COMMON FOOT PROBLEMS
 
 
ARTHRITIS
The human foot contains joints (hinge-like structures located where two bones meet), and just like joints elsewhere in the body these are subject to the development of arthritis. The most common foot joint affected is that at the base of the big toe, but any foot joint can be involved. Most arthritis in the foot is of the chronic, “wear and tear” variety known as osteoarthritis. This may be the result of an old injury at the site or it may be related to the mechanics of one’s foot (eg. having a very high arch). Some other types of arthritis that can affect the foot include gout (which usually also causes swelling and redness) and rheumatoid arthritis (which often also involves the hands). Arthritis pain in the foot is usually most noticeable upon standing on the foot after a period of rest, especially after first getting out of bed in the morning.

ATHLETE’S FOOT
This is a fungal infection that, although more common in the young and in athletic individuals, may actually be found in individuals of any age and of any level of activity. The most typical form creates itchy, moist areas between the toes, especially the two smallest toes. Sometimes athlete’s foot can affect the toenails causing thickening and a yellowish discoloration. Another form of athletes foot simply causes redness and dry streaks on the skin of the sole of the foot.

BUNIONS
These are bumps on the inside of the foot at the base of the big toe. They are thought to be hereditary but are more likely to become painful in tight-fitting shoes. Oftentimes the big toe will turn out toward the other toes and may cause pain due to pressure on those smaller digits.
In severe cases bunions may be associated with significant arthritis in the joint at the base of the big toe.

CORNS AND CALLUSES
These are areas of thickened skin caused by pressure from the overlying shoe and the underlying bone. Corns occur on the tops or sides of the toes while calluses are found mainly under the ball of the foot. Both can cause significant discomfort, especially in ill-fitting shoes.

DIABETES-RELATED PROBLEMS
Diabetes is a disease that can have particularly harsh effects on the foot. Some diabetics develop alterations in the function of their nerves that can cause the feet to lose the ability to warn these individuals when an injury (eg. stepping on a sharp object) has occurred. The loss of the protective sensation of pain or discomfort may result in the development of skin wounds and infections.

Diabetics may also develop problems with the circulation in their legs and feet that can also lead to skin wounds and, in the worst cases, gangrene.

We recommend the following steps be taken by diabetics to protect their feet:

  1. Examine the feet daily. Look and feel for signs of a problem. These include redness, swelling, cuts or areas of bleeding, bruises or “black and blue” discoloration, excessive whitening between the toes (maceration), or drainage of any kind.
  2. Examine shoegear prior to wearing. Look and feel for irregularities or foreign objects. Wear comfortable shoes and inspect your feet again immediately after wearing a new pair of shoes.
  3. Wash the feet daily and dry them well afterwards, especially between the toes. If the skin is excessively dry, apply a moisturizing cream after bathing, but do not use it between the toes.
  4. Avoid walking barefoot, no matter how comfortable it feels.
  5. If a diabetic wishes to soak their feet, they should check their feet carefully beforehand and also make sure the water temperature is not hot.
  6. When cutting a diabetic’s toenails, the nail plate should be cut straight across, avoiding digging into the corners of the nail. Afterwards, apply an antibiotic cream to the plate.
  7. If a diabetic believes a problem may be present they should seek medical attention form their primary care physician or podiatrist as soon as possible. Many potentially damaging foot problems are easily controlled with early intervention.
HAMMERTOES
These are contracted (bent) toes caused by an imbalance of the tendons on the top and the bottom of the toe. Frequently they lead to the development of corns on the top of the toe (where the shoe rubs against it) or on the side of the toe (where the neighboring toe rubs against it) and calluses under the ball of the foot near the base of the toe.

HEEL PAIN AND PLANTAR FASCIITIS
Pain on the bottom of the heel or arch is a common and often significant problem. It can be associated with a gain in weight, a change in shoegear or a change in activity (eg. a new job or an increase in exercise intensity). The plantar fascia is a band of connective tissue that extends from the undersurface of the heel bone to the bones in the ball of the foot. It functions (along with other soft tissues) in maintaining the arch of the foot. It can be injured at the point where it attaches to the heel (often associated with a heel spur seen on x-ray) or further toward the ball of the foot (the condition known as plantar fasciitis). Both heel pain and plantar fasciitis are usually most symptomatic when taking the first steps after a period of rest, especially arising from bed in the morning.

NEUROMAS
A neuroma is a swollen nerve that is usually found between the bases of the third and fourth toes. It can cause significant discomfort, especially in tight-fitting shoegear.

SHOE GEAR ISSUES
Finding a comfortable and supportive shoe can be a difficult endeavor. When purchasing shoes always measure your current shoe size (using a metal Braddock device while standing). It is not unusual for feet to increase in length and width as we age. If one foot is larger than the other, buy shoes to fit the larger foot. Our feet also have a tendency to change size during the course of the day. A shoe that may fit comfortably in the morning may feel tight by the end of the day. Therefore it is recommended to purchase shoegear toward the end of the day.
Supportive shoes typically are firm in the back portion that wraps around the heel (called the counter of the shoe). However it is important that the shoe undersurface (the outersole) have good flexibility underlying the ball of the foot.

SPORTS-RELATED PROBLEMS
The human foot is particularly prone to sports-related trauma. A sprain is a partial or complete tearing of the ligaments that connect one bone to another at a joint. Although ankle sprains are very common conditions, any of the joints in the foot may be sprained. This injury is more common when fatigue lessens the ability of the surrounding musculature to support the joint.

FOOT DEFORMITIES AND ORTHOTIC MANAGEMENT
The foot is a dynamic structure which can present in many forms ranging from a planus foottype, with low arches, to a cavus foottype with high arches. In many cases there can be significant pain associated with the underlying structure of the foot and how it functions with normal standing and walking. Often, shoe gear alone cannot accommodate this and the need for additional support and offloading with custom orthotics is indicated.

TOENAIL PROBLEMS
Common toenail problems include ingrown nails and fungal nails. The former are due to the penetration of the edge of the nail plate into the surrounding soft tissue. If the edge pierces that tissue, bacterial infection (evidenced by redness and swelling) typically occurs. There are several causes of ingrown nails, including ill-fitting shoegear and improper nail cutting technique.

Fungal toenails (a condition called onychomycosis) usually appear thickened and have a yellowish discoloration. They may begin right after trauma to the nail (eg. another individual stepping on the toe) but oftentimes occur without any known injury. They are more common in people with chronic athletes foot. Onychomycosis usually begins at the tip of the nail and progresses backwards. It is most commonly seen in the great toe but may affect all of the toenails. The fungi that cause this condition prefer moist, dark environments and therefore toenails are more likely to be involved than fingernails.

WARTS
These are areas of raised and thickened skin caused by a viral infection of the skin cells. They are more common in children and may be very painful if located under a boney area (eg. the ball of the foot). The viruses that cause warts thrive in moist environments and thus these infections are quite common in swimmers and individuals who tend to perspire excessively.
   
 
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