PAIN | BUNIONS
AND CALLUSES | DIABETES
OF JUVENILE DIABETICS |
OF ADULT DIABETICS | FLAT
SURGERY | INGROWN
TOENAILS | JOGGING
The human foot is made up of 26 bones, 19-foot muscles, 13 leg muscles and
15 ligaments along with over a mile of tiny blood vessels and nerves. The
arch forms a bridge between the front and the back part of the foot. It
is made up of bones, ligaments and tendons and is subjected to a lot of
stress and work. Ill-fitting shoes, long periods of time on your feet, and
hard surfaces can all cause arch pain. Arch pain itself is often an early
symptom telling you that the bones, ligaments and muscles of the foot are
being overworked and are getting tired. Tired legs and feet, foot and leg
cramps, and perhaps even low back pain can frequently accompany it.
Your mother was wrong. You didn't get bunions from torturing your feet
in high fashioned shoes. If pointed-toe, spike-heeled shoes created your
bunions, where did your 12-year-old daughter get hers? Why does your mother
have them? And where did Grandma get her bunions? From Great Grandma.
The bunion ranks next to the corn and callus as a major cause of foot
misery -- discomfort is too mild a word. A bunion is the progressive movement
of the great toe toward the second toe with a "bump of bone"
forming on the side of the big toe joint, or on top of it There are many
causes for bunions: heredity is the major factor, however poor posture
and improper shoes certainly play in the picture to a lesser degree. The
longer it exists, the more the great toe moves over and the larger the
bump becomes. A bunion can be very painful and unattractive, and ultimately
cause the great toe to become arthritic, or even dislocated. The crooked
great toe and enlarged bump will crowd the lesser toes in a shoe. This
can cause the patient to walk improperly and also lead to arch, leg or
A large percentage of bunions are painless and I advise my patients to
leave them alone. Bunions should be surgically removed only when the patient
can no longer find shoes to comfortably fit their feet.
During your lifetime, you will walk, dance, hop, skip and jump the equivalent
of four times around the earth and all on the same two feet. They are
made to last, but abuse your feet, and you'll pay with every tortured
Corns are an example of avoidable pain. A corn is a circumscribed thickening
of the skin that develops because of recurrent friction and pressure.
A corn is very similar to a callus, with the exception that a corn is
usually found on the toes, whereas a callus is more frequently found beneath
the ball of the foot, often associated with a metatarsal bone.
Painful corns on the toes have probably caused more foot pain and misery
than any other single problem. The most common cause is a contracted or
crooked toe, often referred as a hammer-toe, which will not lie flat in
a shoe. Frequently, a bony spur or enlargement will contribute to this
problem. Shoes do not cause corns, but they certainly can aggravate them.
When the shoe cannot fit comfortably over the toe, the patient suffers
the agony of a vise-like squeeze of the skin between the prominent bone
spur and shoe, creating the corn. Never try to break in a shoe. As a rule,
shoes break in feet. If the shoe fits well except for one small spot,
have it stretched.
Sometimes corns can become infected, especially in patients with diabetes,
poor circulation or loss of sensation. Conservative treatments with prescription
inserts, commonly referred to as "orthotics," may help mechanically
control the function of the foot, preventing early diagnosed hammer-toe
deformities from rigidly fusing and forming a painful "corn".
Over-the-counter medicated remedies should be avoided especially in diabetics.
Surgical treatment is considered only when conservative treatment provides
little or no lasting relief, and can be accomplished in an outpatient
setting with minimal loss of time off one's feet. Ninety to 100% of corns
generally do not recur following appropriate surgery.
Each year 60,000 Americans discover that they have diabetes. In addition,
tens of thousands more have the disease without knowing it. If they are
not diagnosed and treated, some may be among the nearly 15,000 people
with diabetes who this year will undergo foot, toe, or leg amputations.
All of us are likely to have problems with our feet, but diabetics may
develop serious problems more quickly and have more complications, especially
when circulation or nerves are impaired. When circulation is poor, the
tissue in the foot is less able to fight infection. When nerves are impaired,
an injury can occur without pain and, as a result may go unnoticed. Even
the most trivial injury, if left untreated, can lead to serious complications.
The key for the diabetic is to view all foot problems as potentially dangerous
and to prevent them or seek podiatric care as soon as they occur. The
endocrinologist is another key player in the prevention of diabetic complications.
OF JUVENILE DIABETICS
A cut, scrapes, blisters, and puncture wounds are a part of childhood.
