceration (break down of the skin). Once these lesions become evident, a vicious cycle is set into motion. The skin build-up attracts more pressure and friction to the involved site and thus, the lesion size increases.

How do you treat them ?
There are many ways to treat a Lister’s corn. First, proper shoe gear should be worn and the shoes should not be tight or ill fitted. Periodic debridement of the corn should be performed by a podiatrist. Finally, the structural deformity, if present, should be addressed. This might include removal of a bone spur, correction of a hammertoe deformity with surgery or special inserts called orthotics that can be made by your podiatrist. These seemingly simple skin lesions can in many cases, cause extreme discomfort and result in moderate degrees of disability while wearing shoes. A corrective approach to the Lister's corn is in most cases, the recommended treatment of choice.

Neuroma
Definition
A neuroma is a common problem in the foot that is associated with pain, swelling, and inflammation of a nerve in the ball of the foot. Also called “Morton’s neuroma,” this condition is seen most often between the 3rd and 4th toes. Symptoms include sharp or shooting pain, burning, numbness, tingling or cramping in the front of the foot.

Causes
Morton’s neuroma is caused by abnormal function of the foot that leads to the metatarsal bones, located behind the toes, squeezing a nerve between the metatarsal heads. This condition may develop after significant pressure is placed on the ball of the foot while standing, walking, or running. Narrow shoes, or shoes with high heels, may also produce the painful symptoms as they pinch the nerve between the toes.

Treatment
Selecting properly fitting footwear is the first step in treating a neuroma. Shoes should have a low heel and a high, wide toe box area. Your podiatrist may also treat a neuroma with padding or strapping of the foot, anti-inflammatory medications, physical therapy, or injections. The mainstay of conservative treatment is an orthotic device to control the abnormal foot function that led to the neuroma.

On occasion, surgical removal of the neuroma is indicated when conservative therapy is ineffective.

Neuropathy
What is it ?
Neuropathy is a condition that affects the nerves in the body. Each nerve has a special covering and when that covering is damaged, the nerve doesn’t function normally. A “tingling” sensation or a feeling of “pins and needles” may be a warning sign to the patient that his or her nerves are functioning abnormally. When the condition of neuropathy worsens, the patient may lose complete feeling in different parts of the body. Most commonly, neuropathy tends to affect the hands and feet. When the hands and feet become neuropathic, it is very difficult for one to carry out the activities of daily living.

What causes it ?
Many diseases such as diabetes, alcoholism, vitamin deficiencies, trauma and certain drugs can cause neuropathy. The most common cause of neuropathy is diabetes mellitus. In diabetes, the elevated sugar affects the nerves and can result in pain or loss of sensation. If the sugar is not well controlled, the neuropathy progressively worsens and can cause serious disability in one’s life. Simple tasks such as walking barefoot or soaking your hands and feet can be potentially dangerous in the neuropathic patient. Constant monitoring of water temperature before bathing is essential in preventing unintentional burns or injury.

How is it treated ?
A neuropathy can be a very difficult condition to treat. In general, a doctor can treat the symptoms that accompany nerve damage however, certain types and stages of nerve damage are permanent. Oral medications can be given to control the pain and other associated nerve-like symptoms. With advanced nerve damage in the hands and feet, it is essential for the patient to be cognizant of all precautions.

It is mandatory for patients with neuropathies of the feet to constantly wear shoes and socks. Examination of the bottom of one's foot is required as well as checking the inside of shoes before putting them on. Having another family member evaluate the temperature of the water before bathing can help prevent unnecessary burns to the hands and feet. Neuropathy can be a very devastating condition. However, the more one knows about this ailment, the more effective is the clinical management.

Osteoarthritis
What is it ?
Osteoarthritis is a condition involving a degenerative or gradual break- down and wearing away of the joints. A normal joint has healthy bone surfaces on each side separated by a smooth cartilaginous interface or lining. The osteoarthritic joint is narrowed or closed due to a loss of the cartilage and the opposing bone surfaces are frequently abnormal with calcium spurs, cysts, and changes in density. Two common problems that seem to go hand in hand with an involved joint are that of localized pain and swelling. As the actual joint space becomes narrowed, a subsequent loss of motion is usually noticed. The foot with its many irregularly shaped joints is a common site for early osteoarthritic changes.

