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Foot & Ankle Ailment
Abnormal position of the toe relative to the long bones (metatarsal) of the foot. This abnormal position can lead to a bump on the side of the foot causing pain with pressure, wearing tight shoes (such as dress shoes), or even just walking. Bunions can get worse over time if not addressed properly when you first start having symptoms. Bunions can be inherited and pain can worsen based on the way we walk. Other conditions such as neuromuscular disorders or congenital deformities can also cause bunions.
Abnormal curvature of the toes related to poor muscle balancing. Hammertoes can get worse with improper shoe gear (wrong size, tight toe box, consistently wearing high heels). Along with the abnormal position, pain can appear with direct pressure to the top of the toes, when wearing shoes. You may also notice some skin changes to the top part of the toes in the form of redness and/or corn formation.
There are many causes of heel pain, but you do not have to live through it. Some of the common causes are related to plantar fasciitis, open growth plates (for children), Achilles tendonitis. One of the most common causes of heel pain is plantar fasciitis. The soft tissue band, attached to the heel bone, is inflamed and causes pain with every step.
Common causes:
- Achilles tendonitis
- Plantar fasciitis
- Calcaneal apophysitis – strain on the open growth plate (children)
There are a lot of tendons in the foot and around the ankle that provide the proper motion during walking, running, jogging, and all other exercises. Tendonitis can occur when a tendon is overused or there are sudden motions to joints leading to an inflammatory response. If tendonitis is not treated early on by specialist at Varni Foot and Ankle Care, this may lead to a reduction in activity level and continuous pain. Untreated tendonitis can lead to possible rupture and surgery if medical attention is not sought early on.
Common areas of tendonitis
- Posterior tibial tendon (inside of the ankle)
- Peroneal tendon (outside of the ankle)
- Achilles tendon (behind ankle)
Arthritis occurs when the smooth lining (cartilage) of the joint has eroded over the years. Arthritis can be due to aging, trauma such as a fracture, and/or underlying foot deformity. When the cartilage is missing, the joint is not able to glide or move in a normal fashion. It may lead to pain and inflammation around that specific joint. Underlying medical conditions such as autoimmune disorders and gout can also lead to arthritis.
Abnormal enlargement of a nerve or multiple nerves between the toes. Commonly called ‘Morton’s neuroma’. This enlargement of the nerve tissue can give abnormal sensation to the toes or to the ball of the feet. Also gives the sensation of walking on a pebble.
Skin & Nail Issues
Overgrowth of the nail into the adjacent skin leading to pain. Pain can also increase from secondary sources such as direct pressure from tight or narrow shoes (dress shoes, cleats) or underlying toe deformity or position. Overgrowth of the nail and skin can lead to redness, swelling, and/or fluid draining from the skin. This may lead to worsening pain and possibly an infection. Ingrown nails can occur in all ages, including infants.
Nails can get thick and misshapen over time. They may appear yellowish. If the nail gets too thick, it may cause pain and discomfort while wearing shoes. Dr. Panchani may recommend a simple nail biopsy to rule out fungal growth and start you on appropriate treatment.
Infection of the skin caused by fungus. The skin may appear dry, flaky, with possible itchiness. Fungus thrives in dark moist environment, such as shoes. It is commonly seen on the soles of our feet and/or between the toes. It is advisable to seek medical attention if it does not resolve with OTC anti-fungal medications.
Abnormal skin lesions (black dots on callused skin) to the foot. Warts are caused by a virus that can be spread in multiple ways. Warts can be picked up from public areas such as swimming pools when walking barefooted. Warts can appear in all ages, but commonly seen in children and teenagers.
Skin condition causing eczematous rashes or lesions related to outside irritants such as new products (socks, shoes, or sandals) or chemicals. You may notice blisters, rashes, and/or itchiness.
Along with fungal infection of the skin, you may also encounter bacterial infection of the skin. It may initially start with mild redness and swelling, but can worsen if medical attention is not sought early on. Bacterial infection can result from exposure of open sores to the contaminated environment such as lakes, open fractures, ingrown nails, surgeries, untreated wounds, etc.
Abnormal skin thickening on the foot and toes, mainly on the toes and bottom of the foot. Skin becomes thick in areas of high pressure leading to pain during ambulation or wearing shoes. Improper pressure distribution, abnormal shoe wear, underlying foot structure are some of the main causes of corn and callus formation.
Wound Care
Area of skin that breaks open related to excessive pressure in one or more areas of the foot related to tight shoe gear. Pressure ulcers can also develop in bed-bound patients with very little movement to their feet. Pressure ulcers may start with a blister and/or a callus.
When the top layer of the skin fills up with fluid related to excessive pressure or friction while wearing shoes. This is very commonly seen in runners or hikers. Friction blisters can occur if you wear improperly sized shoes.