To prevent such injuries, diabetic children should always wear some kind
of footwear. If foreign bodies such as splinters become lodged in the
foot, or an infection or puncture wound occurs, the child should be treated
promptly by a professional. Ingrown toenails can cause infections, which
tend to be especially severe in diabetic children. Athlete's foot is a
fungal infection common in young people. If it or other skin rashes are
not promptly treated, secondary bacterial infections may develop.
PROBLEMS OF ADULT DIABETICS
Concerns of adult and maturity-onset diabetics are somewhat different
from children. Foot problems neglected in youth cause more problems, and
can be compounded by circulation disorders and changes in sensation (diabetic
Have your feet checked professionally at least twice a year.
· Inspect your feet daily.
· Avoid actions that restrict circulation to your feet, such as
smoking, sitting with your legs crossed.
· Avoid burns, including excessive sunburn. Do not put feet in
hot water or add hot water to bath without testing the water temperature.
· Use of over-the-counter corn cures should be avoided.
· Prevent unnecessary cuts and irritations. Do not walk barefoot
or wear rundown shoes.
· When toenails are trimmed, be sure they are straight across.
· Wear shoes that fit.
a simple daily routine of foot hygiene, most long-term complications can
Flat foot is often misunderstood as fallen arches or broken arches. Actually
a flat foot is mainly a structural abnormality of the foot in which the
foot bones maintain a low angle, thereby giving an appearance of an absent
or low arch area. Frequently a flat foot due to its abnormal structure
causes the muscles, tendons and ligaments of the foot to function improperly
and overwork itself, therefore giving symptoms to the person. These symptoms
may include pain and/or cramping sensation in the arch, leg cramps and
increased tendency towards fatigue or tiredness in the foot and leg. In
children with abnormal flat feet, there may be additional signs and symptoms
besides pain and tiredness of the foot and leg. The child may show clumsiness
in walking and running; they may also show an increasing lack of interest
or unwillingness to participate in physical activities such as sports,
or running and walking for any prolonged length of time. Not every flat
foot demonstrates abnormal signs or symptoms, and not every flat foot
needs to be treated. However, if symptoms persist, then it will be wise
to seek professional help from your podiatrist. If left untreated, the
symptomatic flat foot may become progressively more painful and disabling
and may lead to the formation of bunions, hammertoes or arthritis of the
foot. Through careful examination and x-ray studies, your podiatrist can
determine the cause and severity of the flat foot problem and initiate
a treatment program aimed at relieving the discomfort and stopping the
progression of the abnormality.
There are many commonly asked questions regarding corrective surgery about
such topics as disability, pain, and cost. Most importantly, we understand
the apprehension associated with the prospect of foot surgery. While this
apprehension is quite normal, a better understanding of what to expect
will frequently help put this concern in proper perspective. Rapid advances
in local anesthetic techniques and pain control have made it possible
to correct many common foot problems permanently, on an ambulatory or
out-patient basis, and with minimal disability and loss of time from work
and daily activities. Some common foot problems amenable to this type
of care are such things as: ingrown toenails, warts, corns/calluses, hammertoes
and bunions. When necessitated because of concurrent medical problems
or a need for more comprehensive medical management, arrangements are
made for hospitalization and general anesthesia. The fact is, a better
understanding of foot function, along with refinements of traditional
surgical techniques and instrumentation, have made it possible to permanently
alleviate or substantially improve most common foot problems. In regard
to health insurance, podiatric medical and surgical foot care services
are covered as a part of the benefit package under Medicare, BC/BS, and
most every private health insurance program. For a more comprehensive
overview of this subject, you may wish to call your particular insurance
plan for specific details.
One of the most common foot problems, ingrown toenails, can occur at anytime
-- from infancy to old age. It occurs as a result of the nail edge embedding
itself into the skin causing, pain, swelling, redness, and frequently,
infection. It can occur on any toe, but most commonly on the great toe.
They are painful and tend to recur -- but the cure is quick, painless
and permanent with virtually no loss of time from any activity and generally
one is able to resume wearing shoes and return to most normal activities
Over the counter medications are virtually worthless for ingrown toenails
and can be dangerous, particularly to individuals with compromised circulation
or diabetics. Tight shoes tend to aggravate ingrown nails but certainly
do not cause them.
TREATMENT: The only permanent cure for an ingrown toenail involves the
removal of the offending spicule of nail, including its root, in addition
to addressing any concurrent infection, which may be present. The procedure
is generally painless and takes only a few minutes in our office under
a local anesthetic.