What causes it ?
It is difficult to identify or discuss the actual cause of osteoarthritis. Typically, it is regarded as a disease or condition of aging. In other words, sooner or later if one lives long enough, he or she will develop osteoarthritis. The degree of involvement however, the age of onset, and the extent of disability and progression of the condition are large question marks with no exact answers. We simply don’t know enough to make accurate predictions about the progression of this painfully degenerative ailment.

How do you treat it ?
The treatment approach to the osteoarthritic patient is focused primarily on reducing and managing the associated symptoms. The main objectives are to reduce pain, swelling, and possibly any further degeneration of the joints. We accomplish these goals by using oral anti-inflammatory medications, physical therapy, shoe modifications, injection therapy, and prescription orthotics. In certain cases, we use surgical procedures to repair and restore the existing joints that have been destroyed by the arthritic process. It should be kept in mind that as of today, we do not have a cure for osteoarthritis. At best, we can develop effective treatments for symptomatic relief but with normal wear and tear of the joints in the aging process, this condition will continue to accompany us.

Osteomyelitis
What is it ?
Osteomyelitis is an infection of the bone. In order for the bone to become infected, a pathogenic or infection producing organism must gain access to the involved site. There are two basic types of osteomyelitis; acute and chronic. Acute osteomyelitis is one in which there is an “active” infection. The skin surrounding the wound is usually red, warm, swollen, and frequently has a foul smelling discharge from the wound site. Chronic osteomyelitis is just how it sounds; “a chronic or long-standing infection”. The difference between acute and chronic osteomyelitis is that the acute form shows the traditional clinical signs of infection whereas the chronic form usually does not. Chronic osteomyelitis frequently involves exposed bone. However, the redness, heat, swelling, and malodorous drainage is usually not present.
What causes it ?,/b>
Osteomyelitis can be caused by a number of factors. An aggressive infection that breaks through the skin and penetrates the bone is usually the way it works. A simple opening in the skin from an ulcer, trauma, or surgery can cause this condition. If the infection is not quickly treated, an osteomyelitis may form. Diabetics are often prone to developing this type of bone infection. The reason is that many diabetics do not have adequate feeling on the bottom of their feet and will develop ulcers without being aware of the problem. The infection then progresses and is often not treated in time to prevent a bone infection. If you have an “opening” or localized wound site on your foot that seems to be slow or non-healing, a specialist should be consulted.

How is it treated ?
Osteomyelitis can be treated either conservatively or aggressively depending on the severity of the condition. Conservative treatment would consist of intravenous antibiotics without removing bone. This treatment is frequently utilized initially until lab studies identify the actual organism causing the infection. A more specific medication may be used in an IV fashion to more effectively treat the infection while further studies are done to evaluate the extent of bone involvement. Once this information is available via bone biopsy, bone scan, MRI or x-rays, the offending bone should be removed as well as using IV antibiotics.

Plantar Fibromatosis
What is it ?
Plantar fibromatosis is a common cause of arch pain. A plantar fibroma is a growth found on the plantar fascia or arch ligament on the bottom of the foot. It is nodular in appearance and may or may not be tender on pressure. Most plantar fibromatosis lesions have unpredictable changes in both growth and symptoms. In short, they may have localized symptoms or may be symptom free. When these soft tissue nodules appear in the hand and cause contraction of the fingers, the condition is called Dupuytren's contracture.

