What is a podiatrist?
A podiatrist, also called a doctor podiatric medicine, is a medical specialist who provides diagnoses and treatments,both surgical and non surgical, of the foot and ankle. Some of the common problems treated are; bunions, heel pain, spurs, neuromas, ingrown toenails, hammertoes, warts, corns and calluses. A podiatrist also treats foot and ankle injuries such as sprains and fractures. Podiatrist attend undergraduate medical school training, and also attend graduate school where they receive a doctorate degree in podiatry. Podiatrist are required to take state and national exams as well as be licensed by the state in which they practice.
According to the American podiatric medical Association, there are an estimated 15,000 podiatrist practicing in the United States. The demand for podiatrists is greatly increasing because of the rapidly aging population. The association believes that foot disorders are among the most widespread and neglected health problems affecting people today.
Heel pain is one of the most common conditions seen in my clinic. The most common condition is plantar fasciitis although conditions such as Achilles tendinitis, bursitis and nerve entrapment are also seen quite frequently. Diagnosing the specific condition depends on a careful examination and history of how and when the pain affects the patient. Plantar fasciitis is an inflammation in the large band of tissue (plantar fascia) that extends from the heel bone to the ball of the foot and into the toes. Patients suffering from this condition may experience pain in the bottom of the heel and in many cases extending into the arch of the foot. This condition is usually caused by mechanical stresses in the foot. The majority of patients experience most of the pain when getting up from a rest. Treatments for plantar fasciitis usually involve mild stretching exercises, rest, shoe gear modifications, orthotic devices, splints and injection therapy. While most patients respond very well to these conservative measures some patients do not and require surgery to correct the problem.
Another cause of heel pain is Achilles tendonitis. This condition is almost always an overuse condition. Repetitive action using the Achilles tendon puts too much stress on the tendon. This leads to micro-injuries in the tendon resulting in inflammation. In some cases patients have a bone spur where the Achilles tendon attaches to the heel bone. The best forms of treatment for Achilles tendonitis are; immobilization in a walking boot or cast, physical therapy, orthotics, and anti-inflammatories. In some cases the tendon may be severely damaged and surgery may be necessary to repair the tendon and remove the spur.
Bursitis is a painful condition of the heel that is most commonly located on the bottom of the heel and the less frequentlyon the back of the heel. It is a small fluid-filled sac that protects the heel from friction. Repetitive motion and irritation from shoes may cause the bursa to become inflamed. Treatments may include rest, ice and oral anti-inflammatories. Padding and steroid injections are very effective in reducing pain and inflammation. If conservative measures do not work surgery may be necessary to provide relief.
The least common of the four conditions is heel pain due to nerve involvement. In this condition the patient may feel a burning or electrical type pain that radiates into the foot from the heel. Treatment for this condition usually involves orthotic therapy and steroid injection therapy. It is necessary to stop the abnormal function of the foot and relieve pressure on the nerve. If this does not help it may be necessary to perform surgery to decompress the nerve.
Because heel pain is difficult to differentiate, it is best to be evaluated and treated by a foot and ankle surgeon.
“Doctor I have this bump on my foot”
A common complaint from patient’s is: “Doctor I have this bump on my foot.” The majority of these bumps found on people’s feet are non-serious. Cancerous lesions found on the foot are quite rare; however it is always best to have these abnormalities examined and diagnosed by a foot specialist.
The majority of bumps on the foot cause pain and can be located anywhere. They usually increase in size over time and cause secondary pain by applying pressure on nerves, tendons, and ligaments. The larger the bump becomes, the more difficult it may be to resolve the condition.
The most common bumps found on the foot are usually due to a bony prominence. A common example of this is a bunion deformity. This is where the bone behind the first toe (big toe) leans inward and may rub against the shoe causing pain. Bone spurs may also cause a bump that rubs against a shoe resulting in the formation of a callus or corn. These conditions are best treated with shoe gear modifications, padding, injections, and orthotics. Ultimately surgery may be required to correct the problem. This can be performed in an outpatient setting with the use of IV sedation and local anesthetics.
The second most common type of bump found on the foot is a ganglion cyst. This is a fluid-filled sac that originates from a tendon sheath or a joint. Fluid leaks into the sac and thickens over time. The condition usually is smaller after resting and larger after activity. It will fluctuate in size daily in many cases. These are noncancerous lesions that usually do not go away on their own. Conservative treatment usually involves draining them and injecting them with a steroid. This usually gives temporary relief. Surgery is usually required to correct the problem.
In some cases, a bump may be cancerous. For bumps that are suspected of being cancerous, we usually perform a biopsy to get a diagnosis. In this instance the physician takes a tissue sample and sends it to a laboratory where a pathologist will determine the diagnosis. Other studies such as MRIs may be used to evaluate the size and involvement of adjacent structures. Once all the information is gathered surgery may be performed to remove the mass.
Remember bumps on the foot do not tend to go away on their own. It is best to have them evaluated by a foot specialist early on.
Children's foot and leg pain
When children experience leg pain, many times it is due to a foot related deformity. Early intervention by a foot and ankle specialist is key to proper treatment.
The term flatfeet is used for feet that have a poorly developed arch. This is a common condition seen in children and adults. Many times the child will have no symptoms; however, many will exhibit symptoms. One common complaint is that the feet and legs “get tired”. Many of these children will have an aversion to athletic activities and walking. They will gravitate towards more sedentary type activity.
Many times children experience leg pain and parents think it may be temporary “growing pains” without realizing it could be due to a foot related problem. For example, flat feet may cause an overpull of the ligaments and tendons in the leg and foot which causes cramping, pain, and tenderness in the foot, lower leg, and knee. A podiatrist will do a lower extremity examination to assess the structure and function of the feet and often use weightbearing digital x-rays for a more comprehensive understanding. This will help determine if the condition is due to flatfeet.
Treatment for flatfeet usually involves stretching specific muscle groups, strengthening other muscle groups, shoe gear modifications, and custom orthotics. In instances where the deformity is significant, surgery may be required to resolve the deformity.
What causes an ingrown toenail?
There are four main causes for ingrown toenails. Injury is one of the common causes. This usually involves dropping something on the toe. Family traits are one of the most common causes of ingrown nails. The nail is usually curved downward more on the sides which results in the nail easily becoming ingrown. This can be corrected by a minor in office procedure.
Two other reasons are tight shoes and cutting the nails where the edges are curved. Tight shoes cause increased pressure on top of the toe causing the nail to press down against the sides. Toenails should be cut straight across and any sharp or rough edges smoothed down with a nail file.
Why are my toenails thick and discolored?
Many times toenails become infected with fungus. The condition is called onychomycosis and can be very difficult to treat. Topical medications are available over-the-counter but they are minimally effective. Laser treatment seems to be the best way to to improve fungal nails.
How do I fix my toenail fungus?
A fungal infection of the toenail can produce very embarrassing discoloration and thickening. This can cause the nail to deform and become quite painful.
The Cutera Genesis plus laser is used in our office to successfully treat fungal toenails. We experience an 80-90% improvement in the cosmetic appearance of fungal toenails.