With jogging as one of the nation's favorite outdoor activities, a few
words of advice and caution should be given to the beginning and the serious
joggers. Although jogging is a healthy sport, it is not intended for everybody
just as skin diving is not intended for everyone. Persons with high blood
pressure, diabetes, anemia or any other diagnosed disease, persons taking
prescription medications, and persons over age 35 should consult their
family physicians regarding their health status before starting on a jogging
program. Proper daily warm-up and warm-down exercises before and after
jogging are essential to both the novice and the serious jogger. These
exercises are intended to limber the muscles and help prevent cramps or
injuries to muscle groups.
Just like any other sport, the proper equipment is usually necessary for
a better performance. In jogging padding inside the shoe is necessary
so as to help absorb the stress in jogging. The training terrain should
not be hard and, the clothing should be loose and non-confining and the
shoes should be soft and flexible with proper unyielding. The two most
preferable types of surfaces are dirt roads and grass. A word of caution:
grassy areas sometimes my have small potholes that can cause tripping
and falling, so one should be careful when using this kind of surface.
In modern day cities, asphalt and concrete are almost unavoidable and
if one must jog over these hard surfaces, asphalt is slightly softer and
less jarring to the jogger. Like any other sport, jogging can have related
injuries. Early signs of trouble may include heel and arch pain, foot
and leg fatigue or cramps, or inability to go beyond a certain distance.
These are often indications of injury, improper stretching exercises,
improper terrain or faulty training methods; such as increasing the running
distance too much too soon. If pain and discomfort persist, then professional
help from a podiatrist should be sought.
There are various types of nerve tumors found in the foot. Here we are
concerned with the most common type called a neuroma or Morton's neuroma.
A neuroma is a benign nerve tumor of the foot, which can be caused by
a variety of factors, such as injury, stress to the foot, improper foot
function and structural problems, like bunions, which may result in crowding
of the feet in shoes. All of these factors generate a frequent irritation
to the nerve and can subsequently cause and enlargement of that nerve,
thereby forming a neuorma. Frequently, a neuroma causes a burning pain
localized to the ball of the feet. This burning sensation may sometimes
change to a pins and needles type of feeling that may travel into the
toes or back into the rest of the foot. These unpleasant sensations usually
occur while the person is walking with shoes and may improve or even subside
when the shoes are removed and the painful area massaged. If you should
suffer from these symptoms, it is advisable to see your Podiatrist. After
a careful examination to determine the cause and severity of the neuroma,
your foot specialist will be able to prescribe the proper program of treatment.
This may include conservative measures such as injection therapy to calm
down the nerve irritation or possibly an orthotic support to relieve or
eliminate the stress to the foot. In severe cases in which the neuroma
does not respond to conservative treatment, then a simple, relatively
painless surgical procedure may be necessary to obtain relief.
Foot and leg injuries are common hazards in sports. Among the most common
injuries are shin splints, tendonitis, ankle sprains, stress fractures,
and heel and arch pains. These injuries can be brought on by a number
of reasons. Frequently, slight changes in the terrain, improper warm-up
period and abnormal wear of the shoe can all bring on an injury. If an
injury happens to you, the immediate treatment should consist of ice and
rest. Ice applied to the area of injury within the initial 24 to 48 hours
usually helps prevent excessive swelling. Rest should consist of reducing
the amount of sports activities, or in severe cases, staying away from
sports until healing is complete. If symptoms of pain in the foot persist,
then it is advisable to see a podiatrist. Most athletes are reluctant
to seek professional help for fear that they may be told to limit their
sports activities. However, with early diagnosis and treatment, chances
of complete healing are greatly improved. While no person is guaranteed
against injuries, there are a few helpful hints that can decrease your
chances of sustaining an injury. Proper warm-up and warm-down exercises,
strengthening exercises for muscles and watching out for uneven surfaces
or abnormal wear of the shoe can all help. Athletes place special demands
on their bodies and their foot and ankle injuries should receive prompt
and specialized attention, particularly if they are inhibiting the athlete's
physical performance. One of the goals of podiatric medicine is to keep
the athlete active in sports, while protecting him from further injury.
No injury is too minor or trivial to ignore. An untreated foot injury
can potentially lead to long-term inconveniences.
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Phone: (334) 396-FEET (3338)
Fax: (334) 244-4184
1558 E. Trinity Blvd. Montgomery, AL 36106
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