What causes it ?
The cause of plantar fibromatosis is unknown. Associated factors for developing plantar fibromatosis include epilepsy, thyroid disorders, alcoholic cirrhosis and Dupuytren’s contracture of the hands. Some authorities believe that localized trauma with injury to the thickened plantar bands can cause this condition. In certain cases, these nodular lesions can spread and involve a fairly extensive segment of the bottom of the foot. How is it treated ?
Treatment for plantar fibromatosis includes conservative and surgical approaches. Conservative care includes padding or off-loading of the nodules to decrease discomfort. Steroid injections into the growth to try to shrink it may also be incorporated. If conservative treatment fails, surgical excision of the growth might be necessary. It is essential to periodically observe and monitor any progressive changes in this condition in terms of both size and symptoms. Once it is determined that the nodules are spreading, it is important to take on a more aggressive approach to its clinical management.

Plantar Warts
What are they ?
Today, we know that you don’t have to be a liar, touch a toad, or drink a witch's evil potion to get a wart. In all probability, you can’t even grow one by touching another person’s wart. Apparently, these lesions are non-contagious but can spread within the involved area of the same individual. In actuality, warts are encapsulated or walled off growths of viral tissue. Plantar warts on the feet are frequently painful with squeezing type pressure. In the vast majority of cases, the growth of a wart is preceded by some sort of skin puncture or wound defect that in all probability, allows an entry site for contamination. Whether we all have inactive or potential wart viruses circulating in our bodies or gain the virus through the wound is as of yet unclear.

An interesting and often confusing distinction must be made between certain calluses and plantar warts. Skin lines or striations can be seen passing through callus tissue whereas they will pass around a wart. In addition, plantar warts, upon close examination, will often demonstrate small black dots which when trimmed will bleed. These are tiny blood vessels, which become caught in the growth itself and are absent in regular callus tissue. A final line of distinction in identifying a wart is in its response to pressure. Squeezing a wart will usually produce extreme pain as opposed to similar pain from direct pressure on calluses.

How do you treat them ?
Warts that appear on the hands and fingers are usually more responsive to therapy than are those on the feet. The professional methods of treatment available for plantar warts include just about everything from chemical applications and surgery to Lawrey’s seasoned salt and hypnosis. Some warts respond quickly and some do not, and that my friends, is just plain honesty. Each foot specialist seems to have his or her own favorite treatment methods that prove effective in the majority of cases. Even though we all know those old wives tales to be ridiculous, perhaps until your appointment with your foot specialist, you should stay away from toads, telling lies, and drinking weird tasting brews.

Posterior Tibial Tendon Dysfunction
Definition
Posterior tibial tendon dysfunction is a commonly seen problem that involves a strain placed on one of the major tendons in the foot and ankle. The PT tendon runs along the inside of the ankle and attaches to the bones of the middle part of the foot. With posterior tibial tendon dysfunction, the tendon does not perform its job of holding up the arch; this results in flat feet. This can lead to the development of other problems like heel pain, arch pain, plantar fasciitis and heel spurs. Tendonitis involves painful inflammation which may be worse upon weight bearing, especially when walking or running.

Causes
Posterior Tibial tendonitis develops when the muscle is overused and the tendon becomes strained. Biomechanical problems such as over-pronation, or flat feet, can lead to posterior tibial tendon dysfunction. With long term strain of the tendon, damage occurs and the tendon becomes painful, inflamed, and swollen. The tendon may develop a partial or complete rupture. Loss of tendon function can be permanent.

Treatment,/b>
In the early stages of PT tendon dysfunction, symptoms are treated by limiting activity to control pain and swelling. Conservative treatments include proper shoes, anti-inflammatory medication, and padding or strapping of the foot. For severe cases, immobilization with a brace or cast is required. Orthotic devices provide long term control of the function of the foot and support of the arch structure.

Pronation
What is it ?
The term pronation is actually a description of directional movement that can be used in reference to various body segments. For instance, a tennis player should pronate the hand while serving and a pitcher should pronate the hand during delivery. In the foot, pronation describes an in- rolling or collapsing of the longitudinal arch during weight bearing. This sounds pretty bad doesn’t it? Well, maybe yes and maybe no. Some pronation is good because it allows our foot and ankle to function correctly and makes it possible for us to walk effectively on an uneven ground surface. Pronation only becomes a problem when it exceeds the normal range. If the foot remains in-rolled or collapsed for a longer time period then it should, then we have an unstable foot, which can lead to a wide variety of clinical problems. Bunions, corns, calluses, heel pain, shin splints, knee pain and the list goes on and on, can all be caused directly or indirectly by excessive pronation. In a sense, excessive pronation should be the potential public enemy number one and the possible cause of a good deal of our foot grief.