Where there is a break in the skin related to an injury. If these types of wounds are left untreated, they can lead to an infection and prolonged pain. Untreated puncture wounds may lead to prolonged swelling and possible abscess formation.
Diabetic ulcers occur in a similar manner to pressure ulcers, but they can be difficult to treat with underlying diabetes. They are caused by excessive pressure, commonly on the bottom surface of the foot. Due to excessive pressure and lack of sensation due to diabetic neuropathy, an ulcer can go undetected. They start with callus formation and overtime causing the underlying skin to break down. If they go untreated, it may lead to skin and/or bone infection and serious complications such as lower limb amputation.
Foot & Ankle Injuries
There are 28 bones in each foot, which can break from various injuries. Misplacement or abnormal positioning of the foot during activities can lead to breaks. Fractures can be treated with or without surgical intervention based on the type of fracture, the position of the broken bone, level of pain, and visible deformity present from the fracture on the foot or ankle. If certain fractures are not treated early on, it may lead to arthritis in the long-run. Along with injury-induced fractures, stress fractures can also occur from overuse or excessive stress to the bones.
Types of fractures
- Stress fractures
- Metatarsal fractures – Jones fractures, avulsion fractures
- Digital fractures
- Ankle fractures
- Heel bone fracture (calcaneus)
- Fractures involving joints
There are various tendons in the foot that help control the motions of the foot. Tendon injuries can occur from simple to severe foot or ankle sprains. Along with injuries from sprains, prolonged or untreated tendonitis can to tendon injuries such as tears or ruptures. Tendon injuries are commonly seen in athletes.
Common tendon injuries
- Achilles tendon ruptures
- Peroneal tendon tears
- Posterior tibial tendon tears
Our bones are held together by multiple ligaments (soft tissue bands). During an activity, they hold our bones in place, but if there is a misstep, sudden or abrupt movements of foot or ankle, the ligaments can be pulled beyond their normal holding strength. When they are pulled (sprain) that can lead to sudden pain and swelling, possibly even bruising. Ligamentous injuries should be seen by a provider at Varni Foot and Ankle Care to get proper medical care and guidance to help you get back on your feet and active again.
Common Ligament injuries
- Lisfranc’s ligament
- Ankle ligament sprain
- Plantar plate tears
Regenerative Medicine
Stem cell therapy is composed of stem cells that are injected into the area of concern to regenerate new cells of the injured tissue and help promote healing. Stem cells are derived from various sources. To acquire more information, contact us at Varni Foot and Ankle Care and see if this is a viable option for you.
Another alternative is platelet-rich plasma therapy, which involves deriving growth factors from your own blood using the latest technology and then injecting the growth factors to the area of concern. To acquire more information, contact us at Varni Foot and Ankle Care and see if this is a viable option for you.
Orthotics & Braces
After undergoing various treatment options for heel pain or arch pain, Dr. Panchani recommends proper arch support for long-term pain relief. Custom inserts are conformed and individualized for your feet. They are interchangeable from shoes to shoes. We can also have custom inserts made to suit your lifestyle, whether it’s for your dress shoes, athletic shoes, or every day walking shoes. Custom inserts may also be necessary, if you have areas of excessive pressure leading to callus or ulcer formations, especially if you have diabetes.
At times custom orthotics may not be enough to help control your foot or ankle pain and surgery is not an option for you. The custom brace would allow you to better control the abnormal motion of the foot and ankle, especially if you have underlying arthritis in the joints or a deformity. In order to get a custom brace, we take a cast impression of your foot and ankle. Talk to us at Varni Foot and Ankle Care to see if this a good option for you.
Diabetic Foot
One of the major complications of uncontrolled diabetes is diabetic peripheral neuropathy. Neuropathy is injury-induced to the nerves due to abnormal sugar levels. Peripheral neuropathy develops slowly and worsens over time. Damaged nerves can lead to various abnormal sensations such as burning, tingling, or even lack of sensation such as numbness. Complications from lack of sensation can lead to other foot complications such as ulcers (the breakdown of skin).
If there is uncontrolled diabetes (elevated daily blood sugars and high A1c), another complication that can occur to the lower extremities is poor circulation (peripheral vascular disease). This is the lack of blood flow to your feet. You may experience resting pain in your toes, feet, or even the back of your legs. You may also experience cramping in your calf muscles after walking a few blocks. Diabetes is not the only cause of poor blood flow, there are many other reasons such as smoking history.
These are areas on the foot that undergo excessive pressure and form calluses. If there are underlying diabetes and neuropathy, these lesions can break down and cause an ulcer to form. If you have calluses forming on your feet, seek medical attention at Varni Foot and Ankle Care and address this issue before it becomes an ulcer.