What causes it ?
As stated earlier, we pronate out of necessity, in order to adequately adapt to uneven ground surfaces. In short, our ability to walk, stand, and function throughout normal gait is largely dependent upon our capacity to pronate. However, in some instances, our mechanics or functioning capabilities become abnormal and excessive pronation is a common result. A two hundred-pound man standing on his feet all day on cement floors with two poorly supported ankles due to excessive pronation is predictably waiting for clinical problems to occur.

How do you treat it ?
The treatment of excessive pronation is more difficult than what it might seem. A thorough examination by a foot specialist is necessary in order to identify not only the degree or extent of pronation but also the source of the excessive motion. Orthotics or supportive functional devices are the chief means of treating this condition. The foot specialist will prescribe and utilize a specific product to address the particular needs of the patient. It is important to keep in mind that pronation is much like candy…a little bit is good while too much can cause decay.

Shin Splints
What are they ?
Shin splints is a condition that involves an inflammation to the shinbone of the lower extremity with or without involvement of the surrounding soft tissues. It is most commonly seen in runners or athletes and can cause considerable pain and lengthy periods of disability. It is a type of over use injury, meaning that as one trains harder and with greater distances, the athlete has a greater tendency to develop this condition. If the cause of the problem is not treated, a shin splints condition can lead to a rupture of an associated tendon or even a fracture of the shinbone itself. here are different types of shin splints, which are based upon their location in the lower extremity. The bottom line though, is that they hurt, cause varying degrees of disability, and usually require professional treatment.

What causes them ?
Shin splints can occur when one participates in an exercise that places a repetitive stress on the lower extremities. Running, impact aerobics, and the various racquet sports can all lead to the development of shin splints. Stress is placed on the tendons in the leg and causes an abnormal torque or tension. This abnormal force is due to the stress placed on the tendon to prevent it from tearing. The muscle starts to pull away from the bone and also causes the lining on the bone to be pulled away. This causes an inflammation of the bone, which causes pain.

How do you treat them ?
The treatment of shin splints begins with rest, ice, compression, and elevation. All of these should help to decrease the involved inflammation and pain. Further treatment includes non-steroidal anti-inflammatories (NSAID’S), such as Ibuprofen and other prescription medications. A modification in one’s training routine or the type of shoes worn will also usually help. A device inserted into the shoe called an orthotic, may eventually be needed to control the patient’s mechanics and improve his or her weight bearing activities.

Soft Corns
What are they ?
Ouch! These toes are killing me ! Soft corns are painful lesions or skin build-ups that occur between the toes. Most frequently, they are located between the fourth and fifth (small) toes but can also involve the other digits of the foot. As opposed to the traditional hard corn that occurs on the top of a toe, these so-called soft lesions prefer the areas between the digits where there is moisture and warmth. These lesions are usually quite painful because of persistent friction and are worsened by shoe pressure. The shape and narrowed forefoot confinement of the typical woman’s dress or business shoe, along with a raised heel, creates a ripe environment for these soft corns to occur. Once these soft corns take residence on a foot, it doesn’t take long before the patient needs some help.

What causes them ?,/b>
In many of the cases involving a painful soft corn, the underlying culprit seems to be a calcium deposit or small spur of bone lying just beneath the lesion itself. A patient can frequently feel this bony prominence by gently palpating the lesion and feeling a hardened protrusion or bump on the hone itself. As the soft corn becomes further aggravated and in the absence of professional care, it may become infected. A soft corn that is surrounded by skin discoloration is painful to touch, has localized heat or warmth, and is having a pus or bloody discharge is suggestive of an infection and should be seen immediately by a foot specialist.

How do you treat them ?
The early treatment of a painful soft corn should include a careful monitoring and selection of shoes in order to relieve the persistent pressure. Some sort of pad or cotton ball between the involved toes also helps to relieve the localized pressure and reduces the discomfort. In some instances, a local injection of a steroid or anti-inflammatory medication can be beneficial in not only reducing the discomfort but also in shrinking the lesion size itself. In those cases where the soft corn seems resistant to other measures of care or is so annoying that the patient strongly desires a corrective course of action, surgery is a viable consideration. Procedures are available to address this problem while causing minimal discomfort, inconvenience, and cost.

Stone Bruise
What is it ?
A stone bruise is another name for a deep contusion to a bone and/or the associated soft tissue structures. This can be caused from any injury to the foot or ankle. In most cases, a stone bruise involves pain with or without localized swelling in the forefoot or metatarsal fat pad of the foot. The patient will often describe the discomfort as a deep kind of bruise and walking on the involved site is like walking on a pebble. Stone bruises are usually quick in onset, persistently painful with weight bearing, and are frequently difficult to resolve.

What causes it ?
The most frequent cause of a stone bruise is blunt trauma or an impact injury to a bony prominence or its associated soft tissue structures. While the impact force is not enough to cause a fracture, it is sufficient to bruise the soft tissue in the area. In addition to the ball of the foot, the heel bone is also frequently involved in this injury.

How do you treat them ?
Stone bruises are initially treated with rest, ice and elevation. All of these treatments will help to decrease the inflammation and pain. Depending on the severity of the discomfort, a stone bruise can also be treated with non-weight bearing to the foot or a non-steroidal anti-inflammatory such as Ibuprofen or a prescription medication prescribed by a podiatrist. The patient should understand that these injuries can be stubborn and somewhat resistant to therapy. Patience and a cooperative attitude are often necessary and beneficial during the course of treatment.

Stress Fractures
What are they ?
As the name implies, a stress fracture is a break in the bone, which results from cumulative and/or repetitive strain to a particular site. These fractures are most commonly seen affecting the long bones or metatarsals of the foot. More specifically, they seem to involve most often, the three middle metatarsals. Pain in varying degrees is usually the chief complaint and it may or may not be accompanied by swelling and discoloration. A lump or soft tissue enlargement is frequently present over the site involved. Stress fractures are often problems because of their tendency to be missed or neglected. In most cases of metatarsal stress fractures, the actual bone break does not show on a regular x-ray for about ten days to two weeks from its onset. These fractures should be identified as soon as possible and properly managed by a specialist in order to insure a good result and prevent unnecessary disability.

What causes them ?
The main cause of a stress fracture, as stated earlier, is that of cumulative or repetitive strain to a particular bone site. A long day on cement floors at a mall, an unusually hard hike or exercise walk, or maybe a long march in the military or as a member of a marching band can all qualify as possibly overstressing a metatarsal bone leading to a fracture. Cumulative strain to a particular site involves smaller stress loads that are repeated over a lengthy period of time. Either heavy strain for a short time period or lighter loads repeated over a longer time period can produce localized stress fractures. Usually, an x-ray taken after about ten days from the injury onset will identify the fracture site. Occasionally, more sophisticated tests are performed such as bone scans which are capable of making an earlier diagnosis.

How are they treated ?
A stress fracture is treated in much the same manner as most any other bone break. The area involved must be protected, supported, and immobilized to some extent. Motion at the fracture site has to be controlled so as to allow proper healing to occur. In most cases, a protective fracture shoe is used to accomplish these goals. The patient should limit his or her walking and should be followed up by a foot specialist to monitor the healing process.

Tailors Bunions
What is it ?,/b>
A tailor’s bunion is an enlargement or protruding segment of bone with possible soft tissue involvement on the outer aspect of the foot. It is usually considered to be a progressive condition meaning that without treatment, it will usually worsen with time. This type of bunion or bunionette as it is sometimes referred to, can become painful due to the unavoidable shoe pressure in that area. An interesting fact of little relevance is that you don’t have to be a tailor to get a tailor’s bunion. Historically, these problems were found frequently in tailors and it was believed that the condition resulted from their crossed leg sitting position while working.

What causes it ?
There are four basic causes of tailor’s bunions, which are generally agreed upon by most authorities. The first is that the involved metatarsal shaft or long bone on the outer aspect of the foot is abnormally curved. This excessive bending of the bone creates a ripe situation for the formation of a tailor’s bunion. A second cause of a tailor’s bunion is that of faulty mechanics during walking. In short, it is possible that biomechanical dysfunction during one’s gait can cause problems of this type. Trauma or injury to the outer aspect of the foot can also precipitate the onset of a tailor’s bunion. A fourth category of conditions that can cause the formation of a tailor’s bunion is that of the arthridities. Osteoarthritis, rheumatoid arthritis, and gout can all play a causative role in a tailor’s bunion deformity.

How do you treat it ?
The effective treatment for a painful tailors bunion includes shoe modifications, protective foot padding, injection therapy, orthotics, and surgery. Obviously, the orthotics or supportive devices are used to alter the mechanics or functioning of the foot while surgery is used to correct or reduce the existing deformity. A tailor’s bunion can be an annoying problem, which can worsen with continued shoe pressure and improper foot function. With early identification and proper treatment these problems can usually be readily managed.

Tarsal Tunnel Syndrome
Definition
Tarsal tunnel syndrome is a condition that involves pain at the inside of the ankle. This condition is similar to carpal tunnel syndrome in the hands and wrists. Patients may complain of burning, radiating, or shooting pain that starts at the ankle but may travel to the toes or up the lower leg. This type of pain may be persistent, or may come and go regardless of activity or rest. The patient may not recall any specific injury that initiated the pain.

Causes
The posterior tibial nerve is the major nerve that supplies the foot. This nerve travels down from the lower leg and courses around a ligament at the ankle before it travels to the arch. Tarsal tunnel syndrome occurs when this nerve becomes inflamed. This can happen for many reasons: excessive pronation (a fallen arch), arthritis, trauma, obesity, cysts, and swollen blood vessels have each been associated with the development of tarsal tunnel syndrome.

Treatment
The correct diagnosis should be made by your podiatrist, as tarsal tunnel syndrome can often be mistaken for other painful conditions. Initial treatment may involve rest, ice, anti-inflammatory medications, immobilization of the foot, or physical therapy. In some cases your physician may order a special test to analyze the nerves, or special imaging to see if any structures in the ankle are pressing against the inflamed nerve. Surgery can be helpful in cases that do not respond to conservative treatment.

Tendonitis
What is it ?
Tendonitis is an inflammation of the tendons. It is commonly seen in athletes subsequent to specific periods of activity. It is classified as an over use injury which suggests that repetitive injury or damage is the true culprit as opposed to an acute injury. This however, is an acceptable theory, which helps the practitioner to understand the problem, and is not necessarily the reality in each case. The symptoms of a tendonitis problem include localized pain, swelling, and a frequent reduction in range of motion that may develop gradually or appear suddenly.

What causes it ?
A tendonitis is usually caused when an excessive stress has been applied to a tendon on a repetitive basis over a period of time. It can be caused by over use of a particular muscle or from abnormal foot mechanics. It is most commonly seen in the Achilles tendon which is the long thick band running down the back of one's leg and attaches to the heel.

How do you treat them ?,/b>
A treatment for a tendonitis problem includes rest, compression, ice and elevation. These will to reduce the inflammation and pain. Anti-inflammatory medications may also help to decrease the discomfort and may be used before or after exercise.

The prevention of a tendonitis includes proper warm up exercises and stretching. Proper shoe gear should be worn along with a modification in one’s training habits. A device called an orthotic that can alter the biomechanics of the foot may also help prevent and treat tendonitis problems particularly if they are of the chronic type. It is important to not neglect or ignore professional treatment for these problems since prolonged abuse and damage can possibly result in stress fractures, tendon ruptures, and lengthy periods of disability. A localized tendonitis is one of your body's warning signs that should be immediately addressed.

Toe Fractures
Definition and Cause
Talking about pain…wow! Few injuries to the foot produce more pain than that of a fractured or broken toe. These injuries are often thought of as vocabulary expanders because they can easily make a person say words that they never used before. The mechanism or cause of a toe fracture seems embarrassingly obvious yet seemingly unavoidable. A sudden blow or stubbing of a toe against a heavy non-yielding object, an impact injury involving something dropping on top of a toe, or that common injury of catching a small toe on the leg of a piece of furniture in your bedroom can each cause a fracture. The toe hurts high on the pain scale, swells and turns reddish pink, and after a day or so takes on a bluish bruised type of discoloration. If these signs are present and you just don’t want to move that toe, then the chances are that you have a fracture.

Treatment
It is at this point that we frequently find an area of public confusion regarding the treatment of toe fractures. Many of our patients and those not seeking medical care believe that toe fractures will heal by themselves and do not really need supervised medical attention. This author disagrees and would like to point out several facts on this issue.

Fractures of the toe should be seen professionally in order to evaluate the extent of the injury. In other words, not all fractures are the same and some will heal much faster then others while certain ones may not heal at all. A proper evaluation and management are necessary to insure the best possible result.

Certain fractures may involve deviations or crooked positioning of the involved toe after the injury. These should be treated early on by a specialist in order to prevent future disability and possible problems.

Proper treatment of a fractured toe should involve some level of immobilized splinting and support. Ignoring the injury and enduring the pain do not create an optimal environment for fracture healing.

In closing, these injuries occur with sudden onset, extreme pain, and obvious shoe wear difficulties. Proper evaluation, management, and periodic monitoring are recommended procedures for this problem. My special advice regarding fractures of the toe or toes…try to avoid injuries and by all means, watch your language !

Turf Toe Injury
What is it ?
A turf toe injury is a sprain to the ligaments of the large toe joint. The name comes from injuries seen in professional athletes that play sports on artificial turf. This injury can be very painful for the athlete and can easily interfere with one's normal running activities. There is frequently a localized swelling of the large toe joint with turf toe injuries, while weight bearing and range of motion testing will usually accentuate the pain.

What causes it ?
A turf toe injury is caused when one bends their big toe joint up (hyperextension) or down (hyperflexion) past the normal allowable amount of range of motion. This causes a sprain of the ligaments surrounding the big toe joint and subsequent pain on weight bearing. The most frequent type of turf toe injury encountered is due to hyperextension. Associated with this condition is often an overstretching of the plantar (bottom) capsule of the involved joint. The toe must be evaluated to rule out a fracture, tendon rupture or dislocation.

How do you treat them ?
Treatment for turf toe includes rest, ice, and compression of the joint. These should all be done to help decrease swelling of the joint and associated soft tissue structures. The toe can also be splinted with athletic tape as one returns to activities. The splint will help to decrease the range of motion of the toe so as to prevent further injury. A special device that is inserted into the shoe provides an extension for the big toe and can be used for long-term treatment. These conditions will usually respond well to therapy but must be recognized and properly diagnosed early.

Ulceration
What is it ?
An ulceration is an absence of or defect in the normal lining of the skin layers (epidermis and dermis). In a sense, an ulceration is a hole or cavity in the skin that may be wet or dry and potentially, very resistive to healing. Patients with diabetes, poor circulation and those who are bedridden may have increased tendencies to develop ulcerations. The symptom level, clinical appearance, and response to therapy are largely dependent upon the type and location of the ulceration.

What causes them ?
There are many types of ulcers including those caused by loss of sensation of the skin, decreased blood flow, pressure to a specific area of the foot, and ulcers due to problems with the valves in the veins.

The diabetic ulceration is caused by an unhealthy condition of the nerves. Because the nerves are debilitated, they do not function properly and result in a loss of sensation. A diabetic patient may step on a needle or other object in the shoe and not even be aware of the problem due to reduced sensation. The skin will eventually break down and result in an ulceration.

Ischemic ulcerations are ulcers that are caused by decreased blood flow and poor blood supply to the feet due to calcified arteries or blockages of the blood vessels. Because the skin is not getting the nourishment it needs to survive from the arteries, it begins to die. This often leads to an ulceration.

A pressure ulceration is caused when a portion of the foot is left in contact with an area such as a bed mattress for an excessive period of time. This type of ulceration is commonly seen in patients who are bedridden and unable to move on their own. The pressure to the area cuts off the blood supply, which can cause tissue death leading to an ulceration.

A venous stasis ulceration occurs due to an incompetent or faulty valve between the superficial and deep veins in the legs. This results in fluid being backed up into the superficial veins. Eventually there is too much fluid in the leg. The fluid has nowhere to go and so it begins to weep onto the skin. Eventually an ulceration will occur.

How do you treat them ?
There are many different treatments for ulcers and the type of ulceration involved largely determines the specific method of care. In general, ulcers are treated with debridement (removal) of the surrounding tissue and any nonviable tissue. This will help relieve pressure from the ulcer. Some patients are treated with non-weight bearing of the foot to help decrease pressure on the ulcer. Topical wound gels and creams are also used to keep certain ulcers clean and hydrated. Some gels even help remove dead tissue.

The treatment of ischemic ulcerations may require revascularization procedures by a vascular surgeon to increase the blood supply to the feet. Venous stasis ulcers are often treated with compression dressings to help squeeze the fluid out of the legs and back into circulation. These ulcers are also treated with wound gels. Appropriate ulcer therapy can be very effective but often requires time, patience, and cooperation on the part of the patient.

Warts
Definition
Plantar warts, also called verruca plantaris, are caused by a virus and occur on the bottom of the feet (the ‘plantar’ surface). They are contagious, and may grow as a single wart or spread into clusters. They look rough, thick, and bumpy, with a grey or brown color. The center of the wart may have several pinpoint areas of darkish discoloration. They may bleed when scraped. Warts can be quite painful, especially if they are located on a weight bearing area of the foot.

Causes
Warts are benign growths that are caused by a common organism called the Human Papilloma Virus (HPV). The virus usually enters the foot through a break in the skin; exposure may occur by walking barefoot on contaminated surfaces such as public showers, locker rooms, or swimming pools. Some people appear to be immune to the virus, while others are more susceptible.

Treatment
Many over-the-counter medications are available to treat warts, including topical medicines and patches. Warts can be difficult to cure in certain cases, and may enlarge to become increasingly painful. They also have the potential to spread to other areas of the feet. If warts persist after several treatments, they can be removed surgically in your podiatrist’s office.

Wet Feet
Definition
Wet feet or hyperhidrosis as it is medically known is a condition that can be both embarrassing and annoying for the person involved. By definition, it is an abnormal glandular condition resulting in an excessive accumulation of moisture or perspiration on the skin. These patients will often come into the office complaining of excessive foot odors, skin discolorations, rashes, and concern over frequently having wet or moist socks. Frequent areas of involvement seem to include the toes, metatarsal fat pads, and arches. The skin itself will often take on a whitened or blanched type of appearance and will be moist to the touch.

Cause
Some people will perspire more then others. Usually, the glandular secretions will evaporate under normal circumstances and not become any sort of problem. In certain cases however, greater than normal levels of perspiration occur and the skin’s evaporation or drying mechanism is incapable of handling the moisture load. The result is a wet skin condition that holds surface bacteria and with time, will cause offensive odors.

Treatment
The treatment plan for a wet skin condition is obvious. Topical medications are prescribed by a foot specialist or dermatologist to reduce the glandular secretions and dry the skin. The patient is directed to change his or her shoes and socks frequently to allow for adequate aeration. Occasionally, some attention might be directed at dietary intake in order to reduce the ingestion of certain spicy foods. Proper hygiene involving bathing and thoroughly drying the feet is an essential part of the long-term therapy. This condition is one that can be readily managed and with a cooperative patient, most likely rectified.